TRANSOSSEOUS GUIDE
Instruments and methods for surgical transosseous attachment to a bone include a guide able to guide the formation of intersecting bone tunnels and a passer able to pass a member through the bone tunnels.
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This application is a continuation of U.S. Patent application Ser. No. 15/211,764 filed on Jul. 15, 2016, entitled “Transosseous Guide”, which claims the benefit of U.S. Provisional Application No. 62/193,888, filed Jul. 17, 2015, which are hereby incorporated by reference in their entirety.
FIELD OF THE INVENTIONThe invention relates to transosseous guides and methods for transosseous attachments.
BACKGROUNDA variety of surgical procedures require the attachment of something relative to a surgical site. For example, in surgery relating to the skeletal system, it is often advantageous to attach soft tissue, suture, implants, and/or other items in or adjacent to a joint. For example, soft tissues such as ligaments, tendons, fascia, other capsular material, and/or muscle may be attached to an adjacent bone. Such soft tissues may be adjacent to bones at skeletal joints including but not limited to the joints of the hands and feet, ankle, wrist, knee, elbow, hip, shoulder, and spine. For example, it is often advantageous to pass a suture through a portion of a bone to form a transosseous attachment to the bone.
SUMMARYExamples of the invention provide instruments and methods for surgical transosseous attachment to a bone.
In one example of the invention, a method for placing a member transosseously through first and second transverse, intersecting bone tunnels includes inserting a first tunnel member into a bone along a first insertion axis, the first tunnel member having a proximal end and a distal end, the first tunnel member having a first longitudinal passage at least partway through the first tunnel member; inserting a second tunnel member into the bone along a second insertion axis, the second insertion axis intersecting the first insertion axis, the second tunnel member having a proximal end and a distal end, the second tunnel member having a second longitudinal passage at least partway through the second tunnel member; inserting a passer through the first and second tunnel members, the passer simultaneously extending through the first and second axial passages and out of the proximal end of the first tunnel member and out of the proximal end of the second tunnel member.
In another example of the invention a method for placing suture transosseously through first, second, and third transverse, intersecting bone tunnels includes forming a first bone tunnel in a bone with a first tunnel member; forming a second bone tunnel transverse to and intersecting the first bone tunnel with a second tunnel member; placing a first portion of suture through the first and second bone tunnels and at least partway through the first tunnel member; forming a third bone tunnel transverse to and intersecting the first bone tunnel with the second tunnel member while the first flexible element is present in the first tunnel member; placing a second portion of suture through the first and third tunnels and at least partway through the first tunnel member while the first flexible element is present in the first tunnel member.
In another example of the invention, a method for placing a member transosseously through first and second transverse, intersecting bone tunnels includes inserting a first tunnel member into a bone along a first insertion axis, the first tunnel member having a proximal end and a distal end, the first tunnel member having a first longitudinal passage at least partway through the first tunnel member; using a guide to select a second insertion axis from a plurality of insertion axes that each intersect the first insertion axis, each of the plurality of insertion axes forming a different angle relative to the first insertion axis; inserting a second tunnel member into the bone along the selected second insertion axis, the second tunnel member having a proximal end and a distal end, the second tunnel member having a second longitudinal passage at least partway through the second tunnel member; inserting a passer through the first and second tunnel members, the passer simultaneously extending through the first and second axial passages and out of the proximal end of the first tunnel member and out of the proximal end of the second tunnel member.
Various examples of the present invention will be discussed with reference to the appended drawings. These drawings depict only illustrative examples of the invention and are not to be considered limiting of its scope.
The following illustrative examples depict instruments and methods to form a tunnel through a bone and pass a member through the bone tunnel. The illustrative examples depict passing a round suture through a bone tunnel to attach soft tissue to the bone. However, the instruments and methods of the invention may be used to pass other elements through a bone tunnel including, suture passers, suture tapes, cables, soft tissues, grafts, and other elements. Examples of instruments and methods of the invention may be used to pass any member through any bone, at surgical sites anywhere in a patient's body, and for any purpose. The terms “suture” and “suture strand” are used herein to mean any strand or flexible member, natural or synthetic, able to be passed through a bone tunnel and useful in a surgical procedure. The term “transverse” is used herein to mean to cross at an angle; i.e. not parallel. The term includes, but is not limited to right angles.
