Method and apparatus for coupling anatomical features

• US 8,137,382 B2
• Filed: 08/22/2008
• Issued: 03/20/2012
• Est. Priority Date: 11/05/2004
• 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): Erezo, Darwin
• Assistant Examiner(s): ORKIN, ALEXANDER J
• Application Number:
  US12/196,407
• Publication Number:
  US 20090054928A1
• Time in Patent Office: 1,306 Days
• Field of Search: 606/232, 606/228, 606/139, 606/148, 623/13.14, 623/23.72
• US Class Current: 606/232
• 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 for applying suture clamps, clips or locks A61B2017/0488
• 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 lateral eyelet for attaching suture to needle A61B2017/06019
• 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 hollow suture needles A61B2017/061
• 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 and apparatus for coupling a soft tissue implant into a locking cavity formed within a bone is disclosed. The apparatus includes a member to pull the soft tissue implant into a femoral tunnel. The member includes a suture having first and second ends which are passed through first and second openings associated with the longitudinal passage to form a pair of loops. Portions of the suture lay parallel to each other within the suture. Application of tension onto the suture construction causes retraction of the soft tissue implant into the femoral tunnel.

Claims

1. A method for use in coupling a first portion of an anatomy to a second portion of the anatomy comprising:

passing a suture through a first fastener;

coupling a second fastener to the suture;

passing a first end of the suture through a first aperture defined by a body of the suture into a 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 a first adjustable loop;

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 a second adjustable loop, the first fastener being positioned at the passage portion of the suture;

coupling the first fastener to the first portion of the anatomy;

coupling the second fastener to the second portion of the anatomy; and

applying tension onto at least one of the first and second ends to constrict the first and second adjustable loops.

2. The method according to claim 1 further comprising:

forming a first tunnel in a bone;

threading the first loop through the tunnel;

applying tension onto at least one of the first and second ends to constrict the first loop; and

wherein coupling the second fastener to the second portion of the anatomy is coupling the second fastener to tissue.

3. The method according to claim 2 wherein applying tension onto at least one of the first and second ends includes drawing the soft tissue into the first tunnel.

4. The method according to claim 2 wherein the first fastener includes an anchor having a first profile allowing insertion through the first tunnel and a second profile allowing engagement with a positive locking surface of the bone.

5. The method according to claim 2, wherein the bone includes an ulna.

6. The method according to claim 2, further comprising coupling the soft tissue to a humerus.

7. The method according to claim 2, wherein coupling the first fastener to the first portion of the anatomy includes passing the first fastener through the first tunnel and engaging the first fastener with a positive locking surface of the bone adjacent the first tunnel.

8. The method according to claim 1 wherein the first portion of the anatomy is selected from the group consisting of bone, tissue, a prosthetic;

and

wherein the second portion of the anatomy is selected from the group consisting of bone, tissue, and a prosthetic.

9. The method according to claim 1 wherein the first portion of the anatomy comprises a bone-tendon-bone prosthetic.

10. The method according to claim 1, wherein applying tension onto at least one of the first and second ends to constrict the first and second loops includes drawing the first and second loops into the first bore.

11. A method for use in 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, the first anchor having an adjustable suture construct extending therefrom;

positioning a second anchor relative to the second bore;

positioning the adjustable suture construct between the first and second bones;

tensioning at least one end of the adjustable suture construct to position the first bone relative to the second bone; and

coupling soft tissue to first and second adjustable loops of the adjustable suture construct;

wherein the adjustable suture construct includes a passage portion defined by a body of a suture used to form the adjustable suture construct, the passage portion being positioned at the first anchor and allowing portions of the first and second adjustable loops to slide relative to and through the passage portion to adjust a size of the first and second adjustable loops, the soft tissue being coupled to an end of the first and second adjustable loops opposite the passage portion.

12. The method according to claim 11, wherein forming the first bore in the first bone of the anatomy includes forming the bore through the first bone.

13. The method according to claim 11, 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.

14. The method according to claim 11, wherein providing the first anchor includes providing a toggle anchor.

15. The method according to claim 11, wherein tensioning at least one free end of the adjustable suture construct to position the first bone relative to the second bone includes tensioning first and second ends of the adjustable suture construct to reduce a size of the first and second loops and tension the soft tissue relative to the first and second bones.

16. The method according to claim 11, wherein positioning a second anchor relative to the second bore includes positioning the second anchor in the second bore in an interference fit.

17. The method of claim 11, further comprising coupling the second anchor to the soft tissue.

18. The method according to claim 11, wherein the first bone includes an ulna and the second bone includes a humerus.

19. A method for use in 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, the first anchor having an adjustable suture construct extending therefrom, the adjustable suture construct formed from a suture having a body forming a passage portion that defines an internal bore, where first and second ends of the suture pass through the internal bore and extend therefrom to form first and second adjustable loops, the first and second adjustable loops having a first end at the passage portion and a second opposite end configured to receive the soft tissue, the first anchor being positioned at the passage portion;

positioning a second anchor relative to the second bore;

coupling soft tissue to the first and second adjustable loops;

positioning the adjustable suture construct and soft tissue between at least a portion of the first and second bones; and

tensioning at least one end of the adjustable suture construct to reduce a size of the first and second loops and position the first bone relative to the second bone.

