US 20050033366 A1
A tissue anchoring system includes a tissue anchor affixed to an end of a cable and supported for insertion on a delivery device, the manipulation of which permits placement of the anchor on a far side of the tissue. A tensioning, crimping and cutting tool designed for use along the cable's longitudinal axis, thus reducing the number of incisions required. A suture anchoring system is also described for introducing a loop of suture into a surgical site and anchoring it, for instance, across a tear in soft tissue.
66. A bone opening protector, comprising:
a first portion having an opening therein, said first portion adapted to engage a surface surrounding a bone opening; and
an anchoring extension connected to said first portion, said anchoring extension adapted to extend into bone to inhibit movement of said first portion.
67. The bone opening protector of
68. The bone opening protector of
69. The bone opening protector of
70. The bone opening protector of
71. The bone opening protector of
72. A system for protecting a bone from damage, the system comprising:
a bone opening protector including,
a first end portion,
a generally cylindrical body extending from the first end portion, the body including
a lumen extending through the first end portion, and
a roughened exterior surface,
a rounded surface connecting an opening in the first end portion to the lumen; and
a cable extending through the bore.
73. The system of
74. The system of
75. The system of
76. The system of
77. The system of
78. A method of establishing a connection through a bone, the method comprising:
forming a passage through the bone, the passage having proximal and distal openings on the bone surface;
inserting a cable through a bore in a bone protector;
inserting the bone protector into the passage, wherein a portion of the bone protector projects from the proximal opening; and
applying tension to the cable.
79. The method of
80. The method of
81. The method of
preventing contact between the cable and the proximal opening on the bone surface.
82. The method of
83. A bone opening protector for protecting a bone comprising:
a first end surface for preventing wear at a surface opening of the bone;
an anchoring portion extending from the first end surface for engaging a passage in the bone, wherein the anchoring portion includes a through bore that extends through the first end surface;
a rounded interface between the bore and an aperture in the first end surface.
84. The bone opening protector of
85. The bone opening protector of
The present invention relates to surgical devices and methods and, more particularly, to devices and methods for the repair of bone and soft tissue.
It is a common requirement in orthopedic surgical procedures to anchor two or more elements together, such as pieces of a bone, two or more bones, or a combination of soft tissue and bone. This has been accomplished by a number of devices, such as bone bolts that penetrate two pieces of bone and use a nut to draw the segments together, bone screws and interconnecting plates, wires circling at least two pieces of bone, or sutures into the tissue.
Often such devices require a relatively large access opening through surrounding and/or covering tissue to implant the anchoring devices. The enlarged access site may increase patient pain and lengthen recovery time. Further, in some locations it is difficult and impractical to make large access points to reach the appropriate site because of surrounding joints and vessels. Even with devices that penetrate the tissue in a substantially linear manner, i.e. lag bolts, the fracture must often be reduced before drilling and insertion of the bolt. Further, some of these devices may be difficult to use since it may be hard to reduce a fracture between two bone segments and maintain that reduction while the device is inserted. This is particularly true with small bone fragments were the use of threaded implants may tend to rotate one bone segment with respect to another, thereby creating a misalignment between the fragments.
Cerclage systems provide an alternative to implants that must penetrate the bone to achieve fixation. Such devices have been taught by Miller et al. (U.S. Pat. No. 5,312,410) and Songer et al. (U.S. Pat. No. 5,536,270). These systems rely on passing a cable around two segments of bone and then tensioning the cable to squeeze the bone segments together. A significant drawback of these systems is that they require access around the entire bone.
Therefore, there, remains a need for a convenient and effective system for securing two segments of tissue-together. Such a system should preferably be operable through a relatively small insertion opening or openings to securely hold two tissue segments.
An anchor system according to the present invention can comprise an elongated flexible member having a diameter, a proximal end, a distal end and a longitudinal axis; an anchor having a proximal end, a distal end, a central portion between the proximal end and the distal end and a longitudinal axis extending between the proximal end and the distal end, the anchor including a longitudinal slot extending longitudinally from the proximal end to the central portion, the slot having a width greater than the flexible member diameter, the flexible member distal end affixed adjacent the central portion. The anchor is moveable relative to the flexible member between a first position wherein the longitudinal axes of the flexible member and the anchor are generally parallel with a portion of the flexible member adjacent the distal end residing within the slot and a second position wherein the longitudinal axes of the flexible member and the anchor are generally perpendicular.
