Method and apparatus for positioning a suture anchor

• US 5,814,073 A
• Filed: 12/13/1996
• Issued: 09/29/1998
• Est. Priority Date: 12/13/1996
• Status: Expired due to Term

• Current Assignee: Bonutti Skeletal Innovations LLC (Acacia Research Corporation)
• Original Assignee: Peter M. Bonutti
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): Buiz, Michael Powell
• Assistant Examiner(s): PHAM, THUY D
• Application Number:
  US08/764,199
• Time in Patent Office: 655 Days
• Field of Search: 606/232, 606/104, 606/213, 604/904, 604/11, 604/14-16, 604/18
• 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 17/06066 Needles, e.g. needle tip configurations making needles B21G1/00
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3431 being collapsible, e.g. made of thin flexible material A61B17/3423 takes precedence
• CPC Class Codes: A61B 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/3486 Balloon
• CPC Class Codes: A61M 2025/0024 Expandable catheters or sheaths
• CPC Class Codes: A61M 2025/0089 Single injection needle protruding axially, i.e. along the longitudinal axis of the catheter, from the distal tip
• CPC Class Codes: A61M 2025/0095 being one or more needles protruding from the distal tip and which are not used for injection nor for electro-stimulation, e.g. for fixation purposes
• CPC Class Codes: A61M 25/0084 being one or more injection needles
• CPC Class Codes: A61M 25/04 in the body, e.g. expansible A61M25/10, A61M16/0488 take precedence
• CPC Class Codes: A61M 25/06 Body-piercing guide needles or the like
• CPC Class Codes: A61M 25/0662 Guide tubes

Abstract

An inserter assembly is operable between a closed condition blocking movement of a suture anchor through the inserter assembly and an open condition in which the inserter assembly is ineffective to block movement of the anchor. The inserter assembly may have an end portion which pierces body tissue. In one embodiment, a tubular member has a plurality of segments which are moved from a closed condition to an open condition. In another embodiment, a plurality of wires extend along an inner side of a passage in a sheath. As the suture anchor slides along the wires, force is transmitted to the sheath to expand the sheath and operate the inserter assembly from the closed condition to the open condition. If desired, the wires may be omitted and the sheath resiliently expanded by a member which encloses the suture anchor. Indicia may be provided to indicate the depth to which the inserter assembly is inserted into body tissue.

Claims

1. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of positioning an end portion of a tubular member relative to body tissue with the end portion of the tubular member in a closed condition at least partially blocking a passage in the tubular member, said step of positioning the end portion of the tubular member relative to body tissue with the end portion of the tubular member in the closed condition includes piercing an imperforate surface on the body tissue with the end portion of the tubular member, moving a suture anchor along the passage in the tubular member with a suture disposed in engagement with the suture anchor, operating the end portion of the tubular member from the closed condition to an open condition, and moving the suture anchor through the end portion of the tubular member into the body tissue while the end portion of the tubular member is in the open condition.

2. A method as set forth in claim 1 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes applying force against the end portion of the tubular member with a leading end portion of the suture anchor while moving the suture anchor along the passage in the tubular member.

3. A method as set forth in claim 1 wherein said step of moving the suture anchor through the end portion of the tubular member includes pressing a circular array of surface areas on the inside of the end portion of the tubular member against an exterior surface of the suture anchor.

4. A method as set forth in claim 1 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes moving portions of segments of the end portion of the tubular member apart.

5. A method as set forth in claim 1 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes sliding the suture anchor along outer side surfaces of a plurality of wires disposed in the end portion of the tubular member.

6. A method as set forth in claim 1 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes resiliently expanding the end portion of the tubular member under the influence of force applied against the end portion of the tubular member by the anchor.

7. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of positioning an end portion of a tubular member relative to body tissue with the end portion of the tubular member in a closed condition at least partially blocking a passage in the tubular member, said step of positioning an end portion of the tubular member relative to body tissue includes moving the end portion of the tubular member into body tissue until indicia on the end portion of the tubular member indicates that the tubular member has been inserted a predetermined distance into the body tissue, moving a suture anchor along the passage in the tubular member with a suture disposed in engagement with the suture anchor, operating the end portion of the tubular member from the closed condition to an open condition, and moving the suture anchor through the end portion of the tubular member into the body tissue while the end portion of the tubular member is in the open condition.

8. A method as set forth in claim 7 wherein said step of positioning the end portion of the tubular member relative to body tissue with the end portion of the tubular member in the closed condition includes piercing an imperforate surface on the body tissue with the end portion of the tubular member.

9. A method as set forth in claim 8 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes applying force against the end portion of the tubular member with a leading end portion of the suture anchor while moving the suture anchor along the passage in the tubular member.

