Method and apparatus for coupling soft tissue to a bone

• US 9,149,267 B2
• Filed: 11/10/2011
• Issued: 10/06/2015
• 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: Norton, Daniel, Stone, Kevin T., Denham, Gregory J., Kaiser, Ryan A.
• Primary Examiner(s): Dornbusch, Dianne
• Application Number:
  US13/293,825
• Publication Number:
  US 20120059417A1
• Time in Patent Office: 1,426 Days
• US Class Current: 1/1
• 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 17/0487 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 17/16 Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans arthroscopic bone cutters A61B17/320016; dental implant drills potentially for other surgical use A61C8/0089; bone grinders A61F2/4644, A22C17/06; A61B17/1662 takes precedence over all other subgroups except A61B17/17
• CPC Class Codes: A61B 17/1615 Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material
• CPC Class Codes: A61B 17/1655 for tapping
• CPC Class Codes: A61B 2017/00336 with a protective sleeve, e.g. retractable or slidable
• CPC Class Codes: A61B 2017/00858 high friction, non-slip on handles A61B2017/00429
• 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 2017/0414 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 2017/0432 the separate member staying in the anchor after placement
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• CPC Class Codes: A61B 2017/0441 the shaft being a rigid coil or spiral
• CPC Class Codes: A61B 2017/0445 cannulated, e.g. with a longitudinal through-hole for passage of an instrument
• 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 2017/0477 with pre-tied sutures
• CPC Class Codes: A61B 2017/06185 : hollow or tubular hollow suture needles A61B2017/061

Abstract

A method can include forming a bore in a bone of a patient and positioning a first anchor in the bore. The first anchor can have a self-locking adjustable suture construct extending therefrom that can include first and second adjustable loops. The first adjustable loop can be positioned about a first portion of the soft tissue and the second adjustable loop can be positioned about a second portion of the soft tissue different than the first portion. A coupling element carried by the second adjustable loop can be coupled to the first adjustable loop. An end of the adjustable suture construct can be tensioned to reduce a size of the first and second adjustable loops to couple the soft tissue to the bone.

Claims

1. A method for use in coupling soft tissue to bone, comprising:

forming a bore in a bone of a patient;

positioning a first anchor in the bore of the bone, the first anchor having a self-locking adjustable suture construct extending therefrom, the adjustable suture construct having first and second adjustable loops;

positioning the first adjustable loop about a first portion of the soft tissue;

positioning the second adjustable loop about a second portion of the soft tissue different than the first portion;

positioning a coupling element carried by the second adjustable loop through the first adjustable loop; and

tensioning an end of the adjustable suture construct such that the coupling element is coupled to the first adjustable loop and the first and second adjustable loops cooperate to form a loop structure over at least a portion of the soft tissue to couple the soft tissue to the bone.

2. The method of claim 1, wherein positioning the first anchor in the bore of the bone includes positioning a first flexible anchor in the bore of the bone;

and

wherein positioning the coupling element carried by the second adjustable loop through the first adjustable loop includes positioning a second flexible anchor carried by the second adjustable loop through the first adjustable loop.

3. The method of claim 2, wherein positioning the first adjustable loop about the first portion of the soft tissue includes piercing the first adjustable loop through the first portion of the soft tissue.

4. The method of claim 2, wherein positioning the first adjustable loop about the first portion of the soft tissue includes:

positioning the first adjustable loop between the soft tissue and the bone such that the first adjustable loop extends about a first side of the soft tissue; and

wherein positioning the second adjustable loop about a second portion of the soft tissue includes positioning the second adjustable loop relative to a second opposite side of the soft tissue.

5. The method of claim 2, wherein positioning the second adjustable loop relative to the second portion of the soft tissue includes positioning the second adjustable loop and the second flexible anchor carried thereby through at least a portion of the first portion of the soft tissue.

6. The method of claim 2, wherein tensioning an end of the adjustable suture construct includes tensioning first and second ends of the adjustable suture construct thereby drawing the first flexible anchor and leg members extending therefrom that can move relative to the adjustable suture construct into engagement with a cortical layer of the bone to secure the adjustable suture construct to the bone.

