Method and apparatus for coupling soft tissue to a bone

• US 10,092,288 B2
• Filed: 09/28/2016
• Issued: 10/09/2018
• Est. Priority Date: 02/03/2006
• Status: Active Grant

• Current Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Inventors: Denham, Gregory J., Stone, Kevin T.
• Primary Examiner(s): ORKIN, ALEXANDER J
• Application Number:
  US15/278,777
• Publication Number:
  US 20170014225A1
• Time in Patent Office: 741 Days
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 17/0642 for bones, e.g. for osteosynthesis or connecting tendon to bone
• CPC Class Codes: A61B 2017/00526 Methods of manufacturing
• CPC Class Codes: A61B 2017/00845 of moving parts with respect to each other
• CPC Class Codes: A61B 2017/00858 high friction or non-slip
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0406 Pledgets
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/042 plastically deformed during insertion
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• CPC Class Codes: A61B 2017/0445 cannulated, e.g. with a longitudinal through-hole for passage of an instrument
• CPC Class Codes: A61B 2017/0448 Additional elements on or within the anchor
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/0475 : using sutures having a slip knot
• CPC Class Codes: A61B 2017/0477 : with pre-tied sutures
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2017/0618 : elastic, e.g. stretchable
• CPC Class Codes: A61B 2017/06185 : hollow or tubular
• CPC Class Codes: A61F 2/08 : Muscles; Tendons; Ligaments sutures A61B17/04
• CPC Class Codes: A61F 2/0805 : Implements for inserting tendons or ligaments
• CPC Class Codes: A61F 2/0811 : Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2002/0823 : Modular anchors comprising a plurality of separate parts
• CPC Class Codes: A61F 2002/0852 : Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
• CPC Class Codes: A61F 2002/0858 : Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
• CPC Class Codes: A61F 2002/0864 : Fixation of tendon or ligament between anchor elements, e.g. by additional screws in the anchor, anchor crimped around tendon
• CPC Class Codes: A61F 2002/087 : Anchor integrated into tendons, e.g. bone blocks, integrated rings
• CPC Class Codes: A61F 2002/0882 : Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone
• CPC Class Codes: A61F 2002/0888 : Anchor in or on a blind hole or on the bone surface without formation of a tunnel
• CPC Class Codes: D04C 1/06 : Braid or lace serving particular purposes
• CPC Class Codes: D04C 1/12 : Cords, lines, or tows
• CPC Class Codes: D10B 2509/00 : Medical; Hygiene
• CPC Class Codes: D10B 2509/04 : Sutures

Abstract

A method and apparatus for coupling a soft tissue implant into a locking cavity formed within a bone is disclosed. The apparatus includes a member to pull the soft tissue implant into a femoral tunnel. The member includes a suture having first and second ends which are passed through first and second openings associated with the longitudinal passage to form a pair of loops. A collapsible tube is positioned about the suture. Application of tension onto the suture construction causes retraction of the soft tissue implant into the femoral tunnel and the collapse of the tube to form an anchor.

Claims

1. A method of coupling soft tissue to bone, comprising:

forming a bore in a bone;

coupling a soft tissue graft to a first adjustable loop and a second adjustable loop of an adjustable suture construct, the adjustable suture construct including a first suture with a first free end and a second free end, wherein the first free end of the first suture passes through a first longitudinal passage in the first suture to form the first adjustable loop, and wherein the second free end of the first suture passes through a second longitudinal passage in the first suture to form the second adjustable loop, the first longitudinal passage separate from the second longitudinal passage in the first suture;

positioning a fixation member coupled to the adjustable suture construct outside the bone proximate a first opening in an outer surface of the bone, the first opening in the outer surface of the bone providing access to the bore; and

tensioning the soft tissue graft with the adjustable suture construct.

2. The method of claim 1, wherein the bone is a femur, the bore is a femoral tunnel that extends through a portion of the femur from the first opening to a second opening in the outer surface of the femur, and the soft tissue graft is an ACL.

3. The method of claim 2, wherein said positioning the fixation member outside the femur proximate the first opening in the outer surface of the femur includes:

passing the fixation member through the second opening in the outer surface of the femur, through the femoral tunnel, and through the first opening in the outer surface of the femur in a first profile; and

thereafter converting the fixation member to a second profile for contacting bone around the first opening.

4. The method of claim 1, wherein, with the first free end passing through the first longitudinal passage in the first suture to form the first adjustable loop and with the second free end passing through the second longitudinal passage in the first suture to form the second adjustable loop, the first free end can be pulled through the first longitudinal passage to decrease a size of the first adjustable loop without decreasing a size of the second adjustable loop and the second free end can be pulled through the second longitudinal passage to decrease a size of the second adjustable loop without decreasing a size of the first adjustable loop.

5. The method of claim 1, wherein the first longitudinal passage and the second longitudinal passage are longitudinally spaced apart from one another along a length of the first suture.

6. The method of claim 1, wherein the first adjustable loop and the second adjustable loop are looped through one another.