A first tunnel member 110 is engageable with the guide body 102 coaxial with the first guide axis 104 and includes a proximal end 112, a distal end 114, and a first longitudinal passage 116 (
A second tunnel member 120 is engageable with the guide body 102 coaxial with the second guide axis 106 and includes a proximal end 122, a distal end 124, and a second longitudinal passage 126 (
A passer 136 (
In the illustrative embodiment of
The first tunnel member may include a drill guide, a punch guide, a punch, or other suitable member for forming a bone tunnel and/or for inserting into a bone tunnel. In the illustrative example of
The second tunnel member may include a drill guide, a punch guide, a punch, or other suitable member for forming a bone tunnel and/or inserting into a bone tunnel. In the illustrative example of
The relief opening 148 in the first tunnel member allows bone chips or other debris to exit the first tunnel member 110 when the second tunnel member 120 engages it. In the illustrative example of
The length of the first and second tunnel members 110, 120 that extends from the guide body to their intersection location may be any desired length. However, it has been found by the inventors that for rotator cuff repair surgery on a human shoulder, a length of each member in the range of 2-8 inches is useful. More preferably the length is in the range of 4-6 inches. The length for each member may be the same or different. In the example of
The passer 136 includes a first, or proximal, end 180 and a second, or distal, end 182 defining a loop 188. In the illustrative example of
In the example of
For other applications such as for example for attaching soft tissue to a bone adjacent a knee joint, ankle or other location different spacing and angular range may be desirable. Similarly, the length of the first and second tunnel member may be varied. For example, for repairing a torn Achilles tendon, a guide having an angular range of 50 to 80 degrees has been found suitable with either a sliding adjustable guide like that of
The exemplary guides and methods of the invention make it possible to form intersecting bone tunnels in a bone and extend, in one motion, a passer through the guide and bone tunnels from a first position external to the bone to a second position external to the bone. A first end of a member, such as a suture, may then be engaged with the passer outside of the bone tunnels. By having the engaging step outside of the bone tunnels, it may be done with simple manual manipulation of the passer loop and the first end of the member with easy access and visibility and without specialized arthroscopic instrument or procedures. The first end of the member may then be passed, in one motion, through the guide and bone tunnels from the second position external to the bone to a first position external to the bone to thread the member through the intersecting bone tunnels. The member may be used in any desirable manner. For example, a member in the form of a suture 194 may be so passed and then used to secure soft tissue 196 to the bone 198 as shown in
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While the illustrative examples have shown bone tunnels being formed by punching instruments into the bone, it is also within the scope of the invention to form bone tunnels by drilling, reaming, broaching, and/or any suitable tunnel forming process. It is contemplated, and within the scope of the invention, that the various features of the illustrative examples may be interchanged among the illustrative examples.
The following are further examples of the invention
- 1. An instrument for placing a member transosseously through first and second transverse, intersecting bone tunnels, the instrument comprising:
- a guide body defining a first guide axis and a second guide axis, the first guide axis and the second guide axis intersecting at a location spaced from the guide body;
- a first tunnel member engaged with the guide body coaxial with the first guide axis, the first tunnel member having a proximal end and a distal end, the first tunnel member having a first longitudinal passage at least partway through the first tunnel member;
- a second tunnel member engaged with the guide body coaxial with the second guide axis, the second tunnel member having a proximal end and a distal end, the second tunnel member having a second longitudinal passage at least partway through the second tunnel member; and
- a passer operable to extend from the proximal end of the second tunnel member, through the distal end of the second tunnel member, through the distal end of the first tunnel member, and to the proximal end of the first tunnel member in one continuous path.
- 2. The instrument of example 1 wherein the first and second guide axes define a guide angle between them, the guide angle being adjustable.
- 3. The instrument of example 1 wherein the guide body includes a first arc member and a second arc member, the first arc member and the second arc member being joined in sliding relationship along an arc shaped path of constant radius, the guide body being adjustable between a first position in which the first guide axis and the second guide axis define a first angle between them and a second position in which the first guide axis and the second guide axis define a second angle between them, the second angle being greater than the first angle.
