US20030195563A1 - Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device - Google Patents

Abstract

An innovative bone anchor and methods for securing connective tissue, such as tendons, to bone, which permit a suture attachment that lies entirely beneath the cortical bone surface. Advantageously, the suturing material between the connective tissue and the bone anchor is secured without the need for tying a knot. The suture attachment to the bone anchor involves the looping of a length of suturing material around a self-locking wedge block in the anchor, thereby avoiding an eyelet connection which requires a kot and which concentrates stress on a very small portion of the suturing material. Thus, failure rates are greatly decreased over conventional techniques, and the innovative procedures are significantly easier to perform than conventional techniques.

Description

BACKGROUND OF THE INVENTION
• This invention relates generally to methods and apparatus for attaching soft tissue to bone, and more particularly to anchors and methods for securing connective tissue, such as ligaments or tendons, to bone. The invention has particular application to arthroscopic surgical techniques for reattaching the rotator cuff to the humeral head, in order to repair the rotator cuff.[0001]
• It is an increasingly common problem for tendons and other soft, connective tissues to tear or to detach from associated bone. One such type of tear or detachment is a “rotator cuff” tear, wherein the supraspinatus tendon separates from the humerus, causing pain and loss of ability to elevate and externally rotate the arm. Complete separation can occur if the shoulder is subjected to gross trauma, but typically, the tear begins as a small lesion, especially in older patients.[0002]
• To repair a torn rotator cuff, the typical course today is to do so surgically, through a large incision. This approach is presently taken in almost 99% of rotator cuff repair cases. There are two types of open surgical approaches for repair of the rotator cuff, one known as the “classic open” and the other as the “mini-open”. The classic open approach requires a large incision and complete detachment of the deltoid muscle from the acromion to facilitate exposure. The cuff is debrided to ensure suture attachment to viable tissue and to create a reasonable edge approximation. In addition, the humeral head is abraded or notched at the proposed soft tissue to bone reattachment point, as healing is enhanced on a raw bone surface. A series of small diameter holes, referred to as “transosseous tunnels”, are “punched” through the bone laterally from the abraded or notched surface to a point on the outside surface of the greater tuberosity, commonly a distance of 2 to 3 cm. Finally, the cuff is sutured and secured to the bone by pulling the suture ends through the transosseous tunnels and tying them together using the bone between two successive tunnels as a bridge, after which the deltoid muscle must be surgically reattached to the acromion. Because of this maneuver, the deltoid requires postoperative protection, thus retarding rehabilitation and possibly resulting in residual weakness. Complete rehabilitation takes approximately 9 to 12 months.[0003]
• The mini-open technique, which represents the current growing trend and the majority of all surgical repair procedures, differs from the classic approach by gaining access through a smaller incision and splitting rather than detaching the deltoid. Additionally, this procedure is typically performed in conjunction with arthroscopic acromial decompression. Once the deltoid is split, it is retracted to expose the rotator cuff tear. As before, the cuff is debrided, the humeral head is abraded, and the so-called “transosseous tunnels”, are “punched” through the bone or suture anchors are inserted. Following the suturing of the rotator cuff to the humeral head, the split deltoid is surgically repaired.[0004]
• Although the above described surgical techniques are the current standard of care for rotator cuff repair, they are associated with a great deal of patient discomfort and a lengthy recovery time, ranging from at least four months to one year or more. It is the above described manipulation of the deltoid muscle together with the large skin incision that causes the majority of patient discomfort and an increased recovery time.[0005]
• Less invasive arthroscopic techniques are beginning to be developed in an effort to address the shortcomings of open surgical repair. Working through small trocar portals that minimize disruption of the deltoid muscle, a few surgeons have been able to reattach the rotator cuff using various bone anchor and suture configurations. The rotator cuff is sutured intracorporeally and an anchor is driven into bone at a location appropriate for repair. Rather than thread the suture through transosseous tunnels which are difficult or impossible to create arthroscopically using current techniques, the repair is completed by tying the cuff down against bone using the anchor and suture. Early results of less invasive techniques are encouraging, with a substantial reduction in both patient recovery time and discomfort.[0006]