Another embodiment of an anchoring system according to the present invention, comprises an elongated flexible member having a proximal end, a distal end and a first diameter; and an anchor affixed to the distal end, the anchor moveable between an insertion configuration adapted for insertion through a tissue opening and an anchoring configuration adapted to inhibit passage through the tissue opening, the insertion configuration having a second diameter less than twice the first diameter, and the anchoring configuration having a third diameter greater than the second diameter.
The system further includes a delivery device having a distal end, the distal end adapted to releasably receive at least the anchor proximal end for releasably retaining the anchor in the first position for insertion through at least a portion of a section of tissue, the anchor releasable from the delivery device for anchoring the flexible member in the section of tissue. The delivery device includes a mechanism for releasably exerting a longitudinal force on the flexible member in a proximal direction, for retaining the anchor proximal end in the delivery device and thereby in the first position.
In one embodiment, the insertion device comprises an inner tube having a longitudinal bore extending from a proximal end to a distal end, the inner bore sized to permit passage of an elongated flexible member and to prevent passage of an anchor attached to an elongated flexible member; an outer tube having a longitudinal bore extending from a proximal end to a distal end, the outer tube bore dimensioned to permit the inner tube to pass therethrough; and a mechanism for applying tension to an elongated flexible member, the means positioned adjacent the distal end of the inner tube.
The system of the present invention further contemplates a crimping tool which can comprise an outer member having an inner passage and a distal end having an outer diameter. A crimping mechanism can be disposed within the inner passage adjacent the distal end. The crimping mechanism movable with respect to the outer member between a crimping position and an open position.
An alternative embodiment of the present invention includes a suture anchoring system for attaching a first section of tissue to a second section of tissue via a unitary incision having a longitudinal axis. The anchoring system comprises a suture anchor connected to a suture material having a first end, a second end, a longitudinal axis, and a diameter. The suture anchor has a longitudinal axis generally extending from a proximal end to a distal end and a first cross-sectional dimension generally along the longitudinal axis greater than a second cross-sectional dimension generally perpendicular to the longitudinal axis. The system further includes a mechanism for slidably affixing a central portion of the suture material to the suture anchor, the first end and the second end of the suture material retainable outside the incision. The suture anchor is pivotable relative to the suture material between a first position wherein the longitudinal axes of the incision and the suture anchor are generally parallel and a second position wherein the longitudinal axes of the incision and the suture anchor are generally perpendicular.
The present invention also contemplates a bone opening protector having a first portion defining an opening therein to receive a cable. The first portion is adapted to engage a surface surrounding a bone opening. The protector also includes an anchoring extension, connected to the first portion, adapted to extend into bone to inhibit movement of the first portion.
The invention further contemplates a method for joining two sections of tissue. The method includes providing a first anchor, an elongated member attached to the first anchor, a second anchor slidable on the elongated member and having a deformable portion adapted to engage the elongated member, and a crimping tool having an outer member and an inner member movably disposed within the outer member. The first anchor is inserted into a first section of tissue. The second anchor is threaded on the elongated member. Tension is applied on the elongated member to urge the first section of tissue toward a second section of tissue. The elongated member is threaded through the crimping device, and the inner member of the crimping device is moved with respect to the outer member thereby deforming the deformable portion of the second anchor and maintaining the tension applied to the elongated member.
One object of the invention is to provide an element for anchoring tissue.
Another object is to provide a system for delivering the tissue anchoring element.
A further object is to provide such a system that also tightens and ligates the anchoring element.
An additional object of the present invention is to provide a crimping tool.
Still another object is to provide a method for delivering a tissue anchoring element to a surgical site.
Yet another object is to provide an element for anchoring suture material.
Yet a further object is to provide a system for delivering the suture anchoring element.
