Soft tissue attachment and repair

• US 20030130694A1
• Filed: 10/23/2002
• Published: 07/10/2003
• Est. Priority Date: 12/02/1999
• Status: Active Grant

• Current Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Original Assignee: Smith & Nephew Incorporated (Smith & Nephew PLC)
• Inventors: Sikora, George, Ek, Steven, Bojarski, Ray, Torrie, Paul Alexander
• Granted Patent: US 7,887,551 B2
• Time in Patent Office: Days
• US Class Current: 606/228
• 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 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• 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 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• 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 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/0437 the barbs being resilient or spring-like
• 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 2017/0458 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 2017/061 : hollow or tubular suture extending inside a hollow needle A61B2017/06052; hollow sutures A61B2017/06185
• CPC Class Codes: A61B 2017/0646 : for insertion into cartillege, e.g. meniscus
• CPC Class Codes: A61B 2017/0647 : having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/0648 : threaded, e.g. tacks with a screw thread
• 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 2002/0882 : 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

Abstract

A surgical assembly includes a fastener, a retainer, and a flexible member. The fastener is configured to be secured within bone tissue. The flexible member connects the fastener to the retainer and is movably attached to the retainer such that pulling on a free end of the flexible member shortens a length of the flexible member between the fastener and the retainer. A method includes positioning a fastener within bone tissue, positioning a retainer against soft tissue to be attached to the bone tissue, and pulling a free end of a flexible member. The fastener and the retainer are connected by the flexible member, the flexible member is movably attached to the retainer, and pulling on the free end of the flexible member shortens a length of the flexible member between the fastener and the retainer.

Claims

1. A surgical assembly comprising:

a fastener configured to be secured within bone tissue;

a retainer for engaging tissue; and

a flexible member connecting the fastener to the retainer, the flexible member being movably attached to the retainer such that pulling on a free end of the flexible member shortens a length of the flexible member between the fastener and the retainer to urge the tissue against the bone tissue.

2. The surgical assembly of claim 1 wherein the movable attachment of the flexible member to the retainer is configured to enable the length of the flexible member between the fastener and the retainer to be shortened, but not lengthened.

3. The surgical assembly of claim 2 wherein the movable attachment includes a knot formed in the flexible member.

4. The surgical assembly of claim 3 wherein the knot comprises a slip knot.

5. The surgical assembly of claim 1 wherein the flexible member comprises a suture.

6. The surgical assembly of claim 1 wherein the retainer includes a smooth first surface and a second surface that includes protrusions.

7. The surgical assembly of claim 1 wherein the retainer includes a smooth first surface and a second surface having a length and protrusions that are transverse to the length of the second surface.

8. The surgical assembly of claim 1 wherein the retainer has a low profile such that the retainer does not protrude sufficiently from the tissue to impinge against adjacent tissue.

9. The surgical assembly of claim 1 wherein the retainer has a thickness of between approximately 0.5 and 2.5 millimeters.

10. The surgical assembly of claim 1 wherein the retainer has a thickness of approximately 2 millimeters.

11. The surgical assembly of claim 1 wherein the fastener comprises a screw.

12. The surgical assembly of claim 10 wherein the screw comprises a threaded shank and a head, and the head defines at least one opening and the flexible member passes through the opening.

13. The surgical assembly of claim 12 wherein the screw comprises a ridge between the shank and the head.

14. The surgical assembly of claim 1 further comprising a delivery device for delivering the fastener and retainer to a surgical site.

15. The surgical assembly of claim 14 wherein the delivery device includes a cannula defining a lumen for receiving the fastener and retainer.

16. The surgical assembly of claim 14 further comprising a retractable needle positioned within the lumen and connected to a switch in the delivery device for advancing and retracting the needle.

17. A surgical method comprising:

positioning a fastener within bone tissue;

positioning a retainer against soft tissue to be attached to the bone tissue, the fastener and retainer being connected by a flexible member, the flexible member being movably attached to the retainer; and

pulling a free end of the flexible member to shorten a length of the flexible member between the fastener and the retainer to urge the soft tissue against the bone tissue.