7. The method of claim 2, wherein positioning the first flexible anchor in the bore of the bone includes positioning the first flexible anchor slidably coupled to a passage portion of the adjustable suture construct in the bore, the first and second adjustable loops extending from the passage portion.

8. The method of claim 7, wherein tensioning an end of the adjustable suture construct includes:

tensioning a first end of the adjustable suture construct to reduce a size of the first loop such that an end portion of the first loop engages a portion of the second loop and draws the portion of the second loop toward the soft tissue; and

tensioning a second end of the adjustable suture construct to draw the second flexible anchor carried by an end portion of the second loop into engagement with the end portion of the first loop to form the loop structure.

9. The method of claim 8, wherein tensioning the second end to draw the second flexible anchor carried by the end portion of the second loop into engagement with the end portion of the first loop includes drawing the second flexible anchor and leg members extending therefrom that are not carried by the second loop into engagement with the first loop.

10. The method of claim 7, wherein positioning the first flexible anchor in the bore of the bone includes positioning the first flexible anchor slidably coupled to a passage portion of the adjustable suture construct in the bore, the adjustable suture construct having a first end of a suture extending into and through the passage portion defined by the suture so as to place the first end of the suture outside of the passage portion and define the first adjustable loop, and having a second end of the suture extending into and through the passage portion so as to place the second end of the suture outside of the passage portion and define the second adjustable loop.

11. The method of claim 10, wherein the first end of the suture is passed into the passage portion through a first aperture defined by the suture into the passage portion and out a second aperture defined by the suture, and the second end of the suture is passed through the second aperture into the passage portion and out the first aperture.

12. The method of claim 11, wherein the first adjustable loop extends from a first end of the passage portion and the second adjustable loop extends from a second opposite end of the passage portion.

13. The method of claim 11, wherein the first adjustable loop and the second adjustable loop each extend from the first and second ends of the passage portion.

14. The method of claim 7, wherein tensioning an end of the adjustable suture construct includes:

tensioning a first end of the adjustable suture construct to reduce a size of the first loop such that an end portion of the first loop engages a portion of the second loop and draws the portion of the second loop into the bore; and

tensioning a second end of the adjustable suture construct to reduce a size of the second adjustable loop about the end portion of the first adjustable loop and draw the second flexible anchor toward the end portion of the first adjustable loop and into engagement with the soft tissue, the bone, the end portion of the first loop, or combinations thereof.

15. The method of claim 2, wherein positioning the second flexible anchor carried by the second adjustable loop through the first adjustable loop includes positioning the second flexible anchor carried by the second adjustable loop through an annular fastening element carried by the first adjustable loop;

and

wherein tensioning an end of the adjustable suture construct such that the coupling element is coupled to the first adjustable loop includes tensioning first and second ends of the adjustable suture construct such that the second flexible anchor engages with the fastening element to couple the first adjustable loop to the second adjustable loop and cooperate to form the loop structure.

16. The method of claim 15, wherein positioning the second flexible anchor carried by the second adjustable loop through an annular fastening element carried by the first adjustable loop includes positioning a passing strand integrally formed with the second flexible anchor so as to extend from one end thereof through the annular fastening element;

and

drawing the passing strand through the fastening element to draw the second flexible anchor and a portion of the associated second adjustable loop through the fastening element.

17. The method of claim 1, wherein forming the bore in the bone of the patient includes forming the bore in a glenoid;

and

wherein positioning the first and second adjustable loops about the respective first and second portions of the soft tissue includes positioning the first and second adjustable loops about the respective first and second portions of a labrum.

18. The method of claim 1, wherein forming the bore in the bone of the patient includes forming the bore in a humerus;

and

wherein positioning the first and second adjustable loops about the respective first and second portions of the soft tissue includes positioning the first and second adjustable loops about the respective first and second portions of a rotator cuff.

19. A method for use in coupling soft tissue to bone, comprising:

forming a bore in a bone of a patient;

positioning a first anchor in the bore of the bone, the first anchor having a self-locking adjustable suture construct extending therefrom, the adjustable suture construct having first and second adjustable loops extending from a passage portion and being adjustable relative thereto, the first anchor coupled to the passage portion;

positioning the first adjustable loop about a first portion of the soft tissue;

positioning the second adjustable loop about a second portion of the soft tissue different than the first portion;

coupling a coupling element carried by the second adjustable loop to the first adjustable loop to form a loop structure over at least a portion of the soft tissue; and

tensioning first and second ends of the adjustable suture construct to reduce a size of the first and second adjustable loops relative to the passage portion to thereby reduce a size of the loop structure and couple the soft tissue to the bone.

