Devices and methods for stabilizing tissue and implants

• US 9,579,129 B2
• Filed: 03/11/2014
• Issued: 02/28/2017
• Est. Priority Date: 10/26/2004
• Status: Active Grant

• Current Assignee: P TECH, LLC
• Original Assignee: P TECH, LLC
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): LAWSON, MATTHEW JAMES
• Application Number:
  US14/204,522
• Publication Number:
  US 20140194988A1
• Time in Patent Office: 1,085 Days
• Field of Search: 623 1311- 132, 623 1711- 1716
• 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 17/7064 Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
• CPC Class Codes: A61B 17/7067 Devices bearing against one or more spinous processes and also attached to another part of the spine; Tools therefor
• CPC Class Codes: A61B 17/842 Flexible wires, bands or straps A61B17/72, A61B17/82, A61B17/86 take precedence
• CPC Class Codes: A61B 2017/00398 using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/00951 adhesive
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2090/064 for measuring force, pressure or mechanical tension
• CPC Class Codes: A61F 2/0063 Implantable repair or support meshes, e.g. hernia meshes
• 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 2/30749 Fixation appliances for connecting prostheses to the body
• CPC Class Codes: A61F 2/4405 for apophyseal or facet joints, i.e. between adjacent spinous or transverse processes devices implanted between spinous or transverse processes A61B17/7062
• CPC Class Codes: A61F 2/441 made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
• CPC Class Codes: A61F 2/442 Intervertebral or spinal discs, e.g. resilient non-disc-shaped intervertebral inflatable pockets A61F2/441; non-disc-shaped intervertebral fusion implants A61F2/4455
• CPC Class Codes: A61F 2002/30462 retained or tied with a rope, string, thread, wire or cable
• CPC Class Codes: A61F 2002/4435 Support means or repair of the natural disc wall, i.e. annulus, e.g. using plates, membranes or meshes
• CPC Class Codes: A61L 27/58 Materials at least partially resorbable by the body

Abstract

An implant for repairing a joint between a first bone and a second bone includes a first section constructed of a substantially rigid material and a graft constructed of soft tissue having a first end and a second end. The first section has a first end surface configured for positioning against the first bone. The graft is configured for stabilizing the first section relative to the first bone. A first fastener is configured for mounting to the graft and the first section to anchor the graft to the first section. A second fastener is configured for mounting to the graft and the first bone to anchor the graft to the first bone.

Claims

1. A system for stabilizing a ligament, the system comprising:

a ligament graft having a graft length, a superior end portion and an inferior end portion, the ligament graft configured for positioning proximate the ligament such that the superior end portion is positioned at a first side of the ligament and the inferior end portion is positioned at a second side of the ligament, the graft length being greater than a distance between a first midpoint of a first vertebra and a second midpoint of the second vertebra associated with the ligament;

a first fastener configured for positioning against the superior end portion;

a second fastener configured for positioning against the inferior end portion; and

a suture secured to at least one of the first and the second fasteners in an implanted configuration and configured for extending through the superior end portion, the ligament, the first vertebra, the intervertebral disc, the second vertebra, and the inferior end portion, the suture being tensioned.

2. The system of claim 1 further comprising:

a fifth fastener; and

a sixth fastener, the fifth fastener configured for securing the inferior end portion to a third vertebra that is positioned at an inferior side of the second vertebra and the sixth fastener configured for securing the superior end portion to a fourth vertebra that is positioned at a superior side of the first vertebra.

3. The system of claim 2, further comprising:

a seventh fastener and a second suture associated with the fifth fastener, the fifth fastener, the seventh fastener and the second suture configured for securing the inferior end portion to the third vertebra.

4. The system of claim 2, further comprising:

an eighth fastener and a third suture associated with the sixth fastener, the eighth fastener, the sixth fastener and the third suture configured for securing the superior end portion to the fourth vertebra.

5. The system of claim 1, wherein the ligament graft is constructed of collagen.

6. The system of claim 1, wherein the ligament graft includes a material selected from the group consisting of an autograft material, an allograft material and a zenograft material.

7. The system of claim 1, wherein the ligament graft is constructed of a polymer, a carbon fiber material, a polyether ether ketone material and a polytetrafluoroethylene material.

8. The system of claim 1, further comprising:

a plurality of posterior fasteners; and

a posterior suture, the plurality of posterior fasteners and the posterior suture configured for placement on a posterior of at least one of the first vertebra, the second vertebra, a third vertebra and a fourth vertebra to stabilize the first, second, third and fourth vertebrae relative to each other.

9. The system of claim 1 further comprising:

a second ligament graft having a graft height greater than a thickness of an intervertebral disc between the first and second vertebrae;

a third fastener; and

a fourth fastener, the third fastener configured to secure the second ligament graft to the first vertebra and the fourth fastener configured to secure the second ligament graft to the second vertebra.

10. A system for stabilizing a ligament, the system comprising:

a first fastener configured for positioning against a first side of the ligament proximate a first vertebra;

a second fastener configured for positioning against a second side of the ligament proximate a second vertebra;

a first suture secured to the first fastener and configured for positioning through the ligament at the first side, through the ligament at the second side and for securing to the second fastener, the first suture tensioned between the first and second fasteners causing ends of the ligament to be draw together;

a support rod configured for positioning against a first spinous process of the first vertebra, and a second spinout process of the second vertebra;

a plurality of plate fasteners configured for positioning against the plate;

a plurality of spinous process fasteners configured for positioning against the spinous processes of the first and second vertebrae; and

a second suture secured to at least one of the plurality of plate fasteners and to at least one of the plurality of spinous process fasteners, the second suture tensioned between the at least one of the of plate fasteners and the at least one of the plurality of plate fasteners.