10. A method as set forth in claim 7 wherein said step of moving the suture anchor through the end portion of the tubular member includes pressing a circular array of surface areas on the inside of the end portion of the tubular member against an exterior surface of the suture anchor.

11. A method as set forth in claim 7 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes moving portions of segments of the end portion of the tubular member apart.

12. A method as set forth in claim 7 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes sliding the suture anchor along outer side surfaces of a plurality of wires disposed in the end portion of the tubular member.

13. A method as set forth in claim 7 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes resiliently expanding the end portion of the tubular member under the influence of force applied against the end portion of the tubular member by the anchor.

14. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of positioning an end portion of a tubular member relative to body tissue with the end portion of the tubular member in a closed condition at least partially blocking a passage in the tubular member, said step of positioning an end portion of the tubular member relative to body tissue includes moving the end portion of the tubular member into body tissue and covering indicia corresponding to the depth of movement of the tubular member into body tissue with body tissue as the tubular member is moved into the body tissue, interrupting said step of moving the end portion of the tubular member into body tissue upon covering of indicia corresponding to a desired depth of insertion of the tubular member into the body tissue, moving a suture anchor along the passage in the tubular member with a suture disposed in engagement with the suture anchor, operating the end portion of the tubular member from the closed condition to an open condition, and moving the suture anchor through the end portion of the tubular member into the body tissue while the end portion of the tubular member is in the open condition.

15. A method as set forth in claim 14 wherein said step of positioning the end portion of the tubular member relative to body tissue with the end portion of the tubular member in the closed condition includes piercing an imperforate surface on the body tissue with the end portion of the tubular member.

16. A method as set forth in claim 14 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes applying force against the end portion of the tubular member with a leading end portion of the suture anchor while moving the suture anchor along the passage in the tubular member.

17. A method as set forth in claim 14 wherein said step of moving the suture anchor through the end portion of the tubular member includes pressing a circular array of surface areas on the inside of the end portion of the tubular member against an exterior surface of the suture anchor.

18. A method as set forth in claim 14 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes moving portions of segments of the end portion of the tubular member apart.

19. A method as set forth in claim 14 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes sliding the suture anchor along outer side surfaces of a plurality of wires disposed in the end portion of the tubular member.

20. A method as set forth in claim 14 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes resiliently expanding the end portion of the tubular member under the influence of force applied against the end portion of the tubular member by the anchor.

21. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a suture anchor having a suture disposed in engagement with the suture anchor, providing a tubular member, inserting the tubular member into body tissue, covering indicia on the tubular member with body tissue as the tubular member is inserted into the body tissue, interrupting said step of inserting the tubular member into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the tubular member into body tissue, moving the suture anchor along a passage in the tubular member with the suture disposed in engagement with the suture anchor, expanding at least a portion of the passage in the tubular member while moving the suture anchor along the passage in the tubular member, and moving the suture anchor out of the passage in the tubular member into the body tissue with the suture disposed in engagement with the suture anchor.

22. A method as set forth in claim 21 wherein said step of expanding at least a portion of the passage in the tubular member includes transmitting force from a leading end portion of the suture anchor to the tubular member while moving the suture anchor along the passage in the tubular member and expanding at least a portion of the tubular member under the influence of the force transmitted from the leading end portion of the suture anchor to the tubular member.

23. A method as set forth in claim 21 wherein said step of inserting the tubular member into the body tissue includes piercing the body tissue with an end portion of the tubular member prior to performing said step of expanding at least a portion of the passage in the tubular member.

24. A method as set forth in claim 21 wherein said step of expanding at least a portion of the passage in the tubular member includes resiliently stretching material which forms at least a portion of the tubular member.

25. A method as set forth in claim 21 wherein said step of expanding at least a portion of the passage in the tubular member includes moving segments of the tubular member from an initial position in which portions of the segments of the tubular member are disposed in engagement with each other to an extended position in which the portions of the segments of the tubular member are spaced apart from each other.

26. A method as set forth in claim 21 wherein said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, said step of moving the suture anchor along a passage in the tubular member includes sliding the suture anchor along the wires.

27. A method as set forth in claim 26 wherein said step of expanding at least a portion of the passage in the tubular member includes expanding at least a portion of the sheath under the influence of force applied against the wires by the suture anchor while sliding the suture anchor along the wires.

28. A method as set forth in claim 21 wherein said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, said step of moving the suture anchor along a passage in the tubular member includes applying force against the suture anchor with a pusher member and sliding the pusher member along the wires.