• Unfortunately, the skill level required to facilitate an entirely arthroscopic repair of the rotator cuff is inordinately high. Intracorporeal suturing is clumsy and time consuming, and only the simplest stitch patterns can be utilized. Extracorporeal knot tying is somewhat less difficult, but the tightness of the knots is difficult to judge, and the tension cannot later be adjusted. Also, because of the use of bone anchors to provide a suture fixation point in the bone, the knots that secure the soft tissues to the anchor by necessity leave the knot bundle on top of the soft tissues. In the case of rotator cuff repair, this means that the knot bundle is left in the shoulder capsule where it is able to be felt by the patient postoperatively when the patient exercises the shoulder joint. So, knots tied arthroscopically are difficult to achieve, impossible to adjust, and are located in less than optimal areas of the shoulder. Suture tension is also impossible to measure and adjust once the knot has been fixed. Consequently, because of the technical difficulty of the procedure, presently less than 1% of all rotator cuff procedures are of the arthroscopic type, and are considered investigational in nature.[0007]
• Another significant difficulty with current arthroscopic rotator cuff repair techniques are shortcomings related to currently available suture anchors. Suture eyelets in bone anchors available today, which like the eye of a needle are threaded with the thread or suture, are small in radius, and can cause the suture to fail at the eyelet when the anchor is placed under high tensile loads.[0008]
• There are various bone anchor designs available for use by an orthopedic surgeon for attachment of soft tissues to bone. The basic commonality between the designs is that they create an attachment point in the bone for a suture that may then be passed through the soft tissues and tied, thereby immobilizing the soft tissue. This attachment point may be accomplished by different means. Screws are known for creating such attachments, but suffer from a number of disadvantages, including their tendency to loosen over time, requiring a second procedure to later remove them, and their requirement for a relatively flat attachment geometry.[0009]
• Another approach is to utilize the difference in density in the cortical bone (the tough, dense outer layer of bone) and the cancellous bone (the less dense, airy and somewhat vascular interior of the bone). There is a clear demarcation between the cortical bone and cancellous bone, where the cortical bone presents a kind of hard shell over the less dense cancellous bone. The aspect ratio of the anchor is such that it typically has a longer axis and a shorter axis and usually is pre-threaded with a suture. These designs use a hole in the cortical bone through which an anchor is inserted. The hole is drilled such that the shorter axis of the anchor will fit through the diameter of the hole, with the longer axis of the anchor being parallel to the axis of the drilled hole. After deployment in to the cancellous bone, the anchor is rotated 90° so that the long axis is aligned perpendicularly to the axis of the hole. The suture is pulled, and the anchor is seated up against the inside surface of the cortical layer of bone. Due to the mismatch in the dimensions of the long axis of the anchor and the hole diameter, the anchor cannot be retracted proximally from the hole, thus providing resistance to pull-out. These anchors still suffer from the aforementioned problem of eyelet design that stresses the sutures.[0010]
• Still other prior art approaches have attempted to use a “pop rivet” approach. This type of design requires a hole in the cortical bone into which a split shaft is inserted. The split shaft is hollow, and has a tapered plug leading into its inner lumen. The tapered plug is extended out through the top of the shaft, and when the plug is retracted into the inner lumen, the tapered portion causes the split shaft to be flared outwardly, ostensibly locking the device into the bone.[0011]
• Other methods of securing soft tissue to bone are known in the prior art, but are not presently considered to be feasible for shoulder repair procedures, because of physicians' reluctance to leave anything but a suture in the capsule area of the shoulder. The reason for this is that staples, tacks, and the like could possibly fall out and cause injury during movement. As a result of this constraint, the attachment point often must be located at a less than ideal position. Also, the tacks or staples require a substantial hole in the soft tissue, and make it difficult for the surgeon to precisely locate the soft tissue relative to the bone.[0012]