- 4. The instrument of example 3 wherein the first guide axis is defined by a passage in the first arc member and the second guide axis is defined by a passage in the second arc member.
- 5. The instrument of example 3 wherein the first angle and the second angle are in the range of 20 to 110 degrees.
- 6. The instrument of example 5 wherein the first angle and the second angle are in the range of 60 to 90 degrees.
- 7. The instrument of example 1 further comprising third and fourth guide axes, the second, third, and fourth guide axes intersecting the first guide axis at the same location on the first guide axis.
- 8. The instrument of example 1 wherein the first tunnel member is fixed to the guide body.
- 9. The instrument of example 1 wherein the first tunnel member comprises a drill guide.
- 10. The instrument of example 1 wherein the first tunnel member comprises a bone punch.
- 11. The instrument of example 10 wherein the first tunnel member includes a first side wall and a first side opening in the first side wall nearer the distal end than the proximal end, the first longitudinal passage extending from the proximal end of the first tunnel member toward the distal end of the first tunnel member and communicating with the first side opening.
- 12. The instrument of example 11 wherein the second guide axis passes through the first side opening.
- 13. The instrument of example 11 wherein the first tunnel member includes a relief opening through the side wall opposite the first side opening and communicating with the first longitudinal passage and first side opening.
- 14. The instrument of example 11 wherein the first tunnel member includes indicia on an outer surface and operable to align with a bone surface to indicate a depth of penetration of the first tunnel member into a bone corresponding to a predetermined tunnel depth.
- 15. The instrument of example 1 wherein the second tunnel member is separate from the guide body and the second tunnel member engages the guide body in axial sliding relationship along the second guide axis.
- 16. The instrument of example 1 wherein the second tunnel member comprises a drill guide.
- 17. The instrument of example 1 wherein the second tunnel member comprises a bone punch.
- 18. The instrument of example 17 wherein the second tunnel member includes a second side wall and a second side opening in the second side wall nearer the distal end than the proximal end, the second longitudinal passage extending from the proximal end of the second tunnel member toward the distal end of the second tunnel member and communicating with the second side opening.
- 19. The instrument of example 18 wherein the first tunnel member includes a first side wall and a first side opening in the first side wall nearer the distal end than the proximal end, the first longitudinal passage extending from the proximal end of the first tunnel member toward the distal end of the first tunnel member and communicating with the first side opening, the first tunnel member and second tunnel member being engageable at their distal ends so that the first side opening and second side opening are in communication with one another.
- 20. The instrument of example 19 wherein the distal end of the second tunnel member is operable to insert into the first side opening with the second side opening in communication with the first side opening.
- 21. The instrument of example 20 further comprising an angled surface at the distal end of the second longitudinal passage, the angled surface facing the second side opening, the angled surface operable to deflect the passer through the second side opening.
- 22. The instrument of example 1 wherein the passer comprises a first end and a second end, the passer defining a loop at its second end.
- 23. The instrument of example 1 wherein the passer is formed of a super elastic material.
- 24. The instrument of example 1 wherein the passer has a length greater than the combined length of the first and second longitudinal passages.
- 25. The instrument of example 22 wherein the loop is bent.
- 26. The instrument of example 22 wherein the passer comprises a shaft and a wire extending from the shaft, the shaft extending away from the first end, the shaft having a shaft length, the shaft being relatively rigid compared to the wire, the wire being attached to an end of the shaft and extending away from the shaft to the second end where the wire defines the loop, the wire extending from the rigid shaft a wire length, the wire being relatively flexible compared to the shaft.
- 27. The instrument of example 26 wherein the passer further comprises an outer tube engaged with the shaft in axial sliding relationship and moveable relative to the shaft from a first position in which the outer tube encloses a portion of the wire length and a second position in which the outer tube encloses less of the wire length.