29. A method as set forth in claim 21 wherein said step of moving the suture anchor along a passage in the tubular member is performed with at least a portion of the suture anchor enclosed by an expansion member, said step of expanding at least a portion of the passage in the tubular member includes transmitting force from the expansion member to the tubular member while moving the expansion member and the suture anchor together along the passage in the tubular member.

30. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a suture anchor having a suture disposed in engagement with the suture anchor, providing a tubular member, moving the suture anchor along a passage in the tubular member with the suture disposed in engagement with the suture anchor, expanding at least a portion of the passage in the tubular member while moving the suture anchor along the passage in the tubular member, inserting the tubular member into the body tissue by piercing an imperforate surface area on the body tissue with an end portion of the tubular member prior to performing said step of expanding at least a portion of the passage in the tubular member, moving the suture anchor out of the passage in the tubular member into the body tissue with the suture disposed in engagement with the suture anchor, said steps of expanding at least a portion of the passage in the tubular member and moving the suture anchor out of the passage in the tubular member into body tissue include applying force against the suture anchor with a pusher member, and, thereafter, changing the orientation of the suture anchor relative to the body tissue by applying force against the suture anchor with the pusher member and tensioning the suture.

31. A method as set forth in claim 30 wherein said step of expanding at least a portion of the passage in the tubular member includes transmitting force from a leading end portion of the suture anchor to the tubular member while moving the suture anchor along the passage in the tubular member and expanding at least a portion of the tubular member under the influence of the force transmitted from the leading end portion of the suture anchor to the tubular member.

32. A method as set forth in claim 30 wherein said step of expanding at least a portion of the passage in the tubular member includes resiliently stretching material which forms at least a portion of the tubular member under the influence of force transmitted from the pusher member through the suture anchor to the tubular member.

33. A method as set forth in claim 30 wherein said step of expanding at least a portion of the passage in the tubular member includes moving segments of the tubular member from an initial position in which portions of the segments of the tubular member are disposed in engagement with each other to an extended position in which the portions of the segments of the tubular member are spaced apart from each other under the influence of force transmitted from the pusher member through the suture anchor to the segments of the tubular member.

34. A method as set forth in claim 30 wherein said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, said step of moving the suture anchor along a passage in the tubular member includes sliding the suture anchor along the wires.

35. A method as set forth in claim 34 wherein said step of expanding at least a portion of the passage in the tubular member includes expanding at least a portion of the sheath under the influence of force applied against the wires by the suture anchor while sliding the suture anchor along the wires.

36. A method as set forth in claim 30 wherein said step of providing a tubular member includes providing a tubular member having a sheath which at least partially encloses a plurality of wires which extend along at least a portion of the passage in the tubular member, said step of moving the suture anchor along a passage in the tubular member includes applying force against the suture anchor with the pusher member and sliding the pusher member along the wires.

37. A method as set forth in claim 30 wherein said step of moving the suture anchor along a passage in the tubular member is performed with at least a portion of the suture anchor enclosed by an expansion member, said step of expanding at least a portion of the passage in the tubular member includes transmitting force from the expansion member to the tubular member while moving the expansion member and the suture anchor together along the passage in the tubular member.

38. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of providing a suture anchor having a suture disposed in engagement with the suture anchor, providing a tubular member, moving the suture anchor along a passage in the tubular member with the suture disposed in engagement with the suture anchor, inserting the tubular member into body tissue, covering indicia on the tubular member with body tissue as the tubular member is inserted into the body tissue, interrupting said step of inserting the tubular member into body tissue in response to covering of indicia corresponding to a desired depth of insertion of the tubular member into body tissue, expanding at least a portion of the passage in the tubular member while moving the suture anchor along the passage in the tubular member, moving the suture anchor out of the passage in the tubular member into the body tissue with the suture disposed in engagement with the suture anchor, said steps of expanding at least a portion of the passage in the tubular member and moving the suture anchor out of the passage in the tubular member into body tissue include applying force against the suture anchor with a pusher member, and, thereafter, changing the orientation of the suture anchor relative to the body tissue by applying force against the suture anchor with the pusher member and tensioning the suture.

39. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of positioning an end portion of a tubular member relative to body tissue with the end portion of the tubular member in a closed condition at least partially blocking a passage in the tubular member, said step of positioning the end portion of the tubular member relative to body tissue with the end portion of the tubular member in the closed condition includes forming an opening in the body tissue at a location which is free of naturally occurring openings and moving the end portion of the tubular member into the opening, said step of forming an opening in the body tissue at the location which is free of naturally occurring openings includes piercing an imperforate surface on the body tissue with the end portion of the tubular member, moving a suture anchor along the passage in the tubular member with a suture disposed in engagement with the suture anchor, operating the end portion of the tubular member from the closed condition to an open condition while the end portion of the tubular member is in the opening formed in the body tissue at the location which is free of naturally occurring openings, and moving the suture anchor through the end portion of the tubular member into the body tissue while the end portion of the tubular member is in the open condition.

