Suture anchor inserter assembly and method

• US 5,897,574 A
• Filed: 07/07/1998
• Issued: 04/27/1999
• Est. Priority Date: 07/01/1996
• 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): Jackson, Gary
• Application Number:
  US09/111,079
• Time in Patent Office: 294 Days
• Field of Search: 606/232, 606/104
• 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 17/0493 Protective devices for suturing, i.e. for protecting the patient's organs or the operator
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/2905 flexible

Abstract

A suture anchor inserter assembly includes a manually engageable handle and a shaft which extends axially outward from the handle. The shaft includes an inner member which is fixedly connected with the handle and an outer member which is retractable into the handle. An anchor is received in a chamber formed at the outer end of the shaft. A suture extends through a passage in the shaft, a passage in the handle and along an outer side of the shaft. The suture is tensioned to press the anchor into the chamber in the handle. A retainer assembly is manually operable to release the outer member for axial movement relative to the inner member. The handle advantageously has a triangular cross-sectional configuration.

Claims

1. An apparatus for use in positioning a suture anchor relative to body tissue, said apparatus comprising a handle having a longitudinal central axis, an inner member having a first end portion disposed adjacent to said handle and a second end portion spaced from said handle, and a tubular outer member at least partially enclosing said inner member, said tubular outer member having a first end portion disposed adjacent to and connected with said handle and a second end portion spaced from said handle, said first end portion of at least one of said inner and outer members being connected to said handle, said inner and outer members being movable relative to each other during positioning of the suture anchor relative to body tissue, said first end portions of said inner and outer members having coincident linear central axes which extend parallel to the longitudinal central axis of said handle, said second end portions of said inner and outer members having coincident nonlinear central axes with portions which extend transverse to the longitudinal central axis of said handle, one of said second end portions of said inner and outer members being flexible to facilitate relative movement between said inner and outer members with the longitudinal central axes of the first portions of said inner and outer members in a parallel relationship with the longitudinal central axis of said handle during positioning of the suture anchor relative to the body tissue.

2. An apparatus as set forth in claim 1 wherein said first end portion of said inner member is fixedly connected with said handle and said outer member is slidable along said inner member.

3. An apparatus as set forth in claim 1 wherein said outer member is slidable along said inner member into said handle to move said outer member from an extended position in which said second end portion of said outer member extends beyond said second end portion of said inner member to a retracted position in which said second end portion of said inner member extends beyond said outer member, said inner and outer members cooperating to form a chamber for receiving the suture anchor when said outer member is in the extended position.

4. An apparatus as set forth in claim 1 wherein said second end portion of said inner member has a predetermined arcuate configuration and said second end portion of said outer member is flexible to facilitate relative movement between said inner and outer members while said second end portion of said inner member maintains its predetermined arcuate configuration.

5. An apparatus as set forth in claim 1 wherein said second end portion of said inner member has surface means for applying force transmitted from said handle through said inner member to a trailing end of the suture anchor to move the suture anchor into body tissue as said outer member slides along said inner member toward said handle.

6. An apparatus as set forth in claim 1 wherein said inner member has surface means for defining a passage which receives a suture which extends through the anchor, said passage in said inner member extends between said first and second end portions of said inner member.

7. An apparatus as set forth in claim 1 further including surface means connected with said tubular outer member for engaging body tissue and transmitting force between the body tissue and said tubular outer member to effect movement of said tubular outer member toward said handle.

8. An apparatus as set forth in claim 1 further including means connected with said handle for limiting the extent of relative movement between said inner and outer members.

9. An apparatus as set forth in claim 1 further including a retainer member disposed on said handle and movable relative to said handle between a retaining position in which said retainer member is effective to retain said inner and outer members against relative movement and a release position in which said retainer member is ineffective to retain said inner and outer members against relative movement.

10. An apparatus as set forth in claim 9 wherein said retainer member includes surface means which is engageable with a portion of a suture connected with the anchor to retain the engaged portion of the suture against movement relative to said handle.

