Method and apparatus for securing soft tissue to bone

• US 8,562,647 B2
• Filed: 10/29/2010
• Issued: 10/22/2013
• Est. Priority Date: 09/29/2006
• Status: Active Grant

• Current Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Inventors: Kaiser, Ryan A., Denham, Gregory J., Stone, Kevin T.
• Primary Examiner(s): Dornbusch, Dianne
• Application Number:
  US12/915,962
• Publication Number:
  US 20110098727A1
• Time in Patent Office: 1,089 Days
• Field of Search: 606/139, 606/151, 606/232, 606/60, 606/300, 606/301, 606/313, 128/898, 623/13.11, 623/13.14, 623 1317- 132, 623/19.11
• 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 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 2017/00792 Plastic surgery
• CPC Class Codes: A61B 2017/0404 Buttons
• 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 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/06185 hollow or tubular hollow suture needles A61B2017/061

Abstract

A method and apparatus for securing soft tissue to bone can include forming a bore in the bone and carrying a flexible suture anchor into the bore. The flexible anchor can include a passage and can be coupled to a suture construct. The suture construct can include at least one self-locking adjustable loop, and the flexible anchor can include a first profile while being carried into the bore. A shape of the flexible anchor can be changed from the first profile to a second profile forming an anchoring mass to retain the flexible anchor in the bore. Tension can be applied to a portion of the suture construct to reduce a size of the self-locking adjustable loop and secure the soft tissue relative to the flexible anchor and the bone.

Claims

1. A method for securing soft tissue to bone, comprising:

forming a bore in the bone;

carrying a flexible anchor into the bore, the flexible anchor including a passage and being coupled to a suture construct, the suture construct including a suture having first and second free ends, a body defining a passage portion and at least one self-locking adjustable loop, at least one of the first or second free ends passing through the passage portion of the body to form the self-locking adjustable loop, the flexible anchor coupled to the suture construct by the first or second free end of the suture construct extending through an intermediate portion of the passage spaced apart from respective ends of the flexible anchor such that the flexible anchor is coupled to the at least one self-locking adjustable loop and is slidable relative thereto, where portions of the flexible anchor between the intermediate portion and each end define anchoring leg portions free of the suture, the flexible anchor including a first profile while being carried into the bore;

changing a shape of the flexible anchor from the first profile to a second profile forming an anchoring mass to retain the flexible anchor in the bore; and

applying tension to a portion of the suture construct to reduce a size of the self-locking adjustable loop and secure the soft tissue relative to the flexible anchor and the bone and maintain the reduced size of the self-locking adjustable loop in an absence of a knot.

2. The method of claim 1, wherein changing a shape of the flexible anchor includes collapsing the flexible anchor from the first profile to the anchoring mass of the second profile, wherein the anchoring mass includes a width in a direction perpendicular to a longitudinal axis of the bore greater than the first profile.

3. The method of claim 2, wherein forming a bore in bone includes forming a bore through a cortical layer of the bone and into a cancellous layer of the bone;

and

wherein changing a shape of the flexible anchor includes seating the anchoring mass against the cortical layer of the bone.

4. The method of claim 3, wherein changing a shape of the flexible anchor includes forming the anchoring mass where the width is greater than a width of the bore through the cortical layer of the bone.

5. The method of claim 1, wherein carrying a flexible anchor into the bore includes carrying a tubular flexible anchor into the bore, wherein the flexible anchor is formed from a woven or braided suture material.

6. The method of claim 1, wherein applying tension to a portion of the suture construct to reduce a size of the self-locking adjustable loop and secure the soft tissue relative to the flexible anchor and the bone includes sliding the suture construct relative to the flexible anchor in the formed anchor mass of the second profile.

7. The method of claim 1, wherein carrying a flexible anchor into the bore includes coupling the flexible anchor to a distal tip of an inserter instrument.

8. The method of claim 7, further comprising:

positioning a cannulated guide member relative to the bore; and

inserting the inserter instrument having the flexible anchor coupled thereto into the guide member to guide the distal tip of the inserter instrument into the bore.

9. The method of claim 7, further comprising routing a portion of the suture construct through a recess in a handle of the inserter instrument and through a protrusion in the handle having a removable securing member configured to removable secure the suture construct to the protrusion and facilitate retaining the flexible anchor relative to the distal tip.

