Method and apparatus for coupling anatomical features

• US 8,771,316 B2
• Filed: 03/05/2012
• Issued: 07/08/2014
• 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: Denham, Gregory J., Stone, Kevin T.
• Primary Examiner(s): McDermott, Corrine M
• Assistant Examiner(s): ORKIN, ALEXANDER J
• Application Number:
  US13/412,116
• Publication Number:
  US 20120165938A1
• Time in Patent Office: 855 Days
• Field of Search: 606/139, 606/142, 606/144, 606/148, 606/228, 606/232, 623/13.14
• US Class Current: 606/232
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• 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 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• 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 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0412 having anchoring barbs or pins extending outwardly from suture anchor body
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0417 T-fasteners
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• CPC Class Codes: A61B 2017/0445 cannulated, e.g. with a longitudinal through-hole for passage of an instrument
• CPC Class Codes: A61B 2017/0448 Additional elements on or within the anchor
• CPC Class Codes: A61B 2017/045 snug fit within the anchor
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/0475 using sutures having a slip knot
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/06185 hollow or tubular hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/0641 : having at least three legs as part of one single body
• CPC Class Codes: A61F 2/08 : Muscles; Tendons; Ligaments sutures A61B17/04
• CPC Class Codes: A61F 2/0811 : Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2002/0829 : without deformation of anchor parts, e.g. fixation screws on bone surface, extending barbs, cams, butterflies, spring-loaded pins
• CPC Class Codes: A61F 2002/0852 : Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
• CPC Class Codes: A61F 2002/0864 : Fixation of tendon or ligament between anchor elements, e.g. by additional screws in the anchor, anchor crimped around tendon
• CPC Class Codes: A61F 2002/087 : Anchor integrated into tendons, e.g. bone blocks, integrated rings
• CPC Class Codes: A61F 2002/0882 : Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone
• CPC Class Codes: A61F 2002/0888 : Anchor in or on a blind hole or on the bone surface without formation of a tunnel
• CPC Class Codes: Y10T 29/49826 : Assembling or joining

Abstract

A method of coupling a first portion of an anatomy to a second portion of the anatomy includes coupling first and second bones of the anatomy with a bone-tendon-bone implant. The bone-tendon-bone implant has a first bone end, a second bone end and a replacement tendon between the first and second bone ends. The first and second bone ends are positioned in corresponding first and second bores of the first and second bones. The first bone end is secured to the first bone with a first bone anchor. A second anchor coupled to the bone-tendon-bone implant is passed through and outside the second bore. The second anchor is coupled to an adjustable suture construct having two adjustable suture loops. Tensioning at least one of first and second ends of the adjustable suture construct tensions the replacement tendon and positions the first bone relative to the second bone.

Claims

1. A method of coupling a first portion of an anatomy to a second portion of the anatomy comprising:

forming a first bore in a first bone of the anatomy;

forming a second bore in a second bone of the anatomy;

coupling the first and second bones with a bone-tendon-bone implant, wherein the bone-tendon-bone implant has a first bone end, a second bone end and a replacement tendon between the first and second bone ends;

positioning the first bone end in the first bore;

securing the first bone end with a first anchor in the first bone;

positioning the second bone end in the second bore;

passing a second anchor coupled to the bone-tendon-bone implant through and outside the second bore, the second anchor coupled to an adjustable suture construct having a first end and a second end; and

tensioning at least one of the first end and the second end of the adjustable suture construct to tension the replacement tendon and position the first bone relative to the second bone;

wherein the adjustable suture construct includes a passage portion defined by a body of a suture used to form the adjustable suture construct and first and second adjustable loops slidable relative to the passage portion to adjust a size of the first and second adjustable loops and tension the replacement tendon.

2. The method of claim 1, wherein the passage portion of the adjustable suture construct passes through a bore of the second anchor.

3. The method of claim 1, wherein the first and second adjustable loops are coupled to the replacement tendon.

4. The method of claim 1, wherein the first and second adjustable loops are coupled to the second bone end.

5. The method of claim 4, wherein the first and second adjustable loops are passing through a separate suture loop attached to the second bone end.

