TACK ANCHOR SYSTEMS, BONE ANCHOR SYSTEMS, AND METHODS OF USE
Systems, apparatuses and methods for securing tissue to bone using tack anchors, bone anchoring systems are described. The tack anchor may include a body and a securing element. The body may include one or more compressible flanges, an opening and, a cavity. The cavity may include an opening near or proximate the flanges, and be configured to receive a suture. The securing element may be configured to slide into the opening of the body to secure a portion of one or more sutures in the cavity such that the ends of the sutures are accessible through the cavity opening. In some embodiments, tack anchor tool for insertion of a tack anchor into tissue and/or bone is described.
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This patent application claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 60/905,216, filed Mar. 5, 2007 by Gary S. Fanton et al. for TACK ANCHOR SYSTEMS, BONE ANCHOR SYSTEMS, AND METHODS OF USE (Attorney's Docket No. 6008-01100), which patent application is hereby incorporated herein by reference.
BACKGROUND1. Field of the Invention
The present invention relates to systems, methods and apparatus for securing tissue to bone. More particularly, the invention relates to apparatus and methods for facilitating the attachment of tissue to bone using tack anchoring systems and/or a bone anchoring system. The present invention also relates to a tack anchor tool instrument for inserting a tack anchor system into tissue and/or bone.
2. Description of the Related Art
Many attempts have been made to provide devices that allow the arthroscopic securing of torn tissue to a human bone. For example, numerous devices have been designed to allow a torn rotator cuff to be secured to a humeral head of the shoulder.
Typically, in a first step, a hole is drilled into the bone under arthroscopic visualization. A length of a suture length is threaded through a portion of a tissue, and then coupled to a bone anchor configured. One or more sutures may be manipulated outside of the arthroscopic site.
Once the suture is coupled between the tissue and the bone anchor, the bone anchor may be inserted into the hole. The bone anchor may be configured to lock itself within the hole in the bone upon deployment therein. Several means for securing the bone anchor within the hole of a bone are known in the art.
Once the bone anchor is secured within the hole in the bone, one or both ends of the suture may be tensioned to approximate the positioning of the tissue with respect to the bone. Once the tissue is positioned as desired, the suture may be locked in place to maintain the tension in the suture. The free end or ends of the suture may be clipped under arthroscopic visualization to complete the procedure.
An example of a previously known method and apparatus for attaching tissue to bone is described in U.S. Pat. No. 6,585,730 to Foerster, which is incorporated by reference herein. Foerster describes devices and methods for securing sutures to a bone anchor without the requirement of knot tying. In Foerster, suture legs, after having been placed into soft tissues to be anchored to bone, are threaded through the anchor and then through a floating wedge block located at the distal end of the anchor. The wedge block is configured such that it has a hollow lumen through the center, and a conically tapered outer surface. The sutures are passed back around the outside of the wedge block such that they rest on the conical surface. They are then re-threaded in the opposite direction back through the anchor, exiting the anchor at the proximal end thereof. The anchor is then inserted into the bone, and secured. When tension is placed on the legs of the suture passing back out of the anchor, the suture is drawn through the hollow center lumen, around the distal end of the wedge block, and back out of the anchor. This tension tends to cause the wedge block to force its way back up into the anchor body, and a means to prevent this may be employed. Such means may include any structure that selectively holds the wedge block separate from the anchor body.
At this juncture, by pulling on the suture legs, any slack in the sutures is removed, and the soft tissues are drawn toward the anchor. When the soft tissues are in the desired orientation, relative to the bone to which they are to be attached, the structure holding the wedge block is removed, and the back tension on the sutures pulls the wedge block into the matching taper in the anchor body, maintaining the compressive force on the suture legs.
Another previously known knot less suture anchor is described in U.S. Pat. No. 6,692,516 to West et al. (“West”), which is incorporated by reference herein. West describes a knotless suture anchor and method for knotlessly securing. The suture anchor has a deformable portion for engaging with a wall of a borehole in a first tissue member, a shaft for providing a force to the deformable portion to deform the deformable portion to cause the deformable portion to engage the wall of the borehole, a suture retaining portion in at least one of the deformable portion and the shaft for retaining two suture portions in the retaining portion with a loop formed between the two suture portions. The loop is adapted to traverse a second tissue member to be attached to the first tissue member. Application of the force to deform the deformable portion causes engagement of the deformable portion with the borehole to secure the suture anchor to the first tissue and clamping of at least one of the two suture portions in the suture retaining portion thereby to secure the suture forming the loop in the suture retaining portion and secure the second tissue to the suture anchor.
Systems, apparatus and methods are desired for securing tissue to bone that allow direct tactile feedback of the tension in the suture between the tissue and bone. During securing tissue to bone, it is desired to be able to adjust positioning of the tissue with respect to the bone. In securing the tissue to bone, the suture may be locked in place without tying a knot.
Endoscopic suturing techniques and instruments have been developed to facilitate the suturing of tissue during endoscopic surgical procedures. Access to a surgical work site within a patient's body is normally provided through one or more portals formed directly in the patient's body or through one or more cannulas inserted into the patient's body through small incisions. A chosen surgical procedure is carried out by a surgeon through the use of elongated instruments inserted through these cannulas and it often becomes necessary to suture selected tissue at the surgical work site.
The arthroscopic work site is typically accessible only through a small portal or cannula. Since it is very difficult to tie sutures within the body, various devices and techniques have been developed to enable the surgeon to tie sutures endoscopically. For example, some procedures enable the surgeon to pass a suture through the target tissue and form a surgical knot extracorporeally and then move the knot with a knot pusher through the portal or cannula into position adjacent the desired tissue to be sutured. Formation of the knot requires the surgeon to manually retrieve and tie a knot on the suture after the suture is threaded through the tissue(s). This procedure is often tedious and time-consuming. The procedure further requires that a mechanical means of retrieving the suture be provided. Most devices require the use of a separate tool to grab onto and retrieve the suture, thereby further reducing the working space and adding risk of contamination, or leading to a tendency for the suture to deform or collapse suture is manually retrieved. In addition, tying the knot in this manner is particularly difficult during endoscopic surgeries, where the visual field for the surgeon is severely limited by the narrow surgical area. As a result of these setbacks, there is a need for an improved method of retrieving a suture, as well as for surgical devices that will facilitate such method.
SUMMARY OF THE INVENTIONIn some embodiments, a bone anchor system includes a main body and an insert. The bone anchor system is suitable for coupling a tissue structure to bone. The bone anchor system may insert in an opening of a bone. The insert includes a cavity disposed therein. The cavity has a proximal end, a distal end and an opening at the proximal end of the insert. The distal end of the cavity includes an inner surface.
In some embodiments, the bone anchor system includes a locking assembly. The locking assembly includes two or more locking elements configured be coupled to a suture, and to interact with each other to lock a suture in place to inhibit undesirable movement of the sutured tissue.
In some embodiments, the locking assembly is a two bar locking assembly. One or more of the locking elements may be axially moveable in the cavity. The locking elements are positioned with respect to each other to form a gap to allow a suture of a desired size. A suture positioned in the gap may be compressed and locked in place when tension in an undesirable direction is applied to the suture. In some embodiments, a suture may be threaded through a two bar locking assembly to permit movement of the suture only in a desired direction.
In some embodiments, a suture loop is coupled to a tissue and two ends of the suture are coupled to a two bar locking assembly. The suture ends pass though the opening of a first locking ring and then pass under and wrap around an upper bar of a second locking ring. The suture passes though a gap between the locking elements, under the upper bar of the first locking ring, and then around the upper bar of the first locking ring. Proximal ends of the suture are accessible. Optimization of tissue placement relative to a bone anchor may be achieved by individually tensioning each of the suture ends. Once in place, the suture is compressed between the locking elements, preventing the suture from slipping or moving in an undesirable direction. In some embodiments, the locking elements reversibly engage after the tissue has been placed.
In some embodiments, apparatuses and methods for securing tissue to bone allow direct tactile feedback of the tension in the suture between the tissue and the bone is obtained. In some embodiments, apparatuses and methods for securing tissue to bone allow tensioning both ends of a suture individually to enhance placement of the tissue with respect to the bone. In some embodiments, apparatuses and methods for securing tissue to bone allow a suture to be locked in place without tying a knot.
In some embodiments, an apparatus is provided that includes a bone anchor member. The bone anchor member may be securely disposed in a hole drilled in a bone. A suture length may be coupled between the bone anchor member and tissue. In some embodiments, a suture length is coupled between a plug portion that fits within a bore of the bone anchor member and the tissue. One or more ends of the suture may be individually tensioned to enhance the placement of the tissue with respect to the bone and secure the suture.
In some embodiments, a system is provided to insert a bone anchor to a site in a bone that allows for a bone anchor to be placed into a site in a bone and thread a suture therethrough.
In some embodiments, a self-contained suture passer is provided to allow a surgeon to form and retrieve a suture loop in a tissue. The suture passer may be operated without the need of a separate mechanical means to retrieve the suture.
In an embodiment, a suture passer may include a proximal end having a handle and a suture-engaging element slidably coupled to the handle. The suture-engaging element may be configured to be slideable between a first position and a second position. The suture passer may include an elongated central portion coupled to the proximal end and extending distally from the handle. The suture passer may further include a distal end comprising a means for grasping a tissue. Said tissue grasping means may include an upper jaw and a lower jaw, the upper and a lower jaws being reversibly engageable. The jaws may further include one or more suture passages passing through the upper and lower jaws, and a reversibly extendable suture threader. In an embodiment, a reversibly engageable suture capture element may be disposed at the distal end of the suture passer. The suture passer may be coupled to suture engaging element at the proximal end such that sliding the suture-engaging element from the first to the second position engages a suture loop passing through a suture passage.
