Method for repairing a meniscal tear in a knee

• US 6,406,479 B1
• Filed: 05/18/1999
• Issued: 06/18/2002
• Est. Priority Date: 06/02/1997
• Status: Expired due to Term

• Current Assignee: Daniel F. Justin, Thomas F. Winters
• Original Assignee: Daniel F. Justin, Thomas F. Winters
• Inventors: Justin, Daniel F., Winters, Thomas F.
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): Woo, Julian W.
• Application Number:
  US09/314,431
• Time in Patent Office: 1,127 Days
• Field of Search: 606/75, 606/104, 606/216, 606/217, 606/218, 606/153, 606/154, 606/76, 606/77, 606/72, 606/213
• US Class Current: 606/104
• 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, resorptive for implantable prostheses A61F2210/0004
• CPC Class Codes: A61B 2017/0646 for insertion into cartillege, e.g. meniscus
• CPC Class Codes: A61B 2017/0647 having one single leg, e.g. tacks
• CPC Class Codes: Y10S 606/907 Composed of particular material or coated
• CPC Class Codes: Y10S 606/908 Bioabsorbable material
• CPC Class Codes: Y10S 606/91 Polymer
• CPC Class Codes: Y10S 606/916 Tool for installing or removing orthopedic fastener

Abstract

A fastener for use in soft tissue repair includes a resorbable polymer or suture core having one or more collagen bands in surrounding relation to the core. The bands are expandable between a dehydrated state for insertion and a hydrated state for healing, and are dimensioned and positioned to bring two sides of a tear into apposition to promote healing of the tear. The fastener insertion method includes driving an elongated tube across the tear, inserting a fastener down the tube until it breaches the tear, and removing the tube, leaving the fastener in position to expand and promote healing of the tear.

Claims

1. A method for repairing a tear in soft tissue comprising the steps of:

driving a trocar comprising an elongated pointed instrument across the tear in a direction generally normal to the tear;

passing a tube over the trocar to a position wherein the tube breaches the tear;

removing the trocar from the soft tissue;

introducing a fastener in a dehydrated state into the tube and pushing the fastener to a position adjacent a distal end of the tube, the fastener comprising;

an elongated core having;

a distal portion having a narrowing cross section toward a pointed distal end, for facilitating an insertion of the fastener into soft tissue; and

a narrowed central portion extending between a proximal end and the distal portion; and

a collagen band positioned in surrounding relation to the core central portion, the collagen band expandable between the dehydrated state and a hydrated state wherein the collagen band is shaped to bring two opposing sides of the tear into apposition;

removing the tube from the soft tissue, leaving the fastener in position to breach the tear; and

permitting the fastener to hydrate in situ, causing the collagen band to swell, bringing the opposing sides of the tear into apposition and forming an interference fit between the fastener and the soft tissue for retaining the fastener in position.

2. A method for repairing a tear in soft tissue comprising the steps of:

driving a trocar comprising an elongated pointed instrument across the tear in a direction generally normal to the tear;

passing a tube over the trocar to a position wherein the tube breaches the tear;

removing the trocar from the soft tissue;

introducing a fastener in a dehydrated state into the tube and pushing the fastener to a position adjacent a distal end of the tube, the fastener comprising;

an elongated core having;

a first conical portion having a narrowing cross section toward a distal end, wherein in use an insertion of the fastener into soft tissue is facilitated by the narrowed distal end;

a second conical portion having a narrowing cross section toward a proximal end of the first conical portion; and

a narrowed central portion extending between a proximal end and the second conical portion;

a first collagen band positioned in surrounding relation to the core central portion; and

a second collagen band positioned in surrounding relation to at least a distal section of the second conical portion;

wherein the first and the second collagen bands are expandable between the dehydrated state and a hydrated state for healing, wherein the first and the second collagen bands when hydrated bring two opposing sides of the tear into apposition;

removing the tube from the soft tissue, leaving the fastener in position to breach the tear; and

permitting the fastener to hydrate in situ, causing the collagen bands to swell, bringing the opposing sides of the tear into apposition and forming an interference fit between the fastener and the soft tissue for retaining the fastener in position.

3. A method for repairing a tear in soft tissue comprising the steps of:

driving a trocar comprising an elongated pointed instrument across the tear in a direction generally normal to the tear;

passing a tube over the trocar to a position wherein the tube breaches the tear;

removing the trocar from the soft tissue;

introducing a fastener in a dehydrated state into the tube and pushing the fastener to a position adjacent a distal end of the tube, the fastener having;

a first conical portion narrowing toward a distal end having a pointed tip;

a second conical portion proximal of and narrowing toward the first conical portion;

a narrowed central portion proximal of the second conical portion;

a third conical portion narrowing toward a proximal end;

a fourth conical portion distal of and narrowing toward the third conical portion;

wherein the fastener comprises a collagen material expandable between the dehydrated state and a hydrated state for healing;

removing the tube from the soft tissue, leaving the fastener in position to breach the tear; and

permitting the fastener to hydrate in situ, causing the fastener to swell, the swollen conical portions bringing the opposing sides of the tear into apposition to promote healing and further forming an interference fit between the fastener and the soft tissue for retaining the fastener in position.

