Methods and apparatus for preventing migration of sutures through transosseous tunnels

• US 5,860,978 A
• Filed: 08/09/1996
• Issued: 01/19/1999
• Est. Priority Date: 09/25/1990
• Status: Expired due to Fees

• Current Assignee: DePuy Mitek Incorporated (Johnson & Johnson)
• Original Assignee: Innovasive Devices Inc. (Johnson & Johnson)
• Inventors: McDevitt, Dennis, Nicholson, James
• Primary Examiner(s): Brown, Michael A.
• Application Number:
  US08/689,443
• Time in Patent Office: 893 Days
• Field of Search: 606/72, 606/73, 606/232, 623/13, 623/14, 623/16, 411/54, 411/55, 411/57, 411/60
• US Class Current: 606/232
• CPC Class Codes: A01B 1/222 Adjustable blades
• 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 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/32053 Punch like cutting instruments, e.g. using a cylindrical or oval knife A61B17/326 takes precedence; trepans A61B17/1695; for use on the cornea A61F9/007
• CPC Class Codes: A61B 17/686 Plugs, i.e. elements forming interface between bone hole and implant or fastener, e.g. screw
• CPC Class Codes: A61B 17/82 for bone cerclage apparatus for manipulating wires or straps A61B17/8861; wires, bands or straps other than cerclage A61B17/842
• CPC Class Codes: A61B 2017/0403 Dowels other bone dowels A61B17/68; dowels for connecting prosthetic parts A61F2002/30433
• CPC Class Codes: A61B 2017/0406 Pledgets
• 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 2017/0424 the separate member staying in the anchor after placement
• CPC Class Codes: A61B 2017/0425 the anchor or the separate member comprising threads, e.g. a set screw in the anchor
• 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 2017/045 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 2017/0464 for soft tissue
• CPC Class Codes: A61B 2090/037 with a frangible part, e.g. by reduced diameter
• 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 2002/0835 : with deformation of anchor parts, e.g. expansion of dowel by set screw
• 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 2002/0864 : Fixation of tendon or ligament between anchor elements, e.g. by additional screws in the anchor, anchor crimped around tendon
• 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: Y10S 623/902 : Method of implanting

Abstract

An improved method for attaching soft tissue to bone by passing a suture through an opening in the bone, e.g., a transosseous tunnel, and affixing the soft tissue with the suture. The improvement, for preventing the suture from migrating through the bone at the end of the opening, includes placing a eyelet into an end of the bone opening and passing the suture through the eyelet, as well as through the opening in the bone, in order to affix the soft tissue to the bone with the suture.

Claims

1. In a method for attaching soft tissue to bone by passing a suture through a transosseous tunnel in the bone and affixing the soft tissue with the suture, the improvement, comprising the steps of

A. reinforcing an opening at an end of the tunnel by placing an eyelet into the end of the tunnel, the eyelet having an channel extending therethrough;

B. passing the suture through the channel of the eyelet, as well as through the transosseous tunnel, in order to affix the soft tissue to the bone with the suture.

3. In a method according to any of claims 1 and 2, the further improvement comprising screwing the eyelet into bone at the end of the tunnel.

4. In a method according to any of claims 1 and 2, the further improvement comprising affixing the eyelet into bone at the end of the tunnel by interference fit.

2. In a method for rotator cuff repair by attaching the spinatus tendon to the humerus by passing a suture through a transosseous tunnel in the bone and affixing the soft tissue with the suture, the improvement comprising the steps of

A. reinforcing an opening at an end of the tunnel by placing an eyelet into an end of the tunnel, the eyelet having an channel extending therethrough;

B. passing the suture through the channel of the eyelet, as well as through the transosseous tunnel, in order to affix the soft tissue to the bone with the suture.

5. In a method according claim 2, the further improvement comprising expanding an opening at the end of the tunnel prior to placing the eyelet therein.

6. In a method for attaching soft tissue to bone by passing a suture through a transosseous tunnel and affixing the soft tissue with the suture, the improvement comprising

A. reinforcing a bone opening at an end of the tunnel by placing an expandable member into the bone opening at the end of the tunnel, the expandable member having an channel extending therethrough;

B. inserting an insertion element into the channel of the expandable member, the insertion element including an channel extending therethrough, at least a portion of the insertion element including an outer diameter greater than an inner diameter of the channel at least a portion of the expandable member for expansion thereof upon engagement therewith, whereby, inserting the insertion element into the expandable member causes expandable member to expand to obtain a pressure fit with the bone opening; and

C. passing the suture through the channel of the insertion element, as well as through the transosseous tunnel, in order to affix the soft tissue to the bone with the suture.

8. In a method according to any of claims 6 and 7, wherein the method is adapted for rotator cuff repair, the further improvement wherein the placing step includes the step of placing the expandable member into an end of a transosseous tunnel in the humerus.

9. In a method according to any of claims 6 and 7, the further improvement comprising using an emplacement element to place an expandable member into the end of the bone opening.

10. In a method according to claim 9, the further improvement wherein the expandable member being frangibly attached to the emplacement element.

11. In a method according to claim 10, the further improvement wherein

the inserting step includes applying force to the insertion element, and

the method comprises breaking the frangible attachment between the expandable member and the emplacement element by applying force to the insertion element subsequent to expansion of the expandable member in the bone opening.

12. In a method according to claim 11, wherein the method is adapted for rotator cuff repair, the further improvement wherein the placing step includes the step of placing the expandable member into an end of a transosseous tunnel in the humerus.