In some embodiments, a tack anchor is described. The tack anchor may include a body and a securing element. The body may include one or more compressible flanges, an opening and a cavity. The cavity may include an opening near or proximate the flanges, and be configured to receive a suture. The securing element may be configured to slide into the opening of the body to secure a portion of one or more sutures in the cavity such that the ends of the sutures are accessible through the cavity opening.
In some embodiments a tack anchor tool may be used to insert a tack anchor into tissue and/or bone. The tack anchor tool may include a first elongated member, a second elongated member, and a handle. The first elongated member may include a cavity and a stop. The tack anchor may be coupled to the end of the first elongated member. The second elongated member may be coupled to the handle and be insertable into the first elongated member. The handle and second elongated member include cavities that are configured to receive one or more sutures. During use, the second elongated member is configured to displace the tack anchor from the distal end of the first elongated member so that at least one of the flanges of the tack anchor opens outward.
Methods of inserting tack anchors and bone anchors are described herein. In some embodiments, methods of attaching tissue to bone using tack anchors and/or bone anchors is described herein.
In one form of the present invention, there is provided a tack anchor, comprising:
a body, wherein the body comprises one or more compressible flanges, an opening and a cavity, wherein the cavity comprises an opening near or proximate the flanges, and wherein the cavity is configured to receive a suture; and
a securing element, wherein the securing element is configured to slide into the opening of the body and wherein the securing element is configured to secure a portion of one or more sutures in the cavity such that the ends of the sutures are accessible through the cavity opening.
In another form of the present invention, there is provided a tack anchor tool, comprising:
a hollow first elongated member comprising a stop, wherein the stop is coupled to an outer surface of the first elongated member, and wherein a tack anchor is configured to couple to the distal end of the first elongated member;
a hollow second elongated member, wherein the second elongated member is configured to be inserted into the first elongated member;
a handle coupled to the second elongated member, wherein the handle and second elongated member are configured to receive a suture; and
wherein the second elongated member is configured to displace the tack anchor from the distal end of the first elongated member so that at least one of the flanges of the tack anchor opens outward.
In another form of the present invention, there is provided a method of inserting one or more tack anchors into a bone, comprising:
coupling a portion of a suture to the tack anchor, wherein the tack anchor comprises one or more compressible flanges;
coupling the tack anchor to a tack anchor tool; and
positioning a distal end of the tack anchor on the bone; and
applying force to a handle of the tack anchor tool such that the distal end of the tack anchor is inserted into the bone and the flanges of the tack anchor open outward;
removing the tack anchor tool by sliding the tack anchor tool in a proximal direction along the longitudinal axis of the sutures.
In another form of the present invention, there is provided a method of connecting tissue to bone, comprising:
pulling tissue onto an area of bone;
inserting a first tack anchor through the tissue and into the bone,
inserting a second tack anchor proximate to the first tack anchor, wherein the first tack anchor and the second tack anchor comprise one or more compressible flanges and one or more sutures, and wherein, upon insertion, at least one of the flanges of the first tack anchor and at least one of the flanges of the second tack anchor opens outward;
inserting a first bone anchor into the bone such that the first bone anchor is positioned proximate to the first tack anchor,
inserting a second bone anchor into a bone such that the second bone anchor is positioned proximate the second tack anchor, and wherein the first bone anchor and second bone anchor comprise a two bar locking assembly at least partially disposed in a cavity of the bone anchor main body, and wherein the two bar locking assembly comprises at least two interacting locking elements;
securing at least one of the sutures of the first tack anchor to the two bar locking assembly of the second bone anchor; and
securing at least one of the sutures of the second tack anchor to the two bar locking assembly of the first bone anchor.
In another embodiment of the present invention, there is provided a kit comprising;
one or more tack anchors, wherein at least one of the tack anchors comprises one or more compressible flanges;
one or more sutures; and
at least one tack anchor tool.
In another embodiment of the present invention, there is provided a two-part suture anchor comprising:
a first anchor component comprising a first body, an opening formed within the first body and defining a first stop surface, and apparatus for engaging bone surrounding the first body of the first anchor component; and
a second anchor component comprising a second body defining a second stop surface, the second body being inwardly compressible, and a pair of sliding rings secured to the second body so as to be independently movable relative to the second body, wherein the rings are configured to receive suture therethrough;
wherein the second body of the second anchor component is configured to be compressed and advanced into the opening formed within the first body of the first anchor component until the second stop surface of the second body engages the first stop surface of the first body, whereupon to secure the second body to the first body.
In another embodiment of the present invention, there is provided a method for securing suture to bone, the method comprising:
providing a two-part suture anchor comprising:
-
- a first anchor component comprising a first body, an opening formed within the first body and defining a first stop surface, and apparatus for engaging bone surrounding the first body of the first anchor component; and
- a second anchor component comprising a second body defining a second stop surface, the second body being inwardly compressible, and a pair of sliding rings secured to the second body so as to be independently movable relative to the second body, wherein the rings are configured to receive suture therethrough;
- wherein the second body of the second anchor component is configured to be compressed and advanced into the opening formed within the first body of the first anchor component until the second stop surface of the second body engages the first stop surface of the first body, whereupon to secure the second body to the first body;
securing suture to one of the pair of sliding rings;
deploying the first anchor component in bone; and
advancing the second body of the second anchor component into the opening formed within the body of the first anchor component until the second stop surface of the second body engages the first stop surface of the first body whereby to secure the second body to the first body.
Other objects and advantages of the invention will become apparent upon reading the following detailed description and upon reference to the accompanying drawings in which:
While the invention is susceptible to various modifications and alternative forms, specific embodiments thereof are shown by way of example in the drawings and will herein be described in detail. It should be understood, however, that the drawing and detailed description thereto are not intended to limit the invention to the particular form disclosed, but on the contrary, the intention is to cover all modifications, equivalents and alternatives falling with in the spirit and scope of the present invention as defined by the appended claims.
DETAILED DESCRIPTIONBone anchor member 20 may secure tissue T to bone B. Bone anchor member 20 may be used in conjunction with a length of suture 30. Suture 30 has first end 32a and second end 32b. Ends 32a, 32b may be coupled to bone anchor member 20. A central region of suture 30 forms loop 34. Loop 34 may be threaded through a section of tissue T near the torn end of the tissue using generally known threading techniques. In embodiments described herein tissue, hole, and bone refer to T, H and B, respectively, as described in
Referring to
Bone anchor member 20 includes first passage 60 and second passage 70. Passages 60, 70 extend laterally through a main body of bone anchor member 20, as depicted in
Passage 60 is shown disposed proximal to second passage 70, i.e., the passage 60 is closer to proximal region 22 of bone anchor member 20. However, as will be apparent to one skilled in the art, the passages also may be disposed adjacent one another, or otherwise positioned, to achieve the objects of the present invention.
Passages 60, 70 include at least one cleated member 74. Cleated member 74 includes angled sections 75 and substantially orthogonal sections 76. Orthogonal sections 76 are disposed adjacent one another, thereby forming a cleated shape, as shown in
In certain embodiments, an outer diameter of suture 30 may be slightly larger than an inner diameter of cleated passages 60 and 70. Therefore, suture ends 32a and 32b can pass through cleated passages 60 and 70 in a proximal direction with relatively little resistance while the suture holds significantly greater force in the distal direction.
In one embodiment, a method for coupling suture 30 between tissue T and bone anchor member 20, a central region of suture 30 can be looped through tissue T first, such that free ends 32a and 32b extend from the tissue. Free end 32a is then threaded through one-way cleated passage 60 in a proximal direction, while free end 32b is threaded through one-way cleated passage 70, also in a proximal direction.
As will be apparent to one skilled in the art, suture 30 may be coupled between tissue T and bone anchor member 20 using other threading techniques, so long as the suture ultimately is situated in a manner depicted in
First end 32a of suture 30 is disposed through first passage 60, then transitioned into loop portion 34a. Loop portion 34a transitions into loop portion 34b, forming loop 34 therebetween, which is coupled to tissue T. Loop portion 34b transitions into second end 32b, which is disposed through passage 70, as shown in
After suture 30 is coupled to bone anchor member 20 and a tissue, bone anchor member 20 is distally advanced into a hole of a bone under arthroscopic guidance. Exterior cleated members 42 of bone anchor member 20 allow the bone anchor member to be advanced distally within the bone hole when an appropriate force is applied, but exterior cleated members 42 inhibit proximal movement of bone anchor member 20 to provide a secure anchor within the bone.
Pulling one or both of suture ends 32a and 32b proximally through cleated passages 60 and 70 may approximate the positioning of the tissue with respect to the bone. The use of two separate passages allows the surgeon to tension each end of the suture independently, which is often desirable when tissue is torn irregularly.
Further, the use of a plurality of cleated passages 60, 70 permits incremental tensioning of first and second suture ends 32a, 32b. This allows incremental adjustment during positioning of the tissue, using tactile feedback as a guide. Once a desired tension is achieved, retraction of the suture ends is stopped, and the suture is automatically locked in place. Thus, there is no need to tie a knot.
In some embodiments, guide channels 50 and 52 permit the retraction of suture ends 32a, 32b when bone anchor member 20 is secured within a hole of the bone by providing a clearance between the bone anchor member and the bone itself.
Alternatively, suture 30 may be coupled to bone anchor member 20 using techniques described herein below with respect to
Turning to
Guide channel portions 50a of mating portion 22a and guide channel 50b of mating portion 22b form guide channel 50′ in the assembled state as depicted in
Mating portion 22a includes at least one mating pocket 59, as depicted in
In a preferred embodiment, protrusion 55 includes ledge 57, as shown in detail “B” of
During use, a first suture end may be positioned in cleated passage portion 60a, and a second suture end positioned in cleated passage portion 70a of
The first and second suture ends are disposed through cleated passages 60′, 70′. Using the bone anchor describe in
An alternate embodiment of bone anchor 100 is described in
Referring to
During use, after bone anchor member 102 is secured in the hole, plug portion 110 may be inserted into bore 104 of bone anchor member 102. Plug portion 110 may include cleated members 116 on the outer surface thereof. Cleated members 116 may be configured to permit the advancement of plug portion into bore 104 and allow plug portion 110 to engage and frictionally grip inner wall 105, thereby securing the plug portion 100 to bone anchor member 102.