18. The surgical method of claim 17 wherein the movable attachment of the flexible member to the retainer enables shortening but not lengthening of the length of the flexible member between the fastener and the retainer.

19. The surgical method of claim 18 wherein the movable attachment includes a slip knot formed in the flexible member and pulling the free end moves the slip knot along the flexible member.

20. The surgical method of claim 17 wherein positioning the fastener within bone tissue comprises rotatably inserting the fastener into bone tissue.

21. The surgical method of claim 17 wherein positioning the retainer against soft tissue comprises:

locating the retainer within a needle;

passing the needle through the soft tissue such that a protrusion on the retainer passes through at least a portion of the soft tissue; and

withdrawing the needle from the soft tissue such that the retainer is pulled from the needle by the interaction of the protrusion and the soft tissue.

22. The surgical method of claim 21 further comprising positioning a second retainer against the tissue on a side of the tissue opposite that of the first retainer, wherein the second retainer is positioned within the needle, the flexible member connects the second retainer to the first retainer and the fastener, and withdrawing the needle from the tissue causes the flexible member to be under tension such that the second retainer is pulled from the needle.

23. The surgical method of claim 22 wherein pulling the free end of the flexible member moves a slip knot along the flexible member, the slip knot being positioned between positioned between the free end of the flexible member and the second retainer.

24. The surgical method of claim 17 wherein the retainer has a low profile such that the retainer does not protrude sufficiently to impinge against adjacent tissue when the retainer is positioned against soft tissue.

25. The surgical method of claim 17 wherein the retainer has a thickness of between approximately 0.5 and 2.5 millimeters.

26. The surgical method of claim 17 wherein the retainer has a thickness of approximately 2 millimeters.

27. A surgical assembly comprising:

a first screw;

a second screw; and

a flexible member connecting the first screw to the second screw, the flexible member being movably attached to the second screw such that pulling on a free end of the flexible member shortens a length of the flexible member between the first screw and the second screw.

28. The surgical assembly of claim 27 further comprising a cannula for receiving the first and second screws, the cannula having a lumen and a distal end, the first screw being received within the lumen and the second screw being located at the distal end, the first screw and the cannula being configured to limit relative rotation therebetween.

29. The surgical assembly of claim 28 further comprising a pusher rod extending into the cannula for advancing the first screw to the distal end of the cannula.

30. A surgical assembly comprising:

a delivery device comprising a handle and a cannula, the cannula extending from the handle and including a longitudinal channel and a longitudinal slot in the cannula along at least a portion of the length of the channel; and

a surgical device comprising a first retainer, a second retainer, a flexible member coupling the first retainer and the second retainer, the flexible member being movably attached to the first retainer such that pulling on a free end of the flexible member shortens a length of the flexible member between the first retainer and the second retainer,

wherein the first retainer is positioned within the longitudinal channel, the second retainer is positioned adjacent to an outer surface of the cannula, and the flexible member passes from the longitudinal channel through the longitudinal slot.

31. The surgical assembly of claim 30 further comprising a pusher tube slidably positioned within the cannula and including a thumb switch extending through the longitudinal slot for advancing and retracting the pusher tube.

32. The surgical assembly of claim 30 wherein the movable attachment comprises a slip knot.

33. The surgical assembly of claim 32 wherein the movable attachment is positioned within the longitudinal channel.

34. The surgical assembly of claim 32 wherein the movable attachment is positioned outside of the longitudinal channel.

35. A surgical method comprising:

drilling a channel through bone tissue and soft tissue;

pulling a first flexible member to pull a fastener in a first direction through the channel such that the fastener passes through the bone tissue and the soft tissue;

pulling a second flexible member to pull the fastener in a second direction against the soft tissue, the second flexible member connecting the fastener to a retainer; and

pulling a free end of the second flexible member to shorten a length of the second flexible member between the fastener and the retainer, whereby pulling the free end of the second flexible member positions the retainer against the bone.