Yet an additional object is to provide a method for delivering a suture anchoring element to a surgical site.
Still a further object of the present invention is to provide a bone opening protector.
Other objects and advantages of the present invention will be apparent from the following description.
FIG; 7A illustrates a suture anchor according to the present invention supported by a delivery device's distal end.
For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, such alterations and further modifications in the illustrated device, and such further applications of the principles of the invention as illustrated therein being contemplated as would normally occur to one skilled in the art to which the invention relates.
Attached to the cable's distal end 202 is a generally cylindrical anchor 30 (
The anchor 30 has a distal portion 317 having a first cross-sectional diameter 306, or width, larger than the diameter 206 of the cable 20. In a preferred embodiment, diameter 306 is less than twice diameter 206, thus providing a relatively small insertion diameter. This first cross-sectional diameter 306 generally coincides with a cylindrical diameter. In a preferred embodiment, diameter 306 substantially equals the outer diameter of delivery device 40. A second cross-sectional dimension 308, or length, is significantly larger than the width 306. This length 308 generally coincides with the length of the anchor 30 from proximal end 304 to distal end 302.
The anchor 30 also has a proximal portion 310 opposite the distal portion 317, the proximal portion 310 having a width 320, the proximal portion width 320 smaller than the distal portion width 306. The proximal portion 310 includes a taper 318 tapering toward the proximal end 304 and a thickness 322. It will be understood that upon engaging a surface with cable 20 proximally tensioned, taper 318 assists the anchor in flipping to an anchoring position and in sliding under adjacent tissue during the flipping process. There is a shoulder 311 between the proximal portion 310 and the wider distal portion 317, for engaging the distal end of the delivery device 40.
In addition, the anchor 30 has a generally longitudinal slot 314 extending from the proximal end 304 into the distal portion 317. Slot 314 has a width 312 equal to or greater than the cable diameter 206. The distal end 202 of the cable 20 is affixed, for example, via crimping, within the anchor bore 301 between the anchor's distal end 302 and the slot's distal end 315 (see
In a preferred embodiment, the anchor outer diameter 306 is less than twice the cable diameter 206. This permits the cable and anchor combination to be inserted through a relatively small hole or incision. However, the length 308 is much greater than the anchor diameter 306 thereby providing a secure anchorage for the cable.
The anchor 30 is movable in relation to the cable 20 between two positions: a first position (
The present invention further contemplates a delivery device for insertion of a cable and anchor combination. Although the device is illustrated for use with the above described anchor, it is contemplated that the delivery device may be used or adapted for use with a variety of cable and anchor combinations. A first embodiment of the delivery device 40 (
The cable/anchor 20/30 combination is inserted into tissue with the aid of the delivery device 40, which is used to provide mechanical stiffness to the cable 20. The cable's proximal end 204 is passed through the delivery device 40 from the distal end 402 through the bore 401 to beyond the proximal end 404. The anchor's proximal portion 310 is seated in the delivery device bore 401 adjacent the distal end 402, and tension is maintained on the cable's proximal end 204 to retain the anchor 30 in the first position. Although a preferred embodiment of the device shows proximal end 304 held within bore 401, it is contemplated that proximal end 304 may include threads and delivery device 40 may similarly have cooperable threads on the distal end such that the device may be threadedly held on delivery device 40. Alternatively, there may be a frangible connection between proximal end 304 and the distal end of the delivery device, the frangible connection breakable to permit anchor 30 to move to the second position.
In a second embodiment of a delivery device according to the present invention, (
In this embodiment, the delivery device 70 comprises a body 72, which has a handle portion 720 having a proximal end 722 and a recess 728 at the distal end 724. The recess 728, which extends from the top 721 to the bottom 723 of the delivery device body 72, is rounded at its proximal end 725. A longitudinal bore 726 extends from the proximal end 722 to the distal 724 end, the bore 726 being dimensioned to permit cable 20 to pass therethrough.