Referring to
Alternatively, suture 30 may be coupled to plug portion 110 using techniques described hereinbelow with respect to
If desired, passages 118 and 120 of
Plug portion 110 includes one or more guide channels 125 disposed in a lateral surface of plug body 113. Guide channel 125 may be similar to guide channels 50 and 52 of
Alternatively, passages 118 and 120 may be substantially smooth passages, such that cleated members 74 are not employed. In this case, passages 118 and 120 permit substantially unimpeded movement of suture 30 through the passages. In operation, suture ends 32a and 32b may be individually tensioned prior to insertion of plug portion 110 into bone anchor member 102. When the tissue has been appropriately secured to the bone, plug portion 110 is then forced into bore 104 of bone anchor member 102. This causes suture ends 32a and 32b to be sandwiched between plug portion 110 and bone anchor member 102 when guide channels 125 are not present. Accordingly, the suture is secured between the two portions using a force fit.
Referring to
Plug portion 150 includes main body 153. In an embodiment, main body 153 may be substantially cylindrical in shape. In an embodiment, the exterior surface 156 of main body 153 may be substantially smooth. Main body 153 may include taper 157 at the distal end thereof.
Suture 30 having first and second ends 32a, 32b is coupled to plug portion 150. A method of coupling is described hereinbelow with respect to
In operation, bone anchor member 142 is advanced into a hole of a bone (e.g., see
Plug portion 150 may be inserted into bore 144 of bone anchor member 142. An outer diameter of exterior surface 156 of plug portion 150 may be slightly larger than an inner diameter of bore 144. Accordingly, when plug portion 150 is urged distally, a force fit is achieved to secure plug portion 150 within the bore of bone anchor member 142.
Taper 157 of plug portion 150 facilitates the distal advancement of the plug portion with respect to bone anchor member 142. Interior cleated members 145 are configured to permit advancement of plug portion 110 into bore 144 in a distal direction only.
First and second suture ends 32a and 32b may be coupled to plug portion 150 in a manner described hereinabove with respect to
First and second passages 158, 160 may include cleated members 74 (see
Plug portion 150 includes one or more guide channels 165 disposed in a lateral surface of plug body 153, as shown in
Alternatively, passages 158, 160 may be smooth passages, such that cleated members 74 are not employed and guide channels 165 are not present. In some embodiments, passages 158,160 may be substantially smooth. During use, suture ends 32a, 32b may be individually tensioned prior to insertion of plug portion 150 into bone anchor member 142. When tissue is appropriately secured to the bone, then plug portion 150 is forced into bore 144 of bone anchor member 142. This causes suture ends 32a, 32b to be sandwiched between plug portion 150 and bone anchor member 142. Accordingly, the suture is secured between the two portions using a force fit.
Further embodiments of a plug portion are described in
Plug portion 110′ includes first and second plug portions 110a, 110b, which are coupled together using hinge member 115. Hinge member 115 may be integral to first and second plug portions 110a, 110b, or the hinge member may be a third element that couples two distinct portions together.
Hinge member 115 permits plug portion 110′ to transition between a closed state, as shown in
With the suture ends in place, plug portion 110′ may be transformed into a closed state, depicted in
As will be apparent to one skilled in the art, hinge member 115 serves to ensure proper alignment of first and second plug portions 110a, 110b in the closed state. If desired, a securing means, such as protrusion 55 and pocket 59 of
During use, a first suture end may be positioned in passage portion 118b′, and then a second suture end is placed in passage portion 120b′. Since these passage portions are each greater than 180, the suture ends may be pressed into the passage portions. Using such a method the suture ends remain at least partially in place. With the suture ends in place, plug portion 110″ is transformed to a closed state. In the closed state, passage portions 118a′, 118b′ form a first one-way, 360-degree passage through which the first suture end may pass. The second passage portions 120a′, 120b′ form a second one-way, 360-degree passage through which the second suture end may pass.
Referring to
Hinge member 115 is located on a lateral surface of plug portion 110′, as opposed to on the distal end of the plug portion, as shown in detail “D”. Like the embodiment of
As will be apparent to one skilled in the art, passage portions 118a and 120a may be larger than passage portions 118b and 120b, respectively, as described with respect to
Referring to
Unlike the embodiments described hereinabove, bone anchor member 180 includes at least one adhesive delivery channel 188, which is provided within main body 181. Adhesive delivery channel 188 may be formed by drilling a hole into an upper surface of main body 181, such that the hole extends through first passage 184 and second passage 186. As will be apparent to one skilled in the art, however, channel 188 may be formed using other known techniques.
First and second passages 184 and 186 may include cleated members 74 of
After bone anchor member 180 is secured in a hole the bone, the position of tissue relative to the bone may be approximated by individually tensioning first and second ends 32a, 32b of suture 30, as described extensively above and incorporated herein. When the tissue has the desired placement, an adhesive may be delivered to adhesive delivery channel 188. The delivery of an adhesive to channel 188 may be facilitated using a needle-like tube (not shown) disposed within a working cannula. The needle-like tube has a distal opening that may be placed in close proximity to, or within, adhesive delivery channel 188 to deliver an adhesive thereto.
The adhesive is allowed to flow distally through adhesive delivery channel 188 and into portions of first and second passages 184 and 186. The adhesive may contact at least a portion of suture 30 positioned in corresponding regions of first and second passages 184 and 186, thereby locking the suture in place. As will be apparent to one skilled in the art, although one adhesive delivery channel 188 is depicted in
Referring to
Bone anchor member 202 includes main body 203 having bore 204 disposed therein. Main body 203 of bone anchor member 202 includes exterior cleated members 206, which are configured to be inserted into a hole of a bone (e.g., see
Plug portion 210 may be substantially cylindrical in shape and includes main body 213. Main body 213 has smooth exterior surface 216 and taper 217. Optionally, taper 217 may be formed at the distal end of main body 213.
Suture 30 having first and second ends 32a, 32b is coupled to plug portion 210, in a manner described hereinabove with respect to
The outer diameter of main body 213 may be sized slightly larger than an inner diameter of bore 204. The size of diameter is selected to allow main body 213 of plug portion 210 to be distally advanced into bore 204 when forced. Taper 207 of bone anchor member 202 facilitates advancement of plug portion 210 into bore 204.
In operation, bone anchor member 202 is secured within a hole of a bone when the bone anchor member is distally advanced into the hole, as depicted in
Plug portion 210 is advanced distally into bore 204 of bone anchor member 202 and secured therein using a force fit, as described hereinabove. At this time, surrounding regions of the bone may apply a compressive force upon bone anchor member 202, as indicated by the larger directional arrows in
In some embodiments, passages 218 and 219 may include cleated members 74 as described hereinabove with respect to
In certain embodiments, the position of the tissue relative to the bone may be approximated by individually tensioning suture ends 32a and 32b prior to insertion of plug portion 210 into bone anchor member 202. In some embodiments, the tissue position is approximated when passage 219 is disposed just above bore 204. Once the desired positioning of the tissue is achieved, plug portion 210 is advanced distally into bore 204, thereby locking the suture. Specifically, the suture will be sandwiched between exterior surface 216 of plug portion 210 and inner wall 205 of bone anchor member 202.
Referring to
Bone anchor member 222 includes main body 223 having bore 224 disposed therein, as depicted in
Plug portion 230 includes main body 233 having proximal region 235, central region 234 and tapered distal region 237. Tapered distal region 237 is sized to pass through taper 227 of bone anchor member 222 when a distally directed force is applied to plug portion 230. When further force is applied, central region 234 of plug portion 230 is advanced into bore 224 via taper 227. When further force is applied to plug portion 230, proximal region 235 is advanced past taper 227. Once proximal region 235 is fully inserted into bore 224, proximal stop 228 is configured to abut proximal edge 236 of plug portion 230, thereby securing the plug portion within bone anchor member 222.
As will be apparent to one skilled in the art, apparatus 220 may further include any of the other features described above with respect to the embodiments of
In some embodiments, a bone anchor may be positioned in bone throughole HT, which has two openings to the surface of the bone. Referring to
Bone anchor 240 includes main body 242 having proximal and distal ends. Flange 245 disposed at the proximal end and taper 246 formed at the distal end of main body 242. Main body 242 includes exterior surface 243 disposed between flange 245 and taper 246.
Bone anchor 240 includes first and second passages 250 and 252, each having a plurality of cleated members 254. Each of the cleated members includes angled sections 255 and substantially orthogonal sections 256, which are disposed adjacent one another thereby forming a cleated shape, as described hereinabove with respect to cleated members 74 of
During use, a loop of suture 30 may be coupled through tissue T first, with free ends 32a and 32b extending from the tissue. Free end 32a then is threaded through first passage 250 in a proximal direction. Free end 32b is threaded through second passage 252, also in a proximal direction. The suture may be threaded through passages 250,252 and tissue T by arthroscopically operating on one or both sides of bone B.
As will be apparent to one skilled in the art, suture 30 may be coupled between tissue T and bone anchor 240 using other arthroscopic threading techniques, so long as the suture ultimately is situated in a manner depicted in
Once the suture is threaded as shown in
In accordance with one aspect of the present invention, cleated passages 250 and 252 are configured to permit one-way movement of first and second suture ends 32a and 32b, respectively. For example, when first end 32a is pulled in a proximal direction, angled sections 255 permit movement of the suture end in the proximal direction. However, suture end 32a is inhibited from distally advancing within passage 250. The use of two separate passages allows each end of the suture to be separately tensioned, which is often desirable when tissue T is torn irregularly.
