Method and apparatus for re-attaching the labrum to the acetabulum, including the provision and use of a novel suture anchor system

• US 9,179,905 B2
• Filed: 07/19/2010
• Issued: 11/10/2015
• Est. Priority Date: 07/17/2009
• Status: Active Grant

• Current Assignee: Stryker Puerto Rico Holdings BV (Stryker Corporation)
• Original Assignee: Pivot Medical, Inc. (Stryker Corporation)
• Inventors: Pamichev, Chris, Burley, J. Brook, Nikolchev, Julian, Flom, James
• Primary Examiner(s): Anderson, Gregory
• Assistant Examiner(s): LYNCH, ROBERT A
• Application Number:
  US12/839,246
• Publication Number:
  US 20110071545A1
• Time in Patent Office: 1,940 Days
• Field of Search: 411/34, 411/35, 411/38, 411/44, 411/45, 411/54, 411/54.1, 411/56, 411/57.1, 411/58, 411/59, 411/60.1, 411/390, 411/490, 411/498, 606/53, 606/60, 606/86.R, 606/104, 606/139, 606/144, 606/148, 606/232, 606/300, 606/326, 606/327, 606/916, 623/13.14, 244/53
• 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 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1746 for the acetabulum
• 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 2017/0414 having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/042 plastically deformed during insertion
• CPC Class Codes: A61B 2017/0422 by insertion of a separate member into the body of the anchor
• CPC Class Codes: A61B 2017/0424 the separate member staying in the anchor after placement
• CPC Class Codes: A61B 2017/0427 having anchoring barbs or pins extending outwardly from the anchor body
• CPC Class Codes: A61B 2017/0438 slotted, i.e. having a longitudinal slot for enhancing their elasticity
• 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 2017/0451 Cams or wedges holding the suture by friction
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61F 2/34 Acetabular cups
• CPC Class Codes: A61F 2002/345 the inner and outer (hemi)spherical surfaces of a shell, e.g. an intermediate shell, having distinct centres of rotation, both located on the centre line of the shell
• CPC Class Codes: A61F 2220/0008 Fixation appliances for connecting prostheses to the body

Abstract

Apparatus for securing a first object to a second object, comprising an elongated body having a distal end and a proximal end, and a lumen extending therebetween, the lumen comprising a first section and a second section, the first section being disposed distal to the second section, and with the first section having a wider diameter than the second section; at least one longitudinally-extending slit extending through the side wall of the elongated body and communicating with the lumen, the slit having a distal end and a proximal end, with the distal end of the slit being spaced from the distal end of the elongated body; and an elongated element extending through the lumen, the elongated element comprising a proximal end and a distal end and having an enlargement at its distal end, the enlargement having a diameter greater than the second section.

Claims

1. Apparatus for securing a first object to a second object, said apparatus comprising:

an elongated body having a distal end, a proximal end, and a lumen extending between said distal end and said proximal end, said lumen comprising a first section and a second section, said first section of said lumen being disposed distal to said second section of said lumen, with said first section of said lumen having a wider diameter than said second section of said lumen;

an enlargement slidably disposed at least in part in said first section of said lumen, said enlargement having a diameter greater than said second section of said lumen;

a single closed loop of a first suture slidably disposed in said lumen of said elongated body, said single closed loop of said first suture having a distal end and a proximal end, said distal end of said single closed loop of said first suture being connected to said enlargement and said proximal end of said single closed loop of said first suture extending through said second section of said lumen and protruding out said proximal end of said elongated body, said single closed loop of said first suture and said elongated body together defining an eyelet proximal to said elongated body, said eyelet being of variable size as said single closed loop of said first suture moves along said lumen of said elongated body, said first suture having a first diameter; and

an open loop of a second suture extending through said eyelet defined by said single closed loop of said first suture and said elongated body, said open loop of said second suture extending through said single closed loop of said first suture external to said elongated body, said second suture having a second diameter larger than said first diameter;

wherein said enlargement comprises an expander having a distal end, a proximal end and a passageway extending therebetween, wherein said single closed loop of said first suture is connected to said enlargement by passing said single closed loop of said first suture through said passageway of said expander and forming a knot in said single closed loop of said first suture distal to said expander, and further wherein said expander is initially completely disposed in said first section of said lumen;

said elongated body, said enlargement, said single closed loop of said first suture and said open loop of said second suture being constructed such that proximal movement of said open loop of said second suture causes proximal movement of said single closed loop of said first suture, which causes proximal movement of said enlargement into said second section of said lumen, whereby to laterally expand said elongated body.

