Method and apparatus for re-attaching the labrum to the acetabulum including the provision and use of a novel suture anchor system

• US 10,123,793 B2
• Filed: 11/09/2015
• Issued: 11/13/2018
• Est. Priority Date: 07/17/2009
• Status: Active Grant

• Current Assignee: Stryker Puerto Rico Holdings BV (Stryker Corporation)
• Original Assignee: Pivot Medical, Inc. (Stryker Corporation)
• Inventors: Pamichev, Chris, Burley, J. Brook, Nikolchev, Julian, Flom, James
• Primary Examiner(s): LYNCH, ROBERT A
• Application Number:
  US14/935,659
• Publication Number:
  US 20160157850A1
• Time in Patent Office: 1,100 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 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• 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 lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/042 plastically deformed during insertion
• CPC Class Codes: A61B 2017/0422 by insertion of a separate member into the body of the anchor
• CPC Class Codes: A61B 2017/0424 the separate member staying in the anchor after placement
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/0438 slotted, i.e. having a longitudinal slot for enhancing their elasticity
• 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 2017/045 snug fit within the anchor
• CPC Class Codes: A61B 2017/0451 Cams or wedges holding the suture by friction
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61F 2/34 Acetabular cups
• CPC Class Codes: A61F 2002/345 the inner and outer (hemi)spherical surfaces of a shell, e.g. an intermediate shell, having distinct centres of rotation, both located on the centre line of the shell
• CPC Class Codes: A61F 2220/0008 Fixation appliances for connecting prostheses to the body

Abstract

A method for securing a first object to a second object comprising providing apparatus comprising an elongated body having a lumen; an enlargement; a first elongated element, the distal end of the first elongated element being connected to the enlargement and the proximal end of the first elongated element extending through the lumen; and a second elongated element connected to the first elongated element external to the elongated body; inserting the elongated body into the second object; moving the second elongated element proximally so as to cause proximal movement of the first elongated element so as to cause the enlargement to move into a second portion of the lumen, whereby to laterally expand the elongated body; and securing the first object to the second object with the second elongated element.

Claims

1. A method for securing a first object to a second object, the method comprising:

providing apparatus comprising;

an elongated body having a distal end, a proximal end, and a lumen opening on the proximal end and extending toward the distal end, the lumen comprising a first portion and a second portion, the first portion of the lumen being disposed distal to the second portion of the lumen, with the first portion of the lumen having a wider diameter than the second portion of the lumen;

an enlargement slidably disposed at least in part in the first portion of the lumen, the enlargement having a diameter greater than the second portion of the lumen;

a loop of a first suture slidably disposed in the lumen of the elongated body, the loop of the first suture having a distal end and a proximal end, the distal end of the loop of the first suture being connected to the enlargement and the proximal end of the loop of the first suture extending through the second portion of the lumen and protruding out the proximal end of the elongated body, the loop of the first suture and the elongated body together defining an eyelet proximal to the elongated body, the first suture having a first diameter; and

a loop of a second suture extending through the eyelet defined by the loop of the first suture and the elongated body, the loop of the second suture extending through the loop of the first suture external to the elongated body, the second suture having a second diameter larger than the first diameter;

inserting the elongated body into the second object;

moving the loop of the second suture proximally so as to cause proximal movement of the loop of the first suture so as to cause the enlargement to move into the second portion of the lumen, whereby to laterally expand the elongated body; and

securing the first object to the second object with the second suture.

2. A method according to claim 1 wherein the loop of the second suture is passed through the first object before the elongated body is inserted into the second object.

3. A method according to claim 1 wherein the second suture is passed through the first object after the elongated body is inserted into the second object.

4. A method according to claim 1 wherein the first object comprises tissue and the second object comprises bone.

5. A method according to claim 1 wherein the enlargement expands the elongated body when the enlargement is pulled proximally into the second portion of the lumen.

6. A method according to claim 1 wherein a side wall of the elongated body comprises a weakened section adjacent to the second portion of the lumen of the elongated body.

7. A method according to claim 1 wherein the elongated body further comprises at least one longitudinally-extending slit extending through a side wall of the elongated body and communicating with the lumen.

8. A method according to claim 7 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit being spaced from the distal end of the elongated body.

9. A method according to claim 7 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the proximal end of the at least one longitudinally-extending slit being spaced from the proximal end of the elongated body.

10. A method according to claim 7 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit opening on the distal end of the elongated body.

11. A method according to claim 7 wherein at least one of the distal end and the proximal end of the longitudinally-extending slit terminates in a relief hole.

12. A method according to claim 7 wherein there are two longitudinally-extending slits, and further wherein the two longitudinally-extending slits are approximately diametrically opposed to one another.

13. A method according to claim 7 wherein the elongated body comprises at least one rib.

14. A method according to claim 13 wherein the at least one longitudinally-extending slit passes through the at least one rib.

15. A method according to claim 7 wherein the at least one longitudinally-extending slit has a distal end, a proximal end and an intermediate portion extending therebetween, with the distal end terminating in the first portion, the proximal end terminating in or proximal to the second portion.

16. A method according to claim 7 wherein proximal movement of the enlargement into the second portion of the lumen causes the second portion of the lumen to expand laterally in the vicinity of the at least one slit, whereby to laterally expand the elongated body.

17. A method according to claim 7 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit being spaced from the distal end of the elongated body and with the proximal end of the at least one longitudinally-extending slit being spaced from the proximal end of the elongated body.

18. A method according to claim 1 wherein the elongated body comprises a plurality of ribs.

19. A method according to claim 1 wherein the lumen of the elongated body further comprises a third portion disposed proximal to the second portion of the lumen, the third portion of the lumen having a diameter smaller than the second portion of the lumen.

20. A method according to claim 19 wherein the second portion of the lumen is separated from the third portion of the lumen by a transition zone.

21. A method according to claim 1 wherein the first portion of the lumen of the elongated body and the second portion of the lumen of the elongated body have a substantially circular cross-section.

22. A method according to claim 1 wherein the first portion of the lumen is separated from the second portion of the lumen by a first transition zone.

23. A method according to claim 1 wherein the elongated body is laterally expanded without causing the distal end of the elongated body to split open.

24. A method according to claim 1 wherein the elongated body is laterally expanded without causing the proximal end of the elongated body to split open.

25. A method according to claim 1 wherein the enlargement comprises a solid member.

26. A method according to claim 1 wherein the enlargement comprises a knot.

27. A method according to claim 1 wherein the enlargement comprises a solid member and a suture knot, the solid member being disposed proximal to the suture knot.

28. A method according to claim 1 wherein the enlargement is initially completely disposed in the first portion of the lumen.

29. A method according to claim 1 wherein the enlargement is initially at least partially disposed in the first portion of the lumen.

30. A method according to claim 1 wherein the loop of the first suture is movable relative to the elongated body, whereby to provide an eyelet of variable size.

31. A method according to claim 1 further comprising an inserter for manipulating the elongated body.

32. A method according to claim 31 wherein the inserter comprises a hollow push tube having a lumen extending therethrough.

33. A method according to claim 32 wherein the loop of the second suture extends through the lumen of the push tube.

34. A method according to claim 33 wherein the elongated body is held to the inserter by applying proximally-directed tension to the loop of the second suture.

35. A method according to claim 33 wherein the elongated body is held to the inserter with a male-female connection.

36. A method according to claim 1 wherein the loop of the first suture is formed out of #2-0 suture and the loop of the second suture is formed out of #1 suture.

37. A method according to claim 1 wherein the elongated body comprises at least one rib.

38. A method according to claim 37 wherein the at least one rib is resilient.

39. A method according to claim 1 wherein the elongated body is generally cylindrical.

40. A method for securing a first object to a second object, the method comprising:

providing apparatus comprising;

an elongated body having a distal end, a proximal end, and a lumen opening on the proximal end and extending toward the distal end, the lumen comprising a first portion and a second portion, the first portion of the lumen being disposed distal to the second portion of the lumen, with the first portion of the lumen having a wider diameter than the second portion of the lumen;

an enlargement slidably disposed at least in part in the first portion of the lumen, the enlargement having a diameter greater than the second portion of the lumen;

a first elongated element slidably disposed in the lumen of the elongated body, the first elongated element having a distal end and a proximal end, the distal end of the first elongated element being connected to the enlargement and the proximal end of the first elongated element extending through the second portion of the lumen and protruding out the proximal end of the elongated body, the proximal end of the first elongated element extending through the second portion of the lumen having a maximum width; and

a second elongated element connected to the first elongated element external to the elongated body, the second elongated element having a width, wherein the width of the second elongated element is larger than the maximum width of the proximal end of the first elongated element extending through the second portion of the lumen;

inserting the elongated body into the second object;

moving the second elongated element proximally so as to cause proximal movement of the first elongated element so as to cause the enlargement to move into the second portion of the lumen, whereby to laterally expand the elongated body; and

securing the first object to the second object with the second elongated element.

41. A method according to claim 40 wherein the lumen further comprises a third portion disposed proximal to the second portion of the lumen, the third portion of the lumen having a diameter smaller than the second portion of the lumen.

42. A method according to claim 41 wherein the second portion of the lumen is separated from the third portion of the lumen by a transition zone.

43. A method according to claim 40 wherein the elongated body further comprises at least one longitudinally-extending slit extending through a side wall of the elongated body and communicating with the lumen.

44. A method according to claim 43 wherein at least one of the distal end and the proximal end of the longitudinally-extending slit terminates in a relief hole.

45. A method according to claim 43 wherein there are two longitudinally-extending slits, and further wherein the two longitudinally-extending slits are approximately diametrically opposed to one another.

46. A method according to claim 43 wherein the elongated body comprises at least one rib.

47. A method according to claim 46 wherein the at least one longitudinally-extending slit passes through the at least one rib.

48. A method according to claim 43 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit being spaced from the distal end of the elongated body.

49. A method according to claim 43 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the proximal end of the at least one longitudinally-extending slit being spaced from the proximal end of the elongated body.

50. A method according to claim 43 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit opening on the distal end of the elongated body.

51. A method according to claim 43 wherein the at least one longitudinally-extending slit has a distal end, a proximal end and an intermediate portion extending therebetween, with the distal end terminating in the first portion, the proximal end terminating in or proximal to the second portion.

52. A method according to claim 43 wherein proximal movement of the enlargement into the second portion of the lumen causes the second portion of the lumen to expand laterally in the vicinity of the at least one slit, whereby to laterally expand the elongated body.

53. A method according to claim 43 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit being spaced from the distal end of the elongated body and with the proximal end of the at least one longitudinally-extending slit being spaced from the proximal end of the elongated body.

54. A method according to claim 40 wherein the enlargement comprises a solid member.

55. A method according to claim 40 wherein the enlargement comprises a knot.

56. A method according to claim 40 wherein the enlargement comprises a solid member and a suture knot, the solid member being disposed proximal to the suture knot.

57. A method according to claim 40 wherein the enlargement is initially completely disposed in the first portion of the lumen.

58. A method according to claim 40 wherein the first elongated element is formed out of #2-0 suture and the second elongated element is formed out of #1 suture.

59. A method according to claim 40 wherein the first elongated element is movable relative to the elongated body, whereby to provide an eyelet of variable size.

60. A method according to claim 40 wherein the elongated body is generally cylindrical.

61. A method according to claim 40 wherein the elongated body comprises at least one rib.

62. A method according to claim 61 wherein the at least one rib is resilient.

63. A method according to claim 40 further comprising an inserter for manipulating the elongated body.

64. A method according to claim 63 wherein the inserter comprises a hollow push tube having a lumen extending therethrough.

65. A method according to claim 64 wherein the second elongated element extends through the lumen of the push tube.

66. A method according to claim 65 wherein the elongated body is held to the inserter by applying proximally-directed tension to the second elongated element.

67. A method according to claim 65 wherein the elongated body is held to the inserter with a male-female connection.

68. A method according to claim 40 wherein a side wall of the elongated body comprises a weakened section adjacent to the second portion of the lumen of the elongated body.

69. A method according to claim 40 wherein the second elongated element is passed through the first object after the elongated body is inserted into the second object.

70. A method according to claim 40 wherein the first object comprises tissue and the second object comprises bone.

71. A method according to claim 40 wherein the enlargement expands the elongated body when the enlargement is pulled proximally into the second portion of the lumen.

72. A method according to claim 40 wherein the elongated body comprises a plurality of ribs.

73. A method according to claim 40 wherein the first portion of the lumen of the elongated body and the second portion of the lumen of the elongated body have a substantially circular cross-section.

74. A method according to claim 40 wherein the first portion of the lumen is separated from the second portion of the lumen by a first transition zone.

75. A method according to claim 40 wherein the elongated body is laterally expanded without causing the distal end of the elongated body to split open.

76. A method according to claim 40 wherein the elongated body is laterally expanded without causing the proximal end of the elongated body to split open.

77. A method according to claim 40 wherein the enlargement is initially at least partially disposed in the first portion of the lumen.

78. A method according to claim 40 wherein the second elongated element is passed through the first object before the elongated body is inserted into the second object.