4. A method for repairing a tear in soft tissue comprising the steps of:

driving a trocar comprising an elongated pointed instrument across the tear in a direction generally normal to the tear;

passing a tube over the trocar to a position wherein the tube breaches the tear;

removing the trocar from the soft tissue;

introducing an elongated generally cylindrical fastener into the tube and pushing the fastener to a position adjacent a distal end of the tube, the fastener having;

a first distal portion narrowing toward a distal end for facilitating insertion into the soft tissue;

a second distal portion extending in a proximal direction from the first distal portion;

a distal slit extending generally longitudinally from the distal end into the second distal portion, forming two half-cylindrical distal sections;

a proximal portion extending from a proximal end in a distal direction;

a proximal slit extending generally longitudinally from the proximal end into the proximal portion, forming two half-cylindrical proximal sections;

wherein the fastener is biased to expand via the distal slit and the proximal slit between an insertion position wherein the distal sections and the proximal sections are closely opposed and a healing position wherein the distal sections and the proximal sections are flared; and

removing the tube from the soft tissue, leaving the fastener in position to breach the tear and permitting the fastener distal sections and proximal sections to flare to the healing position, bringing the two sides of the tear into apposition for promoting healing and further forming an interference fit between the fastener and the soft tissue for retaining the fastener in position.

5. A method for repairing a tear in soft tissue comprising the steps of:

driving a trocar comprising an elongated pointed instrument across the tear in a direction generally normal to the tear;

passing a tube over the trocar to a position wherein the tube breaches the tear;

removing the trocar from the soft tissue;

introducing an elongated generally cylindrical fastener into the tube and pushing the fastener to a position adjacent a distal end of the tube, the fastener having;

a first distal portion narrowing toward a distal end for facilitating insertion into the soft tissue;

a second distal portion extending in a proximal direction from the first distal portion;

a first distal slit extending generally longitudinally from the distal end into the second distal portion;

a second distal slit extending generally longitudinally from the distal end into the second distal portion, the second distal slit generally normal to the first distal slit, the first and the second distal slits forming four quarter-cylindrical distal sections;

a proximal portion extending from a proximal end in a distal direction;

a first proximal slit extending generally longitudinally from the proximal end into the proximal portion;

a second proximal slit extending generally longitudinally from the proximal end into the proximal portion, the second proximal slit generally normal to the first proximal slit, the first and the second proximal slits forming four quarter-cylindrical proximal sections;

wherein the fastener is biased to expand via the distal slits and the proximal slits between an insertion position wherein the distal sections and the proximal sections are closely opposed and a healing position wherein the distal sections and the proximal sections are flared; and

removing the tube from the soft tissue, leaving the fastener in position to breach the tear and permitting the fastener distal sections and proximal sections to flare to the healing position, bringing the two sides of the tear into apposition for promoting healing and further forming an interference fit between the fastener and the soft tissue for retaining the fastener in position.

6. A method for repairing a tear in soft tissue comprising the steps of:

introducing a fastener in a dehydrated state into a tube and pushing the fastener to a position adjacent a distal end of the tube, the fastener comprising;

an elongated core having;

a distal portion having a narrowing cross section toward a pointed distal end, for facilitating an insertion of the fastener into soft tissue; and

a narrowed central portion extending between a proximal end and the distal portion; and

a collagen band positioned in surrounding relation to the core central portion, the collagen band expandable between the dehydrated state and a hydrated state wherein the collagen band is shaped to bring two opposing sides of the tear into apposition;

driving the tube and fastener across the tear in a direction generally normal to the tear, the pointed distal end of the fastener piercing the soft tissue, to a position wherein the tube and the fastener breach the tear;

removing the tube from the soft tissue, leaving the fastener in position to breach the tear; and

permitting the fastener to hydrate in situ, causing the collagen band to swell, bringing the opposing sides of the tear into apposition and forming an interference fit between the fastener and the soft tissue for retaining the fastener in position.