11. An apparatus as set forth in claim 9 wherein said handle includes a guide surface along which said retainer member is movable between the retaining and release positions, said guide surface being effective to guide movement of the retainer member along a path having a central axis which extends transverse to the longitudinal central axis of said handle and to the coincident linear central axes of said inner and outer members.

12. An apparatus as set forth in claim 9 wherein said retainer member has a manually engageable end portion against which force is manually applied to move said retainer member from the retaining position to the release position.

13. An apparatus as set forth in claim 9 further including first and second stop surfaces connected with said outer member, said first and second stop surfaces being spaced from each other along a central axis of said first end portion of said outer member, said retainer member being disposed adjacent to said first stop surface when said outer member is in a first position relative to said inner member, said retainer member being disposed adjacent to said second stop surface when said outer member is in a second position relative to said inner member.

14. An apparatus as set forth in claim 9 wherein said retainer member includes an opening through which the central axes of said first end portions of said inner and outer members extend, said opening being movable transversely to the central axes of said first end portions of said inner and outer members upon movement of said retainer member between the retaining and release positions, the central axes of said first end portions of said inner and outer members extend through a first portion of the opening in said retainer member when said retainer member is in the retaining position, the central axes of said first end portions of said inner and outer members extend through a second portion of the opening in said retainer member when said retainer member is in the release position.

15. An apparatus as set forth in claim 9 wherein said handle includes three longitudinally extending sides disposed in a triangular array with longitudinal axes of said sides extending parallel to the longitudinal central axis of said handle, said retainer member projects from one of said sides of said handle when said retainer member is in the retaining position.

16. An apparatus as set forth in claim 1 wherein said handle includes three longitudinally extending sides disposed in a triangular array having a central axis which is parallel to central axes of said inner and outer members.

17. An apparatus as set forth in claim 1 wherein a first one of said longitudinally extending sides of said handle includes surface means for defining a slot which receives a portion of a suture, said slot having a longitudinal central axis which extends parallel to a longitudinal central axis of said handle.

18. An apparatus as set forth in claim 17 wherein a second one of said longitudinally extending sides of said handle includes surface means for defining a recess which receives a needle connected with the suture.

19. An apparatus as set forth in claim 17 wherein a third one of said longitudinally extending sides of said handle includes surface means for defining a recess for receiving a portion of the suture.

20. An apparatus as set forth in claim 16 wherein said longitudinally extending sides of said handle are interconnected by a plurality of longitudinally extending corner portions having axes which extend parallel to the longitudinal central axis of said handle, said longitudinally extending sides of said handle intersect at said corner portions of said handle, a first one of said longitudinally extending sides of said handle including a first plurality of ribs which extend between a first one of said corner portions and a second one of said corner portions, a second one of said longitudinally extending sides of said handle including a second plurality of ribs which extend between said second one of said corner portions and a third one of said corner portions.

21. An apparatus as set forth in claim 1 further including means for limiting the depth to which an anchor is to be inserted into body tissue to a selected one of a plurality of depths, said means for limiting the depth to which an anchor is to be inserted into body tissue includes means for limiting the distance which said inner and outer members move relative to each other to a selected one of a plurality of distances.

22. An apparatus as set forth in claim 21 wherein said means for limiting the depth to which an anchor is inserted into body tissue includes depth indicator means disposed on said handle for indicating the depth to which an anchor is to be inserted into body tissue.

23. A method of positioning a suture anchor in body tissue, said method comprising the steps of positioning the suture anchor relative to inner and outer members connected with a handle, retaining said inner and outer members against movement relative to the handle, manually moving an actuator member relative to the handle to release a first one of the inner and outer members for movement relative to a second one of the inner and outer members, and moving the inner and outer members relative to each other, said step of moving the inner and outer members relative to each other includes flexing a first one of the inner and outer members to change the configuration of the first one of the inner and outer members during movement of the inner and outer members relative to each other.

24. A method as set forth in claim 23 wherein said step of flexing the first one of the inner and outer members to change the configuration of the first one of the inner and outer members includes flexing the outer member under the influence of force applied against the outer member by the inner member.

