ADJUSTABLE KNOTLESS LOOPS

• US 20090082805A1
• Filed: 08/22/2008
• Published: 03/26/2009
• Est. Priority Date: 09/29/2006
• 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., Kaiser, Ryan A.
• Granted Patent: US 7,959,650 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 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 2017/00336 with a protective sleeve, e.g. retractable or slidable
• CPC Class Codes: A61B 2017/00858 high friction or non-slip
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• 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 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2017/06185 hollow or tubular
• CPC Class Codes: A61F 2/0811 Fixation devices for tendons or ligaments
• 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

Methods of attaching a soft tissue to an adjacent bone at a defect site are provided. At least one adjustable loop of a flexible construct is passed through the soft tissue. The at least one adjustable loop is passed through a passage construct. A locking member is passed through the at least one adjustable loop and the adjustable loop is reduced about or within the locking member such that the at least one loop is frictionally retained in the passage construct and locked in place by the locking member to thereby secure the soft tissue.

Claims

1. A method of attaching a first tissue to a second tissue at a site in need of repair comprising:

a. passing at least one adjustable loop of a flexible construct through at least the first tissue;

b. passing the at least one adjustable loop of the flexible construct through a passage construct;

c. passing a locking member through the at least one adjustable loop of the flexible construct; and

d. reducing the at least one adjustable loop of the flexible construct about the locking member such that the at least one loop is frictionally retained at the passage construct and locked in place by the locking member to thereby secure at least the first tissue.

2. The method of claim 1, further comprising passing two adjustable loops through the first tissue or the second tissue.

3. The method of claim 2, wherein the two adjustable loops are defined by a single flexible construct.

4. The method of claim 2, wherein the two adjustable loops are defined by two different flexible constructs.

5. The method of claim 1, wherein passing the locking member through the at least one adjustable loop is performed extra corporeally.

6. The method of claim 1, wherein reducing the at least one adjustable loop comprises engaging an adjusting arm defined by the flexible construct.

7. The method of claim 1, further comprising selectively displacing the locking member to allow the adjustable loop of the flexible construct to selectively move during the reducing of the at least one adjustable loop.

8. The method of claim 1, further comprising passing two locking members through the at least one adjustable loop.

9. The method of claim 1, wherein the locking member is selected from the group consisting of a post, a knotted length of suture, a bar, a dumbbell, and an elbow.

10. The method of claim 1, further comprising pressing the locking member within, about, or adjacent to the adjustable loop.

11. The method of claim 1, wherein the locking member is defined by a region of the passage construct.

12. The method of claim 1, further comprising placing the locking member relative to the adjustable loop to selectively add slack to the adjustable loop.

13. The method of claim 1, further comprising:

a. passing a plurality of adjustable loops through at least the first tissue;

b. passing the plurality of adjustable loops through the passage construct;

c. reducing the plurality of adjustable loops about a plurality of locking members;

d. disposing the plurality of locking members between selected adjustable loops of the plurality of flexible constructs to selectively provide slack to the adjustable loops; and

e. sequentially reducing each adjustable loop while the slack provided by the locking members maintains adequate free movement of members of the plurality of adjustable loops of the plurality of flexible constructs prior to reduction thereof.

14. The method of claim 1, further comprising passing at least two adjustable loops through at least the first tissue and interlacing the adjustable loops to provide a suture bridge.

15. A method of attaching a first tissue to a second tissue at a site in need of repair comprising:

a. disposing an adjustable loop of a flexible construct through a bore defined by a fastener;

b. securing a restriction element of the adjustable loop of the flexible construct on a receiving surface of the fastener;

c. passing the adjustable loop through the first tissue;

d. fixing the fastener to the second tissue such that the adjustable loop and a proximal end of the fastener face the site in need of repair; and

e. engaging an adjusting arm on the flexible construct to reduce the size of the adjustable loop and to reduce the distance between the anchor and the first tissue.

16. The method of claim 15, wherein disposing the adjustable loop comprises disposing a region of the adjustable loop in an interior bore defined by the fastener body that opens at a proximal end of the fastener body and disposing a region of the adjustable loop in a side channel defined by the interior of the fastener body.

17. The method of claim 15, wherein disposing the adjustable loop further comprises disposing a region of the adjustable loop on a plate component of the fastener.

18. The method of claim 15, wherein securing the restriction element of the flexible construct on the receiving surface of the fastener further comprises mounting the restriction element at a distal end of the fastener.

19. The method of claim 15, wherein the receiving surface is selected from the group consisting of a flat surface, a recessed surface, a post, and combinations thereof.

20. The method of claim 19, wherein securing the restriction element on the receiving surface comprises disposing the restriction element on a region of a post housed in the interior of the fastener body.

21. The method of claim 15, further comprising disposing a plurality of flexible constructs on the fastener.

22. The method of claim 21, further comprising interlacing the adjustable loops of the plurality of flexible constructs to form a suture bridge.

23. The method of claim 21, further comprising sequentially reducing each of the plurality of adjustable loops of the flexible constructs.

24. The method of claim 15, wherein the defect is an articular cartilage defect.

25. The method of claim 15, wherein the defect is a labral tear.

26. The method of claim 15, wherein engaging an adjusting arm further facilitates retaining the fastener proximal end in abutment with the soft tissue.

27. A method of attaching a soft tissue to a bone at a site in need of repair comprising:

passing a first adjustable loop of a first flexible construct contained in a bore defined by a first fastener through the soft tissue;

attaching the first fastener to the bone;

passing a second adjustable loop of a second flexible construct contained in a bore defined by a second fastener through the soft tissue;

attaching the second fastener to the bone;

passing the first adjustable loop and the second adjustable loop through a passage construct;

passing a locking member through the two adjustable loops; and

reducing the first and second adjustable loops about the locking member to thereby attach the soft tissue.

28. The method of claim 27, further comprising engaging a first adjusting arm on the first flexible construct to reduce the size of the first adjustable loop and engaging a second adjusting arm on the second flexible construct to reduce the size of the second adjustable loop and thereby forming a suture bridge to secure the soft tissue to the bone.

29. The method of claim 27, further comprising folding the locking member upon itself to create a ring locking member after attaching the first and second adjustable loops thereto.

30. The method of claim 27, further comprising engaging the first adjusting arm and the second adjusting arm at the proximal end of the respective fasteners to cause reduction of the respective adjustable loops.

31. The method of claim 27, further comprising passing a plurality of adjustable loops through a single fastener.

32. The method of claim 27, further comprising interlacing a plurality of adjustable loops from a plurality of fasteners to form the suture bridge.

33. The method of claim 27, further comprising securing the locking member to the soft tissue.

34. A method of attaching a rotator cuff to a bone at a site in need of repair comprising:

passing a first adjustable loop of a first flexible construct contained in a bore defined by a first fastener through the rotator cuff;

attaching the first fastener to the bone;

passing a second adjustable loop of a second flexible construct contained in a bore defined by a second fastener through the rotator cuff;

attaching the second fastener to the bone at a first distance to the first fastener;

passing the adjustable loops over a self-contained locking member; and

reducing the first and second adjustable loops about the locking member to thereby attach the rotator cuff to the bone.

35. The method of claim 34, further comprising passing a plurality of adjustable loops through at least one of the first fastener or the second fastener.

36. The method of claim 34, further comprising interlacing a plurality of adjustable loops from a plurality of fasteners to form a suture bridge.

37. The method of claim 34, further comprising sequentially reducing each of the plurality of adjustable loops of the flexible constructs.

38. The method of claim 34, wherein attaching the second fastener to the bone at a first distance from the first fastener comprises attaching the second fastener at a position selected from the group consisting of lateral to the first fastener, medial to the first fastener, anterior to the first fastener, or posterior to the first fastener.