METHODS AND DEVICES FOR REPAIRING TRIANGULAR FIBROCARTILAGE COMPLEX TEARS

• US 20050192632A1
• Filed: 02/26/2004
• Published: 09/01/2005
• Est. Priority Date: 02/26/2004
• Status: Active Grant

• Current Assignee: DePuy Synthes Products LLC (Johnson & Johnson)
• Original Assignee: DePuy Mitek Incorporated (Johnson & Johnson)
• Inventors: Scanlon, Meghan, Geissler, William, Belloli, Donna, Cook, Shelby
• Granted Patent: US 7,455,683 B2
• Time in Patent Office: Days
• US Class Current: 606/232
• 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 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/0646 for insertion into cartillege, e.g. meniscus
• 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 2002/0852 Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
• CPC Class Codes: A61F 2002/0882 Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone

Abstract

Methods and devices for repairing the TFCC of a patient'"'"'s wrist are provided. In general, the device includes first and second anchor bodies that are connected to one another by a suture. The first anchor body is configured to be passed through a portion of the TFCC of a patient'"'"'s wrist and an anchoring tissue, preferably using a delivery device, such that the first anchor body is positioned across a torn portion of the TFCC, the second anchor body is positioned across the anchoring tissue, and the suture extends therebetween. The suture can then be tensioned to anchor the TFCC to the anchoring tissue.

Claims

1. A method for repairing tears in the triangular fibrocartilage complex of a patient'"'"'s wrist, comprising:

passing a delivery device through an anchoring tissue and a portion of the triangular fibrocartilage complex of a patient'"'"'s wrist, the delivery device carrying a first anchor body that is connected to a second anchor body by a suture;

releasing the first anchor body from the delivery device such that the first anchor body is positioned across a torn portion of the triangular fibrocartilage complex, the second anchor body is positioned across an anchoring tissue, and the suture extends therebetween; and

tensioning the suture to anchor the triangular fibrocartilage complex to the anchoring tissue.

2. The method of claim 1, wherein the triangular fibrocartilage complex has an ulna-sided tear, and the anchoring tissue is selected from the group consisting of the dorsal capsule and the extensor carpi ulnaris subsheath, and the ulna bone.

3. The method of claim 1, wherein the triangular fibrocartilage complex has a radial-sided tear, and the anchoring tissue comprises the radius bone.

4. The method of claim 1, wherein the suture includes a slip knot formed thereon, and wherein the step of tensioning the suture comprising pulling a trailing end of the suture such that the slip knot and the second anchor body move toward the first anchor body.

5. The method of claim 1, wherein each anchor body includes a central portion adapted to receive the suture, and a tissue-engaging portion.

6. The method of claim 5, wherein each anchor body includes a bore extending through the central portion for receiving the suture.

7. The method of claim 5, wherein the central portion of the first anchor body is substantially semi-circular, and the tissue-engaging portion is generally elongate.

8. The method of claim 7, wherein the central portion of the first anchor body is substantially planar, and the tissue-engaging portion is substantially cylindrical.

9. The method of claim 7, wherein the tissue-engaging portion has a length that is greater than a maximum diameter of the central portion such that opposed ends of the tissue-engaging portion form tissue-engaging wings.

10. The method of claim 7, wherein the tissue-engaging portion has a length that is greater than a height of the central portion.

11. The method of claim 5, wherein the tissue-engaging portion of the second anchor body is in the form of a circular base, and wherein the central portion comprises a substantially cylindrical extension of the circular base with chamfered sidewalls.

12. The method of claim 11, wherein the circular base and the substantially cylindrical extension further comprise a suture-receiving bore extending therethrough.

13. The method of claim 12, wherein the suture-receiving bore in the circular base further comprises a recess formed in an opening thereof, the recess being adapted to seat a knot formed on the suture.

14. The method of claim 13, wherein the recess is formed from a chamfer in the tissue-engaging portion.

15. The method of claim 11, wherein a diameter of the circular base is greater than a maximum diameter of the substantially cylindrical extension.

16. The method of claim 1, wherein the first and second anchor bodies are formed from a bioabsorbable polymeric material.

17. The method of claim 1, wherein the suture is selected from the group consisting of non-bioabsorbable, and bioabsorbable sutures.

18. The method of claim 1, wherein the delivery device includes an elongate needle having a channel formed in at least a distal portion thereof, wherein the channel adapted to slidably receive at least a portion of the first anchor body.

19. The method of claim 18, wherein the channel in the elongate needle is adapted to slidably receive a plurality of anchor bodies.

20. The method of claim 18, wherein the first anchor body includes a tissue-engaging portion that is adapted to be slidably received in the channel formed in the elongate needle of the delivery device.

21. The method of claim 18, wherein at least the distal-most portion of the delivery needle has a diameter in the range of about 16 to 18 gauge.

22. The method of claim 18, further comprising a handle member coupled to the elongate needle, and a trigger mechanism formed on the handle and effective to, upon actuation, advance the first anchor body in a distal direction to release the first anchor body.

23. The method of claim 18, further comprising a handle member coupled to the elongate needle and having a suture-receiving channel formed therein.

24. An anchor system for repairing tears in the triangular fibrocartilage complex, comprising:

a first anchor body having a central portion adapted to receive a suture, and opposed wing members extending from opposed sides of the central portion, the wing members defining a length that is greater than a height of the central portion;

a second anchor body having a circular base with a substantially cylindrical central portion extending therefrom, the second anchor body include a bore extending through the circular base and the substantially cylindrical central portion for receiving a suture; and

a suture loop extending through the central portion of the first and second anchor bodies, and including a slip knot formed therein and positioned adjacent the second anchor body.

25. The anchor system of claim 24, wherein the first and second anchor bodies each have a size adapted to be used to repair tears in the triangular fibrocartilage complex of a patient'"'"'s wrist.

26. The anchor system of claim 24, wherein the central portion of the first anchor body is substantially semi-circular, and the opposed wing members are formed from an elongate, generally cylindrical member coupled to the central portion.

27. The anchor system of claim 26, wherein the elongate, generally cylindrical member has a length that is greater than a maximum diameter of the central portion.

28. The anchor system of claim 27, wherein the length of the elongate member is in the range of about 3.5 mm to 4.5 mm and the maximum diameter of the central portion is in the range of about 2.0 mm to 4.0 mm.

29. The anchor system of claim 27, wherein the length of the elongate member is about 4.0 mm and the maximum length of the central portion is about 3.0 mm.

30. The anchor system of claim 24, wherein the first anchor body includes a bore extending through the central portion for receiving the suture.

31. The anchor system of claim 24, wherein the second anchor body further comprises a recess formed at one end of the bore and adapted to seat the slip knot formed on the suture.

32. The anchor system of claim 31, wherein the circular base is positioned radially outward of the recess.

33. The anchor system of claim 24, wherein the first and second anchor bodies are formed from a bioabsorbable polymeric material.

34. The anchor system of claim 24, wherein the suture is selected from the group consisting of non-bioabsorbable and bio-absorbable sutures.

35. The anchor system of claim 24, further comprising a delivery device adapted to seat the first anchor body.

36. The anchor system of claim 35, wherein the delivery device is adapted to seat a plurality of anchor bodies.

37. The anchor system of claim 35, wherein the delivery device includes an elongate needle having a channel formed in at least a distal portion thereof and adapted to slidably receive at least a portion of the first anchor body.

38. The anchor system of claim 37, wherein the opposed wing members of the first anchor body are formed from an elongate, generally cylindrical member coupled to the central portion, the elongate, generally cylindrical member being adapted to be slidably disposed within the channel formed in the elongate needle of the delivery device.

39. The anchor system of claim 37, wherein the substantially cylindrical central portion of the second anchor body has an outer diameter that is substantially the same as or less than an inner diameter of the channel in the elongate needle of the delivery device.

40. The anchor system of claim 37, wherein at least the distal-most portion of the delivery needle has a diameter in the range of about 16 to 18 gauge.

41. The anchor system of claim 37, further comprising a handle member coupled to the elongate needle, and a trigger mechanism formed on the handle and effective to, upon actuation, advance the first anchor body in a distal direction.

42. The anchor system of claim 37, further comprising a handle member coupled to the elongate needle and having a suture-receiving channel formed therein.

43. A method for repairing tears in the triangular fibrocartilage complex of a patient'"'"'s wrist, comprising:

passing a delivery device through a portion of a torn triangular fibrocartilage complex of a patient'"'"'s wrist at a first location, the delivery device carrying first and second anchor bodies that are connected to one another by a suture;

releasing the first anchor body from the delivery device such that the first anchor body is resting against an anchoring tissue;

passing the delivery device through a portion of the torn triangular fibrocartilage complex of a patient'"'"'s wrist at a second location adjacent to the first location;

releasing the second anchor body from the delivery device such that the second anchor body is resting against the anchoring tissue adjacent to the first anchor body, and the suture extends from the first anchor body and second anchors bodies across the torn triangular fibrocartilage complex, and a portion of the suture rests against a tissue surface opposed to the anchoring tissue; and

tensioning the suture to re-approximate the torn triangular fibrocartilage complex.

44. The method of claim 43, wherein the tissue surface that a portion of the suture rests against comprises the triangular fibrocartilage complex.

45. The method of claim 43, wherein the anchoring tissue is the triangular fibrocartilage complex, and the tissue surface that a portion of the suture rests against is selected from the group consisting of the dorsal capsule and the extensor carpi ulnaris subsheath, and the ulna bone.

46. The method of claim 43, wherein the anchoring tissue is the triangular fibrocartilage complex, and the tissue surface that a portion of the suture rests against comprises the radius bone.