As will be apparent to one skilled in the art, the methods described in
Further, the suture securing methods described in
Bone anchor member 272 includes first and second spring elements 292a and 292b, which are disposed at a distal region of bore 274. First and second spring members 292a and 292b may be integrally formed with bone anchor body 273, or may be separate elements coupled to body 273. First and second spring elements 292a and 292b may be deformed to accommodate plug portion 280 within bore 274, and also to enable locking and unlocking of a suture (not shown in
First and second passages 298 and 299 extend laterally through main body 273 of bone anchor member 272. First and second passages 298 and 299 are configured to selectively align with first and second passages 288 and 289 of plug portion 280, for the purposes described hereinafter.
Plug portion 280 of apparatus 270 includes main body 283 having proximal and distal ends. The proximal end includes flange 284. Taper 286 is disposed between flange 284 and main body 283. Distal taper 287 is disposed at the distal end of plug portion 280.
Plug portion 280 includes first and second passages 288 and 289, which extend laterally through main body 283. In some embodiments, first and second passages 288 and 289 include substantially smooth interior surfaces.
When plug portion 280 is fully inserted into bore 274, first and second spring elements 292a and 292b are inclined to urge plug portion 280 in a proximal direction, to allow flange 284 to abut proximal stop 278 (see
Insertion tool 294 may be a rod or other substantially rigid member configured to transfer a distally directed force from a physician to plug portion 280. In some embodiments, insertion tool 294 engages mating slot 295, as shown in
The provision of a distally directed force acting on plug portion 280 causes first and second passages 288 and 289 to become substantially aligned with first and second passages 298 and 299 of bone anchor member 272, respectively, as shown in
Once the suture is coupled to apparatus 270, apparatus 270 is inserted into a hole of a bone under arthroscopic guidance. Cleated members 276 secure apparatus 270 within the hole, as described hereinabove. At this time, first and second suture ends 32a and 32b will extend outside of the arthroscopic field of vision.
First and second suture ends 32a and 32b may be selectively tensioned to approximate the positioning of the tissue with respect to the bone when first and second passages 288 and 289 are aligned with first and second passages 298 and 299, respectively. During tensioning of the suture ends, insertion tool 294 urges plug portion distally to cause the passages to align, as shown in
When a desired positioning of the tissue is achieved, the force applied to plug portion 280 is removed (e.g., by proximally retracting insertion tool 294, as shown in
If it becomes necessary to adjust the positioning of the tissue with respect to a bone during use, then insertion tool 294 may be inserted into mating slot 295, as shown in
Bone anchor member 272′ is used in conjunction with plug portion 280 in a manner similar to that described hereinabove with respect to
When a desired positioning of tissue is achieved, the force imposed upon plug portion 280 is removed (e.g., by proximally retracting insertion tool 294, as shown in
Referring to
Apparatus 300 includes bone anchor member 302 and plug portion 310. Bone anchor member 302 is similar to the bone anchor members described hereinabove and includes main body 303 having plurality of cleated members 306, which are configured to anchor plug portion 302 within a hole of a bone (e.g., see
Plug portion 310 of apparatus 300 includes main body 311 having distal region 318 and central bore 312, as shown in
Bone anchor member 302 includes first and second semi-circular channels 305a and 305b, which are formed at diametrically opposing surfaces of main body 303, as shown in
Apparatus 300 also includes actuation knob 321, which is disposed on an outer surface of plug portion 310, as shown in
When actuation knob 321 is disposed within first recess 322, first and second semi-circular channels 305a and 305b of bone anchor member 302 are aligned with first and second semi-circular channels 315a and 315b of plug portion 310, respectively, thereby forming first and second circular channels, as shown in
When actuation knob 321 is disposed within second recess 323, first and second semi-circular channels 305a and 305b of bone anchor member 302 are not aligned with corresponding channels 315a and 315b of plug portion 310, as shown in
During use, suture 30 is coupled to apparatus 300 in a manner shown in
Loop portion 34a then is threaded through a tissue and transitions into loop portion 34b. Loop portion 34b is threaded through the second circular channel formed by semi-circular channels 305b and 315b. Loop portion 34b passes through a second aperture 327 and transitions into second suture end 32b. Second suture end 32b extends through central bore 312 of plug portion 310.
During use, first and second suture ends 32a and 32b may be selectively tensioned when actuation knob 321 is disposed within first recess 322, as shown in
It should be noted that, as first and second ends 32a and 32b are individually tensioned, rounded edges 328 of plug portion 310 (see
To lock the suture in place, plug portion 310 is rotated with respect to bone anchor member 302 to cause actuation knob 321 to be advanced into second recess 323. The rotation of plug portion 310 may be achieved by inserting an actuation tool such as a hexagonal key (not shown) into mating slot 325. Once knob 321 is secured within second recess 323, as shown in
The positioning of tissue may be optimized (e.g., tweaked) with respect to bone after the suture has been locked, the actuation tool may be inserted into mating slot 325 and force applied to cause knob 321 to rotate in an opposing direction into first recess 322. As described above, this forms two fully circular channels through which the suture may be advanced or retracted to facilitate positioning of the tissue with respect to the bone.
Bone anchor member 340 includes at least one passage 352 and flexible member 350. Passage 352 extends laterally through main body 343. Flexible member 350 is disposed proximal to passage 352. Flexible member 350 has a relaxed configuration in which it assumes a convex shape (e.g., bowed away from passage 352). In the relaxed configuration, shown in
In use, before bone anchor member 340 is inserted into a hole of a bone, first suture end 32a is passed through passage 352. The first suture end then becomes loop portion 34a, which is threaded through the tissue, as described hereinabove. Loop portion 34a extends through the tissue to become loop portion 34b. Loop portion 34b passes back through passage 352 and becomes second suture end 32b. First and second suture ends 32a and 32b extend outside of the arthroscopic site and may be individually tensioned during use.
After suture 30 is coupled to apparatus 340 and the tissue, bone anchor member 340 is advanced distally into a hole of a bone (e.g., see
Once a desired tissue positioning is achieved, the suture may be locked in place by apply a distally directed force upon flexible member 350, as depicted in
As will be apparent to one skilled in the art, any number of mechanisms may be employed to apply a distally directed force upon flexible member 350, and further, to lock the flexible member in the concave position depicted in
Alternatively, the flexible member may be “bi-stable,” such that the flexible member has only two stable states. In the first state, the flexible member is positioned as shown in
In some embodiments, a threaded member may be used to hold the suture in a locked state. As shown in
In an unlocked state, threaded cap 360 is situated proximally within bore 358′, as shown in
If re-adjustment of the suture is necessary, locking tool 375 may be rotated counterclockwise within mating slot 365 to proximally retract the threaded cap. This will remove the forces imposed upon the suture, as depicted in
In some embodiments, flexible member 350 is omitted entirely. In this case, threaded cap 360 may directly pinch the suture in passage 352 to lock the suture in place.
Referring now to
Locking member 380 includes cylindrical body 381, which is configured to be confined within recess 391 of main body 343″, as shown in
First and second support members 383a and 383b are disposed beneath cylindrical body 381, and may be formed integrally with locking member 380. As shown in
During use, suture 30 is secured to a tissue and disposed through passage 352″, as described hereinabove with respect to
When locking member 380 is elevated within recess 391, distal protrusion 382 may not substantially extend into passage 352″, thereby permitting movement of the suture within passage 352″. At this time, first and second suture ends 32a and 32b may be individually tensioned to approximate the positioning of the tissue with respect to the bone.
Once a desired positioning is achieved, the suture may be locked in place by any number of techniques that cause first and second support members 383a and 383b to be lowered or eliminated, thereby lowering cylindrical body 381 within recess 391 and urging distal protrusion 382 towards corresponding pocket 355″, as depicted in
In certain embodiments, first and second support members 383a and 383b may be fused with support ledge 395 of main body 343″. In some embodiments, ultrasonic energy is delivered to a proximal surface of locking member 380, via bore 358″, using techniques that are known in the art. The provision of ultrasonic energy causes first and second support members 383a and 383b to fuse with support ledge 395, thereby lowering locking device 380 and locking the suture disposed within passage 352″ in place.
In the embodiments of
Further, it will be apparent to one skilled in the art that an adhesive, for example, cyanoacrylate, epoxy, bone cement and so forth, may be employed in conjunction with any of the embodiments described in
Bone anchor member 402 includes main body 403 having cleated members 406, which are configured to secure bone anchor member 402 in a hole of a bone, as described hereinabove. Bone anchor member 402 also includes first and second passages 408 and 412, which extend laterally through main body 403.
Bone anchor member 402 further includes guide channels 409a, 409b, 413a and 413b, which are disposed in exterior surfaces of main body 403. The guide channels may be similar to guide channels 50 and 52 of
In use, first suture end 32a passes through guide channel 409a, through passage 408 and through guide channel 409b. The first suture end then transitions into loop 34, which is threaded through a tissue. Loop 34 of suture 30 then transitions into second suture end 32b. Second suture end 32b passes through guide channel 413b, through passage 412, and through guide channel 413a. Accordingly, the suture is coupled between the tissue and apparatus 400.
Plug portion 410 having main body 411 is configured to be disposed within a central bore of bone anchor member 402. Plug portion 410 includes actuation knob 422, which is configured to be disposed in first recess 423 of bone anchor member 402 in an unlocked state, and disposed within second recess 424 in a locked state.
In the unlocked state, (e.g., when knob 422 is disposed within first recess 423) plug portion 410 is oriented such that main body 411 does not substantially overlap with first and second passages 408 and 412 of bone anchor member 410.
In some embodiments, first and second ends 32a and 32b of suture 30 are selectively tensioned when knob 422 is disposed within first recess 423. This is because first and second passages 408 and 412 provide a substantially unimpeded circular channel within which the suture can pass.