10. The method of claim 1, wherein forming a bore in the bone includes forming a bore in a portion of glenoid bone.

11. The method of claim 10, wherein applying tension to a portion of the suture construct to reduce a size of the self-locking adjustable loop and secure the soft tissue relative to the flexible anchor and the bone includes securing a portion of a labrum to the glenoid bone.

12. The method of claim 1,

wherein the suture construct includes the first free end passing into and through the passage portion to form a first self-locking adjustable loop and the second free end passing into and through the passage portion in an opposite direction as the first end to form a second self-locking adjustable loop.

13. The method of claim 12, wherein applying tension to a portion of the suture construct to reduce a size of the self-locking adjustable loop includes applying tension to the free ends to pull first and second portions of the suture construct passing through the passage portion in opposite directions relative to the passage portion to reduce a size of the first and second self-locking adjustable loops and secure the soft tissue to the bone.

14. The method of claim 12, wherein the flexible anchor includes first and second flexible anchors coupled to the respective first and second self-locking adjustable loops.

15. The method of claim 14, wherein forming a bore in the bone includes forming a first bore and a second bore in the bone;

wherein carrying a flexible anchor into the bore includes carrying the first flexible anchor into the first bore and carrying the second flexible anchor into the second bore to position the suture construct relative to the soft tissue; and

wherein applying tension to a portion of the suture construct includes applying tension to the first and second ends to reduce a size of the first and second self-locking adjustable loops thereby changing the shape of the first and second flexible anchors to the anchoring mass of the second profile and securing the soft tissue to the bone.

16. The method of claim 12, wherein the flexible anchor includes first and second flexible anchors, the first flexible anchor being coupled to a summit portion of the first and second self-locking adjustable loops and the second flexible anchor being coupled to the passage portion, the summit portion being positioned opposite of the passage portion.

17. The method of claim 16, wherein carrying a flexible anchor into the bore includes inserting the second flexible anchor through the soft tissue and into the bore such that the passage portion is in the bore while the second flexible anchor remains outside of the soft tissue;

and

wherein applying tension to a portion of the suture construct includes applying tension to the first and second ends to reduce a size of the first and second self-locking adjustable loops to secure the first flexible anchor in the bone and engage the second flexible anchor with a surface of the soft tissue to tightly secure the soft tissue relative to the first flexible anchor and the bone.

18. A method for securing soft tissue to bone, comprising:

forming a bore in the bone;

providing a suture construct, including;

a suture having first and second free ends and a body defining a passage portion;

first and second flexible suture anchors each having a first end and a second end;

the first and second flexible anchors coupled to the suture by a portion of the suture extending through first and second openings in each flexible anchor, where the first and second openings are between and spaced apart from the first and second ends to form first and second flexible anchoring legs free of the suture for each flexible anchor;

the first and second free ends of the suture extending into and through the passage portion of the body in opposite directions to form first and second self-locking adjustable loops;

carrying the first flexible suture anchor into the bore, the first flexible anchor including a first profile while being carried into the bore;

changing a shape of the first flexible anchor from the first profile to a second profile forming an anchoring mass to retain the first flexible anchor in the bore; and

applying tension to the first and second ends of the suture construct to reduce a size of the first and second self-locking adjustable loops and secure the soft tissue relative to the first flexible anchor and the bone and maintain the reduced size of the first and second self-locking adjustable loops in an absence of a knot.

19. The method of claim 18, wherein the first and second flexible anchors being coupled to the suture includes coupling the first flexible anchor to the passage portion of the suture construct and coupling the second flexible anchor to a summit portion of the first and second self-locking adjustable loops, the summit portion being positioned opposite of the passage portion.

20. The method of claim 18, wherein applying tension to the first and second ends of the suture construct to reduce a size of the first and second self-locking adjustable loops and secure the soft tissue relative to the first flexible anchor and the bone includes sliding the first loop relative to the first flexible anchor in the second profile and the second loop relative to the second flexible anchor.

21. The method of claim 18, wherein forming a bore in the bone includes forming first and second bores in the bone;

wherein carrying the first flexible suture anchor into the bore includes carrying the first flexible anchor into the first bore and carrying the second flexible anchor into the second bore to position the suture construct relative to the soft tissue; and

wherein applying tension to the first and second ends of the suture construct to reduce a size of the first and second self-locking adjustable loops includes applying tension to the first and second ends of the suture construct to reduce a size of the first and second self-locking adjustable loops and secure the soft tissue relative to the first and second flexible anchors secured in the respective first and second bores.

