Graft fixation using a screw or plug against suture or tissue

• US 20020013608A1
• Filed: 06/22/2001
• Published: 01/31/2002
• Est. Priority Date: 06/22/2000
• Status: Active Grant

• Current Assignee: Arthrex Incorporated
• Original Assignee: Arthrex Incorporated
• Inventors: ElAttrache, Neal, Burkhart, Stephen S., Dreyfuss, Peter
• Granted Patent: US 6,544,281 B2
• Time in Patent Office: Days
• US Class Current: 606/232
• 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 17/864 hollow, e.g. with socket or cannulated
• CPC Class Codes: A61B 17/8645 Headless screws, e.g. ligament interference screws
• CPC Class Codes: A61B 17/8875 Screwdrivers, spanners or wrenches
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/044 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 2017/045 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: A61F 2/0805 Implements for inserting tendons or ligaments
• CPC Class Codes: A61F 2/0811 Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2002/0841 Longitudinal channel for insertion tool running through the whole tendon anchor, e.g. for accommodating bone drill, guidewire
• CPC Class Codes: A61F 2002/0858 Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
• CPC Class Codes: A61F 2002/0888 Anchor in or on a blind hole or on the bone surface without formation of a tunnel

Abstract

A method for securing soft tissue to bone with excellent pull-out strength which does not require the surgeon to tie suture knots to secure the tissue to the bone. A blind hole or socket is created in the bone at the location the graft is to be secured. Preferably, suture is then passed through the graft at desired points. A cannulated driver is pre-loaded with a cannulated plug or screw slidably disposed onto the distal portion of the driver. In a preferred embodiment, a separate piece of suture is passed through the cannula of the driver with a loop end of that suture exposed at the distal end of the driver. The ends of the suture attached to the graft are fed through the suture loop at the end of the driver. Alternatively, the graft itself may be fed through the suture loop, in which case it is not necessary to attach suture through the graft. In another embodiment, the suture loop exposed at the distal end of the cannula of the driver may be omitted, and the sutures attached to the graft may then be fed through the driver cannula from the distal end to position the graft relative to the driver. The driver is inserted into the hole with the screw or plug just outside the hole. Tension is then placed on the suture. Once adequate tension is achieved on the suture, the driver is pressed into the hole, which engages the first thread or bump of the screw or plug on the bone. The screw or plug is then fully advanced into the hole using the driver. When the screw or plug is fully inserted, the suture loop is freed and the driver is removed. The loose ends of the sutures protruding from the anchor site can be cleaned up by clipping them short.

Claims

1. A method of soft tissue repair, comprising the steps of:

forming a hole in a bone at a location at which a soft tissue graft is to be affixed;

attaching at least one suture to the soft tissue graft to be affixed;

capturing the suture attached to the graft and inserting the suture into the bottom of the hole;

drawing the soft tissue graft to the hole; and

installing a tissue anchor into the hole to secure the suture in the hole by interference-friction fixation between the tissue anchor and the bone forming the hole.

2. The method of graft repair according to claim 1, wherein the tissue anchor is a cannulated intereference device, and the method further comprises the steps of:

loading the cannulated interference device onto a cannulated driver; and

using the driver to install the interference device into the hole.

3. The method of graft repair according to claim 2, wherein the interference device is a screw.

4. The method of graft repair according to claim 2, wherein the interference device is one of a wedge or a plug.

5. The method of graft repair according to claim 2, further comprising the step of passing suture through the cannula of the driver such that a loop of suture is exposed at the distal end of the driver, wherein the step of capturing the suture attached to the graft includes:

feeding the suture attached to the graft through the loop of suture at the distal end of the driver,

tightening the suture loop, and

inserting the distal end of the driver into the hole.

