Method and apparatus for surgical repair

• US 7,569,059 B2
• Filed: 04/20/2005
• Issued: 08/04/2009
• Est. Priority Date: 04/20/2005
• Status: Expired due to Fees

• Current Assignee: Arthroscopic Innovations LLC
• Original Assignee: Arthroscopic Innovations LLC
• Inventors: Cerundolo, Daniel
• Primary Examiner(s): Robert; Eduardo C
• Assistant Examiner(s): CARTER, TARA ROSE E
• Application Number:
  US11/110,540
• Publication Number:
  US 20060241619A1
• Time in Patent Office: 1,567 Days
• Field of Search: 606/86, 606/96, 606/98, 606/104, 606148-150, 606/86.R, 606 62- 67, 623/11.11, 623 1311- 1319
• US Class Current: 606/86.00R
• 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 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• 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 17/1714 for applying tendons or ligaments implements for applying tendons or ligaments A61F2/0805
• CPC Class Codes: A61B 17/1778 for the shoulder
• CPC Class Codes: A61B 17/1796 for holes for sutures or flexible wires
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0445 cannulated, e.g. with a longitudinal through-hole for passage of an instrument
• CPC Class Codes: A61B 2017/0456 Surface features on the anchor, e.g. ribs increasing friction between the suture and the anchor
• CPC Class Codes: A61B 2017/06052 Needle-suture combinations in which a suture is extending inside a hollow tubular needle, e.g. over the entire length of the needle hollow suture needles A61B2017/061
• CPC Class Codes: A61B 2017/06076 helically or spirally coiled for sutures A61B2017/06171
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/564 Methods for bone or joint treatment

Abstract

A method and apparatus for performing a surgical repair may involve the use of a guide to form a passageway through the body portion, such as bone. In addition, or alternately, the guide may be used to provide a suture or suture-like material through a passageway, e.g., to secure to a material relative to the body portion. The passageway may be formed by first and second intersecting holes formed in the body portion. Both ends of a suture may be positioned in the passageway, and be secured relative to the body portion near one of the openings into the passageway. A straightened pathway between the first and second openings of the passageway may be formed, e.g., using a flossing operation.

Claims

1. A method for performing a surgical repair, comprising:

providing a first hole in a body portion;

positioning a first portion of a guide relative to the first hole, the first portion extending at least partially into the first hole;

forming a second hole transverse to the first hole using a second portion of the guide so that the second hole is aligned with the second portion of the guide and intersects with the first hole and forms a passageway with the first hole through the body portion;

using the first and second portions of the guide, while the first and second portions of the guide remain fixed in place relative to each other and relative to the first and second holes, to provide a suture through the passageway by providing the suture through a passage extending along a length of the first or second portion of the guide and into the passageway and retrieving the suture using the other of the first or second portion;

securing a repair suture to a material to be secured relative to the body portion;

positioning at least a portion of the repair suture in the passageway; and

securing the material relative to the body portion using the repair suture.

2. The method of claim 1, further comprising:

providing at least one arthroscopic portal though tissue for access to at least one portion of the body portion; and

using the at least one arthroscopic portal to form the passageway.

3. The method of claim 1, wherein the step of positioning a first portion of a guide comprises:

placing a first guide member relative to the first hole;

positioning the first guide member relative to a reference structure; and

positioning a second guide member relative to the reference structure, wherein the second guide member is used to form the second hole.

4. The method of claim 3, wherein the step of forming the second hole comprises:

using the second guide member to define a starting point for the formation of the second hole or to guide the movement of a perforator.

5. The method of claim 3, wherein the first and second guide members each include a tube that is securable in the first and second holes, respectively.

6. The method of claim 5, further comprising:

positioning the first guide tube relative to the reference structure at a first position; and

positioning the second guide tube relative to the reference structure at a second position so that distal ends of the first and second guide tubes are adjacent each other in the body portion.

7. The method of claim 6, wherein the step of using the guide comprises:

positioning the suture in the first guide tube; and

retrieving the suture from the second guide tube.

8. The method of claim 7, wherein the step of retrieving comprises:

inserting a suture retriever into the second guide tube;

engaging the suture in the first guide tube with a suture retriever; and

withdrawing the suture retriever and engaged suture from the second guide tube.