7. In a method for attaching soft tissue to bone by passing a suture through a transosseous tunnel and affixing the soft tissue with the suture, the improvement comprising

A. reinforcing a bone opening at an end of the tunnel by placing a substantially cylindrical expandable member into the bone opening at the end of the tunnel, the expandable member having an axial channel extending between its proximal and distal ends;

B. inserting an elongate insertion element into the channel of the expandable member, the insertion element including an axial channel extending between its proximal and distal ends, at least a portion of the insertion element including an outer diameter greater than an inner diameter of at least a portion of the axial channel of the expandable member for expansion thereof upon engagement therewith, whereby, inserting the insertion element into the expandable member causes expandable member to be to expand to obtain a pressure fit with the bone opening; and

passing the suture through the axial channel of the insertion element, as well as through the transosseous tunnel, in order to affix the soft tissue to the bone with the suture.

13. In a method for attaching soft tissue to bone by passing a suture through a transosseous tunnel and affixing the soft tissue with the suture, the improvement comprising

A. reinforcing a bone opening at an end of the tunnel by using an emplacement element to place an expandable member into the bone opening at the end of the tunnel, the expandable member having an channel extending therethrough, the expandable member being frangibly attached to the emplacement element;

and

B. applying a compressive force to said expandable member to expand its channel so that an outer surface of said expandable member engages with the bone; and

C. breaking the frangible attachment between the expandable member and the emplacement element, and removing the emplacement element; and

D. passing the suture through the axial channel of the insertion element, as well as through the transosseous tunnel, in order to affix the soft tissue to the bone with the suture.

14. In a method according to claim 13, the further improvement comprising applying the compressive force to the expandable element by inserting into the channel thereof an insertion element including an outer diameter greater than an inner diameter of at least a portion of the channel of the expandable member for expansion thereof upon engagement therewith.

15. In a method according to any of claims 13 and 20, wherein the method is adapted for rotator cuff repair, the further improvement wherein the emplacement element is used to place the expandable member into an end of a transosseous tunnel in the humerus.

16. In a method for attaching soft tissue to bone by passing a suture through a transosseous tunnel in the bone and affixing the soft tissue with the suture, the improvement comprising the steps of

A. reinforcing an opening at an end of the tunnel by placing an eyelet into the end of the tunnel, the eyelet including a body disposed within the tunnel and a flanged head that protrudes above a surface of the bone, the eyelet further having an channel extending therethrough;

B. passing the suture through the channel of the eyelet, as well as through the transosseous tunnel, in order to affix the soft tissue to the bone with the suture.

17. In a method according to any of claims 16 and 17, the further improvement comprising screwing the eyelet into bone at the end of the tunnel.

18. In a method according to any of claims 16 and 17, the further improvement comprising affixing the eyelet into bone at the end of the tunnel by interference fit.

21. In a method according to any of claims 18 and 20, wherein the method is adapted for rotator cuff repair, the further improvement wherein the placing step includes the step of placing the expandable member into an end of a transosseous tunnel in the humerus.

22. In a method according to any of claims 18 and 20, the further improvement comprising using an emplacement element to place an expandable member into the end of the bone opening.

23. In a method according to claim 22, the further improvement wherein the expandable member being frangibly attached to the emplacement element.

24. In a method according to claim 23, the further improvement wherein the inserting step includes applying force to the insertion element, and the method comprises breaking the frangible attachment between the expandable member and the emplacement element by applying force to the insertion element subsequent to expansion of the expandable member in the bone opening.

25. In a method according to claim 24, wherein the method is adapted for rotator cuff repair, the further improvement wherein the placing step includes the step of placing the expandable member into an end of a transosseous tunnel in the humerus.

19. In a method for attaching soft tissue to bone by passing a suture through a transosseous tunnel and affixing the soft tissue with the suture, the improvement comprising

A. reinforcing an opening at an end of the tunnel by placing an expandable member into an end of the bone opening, the expandable member including a body disposed within the tunnel and a flanged head that protrudes above a surface of the bone, the expandable member further including an channel extending therethrough;

B. inserting an insertion element into the channel of the expandable member, the insertion element including an channel extending therethrough, at least a portion of the insertion element including an outer diameter greater than an inner diameter of the channel at least a portion of the expandable member for expansion thereof upon engagement therewith, whereby, inserting the insertion element into the expandable member causes expandable member to expand to obtain a pressure fit with the bone opening; and

C. passing the suture through the channel of the insertion element, as well as through the transosseous tunnel, in order to affix the soft tissue to the bone with the suture.

20. In a method for attaching soft tissue to bone by passing a suture through a transosseous tunnel and affixing the soft tissue with the suture, the improvement comprising

A. reinforcing an opening at an end of the tunnel by placing a substantially cylindrical expandable member into an end of the bone opening, the expandable member including a body disposed within the tunnel and a flanged head that protrudes above a surface of the bone, the expandable member having an axial channel extending between its proximal and distal ends;

B. inserting an elongate insertion element into the channel of the expandable member, the insertion element including an axial channel extending between its proximal and distal ends, at least a portion of the insertion element including an outer diameter greater than an inner diameter of at least a portion of the axial channel of the expandable member for expansion thereof upon engagement therewith, whereby, inserting the insertion element into the expandable member causes expandable member to be to expand to obtain a pressure fit with the bone opening; and

C. passing the suture through the axial channel of the insertion element, as well as through the transosseous tunnel, in order to affix the soft tissue to the bone with the suture.