7. The method of claim 1, wherein the adjustable suture construct passes through an aperture in the fixation member.

8. A method of coupling soft tissue to bone, comprising:

forming a bore in a bone;

coupling a soft tissue graft to a first adjustable loop and a second adjustable loop of an adjustable suture construct, the adjustable suture construct including a suture having a suture body, a first free end, and a second free end, the suture body defining a hollow passage in the suture body that is situated between the first free end and the second free end of the suture, the first free end of the suture passing through a first aperture in the suture body, along a first longitudinal portion of the hollow passage, and out a fourth aperture in the suture body to form the first adjustable loop, the second free end of the suture passing through a second aperture in the suture body, along a second longitudinal portion of the hollow passage, and out a third aperture in the suture body to form the second adjustable loop, wherein the first aperture, the second aperture, the third aperture, and the fourth aperture are all separate apertures in the suture body, and wherein the first longitudinal portion of the hollow passage is longitudinally spaced apart from the second longitudinal portion of the hollow passage along the suture body;

positioning a fixation member coupled to the adjustable suture construct outside the bone proximate a first opening in an outer surface of the bone, the first opening in the outer surface of the bone providing access to the bore; and

tensioning the soft tissue graft with the adjustable suture construct.

9. The method of claim 8, wherein the bone is a femur, the bore is a femoral tunnel that extends through a portion of the femur from the first opening to a second opening in the outer surface of the femur, and the soft tissue graft is an ACL.

10. The method of claim 9, wherein said positioning the fixation member outside the femur proximate the first opening in the outer surface of the femur includes:

passing the fixation member through the second opening in the outer surface of the femur, through the femoral tunnel, and through the first opening in the outer surface of the femur in a first profile; and

thereafter converting the fixation member to a second profile for contacting bone around the first opening.

11. The method of claim 8, wherein said tensioning the soft tissue graft with the adjustable suture construct includes pulling on the first free end and the second free end of the suture.

12. The method of claim 8, wherein the first free end can be pulled through the first longitudinal portion of the hollow passage to decrease a size of the first adjustable loop without decreasing a size of the second adjustable loop and the second free end can be pulled through the second longitudinal portion of the hollow passage to decrease a size of the second adjustable loop without decreasing a size of the first adjustable loop.

13. The method of claim 8, wherein the hollow passage in the suture body maintains positioning relative to the fixation member during said tensioning the soft tissue graft.

14. The method of claim 8, wherein the adjustable suture construct passes through an aperture in the fixation member.

15. A method for placing an ACL in a femoral tunnel formed in a femur in a patient, the method comprising:

locating a fixation member outside the femur proximate a first opening in an outer surface of the femur, the first opening in the outer surface of the femur providing access to a femoral tunnel that extends through a portion of the femur to a second opening in the outer surface of the femur, wherein an adjustable suture construct coupled to the fixation member extends back through the femoral tunnel and includes a suture having a suture body, a first free end, and a second free end, the suture body defining a hollow passage in the suture body that is situated between the first free end and the second free end of the suture, the first free end of the suture passing through a first aperture in the suture body, along a first longitudinal portion of the hollow passage, and out a fourth aperture in the suture body to form a first adjustable loop, the second free end of the suture passing through a second aperture in the suture body, along a second longitudinal portion of the hollow passage, and out a third aperture in the suture body to form a second adjustable loop, wherein the first aperture, the second aperture, the third aperture, and the fourth aperture are all separate apertures in the suture body, and wherein the first longitudinal portion of the hollow passage is longitudinally spaced apart from the second longitudinal portion of the hollow passage along the suture body;

coupling a leading end of an ACL to the first adjustable loop and the second adjustable loop outside the femoral tunnel; and

tensioning the ACL with the adjustable suture construct so as to pull the leading end of the ACL in the femoral tunnel toward the first opening in the outer surface of the femur.

16. The method of claim 15, wherein the leading end of the ACL is provided by a folded portion of the ACL.

17. The method of claim 15, wherein the ACL is an artificial ACL.

18. The method of claim 15, wherein the first opening in the outer surface of the femur and a first longitudinal section of the femoral tunnel have a first diameter, and wherein the second opening in the outer surface of the femur and a second longitudinal section of the femoral tunnel have a second diameter that is larger than said first diameter.

19. The method of claim 15, wherein the first free end and the second free end of the suture construct pass through an aperture in the fixation member.

20. The method of claim 15, wherein said locating the fixation member outside the femur proximate the first opening in the outer surface of the femur includes:

passing the fixation member through the second opening in the outer surface of the femur, through the femoral tunnel, and through the first opening in the outer surface of the femur in a first profile; and

thereafter converting the fixation member to a second profile for contacting bone around the first opening.

21. The method of claim 15, wherein the first free end can be pulled through the first longitudinal portion of the hollow passage to decrease a size of the first adjustable loop without decreasing a size of the second adjustable loop and the second free end can be pulled through the second longitudinal portion of the hollow passage to decrease a size of the second adjustable loop without decreasing a size of the first adjustable loop.

22. The method of claim 21, wherein the hollow passage in the suture body maintains positioning relative to the fixation member during said pulling on the first free end and the second free end of the suture.