Method and apparatus for soft tissue fixation

• US 8,652,171 B2
• Filed: 05/02/2011
• Issued: 02/18/2014
• Est. Priority Date: 02/03/2006
• Status: Active Grant

• Current Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Inventors: Stone, Kevin T., Denham, Gregory J.
• Primary Examiner(s): Dornbusch, Dianne
• Application Number:
  US13/098,927
• Publication Number:
  US 20110208240A1
• Time in Patent Office: 1,023 Days
• Field of Search: 606/60, 606/300, 606/232, 606/301, 606/313, 606/151, 128/898, 623/13.11, 623/13.14, 623 1317- 132, 623/14.12
• 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 17/0487 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 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61B 2017/00336 with a protective sleeve, e.g. retractable or slidable
• CPC Class Codes: A61B 2017/00858 high friction or non-slip
• CPC Class Codes: A61B 2017/0406 Pledgets
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• CPC Class Codes: A61B 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2017/06185 hollow or tubular

Abstract

A surgical method can include passing at least two adjustable loops of a flexible construct through at least the first tissue to extend from an outer surface of the first tissue opposite a tissue engaging surface facing the second tissue, and attaching the two adjustable loops to a first selected area of the second tissue. The method can further include positioning an elongated locking member within the two adjustable loops such that the locking member extends between the two adjustable loops adjacent the outer surface, engaging the locking member with the outer surface by drawing the two adjustable loops towards the outer surface, and compressing the first tissue between the locking member and the second tissue by tensioning the two adjustable loops. Related tissue fixation devices are also provided.

Claims

1. A method of attaching a first tissue to a second tissue, comprising:

passing at least two adjustable loops through at least the first tissue to extend from an outer surface of the first tissue opposite a tissue engaging surface facing the second tissue;

attaching the two adjustable loops to a first selected area of the second tissue;

positioning a locking member within the two adjustable loops such that the locking member extends through the two adjustable loops adjacent the outer surface;

engaging the locking member with the outer surface by drawing the two adjustable loops towards the outer surface; and

compressing the first tissue between the locking member and the second tissue by tensioning the two adjustable loops.

2. The method of claim 1, further comprising:

passing tensioning members extending from the two adjustable loops through the first tissue to exit the outer surface; and

selectively manipulating the tensioning members to draw the two adjustable loops into engagement with the locking member to compress the first tissue.

3. The method of claim 2, wherein the positioning an elongated locking member within the two adjustable loops includes:

passing a first one of the tensioning members through a first one of the two adjustable loops; and

passing a second one of the tensioning members through a second one of the two adjustable loops.

4. The method of claim 2, further comprising attaching the tensioning members to at least a second selected area of the second tissue.

5. The method of claim 4, wherein the attaching the tensioning members to the second selected area includes:

attaching a suture anchor to the second tissue in the second selected area; and

attaching at least one of the tensioning members to the suture anchor.

6. The method of claim 2, further comprising:

wrapping at least one of the tensioning members around the locking member.

7. The method of claim 1, further comprising:

engaging the two adjustable loops with a central section of the locking member disposed between loop engagement members of the locking member; and

engaging the loop engagement members with the two adjustable loops by adjusting a length of the locking member.

8. The method of claim 7, wherein:

engaging the loop engagement Members with the two adjustable loops includes deforming at least one of the loop engagement members from a first configuration to a second configuration different from the first configuration.

9. The method of claim 1, wherein:

passing the two adjustable loops through the first tissue includes forming separate elongate incisions to extend in one of a parallel, a coaxial, and an angled manner with respect to each other.

10. The method of claim 1, further comprising:

attaching a suture anchor to the second tissue in the first selected area; and

passing a suture strand of a flexible construct through the suture anchor to form the two adjustable loops.

11. The method of claim 1, further comprising:

attaching an end of the locking member to the second tissue at a second selected area separate from the first selected area.

12. The method of claim 1, further comprising:

engaging the two adjustable loops with peripheral recesses of the locking member.

13. The method of claim 1, further comprising:

wrapping the locking member around a first one of the two adjustable loops; and

engaging a second one of the two adjustable loops with a loop engaging member of the locking member.

14. The method of claim 1, further comprising:

passing at least one tensioning member of the two adjustable loops through the first tissue to exit the tissue engaging surface; and

selectively manipulating the tensioning member to draw at least a corresponding one of the two adjustable loops into engagement with the locking member to compress the first tissue.

