Implant stabilizing instrument, kit and method

• US 20040267270A1
• Filed: 06/30/2003
• Published: 12/30/2004
• Est. Priority Date: 06/30/2003
• Status: Active Grant

• Current Assignee: Depuy Products Incorporated (Johnson & Johnson)
• Original Assignee: Depuy Products Incorporated (Johnson & Johnson)
• Inventors: Schwartz, Herbert E., Malaviya, Prasanna, Jacobs, Andrew M., Kemppainen, John W., Zannis, Anthony D., Clarke, Rhonda B., Day, Carolyn K.
• Granted Patent: US 7,473,259 B2
• Time in Patent Office: Days
• US Class Current: 606/86.00R
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/06057 Double-armed sutures, i.e. sutures having a needle attached to each end

Abstract

A surgical instrument stabilizes an implant as the implant is secured to native tissue at a damaged tissue site such as in an intra-articular space. The instrument has a proximal end portion, a distal end portion and an intermediate portion. The distal end portion has a template for guiding an attachment mechanism into the implant and the adjacent native tissue. The distal end portion can also have barbs to engage the implant to enhance stabilization of the implant. Several instruments can be provided in a surgical kit with different lengths and shapes of distal end portions. A surgical kit could also contain modular distal end portions of varying sizes and shapes. A surgical method utilizing the stabilizing instrument is also disclosed.

Claims

1. A surgical instrument for stabilizing an implant as a surgeon introduces an attachment mechanism to secure the implant to native tissue at the damaged tissue site comprising:

a proximal end portion to be held by a surgeon;

a distal end portion;

an intermediate portion between the proximal end portion and distal end portion;

wherein the distal end portion defines an attachment template for guiding an attachment mechanism through the implant and into the native tissue of the damaged tissue site.

2. The surgical instrument of claim 1 wherein the distal end portion of the surgical instrument is sized and shaped to fit in the intra-articular space of a joint.

3. The surgical instrument of claim 1 further comprising:

a proximal transition portion connecting the proximal end portion and the intermediate portion; and

a distal transition portion connecting the distal end portion and the intermediate portion.

4. The surgical instrument of claim 3 wherein the proximal transition portion and distal transition portion comprise curves.

5. The surgical instrument of claim 3 wherein the proximal transition portion and distal transition portion comprise angles between 0°

and 180°

.

6. The surgical instrument of claim 1 wherein the distal end portion of the instrument has a top surface and a bottom surface and the attachment template comprises a suturing template including a guide hole extending from the top surface to the bottom surface.

7. The surgical instrument of claim 6 wherein the suturing template includes a second guide hole and a slot connecting the two guide holes, the slot being open at the top surface and bottom surface of the distal end portion.

8. The surgical instrument of claim 7 wherein each guide hole has a diameter and the slot has a width less that the diameters of the guide holes.

9. The surgical instrument of claim 8 wherein the guide holes are sized and shaped to receive and guide suture needles and the slot is sized and shaped to receive a length of suture.

10. The surgical instrument of claim 6 wherein:

the guide hole has a central longitudinal axis;

the top surface and bottom surface of the distal end portion lie in substantially parallel planes; and

the central longitudinal axis of the guide hole is perpendicular to the planes of the top surface and bottom surface of the distal end portion.

11. The surgical instrument of claim 6 wherein:

the guide hole has a central longitudinal axis;

the top surface and bottom surface of the distal end portion lie in substantially parallel planes; and

the central longitudinal axis of the guide hole defines an acute angle with the planes of the top surface and bottom surface of the distal end portion.

12. The surgical instrument of claim 6 wherein the bottom surface of the distal end portion includes a barb for engaging the implant.

13. The surgical instrument of claim 6 wherein the bottom surface of the distal end portion has a plurality of barbs for engaging the implant.

14. The surgical instrument of claim 1 wherein:

the proximal end portion has a central longitudinal axis;

the distal end portion has a central longitudinal axis;

the intermediate portion has a central longitudinal axis; and

the central longitudinal axis of the proximal end portion is offset from the central longitudinal axis of the distal end portion.

15. The surgical instrument of claim 14 wherein:

the central longitudinal axis of the proximal end portion defines an angle greater than 0° and

less than 180°

with the central longitudinal axis of the intermediate portion; and

the central longitudinal axis of the distal end portion defines an angle greater than 0° and

less than 180°

with the central longitudinal axis of the intermediate portion.

16. The surgical instrument of claim 14 wherein the central longitudinal axes of the proximal end portion, intermediate portion and distal end portion are co-linear in plan view and are co-planar in elevation.

17. The surgical instrument of claim 16 wherein the central longitudinal axes of the distal end portion and proximal end portion each defines an angle of from about 30°

to about 45°

with the central longitudinal axis of the intermediate portion.

18. The surgical instrument of claim 14 wherein the central longitudinal axes of the proximal end portion, intermediate portion and distal end portion are not co-linear in plan view and are not co-planar in elevation.

19. The surgical instrument of claim 18 wherein the central longitudinal axes of the distal end portion and proximal end portion each defines an angle of from about 30°

to about 45°

with the central longitudinal axis of the intermediate portion.

20. The surgical instrument of claim 1 wherein the proximal end portion, intermediate portion and distal end portion are integral.

21. The surgical instrument of claim 1 wherein the distal end portion is removable from the intermediate portion.

22. The surgical instrument of claim 1 wherein the instrument is sized and shaped so that the distal end portion can be introduced arthroscopically into an intra-articular space of a joint.