- 28. An instrument for placing a member transosseously through first and second transverse, intersecting bone tunnels in a bone, the instrument comprising:
- a guide body defining a first guide axis and a second guide axis, the first guide axis and the second guide axis intersecting at a location spaced from the guide body;
- a first tunnel member engageable with the guide body coaxial with the first guide axis, the first tunnel member having an outer surface, a proximal end, a distal end, and a first longitudinal passage at least partway through the first tunnel member, the first tunnel member outer surface having a recess formed therein and communicating with the first longitudinal passage;
- a second tunnel member engaged with the guide body coaxial with the second guide axis, the second tunnel member having an outer surface, a proximal end, a distal end, and a second longitudinal passage at least partway through the second tunnel member, the second tunnel member outer surface having an opening formed therein and communicating with the second longitudinal passage, the recess of the first tunnel member being operable to receive the distal end of the second tunnel member with the opening communicating with the recess, wherein the first longitudinal passage, recess, opening, and second longitudinal passage form a continuous passage from the proximal end of the first tunnel member to the proximal end of the second tunnel member.
- 29. The instrument of example 28 wherein the recess is transverse to the first longitudinal axis and the opening is transverse to the second longitudinal axis.
- 30. The instrument of example 28 further comprising a passer having an elongate flexible portion operable to simultaneously extend through both the first and second longitudinal passages while the second tunnel member is received in the recess of the first tunnel.
- 31. The instrument of example 28 wherein the guide body includes a first arc member and a second arc member, the first arc member and the second arc member being joined in sliding relationship along an arc shaped path of constant radius, the guide body being adjustable between a first position in which the first guide axis and the second guide axis define a first angle between them and a second position in which the first guide axis and the second guide axis define a second angle between them, the second angle being greater than the first angle.
- 32. The instrument of example 31 wherein the first guide axis is defined by a passage in the first arc member and the second guide axis is defined by a passage in the second arc member.
- 33. The instrument of example 31 wherein the first angle and the second angle are in the range of 20 to 110 degrees.
- 34. The instrument of example 31 wherein the first angle and the second angle are in the range of 60 to 90 degrees.
- 35. The instrument of example 28 wherein the first tunnel member is fixed to the guide body.
- 36. The instrument of example 28 wherein the first tunnel member comprises a drill guide.
- 37. The instrument of example 28 wherein the first tunnel member comprises a bone punch.
- 38. The instrument of example 28 wherein the first tunnel member includes a relief opening through the side wall opposite the recess and communicating with the first longitudinal passage and recess.
- 39. The instrument of example 28 wherein the first tunnel member includes indicia on an outer surface and readable relative to a bone surface to indicate a depth of penetration of the first tunnel member into a bone corresponding to a predetermined tunnel depth.
- 40. The instrument of example 28 wherein the second tunnel member is separate from the guide body.
- 41. The instrument of example 40 wherein the second tunnel member engages the guide body in axial sliding relationship along the second guide axis.
- 42. The instrument of example 28 wherein the second tunnel member comprises a drill guide.
- 43. The instrument of example 28 wherein the second tunnel member comprises a bone punch.
- 44. The instrument of example 28 further comprising an angled surface at the distal end of the second longitudinal passage, the angled surface facing the opening, the angled surface operable to deflect the passer through the opening.
- 45. The instrument of example 28 wherein the passer comprises a first end and a second end, the passer defining a loop at its second end.
- 46. The instrument of example 45 wherein the passer is formed of a super elastic material.
- 47. The instrument of example 28 wherein the passer has a length greater than the combined length of the first and second longitudinal passages.
- 48. The instrument of example 45 wherein the loop is bent.
- 49. The instrument of example 28 wherein the passer comprises a relatively rigid shaft extending away from the first end, a relatively flexible wire attached to the shaft and extending away from the shaft to the second end.
- 50. An instrument for placing a member transosseously through first and second transverse, intersecting bone tunnels, the instrument comprising:
- a guide body defining a first guide axis, a second guide axis, and a third guide axis, the second and third guide axes intersecting the first guide axis at a location spaced from the guide body, the second and third guide axes intersecting the first guide axis at the same location;
- a first tunnel member engaged with the guide body coaxial with the first guide axis, the first tunnel member having a proximal end and a distal end, the first tunnel member having a first longitudinal passage at least partway through the first tunnel member, the first tunnel member including a first side wall and a first side opening in the first side wall nearer the distal end than the proximal end, the first longitudinal passage extending from the proximal end of the first tunnel member toward the distal end of the first tunnel member and communicating with the first side opening;
- a second tunnel member engaged with the guide body coaxial with the second guide axis, the second tunnel member having a proximal end and a distal end, the second tunnel member having a second longitudinal passage at least partway through the second tunnel member, the second tunnel member including a second side wall and a second side opening in the second side wall nearer the distal end than the proximal end, the second longitudinal passage extending from the proximal end of the second tunnel member toward the distal end of the second tunnel member and communicating with the second side opening, the first tunnel member and second tunnel member being engageable at their distal ends so that the first side opening and second side opening are in communication with one another; and
- a passer operable to extend from the proximal end of the second tunnel member, through the second side opening, through the first side opening, and to the proximal end of the first tunnel member in one continuous path.