To lock the suture in place, plug portion 410 is rotated to cause knob 422 to be advanced into second recess 424. The rotation of plug portion 410 with respect to bone anchor member 402 may be achieved by inserting an actuation tool (e.g., a rectangular key) into mating slot 427. Once knob 422 is secured within second recess 424, the suture is locked in place because main body 411 of plug portion 410 impinges upon passages 408 and 412.
To adjust (e.g., tweak) the positioning of the tissue with respect to the bone after the suture is in the locked state, the actuation tool may be inserted into mating slot 427 to cause knob 422 to rotate back into first recess 423 (see
Referring to
Plug portion 450 has main body 451 having proximal and distal regions. The proximal region includes first and second guide channels 456 and 457, which are recessed in opposing lateral surfaces of main body 451. The distal region of main body 451 includes circumferential recess 453 and distal taper 454. Plug portion 450 also has a central region having passage 448 disposed laterally therethrough.
Before plug portion 450 is inserted into bore 444, first suture end 32a is passed through passage 448. The first suture end then becomes loop portion 34a, which is threaded through a tissue. Loop portion 34a extends through the tissue to become loop portion 34b. Loop portion 34b passes back through passage 448 and becomes second suture end 32b. First and second suture ends 32a and 32b may be manipulated during use.
Alternatively, as described hereinabove, a central region of suture 30 may be threaded through the tissue, and the free ends of the suture then may be passed through passage 448 in a proximal direction to achieve the depicted position of the suture.
In some embodiments, bone anchor member 442 is inserted into a hole of the bone before plug portion 450 is inserted into bore 444. Once bone anchor member 442 is securely disposed within the hole, plug portion 450 is positioned slightly above bone anchor member 442, so that passage 448 is proximal to bore 444. At this time, first and second suture ends 32a and 32b may be individually tensioned to approximate the positioning of the tissue with respect to the bone (e.g., see
Once the desired positioning is achieved, plug portion 450 may be advanced distally into bore 444 of bone anchor member 442. An insertion tool, such as insertion tool 294 of
At this time, first and second suture ends 32a and 32b are compressed within guide channel 456, while suture loop portions 34a and 34b are compressed within guide channel 457. Guide channels 456 and 457 may be sized to ensure that the suture is completely locked in place when plug portion 450 is inserted into bore 444 (see
Referring to
In
The operation of a bone anchor system using plug portion 450′ is substantially similar to the steps described in
Referring to
Plug portion 450″ includes main body 451′ having first suture clearance channel 456′ formed in a first lateral surface of the body, and second suture clearance channel 457′ formed in an opposing lateral surface of the body. Plug portion 450″ also includes clearance recess 455 on a distal region of main body 451′, along with suture channel 466′.
Main body 451′ includes a plurality of cleated members 459a, which are formed adjacent to suture channel 466′. Also, bone anchor portion 442″ includes a plurality of cleated members 459b formed in bore 444. Cleated members 459b are configured to oppose cleated members 459a when plug portion 450″ is disposed in bore 444 of bone anchor member 442″, as shown in
During use, suture length 30a is coupled to bone anchor member 442″ by first forming loop 470 between regions 35a and 35b of the suture. A central portion of suture 30a then is looped around suture channel 466′ of plug portion 450″. At this time, proximal suture ends 33a and 33b are proximate clearance channel 456′, while suture regions 35a and 35b are in the vicinity of clearance channel 457′. Plug portion 450″ then is lowered into bore 444 of bone anchor member 442″, as depicted in
When an appropriate force is applied, distal taper 454 of plug portion 450″ passes over protrusion 449 of bone anchor member 442″. At this time, protrusion 449 is confined within recess 453, as shown in
In certain embodiments, suture loop 470 may be coupled directly to a tissue, as generally set forth hereinabove. Tensioning of suture ends 33a and 33b may directly effect positioning of the tissue. Further, as set forth above, cleated members 459a and 459b may form a one-way channel that facilitates tensioning of the suture ends, and locks the suture ends in place.
In some embodiments, a second suture length may be employed to anchor a tissue to a bone.
In
Second suture 30b is coupled to first suture 30a by pulling proximal ends 32a and 32b through loop 470. At this time, four proximal suture ends will extend proximally from an access cannula (not shown). Specifically, proximal ends 32a and 32b of second suture 30b, along with proximal ends 33a and 33b of first suture 30a, all extend from the access cannula. Each of the four suture ends may be individually tensioned during use.
As each of the four suture ends 32a, 32b, 33a and 33b are selectively tensioned, loop 470 and suture regions 35a and 35b are urged towards clearance channel 457′, as shown in
At this time, the various suture regions that are drawn towards clearance channel 457′ become inserted within the clearance channel to effectively lock the sutures in place. In effect, as tension is applied to the four suture ends 32a, 32b, 33a and 33b, tissue T is approximated to bone, and ultimately, the sutures are locked in place.
The use of the described method may save considerable time and effort during a surgical procedure. For example, bone anchor member 442″, plug portion 450″ and first suture 30a (including loop 470) may be provided in an already assembled state, as shown in
At an appropriate time, second suture 30b is coupled to tissue T via loop 471. Using this method, it is not necessary to thread proximal suture ends 32a and 32b through plug portion 450″ or bone anchor member 442″ after suture 30b is coupled to tissue T. Rather, suture ends 32a and 32b are pulled through loop 470 of first suture 30a. In short, first suture 30a is coupled to tissue T, and then proximal ends 32a and 32b are guided through previously provided loop 470, thereby saving operating time and effort.
Referring to
Bone anchor 500 includes main body 502 and insert 504. Main body 502 has cleats 506, which are used to secure the bone anchor 500 to bone as discussed above. Main body 502 may have any other suitable feature to secure the anchor 500 to bone, such as an expandable portion, without departing from the scope of the invention.
Insert 504 is positioned in recess 508 in main body 502. The suture enters apparatus 500 through the proximal end of recess 508 and extends through a space between main body 502 and insert 504. The suture then passes through hole 510 in insert 504. Hole 510 is, in some embodiments, triangular shaped to accommodate different size suture as shown in
Insert 504 is movable between the closed position of
Insert 504 may be moved to the unlocked position of
Referring to
Bone anchor 530 has main body 532 with cleats 531 used to secure the bone anchor to bone although any other feature may be provided to secure bone anchor 530 to bone. The suture is locked with a suture lock 533. Suture lock 533 permits the suture to be advanced in the direction of arrow 556, but prevents movement in the other direction. The suture extends around bearing surface 534. Bearing surface 534 may be roller 536 although a non-rotating member may also be used. Roller 536 is mounted within hole 538. Suture lock 533 has first locking portion 540 and second locking portion 542, but may include any number of locking portions.
The first and second locking portions 540, 542 are integrally formed as ring clip 550. Ring clip 550 seats within annular recess 552 in main body 532. Suture locks 540, 542 include suture engaging portion 554 extending from ring clip 550. Locks 540, 542 may include an integrally formed living hinge 556. Living hinge 556 may permit the suture engaging portion 554 to deflect inwardly when suture is pulled in the direction of arrow 556. Suture lock 533 permits the suture to be pulled in the direction of arrow 556 and prevents the suture from being moved in the opposite direction. Bone anchor 530 is used in the same manner as bone anchors described herein.
Referring to
Bone anchor 560 includes suture lock 564. Suture lock 564 allows a suture to be pulled in the direction of arrow 566, and prevents movement in the other direction. Suture lock 564 includes cam 568 having pinned connection 570 formed by pin 571 rotatable within hole 573 (see
Bone anchor 560 includes release element 576 for releasing suture lock 564. Release element 576 may be part of introducer 578. Introducer 578 may be used when advancing bone anchor 560 into bone. Release element 576 extends through a channel of introducer 578. Release element 576 and main body 572 may be configured (e.g., threaded) to allow the release element to be rotated and advanced to a desired position (e.g., as depicted in
Referring to
It will be apparent to practitioners of ordinary skill in the art that, while the non-limiting embodiment of bone anchor 600 depicted in
Bone anchor 600 may include main body 610 with sides 611. Sides 611 may form cavity 612. Sides 611 may entirely or at least partially enclose cavity 612. The cavity may extend distally along the entire length of the main body, or may optionally extend along only a portion of the length of the main body. Cavity 612 extends to the proximal end of the main body to form opening 613.
Main body 610 has inner surface 615 positioned at the distal end of end of cavity 612. Inner surface 615 may be formed from the main body at the time of its manufacture, or may be formed by coupling block 616 to the distal end of main body 610 (see
In some embodiments, opening 613 may be fully surrounded at the proximal end of main body 610. In certain embodiments, side surfaces 640 are coupled to main body 610 to enclose opening 613. Side surfaces 640 may be formed from the main body at the time of its manufacture, or may be formed by coupling retainer 645 to the proximal end of main body 610, as depicted in
Referring to
In some embodiments, cam 650 may be configured to have an irregular cross sectional shape.
Coupling cam 650 to main body 610 as described above allows the cam to freely pivot in cavity 612. In an embodiment, cam 650 may pivot in a first direction (e.g. downward) until outer cam surface 667 comes into contact with inner surface 615 (e.g., as depicted in
In some embodiments, cam 650 may be configured such that cam surface 667 is biased toward inner surface 615. Any suitable art-recognized means may be used to bias cam surface 667 toward inner surface 615. Examples of methods to bias a cam include, but are not limited to, coupling the cam to a spring bias assembly, or by forming at least a portion of cam and/or inner surface of the main body from a magnetized material.