11. The system of claim 10 further comprising:

a third fastener configured for positioning against a first side of a loosened region of the ligament proximate a second intervertebral disc between the second vertebra and a third vertebra, which is positioned at an inferior side of the second vertebra;

a fourth fastener configured for positioning against a second side of the loosened region of the ligament; and

a third suture secured to the third fastener and the fourth fastener, the third suture tensioned between the third fastener and the fourth fastener.

12. The system of claim 10 further comprising:

a fifth fastener configured for positioning against an upper side of a stretched region of the ligament proximate a third intervertebral disc between a third vertebra, which is positioned at an inferior side of the second vertebra and a fourth vertebra, which is positioned at an inferior side of the third vertebra;

a sixth fastener configured for positioning against a lower side of the stretched region; and

a fourth suture secured to the fifth fastener and the sixth fastener, the fourth suture tensioned between the fifth fastener and the sixth fastener.

13. The system of claim 12, wherein the sixth fastener has a curved configuration and passes through the ligament through the upper side, through a portion of the third vertebra, through the third intervertebral disc, through the fourth vertebra and through the lower side.

14. The system of claim 10, wherein the plurality of plate fasteners is comprised of four fasteners.

15. The system of claim 10, wherein the plurality of spinous process fasteners is comprised of eight fasteners.

16. A method for stabilizing a weakened portion of a ligament of a patient'"'"'s spine, the method comprising:

a) performing a surgical procedure on the spine proximate the weakened portion of the ligament, the ligament including an upper end at a first side of the weakened portion and a lower end at an opposite second side of the weakened portion;

b) securing a first end of a suture directly to the upper end;

c) securing a second end of the suture directly to the lower end; and

d) tightening the suture to draw the first end toward the second end.

17. The method of claim 16, wherein the first end is secured to the upper end by a first fastener and the second end is secured to the lower end by a second fastener, the first and second fasteners secured to the upper and lower ends of the ligament, respectively.

18. The method of claim 16, wherein the suture extends from the upper end to the lower end through the upper and lower ends and the weakened portion of the ligament, the weakened portion comprised of a torn ligament region.

19. The method of claim 16, wherein the suture extends from the upper end to the lower end through the upper and lower ends, the weakened portion comprised of a loosened region, the tightening of step (d) tightening the loosened region.

20. The method of claim 16, wherein the suture extends through the upper end, through a first vertebra, through an intervertebral disc, through a second vertebra and through the lower end, the weakened portion comprised of a stretched region, the tightening of step (d) tightening the stretched region.

21. The method of claim 20, wherein the ligament extends through the structures of the patient'"'"'s spine in a curved configuration.

22. The method of claim 16, wherein steps (b), (c) and (d) are performed on the way out of a surgical incision after the surgical procedure of step (a).

23. The method of claim 16, further comprising:

e) positioning a stabilization implant adjacent spinous processes of the patient'"'"'s spine proximate the weakened portion;

f) securing a first plurality of fasteners to the stabilization implant;

g) securing a second plurality of fasteners to the spinous processes; and

h) securing the first plurality of fasteners to the second plurality of fasteners with a tensioned stabilization suture.

24. A method for stabilizing a weakened portion of a ligament of a patient'"'"'s body, the method comprising:

a) performing a surgical procedure on the patient'"'"'s body through a surgical incision proximate the weakened portion of the ligament, the ligament including an upper end at a first side of the weakened portion and a lower end at an opposite second side of the weakened portion;

b) securing a first fastener to the upper end and a first bone portion proximate the upper end;

c) securing a second fastener to the lower end and a second bone portion proximate the lower end; and

d) securing a suture directly to the first and second fasteners and tightening the suture.

25. The method of claim 24, wherein the first bone portion is associated with a first vertebra and the second bone portion is associated with a second vertebra, the ligament of the weakened portion of the ligament being comprised of a spinal ligament.

26. The method of claim 24, further comprising:

e) securing a first ligament graft adjacent the upper end in step (b); and

f) securing the first ligament graft adjacent the lower end in step (c).

27. The method of claim 26, wherein the first ligament graft spans the weakened portion, the weakened portion comprised of a damaged region.

28. The method of claim 24, further comprising:

e) securing a second ligament graft to the first bone portion with a third fastener; and

f) securing the second ligament graft to the second bone portion with a fourth fastener.

29. The method of claim 24, wherein the suture extends from the first fastener to the second fastener through the upper and lower ends and the weakened portion of the ligament, the weakened portion comprised of a torn ligament region.

30. The method of claim 24, wherein the suture extends from the first fastener to the second fastener through the upper and lower ends, the weakened portion comprised of a loosened region, the tightening of step (d) tightening the loosened region.

31. The method of claim 24, wherein the suture extends from the first fastener, through the upper end, through a first vertebra, through an intervertebral disc, through a second vertebra, through the lower end and to the second fastener, the weakened portion comprised of a stretched region, the tightening of step (d) tightening the stretched region.

32. The method of claim 24, wherein the surgical procedure of step (a) is performed on the patient'"'"'s knee and the first and second bone portions are comprised of bone portions proximate the patient'"'"'s knee.

33. The method of claim 24, wherein the surgical procedure of step (a) is performed on the patient'"'"'s elbow and the first and second bone portions are comprised of bone portions proximate the patient'"'"'s elbow.