9. The method of claim 8, wherein the suture withdrawn from the second guide tube is a lead material, the method further comprising:

attaching the repair suture to the lead material; and

drawing the lead material through the passageway to feed the repair suture into the passageway.

10. The method of claim 1, wherein the step of positioning at least a portion of the repair suture comprises:

positioning two free ends of the repair suture in the passageway.

11. The method of claim 10, wherein the step of securing the material comprises:

using a suture fixation device to secure the repair suture relative to the passageway.

12. The method of claim 1, wherein the body portion is a bone and the material is a tissue to be secured relative to the bone.

13. The method of claim 1, wherein the step of securing a repair suture comprises:

manipulating a needle and repair suture attached to a cannula so as to secure the repair suture to the material.

14. The method of claim 13, wherein the needle has a hollow portion through which the repair suture passes, and the step of manipulating comprises rotating the cannula to move a needle end along an arc-shaped path to place the repair suture in the material.

15. The method of claim 14, further comprising:

grasping the repair suture near the needle end after moving the needle end along an arc-shaped path; and

moving the needle end in a reverse direction to disengage the needle from the material while leaving the repair suture engaged with the material.

16. The method of claim 13, wherein the step of manipulating the needle comprises:

placing the repair suture to form a mattress stitch in the material.

17. The method of claim 1, wherein the material is a rotator cuff, and the body portion is part of a humerus.

18. The method of claim 17, further comprising:

providing a superolateral arthroscopic portal;

providing a lateral arthroscopic portal; and

using the superolateral and lateral arthroscopic portals to form the passageway.

19. The method of claim 18, wherein the first hole is formed in a first direction into the humerus using the superolateral arthroscopic portal;

and

the second hole is formed in a second direction into the humerus using the lateral arthroscopic portal so that the second hole intersects the first hole.

20. A method for forming a passageway in bone, comprising:

providing a first hole into bone of a humerus, the first hole extending into but not through the bone;

securing a first guide member relative to, and at least partially in, the first hole the first guide member including a first guide tube;

positioning the first guide member with respect to a reference structure at a first position;

positioning a second guide member with respect to the reference structure, the second guide member including a second guide tube, and positioning of the second guide member being independent of the first guide member;

drilling or punching a second hole in the humerus bone using the second guide member positioned with respect to the reference structure and using the second guide member to guide the orientation in which the second hole is formed, the second hole being formed so as to be aligned with the second guide member, and be transverse to and intersect the first hole and form a passageway though the humerus bone, the second hole extending into but not through the bone;

positioning the second guide member with respect to the reference structure at a second position such that distal ends of the first and second guide tubes are adjacent each other in the bone;

passing at least a portion of a suture through the passageway in the humerus bone by positioning at least a portion of the suture in the first or second guide tube and retrieving the suture from the other of the first or second guide tube; and

securing a rotator cuff tendon to the humerus bone using the suture.

21. The method of claim 20, wherein the step of passing comprises:

inserting a suture retriever into the second guide tube;

engaging the suture in the first guide tube with the suture retriever; and

withdrawing the suture retriever and engaged suture from the second guide tube.

22. The method of claim 21, wherein the suture withdrawn from the second guide tube is a lead suture, the method further comprising:

securing a repair suture to a tissue to be secured to the bone;

attaching the repair suture to the lead suture;

drawing the lead suture through the passageway to feed the repair suture into the passageway; and

securing the repair suture relative to the passageway.

23. The method of claim 20, further comprising:

securing a suture to the rotator cuff tendon;

passing the suture though the passageway; and

securing the suture relative to the passageway so as to secure the rotator cuff tendon relative to the bone.

24. The method of claim 20, wherein the step of securing the first guide member comprises screwing a distal end of the first guide member into the first hole, the method further comprising:

screwing a distal end of the second guide member into the second hole so that the distal ends of the first and second guide members are adjacent.

25. The method of claim 24, wherein the step of positioning the first guide member comprises abutting a portion of the first guide member against an engagement surface on the reference structure;

and

the step of positioning the second guide member with respect to the reference structure at the second position comprises positioning the second guide member relative to the first guide member by abutting a portion of the second guide member against an engagement surface on the reference structure.

26. The method of claim 20, further comprising:

manipulating a suture-like material in the passageway to form a straightened pathway through the bone.