25. A method as set forth in claim 23 wherein said step of moving the inner and outer members relative to each other includes moving the first one of the inner and outer members relative to a second one of the inner and outer members.

26. A method as set forth in claim 23 wherein said step of moving the inner and outer members relative to each other includes moving the first one of the inner and outer members toward the handle.

27. A method as set forth in claim 23 further including the step of moving the anchor relative to the body tissue while moving the inner and outer members relative to each other.

28. A method as set forth in claim 23 further including the steps of moving the anchor relative to the body tissue while moving the inner and outer members relative to each other, said step of moving the anchor includes moving the anchor under the influence of force transmitted from the handle through the inner member to the anchor.

29. A method as set forth in claim 23 further including the step of moving a leading end portion of the anchor into engagement with body tissue prior to performance of said step of manually moving an actuator member relative to the handle and while performing said step of retaining said inner and outer members against movement relative to the handle.

30. A method as set forth in claim 23 further including the said step of tensioning a suture extending through the anchor while retaining the inner and outer members against movement relative to the handle.

31. A method as set forth in claim 30 wherein said step of tensioning the suture includes gripping a portion of the suture with the actuator member.

32. A method as set forth in claim 23 further including the steps of moving the anchor relative to the body tissue while moving the one of the inner and outer members relative to each other, said step of moving the inner and outer members relative to each other includes moving the outer member toward the handle from a first position in which the outer member extends a first distance from the handle to a second position in which the outer member extends a second distance from the handle, said second distance being smaller than said first distance.

33. A method as set forth in claim 23 wherein said step of moving the inner and outer members relative to each other includes moving the first one of the inner and outer members relative to the handle while maintaining the suture anchor stationary relative to the handle.

34. A method as set forth in claim 23 further including pressing a trailing end of the anchor against an outer end of the inner member under the influence of force transmitted to the anchor through a suture while retaining the inner and outer members against movement relative to the handle.

35. A method as set forth in claim 23 further including the steps of selecting a desired depth of insertion of the anchor into body tissue and interrupting said step of moving the inner and outer members relative to each other upon insertion of the anchor to the desired depth in body tissue.

36. A method as set forth in claim 23 further including the step of moving a depth control member along the handle to a position which corresponds to a desired depth of insertion of the anchor into body tissue, said step of moving a depth control member along the handle being performed while retaining said inner and outer members against movement relative to the handle and prior to performance of said step of manually moving the actuator member relative to the handle.

37. A method of positioning a suture anchor relative to body tissue, said method comprising the steps of moving a handle and an inner member and a tubular outer member which are connected with the handle toward body tissue with a leading end portion of the anchor extending from the outer member and with the outer member enclosing a portion of inner member, engaging body tissue with the leading end portion of the anchor, said step of moving the handle and an inner member and an outer member which are connected with the handle toward body tissue and said step of engaging body tissue with the leading end portion of the anchor being performed with the anchor stationary relative to the handle and the inner and outer members, and, thereafter, moving at least a portion of one of the inner and outer members along an arcuate path relative to the handle and the other of the inner and outer members to position the anchor relative to the body tissue.

38. A method as set forth in claim 37 wherein said step of moving at least a portion of one of the inner and outer members along an arcuate path relative to the handle and the other of the inner and outer members includes flexing the one of the inner and outer members to change the configuration of the one of the inner and outer members.

39. A method as set forth in claim 37 wherein said step of moving at least a portion of one of the inner and outer members along an arcuate path relative to the handle and the other of the inner and outer members includes moving the outer member relative to the handle and the inner member.

40. A method as set forth in claim 37 wherein said step of moving a handle and an inner member and an outer member which are connected with the handle toward body tissue and said step of engaging body tissue with the leading end portion of the anchor are performed with a retainer member in a first position in which the retainer member is effective to retain said inner member and said outer member against movement relative to each other, said method further including moving the retainer member from the first position to a second position in which the retainer member is ineffective to retain said inner member and said outer member against movement relative to each other, said step of moving at least a portion of the inner and outer members along an arcuate path being performed with the retainer member in the second position.