20. The method according to claim 19, wherein forming the first bore in the first bone of the anatomy includes forming the first bore through the first bone;

and

wherein positioning the first anchor relative to the first bore includes positioning the first anchor through the first bore and engaging the first anchor with a positive locking surface of the first bone adjacent the first bore.

21. The method according to claim 19, wherein tensioning at least one end of the adjustable suture construct to reduce the size of the first and second loops and position the first bone relative to the second bone includes tensioning first and second ends of the adjustable suture construct to reduce a size of the first and second loops and tension the soft tissue relative to at least the first bone.

22. The method according to claim 19, further comprising coupling the second fastener to the soft tissue.

23. The method according to claim 19, wherein tensioning at least one end of the adjustable suture construct to reduce the size of the first and second loops and position the first bone relative to the second bone includes drawing the soft tissue into the first bore.

24. The method according to claim 19, wherein positioning the first anchor relative to the first bore includes:

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

engaging the first anchor in a second profile different than the first profile with a positive locking surface of the first bone adjacent the first bore, the adjustable suture construct including a passage portion coupled to the first anchor.

25. The method according to claim 19, wherein the first bone includes an ulna and the second bone includes a humerus.

26. The method according to claim 19, wherein the first and second anchors are coupled to the adjustable suture construct prior to positioning the first anchor relative to the first bore.

27. A method for use in 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, the first anchor having an adjustable suture construct extending therefrom, the adjustable suture construct formed from a suture having a body that defines a longitudinal internal bore, wherein a first end of the suture passes through a first aperture defined by the suture body and into the longitudinal internal bore and out a second aperture defined by the suture body to form a first adjustable loop, and wherein a second end of the suture passes through a third aperture defined by the suture body and into the longitudinal internal bore and out a fourth aperture defined by the suture body to form a second adjustable loop;

positioning a second anchor relative to the second bore;

coupling soft tissue to the first and second adjustable loops;

positioning the adjustable suture construct and soft tissue between at least a portion of the first and second bones; and

tensioning at least one end of the adjustable suture construct to reduce a size of at least one of the first and second adjustable loops.

28. The method according to claim 27, wherein coupling soft tissue to the first and second adjustable loops includes positioning the soft tissue over at least a portion of the first and second adjustable loops.

29. The method according to claim 27, wherein tensioning at least one end of the adjustable suture construct to reduce the size of at least one of the first and second loops includes tensioning first and second ends of the adjustable suture construct to reduce the size of the first and second adjustable loops.

30. The method according to claim 27, wherein tensioning at least one end of the adjustable suture construct to reduce the size of at least one of the first and second loops includes drawing the soft tissue into the first bore.

31. A method for use in coupling a first portion of an anatomy to a second portion of the anatomy comprising:

forming a first bore in a first bone;

positioning soft tissue over at least a portion of first and second adjustable loops of an adjustable suture construct having a body defining a longitudinal internal bore, wherein a first end of the suture passes through a first aperture defined by the suture body and into the longitudinal internal bore and out a second aperture defined by the suture body to form the first adjustable loop, and wherein a second end of the suture passes through a third aperture defined by the suture body and into the longitudinal internal bore and out a fourth aperture defined by the suture body to form the second adjustable loop;

pulling a first anchor in a first profile into the first bore in the first bone to position the soft tissue relative to the first bone, the first anchor coupled to the adjustable suture construct;

adjusting the first anchor to a second profile to engage a positive locking surface of the first bone adjacent the first bore; and

tensioning at least one end of the adjustable suture construct to reduce a size of at least one of the first and second adjustable loops and apply tension to the soft tissue.

32. The method according to claim 31, further comprising:

forming a second bore in a second bone; and

positioning a second anchor relative to the second bone;

wherein tensioning at least one end of the adjustable suture construct includes tensioning at least one end of the adjustable suture construct to apply tension thereto relative to the first and second anchors.

33. A method for use in coupling a first portion of an anatomy to a second portion of the anatomy comprising:

forming a bore in a bone

passing a first fastener having first and second adjustable loops of an adjustable suture construct extending therefrom into the bore, wherein at least a portion of the first and second adjustable loops are coupled to a second fastener;

passing soft tissue over the second fastener;

positioning the second fastener into the bore;

engaging the first fastener with a positive locking surface of the bone; and

tensioning at least one end of the adjustable suture construct to reduce a size of at least one of the first and second adjustable loops and apply tension to the soft tissue, wherein the adjustable suture construct has a body defining a longitudinal internal bore and a first end of the suture passes through a first aperture defined by the suture body and into the longitudinal internal bore and out a second aperture defined by the suture body to form the first adjustable loop, and wherein a second end of the suture passes through a third aperture defined by the suture body into the longitudinal internal bore and out a fourth aperture defined by the suture body to form the second adjustable loop.

34. The method according to claim 33, wherein tensioning at least one end of the adjustable suture construct includes tensioning first and second ends of the adjustable suture construct to reduce a size of the first and second adjustable loops.

35. The method according to claim 33, wherein forming the bore in the bone includes forming the bore through the bone.