• As previously discussed, any of the anchor points for sutures mentioned above require that a length of suture be passed through an eyelet fashioned in the anchor and then looped through the soft tissues and tied down to complete the securement. Much skill is required, however, to both place the sutures in the soft tissues, and to tie knots while working through a trocar under endoscopic visualization.[0013]
• There have been attempts to solve some of the problems that exist in current anchor designs. One such approach is disclosed in U.S. Pat. No. 5,324,308 to Pierce. In this patent, there is disclosed a suture anchor that incorporates a proximal and distal wedge component having inclined mating faces. The distal wedge component has two suture thread holes at its base through which a length of suture may be threaded. The assembly may be placed in a drilled hole in the bone, and when tension is placed on the suture, the distal wedge block is caused to ride up against the proximal wedge block, expanding the projected area within the drilled hole, and locking the anchor into the bone. This approach is a useful method for creating an anchor point for the suture, but does not in any way address the problem of tying knots in the suture to fix the soft tissue to the bone.[0014]
• The problem of placing sutures in soft tissues and tying knots in an endoscopic environment is well known, and there have been attempts to address the problem and to simplify the process of suture fixation. One such approach is disclosed in U.S. Pat. No. 5,383,905 to Golds et al. The patent describes a device for securing a suture loop about bodily tissue that includes a bead member having a longitudinal bore and an anchor member adapted to be slidably inserted within the bore of the bead member. The anchor member includes at least two axial compressible sections which define a passageway to receive two end portions of a suture loop. The axial sections collapse radially inwardly upon insertion of the anchor member within the bore of the bead member to securely wedge the suture end portions received within the passageway.[0015]
• Although the Golds et al. patent approach utilizes a wedge-shaped member to lock the sutures in place, the suture legs are passing through the bore of the bead only one time, in a proximal to distal direction, and are locked by the collapsing of the wedge, which creates an interference on the longitudinal bore of the anchor member. Also, no provision is made in this design for attachment of sutures to bone. The design is primarily suited for locking a suture loop, such as is used for ligation or approximation of soft tissues.[0016]
• An approach that includes bone attachment is described in U.S. Pat. No. 5,584,835 to Greenfield. In this patent, a two part device for attaching soft tissue to bone is shown. A bone anchor portion is screwed into a hole in the bone, and is disposed to accept a plug that has been adapted to receive sutures. In one embodiment, the suture plug is configured so that when it is forced into its receptacle in the bone anchor portion, sutures that have been passed through an eyelet in the plug are trapped by friction between the wall of the anchor portion and the body of the plug portion.[0017]
• Although there is some merit to this approach for eliminating the need for knots in the attachment of sutures to bone, a problem with being able to properly set the tension in the sutures exists. The user is required to pull on the sutures until appropriate tension is achieved, and then to set the plug portion into the bone anchor portion. This action increases the tension in the sutures, and may garrot the soft tissues or increase the tension in the sutures beyond the tensile strength of the material, breaking the sutures.[0018]
• A disclosure that incorporates bone attachment and eliminates knot tying is set forth in U.S. Pat. No. 5,702,397 to Goble et al. One embodiment, in particular, is shown in FIG. 23 of that patent and includes a bone anchor that has a threaded body with an inner cavity. The cavity is open to one end of the threaded body, and joins two lumens that run out to the other end of the threaded body. Within the cavity is disposed a gear, journaled on an axle. A length of suture is threaded through one lumen, around the gear, and out through the other lumen. A ball is disposed within the cavity to ride against a tapered race and ostensibly lock the suture in place. What is not clear from the patent disclosure is how the force D shown as the tension in the suture would lock the ball into the race. Although this embodiment purports to be a self-locking anchor adapted for use in blind holes for fixing sutures into bone, the construct shown is complicated, and does not appear to be adequate to reliably fixate the suture.[0019]