22. A method for securing a labrum to a glenoid bone, comprising:

positioning a cannulated guide instrument on the glenoid bone;

passing a drill bit through the cannulated guide instrument to drill a bore in the glenoid bone;

inserting an inserter instrument into the cannulated guide instrument, the inserter instrument carrying a flexible anchor having a first end and a second end with a suture passed through a first opening and a second opening in the flexible anchor, where the first and second openings are between and spaced apart from the first and second ends to form first and second flexible anchoring legs free of the suture;

inserting the flexible anchor having a first profile into the bore in the glenoid bone;

changing a shape of the flexible anchor from the first profile to a second profile to form an anchoring mass to retain the flexible anchor in the bore; and

attaching the suture to the labrum to secure the labrum to the glenoid bone.

23. The method of claim 22, further comprising viewing through a window in a distal end of the cannulated guide instrument when drilling the bore in the glenoid bone with the drill bit and when inserting the flexible anchor into the bore with the inserter instrument.

24. The method of claim 22, wherein attaching the suture to the labrum to secure the labrum to the glenoid bone, further includes positioning the suture on lateral sides of the labrum to secure the labrum separated from a surface of the glenoid bone to the glenoid bone.

25. The method of claim 22, further comprising maintaining a distal end of the cannulated guide instrument on the glenoid bone at the same location when both passing the drill bit through the cannulated guide instrument and when inserting the inserter instrument into the cannulated guide instrument.

26. The method of claim 22, wherein inserting the flexible anchor into the bore includes impacting the inserter instrument with a mallet to insert the flexible anchor that is folded about mid-length over a distal end of the inserter instrument into the bore in the glenoid bone.

27. The method of claim 22, wherein changing the shape of the flexible anchor from the first profile to the second profile includes expanding a width of the flexible anchor upon forming the anchoring mass, such that the width in the second profile is greater than the width in the first profile.

28. The method of claim 22, further comprising releasing the suture from a handle on the inserter instrument, where the suture is retained in a groove on the handle, to allow tensioning of the suture to change the shape of the flexible anchor from the first profile to the second profile.

29. The method of claim 22, wherein the suture is a suture construct that includes a first self-locking adjustable loop and a second self-locking adjustable loop and the flexible anchor is coupled to at least one of the first and second self-locking adjustable loops.

30. The method of claim 29, wherein the suture has first and second free ends and a body defining a passage portion where the first end is passed into and through the passage portion to form the first self-locking adjustable loop and the second end is passed into and through the passage portion in an opposite direction to form the second self-locking adjustable loop.

31. A method for securing soft tissue to bone, comprising:

forming a suture construct, including;

providing a suture having first and second free ends and a body extending therebetween and defining a passage portion;

providing first and second flexible suture anchors each having a passage;

coupling the first and second flexible anchors to the suture by inserting at least one free end of the suture through an intermediate portion of the passage of each flexible anchor spaced apart from respective ends of the flexible anchor such that portions of each flexible anchor between the intermediate portion and each end define anchoring leg portions free of the suture; and

passing the first and second free ends of the suture into and through the passage portion of the body in opposite directions to form first and second self-locking adjustable loops.

32. The method of claim 31, wherein coupling the first and second flexible anchors to the suture includes coupling the first flexible anchor to the passage portion of the suture construct and coupling the second flexible anchor to a summit portion of the first and second self-locking adjustable loops, the summit portion being positioned opposite of the passage portion.

33. The method of claim 32, further comprising:

forming a bore in the bone;

carrying the first flexible suture anchor into the bore, the first flexible anchor including a first profile while being carried into the bore;

changing a shape of the first flexible anchor from the first profile to a second profile forming an anchoring mass to retain the first flexible anchor in the bore; and

applying tension to the first and second ends of the suture construct to reduce a size of the first and second self-locking adjustable loops and secure the soft tissue relative to the first flexible anchor and the bone.

34. The method of claim 33, wherein forming a bore in the bone includes forming first and second bores in the bone;

wherein carrying the first flexible suture anchor into the bore includes carrying the first flexible anchor into the first bore and carrying the second flexible anchor into the second bore to position the suture construct relative to the soft tissue; and

wherein applying tension to the first and second ends of the suture construct to reduce a size of the first and second self-locking adjustable loops includes applying tension to the first and second ends of the suture construct to reduce a size of the first and second self-locking adjustable loops and secure the soft tissue relative to the first and second flexible anchors secured in the respective first and second bores.

35. The method of claim 33, wherein forming a bore in the bone includes forming a bore in a portion of glenoid bone.