Referring to
In an embodiment, coupling members 630 may extend radially from the main body. In an embodiment, coupling members 630 may be configured to reversibly engage a bone surface. Typically, coupling members may be formed, at least in part, of a substantially rigid or deformable material. In an embodiment, the coupling members are formed from the main body during the time of its manufacture. In some embodiments, coupling members may be manufactured separately and coupled to the exterior surface of the main body. In some embodiments, the main body may be coupled to the coupling members at the point of care setting. The main body may be configured to fit to a variety of coupling members, each having unique features suited to particular applications. A choice of coupling members may be provided to the physician at the point of care and coupled to the main body. Such a system allows the physician to choose the coupling member(s) best suited to a particular patient and application (e.g., size, depth and/or width of the bone hole), without having to interrupt and prolong the procedure underway in order to choose an alternate bone anchor and prepare it for implantation. The coupling of a main body to coupling members may be by any suitable means generally known in the art. By way of non-limiting examples, a main body may be coupled to coupling members using snap-locks, screws, adhesives, or any other suitable means described above or generally known in the art. A non-limiting example is depicted in
In an embodiment, a bone anchor may be positioned in an opening in a bone by first retracting the coupling members. Retraction may be accomplished using a device (e.g., an inserter) that is capable of grasping the coupling members and compressing them toward the main body. When the bone anchor is suitably positioned in the bone opening, the inserter releases coupling members, allowing them to move radially outward and engage the surface of the bone opening. Alternatively, the bone anchor may be inserted into a bone opening without retracting the coupling members, and allowing the coupling members to grip the surface of the opening in which the bone anchor is placed.
Suture 660 may be positioned in bone anchor 600 to allow tensioning one or both ends of the suture to optimize positioning of the tissue relative to the bone. Suture 660 includes distal loop portion 665, which is coupled to the tissue, and suture end portions 662a, 662b, which are coupled to bone anchor 600. During use, suture end portions 662a and 662b may be tensioned so that the tissue is drawn toward the bone anchor.
Suture end portions 662a, 662b may be coupled to bone anchor 600 by entering through opening 613. Suture end portions 662a, 662b extend toward the distal end of main body 610. To engage cam 650, suture end portions 662a, 662b may be wrapped around at least a portion of outer surface of cam surface 650. Optionally, cam 650 may be textured on at least a portion of its outer surface. The texturing may allow the cam surface to frictionally grip the suture. The sutures may be wrapped around cam 650 such that the suture contacts at least about 30%, at least about 40%, at least about 50%, at least about 60%, or at least about 70% of the outer surface of cam 650. In an embodiment, suture end portions 662a, 662b may be wrapped around cam 650 in a hairpin configuration as shown in
In an embodiment, a suture puller (not shown) may facilitate threading of the suture ends through the bone anchor described above and shown in
The suture puller may be threaded through the bone anchor in the same manner as the suture, prior to the positioning of the anchor in a bone opening. The distal end of the suture puller couples to ends of the suture. During use, a loop of suture may pass through a tissue of interest. The end portions of the suture may couple to the distal end of the suture puller. Pulling a proximal end of the suture puller passes the suture puller through the main body of the bone anchor and threads a portion of the suture end through the opening in the main body, around the cam, between the outer cam surface and the inner surface of the main body, and out through the opening in the cavity.
When the suture is coupled to tissue and appropriately threaded through bone anchor 600, the sutured tissue may be drawn toward the bone by individually, or together, tensioning suture end portions 662 and 663 in the direction indicated by arrow 690 shown in
Bone anchor 700 includes insert 710 and main body 715. Insert 710 includes one or more (e.g., a plurality) of flange members 711 (see
In some embodiments, main body 715 may be configured to couple to insert 710. As depicted in
Main body 715 may optionally include a plurality of radial coupling members 716. Radial coupling members 716 may secure bone anchor 700 to bone as described herein. Main body 700 may employ any art-recognized means for securing anchor 700 to bone including, but not limited to, cleats.
Bone anchor 700 may also include locking assembly 740. Locking assembly 740 includes a plurality of locking elements 750. In
In one embodiment, one or more of locking elements 750 may be axially movable in cavity 720. Moving locking element 750 in an axial direction may, in some embodiments, allow the locking elements to interact with each other to either lock or release a suture length positioned in gap 760 by compressing the suture length between upper bars 751a and 751b. In some embodiments, locking element 750 may be moved axially after desired positioning of a sutured tissue (e.g., after fine-tuning placement of the tissue), in order to reversibly lock the suture in place. Axial movement of locking elements 750 may be accomplished using any art-recognized means, including those described in detail above.
Suture 780 is positioned in bone anchor 700 to allow optimal positioning of a tissue relative to the bone by individually tensioning the ends of the suture, while substantially inhibiting movement of the suture and tissue coupled thereto in the opposite direction.
In some embodiments, suture 780 is configured to have a distal loop portion 785 and proximal suture end portions 781a and 781b. Distal loop portion 785 couples to tissue. Suture end portions 781a and 781b may be treaded through the locking assembly of bone anchor 700, and when tensioned in the direction indicated by arrow 790, draw the tissue toward the bone anchor. In some embodiments, suture end portions 781a and 781b may be threaded through a two bar locking assembly as depicted in
In certain embodiments, a suture puller may facilitate threading of the suture ends through the two bar locking assembly as described above. The suture puller may be similar in shape and size to the suture coupled to the tissue, and may be threaded through the bone anchor in the same manner as the suture, prior to the positioning of the anchor in a bone opening. The distal end of the suture puller couples to suture end portions 781a and 781b. During use, a loop of suture passes through a tissue. The end portions of the suture are coupled to the distal end of the suture puller. Pulling the proximal end of the suture puller in a desired direction (e.g., direction 790) passes the suture puller through the locking assembly and threads suture end portions 781a and 781b through ring 750a, under and around upper bar 751b, passed though suture gap 760 and finally wrapped around upper bar 751a.
When the suture is coupled to tissue and appropriately threaded through the locking assembly of the bone anchor, the sutured tissue may be drawn toward the bone by individually or together tensioning suture end portions 781a and 781b in the direction indicated by arrow 790 shown in
Turning now to
The bone anchor embodiments depicted in
Bone anchor 600 is describe in certain embodiments as having the main body configured to be used with a variety of different coupling members, each having features suited to particular applications. It will be readily appreciated by ordinary practitioners of the art however, that this feature is not limited to the embodiments of bone anchor 600. Neither is this feature meant to be limited to the coupling of an internal portion to an external portion. In the contrary, components of the bone anchor assemblies described above are designed with the feature of modularity in mind. The ability to mix-and-match different features of an internal portion of a bone anchor assembly with a wide variety of features of external portions of the bone anchor is intended to be applied, without limitation, to all the embodiments described herein.
Incorporating the feature of modularity into the bone anchor assembly design parameters provides the following advantages: (a) maximized versatility in surgical applications without having to redesign bone anchors suited to such applications; (b) maintaining flexibility of the surgical procedure at the point-of-care; (c) full interchangeability of any component with any other component; (d) adjustability of each bone anchor component independent of the choice or position of other bone anchor components being used in a single surgical application; (e) allows the surgeon to tailor the assembly to the individual anatomy of the patient even in the face of a revision of the surgical procedure that might otherwise damage the bone or tissue; and (f) the use of all styles and sizes of interior and exterior components. The feature of modularity allows the physician to dedicate his or her full attention to the procedure at hand, improving the prognosis and healing of the patient.
Securing a bone anchor member within a hole of a bone may be employed as previously described or using generally known bone securing techniques. For example, cleated members 42 of
Further, while some of the embodiments of the present invention describe use of a bone anchor member only, and other embodiments describe use of a bone anchor member and a plug portion, many of these features may be interchanged. It will be apparent to one skilled in the art that many embodiments depicting a bone anchor member only may be performed using a bone anchor member and plug portion, and vice versa.
Also, for those embodiments described above having a bone anchor member and a plug portion, it will be apparent to those skilled in the art that the suture ends may be tensioned either before or after the plug portion is inserted into the bore of the bone anchor member.
It will also be apparent to one skilled in the art that the plug portion may be securely disposed within the bore of the bone anchor member using various means not specifically disclosed herein. For example, after the plug portion is inserted into the bore of the bone anchor member, an adhesive, for example, cyanoacrylate, epoxy, bone cement and so forth, may be delivered to affix the plug portion to the bone anchor member. Alternatively, an exterior surface of the plug portion may be coated with a biocompatible adhesive that affixes to the bone anchor member after the plug portion is inserted into the bore of the bone anchor member. In some embodiments, heat may be applied to fuse the plug portion to the bone anchor member. It will be apparent to one skilled in the art that still further means for securing the plug portion to the bone anchor member may be employed.
It should be understood that multiple bone anchor members, or multiple bone anchor members coupled to respective plug portions may be used. One or more sutures may be coupled between a desired tissue region and the bone anchor member or plug portion. If multiple sutures and bone anchor members are employed, enhanced sequential tensioning of the tissue may be achieved.
Finally, while the above-described embodiments reference use of apparatus and methods for facilitating attachment of tissue to bone, it will be apparent to one skilled in the art that such apparatus and methods may also be used to secure tissue-to-tissue and bone-to-bone.
The subject bone anchors may be provided to a bone hole using one or more of non-limiting bone inserter embodiments depicted in
In some embodiments, a bone anchor inserter system may include a suture passer device. Turning to
In an embodiment, suture passer 2000 may include a rigid or semi-rigid elongated central portion 2020 extending distally from proximal end 2010. Central portion 2020 may be configured to allow the operable coupling of one or more elements of proximal end 2010 with one or more elements disposed at distal end 2030 of the suture passer.
In an embodiment, distal end 2030 may include a tissue grasping means 2035. A tissue grasping means 2035 may be configured to reversibly grasp a tissue. In an embodiment, tissue-grasping means 2035 may include a lower jaw 2038 and an upper jaw 2037 rotatable coupled to the lower jaw through hinged connection 2039. Rotatable couple means 2012 may be configured to enable the reversible grasping of a tissue between the upper and lower jaws when a surgeon engages a controlling means (e.g., grip 2013) located at the proximal end. In an embodiment, upper jaw 2037 and lower jaw 2038 may each be configured to have at least one suture passage 2040 extending therethrough. Suture passage 2040 may be sized to allow passage of a suture segment and/or a suture loop 2060 through the passage.