• What is needed, therefore, is a new approach for repairing the rotator cuff or fixing other soft tissues to bone, wherein suture tension can be adjusted and possibly measured, the suture resides completely below the cortical bone surface, there is no requirement for the surgeon to tie a knot to attach the suture to the bone anchor, and wherein the procedure associated with the new approach is better for the patient, saves time, is uncomplicated to use, and easily taught to practitioners having skill in the art.[0020]
SUMMARY OF THE INVENTION
• The present invention solves the problems outlined above by providing innovative bone anchor and connective techniques which permit a suture attachment which lies entirely beneath the cortical bone surface. In the present state of the art, the sutures which are passed through the tissues to be attached to bone typically are threaded through a small eyelet incorporated into the head of the anchor and then secured by tying knots in the sutures. Endoscopic knot tying is an arduous and technically demanding task. Therefore, the present invention discloses devices and methods for securing sutures to a bone anchor without the requirement of knot tying.[0021]
• In one embodiment, the suture legs, after having been placed into soft tissues to be anchored to bone, are threaded through the anchor and then through a floating wedge block located at the distal end of the anchor. The wedge block is configured such that it has a hollow lumen through the center, and a conically tapered outer surface. The distal end of the wedge block is the wider end of the cone, and the transition from the inside diameter created by the hollow lumen and the outside diameter created by the conical surface includes smooth radii for dressing the sutures threaded through the hollow lumen. The sutures are passed back around the outside of the wedge block such that they rest on the conical surface. They are then re-threaded in the opposite direction back through the anchor, exiting the anchor at the proximal end thereof. The anchor is then inserted into the bone, and secured. The distal end of the anchor is tapered to match the taper of the conical surface on the wedge block. When tension is placed on the legs of the suture passing back out of the anchor, the suture is drawn through the hollow center lumen, around the distal end of the wedge block, and back out of the anchor. This tension tends to cause the wedge block to force its way back up into the anchor body, and a means to prevent this may be employed. Such means may include any structure that selectively holds the wedge block separate from the anchor body.[0022]
• At this juncture, by pulling on the suture legs, any slack in the sutures is removed, and the soft tissues are drawn toward the anchor. When the soft tissues are in the desired orientation, relative to the bone to which they are to be attached, the structure holding the wedge block is removed, and the back tension on the sutures pulls the wedge block into the matching taper in the anchor body, maintaining the compressive force on the suture legs.[0023]
• In another embodiment, the wedge block may be adapted to have a U-shaped channel along one side of the wedge, and a tapered face along the opposite side of the wedge. The U-shaped channel communicates with the tapered face via a large radius surface that transitions and blends the channel face to the tapered face. The wedge is configured such that it may be placed inside of a hollow cylinder with a tapered face that protrudes into the interior of the cylinder and is configured to mate with the taper of the wedge. The wedge is adapted to permit two legs of the suture to be threaded through the anchor body, and along the U-shaped channel to the distal end of the anchor, wherein the sutures are drawn around the radiused surface and onto the tapered surface of the wedge on the opposite side. The sutures then pass back out of the proximal end of the anchor. As before, the suture legs may pass freely around the tapered wedge block until such time as tension in the bound legs pulls the wedge block back up into the tapered body of the anchor, and locks the suture in place.[0024]
• Thus, with the above-described suture locking system, suture failure rates are dramatically reduced over conventional techniques because of the increased radius over which the suture is loaded, and the inventive procedures are significantly easier to perform than conventional techniques because of the elimination of knot tying.[0025]
• More particularly, there is provided a bone anchor device for attaching connective tissue to bone, which comprises an outer body, and a lumen extending axially through the outer body. Inner walls which define the lumen in a proximal portion of the outer body extend inwardly relative to inner walls which define the lumen in a portion of the outer body distal to the proximal portion. A wedge member is advantageously disposed in a distal end of the lumen, distal to the inwardly extending lumen wall portion, which has outer walls that taper inwardly in a proximal direction therealong. The wedge member is axially movable in the lumen distal end.[0026]
