System and method for meniscal repair through a meniscal capsular tunnel

• US 7,594,922 B1
• Filed: 04/07/2005
• Issued: 09/29/2009
• Est. Priority Date: 04/07/2005
• Status: Expired due to Fees

• Current Assignee: Medicinelodge, Inc (Nelso Antolotti)
• Original Assignee: Medicine Lodge, Inc. (Johnson & Johnson)
• Inventors: Justin, Daniel F., Fallin, T. Wade, Goble, E. Marlowe
• Primary Examiner(s): Ho; (Jackie) Tan-Uyen T
• Assistant Examiner(s): LAUER, CHRISTINA C
• Application Number:
  US11/102,027
• Time in Patent Office: 1,636 Days
• Field of Search: 606/215, 606/219, 606/224, 606/151, 606/157, 606/140, 606/228, 606/213, 606/216, 623/14.12, 623/13.11, 623/13.12, 623/13.13, 623/13.14, 433/3
• US Class Current: 606/213
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• 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 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• 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 17/0625 the needle being specially adapted to interact with the manipulator, e.g. being ridged to snap fit in a hole of the manipulator A61B17/06109 takes precedence
• CPC Class Codes: A61B 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/0643 with separate closing member, e.g. for interlocking with staple
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/0682 for applying U-shaped staples or clamps, e.g. without a forming anvil
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/0474 Knot pushers
• CPC Class Codes: A61B 2017/06057 Double-armed sutures, i.e. sutures having a needle attached to each end
• 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: A61B 2017/320044 : Blunt dissectors
• CPC Class Codes: A61B 90/30 : Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure

Abstract

A system for open or arthroscopic surgical repair of torn or damaged meniscal tissue has a repair member and an instrument. The repair member is a suture, flexible or rigid implant. The instrument has at a portion that is shaped to slide within a meniscal capsular tunnel. The meniscal capsular tunnel is an opening in the knee soft tissue passing from the anterior side of the knee adjacent to the mensical tissue to the posterior side of the knee in both the medial and lateral directions. The instrument interacts with the repair member to either insert it into the meniscus from the posterior side, or to facilitate securing of the repair member so that the repair member holds the meniscal tissue together on either side of a meniscal tear to foster healing of the damaged tissue.

Claims

1. A method of repairing a damaged meniscus of a knee, the method comprising:

inserting a repair member into an anterior portion of a meniscal capsular tunnel of the knee;

actuating the repair member from a position anterior to the meniscus either medially or laterally around at least a portion of the meniscus to position at least a first end of the repair member posteriorly of the meniscus, within the meniscal capsular tunnel; and

passing the first end from the meniscal capsular tunnel through at least a portion of the meniscus.

2. The method of claim 1, wherein the repair member comprises a first end having a barbed shape, the method further comprising securing the first end with the barbed shape in response to passage of the first end through at least a portion of the meniscus.

3. The method of claim 1, further comprising coupling the repair member to a delivery interface of an instrument, wherein actuating the repair member around at least a portion of the meniscus comprises urging a distal end of the instrument around at least a portion of the meniscus, wherein passing the first end from the meniscal capsular tunnel through at least a portion of the meniscus comprises actuating the delivery interface to urge the first end into the meniscus.

4. The method of claim 3, wherein actuating the repair member around at least a portion of the meniscus comprises pressing the distal end against tissues within the knee to dilate a potential space between tissues to form the meniscal capsular tunnel.

5. A method of repairing a damaged meniscus of a knee, the method comprising:

passing a first end of a first repair member through at least a portion of the meniscus;

inserting an instrument into an anterior portion of a meniscal capsular tunnel of the knee;

actuating the instrument from a position anterior to the meniscus either medially or laterally around at least a portion of the meniscus to position at least a distal end of the instrument posteriorly of the meniscus, within the meniscal capsular tunnel;

manipulating the first end with the distal end within a meniscal capsular tunnel of the knee; and

securing the first repair member to the meniscus in response to manipulation of the first end of the first repair member.

6. The method of claim 5, wherein the repair member comprises a second end, wherein securing the repair member to the meniscus comprises securing the first and second ends together.

7. The method of claim 5, wherein, after passage of the first end through at least a portion of the meniscus, the first end protrudes from the meniscus, wherein securing the repair member comprises preventing withdrawal of the end into the meniscus.

8. The method of claim 5, wherein passing the first end through at least a portion of the meniscus comprises inserting the first end from a location anteriorly of a tear to be repaired.

9. The method of claim 5, wherein the repair member comprises a clip comprising first and second ends, wherein securing the repair member comprises securing the first end to the second end.

10. The method of claim 5, wherein inserting the instrument into the meniscal capsular tunnel comprises pressing the distal end against tissues within the knee to dilate a potential space between the tissues to form the meniscal capsular tunnel.

11. The method of claim 10, further comprising actuating the distal end from an anterior portion of the meniscal capsular tunnel to a posterior portion of the meniscal capsular tunnel, wherein manipulating the first end comprises manipulating the first end within the posterior portion.

12. A method of repairing a damaged meniscus of a knee, the method comprising:

pressing a distal end of an instrument against tissues within the knee to dilate a potential space between the tissues anteriorly of the meniscus to permit passage of the distal end posterior to the meniscus;

actuating the instrument from a position anterior to the meniscus either medially or laterally around at least a portion of the meniscus to position at least the distal end of the instrument posteriorly of the meniscus, within a meniscal capsular tunnel;

inserting a first end of a repair member through at least a portion of the meniscus from a position exteriorly of a tear positioned posteriorly, medially, or laterally on the meniscus; and

securing the first end to substantially prevent withdrawal of the repair member from the meniscus during normal operation of the knee to expedite reparation of the tear;

wherein the steps of inserting the first end of the repair member through at least a portion of the meniscus and securing the repair member are carried out without requiring retraction of ligamentomuscular structures positioned exteriorly of the tear.

13. The method of claim 12, wherein inserting the first end through at least a portion of the meniscus comprises:

coupling the repair member to a delivery interface of an instrument; and

actuating the delivery interface to urge the first end through at least a portion of the meniscus from a position posteriorly of the meniscus.

14. The method of claim 12, wherein securing the first end comprises manipulating the first end with a retention interface of an instrument from a position posteriorly of the meniscus.