A pawl housing 75 is movably affixed to the delivery device body's distal end 724 via its rounded proximal side 752, which is dimensioned to slide longitudinally within the delivery device body's recess 728. The pawl housing 75 has a pawl cavity 758 that extends from the pawl housing's top 751 through a portion of the pawl housing. The pawl housing 75 additionally has a longitudinal bore 756 that extends from the proximal side 752 to the distal side 754 through the pawl cavity 758. The bore 756 is dimensioned to permit cable 20 to pass therethrough, and is adapted for communication with the delivery device body's bore 726 when the device is assembled for use. A spring bore 757 extends from the distal side 754 into the pawl cavity 758 and is positioned above the longitudinal bore 756.
The delivery device 70 further comprises an inner tube 73 that is affixed at its proximal end 732 to the pawl housing's distal side 754. The inner tube 73 is generally cylindrical and has a longitudinal bore 736 that extends from the proximal end 732 to the distal end 734 and is dimensioned to permit the cable 20 to pass therethrough but is too small at the distal end 734 to permit the anchor's proximal portion 310 to enter. This bore 736 is in communication with the pawl housing bore 756.
Another element of the delivery device 70 is a nose assembly 74 that is in mechanical communication with the pawl housing 75. The proximal side 742 is affixed to the distal end 724 of the delivery device body 72 with two screws (not shown). These screws are inserted through first and second screw bores 782 that extend from the tapered distal side 744 of the nose assembly 74 through to the proximal side 742. First and second screw bores 782 are positioned to meet third and fourth screw bores 727 (
The nose assembly 74 further has a longitudinal bore 746 that extends from the proximal side 742 to the distal side 744, this bore, 746 dimensioned and positioned to permit the inner tube 73 to pass therethrough and slide relatively thereto.
Affixed to the nose assembly's distal side 744 is the proximal end 762 of a generally cylindrical outer tube 76, which has a longitudinal bore 766 that extends from the proximal end 762 to the distal end 764. Tube 76 may be removable affixed to the nose assembly to permit different sizes and configurations of outer tube 76 to be used with delivery device 70. Alternatively, outer tube 76 may include two components (not shown) with the distal section removably attached to the proximal section such that alternative configurations and dimensions of the distal section can be attached to accommodate various anchor configurations and cable diameters. Bore 766 is dimensioned to permit the inner tube 73 to pass therethrough and the anchor proximal portion 310 to slide thereinto. In a preferred embodiment for use with the anchor of
The delivery device 70 additionally comprises a pawl 77 that has a longitudinal bore 776 that extends from a proximal side 772 to a distal side 774 and is dimensioned to permit the cable 20 to pass therethrough. The pawl 77 is dimensioned so that its lower portion fits within the pawl cavity 758 and is pivotally attached adjacent a lower proximal corner 759 thereto, at a position lower than the longitudinal bore 756. The pawl 77 is pivotable within the pawl housing cavity 758 between a first position against the pawl housing cavity distal side 761 and a second position against the pawl housing cavity proximal side 763.
The pawl longitudinal bore 776 is positioned in communication with the pawl housing bore 756 when the pawl 77 is in the first position thereby allowing cable 20 to pass freely therethrough. When the pawl 77 is in the second position, however, the bore 776 is positioned sufficiently off-axis to pinch the cable 20 and thereby prevent a longitudinal movement of the cable 20. Thus, placing the pawl 77 in the second position also serves to restrain the cable 20 from longitudinal movement.
The pawl 77 also has a spring bore 777 that extends from the distal side 774 in a proximal direction, but does not extend all the way through to the proximal side 772. A pawl spring 78 is affixed to the nose assembly's proximal side 742 and extends through the pawl housing spring bore 757 and into the pawl spring bore 777 to bear against the pawl 77. This spring 78 thus positioned biases the pawl 77 into the second position, which releasably exerts a longitudinal force on the cable 20 in a proximal direction and by the spring force exerted on pawl 77 biases inner tube 73 to the second position.
