Method and system for repairing a tear in the meniscus

• US 5,320,633 A
• Filed: 12/10/1992
• Issued: 06/14/1994
• Est. Priority Date: 12/10/1992
• Status: Expired due to Term

• Current Assignee: Curators of the University of Missouri (University of Missouri)
• Original Assignee: William C. Allen
• Inventors: Allen, William C., Maurizi, Michael G.
• Primary Examiner(s): Graysay, Tamara L.
• Application Number:
  US07/988,454
• Time in Patent Office: 551 Days
• Field of Search: 606/139, 606/144, 606/148, 606/151, 606/213, 606/215, 606/220, 128/898, 623/11, 623/13, 24/706.3, 24/708.5, 24/709.5
• US Class Current: 606/144
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• 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 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/068 Surgical staplers , e.g. containing multiple staples or clampsstaplers containing only one staple A61B17/10; magazines or containers for staples A61B17/105; for performing anastomosis A61B17/115; staplers in general B25C5/00
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable or resorptive
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/0646 for insertion into cartillege, e.g. meniscus
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61F 2/3872 Meniscus for implantation between the natural bone surfaces

Abstract

A system for repairing a tear in the meniscus in the knee joint including a suture having a first leg, a second leg spaced from the first leg and a cross member connecting the first and second legs. An instrument for delivering the suture to the meniscus can be inserted through an incision in the knee and into the vicinity of the meniscus. A first end of the instrument enters the meniscus adjacent to a first side of the tear, passes through the meniscus and exits the meniscus on a second side of the tear in the meniscus generally opposite the first side of the tear. The instrument has a channel extending longitudinally of the instrument in which the first leg of the suture can be inserted. A push rod pushes the first leg and cross member generally lengthwise in the channel and into the meniscus where the suture closes the tear.

Claims

1. A method for repairing a tear in the meniscus at the knee joint, the method comprising the steps of:

making an incision generally at the knee for permitting access to the interior of the knee;

inserting an instrument through the incision to the vicinity of the tear in the meniscus;

entering the meniscus adjacent to a first side of the tear with an end of the instrument;

passing the end of the instrument through the meniscus and exiting the meniscus on a second side of the tear in the meniscus generally opposite the first side of the tear such that the instrument extends through a passage in the meniscus having an entrance on the first side of the tear and an exit on the second side of the tear;

delivering said suture means in the instrument to said passage, said suture means comprising a first leg, a second leg spaced from the first leg and a cross member extending generally transversely with respect to the lengthwise extension of the first and second legs and connecting the first and second legs;

pushing the first leg and cross member generally lengthwise into said passage through the entrance thereof with the first leg and the cross member being resiliently deflected from;

their relaxed positions relative to one another, the first leg moving back to its relaxed position relative to the cross member upon passing out of said passage through the exit thereof and leaving the instrument, the first leg thereafter extending transversely with respect to the lengthwise extension of said passage across the exit thereof and being adapted to engage the meniscus around the exit so that the first leg cannot move back into said passage through the exit, the second leg extending generally transversely with respect to the lengthwise extension of said passage across the entrance thereof and being adapted to engage the meniscus around the entrance of said passage so that the second leg cannot move into said passage through the entrance, and the cross member being disposed in said passage;

the cross member having a length less than the length of said passage such that the first leg and second leg compress the meniscus on opposite sides of the tear to at least partially close the tear.

2. A method as set forth in claim 1 wherein the instrument has an elongated channel therein opening at the end of the instrument which enters the meniscus and at an opposite end of the instrument located outside the knee, the channel being shaped and dimensioned for receiving the first leg of said suture means therein with the lengthwise extension of the first leg parallel to the lengthwise extension of the channel, and wherein the step of pushing the first leg and cross member comprises the steps of:

inserting the first leg of said suture means into the channel in the instrument with the leg being held from substantial radial movement in the channel;

inserting an end of a push rod into the channel from the end of the instrument outside the knee and engaging the first leg therewith;

sliding the push rod into the channel thereby pushing the first leg in the channel, through said passage in the meniscus and out of the channel at the end of the instrument which enters the meniscus; and

withdrawing the instrument from the meniscus with said suture means remaining in the meniscus to close the tear therein.