- 51. The instrument of example 50 wherein the distal end of the second tunnel member is operable to insert into the first side opening with the second side opening in communication with the first side opening.
- 52. The instrument of example 50 further comprising an angled surface at the distal end of the second longitudinal passage, the angled surface facing the second side opening, the angled surface operable to deflect the passer through the second side opening.
Claims
1. An instrument for placing a member transosseously through first and second transverse, intersecting bone tunnels, the instrument comprising:
- a guide body defining a first guide axis and a second guide axis, the first guide axis and the second guide axis intersecting at a location spaced from the guide body;
- a first tunnel member engaged with the guide body coaxial with the first guide axis, the first tunnel member having a proximal end and a distal end, the first tunnel member having a first longitudinal passage at least partway through the first tunnel member;
- a second tunnel member engaged with the guide body coaxial with the second guide axis, the second tunnel member having a proximal end and a distal end, the second tunnel member having a second longitudinal passage at least partway through the second tunnel member; and
- a passer operable to extend from the proximal end of the second tunnel member, through the distal end of the second tunnel member, through the distal end of the first tunnel member, and to the proximal end of the first tunnel member in one continuous path.
2. The instrument of claim 1, wherein the first and second guide axes define a guide angle between them, the guide angle being adjustable.
3. The instrument of claim 1, wherein the first tunnel member is fixed to the guide body.
4. The instrument of claim 1, wherein the first tunnel member comprises a drill guide.
5. The instrument of claim 1, wherein:
- the first tunnel member comprises a bone punch; and
- the first tunnel member comprises a first side wall and a first side opening in the first side wall nearer the distal end than the proximal end, the first longitudinal passage extending from the proximal end of the first tunnel member toward the distal end of the first tunnel member and communicating with the first side opening.
6. The instrument of claim 5, wherein at least one of the following is true:
- the second guide axis passes through the first side opening;
- the first tunnel member comprises a relief opening through the side wall opposite the first side opening and communicating with the first longitudinal passage and first side opening; and
- the first tunnel member comprises indicia on an outer surface and operable to align with a bone surface to indicate a depth of penetration of the first tunnel member into a bone corresponding to a predetermined tunnel depth.
7. The instrument of claim 1, wherein the second tunnel member is separate from the guide body and the second tunnel member engages the guide body in axial sliding relationship along the second guide axis.
8. The instrument of claim 1, wherein:
- the second tunnel member comprises a bone punch; and
- the second tunnel member comprises a second side wall and a second side opening in the second side wall nearer the distal end than the proximal end, the second longitudinal passage extending from the proximal end of the second tunnel member toward the distal end of the second tunnel member and communicating with the second side opening.
9. The instrument of claim 8, wherein the first tunnel member comprises a first side wall and a first side opening in the first side wall nearer the distal end than the proximal end, the first longitudinal passage extending from the proximal end of the first tunnel member toward the distal end of the first tunnel member and communicating with the first side opening, the first tunnel member and second tunnel member being engageable at their distal ends so that the first side opening and second side opening are in communication with one another.
10. The instrument of claim 9, wherein the distal end of the second tunnel member is operable to insert into the first side opening with the second side opening in communication with the first side opening.
11. The instrument of claim 10, further comprising an angled surface at the distal end of the second longitudinal passage, the angled surface facing the second side opening, the angled surface operable to deflect the passer through the second side opening.
12. The instrument of claim 1, wherein the passer has a length greater than the combined length of the first and second longitudinal passages.