7. A method for repairing a tear in soft tissue comprising the steps of:

introducing a fastener in a dehydrated state into a tube and pushing the fastener to a position adjacent a distal end of the tube, the fastener comprising;

an elongated core having;

a first conical portion having a narrowing cross section toward a distal end, wherein in use an insertion of the fastener into soft tissue is facilitated by the narrowed distal end;

a second conical portion having a narrowing cross section toward a proximal end of the first conical portion; and

a narrowed central portion extending between a proximal end and the second conical portion;

a first collagen band positioned in surrounding relation to the core central portion; and

a second collagen band positioned in surrounding relation to at least a distal section of the second conical portion;

wherein the first and the second collagen bands are expandable between the dehydrated state and a hydrated state for healing, wherein the first and the second collagen bands when hydrated bring two opposing sides of the tear into apposition;

driving the tube and fastener across the tear in a direction generally normal to the tear, the pointed distal end of the fastener piercing the soft tissue, to a position wherein the tube and the fastener breach the tear;

removing the tube from the soft tissue, leaving the fastener in position to breach the tear; and

permitting the fastener to hydrate in situ, causing the collagen bands to swell, bringing the opposing sides of the tear into apposition and forming an interference fit between the fastener and the soft tissue for retaining the fastener in position.

8. A method for repairing a tear in soft tissue comprising the steps of:

introducing a fastener in a dehydrated state into a tube and pushing the fastener to a position adjacent a distal end of the tube, the fastener having;

a first conical portion narrowing toward a distal end having a pointed tip;

a second conical portion proximal of and narrowing toward the first conical portion;

a narrowed central portion proximal of the second conical portion;

a third conical portion narrowing toward a proximal end;

a fourth conical portion distal of and narrowing toward the third conical portion;

wherein the fastener comprises a collagen material expandable between the dehydrated state and a hydrated state for healing;

driving the tube and fastener across the tear in a direction generally normal to the tear, the pointed distal end of the fastener piercing the soft tissue, to a position wherein the tube and the fastener breach the tear;

removing the tube from the soft tissue, leaving the fastener in position to breach the tear; and

permitting the fastener to hydrate in situ, causing the fastener to swell, the swollen conical portions bringing the opposing sides of the tear into apposition to promote healing and further forming an interference fit between the fastener and the soft tissue for retaining the fastener in position.

9. A method for repairing a tear in soft tissue comprising the steps of:

introducing a fastener in a dehydrated state into a tube and pushing the fastener to a position adjacent a distal end of the tube, the fastener having;

a first distal portion narrowing toward a distal end for facilitating insertion into the soft tissue;

a second distal portion extending in a proximal direction from the first distal portion;

a distal slit extending generally longitudinally from the distal end into the second distal portion, forming two half-cylindrical distal sections;

a proximal portion extending from a proximal end in a distal direction;

a proximal slit extending generally longitudinally from the proximal end into the proximal portion, forming two half-cylindrical proximal sections;

wherein the fastener is biased to expand via the distal slit and the proximal slit between an insertion position wherein the distal sections and the proximal sections are closely opposed and a healing position wherein the distal sections and the proximal sections are flared;

driving the tube and fastener across the tear in a direction generally normal to the tear, the pointed distal end of the fastener piercing the soft tissue, to a position wherein the tube and the fastener breach the tear; and

removing the tube from the soft tissue, leaving the fastener in position to breach the tear and permitting the fastener distal sections and proximal sections to flare to the healing position, bringing the two sides of the tear into apposition for promoting healing and further forming an interference fit between the fastener and the soft tissue for retaining the fastener in position.

10. A method for repairing a tear in soft tissue comprising the steps of:

introducing a fastener in a dehydrated state into a tube and pushing the fastener to a position adjacent a distal end of the tube, the fastener having;

a first distal portion narrowing toward a distal end for facilitating insertion into the soft tissue;

a second distal portion extending in a proximal direction from the first distal portion;

a first distal slit extending generally longitudinally from the distal end into the second distal portion;

a second distal slit extending generally longitudinally from the distal end into the second distal portion, the second distal slit generally normal to the first distal slit, the first and the second distal slits forming four quarter-cylindrical distal sections;

a proximal portion extending from a proximal end in a distal direction;

a first proximal slit extending generally longitudinally from the proximal end into the proximal portion;

a second proximal slit extending generally longitudinally from the proximal end into the proximal portion, the second proximal slit generally normal to the first proximal slit, the first and the second proximal slits forming four quarter-cylindrical proximal sections;

wherein the fastener is biased to expand via the distal slits and the proximal slits between an insertion position wherein the distal sections and the proximal sections are closely opposed and a healing position wherein the distal sections and the proximal sections are flared;

driving the tube and fastener across the tear in a direction generally normal to the tear, the pointed distal end of the fastener piercing the soft tissue, to a position wherein the tube and the fastener breach the tear; and

removing the tube from the soft tissue, leaving the fastener in position to breach the tear and permitting the fastener distal sections and proximal sections to flare to the healing position, bringing the two sides of the tear into apposition for promoting healing and further forming an interference fit between the fastener and the soft tissue for retaining the fastener in position.