20. The method of claim 19, wherein positioning the first anchor in the bore of the bone includes positioning a first flexible anchor in the bore of the bone;

and

wherein coupling the coupling element carried by the second adjustable loop to the first adjustable loop includes coupling a second flexible anchor carried by the second adjustable loop to the first adjustable loop.

21. The method of claim 20, wherein positioning the first flexible anchor in the bore of the bone includes positioning the first flexible anchor slidably coupled to the passage portion in the bore, the adjustable suture construct having a first end of a suture extending into and through the passage portion defined by the suture so as to place the first end outside of the passage portion and define the first adjustable loop, and having a second end of the suture extending into and through the passage portion in a direction opposite the first end so as to place the second end outside of the passage portion and define the second adjustable loop.

22. The method of claim 21, wherein tensioning first and second ends of the adjustable suture construct includes drawing the first flexible anchor and leg members extending therefrom that can move relative to the adjustable suture construct into engagement with a cortical layer of the bone to secure the adjustable suture construct to the bone.

23. The method of claim 21, wherein coupling the second flexible anchor carried by the second adjustable loop to the first adjustable loop includes:

passing the second flexible anchor and a portion of the associated second adjustable loop through the first adjustable loop; and

engaging the second flexible anchor and leg members extending therefrom that are movable relative to the second adjustable loop with the first adjustable loop to form the loop structure over at least the portion of the soft tissue.

24. The method of claim 23, wherein tensioning first and second ends of the adjustable suture construct includes:

tensioning the first end of the adjustable suture construct to reduce a size of the first loop such that an end portion of the first loop engages a portion of the second loop and draws the portion of the second loop toward the soft tissue; and

tensioning the second end to draw the second flexible anchor carried by an end portion of the second loop into engagement with the end portion of the first loop to form the loop structure.

25. The method of claim 24, wherein tensioning the first end of the adjustable suture construct includes tensioning the first end of the adjustable suture construct to reduce a size of the first loop such that an end portion of the first loop engages a portion of the second loop and draws the portion of the second loop into the bore.

26. The method of claim 21, wherein coupling the second flexible anchor carried by the second adjustable loop to the first adjustable loop includes:

passing the second flexible anchor and a portion of the associated second adjustable loop through an aperture of an annular fastening element carried by the first adjustable loop; and

engaging the second flexible anchor and leg members extending therefrom that are movable relative to the second adjustable loop with the annular fastening element to form the loop structure over at least the portion of the soft tissue.

27. The method of claim 26, further comprising:

passing an elongated passing strand integrally formed with and extending from one of the leg members of the second flexible anchor through the aperture of the annular fastening element; and

separating the passing strand from the one of the leg members after engaging the second flexible anchor and leg members with the annular fastening element.

28. The method of claim 21, wherein tensioning the first and second ends of the adjustable suture construct to reduce a size of the first and second adjustable loops relative to the passage portion applies compression to the passage portion about the suture.

29. The method of claim 28, wherein tensioning the first and second ends of the adjustable suture construct to reduce a size of the first and second adjustable loops includes self-locking the first and second adjustable loops under tension to maintain the reduced size of the first and second adjustable loops in an absence of a knot.

30. The method of claim 21, wherein coupling the second flexible anchor carried by the second adjustable loop to the first adjustable loop includes:

passing the second flexible anchor and a portion of the associated second adjustable loop through an aperture of an annular fastening element carried by the first adjustable loop and through the first adjustable loop; and

engaging the second flexible anchor and leg members extending therefrom that are movable relative to the second adjustable loop with at least the annular fastening element to form the loop structure over at least the portion of the soft tissue.

31. The method of claim 19, wherein the first and second adjustable loops extend from respective first and second opposite ends of the passage portion.

32. The method of claim 19, wherein the first adjustable loop and the second adjustable loop each extend from a first end and an opposite second end of the passage portion.