3. A method as set forth in claim 2 further comprising, prior to the step of inserting the instrument through the incision, the steps of:

inserting elongated guide pin means through the incision to the vicinity of the tear in the meniscus;

penetrating the meniscus adjacent to a first side of the tear with an end of said guide pin means;

passing the end of said guide pin means through the meniscus and exiting the meniscus on a second side of the tear in the meniscus generally opposite the first side of the tear thereby to form said passage through the meniscus;

and wherein the steps of inserting the instrument through the incision, entering the meniscus and passing through said passage and exiting the meniscus comprise the steps of,

sliding the instrument over said guide pin means at an end of said guide pin means opposite the end which penetrates the meniscus with said guide pin means being received in the channel of the instrument,

pushing the instrument along said guide pin means toward the end of said guide pin means which penetrates the meniscus, the end of the instrument entering said passage in the meniscus through its entrance and exiting said passage through the exit,

and wherein the method further comprises the step of withdrawing said guide pin means from the instrument and the knee through the opening in the channel at the end of the instrument outside the knee.

4. A method as set forth in claim 3 wherein the method further comprises the step, prior to said step of withdrawing said guide pin means from the instrument, of gauging the proper size of suture means needed to close the tear using longitudinally spaced graduations on said guide pin means.

5. A method as set forth in claim 2, and wherein the method further comprises, prior to the step of inserting the instrument through the incision, the steps of:

inserting elongated guide pin means through the incision to the vicinity of the tear in the meniscus said guide pin means having longitudinally spaced graduations thereon;

penetrating the meniscus adjacent to a first side of the tear with an end of said guide pin means;

passing the end of said guide pin means through the meniscus and exiting the meniscus on a second side of the tear in the meniscus generally opposite the first side of the tear thereby to from said passage through the meniscus;

closing the tear;

gauging the size of suture means needed to close the tear using the graduations on said guide pin.

6. A system for repairing a tear in the meniscus in the knee joint, the system comprising:

suture means having a first leg, a second leg spaced from the first leg and a cross member extending generally transversely with respect to the lengthwise extensions of the first and second legs and connecting the first and second legs;

an instrument for delivering said suture means to the meniscus, the instrument being adapted for insertion through an incision in the knee and into the vicinity of the meniscus, a first end of the instrument being adapted to enter the meniscus adjacent to a first side of the tear, passing through the meniscus and exiting the meniscus on a second side of the tear in the meniscus generally opposite the first side of the tear such that the instrument extends through a passage in the meniscus having an entrance on the first side of the tear and an exit on the second side of the tear;

the instrument having a channel therein extending longitudinally of the instrument and opening at the first end, the first leg of said suture means being adapted for insertion into the channel and for sliding movement generally longitudinally of the channel, the channel being dimensioned and shaped so that the first leg is held from substantial movement in the channel in directions transverse to the lengthwise extension of the channel;

pusher means for pushing the first leg and cross member of said suture means generally lengthwise in the channel and into said passage through the entrance thereof with the first leg and the cross member being resiliently deflected from their relaxed positions relative to one another, the first leg moving back to its relaxed position relative to the cross member upon leaving said passage through the exit thereof, the first leg thereafter extending transversely with respect to the lengthwise extension of said passage across the exit thereof and being adapted to engage the meniscus around the exit so that the first leg cannot move back into said passage through the exit, the second leg being adapted to extend generally transversely with respect to the lengthwise extension of said passage across the entrance thereof and to engage the meniscus around the entrance of said passage so that the second leg cannot move into said passage through the entrance, and the cross member being disposed in said passage;

the cross member having a predetermined length such that the first leg and second leg compress the meniscus on opposite sides of the tear to at least partially close the tear;

elongated guide pin means having a plurality of longitudinally spaced graduations thereon and a sharpened end for penetrating the meniscus adjacent to the first side of the tear, the sharpened end being adapted to pass through the meniscus and exit the meniscus on the second side of the tear in the meniscus generally opposite the first side of the tear thereby to from said passage through the meniscus, said guide pin means being sized and shaped to be received in the channel of the instrument for guiding insertion of the instrument into and through said passage in the meniscus.

