Tissue anchoring system and method

• US 20020091391A1
• Filed: 02/05/2002
• Published: 07/11/2002
• Est. Priority Date: 01/26/1998
• Status: Active Grant

• Current Assignee: Synthes USA LLC (Johnson & Johnson)
• Original Assignee: Orthodyne, Inc.
• Inventors: Justin, Daniel F., Cole, J. Dean
• Granted Patent: US 6,761,722 B2
• Time in Patent Office: Days
• US Class Current: 606/916
• 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 17/683 comprising bone transfixation elements, e.g. bolt with a distal cooperating element such as a nut
• CPC Class Codes: A61B 17/82 for bone cerclage apparatus for manipulating wires or straps A61B17/8861; wires, bands or straps other than cerclage A61B17/842
• CPC Class Codes: A61B 17/8863 Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
• CPC Class Codes: A61B 17/8869 Tensioning devices
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0454 the anchor being crimped or clamped on the suture
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• 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 2002/0829 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 2002/0858 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: Y10T 29/53952 Tube sleeve or ferrule applying or removing
• CPC Class Codes: Y10T 29/53987 Tube, sleeve or ferrule

Abstract

A tissue anchoring system includes a tissue anchor affixed to an end of a cable and supported for insertion on a delivery device, the manipulation of which permits placement of the anchor on a far side of the tissue. A tensioning, crimping and cutting tool designed for use along the cable'"'"'s longitudinal axis, thus reducing the number of incisions required. A suture anchoring system is also described for introducing a loop of suture into a surgical site and anchoring it, for instance, across a tear in soft tissue.

Claims

1. A method for attaching a first section of tissue to a second section of tissue, the method comprising the steps of:

providing an anchor member having a first dimension larger than a second dimension, the anchor member affixed to a first end of a cable;

inserting the anchor member in combination with the cable into a bore of a delivery device, the bore having a longitudinal axis, a distal end of the anchor member retained outside the delivery device bore, a proximal end of the anchor member inserted into and supported by the bore of the delivery device;

maintaining tension on the cable within the delivery device to retain the anchor member proximal end within the delivery device bore and to maintain the first dimension in alignment with the longitudinal axis;

impelling the anchor member in combination with the insertion device through the first tissue section and then through the second tissue section;

releasing the tension on the cable;

pivoting the anchor member to a position wherein the anchor member first dimension is generally transverse to the bore longitudinal axis;

applying tension to a second end of the cable to force the anchor against a distal side of the second tissue section and to urge the first tissue section into close opposition with the second tissue section;

affixing a retainer to the cable adjacent a proximal side of the first tissue section; and

cutting the cable proximal the retainer.

2. The method of claim 1, wherein the first section of tissue and the second section of tissue includes cortical bone.

3. The method of claim 2, wherein the anchor member is a rigid material sufficient to withstand the force applied to compress a fracture between the first cortical bone section and the second cortical bone section.

4. The method of claim 3, wherein the anchor member is stainless steel.

5. The method of claim 3, wherein the cable has sufficient tensile strength to withstand the force applied to compress a fracture between the first bone segment and the second bone segment.

6. The method of claim 5, wherein the cable is medical grade steel.

7. The method of claim 1, wherein said affixing is performed by deforming a portion of the retainer to engage the cable.

8. The method of claim 7, wherein the method is performed through a unitary incision in the human body.

9. The method of claim 7, further including:

providing a crimping and tensioning tool having an outer member and inner member movably disposed within the outer member;

sliding a retainer on the cable after said pivoting step;

inserting the cable into the crimping and tension tool outer member;

performing said applying tension step utilizing the crimping and tensioning tool to urge the retainer toward the anchor member; and

moving the inner member with respect to the outer member thereby deforming a portion of the retainer.

10. A method for joining two segments of tissue, comprising;

providing a first anchor, an elongated member attached to the first anchor, a second anchor slidable on the elongated member and having a deformable portion adapted to engage the elongated member, and a crimping tool having an outer member and an inner member movably disposed within the outer member;

inserting the elongated member through a proximal tissue segment and a distal tissue segment;

anchoring the first anchor to the distal tissue segment;

sliding the second anchor on the elongated member adjacent the proximal tissue segment;

threading the elongated member through the crimping device;

applying tension on the elongated member to urge the distal tissue segment toward the proximal tissue segment; and

moving the inner member with respect to the outer member thereby deforming the deformable portion of the second anchor and maintaining the tension applied to the elongated member.

11. The method of claim 10, wherein the two segments of tissue include cortical bone.

12. The method of claim 11, wherein the anchor is at least as rigid as cortical bone and the elongated member is more flexible than cortical bone.

13. The method of claim 12, wherein the anchor is pivotable relative to the elongated member between a first position wherein a longitudinal axis of the first anchor is in substantial alignment with a longitudinal axis of the elongated member, and a second position wherein the longitudinal axis of the first anchor is substantially transverse to the longitudinal axis of the elongated member;

said inserting including inserting the first anchor through the proximal and distal tissue segments in the first position and said anchoring includes pivoting the first anchor into the second position.

14. The method of claim 13, further including positioning a washer on the elongated member prior to said sliding.

15. The method of claim 11, further including positioning a bone opening protector adjacent to the proximal tissue segment prior to said sliding to inhibit the elongated member or second anchor from cutting into the bone.

16. The method of claim 10, wherein said moving is rotating said inner member with respect to said outer member.

17. The method of claim 10, wherein the crimping tool includes a tensioning apparatus and a cutting apparatus, and said applying tension includes operating the tension apparatus to exert tension on the elongated member and further including operating the cutting apparatus to cut the elongated member adjacent the second anchor.

19. The method of claim 18, wherein said insertion device is adapted to releasably engage the elongated member, further including applying tension to the elongated member after said interconnecting and releasably engaging the elongated member with the insertion device to thereby hold the first rigid anchor in alignment with the insertion device.

20. The method of claim 18, wherein the tensioning and crimping tool includes a cutting mechanism, further including operating the cutting mechanism to cut the elongated member adjacent the second deformable anchor.

21. The method of claim 20, wherein the cutting mechanism is disposed adjacent the second deformable anchor and cuts a portion of the second deformable anchor during said operating.

18. A method for joining two cortical bone segments, comprising:

providing a first rigid anchor pivotally connected to an elongated flexible member, the first rigid anchor moveable between an insertion position wherein a longitudinal axis of the first anchor is in substantial alignment with a longitudinal axis of the elongated flexible member, and an anchor position wherein the longitudinal axis of the first rigid anchor is substantially transverse to the longitudinal axis of the elongated member, a second deformable anchor slidable along the elongated flexible member, an insertion device adapted to hold a portion of the first anchor, and a tensioning and crimping tool having an outer elongated member and an inner member movably disposed within the outer member;

inserting a portion of the elongated member into the insertion device;

interconnecting a portion of the first rigid anchor and the insertion device;

impelling the insertion device with interconnected first rigid anchor through the first and second cortical bone segments;

pivoting the first rigid anchor with respect to the insertion device to the anchor position;

sliding the second deformable anchor on the elongated member adjacent the proximal tissue segment;

threading the elongated member through the tensioning and crimping tool;

applying tension on the elongated member to urge the first rigid anchor toward the second deformable anchor thereby urging the first cortical bone segment toward the second cortical bone segment; and

moving the inner member with respect to the outer member thereby deforming the deformable portion of the second deformable anchor and maintaining the tension applied to the elongated member.