• In one preferred embodiment, a lumen extends axially through the wedge member, for receiving a suture therein. The wedge member preferably comprises a distal end having a curved surface, and the tapered proximal surface of the wedge member and the inwardly extending lumen internal wall together define a tapered distal lumen which communicates with the lumen.[0027]
• A suture extends through the lumen and around the distal curved surface of the wedge member, and includes a free end extending proximally out of the bone anchor device and a bound end attached to soft tissue to be secured to the bone, wherein when the free end is placed in tension by a proximally directed force, the suture travels about the wedge member until increased tension on the bound end causes the suture to move the wedge member axially in a proximal direction, the proximal axial travel of the wedge member continuing until the proximal surface of the wedge member has moved into sufficient proximity to the inwardly extending internal lumen wall to pinch a length of the suture in the tapered distal lumen.[0028]
• In another aspect of the invention, there is provided a bone anchor device for attaching connective tissue to bone, which comprises an outer body and a lumen extending axially through the outer body. Inner walls which define the lumen taper in a proximal portion of the outer body extend inwardly relative to inner walls which define the lumen in a portion of the outer body distal to the proximal portion. A suture clamping member, consisting of a wedge member, is axially movable in the lumen.[0029]
• In still another aspect of the invention, there is provided a bone anchor device for attaching connective tissue to bone, which comprises an outer body having a lumen extending axially therethrough. Inner walls which define the lumen in a proximal portion of the outer body extend inwardly relative to inner walls which define the lumen in a portion of the outer body distal to the proximal portion. A suture clamping member comprising a wedge member is axially movable in the lumen distal portion. A suture extends through the lumen and around a distal surface of the wedge member, which includes a free end extending proximally out of the bone anchor device and a bound end attached to soft tissue to be secured to the bone. When the free end is placed in tension by a proximally directed force, the suture travels about the wedge member until increased tension on the bound end causes the suture to move the wedge member axially in a proximal direction, the proximal axial travel of the wedge member continuing until the proximal surface of the wedge member has moved into sufficient proximity to the inwardly extending internal lumen wall to pinch a length of the suture therebetween.[0030]
• In another aspect of the invention, there is provided a bone anchor device for attaching connective tissue to bone, which comprises an outer body having an open distal end, and a lumen extending axially through the outer body. Inner walls which define the lumen in a proximal portion of the outer body extend inwardly relative to inner walls which define the lumen in a portion of the outer body distal to the proximal portion. A suture clamping member having an outer surface is disposed in the lumen distal end and is axially movable therein. Advantageously, complementary engaging structure is disposed on each of the suture clamping member outer surface and the lumen inner surface for retaining the suture clamping member in the lumen distal end when the bone anchor device is not in a portion of bone. This complementary engaging structure preferably comprises a pin disposed on one of the suture clamping member outer surface and the lumen inner surface, and a recess for receiving the pin disposed on the other of the suture clamping member outer surface and the lumen inner surface.[0031]
• In yet another aspect of the invention, there is provided a bone anchor device for attaching connective tissue to bone, which comprises an outer body having an outer surface, and a lumen extending axially through the outer body. Inner walls which define the lumen in a proximal portion of the outer body extend inwardly relative to inner walls which define the lumen in a portion of the outer body distal to the proximal portion. A suture clamping member is disposed in the lumen distal portion and is axially movable therein. Additionally, at least one outwardly extendable rib is disposed on the outer body outer surface for anchoring the outer body into surrounding bone.[0032]