15. The method of claim 1, further comprising:

passing a first tensioning member extending from a first one of the two adjustable loops through the first tissue to exit the outer surface;

passing a second tensioning member extending from a second one of the two adjustable loops through the first tissue to exit the outer surface;

overlapping portions of the first and second tensioning members in an area adjacent to the first tissue; and

attaching the first and second tensioning members to the second tissue at second and third selected areas so that the portions of the first and second tensioning members that overlap engage the first tissue.

16. The method of claim 1, further comprising:

passing the two adjustable loops so that the two adjustable loops are spaced apart in a first direction along the first tissue;

passing ends of an elongated locking member through the two adjustable loops in a second direction transverse to the first direction until a portion of the locking member spanning the two adjustable loops is engaged with the two adjustable loops; and

attaching the ends of the locking member to a selected area of the second tissue so that the locking member extends in the second direction.

17. The method of claim 1, further comprising:

securing a suture anchor to the second tissue in the first selected area; and

attaching at least one of the two adjustable loops to the Suture anchor.

18. The method of claim 1, wherein the two adjustable loops are self-locking.

19. The method of claim 1, further comprising:

forming the two adjustable loops by passing tensioning strands extending from opposite ends of a braided body through corresponding apertures defined by the braided body and disposed adjacent the opposite ends, the braided body and the tensioning strands being part of a flexible construct.

20. The method of claim 1, further comprising attaching a suture anchor including a flexible construct to the second tissue, the flexible construct including the two adjustable loops.

21. The method of claim 1, further comprising:

attaching a first suture anchor including a first flexible construct to the second tissue, the first flexible construct extending from the first suture anchor and including a first self-locking adjustable loop as a first one of the two adjustable loops and a first tensioning member extending from the first self-locking adjustable loop; and

attaching a second suture anchor including a second flexible construct to the second tissue, the second flexible construct extending from the second suture anchor and including a second self-locking adjustable loop as a second one of the two adjustable loops and a second tensioning member extending from the second self-locking adjustable loop.

22. A method of attaching a first tissue to a second tissue, comprising:

attaching a suture anchor including a flexible construct to the second tissue, the flexible construct extending from the suture anchor and including at least two independently adjustable loops and tensioning members extending from the two adjustable loops;

passing the at least two independently adjustable loops through the first tissue to extend from an outer surface of the first tissue opposite a tissue engaging surface facing the second tissue;

passing the tensioning members through the first tissue to extend from the outer surface of the first tissue;

positioning a locking member within the two independently adjustable loops such that the locking member extends between the two independently adjustable loops adjacent the outer surface;

cinching the two independently adjustable loops around the locking member by selectively pulling on the tensioning members;

engaging the locking member with the outer surface of the first tissue; and

compressing the first tissue between the locking member and the second tissue by selectively pulling on the tensioning members.

23. A method of attaching a first tissue to a second tissue, comprising:

attaching at least one self-locking adjustable loop to a first selected area of the second tissue, wherein the at least one self-locking adjustable loop is formed by passing at least two ends of a flexible member through a longitudinal passage in the flexible member;

passing the at least one self-locking adjustable loop through at least the first tissue to extend from an outer surface of the first tissue opposite a tissue engaging surface facing the second tissue;

positioning a locking member within the at least one self-locking adjustable loop such that the locking member extends between the adjustable loop and the outer surface of the first tissue;

engaging the locking member with the outer surface of the first tissue by drawing the at least one self-locking adjustable loop toward the outer surface; and

compressing the first tissue between the locking member and the second tissue by tensioning the at least one self-locking adjustable loop.

24. The method of claim 23, further comprising passing a tensioning member extending from the at least one self-locking adjustable loop through the first tissue to exit the outer surface;

and

selectively manipulating the tensioning member to draw the self-locking adjustable loop into engagement with the locking member to compress the first tissue.

25. The method of claim 24, further comprising attaching the tensioning member to at least a second selected area of the second tissue.

26. The method of claim 25, wherein attaching the tensioning member to the second selected area includes:

attaching a suture anchor to the second tissue at the second selected area; and

attaching the tensioning member to the suture anchor.

27. The method claim 23, wherein attaching the at least one self-locking adjustable loop to a first selected area of the second tissue includes attaching a suture anchor to the second tissue in the first selected area with the at least one self-locking adjustable loop coupled thereto.

28. The method of claim 23, wherein the first tissue is a rotator cuff and the second tissue is a humerus.