2. Apparatus according to claim 1 wherein the enlargement comprises a solid member.

3. Apparatus according to claim 1 wherein the enlargement comprises a suture knot.

4. Apparatus according to claim 1 wherein the enlargement comprises a solid member and a suture knot, the solid member being disposed proximal to the suture knot.

5. Apparatus according to claim 1 wherein the elongated body is generally cylindrical.

6. Apparatus according to claim 1 wherein the elongated body comprises ribs.

7. Apparatus according to claim 6 wherein the ribs are slotted.

8. Apparatus according to claim 6 wherein the ribs are resilient.

9. Apparatus according to claim 1 wherein the elongated body comprises at least one longitudinally-extending slit extending through the side wall of the elongated body and communicating with the lumen.

10. Apparatus according to claim 9 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit being spaced from the distal end of the elongated body and with the proximal end of the at least one longitudinally-extending slit being spaced from the proximal end of the elongated body.

11. Apparatus according to claim 9 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit opening on the distal end of the elongated body.

12. Apparatus according to claim 9 wherein the at least one longitudinally-extending slit comprises a distal end and a proximal end, wherein the distal end of the longitudinally-extending slit terminates in a distal relief hole and the proximal end of the longitudinally-extending slit terminates in a proximal relief hole.

13. Apparatus according to claim 9 wherein there are two longitudinally-extending slits, and further wherein the two longitudinally-extending slits are diametrically opposed to one another.

14. Apparatus according to claim 1 wherein the first object comprises tissue and the second object comprises bone.

15. Apparatus according to claim 14 wherein the tissue comprises the labrum and the bone comprises the acetabulum.

16. Apparatus according to claim 1 further comprising an inserter for manipulating the elongated body.

17. Apparatus according to claim 16 wherein the inserter comprises a hollow push tube having a lumen extending therethrough.

18. Apparatus according to claim 17 wherein the first suture and the second suture extend through a portion of the lumen of the push tube.

19. Apparatus according to claim 18 wherein the elongated body is held to the inserter by applying proximally-directed tension to the second suture.

20. Apparatus according to claim 18 wherein the elongated body is held to the inserter with a male-female connection.

21. Apparatus according to claim 1 wherein the outside surface of the elongated body comprises at least one surface groove for receiving at least one of the first suture and the second suture.

22. Apparatus according to claim 1 wherein the lumen of the elongated body is eccentric to the longitudinal axis of the elongated body.

23. Apparatus according to claim 1 wherein the enlargement comprises suture.

24. Apparatus according to claim 1 wherein the second suture is passed through the first object.

25. Apparatus according to claim 1 wherein the closed loop of the first suture is formed out of #2-0 suture and the open loop of the second suture is formed out of #1 suture.

26. Apparatus for securing a first object to a second object, said apparatus comprising:

an elongated body having a distal end, a proximal end, and a lumen extending between said distal end and said proximal end, said lumen comprising a first section and a second section, said first section of said lumen being disposed distal to said second section of said lumen, with said first section of said lumen having a wider diameter than said second section of said lumen;

an enlargement slidably disposed at least in part in said first section of said lumen, said enlargement having a diameter greater than said second section of said lumen;

a single closed loop of a first suture slidably disposed in said lumen of said elongated body, said single closed loop of said first suture having a distal end and a proximal end, said distal end of said single closed loop of said first suture being connected to said enlargement and said proximal end of said single closed loop of said first suture extending through said second section of said lumen and protruding out said proximal end of said elongated body, said single closed loop of said first suture and said elongated body together defining an eyelet proximal to said elongated body, said eyelet being of variable size as said single closed loop of said first suture moves along said lumen of said elongated body, said first suture having a first diameter; and

an open loop of a second suture extending through said eyelet defined by said single closed loop of said first suture and said elongated body, said open loop of said second suture extending through said single closed loop of said first suture external to said elongated body, said second suture having a second diameter larger than said first diameter;