41. A method as set forth in claim 37 further including the steps of selecting a desired depth of insertion of the anchor into body tissue and interrupting said step of moving the at least a portion of one of the inner and outer members along an arcuate path upon insertion of the anchor to the desired depth in the body tissue.

42. A method as set forth in claim 37 further including the steps of moving a stop member along one of the inner members to a position which corresponds to a desired depth of insertion of the anchor into body tissue, and blocking relative movement between the inner and outer members with the stop member upon insertion of the anchor to the desired depth into body tissue.

43. An apparatus for use in positioning a suture anchor relative to body tissue, said apparatus comprising a handle, an inner member having a first end portion connected with said handle and a second end portion spaced from said handle, and a tubular outer member having a first end portion adjacent to said handle and a second end portion at least partially enclosing said inner member, said second end portions of said inner and outer members having a nonlinear configuration, said outer member being movable from a first position to a second position relative to said inner member and said handle during positioning of the suture anchor relative to body tissue, one of said inner and outer members being effective to apply force to the other of said inner and outer members to at least partially change the configuration of the second end portion of the other of said inner and outer members during movement of said outer member from the first position to the second position.

44. An apparatus as set forth in claim 43 wherein said outer and inner members cooperate to form a chamber for receiving at least a portion of the suture anchor when said outer member is in the first position.

45. An apparatus as set forth in claim 43 wherein said outer member is slidable along said inner member toward said handle during movement of said outer member from the first position to the second position.

46. An apparatus as set forth in claim 43 wherein said outer member is flexible to facilitate changing the configuration of the outer member during movement of the outer member relative to the inner member.

47. An apparatus as set forth in claim 43 wherein a first length of said inner member and a first length of said outer member are disposed in said handle in a telescopic relationship when said outer member is in the first position, a second length of said inner member and a second length of said outer member being disposed in said handle in a telescopic relationship when said outer member is in the second position, said second length of said inner member and said second length of said outer member being different than said first length of said inner member and said first length of said outer member so that the extent of the telescopic relationship in said handle between said inner and outer members is different when said outer member is in the second position than when said outer member in the first position.

48. An apparatus as set forth in claim 43 wherein a first length of said outer member is enclosed by said handle when said outer member is in the first position and a second length of said outer member is enclosed by said handle when said outer member is in the second position, said second length of said outer member being different than said first length of said outer member.

49. An apparatus as set forth in claim 43 wherein said handle has a leading end portion, said outer member extends a first distance outward from said leading end portion of said handle when said outer member is in the first position, said outer member extends a second distance outward from said leading end portion of said handle when said outer member is in the second position, said second distance being different than said first distance.

50. An apparatus as set forth in claim 49 wherein said inner member extends outward from said leading end portion of said handle for a third distance, said third distance being less than said first distance and greater than said second distance.

51. An apparatus as set forth in claim 43 wherein said second end portion of one of said inner and outer members has surface means for applying force transmitted from said handle to a trailing end of the suture anchor to move the suture anchor into body tissue as said outer member moves from the first position to the second position.

52. An apparatus as set forth in claim 43 wherein said inner member has surface means for defining a passage which receives a suture which extends through the anchor, said passage in said inner member extends between said first and second end portions of said inner member.

53. An apparatus as set forth in claim 43 further including surface means connected with said tubular outer member for engaging body tissue and transmitting force between the body tissue and said tubular outer member to effect movement of said tubular outer member from the first position to the second position.

54. An apparatus as set forth in claim 43 further including means connected with said outer member for limiting the extent of movement of said outer member relative to said inner member.

55. An apparatus as set forth in claim 43 further including a retainer member disposed on said handle and movable relative to said handle between a retaining position in which said retainer member is effective to retain said outer member in the first position and a release position in which said retainer member is ineffective to retain said outer member in the first position.

56. An apparatus as set forth in claim 55 wherein said retainer member includes surface means which is engageable with a portion of a suture connected with the anchor to retain the engaged portion of the suture against movement relative to said handle when said retainer member is in the retaining position.