6. The method of claim 1, wherein the first end of the suture passes through a first aperture defined by the body of the suture and into longitudinal internal bore defined by the passage portion and out a second aperture defined by the body of the suture to form the first adjustable loop, and wherein the second end of the suture passes through a third aperture defined by the body of the suture and into the longitudinal internal bore and out a fourth aperture defined by the body of the suture to form the second adjustable loop.

7. The method of claim 6, wherein the first and fourth apertures coincide and wherein the second and third apertures coincide.

8. The method of claim 1, further comprising:

passing the second anchor through the first and second bores of the first and second bones in a first orientation parallel to the corresponding bore;

rotating the second anchor to a second orientation outside the second bore of the second bone, the second orientation perpendicular to the first orientation.

9. The method of claim 1, wherein the second anchor is a toggle anchor.

10. The method of claim 1, wherein securing the first bone end with a first anchor in the first bone includes securing the first anchor by an interference fit.

11. The method of claim 1, wherein the first bone is a tibia and the second bone is a femur.

12. The method of claim 1, further comprising selecting the bone-tendon-bone implant from an allograph-tendon construction, an artificial bone-tendon or a bone-tendon-bone prosthetic assembly.

13. The method of claim 1, further comprising securing the second bone end with a third anchor.

14. A method of coupling a first portion of an anatomy to a second portion of the anatomy comprising:

forming a tibial bore in a tibial bone of the anatomy;

forming a femoral bore in a femoral bone of the anatomy;

coupling the tibial and femoral bones with a bone-tendon-bone implant, wherein the bone-tendon-bone implant has tibial bone end, a femoral bone end and a replacement tendon between the tibial and femoral bone ends;

positioning the tibial bone end in the tibial bore;

securing the tibial bone end with an interference anchor in the tibial bone;

positioning the femoral bone end in the femoral bore;

passing a toggle anchor coupled to the bone-tendon-bone implant through and outside the femoral bore in a first orientation substantially aligned with the femoral bore, the toggle anchor coupled to an adjustable suture construct having a first end and a second end, wherein the adjustable suture construct includes a passage portion defined by a body of a suture used to form the adjustable suture construct and first and second adjustable loops slidable relative to the passage portion;

rotating the toggle anchor to a second orientation transverse to the first orientation outside the femoral bore; and

tensioning at least one of the first and second ends of the adjustable suture construct to adjust a size of the first and second adjustable loops to tension the replacement tendon and position the tibial bone relative to the femoral bone.

15. The method of claim 14, wherein the first and second adjustable loops are coupled to the replacement tendon.

16. The method of claim 14, wherein the first and second adjustable loops are coupled to the femoral bone end.

17. The method of claim 16, wherein the first and second adjustable loops are passing through a separate suture loop attached to the femoral bone end.

18. The method of claim 14, wherein the first end of the suture passes through a first aperture defined by the body of the suture and into longitudinal internal bore defined by the passage portion and out a second aperture defined by the body of the suture to form the first adjustable loop, and wherein the second end of the suture passes through a third aperture defined by the body of the suture and into the longitudinal internal bore and out a fourth aperture defined by the body of the suture to form the second adjustable loop.

19. The method of claim 18, wherein the first and fourth apertures coincide and wherein the second and third apertures coincide.

20. A method of coupling a first portion of an anatomy to a second portion of the anatomy comprising:

forming a first bore in a first bone of the anatomy;

forming a second bore in a second bone of the anatomy;

positioning a first bone end of a bone-tendon-bone implant in the first bore;

positioning a second bone end of the bone-tendon-bone implant in the second bore, wherein a replacement tendon is between the first and second bone ends;

securing the first bone end in the first bore with a first anchor and the second bone end in the second bore with a second anchor, wherein the second anchor is positioned outside the second bore and is coupled to an adjustable suture construct having a passage portion defined by a body of a suture used to form first and second adjustable loops that pass through the passage portion;

pulling a first end and a second end of the suture construct to adjust a size of the first and second adjustable loops and position the first bone relative to the second bone.