The delivery device member 70 elements are relatively dimensioned so that a sliding of the inner tube 73 within the outer tube 76 may be accomplished in a longitudinal direction between two positions. In the first position, the inner tube distal end 734 is in spaced relation to the anchor proximal end 304 when the anchor proximal portion 310 is within the outer tube bore 766. In the second position, the inner tube distal end 734 extends to the outer tube distal end 764, which pushes the anchor proximal portion 310 out of the outer tube 76. As has been seen above this ejection of the anchor proximal portion 310 permits the anchor 30 to flip from its first position to its second position, wherein it can anchor the cable 20 from being pulled in a proximal direction. Spring 78 biases the pawl housing 75 into the first position.
Referring now to
As with previously described embodiments, outer tube 810 is sized to receive at least a portion of anchor 30 while inner tube 812 is sized to prevent passage of an anchor such as that shown in
Movement of plunger 830 is controlled by plunger 818 through lever 826. Movement of plunger 818 in the direction of of arrow 860 moves lever 826 about pivot pin 828 to force the lever against plunger 830 to overcome spring 832 and move plunger 830 against inner tube 812. This movement moves the anchor out of outer tube 810 and permits movement to an anchoring position. In a preferred embodiment, plunger 816 includes a slot (shown in dashed lines) 820 sized to receive a distal portion 819 of plunger 818. In the locked position, shown in
The present invention further contemplates a crimping tool for attachment of an anchor to a cable, suture or other elongated member. It being understood that alternative crimping devices may be used to secure anchors to the above described system and that the crimping tool described below may be used or adapted for use with a variety of cabling and suturing systems. The crimping tool of the present system is desirable for the ability to crimp along the axis of a cable at a relatively distant site through a small incision.
Referring now to
The crimping tool 50 additionally comprises an inner elongated generally cylindrical member 54 having a bore 541 dimensioned to permit cable 20 to pass therethrough. The inner cylindrical member 54 is dimensioned to fit within the outer cylindrical member's bore 521 and to be rotatable relatively thereto about a common longitudinal axis. A second crimping handle 548 is affixed to and extends radially outward from the inner member's proximal end 544, which extends proximal of the outer member's proximal end 524.
The handles 528 and 548 are rotatable between a first, open position wherein the respective distal ends 529 and 549 are spaced apart by approximately 90 degrees to a second, crimping position wherein the distal ends 529, 549 are generally opposed. Movement of handles 528 and 548 causes inner member 54 and outer member 52 to rotate with respect to each other.
The crimping means of the crimping tool 50 is illustrated in
The distal end 542 of the inner member 54 has a solid portion 545 that obscures the remaining portion of the bore 541 except for a bi-level stepped opening thereinto. Along the distal most portion is a first roughly semicircular cutout 552 dimensioned, together with the outer member's solid portion 525, to closely surround a ferrule 94 therein when the handles 528, 548 are in the open position. The outer member's protrusion 526 is positioned adjacent the cutout 552 when the handles 528, 548 are in the open position.
Longitudinally adjacent to and proximal of the solid portion 545 is a second roughly semicircular cutout 554 dimensioned to permit the cable 20 to freely slide therethrough but too small to permit the ferrule 94 to pass thereinto. When the handles 528, 548 are moved into the crimping position, the first cutout 552 is rotated toward the solid portion 525 and protrusion 526, and a ferrule 94 residing therein is crimped onto the cable 20.
It can be seen that the tool 50 provides the advantage of crimping the ferrule 94 along the longitudinal axis of the cable 20, rather than at a right angle thereto, such as is common in the art, which permits the procedure to be accomplished through a small unitary incision without removing surrounding tissue.
Although a preferred embodiment of the crimping tool of the present invention is shown for use with cable 20 and ferrule 94, it is contemplated that the device may be sized for a specific application. Moreover, it is contemplated that inner member 54 and outer member 52 may have removable distal portions. A variety of sizes and configurations of distal portions may be interchangeable to fit a variety of flexible member and crimp configurations and types. It is contemplated that the cabling, crimp and crimping distal portions may be packaged as a unit to ensure proper use by the end user with a standard crimping tool 50.
Means are also provided for applying longitudinal tension in a proximal direction relative to the tissue to be repaired. Many devices are know for providing tension to a cable, however, many require a series of pulleys or other change of direction to accomplish the desired tensioning.