• In still another aspect of the invention, there is provided a bone anchor device for attaching connective tissue to bone, which comprises a distal wedge anchor portion comprising an outer body having an outer surface, on which a outwardly deployable anchoring element is situated. Additionally, a proximal driver portion is connected to the distal wedge anchor portion at a proximal end thereof, which includes an actuator for deploying the anchoring element outwardly. Advantageously, the connection between the proximal driver portion and the distal wedge anchor portion is releasable once the anchoring element has been deployed. In a preferred embodiment, this is accomplished because of a designed failure point in the connection between the proximal driver portion and the distal wedge anchor portion, so that upon deployment of the anchoring element outwardly, additional force may be applied to separate the driver portion from the anchor portion so that only the driver portion may be proximally removed from the patient's body.[0033]
• In yet another aspect of the invention, there is disclosed a method for securing connective tissue to bone, which comprises securing a first end of a length of suture to a portion of soft tissue to be attached to a portion of bone. A second end of the length of suture is threaded through a lumen in an outer body of a bone anchor device and about an axially movable suture clamping member disposed in a distal portion of the lumen. The outer body is placed in a blind hole disposed in the portion of bone, and the second end of the length of suture is pulled proximally, so that the suture travels about the axially movable suture clamping member and draws the first end of the length of suture toward the bone anchor device, thereby securing the portion of soft tissue snugly to the portion of bone. Advantageously, when the tension on the first end of the length of suture increases, as the portion of soft tissue is bound to the portion of bone, the suture clamping member is pulled proximally toward inwardly extending walls defining a portion of the lumen, thereby clamping a portion of the length of suture between the inwardly extending lumen walls and the suture anchoring device.[0034]
• Additional steps in the preferred method include anchoring the outer body in the blind hole, preferably by deploying ribs disposed on an outer surface of the outer body to an outwardly extended position, into surrounding cancellous bone, and cutting a portion of the suture second end to complete the procedure.[0035]
• In another aspect of the invention, there is disclosed a method for securing connective tissue to bone, which comprises securing a first end of a length of suture to a portion of soft tissue to be attached to a portion of bone, and threading a second end of the length of suture through a lumen in an outer body of a bone anchor device and about an axially movable suture clamping member disposed in a distal portion of the lumen. The bone anchor device is inserted into a blind hole disposed in the portion of bone, and a deployable anchoring member disposed on an outer surface of the outer body is extended outwardly to secure the bone anchor device in surrounding bone. Following this step, a driver portion of the bone anchor device is separated from the outer body and withdrawn from the patient's body. Then, the second end of the length of suture is pulled proximally, to secure the portion of soft tissue properly to the portion of bone and to anchor the suture in the outer body by moving the suture clamping member axially to a suture clamping position.[0036]
• In still another aspect of the invention, there is provided a bone anchor device for attaching connective tissue to bone, which comprises a body having a longitudinal axis, a distal end, and a proximal end. A surface on the body distal end slopes inwardly toward the longitudinal axis from a distal portion of the surface toward a proximal portion thereof. A suture anchoring member which is movable axially toward and away from sloping surface forms a part of the bone anchor device. The suture anchoring member s a distal end surface and opposing axial surfaces, wherein the distal end and opposing axial surfaces all comprise suture receiving surfaces for contacting suture material wrapped thereabout. In essence, this means that in use, a length of suture material will be wrapped about the suture anchoring member in such a manner that the length of suture material will be in physical contact with all of the distal end surface and opposing side surfaces. In preferred embodiments, one of the opposing axial surfaces is sloped so that a width of the suture anchoring member (i.e. a dimension of the suture anchoring member which is transverse to the longitudinal axis) tapers from a distal end to a proximal end thereof.[0037]
• As has been discussed supra, the sloped axial surface and the inwardly sloped body distal end surface together define a tapered distal lumen.[0038]