40. A method as set forth in claim 39 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes applying force against the end portion of the tubular member with a leading end portion of the suture anchor while moving the suture anchor along the passage in the tubular member with a portion of the suture disposed between an outer side surface on the suture anchor and an inner side surface on the tubular member.

41. A method as set forth in claim 39 wherein said step of moving the suture anchor through the end portion of the tubular member includes pressing a circular array of surface areas on the inside of the end portion of the tubular member against an exterior surface of the suture anchor.

42. A method as set forth in claim 39 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes moving portions of segments of the end portion of the tubular member apart.

43. A method as set forth in claim 39 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes sliding the suture anchor along outer side surfaces of a plurality of wires disposed in the end portion of the tubular member.

44. A method as set forth in claim 39 wherein said step of operating the end portion of the tubular member from the closed condition to the open condition includes resiliently expanding the end portion of the tubular member under the influence of force applied against the end portion of the tubular member by the anchor.

45. A method as set forth in claim 39 wherein said step of moving a suture anchor along the passage in the tubular member is performed with a portion of the suture disposed between an outer side surface on the suture anchor and an inner side surface on the tubular member and includes sliding the portions of the suture disposed between the outer side surface on the suture anchor and the inner side surface on the tubular member along the inner side surface of the tubular member.

46. An apparatus comprising an anchor, a suture having a connector section which extends through said anchor, said suture having first and second leg sections which are connected with said connector section, a tubular member through which said anchor is movable, said first and second leg sections of said suture extend from a first end portion of said tubular member with at least one of said leg sections being at least partially disposed between an outer side surface on said anchor and an inner side surface on said tubular member, and a pusher member which is at least partially disposed in said tubular member and along which said first and second leg sections of said suture extend from said tubular member, said tubular member having a second end portion which is operable from a closed condition blocking movement of said anchor through said second end portion of said tubular member and an open condition in which said second end portion of said tubular member is ineffective to block movement of said anchor into body tissue with said first and second leg sections of said suture extending from said anchor, said pusher member having leading end surface means for applying force against a trailing end of said anchor to press a leading end of said anchor against said second end portion of said tubular member to operate said second end portion of said tubular member from the closed condition to the open condition under the influence of force transmitted from said pusher member through said anchor to said second end portion of said tubular member while said one of said leg sections of said suture is at least partially disposed between said outer side surface on said anchor and said inner side surface on said tubular member, said end portion of said tubular member includes a plurality of segments, each of said segments having an inner surface, an outer surface and a plurality of side surfaces which extend between said inner and outer surfaces, said side surfaces on each of said segments being disposed adjacent to side surfaces on adjacent segments when said end portion of said tubular member is in the closed condition, said outer surfaces on said segments cooperating to form a pointed end of said tubular member when said second end portion of said tubular member is in the closed condition, said pointed end of said tubular member having surface means for piercing an imperforate surface area on body tissue.

47. An apparatus as set forth in claim 46 wherein said end portion of said tubular member is resiliently expandable from the closed condition to the open condition under the influence of force applied against an inner side of said tubular member by said anchor to enable the anchor to move through said second end portion of the tubular member into body tissue with said first and second leg sections of said suture extending from said anchor through said tubular member.

48. An apparatus as set forth in claim 46 wherein said tubular member has a body portion which is connected with said first and second end portions of said tubular member, said body portion and said first and second end portions of said tubular member cooperating to define a passage which extends through said body portion and said first and second end portions when said second end portion is in the open condition, said second end portion of said tubular member being expandable to increase the cross-sectional size of a portion of the passage in said second end portion of said tubular member upon operation of said second end portion of said tubular member from the closed condition to the open condition.

49. An apparatus as set forth in claim 46 wherein said tubular member includes a plurality of wires connected with said plurality of segments, said plurality of segments being resiliently deflectable to effect relative movement between said plurality of segments and to effect relative movement between said plurality of wires.

50. An apparatus as set forth in claim 46 wherein said tubular member includes a sheath and an array of wires which extend along an inner side of said sheath, said array of wires extend from said body portion of said tubular member into said second end portion of said tubular member.

51. An apparatus as set forth in claim 46 wherein said end portion of said tubular member is insertable into body tissue, said end portion of said tubular member having indicia means disposed thereon for indicating the depth of insertion of said end portion of said tubular member into body tissue as the body tissue is pierced by said second end portion of said tubular member.