23. A surgical instrument for engaging and stabilizing an implant as suture is introduced to secure the implant to native tissue at a damaged tissue site comprising:

a proximal end portion to be held by a surgeon, the proximal end portion having a central longitudinal axis;

a distal end portion having a central longitudinal axis offset from the central longitudinal axis of the proximal end portion;

an intermediate portion between the proximal end portion and distal end portion, the intermediate portion having a central longitudinal axis defining an angle of from about 30°

to about 45°

with the central longitudinal axis of the proximal end portion and an angle of from about 30°

to about 45°

with the central longitudinal axis of the distal end portion;

wherein the distal end portion has a top surface lying in a plane and a bottom surface lying in a plane and a pair of spaced guide holes extending from the top surface to the bottom surface, the spaced guide holes being sized and shaped to receive surgical needles, the spaced guide holes being connected by a slot extending from the top surface to the bottom surface, the spaced guide holes and slot defining a suturing guide for attaching the implant to native tissue at the damaged tissue site;

wherein the distal end portion includes a plurality of spaced barbs extending outwardly from the bottom surface, the barbs being sized and shaped to extend through the implant and into the native tissue so that the distal end portion can temporarily engage a portion of the implant as the implant is secured to the native tissue.

24. The surgical instrument of claim 23 wherein the instrument is sized and shaped so that the distal end portion can be introduced arthroscopically into an intra-articular space.

25. The surgical instrument of claim 23 wherein the central longitudinal axes of the proximal end portion, intermediate portion and distal end portion are co-linear in plan view and are co-planar in elevation.

26. The surgical instrument of claim 23 wherein the central longitudinal axes of the proximal end portion, intermediate portion and distal end portion are not co-linear in plan view and are not co-planar in elevation.

27. The surgical instrument of claim 23 wherein:

each guide hole has a central longitudinal axis;

the plane of the top surface of the distal end portion is parallel to the plane of the bottom surface of the distal end portion; and

the central longitudinal axes of the guide holes are perpendicular to the planes of the top surface and bottom surface of the distal end portion.

28. The surgical instrument of claim 23 wherein:

each guide hole has a central longitudinal axis;

the plane of the top surface of the distal end portion is parallel to the plane of the bottom surface of the distal end portion; and

the central longitudinal axes of the guide holes define acute angles with the planes of the top surface and bottom surface of the distal end portion.

29. The surgical instrument of claim 23 wherein the proximal end portion, intermediate portion and distal end portion are integral.

30. The surgical instrument of claim 23 wherein the distal end portion is removable from the intermediate portion.

31. A surgical kit for stabilizing an implant as an attachment mechanism is introduced to secure the implant to native tissue at a damaged tissue site comprising:

a plurality of attachment templates for guiding an attachment mechanism through the implant and into the native tissue at the damaged tissue site;

wherein the attachment templates vary in at least one of the following characteristics;

length and shape; and

wherein each attachment template is sized and shaped to be capable of being introduced arthroscopically to the damaged tissue site;

wherein the kit further includes at least one handle for guiding the templates to the damaged tissue site.

32. The surgical kit of claim 31 wherein there are a plurality of handles and each attachment template is integral with one handle.

33. The surgical kit of claim 31 wherein each attachment template is removably mountable on the handle.

34. The surgical kit of claim 31 wherein the handle comprises a proximal portion and an intermediate portion.

35. A method of attaching an implant to native tissue at a damaged tissue site comprising:

providing an implant;

providing an attachment mechanism for attaching the implant to the native tissue;

providing a surgical instrument including a proximal end portion to be held by a surgeon and a distal end portion, wherein the distal end portion of the surgical instrument defines an attachment template for guiding an attachment mechanism through the implant and into the native tissue at the damaged tissue site;

introducing the implant to the damaged tissue site adjacent to native tissue;

introducing the distal end portion of the surgical instrument to the damaged tissue site;

placing the distal end portion of the surgical instrument against the implant to temporarily stabilize the position of the implant;

guiding the attachment mechanism through the implant and into the native tissue with the attachment template while the distal end portion of the surgical instrument is against the implant.

36. The method of claim 35 wherein the implant comprises an orthopaedic implant and the damaged tissue site comprises a damaged joint site.

37. The method of claim 36 wherein the orthopaedic implant includes an extracellular matrix material.

38. The method of claim 36 wherein the damaged joint site comprises an intra-articular space.

39. The method of claim 38 wherein the native tissue comprises fibrocartilage.

40. The method of claim 39 wherein the fibrocartilage comprises the meniscus of the knee.

41. The method of claim 35 wherein the surgical instrument is introduced arthroscopically.

42. The method of claim 35 wherein:

the attachment mechanism comprises a pair of elongate surgical needles having distal ends, proximal ends and suture extending between the proximal ends of the surgical needles;

the attachment template comprises a pair of spaced guide holes joined by a slot; and

the step of guiding the attachment mechanism through the implant and into the native tissue with the attachment template comprises pushing the elongate surgical needles through the spaced guide holes of the attachment template, through the implant and through the native tissue to pull the suture through the spaced guide holes and slot;

the method further comprising the step of cutting the suture and tying the ends of the suture to secure at least a portion of the implant to the native tissue.

43. The method of claim 42 wherein the native tissue comprises the meniscus of the knee.