6. The method of graft repair according to claim 2, wherein the step of capturing and inserting the suture attached to the graft includes:

inserting the suture attached to the graft into the cannula of the driver from the distal end thereof,

feeding the suture through the driver to the proximal end thereof,

drawing the graft towards the distal end of the driver by pulling on the at least one suture from the proximal end of the driver, and

inserting the distal end of the driver into the hole.

7. The method of graft repair according to claim 2, wherein the driver includes an outer shaft disposed around an inner shaft and movable between a proximal position and a distal position along the inner shaft, and wherein the interference device is loaded onto the inner shaft by inserting the inner shaft through the cannula of the interference device with the outer shaft retracted to the proximal position so that the proximal end of the loaded interference device abuts the distal end of the outer shaft.

8. The method of graft repair according to claim 7, wherein

the interference device is a screw having a hex-shaped cannula,

a distal portion of the inner shaft of the driver is hex-shaped to be matingly insertable into the hex-chaped interference screw cannula,

the inner shaft of the driver is rotatable relative to the outer shaft to move the outer shaft between the proximal and distal positions therealong, and

the interference screw is installed by turning the inner shaft to drive the interference screw into the bone while preventing the outer shaft from rotating so that the outer shaft moves distally along the inner shaft to guide the interference screw into the bone.

9. The method of graft repair according to claim 7, wherein

the interference device is a plug,

the inner shaft of the driver is slidable relative to the outer shaft to move the outer shaft between the proximal and distal positions therealong, and

the interference plug is installed by impacting the outer shaft with a mallet until the proximal end of the outer shaft is aligned with the proximal end of the inner shaft, the interference plug being pushed into the bone by the distal end of the outer shaft.

10. A method of soft tissue repair, comprising the steps of:

forming a hole in a bone at a location at which a soft tissue graft is to be affixed;

capturing the soft tissue graft and inserting the soft tissue graft into the bottom of the hole; and

inserting a tissue anchor into the hole to secure the soft tissue graft in the hole by interference-friction fixation between the tissue anchor and the bone forming the hole.

11. The method of graft repair according to claim 10, wherein the tissue anchor is a cannulated interference device, and the method further comprises the steps of:

loading the cannulated interference device onto a cannulated driver;

passing suture through the cannula of the driver to expose a loop of suture at the distal end of the driver; and

using the driver to install the interference device into the hole,

wherein the step of capturing and inserting the graft includes;

feeding the graft through the loop of suture at the distal end of the driver,

tightening the suture loop from the proximal end of the driver, and

inserting the distal end of the driver into the hole.

12. The method of graft repair according to claim 11, wherein the interference device is a screw.

13. The method of graft repair according to claim 11, wherein the interference device is one of a wedge or a plug.

14. The method of graft repair according to claim 11, wherein the driver includes an outer shaft disposed around an inner shaft and movable between a proximal position and a distal position along the inner shaft, and wherein the interference device is loaded onto the inner shaft by inserting the inner shaft through the cannula of the interference device with the outer shaft retracted to the proximal position so that the proximal end of the loaded interference device abuts the distal end of the outer shaft.

15. The method of graft repair according to claim 14, wherein

the interference device is a screw having a hex-shaped cannula,

a distal portion of the inner shaft of the driver is hex-shaped to be matingly insertable into the hex-shaped interference screw cannula,

the inner shaft of the driver is rotatable relative to the outer shaft to move the outer shaft between the proximal and distal positions therealong, and

the interference screw is installed by turning the inner shaft to drive the interference screw into the bone while preventing the outer shaft from rotating so that the outer shaft moves distally along the inner shaft to guide the interference screw into the bone.

16. The method of graft repair according to claim 14, wherein

the interference device is a plug,

the inner shaft of the driver is slidable relative to the outer shaft to move the outer shaft between the proximal and distal positions therealong, and

the interference plug is installed by impacting the outer shaft with a mallet until the proximal end of the outer shaft is aligned with the proximal end of the inner shaft, whereby the interference plug is pushed into the bone by the distal end of the outer shaft.