In one embodiment (
The cable-affixing means comprises a cleat 51 positioned adjacent to the tensioner's proximal end 564. The cleat 51, which is analogous to such devices known in the art, is adapted to clamp the cable's proximal end 204 to restrain the cable 20 from moving in a longitudinal direction relative to the inner cylindrical member 54 when in a tightened position. When in a releasing position, the cleat 51 permits the cable 20 to slide there past.
The cable-pulling means comprises the tensioner 56 and the inner cylindrical member proximal end 544, which are relatively movable via a screwing motion therebetween, which serves to change the tension on the cable 20. For example, in use the inner cylindrical member 54 and tensioner 56 are mated, and a cable 20 is inserted through the inner cylindrical member bore 541 and through the tensioner bore 561, and a proximal portion of the cable is clamped by tightening the cleat 51. Unscrewing the tensioner 56 relative to the inner cylindrical member 54 serves to pull the cable 20 in a proximal direction, increasing the tension thereon. The nut could be urged to prevent twisting of cable 20.
A cutting mechanism is also provided within the tool 50 whereby, when the handles 528, 548 are moved from the open to the crimping position, the cable 20 is cut at a location proximal to or through the ferrule 94. Referring to
In a particular embodiment the ferrule 94 is typically formed of a metal, such as stainless steel, titanium, or cobalt-chrome alloy. However, in an alternate embodiment the ferrule 94 may be made of a resorbable or non-resorbable polymer material.
The tensioning mechanism shown in
A further embodiment of a tensioning, crimping and cutting tool according to the present invention is disclosed in
Rear housing 924 includes a cable tensioner assembly 926 for applying tension to cable 908 towards the proximal end 913. Tensioning assembly 926 is operable between a tensioning position and the released position shown in
Referring now to
In operation, tensioning assembly 926 is moved to apply proximal tension to cable 908. As previously described, trigger pawl 906 permits proximal movement of the cable. Once proximal tension is released by the tensioning assembly, trigger pawl 906 engages cable 908 to prevent distal movement and thereby maintain the tension while the pawls of the tensioning assembly are disengaged to permit the assembly to return to a forward position. This process may be continued until the desired amount of cable tension has been achieved.
Cable tensioner, crimper and cutter 900 also includes crimping and cutting handles 934 and 936. Referring to
Still a further embodiment of a tensioning, crimping and cutting tool according to the present invention relies on longitudinal movement of the components rather than rotational movement. Referring to
Inner member 959 includes an externally threaded section 971 adjacent flange 972 and at an opposite end, a pair of spaced branches 978 and 979, each having a flared section 980 and 981, respectively. Branch 978 includes a cutting blade 962 and a crimping projection 964 while branch 979 includes a corresponding cutting anvil 963 and crimping depression 965. It is contemplated that inner member 959 may include more than two branches and may have multiple projections disposed adjacent distal end 967.
Inner member 959 is disposed within a preferably tubular outer member 958. Outer member 958 includes an inclined surface 960 adjacent distal end 966. Opposite the inclined surfaces is a flange 968. Nut 969 is disposed about flange 968 and pivotally retained there by mounting pins 970.
In operation, cable 956, having a distal end anchored in a tissue section (not shown), is threaded through inner member 959 and cable retaining assembly 975. A ferrule 957, slidable along cable 956, is positioned within branches 978 and 979 adjacent crimping projection 964 and crimping depression 965. Cleat 977 is rotated to engage cable 956. Nut 973 is rotated about external threads 976 to move the cable retaining assembly with respect to the inner member, which bears against a section of tissue (not shown), and thereby applies tension to cable 956. Once the desired amount of tension is applied, nut 969 is rotated with respect to threads 971 to urge outer member 958 downward toward ferrule 957. As outer member 958 advances, branches 978 and 979 are urged toward each other by acting against inclined surface 960. Thus, cutting blade 962 and cutting anvil 963 cooperate to cut cable 956 while crimping projection 964 and crimping depression 965 crimp ferrule 957 to securely engage cable 956.