57. An apparatus as set forth in claim 55 wherein said handle includes a guide surface along which said retainer member is movable between the retaining and release positions, said guide surface being effective to guide movement of the retainer member along a path having a central axis which extends transverse to a central axis of said outer member.

58. An apparatus as set forth in claim 55 wherein said retainer member has a manually engageable end portion against which force is manually applied to move said retainer member from the retaining position to the release position.

59. An apparatus as set forth in claim 55 further including first and second stop surfaces connected with said outer member, said first and second stop surfaces being spaced from each other along a central axis of said outer member, said retainer member being disposed adjacent to said first stop surface when said outer member is in the first position, said retainer member being disposed adjacent to said second stop surface when said outer member is in the second position.

60. An apparatus as set forth in claim 55 wherein said retainer member includes an opening through which a central axis of said outer member extends, said opening being movable transversely to the central axis of said outer member upon movement of said retainer member between the retaining and release positions, the central axis of said outer member extends through a first portion of the opening in said retainer member when said retainer member is in the retaining position, the central axis of said outer member extends through a second portion of the opening in said retainer member when said retainer member is in the release position.

61. An apparatus as set forth in claim 55 wherein said handle includes three longitudinally extending sides disposed in a triangular array with longitudinal axes of said sides extending parallel to a central axis of said inner member, said retainer member projects from one of said sides of said handle when said retainer member is in the retaining position.

62. An apparatus as set forth in claim 43 wherein said handle includes three longitudinally extending sides disposed in a triangular array having a central axis which is parallel to central axes of said handle.

63. An apparatus as set forth in claim 62 wherein a first one of said longitudinally extending sides of said handle includes surface means for defining a slot which receives a portion of a suture, said slot having a longitudinal central axis which extends parallel to a longitudinal central axis of said outer member.

64. An apparatus as set forth in claim 63 wherein a second one of said longitudinally extending sides of said handle includes surface means for defining a recess which receives a needle connected with the suture.

65. An apparatus as set forth in claim 64 wherein a third one of said longitudinally extending sides of said handle includes surface means for defining a recess for receiving a portion of the suture.

66. An apparatus as set forth in claim 62 wherein said longitudinally extending sides of said handle are interconnected by a plurality of longitudinally extending corner portions having axes which extend parallel to the longitudinal central axis of said handle, said longitudinally extending sides of said handle intersect at said corner portions of said handle, a first one of said longitudinally extending sides of said handle including a first plurality of ribs which extend between a first one of said corner portions and a second one of said corner portions, a second one of said longitudinally extending sides of said handle including a second plurality of ribs which extend between said second one of said corner portions and a third one of said corner portions.

67. An apparatus as set forth in claim 43 wherein said second end portions of said inner and outer members cooperate to define a chamber when said outer member is in the first position, said chamber has a maximum axial extent when said outer member is in the first position, said chamber having an axial extent which is less than the axial extent of the suture anchor when said outer member is in the first position, said second end portion of said inner member cooperates with said outer member to form an end of said chamber which is engageable by a trailing end of the suture anchor when the suture anchor is in said chamber with a leading end of the suture anchor outside of said chamber and with said outer member in the first position.

68. An apparatus as set forth in claim 43 wherein said outer member extends a first distance into said handle when said outer member is in the first position, said outer member extends a second distance into said handle when said outer member is in the second position, said second distance being different than said first distance.

69. An apparatus as set forth in claim 43 further including means for limiting the depth to which an anchor is to be inserted into body tissue to a selected one of a plurality of depths, said means for limiting the depth to which an anchor is to be inserted into body tissue includes means for limiting the distance which said outer member moves relative to said inner member from the first position to the second position to a selected one of a plurality of distances.

70. An apparatus as set forth in claim 69 wherein said means for limiting the depth to which an anchor is inserted into body tissue includes depth indicator means disposed on said handle for indicating the depth to which an anchor is to be inserted into body tissue.