7. A system as set forth in claim 6 wherein said suture means is generally H-shaped.

8. A system as set forth in claim 7 wherein said suture means is made of material which is capable of being absorbed by the body.

9. A system as set forth in claim 6 wherein said guide pin means has a plurality of longitudinally spaced graduations thereon for use in gauging the size of the tear in the meniscus for use in determining the proper size of said suture means needed to close the tear.

10. A system as set forth in claim 6 wherein said pusher means comprises an elongated pusher rod sized and shaped for reception in the channel and for sliding longitudinally in the channel, an end of the pusher rod being adapted to engage the first leg in the channel of the instrument for pushing the first leg in the channel.

11. A system as set forth in claim 10 wherein said pusher rod has a handle mounted generally on its ends opposite the end adapted to engage the first leg of said suture means in the channel.

12. A system for repairing a tear in the meniscus in the knee joint, the system comprising:

suture means having a first leg, a second leg spaced from the first leg and a cross member extending generally transversely with respect to the lengthwise extensions of the first and second legs and connecting the first and second legs;

an instrument for delivering said suture means to the meniscus, the instrument being adapted for insertion through an incision in the knee and into the vicinity of the meniscus, a first end of the instrument being adapted to enter the meniscus adjacent to a first side of the tear, passing through the meniscus and exiting the meniscus on a second side of the tear in the meniscus generally opposite the first side of the tear such that the instrument extends through a passage in the meniscus having an entrance on the first side of the tear and an exit on the second side of the tear;

the instrument having a channel therein extending longitudinally of the instrument and opening at the first end and at a second end of the instrument opposite the first end, the first leg of said suture means being adapted for insertion into the channel generally at the second end thereof and for sliding movement generally longitudinally of the channel, the channel being dimensioned and shaped so that the first leg is held from substantial movement in the channel in directions transverse to the lengthwise extension of the channel;

said suture means being movable generally lengthwise in the channel and into said passage through the entrance thereof with the first leg and the cross member being resiliently deflected from their relaxed positions relative to one another, the first leg moving back to its relaxed position relative to the cross member upon passing out of said passage through the exit thereof and leaving the instrument, the first leg thereafter extending transversely with respect to the lengthwise extension of said passage across the exit thereof and being adapted to engage the meniscus around the exit so that the first leg cannot move back into said passage through the exit, the second leg extending generally transversely with respect to the lengthwise extension of said passage across the entrance thereof and being adapted to engage the meniscus around the entrance of said passage so that the second leg cannot move into said passage through the entrance, and the cross member being disposed in said passage;

the cross member of said suture means having a predetermined length such that the first leg and second leg compress the meniscus on opposite sides of the tear to at least partially close the tear;

elongated guide pin means having a plurality of longitudinally spaced graduations thereon and a sharpened end for penetrating the meniscus adjacent to the first side of the tear, the sharpened end being adapted to pass through the meniscus and exit the meniscus on the second side of the tear in the meniscus generally opposite the first side of the tear thereby to form said passage through the meniscus, said guide pin means being sized and shaped to be received in the channel of the instrument for guiding insertion of the instrument into and through said passage in the meniscus.

13. A system as set forth in claim 12 wherein said guide pin means has a plurality of longitudinally spaced graduations thereon for use in gauging the size of the tear in the meniscus for use in determining the proper size of said suture means needed to close the tear.

14. A system as set forth in claim 12 wherein said suture means is generally H-shaped.

15. A system as set forth in claim 14 wherein said suture means is made of material which is capable of being absorbed by the body.

16. A system as set forth in claim 12 further comprising an elongated pusher rod sized and shaped for reception in the channel and for sliding longitudinally in the channel, an end of the pusher rod being adapted to engage the first leg in the channel of the instrument for pushing the first leg in the channel.

17. A system as set forth in claim 16 wherein said pusher rod has a handle mounted generally on its end opposite the end adapted to engage the first leg of said suture means in the channel.