While threaded engagements have been illustrated for applying cable tension and for moving the outer member, it is contemplated that other mechanisms known to those skilled in the art may be applied to the device described herein. Moreover, nut 973 may be engaged by a torque wrench to provide the user with an estimate of the tension applied to cable 956.
Variations of the present longitudinal crimping tool are within the spirit of the present invention, such tools utilizing movement preferably occurring within the outer tube such that the opening in the tissue is not significantly enlarged beyond the diameter of the outer tube as a result of the crimping process.
Alternative Anchor Embodiments
An alternate form of a tissue anchor comprises an eyelet anchor 32, the structure and function of which are illustrated in
The delivery devices of
The present invention also contemplates the use of a bone opening protector 150 as shown in
It is intended that the surface engaging position 152 lie substantially flush with the surface of the bone. Thus, for openings created perpendicular to the surface of the bone, cylindrical portion 151 and surface engaging portion 152 will be perpendicular. In a preferred embodiment, the corner 154 between the cylindrical portion 151 and surface engagement portion 152 is rounded. This is intended to limit the abrasion and wear on the anchoring member as it slides across the corner. The protector is particularly useful in applications were the cable or suture will be pulled against the corner of the bone opening. As shown in
Tissue Anchoring Method
The method for utilizing the above-described system comprises the following steps, as shown in FIGS. 12A-E, for anchoring two sections of bone together. It is obvious to one skilled in the art that the same technique is applicable to a method for anchoring two different bones together, for anchoring other types of tissue together, or for anchoring another type of tissue to bone [see, e.g.,
Two holes 115 and 116 are drilled through the bone sections 90 and 91, the cable/anchor/delivery device 20/30/40 combination is inserted through the holes 115, 116 until the anchor 30 is completely through the distal hole 115 (
The delivery device 30 is removed from the cable 20, and a washer 93 and ferrule 94 are threaded onto the cable to a position adjacent the proximal hole 912 (
If desired, an eyelet anchor 60, such as shown in
The method described above may be performed utilizing any combination of the delivery devices and tensioning, crimping and cutting tools described herein.
Suture Material Anchoring System and Method
A suture material anchor system 83, as shown in
The suture anchor 84 is an elongated member having a longitudinal axis extending from a proximal end 844 to a distal end 842. The suture anchor 84 also has a pair 845, 846 of cross-bores extending from a first side 847 through to a second, opposed side 848. Cross-bores 845, 846 are dimensioned to permit suture material 86 to pass therethrough. In use suture material 86 is threaded through bore 845 from the first side 847 to the second side 848 and then through the other bore 846 from the second side 848 to the first side 847.
The suture anchor 84 has a narrowed proximal portion 843 at the proximal end 844, proximal of the cross-bores 845, 846, that is dimensioned to be insertable into and supported by the impeller bore 401 or the outer tube bore 766, as previously described for the pivotable anchor 30. The central portion 848 is dimensioned too large to be insertable into the impeller bore 401 or the outer tube bore 766. The suture anchor 84 has a first cross-sectional dimension generally along the longitudinal axis greater than a second cross-sectional dimension generally perpendicular to the longitudinal axis, as before for the pivotable anchor 30.
The suture anchor 84 is manipulable and pivotable by pulling the ends of the suture material, which can accomplish a bracing of the suture anchor 84 against the distal side of the tissue 85 to be repaired. In use, the ends of the suture material 86 are retainable outside the incision, or, alternatively, one end 862 can be retained outside the introducing incision 88, and a second end 864 can be pulled through a second incision 89, as shown in
A method of using the system 83 to repair a soft tissue tear such as a meniscal tear T comprises the steps of piercing the tissue 85 across the tear T, inserting the delivery device/suture material/anchor system into the pierced hole 834, manipulating the delivery device so that the anchor 84 emerges from the far end of the tear T and rotates so that the anchor 84 has its length generally perpendicular to the tear T and thus will not slip out. The surgeon can then manipulate the suture material 86 and tie it off as desired to secure the repair. Alternatively, a second incision 835 may be made at an adjacent site across the tear T as shown in
While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiments have been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected.