TRANSOSTEAL ANCHORING METHODS FOR TISSUE REPAIR

• US 20150039030A1
• Filed: 08/04/2014
• Published: 02/05/2015
• Est. Priority Date: 01/10/2011
• Status: Active Grant

• Current Assignee: Ceterix Orthopaedics, Inc (Smith & Nephew PLC)
• Original Assignee: John G. McCutcheon, Justin D. Saliman, Michael J. Hendricksen
• Inventors: SALIMAN, Justin D., MCCUTCHEON, John G., HENDRICKSEN, Michael J.
• Granted Patent: US 9,913,638 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 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 17/062 Needle manipulators
• CPC Class Codes: A61B 17/0642 for bones, e.g. for osteosynthesis or connecting tendon to bone
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening
• 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 2017/0462 One way system, i.e. also tensioning the suture
• CPC Class Codes: A61F 2/0811 Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2002/0841 Longitudinal channel for insertion tool running through the whole tendon anchor, e.g. for accommodating bone drill, guidewire
• 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

Abstract

Described herein are methods and apparatuses for use in repair of a patient'"'"'s tissue by connecting the tissue to the bone using a transosteal tunnel and anchor configured to pass through the transosteal tunnel. In particular, described herein are methods of repairing an anterior cruciate ligament (ACL) and torn meniscal root. These anchoring apparatuses and method of using them are particularly well suited for use with the low-profile suture passers described herein, since these suture passers may allow access to previously inaccessible regions of the knee (or other body regions).

Claims

1. A method for transosteally repairing a tissue, the method comprising:

forming a tunnel through a bone so that the tunnel extends from a first side of the bone to a second side of the bone;

passing a suture anchor through the tunnel from the first side of the bone, through the tunnel and adjacent to the second side of the bone;

securing the suture anchor within the tunnel adjacent to the second side of the bone;

securing a torn end of the tissue to a suture; and

cinching the suture in the suture anchor by pulling the suture through the anchor from the second side of the bone and out of the first side of the bone.

2. The method of claim 1, further comprising securing the torn end of the tissue to a graft coupled to the anchor.

3. The method of claim 1, wherein forming a tunnel comprises drilling an elongate, straight tunnel through the bone.

4. The method of claim 1, wherein forming a tunnel comprises drilling an elongate, straight tunnel through the bone from the first side of the bone to the second side of the bone.

5. The method of claim 1, wherein forming a tunnel comprises forming the tunnel so that an opening into the tunnel on the first side of the bone is larger than an opening into the tunnel on the second side of the bone.

6. The method of claim 1, wherein forming a tunnel comprises driving a guidewire through the bone from the first side of the bone to the second side of the bone.

7. The method of claim 1, wherein passing a suture anchor comprises passing a suture anchor having a central passageway configured to permit a suture to be pulled in a first direction while preventing the suture from being pulled in a second direction that is opposite to the first direction.

8. The method of claim 1, wherein passing the suture anchor comprises screwing the suture anchor in the tunnel.

9. The method of claim 1, wherein securing the suture anchor within the tunnel adjacent to the second side of the bone comprises extending one or more locking arms from the suture anchor once it has been positioned adjacent to the second side of the bone.

10. The method of claim 1, wherein securing the suture anchor within the tunnel adjacent to the second side of the bone comprises securing the suture anchor within the tunnel so that a distal end of the suture anchor extends from the second side of the bone.

11. The method of claim 1, wherein securing the suture anchor within the tunnel adjacent to the second side of the bone comprises securing the suture anchor so that the suture anchor is recessed within the tunnel relative to the second side of the bone.

12. The method of claim 1, wherein securing the suture anchor within the tunnel adjacent to the second side of the bone comprises securing the suture anchor so that an end of the suture anchor is flush with the second side of the bone.

13. The method of claim 1, wherein securing a torn end of the tissue to a suture comprises precutaneously suturing the torn end of the tissue with a suture passer near the second side of the bone.

14. The method of claim 1, further comprising cutting the end of the suture extending from the first side of the bone.

15. The method of claim 1, further comprising filling the tunnel through the bone after cinching the suture in the anchor.

16. A method for the transosteal repairing a torn anterior cruciate ligament (ACL), the method comprising:

forming a tunnel through a femur so that the tunnel extends from a first side of the femur to a second side of the femur;

passing a suture anchor through the tunnel from the first side of the femur, through the tunnel and securing the suture anchor near the second side of the femur;

securing a torn end of the ACL to a suture; and

anchoring the suture in the suture anchor by pulling the suture through the anchor from the second side of the femur and out of the first side of the femur, wherein the anchor comprises a one-way lock configured to prevent the suture from pulling out of the anchor toward the second side of the femur.

17. A method for transosteally repairing an anterior cruciate ligament (ACL) within the femoral notch, the method comprising:

forming a tunnel through a femur so that the tunnel extends from a first side of the femur to a second side of the femur within the femoral notch;

anchoring a suture anchor within the tunnel and adjacent to the second side of the femur;

securing the suture anchor within the tunnel adjacent to the second side of the femur;

securing a torn end of the ACL to a suture; and

cinching the suture in the suture anchor by pulling the suture through the anchor from the second side of the femur and out of the first side of the femur, wherein the anchor comprises a one-way lock configured to prevent the suture from pulling out of the anchor toward the second side of the femur.

18. A method for the transosteal repairing a torn meniscal root, the method comprising:

forming a tunnel through a tibia so that the tunnel extends from a first side of the tibia to a second side of the tibia on the tibial plateau;

passing a suture anchor through the tunnel from the first side of the tibia, through the tunnel and securing the suture anchor near the second side of the tibia;

securing a torn end of the meniscal root to a suture; and

anchoring the suture in the suture anchor by pulling the suture through the anchor from the second side of the tibia and out of the first side of the tibia, wherein the anchor comprises a one-way lock configured to prevent the suture from pulling out of the anchor toward the second side of the tibia.

19. A method of arthroscopically repairing a torn meniscal root with a first suture and a second suture, the method comprising:

arthroscopically passing a first locking loop stitch through the meniscal tissue with a suture passer, by passing a loop of the first suture from a first side of the meniscal tissue to a second side of the meniscal tissue, passing a first end region of the first suture distal to the loop through the meniscal tissue and through the loop, and passing a second end region of the first suture proximal to the loop through the meniscal tissue and through the loop, and cinching the loop closed; and

forming a second suture stitch by pulling the second suture between the first side of the meniscal tissue and the second side of the meniscal tissue so that a distal end region and a proximal end region of the second suture extend from the meniscal tissue; and

anchoring the proximal and distal end regions of the second suture and the first and second end regions of the first suture.

20. The method of claim 19, further comprising forming a passage through either the tibia or the femur;

and pulling the proximal and distal end regions of the second suture and the first and second end regions of the first suture through the passage.

21. The method of claim 19, wherein arthroscopically passing the first locking loop stitch comprises passing the loop from an inferior to a superior surface of a meniscus with the suture passer.

22. The method of claim 19, further comprising arthroscopically positioning the suture passer with a first jaw between a superior surface of a meniscus and a femur and a second jaw between an inferior surface and a tibia.