Method and apparatus for coupling anatomical features

• US 10,398,428 B2
• Filed: 10/07/2016
• Issued: 09/03/2019
• 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:
  US15/288,183
• Publication Number:
  US 20170020507A1
• Time in Patent Office: 1,061 Days
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• 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 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 2017/0404 Buttons
• 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 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• 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 2017/045 snug fit 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 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/06185 hollow or tubular hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/0641 : having at least three legs as part of one single body
• CPC Class Codes: A61F 2/08 : Muscles; Tendons; Ligaments sutures A61B17/04
• CPC Class Codes: A61F 2/0811 : Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2002/0829 : without deformation of anchor parts, e.g. fixation screws on bone surface, extending barbs, cams, butterflies, spring-loaded pins
• CPC Class Codes: A61F 2002/0852 : Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
• CPC Class Codes: A61F 2002/0864 : 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: Y10T 29/49826 : Assembling or joining

Abstract

A method of coupling a first portion of an anatomy to a second portion of the anatomy includes coupling first and second bones of the anatomy with a bone-tendon-bone implant. The bone-tendon-bone implant has a first bone end, a second bone end and a replacement tendon between the first and second bone ends. The first and second bone ends are positioned in corresponding first and second bores of the first and second bones. The first bone end is secured to the first bone with a first bone anchor. A second anchor coupled to the bone-tendon-bone implant is passed through and outside the second bore. The second anchor is coupled to an adjustable suture construct having two adjustable suture loops. Tensioning at least one of first and second ends of the adjustable suture construct tensions the replacement tendon and positions the first bone relative to the second bone.

Claims

1. An apparatus for engaging bone, the apparatus comprising:

a first bone engaging fastener; and

an adjustable suture construct coupled to the first bone engaging fastener, the adjustable suture construct including a suture with a first free end and a second free end, the first free end extending longitudinally through a first longitudinal passage in the suture to form a first adjustable loop, the second free end extending longitudinally through a second longitudinal passage in the suture to form a second adjustable loop, wherein the first longitude passage is spaced apart from the second longitudal passage in the adjustable suture construct, and wherein, with the first free end extending longitudinally through the first longitudinal passage in the suture to form the first adjustable loop and with the second free end extending longitudinally through the second longitudinal passage in the 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.

2. The apparatus of claim 1, wherein the first bone engaging fastener is an elongate threaded fastener.

3. The apparatus of claim 2, wherein the adjustable suture construct extends down into the elongate threaded fastener through an opening in a trailing end of the elongate threaded fastener to couple the adjustable suture construct to the elongate threaded fastener.

4. The apparatus of claim 3, wherein at least a portion of the first adjustable loop and at least a portion of the second adjustable loop protrude from the opening in the trailing end of the elongate threaded fastener.

5. The apparatus of claim 1 further comprising a second bone engaging fastener coupled to the adjustable suture construct.

6. The apparatus of claim 5, wherein at least one of the first bone engaging fastener and the second bone engaging fastener is a button.

7. The apparatus of claim 6, wherein the first bone engaging fastener and the second bone engaging fastener are buttons.

8. The apparatus of claim 1 further comprising an ACL graft coupled to the adjustable suture construct.

9. The apparatus of claim 8, wherein the ACL graft is coupled to the first adjustable loop and the second adjustable loop.

10. The apparatus of claim 1, wherein the first bone engaging fastener includes a cylindrical body with a flange extending therefrom.

11. An apparatus for engaging bone, the apparatus comprising:

a first bone engaging fastener; and

an adjustable suture construct coupled to the first bone engaging fastener, the adjustable suture construct including a suture with a first free end and a second free end, the first free end extending through a first aperture in the suture, longitudinally along a first longitudinal passage in the suture, and out a fourth aperture in the suture to form a first adjustable loop, the second free end extending through a second aperture in the suture, longitudinally along a second longitudinal passage in the suture, and out a third aperture in the suture 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, wherein, with the first free end extending through the first aperture in the suture, longitudinally along the first longitudinal passage in the suture, and out the fourth aperture in the suture to form the first adjustable loop and with the second free end extending through the second aperture in the suture, longitudinally along the second longitudinal passage in the suture, and out the third aperture in the 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.

12. The apparatus of claim 11, wherein the first longitudinal passage is separate from the second longitudinal passage in the suture.

13. The apparatus of claim 11 further comprising an artificial ACL graft coupled to the first adjustable loop and the second adjustable loop.

14. The apparatus of claim 11, wherein the first bone engaging fastener is an elongate threaded fastener.

15. The apparatus of claim 14, wherein the adjustable suture construct extends down into the elongate threaded fastener through an opening in a trailing end of the elongate threaded fastener to couple the adjustable suture construct to the elongate threaded fastener.

16. The apparatus of claim 15, wherein at least a portion of the first adjustable loop and at least a portion of the second adjustable loop protrude from the opening in the trailing end of the elongate threaded fastener.

17. The apparatus of claim 11 further comprising a second bone engaging fastener coupled to the adjustable suture construct.

18. The apparatus of claim 17, wherein at least one of the first bone engaging fastener and the second bone engaging fastener is a button.

19. The apparatus of claim 18, wherein the first bone engaging fastener and the second bone engaging fastener are buttons.

20. The apparatus of claim 11, wherein the first bone engaging fastener includes a cylindrical body with a flange extending therefrom.

21. The apparatus of claim 11, wherein the first longitudinal passage is spaced apart from the second longitudinal passage in the adjustable suture construct.

22. An apparatus for engaging bone, the apparatus comprising:

a first bone engaging fastener; and

an adjustable suture construct coupled to the first bone engaging fastener, the adjustable suture construct including a suture with a first free end and a second free end, the first free end extending into the suture through a first aperture in the suture, extending longitudinally along the suture within the suture, and extending out of the suture through a fourth aperture in the suture to form a first adjustable loop, the second free end extending into the suture through a second aperture in the suture, extending longitudinally along the suture within the suture, and extending out of the suture through a third aperture in the suture 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, wherein, with the first free end extending into the suture through the first aperture in the suture, extending longitudinally along the suture, within the suture, and extending out of the suture through the fourth aperture in the suture to form the first adjustable loop and with the second free end extending into the suture through the second aperture in the suture, extending longitudinally along the suture, within the suture, and extending out of the suture through the third aperture in the suture to form the second adjustable loop, the first free end can be pulled through the first aperture and the fourth aperture in the suture to decrease a size of the first adjustable loop and the second free end can be pulled through the second aperture and the third aperture in the suture to decrease a size of the second adjustable loop,

wherein the first free end of the suture includes a portion that;

(i) extends longitudinally within the suture between the first aperture in the suture and the fourth aperture in the suture; and

(ii) is received within the first bone engaging fastener.

23. The apparatus of claim 22, wherein the first free end and the second free end are spaced apart from one another while extending longitudinally within the suture.

24. The apparatus of claim 22, wherein the first free end and the second free end overlap one another while extending longitudinally within the suture.