Method and apparatus for coupling anatomical features

• US 9,498,204 B2
• Filed: 07/07/2014
• Issued: 11/22/2016
• 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): ORKIN, ALEXANDER J
• Application Number:
  US14/324,688
• Publication Number:
  US 20140324101A1
• Time in Patent Office: 869 Days
• US Class Current: 1/1
• 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
• 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 2017/0417 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
• 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;

positioning a first anchor relative to the first bore;

positioning a second anchor relative to the second bore;

positioning in the first bore and in the second bore an adjustable suture construct coupled to the first anchor and the second anchor, wherein the adjustable suture construct includes a passage portion defined by a body of a suture, a first adjustable loop slidable relative to the passage portion to adjust a size of the first adjustable loop, and a second adjustable loop slidable relative to the passage portion to adjust a size of the second adjustable loop; and

pulling on at least a first free end of the adjustable suture construct with at least part of the adjustable suture construct positioned in the first bore and in the second bore between the first anchor and the second anchor so as to reduce the size of the first adjustable loop for positioning the first bone relative to the second bone.

2. The method of claim 1, wherein forming the first bore in the first bore of the anatomy includes forming the bore through the first bone.

3. The method according to claim 2, wherein positioning the first anchor relative to the first bore includes:

providing the first anchor with a first profile allowing insertion through the first bore and a second profile allowing engagement with a positive locking surface of the first bone;

passing the first anchor in the first profile through the first bore; and

engaging the first anchor in the second profile with the positive locking surface of the first bone.

4. The method of claim 3, wherein the first anchor is passed through the first bore in the first bone and the second bore in the second bone.

5. The method of claim 1, wherein said pulling on at least a first free end of the adjustable suture construct with at least part of the adjustable suture construct positioned in the first bore and in the second bore between the first anchor and the second anchor includes pulling on a first free end and a second free end of the adjustable suture construct so as to reduce a size of the first adjustable loop and a size of the second adjustable loop for positioning the first bone relative to the second bone.

6. The method of claim 1, wherein the first bore and the second bore are formed axially aligned.

7. The method of claim 1, wherein the first bone is selected from a coracoid process, a lunate, or a radius and the second bone is selected from a scapula, a scaphoid, or an ulna, respectively.

8. The method of claim 1, further comprising passing the first anchor through the first bore and passing the second anchor through the second bore to position the first anchor relative to the first bone and the second anchor relative to the second bone.

9. The method of claim 1, wherein said pulling on at least a first free end of the adjustable suture construct with at least part of the adjustable suture construct positioned in the first bore and in the second bore between the first anchor and the second anchor so as to reduce a size of the first adjustable loop for positioning the first bone relative to the second bone further includes tensioning to stabilize the first bone relative to the second bone and align the bones without a need to form knots in the adjustable suture construct.

10. The method of claim 1, further comprising positioning the first anchor at the passage portion and the second anchor at the first and second adjustable loops.

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

providing an adjustable suture construct having a first anchor and a second anchor coupled to the adjustable suture construct, wherein the adjustable suture construct includes a first adjustable loop and a second adjustable loop that are both slidable relative to a passage portion defined in a body of the suture forming the adjustable suture construct;

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

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

positioning the first anchor relative to the first bore;

positioning the second anchor relative to the second bore; and

pulling on at least a first free end of the adjustable suture construct with at least part of the adjustable suture construct positioned in the first bore and in the second bore between the first anchor and the second anchor so as to reduce a size of the first adjustable loop for stabilizing the first bone relative to the second bone.

12. The method of claim 11, further comprising passing the first anchor through the first bore into a first bone.

13. The method of claim 12, further comprising passing the first anchor through the first bore in the first bone and the second bore in the second bone.

14. The method of claim 11, wherein

the adjustable suture construct is formed by passing a first end of the suture through a first aperture defined by the body of the suture into the passage portion defined by the body of the suture and out a second aperture defined by the body of the suture so as to place the first end outside of the passage portion and form the first adjustable loop, and by passing a second end of the suture through a third aperture defined by the body of the suture into the passage portion and out a fourth aperture defined by the body of the suture so as to place the second end outside of the passage portion and form the second adjustable loop.

15. The method of claim 14, wherein the first and fourth apertures are the same aperture and the second and third apertures are the same aperture.

16. The method of claim 11, wherein the first bone is selected from a coracoid process, a lunate, or a radius and the second bone is selected from a scapula, a scaphoid, or an ulna, respectively.

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

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

forming a second bore through a second bone of the anatomy and axially aligned with the first bore of the anatomy;

passing a first anchor through a second bore in the second bone and the first bore in the first bone to position the first anchor relative to the first bore;

positioning a second anchor relative to the second bore;

positioning in the first bore and in the second bore an adjustable suture construct coupled to the first anchor and the second anchor, wherein the adjustable suture construct includes a passage portion defined by a body of the suture, a first adjustable loop slidable relative to the passage portion to adjust a size of the first adjustable loop, and a second adjustable loop slidable relative to the passage portion to adjust a size of the second adjustable loop; and

pulling on at least a first free end of the adjustable suture construct with at least part of the adjustable suture construct positioned in the first bore and in the second bore between the first anchor and the second anchor so as to reduce the size of the first adjustable loop for stabilizing the first bone relative to the second bone.

18. The method of claim 17, wherein the first bone is a radius and the second bone is an ulna.

19. The method of claim 17, wherein passing the first anchor through the second and first bores includes passing the first anchor with a first profile through the second and first bores and toggling the first anchor to a second profile in engagement with a positive locking surface of the first bone.

20. The method of claim 17, further comprising positioning the first anchor at the passage portion and the second anchor at the first and second adjustable loops.

21. The method of claim 17, wherein the passage portion of the adjustable suture construct is situated between the first free end and a second free end of the adjustable suture construct, the first free end of the adjustable suture construct extending through a first aperture in the suture body, along a first longitudinal portion of the passage portion, and out a second aperture in the suture body to form the first adjustable loop, the second free end of the adjustable suture construct extending through a third aperture in the suture body, along a second longitudinal portion of the passage portion, and out a fourth aperture in the suture body to form the second adjustable loop, wherein the first aperture, the second aperture, the third aperture, and the fourth aperture are all separate apertures in the suture body.