wherein said enlargement comprises an expander having a distal end, a proximal end and a passageway extending therebetween, wherein said single closed loop of said first suture is connected to said enlargement by passing said single closed loop of said first suture through said passageway of said expander and forming a knot in said single closed loop of said first suture distal to said expander, and further wherein said knot is larger than said second section of said lumen;

said elongated body, said enlargement, said single closed loop of said first suture and said open loop of said second suture being constructed such that proximal movement of said open loop of said second suture causes proximal movement of said single closed loop of said first suture, which causes proximal movement of said enlargement into said second section of said lumen, whereby to laterally expand said elongated body.

27. Apparatus according to claim 26 wherein the enlargement comprises a solid member.

28. Apparatus according to claim 26 wherein the enlargement comprises a suture knot.

29. Apparatus according to claim 26 wherein the enlargement comprises a solid member and a suture knot, the solid member being disposed proximal to the suture knot.

30. Apparatus according to claim 26 wherein the elongated body is generally cylindrical.

31. Apparatus according to claim 26 wherein the elongated body comprises ribs.

32. Apparatus according to claim 31 wherein the ribs are slotted.

33. Apparatus according to claim 31 wherein the ribs are resilient.

34. Apparatus according to claim 26 wherein the elongated body comprises at least one longitudinally-extending slit extending through the side wall of the elongated body and communicating with the lumen.

35. Apparatus according to claim 34 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit being spaced from the distal end of the elongated body and with the proximal end of the at least one longitudinally-extending slit being spaced from the proximal end of the elongated body.

36. Apparatus according to claim 34 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit opening on the distal end of the elongated body.

37. Apparatus according to claim 34 wherein the at least one longitudinally-extending slit comprises a distal end and a proximal end, wherein the distal end of the longitudinally-extending slit terminates in a distal relief hole and the proximal end of the longitudinally-extending slit terminates in a proximal relief hole.

38. Apparatus according to claim 34 wherein there are two longitudinally-extending slits, and further wherein the two longitudinally-extending slits are diametrically opposed to one another.

39. Apparatus according to claim 26 wherein the first object comprises tissue and the second object comprises bone.

40. Apparatus according to claim 39 wherein the tissue comprises the labrum and the bone comprises the acetabulum.

41. Apparatus according to claim 26 further comprising an inserter for manipulating the elongated body.

42. Apparatus according to claim 41 wherein the inserter comprises a hollow push tube having a lumen extending therethrough.

43. Apparatus according to claim 42 wherein the first suture and the second suture extend through a portion of the lumen of the push tube.

44. Apparatus according to claim 43 wherein the elongated body is held to the inserter by applying proximally-directed tension to the second suture.

45. Apparatus according to claim 43 wherein the elongated body is held to the inserter with a male-female connection.

46. Apparatus according to claim 26 wherein the outside surface of the elongated body comprises at least one surface groove for receiving at least one of the first suture and the second suture.

47. Apparatus according to claim 26 wherein the lumen of the elongated body is eccentric to the longitudinal axis of the elongated body.

48. Apparatus according to claim 26 wherein the enlargement comprises suture.

49. Apparatus according to claim 26 wherein the second suture is passed through the first object.

50. Apparatus according to claim 26 wherein the closed loop of the first suture is formed out of #2-0 suture and the open loop of the second suture is formed out of #1 suture.

68. Apparatus according to claim 26 wherein the inserter comprises a hollow push tube having a lumen extending therethrough.

69. Apparatus according to claim 68 wherein the first suture and the second suture extend through a portion of the lumen of the push tube.

70. Apparatus according to claim 69 wherein the elongated body is held to the inserter by applying proximally-directed tension to the second suture.