36. A surgical method comprising:

positioning a fastener within bone tissue;

positioning a first retainer against soft tissue to be attached to the bone tissue, the fastener and first retainer being movably attached by a flexible member;

positioning a second retainer against soft tissue to be attached to the bone tissue, the fastener, the first retainer, and the second retainer being movably attached by the flexible member;

pulling a free end of the flexible member to shorten a length of the flexible member between at least any two of the fastener, the first retainer and the second retainer.

37. The surgical method of claim 36 wherein the movable attachment of the flexible member to the retainer enables shortening but not lengthening of the length of the flexible member between any two of the fastener, the first retainer and the second retainer.

38. The surgical method of claim 37 wherein pulling the free end of the flexible member moves a slip knot along the flexible member, the slip knot being positioned between the free end of the flexible member and the second retainer.

39. The surgical method of claim 36 wherein positioning the fastener within bone tissue comprises rotatably inserting the fastener into bone tissue.

40. The surgical method of claim 36 wherein positioning either of the first retainer and the second retainer against soft tissue comprises:

locating the retainer within a needle;

passing the needle through the soft tissue such that a protrusion on the retainer passes through at least a portion of the soft tissue; and

withdrawing the needle from the soft tissue such that the retainer is pulled from the needle by the interaction of the protrusion and the soft tissue.

41. The surgical method of claim 36 wherein pulling a free end of the flexible member comprises moving a slip knot positioned between a free end of the flexible member and the second retainer along the flexible member to shorten a length of the flexible member between at least any two of the fastener, the first retainer and the second retainer.

42. A surgical method comprising:

positioning a fastener within bone tissue;

advancing a delivery device including a needle under a first soft tissue member;

advancing the curved delivery device through a second soft tissue member and positioning a retainer against the second soft tissue member, the fastener and retainer being connected by a flexible member, the flexible member being movably attached to the retainer; and

pulling a free end of the flexible member to shorten a length of the flexible member between the fastener and the retainer.

43. The surgical method of claim 42 wherein the movable attachment of the flexible member to the retainer enables shortening but not lengthening of the length of the flexible member between the fastener and the retainer.

44. The surgical method of claim 42 wherein pulling the free end moves the slip knot along the flexible member, the slip knot being formed in the flexible member.

45. The surgical method of claim 42 wherein positioning the fastener within bone tissue comprises forcibly inserting the fastener into bone tissue.

46. The surgical method of claim 42 wherein positioning the retainer against the second soft tissue comprises:

locating the retainer within the needle;

passing the needle through the second soft tissue such that a protrusion on the retainer passes through at least a portion of the second soft tissue; and

withdrawing the needle from the second soft tissue such that the retainer is pulled from the needle by the interaction of the protrusion and the second soft tissue.

47. The surgical method of claim 42 wherein the delivery device is advanced under the first soft tissue member and the retainer is positioned against the second soft tissue member prior to positioning the fastener within the bone tissue.

48. A surgical method for repairing a meniscal tear comprising:

positioning a delivery device comprising a needle against a first position on soft tissue;

advancing the needle through the soft tissue, a first retainer being positioned within a longitudinal channel of a lumen of the needle and including a protrusion extending from the first retainer through a longitudinal slot in the needle;

withdrawing the needle from the soft tissue such that the first retainer is pulled from the needle by the interaction of the protrusion and the soft tissue;

positioning the delivery device against a second position on the soft tissue;

advancing the delivery device and the needle through the soft tissue, a second retainer being positioned within the longitudinal channel of the lumen and including a protrusion extending from the second retainer through the longitudinal slot in the needle; and

withdrawing the delivery device from the soft tissue such that the second retainer is pulled from the needle by the interaction of the protrusion and the soft tissue.

49. The surgical method of claim 48 wherein positioning the first retainer and the second retainer comprises positioning the first retainer and the second retainer on opposite sides of the meniscal tear.

50. The surgical method of claim 48 wherein positioning the first retainer and the second retainer comprises positioning the first retainer and the second retainer on the same side of the meniscal tear.