13. The instrument of claim 1, wherein the passer comprises a first end and a second end, the passer defining a bent loop at the second end.
14. The instrument of claim 13, wherein the passer further comprises:
- a shaft;
- a wire extending from the shaft; and
- an outer tube;
- wherein: the shaft extends away from the first end; the shaft has a shaft length; the shaft is relatively rigid compared to the wire; the wire is attached to an end of the shaft and extends away from the shaft to the second end at which the wire defines the bent loop; the wire extends from the rigid shaft a wire length; the wire is relatively flexible compared to the shaft; and the outer tube is engaged with the shaft in axial sliding relationship and is moveable relative to the shaft from a first position in which the outer tube encloses a portion of the wire length and a second position in which the outer tube encloses less of the wire length.
15. An instrument for placing a member transosseously through first and second transverse, intersecting bone tunnels in a bone, the instrument comprising:
- a guide body defining a first guide axis and a second guide axis, the first guide axis and the second guide axis intersecting at a location spaced from the guide body;
- a first tunnel member engageable with the guide body coaxial with the first guide axis, the first tunnel member having an outer surface, a proximal end, a distal end, and a first longitudinal passage at least partway through the first tunnel member, the first tunnel member outer surface having a recess formed therein and communicating with the first longitudinal passage;
- a second tunnel member engaged with the guide body coaxial with the second guide axis, the second tunnel member having an outer surface, a proximal end, a distal end, and a second longitudinal passage at least partway through the second tunnel member, the second tunnel member outer surface having an opening formed therein and communicating with the second longitudinal passage, the recess of the first tunnel member being operable to receive the distal end of the second tunnel member with the opening communicating with the recess, wherein the first longitudinal passage, recess, opening, and second longitudinal passage form a continuous passage from the proximal end of the first tunnel member to the proximal end of the second tunnel member.
16. The instrument of claim 23 wherein the recess is transverse to the first longitudinal axis and the opening is transverse to the second longitudinal axis.
17. The instrument of claim 23 further comprising a passer having an elongate flexible portion operable to simultaneously extend through both the first and second longitudinal passages while the second tunnel member is received in the recess of the first tunnel.
18. An instrument for placing a member transosseously through first and second transverse, intersecting bone tunnels, the instrument comprising:
- a guide body defining a first guide axis, a second guide axis, and a third guide axis, the second and third guide axes intersecting the first guide axis at a location spaced from the guide body, the second and third guide axes intersecting the first guide axis at the same location;
- a first tunnel member engaged with the guide body coaxial with the first guide axis, the first tunnel member having a proximal end and a distal end, the first tunnel member having a first longitudinal passage at least partway through the first tunnel member, the first tunnel member including a first side wall and a first side opening in the first side wall nearer the distal end than the proximal end, the first longitudinal passage extending from the proximal end of the first tunnel member toward the distal end of the first tunnel member and communicating with the first side opening;
- a second tunnel member selectively engageable with the guide body coaxial with one of the second and third guide axes, the second tunnel member having a proximal end and a distal end, the second tunnel member having a second longitudinal passage at least partway through the second tunnel member, the second tunnel member including a second side wall and a second side opening in the second side wall nearer the distal end than the proximal end, the second longitudinal passage extending from the proximal end of the second tunnel member toward the distal end of the second tunnel member and communicating with the second side opening, the first tunnel member and second tunnel member being engageable at their distal ends so that the first side opening and second side opening are in communication with one another; and
- a passer operable to extend from the proximal end of the second tunnel member, through the second side opening, through the first side opening, and to the proximal end of the first tunnel member in one continuous path.
19. The instrument of claim 26 wherein the distal end of the second tunnel member is operable to insert into the first side opening with the second side opening in communication with the first side opening.
20. The instrument of claim 27 further comprising an angled surface at the distal end of the second longitudinal passage, the angled surface facing the second side opening, the angled surface operable to deflect the passer through the second side opening.
Type: Application
Filed: Mar 15, 2019
Publication Date: Jul 11, 2019
Applicant: KATOR, LLC (Logan, UT)
Inventors: T. Wade Fallin (Hyde Park, UT), Joel Helgerson (Erie, CO)
Application Number: 16/355,631