71. Apparatus according to claim 69 wherein the elongated body is held to the inserter with a male-female connection.

51. Apparatus for securing a first object to a second object, said apparatus comprising:

an elongated body having a distal end, a proximal end, and a lumen extending between said distal end and said proximal end, said lumen comprising a first cylindrical section, a second cylindrical section and a third cylindrical section, said first cylindrical section of said lumen being disposed distal to said second cylindrical section of said lumen, with said first cylindrical section of said lumen having a wider diameter than said second cylindrical section of said lumen, and said third section of said lumen being disposed proximal to said second section, with said second section of said lumen having a wider diameter than said third section of said lumen, wherein said first cylindrical section of said lumen is separated from said second cylindrical section of said lumen by a first shoulder, and said second cylindrical section of said lumen is separated from said third cylindrical section of said lumen by a second shoulder;

an enlargement slidably disposed at least in part in said first section of said lumen, said enlargement having a diameter greater than said second section of said lumen;

a single closed loop of a first suture slidably disposed in said lumen of said elongated body, said single closed loop of said first suture having a distal end and a proximal end, said distal end of said single closed loop of said first suture being connected to said enlargement and said proximal end of said single closed loop of said first suture extending through said second section of said lumen and said third section of said lumen and protruding out said proximal end of said elongated body, said single closed loop of said first suture and said elongated body together defining an eyelet proximal to said elongated body, said eyelet being of variable size as said single closed loop of said first suture moves along said lumen of said elongated body, said first suture having a first diameter; and

an open loop of a second suture extending through said eyelet defined by said single closed loop of said first suture and said elongated body, said open loop of said second suture extending through said single closed loop of said first suture external to said elongated body, said second suture having a second diameter larger than said first diameter;

said elongated body, said enlargement, said single closed loop of said first suture and said open loop of said second suture being constructed such that proximal movement of said open loop of said second suture causes proximal movement of said single closed loop of said first suture, which causes proximal movement of said enlargement into said second section of said lumen, whereby to laterally expand said elongated body while stopping proximal movement of said enlargement distal to said third section of said lumen.

52. Apparatus according to claim 51 wherein the eyelet varies in size when the closed loop is moved proximally within the elongated body.

53. Apparatus according to claim 51 wherein the enlargement comprises a solid member.

54. Apparatus according to claim 51 wherein the enlargement comprises a suture knot.

55. Apparatus according to claim 51 wherein the enlargement comprises a solid member and a suture knot, the solid member being disposed proximal to the suture knot.

56. Apparatus according to claim 51 wherein the elongated body is generally cylindrical.

57. Apparatus according to claim 51 wherein the elongated body comprises ribs.

58. Apparatus according to claim 57 wherein the ribs are slotted.

59. Apparatus according to claim 57 wherein the ribs are resilient.

60. Apparatus according to claim 51 wherein the elongated body comprises at least one longitudinally-extending slit extending through the side wall of the elongated body and communicating with the lumen.

61. Apparatus according to claim 60 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit being spaced from the distal end of the elongated body and with the proximal end of the at least one longitudinally-extending slit being spaced from the proximal end of the elongated body.

62. Apparatus according to claim 60 wherein the at least one longitudinally-extending slit has a distal end and a proximal end, with the distal end of the at least one longitudinally-extending slit opening on the distal end of the elongated body.

63. Apparatus according to claim 60 wherein the at least one longitudinally-extending slit comprises a distal end and a proximal end, wherein the distal end of the longitudinally-extending slit terminates in a distal relief hole and the proximal end of the longitudinally-extending slit terminates in a proximal relief hole.

64. Apparatus according to claim 60 wherein there are two longitudinally-extending slits, and further wherein the two longitudinally-extending slits are diametrically opposed to one another.

65. Apparatus according to claim 51 wherein the first object comprises tissue and the second object comprises bone.

66. Apparatus according to claim 65 wherein the tissue comprises the labrum and the bone comprises the acetabulum.

67. Apparatus according to claim 51 further comprising an inserter for manipulating the elongated body.

72. Apparatus according to claim 51 wherein the outside surface of the elongated body comprises at least one surface groove for receiving at least one of the first suture and the second suture.

73. Apparatus according to claim 51 wherein the lumen of the elongated body is eccentric to the longitudinal axis of the elongated body.

74. Apparatus according to claim 51 wherein the enlargement comprises suture.

75. Apparatus according to claim 51 wherein the second suture is passed through the first object.

76. Apparatus according to claim 51 wherein the closed loop of the first suture is formed out of #2-0 suture and the open loop of the second suture is formed out of #1 suture.