Turning now to
During operation, a suture length is passed though at least one of the distally located suture passages. Advantageously, the device may be configured such that the suture may be passed through the suture passage in either of the jaws.
Proceeding to
In an embodiment, suture passer 2000 may include a reversibly engageable mechanical means to retrieve the suture or suture loop after is passed though the suture passer. Engagement of the mechanical suture retrieval means during use may obviate the need for a separate device with which to retrieve the suture loop, thereby improving efficiency, maximizing working volume, and minimizing risk of contamination. In an embodiment, a mechanical suture retrieval means may include a suture capture element. Turning to
In some embodiments, a bridging procedure (e.g., suturing in an x pattern) for joining tissue to bone is desired (for example, rotator cuff repair). A bridging procedure may require multiple bone anchors and sutures. During a bridging procedure, it may be possible to pull tissue onto a larger surface area of bone (e.g., a bigger pad or landing area where the tissue is pressed against the bone). When tissue is pulled onto bone having a large surface area, a better tissue/bone repair may be achieved. Since bone anchors occupy space in the landing area, a minimal amount of bone anchors and/or small bone anchors are desired to allow for more area for tissue placement. Instead of using multiple bone anchors, tissue may be tacked to the bone using tack anchors and/or bone anchors. Sutures from the tack anchors may be connected and/or secured to bone anchors over the surface of the tissue to anchor the tissue to the bone. Since tack anchors may be smaller in size than bone anchors, thus occupying less space in the landing area, more bone surface area is available for tissue placement.
A tack anchor may include a body and a securing element (e.g., a pin). The securing element may secure one or more sutures in a cavity of the body. A top portion of the body may include the cavity opening for receiving sutures. A distal portion of the body may include an opening that receives the securing element. The distal end of the body may be rounded, tapered or pointed to allow for the tack to inserted into tissue and/or bone without pre-forming a hole in the bone. In some embodiments, an outer surface of the distal end may include helical threads, cleats as previously described herein for bone anchors, and/or any other surface modification to secure the tack anchor to bone.
The proximal end of the body may include one or more flanges. For example, a proximal end may include 1 flange, 2 flanges, 3 flanges, or 4 flanges. The flanges may be of different widths and/or lengths. In some embodiments, the flanges are of equal lengths and widths. The flanges may be coupled to the distal portion of the tack anchor and from the cavity in the body of the tack anchor. The flanges may be formed of memory metal or other material that allows the flanges to be compressed and upon release of the stress return to their original shape. Using compressible flanges may assist in insertion of the tack anchor into bone, since compressed flanges may be easier to couple to an insertion tool than flared flanges. In some embodiments, upon insertion into bone, the tack anchor may be turned one or more turns to assist in flaring the flanges. A length of the compressed flange may range from about 3 millimeter (mm) to about 6 mm or from about 4 mm to about 5 mm. When flared, a flange may have a flare angle ranging from about 10 degrees to about 90 degrees, about 20 degrees to about 80 degrees, about 30 degrees to about 70 degrees, or about 40 degrees to about 60 degrees.
A length of the tack anchor, from the bottom to the top of the compressed flange, may range from about 5 mm to about 15 mm, from about 6 mm to about 13 mm, from about 7 mm to about 12 mm, or from about 8 mm to 10 mm. A diameter of the middle portion of the body may range from about 1 mm to about 4 mm, from about 1.5 mm to about 3.5 mm, or from about 2 mm to about 3 mm. In some embodiments, a diameter of the middle portion may be about 1.75 mm.
One or more sutures may be pre loaded into the cavity of the tack anchor prior to insertion into tissue and/or bone. The sutures may be secured in the tack anchor in transverse direction using a removable securing element (e.g., a pin or plug). Securing the sutures in a transverse direction allows the suture end to be free at the proximal end of the tack anchor. The sutures may be coupled to a bone anchor located proximate (e.g., diagonal) to the tack anchor.
Tack anchor 3000 includes body 3002 and pin 3004. Body 3002 includes flanges 3006, openings 3008, 3008′, and cavity 3010. Body 3002 may be one piece, two pieces, or multiple pieces. Body 3002 may be manufactured using conventional casting techniques using metallic and/or polymeric materials suitable for use in a human body.
Flanges 3006 may be manufactured from shape memory alloy or memory metal (e.g., nitinol) and/or any other biocompatible material. Flanges 3006 may include titanium and nickel metal. In some embodiments, titanium and nickel may be present in equal amounts in flanges 3006. In certain embodiments, an amount of titanium and nickel in flanges 3006 may be at least 50% by weight, 60% by weight, or 90% by weight. The use of memory metal may allow flanges 3006 to be compressed or stressed as shown in
Distal end 3014 may be tapered, rounded, or any shape suitable for insertion of the tack anchor into bone and/or tissue. In some embodiments, distal end 3014 may have three flat sides which converge at the front. Distal end 3014 may be manufactured from any biocompatible material (for example, nitinol, stainless steel, titanium, and/or polymeric material).
As shown in
In some embodiments, tack anchors may be inserted into tissue and/or bone using a tack anchor tool. The tack anchor tool may include a first elongated member and a second elongated member coupled to a handle. The tack anchor preloaded with sutures may be coupled to a distal end of the first elongated member. The second elongated member may be inserted into the first elongated member, and when force is applied to the second elongated member, the distal end of the second elongated member may contact the tack anchor and eject the tack anchor from the first elongated member into the tissue and/or bone. The tack anchor tool may include a spacer. The spacer may be positioned on the first elongated member to inhibit the second elongated member from contacting the tack anchor prior. Use of a stop may inhibit tack anchors from being ejected from the tack anchor tool inadvertently.
Tack anchor 3000 may be inserted into tissue and/or bone using tack anchor tool 3020.
Elongated member 3022 may be coupled to stop 3030 using known methods to couple polymer to tubing. Stop 3030 may include bottom portion 3038, middle portion 3040, and upper portion 3042. A shape of bottom portion 3038 may be tapered, rounded, and/or conical. Shaft 3036 may insert in and/or coupled to bottom portion 3038. Coupling of shaft 3036 to bottom portion 3038 may reduce manufacturing costs and/or ensures that second elongated member 3024 passes through first elongated member 3022 unimpeded.
Upper portion 3042 of stop 3030 may be elongated and/or cylindrical and have an inner diameter ranging from about 1 mm to about 10 mm, about 2 mm to about 8 mm, about 3 mm to about 6 mm, or about 4 mm to about 5 mm. Upper portion 3042 may include one or more notches 3046 and/or grooves that align with one or more protrusions 3048 of spacer 3028.
A shape of middle portion 3040 of stop 3030 may be elliptical, circular, rectangular, or any shape suitable to allow contact of handle 3026 with the middle portion. Inner regions of bottom portion 3038, middle portion 3040, and upper portion 3042 are aligned to allow passage of second elongated member 3024 through first elongated member 3022.
Handle 3026 includes opening 3064, tie grooves 3066 and gripping grooves 3068. Opening 3064 aligns with the cavity of second elongated member 3024. Opening 3064 has a diameter sufficient to allow sutures to pass through the opening and into the cavity of second elongated member 3024. Tie grooves 3066 may be used to inhibit sutures from becoming entangled. Gripping grooves 3068 may assist in gripping of handle 3026 during use. In some embodiments, handle 3026 does not include tie grooves 3066 or gripping grooves 3068.
Handle 3026, spacer 3028, and stop 3030 may be manufactured from materials different from the materials used to manufacture first and second elongated members. Handle 3026, spacer 3028, and stop 3030 may be made from polymers suitable for surgical use. For example, polyetherimides such as ULTEM® available from GE Plastics (Pittsfield, Mass.) may be used to make handle 3026, spacer 3028, and/or stop 3030. Handle 3026, spacer 3028, and stop 3030 may be manufactured using known polymer molding techniques (e.g., injection molding and/or dyes).
Tack anchor 3000 may be coupled to tack anchor tool 3020 prior to use. For example, second elongated member 3024 may be inserted into first elongated member 3022. Suture 3018 may be inserted into second elongated member 3024, threaded through the second elongated member, and exit through opening 3064 of handle 3026. Alternatively, suture 3018 may be folded and pushed through opening 3064 and through second elongated member 3024 until the folded suture exits the distal end of the second elongated member. After threading suture 3018 through second elongated member 3024, the suture may be inserted into cavity 3010 of tack anchor 3000 (see
In some embodiments, suture 3018 is threaded through first elongated member 3022 and coupled to tack 3000 as shown in
Tack anchor 3000 may be removed from first elongated member 3022 by removing spacer 3028 and applying force to handle 3026. Application of force to handle 3026 drives the handle towards middle section 3040 of stop 3030. Contact of handle 3026 with middle section 3040 allows second elongated member 3024 to contact tack anchor 3000. Contact of second elongated member 3024 with tack anchor 3000 removes the tack anchor from the end of first elongated member 3022 and forces the tack anchor into tissue and/or bone. Once tack anchor 3000 is removed from first elongated member 3022, flanges 3006 open outward to their original (memorized) shape.
In some embodiments, one or more tack anchors sutures, and tack anchor tools may be sold as a kit. The kit may, in some embodiments, include one or more bone anchors, bone screws, a suture passer, or combinations thereof.
In some embodiments, tissue may be connected to bone using one or more tack anchors in combination with one or more bone anchors described herein. Tissue may be pulled onto a landing area of bone and a first tack anchor loaded with sutures may be inserted into tissue and/or bone using a tack anchor tool. A second tack anchor preloaded with sutures may be inserted into the tissue and/or bone proximate to the first tack anchor. A first bone anchor may be inserted through the tissue and into the bone. The first bone anchor may be positioned about 15 mm to about 30 mm or from about 20 mm to about 25 mm from the first tack anchor. A second bone anchor may be inserted through the tissue/bone and positioned about 15 mm to about 30 mm or from about 20 mm to about 25 mm from the second tack anchor. In some embodiments, a hole may be drilled into the bone and a threaded bone anchor may be inserted into the bone.
The sutures from a first tack anchor may be threaded and secured (cinched) through a two bar locking assembly of the second bone anchor using the techniques previously described herein. Sutures from the second tack anchor may be threaded and secured through a two bar locking assembly of the first bone anchor using techniques previously described herein. The procedure may be repeated until all the sutures are secured to the bone anchors. As the suture is threaded and secured (cinched) to the bone anchor, the tissue is pulled down while the bone is pushed up, thus enhanced contact of the tissue with bone is achieved.
In some embodiments, a bone anchor may include a threaded exterior. A threaded exterior may screw into surrounding bone to secure the bone anchor to the bone. Bone may include soft and/or hard portions.
Threads may include a raised helical or spiral rib or raised portion encircling at least a portion of a bone anchor. In some embodiments, threads may spiral in a helical fashion as one continuous thread around an outside surface of at least a portion of a bone anchor. In some embodiments, threads around an outside surface of a bone anchor may include two or more disconnected threads. The threads may turn in a helical configuration around the surface in a similar manner as threads on a screw.
Threads may be formed as part of the surface of the bone anchor. In some embodiments, threads may be coupled to the surface of a bone anchor allowing the threads to be formed from a different material than the bone anchor body material.
Threads may allow a bone anchor to be screwed into bone tissue. In some embodiments, a hole may be formed in bone during formation of the hole and the hole may be threaded such that the threads conform to the threading of a threaded bone anchor. In some embodiments, a hole may be formed in bone after formation of the hole, and the hole may be threaded such that the threads conform to the threading of a threaded bone anchor.
In some embodiments, a bone anchor may be embedded into soft bone or soft tissue. Thus, it may not be necessary to thread a bone hole before inserting a threaded bone anchor. A preformed bone hole may not require pre-threading thereby reducing the number of steps required to implant a bone anchor. In softer bone or tissue, after forming a bone hole, a threaded bone anchor may be positioned in the hole by screwing it into the bone hole.
An unthreaded bone hole may have a diameter which is less than the outer diameter of the threads of a threaded bone anchor. An unthreaded bone hole may have a diameter which is less than the outer diameter of the threads of a threaded bone anchor and the unthreaded bone hole may have a diameter which is at least equal to or greater than the body of the threaded bone anchor. A threaded bone anchor may form a tighter fit in an unthreaded hole than a bone anchor with concentric circular flanges or ridges. The screwing action of a threaded anchor may allow a tighter fit in an opening in bone relative to a bone anchor with concentric circular ridges.
Threads may be formed of a relatively flexible material (e.g., nitinol) allowing the threads to flex and screw into a bone hole, for example, a bone hole which has a smaller diameter than the outer edges of the threading.
In some embodiments, threaded anchor 4000 may include locking elements 4012. The locking elements are depicted as locking rings 4012a and 4012b. Locking rings 4012a and 4012b may function in much the same fashion as described herein to secure an elongated member (e.g., a suture). A securing element may be employed to secure the locking elements within the inner member once the locking elements are positioned within the opening in the inner member of bone anchor 4000. A securing element may include pin 4014.
In some embodiments, an outer threaded member may be inserted into a opening (e.g., hole) in a bone before an inner member is positioned within the outer threaded member. Inserting the outer member first, may inhibit sutures secured to the inner member from becoming entangled as the threaded bone anchor is screwed into the bone opening. Once the outer threaded member is screwed into a bone opening the inner member may be positioned within the outer threaded member.
In some embodiments, threaded bone anchor 4000 may be preassembled before insertion into a hole or opening formed into a bone or tissue. Sutures may be secured in the locking elements after the threaded bone anchor has been positioned in the hole.
In some embodiments, a threaded bone anchor may be assembled before screwing into a bone hole formed in bone or tissue. Sutures may be secured in the locking elements before the bone anchor is screwed into a hole in a bone. The inner member may be turned in a direction opposite of which the bone anchor was originally screwed in without moving the outer threaded member, enabling secured sutures to be unwound.
In some embodiments, a threaded bone anchor may be formed from a single member. The threaded bone anchor may include an opening. Locking elements may be positioned within the opening. The locking elements may be similar to those depicted in
A single member threaded bone anchor may be positioned in a hole formed in a bone and/or tissue. To inhibit sutures from being wound around one another while screwing in the threaded bone anchor, the sutures may be pre-wound in a direction opposite to that which the bone anchor will be screwed in. Pre-winding the sutures in such a manner may allow the sutures to unwind upon screwing the threaded bone anchor into the bone opening.
In this patent, certain U.S. patents have been incorporated by reference. The text of such U.S. patents is, however, only incorporated by reference to the extent that no conflict exists between such text and the other statements and drawings set forth herein. In the event of such conflict, then any such conflicting text in such incorporated by reference U.S. patents is specifically not incorporated by reference in this patent.
Further modifications and alternative embodiments of various aspects of the invention may be apparent to those skilled in the art in view of this description. Accordingly, this description is to be construed as illustrative only and is for the purpose of teaching those skilled in the art the general manner of carrying out the invention. It is to be understood that the forms of the invention shown and described herein are to be taken as the presently preferred embodiments. Elements and materials may be substituted for those illustrated and described herein, parts and processes may be reversed, and certain features of the invention may be utilized independently, all as would be apparent to one skilled in the art after having the benefit of this description to the invention. Changes may be made in the elements described herein without departing from the spirit and scope of the invention as described in the following claims. In addition, it is to be understood that features described herein independently may, in certain embodiments, be combined.
Claims
1-27. (canceled)
28. A method of inserting one or more anchors into a bone, comprising:
- coupling a portion of a suture to the anchor, wherein the anchor comprises one or more compressible flanges;
- coupling the anchor to an anchor tool; and
- positioning a distal end of the anchor on the bone; and
- applying force to a handle of the tack anchor tool such that the distal end of the anchor is inserted into the bone and the flanges of the anchor open outward;
- removing the anchor tool by sliding the anchor tool in a proximal direction along the longitudinal axis of the sutures.
29. The method of claim 28, wherein the anchor tool further comprises a stop and a spacer, and the method further comprises positioning the spacer between the stop and the handle to inhibit a second elongated member of the anchor tool from displacing the anchor from a first elongated member of the anchor tool.
30. The method of claim 29, wherein applying force to the handle comprises forcing the handle to contact the stop.
31. The method of claim 28, further comprising inserting at least 2 anchors into the bone.
32. The method of claim 28, further comprising inserting at least 3 anchors into the bone.
33. The method of claim 28, further comprising positioning at least 2 anchors near or proximate one or more other of the tack anchors.
34. The method of claim 28, further comprising drilling a hole into the bone and threading the anchor into the bone.
35. A method of connecting tissue to bone, comprising:
- pulling tissue onto an area of bone;
- inserting a first anchor through the tissue and into the bone,
- wherein the first anchor comprise one or more compressible flanges and one or more sutures, and wherein, upon insertion, at least one of the flanges of the first anchor opens outward;
- inserting a second anchor into the bone such that the second anchor is positioned proximate to the first anchor,
- wherein the second anchor comprises a two bar locking assembly at least partially disposed in a cavity of the bone anchor main body, and wherein the two bar locking assembly comprises at least two interacting locking elements; and
- securing at least one of the sutures of the first tack anchor to the two bar locking assembly of the second bone anchor.
36-67. (canceled)
68. A method for coupling tissue to bone, the method comprising:
- providing an anchor comprising a cavity, a first locking element having a first opening, a second locking element having a second opening, and a securing element spanning the cavity and passing through each of the two locking elements, wherein the first and second locking elements are movable with respect to the cavity; and
- threading a suture along a suture path through the first opening in the first locking element in a direction toward the second locking element, through a gap between the first locking element and the second locking element, around the second locking element, through the second opening in the second locking element, and back through the first opening in the first locking element.
69. The method of claim 68, further comprising positioning the first and second locking elements with respect to each other such that the suture is moveable along the suture path in a first direction and inhibited from moving in a second direction.
70. The method of claim 68, further comprising moving the first and second locking elements in an axial direction with respect to each other such that movement of the suture in one direction is inhibited.
71. The method of claim 68, further comprising inhibiting the anchor from moving out of a bone with one or more compressible flanges.
72. The method of claim 68, wherein the first locking element comprises a first locking ring, and wherein the second locking element comprises a second locking ring.
73. The method of claim 68, further comprising moving at least one of the first and second locking elements in an axial direction with respect to another of the first and second locking elements to allow or inhibit movement of the suture.
74. The method of claim 68, further comprising inserting the anchor into a bone.
75. The method of claim 74, further comprising drilling a hole into the bone prior to inserting the anchor into the bone.
76. The method of claim 68, further comprising reversibly coupling an inserter to the anchor and positioning the anchor in a bone using the inserter.
77. The method of claim 68, wherein the anchor comprises a first anchor component comprising a first body and an opening formed within the first body; a second anchor component comprising a second body, further comprising compressing and advancing the second body of the second anchor component into the opening formed within the first body of the first anchor component.
78. The method of claim 77, further comprising deploying the first anchor component in bone and advancing the second body of the second anchor component into the opening formed within the first body of the first anchor component.
79. The method of claim 77, further comprising securing the second body to the first body when a second stop surface of the second body engages a first stop surface of the first body.
Type: Application
Filed: Jun 3, 2014
Publication Date: Sep 25, 2014
Applicant: TORNIER, INC. (Bloomington, MN)
Inventors: Gary S. Fanton (Portola Valley, CA), John Krumme (Woodside, CA)
Application Number: 14/295,105
International Classification: A61B 17/04 (20060101);