• Now, it is to be understood that the above described invention is particularly suited to locking sutures that have been passed through soft tissues and are to be anchored to bone. The creation of an anchor point within the bone is outside the scope of this invention, although many alternative methods of anchoring suture to bone are contemplated. For example, some currently preferred methods are discussed in U.S. patent application Ser. No. 09/616,802, entitled Method & Apparatus for Attaching Connective Tissues to Bone Using a Suture Anchoring Device, filed on Jul. 14, 2000. The referenced application is commonly assigned with the present application, and is incorporated by reference in its entirety herein. Other prior art anchors, such as screws, moly bolts, and pop rivets may be adapted for use with the present invention as well.[0039]
• The invention, together with additional features and advantages thereof, may best be understood by reference to the following description taken in conjunction with the accompanying illustrative drawing.[0040]
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a cross-sectional view of one embodiment of a portion of a bone anchor having a suture lock constructed in accordance with the principles of the present invention;[0041]
• FIG. 2 is a plan view of a second embodiment of a bone anchor having a suture lock similar to that shown in FIG. 1;[0042]
• FIG. 2A is a cross-sectional view taken along[0043]lines2A-2A of FIG. 2;
• FIG. 2B is a view taken along[0044]lines2B-2B of FIG. 2;
• FIG. 3 is a plan view similar to that of FIG. 2, illustrating a first step in a preferred method for using the embodiment of FIG. 2;[0045]
• FIG. 3A is a cross-sectional view taken along[0046]lines3A-3A of FIG. 3;
• FIG. 3B is a distal end view taken along[0047]lines3B-3B of FIG. 3;
• FIG. 4 is a plan view similar to that of FIG. 3, illustrating a second step in a preferred method for using the embodiment of FIG. 2;[0048]
• FIG. 4A is a cross-sectional view taken along[0049]lines4A-4A of FIG. 4;
• FIG. 4B is a distal end view taken along lines[0050]4B-4B of FIG. 4;
• FIG. 5 is a plan view similar to those of FIGS. 3 and 4, illustrating a third step in a preferred method for using the embodiment of FIG. 2;[0051]
• FIG. 5A is a cross-sectional view taken along[0052]lines5A-5A of FIG. 5;
• FIG. 6 is a plan view similar to those of FIGS.[0053]3-5, illustrating a fourth step in a preferred method for using the embodiment of FIG. 2;
• FIG. 6A is a cross-sectional view taken along[0054]lines6A-6A of FIG. 6;
• FIG. 6B is a view taken along lines[0055]6B-6B of FIG. 6;
• FIG. 6C is a cross-sectional view of one type of suture material which may be used in the present invention;[0056]
• FIG. 6D is a cross-sectional view illustrating the suture of FIG. 6C after it has been clamped and compressed by the wedge clamp of the present invention;[0057]
• FIG. 7 is a plan view similar to those of FIGS.[0058]3-6, illustrating a fifth step in a preferred method for using the embodiment of FIG. 2;
• FIG. 8 is a schematic view illustrating a first step in a preferred method for using a suture lock and bone anchor constructed in accordance with the present invention to repair a tom rotator cuff arthroscopically;[0059]
• FIG. 9 is an enlarged schematic view illustrating the distal end of the instrument shown in FIG. 8;[0060]
• FIGS.[0061]10-14 are views similar to FIG. 9 illustrating sequential steps in the aforementioned method; and
• FIG. 15 is a schematic view similar to FIG. 8 illustrating the repaired rotator cuff at the conclusion of the aforementioned method.[0062]
DESCRIPTION OF THE PREFERRED EMBODIMENT
• Referring now more particularly to the drawings, there is shown in FIG. 1 a[0063]bone anchor10 constructed in accordance with an embodiment of the present invention, comprising abody12 which includesthreads14 on an outside surface thereof, aproximal lumen16, and a tapereddistal lumen18 that communicates with theproximal lumen16. Awedge body20 includes atapered end22 and alumen24 through thewedge body20. The lumen terminates in alarge blend radius26 at the distal end of thewedge body20. Asuture28 which includes abound leg30 and afree leg32 is threaded through theproximal lumen16 and thewedge body lumen24, passes around thelarge blend radius26, and is redirected back through theproximal lumen16. Thebound leg30 is considered bound because in practice, this leg of the suture is “bound” to the soft tissues to be attached to bone by virtue of passing the sutures through the tissues using conventional suturing techniques known in the art. Thefree leg32 is considered “free” because the surgeon, in practice, has control over this leg of the suture with his or her hands.
• In operation, as the surgeon pulls on the[0064]free leg32 of thesuture28, thebound leg30 of the suture follows through the bone anchor until such time as the tissues binding in thebound leg30 of thesuture28 creates a tension in thesuture28. At this point, tension in thesuture28 tends to urge thewedge body20 up into the tapereddistal lumen18, pinching thesuture28 between the tapereddistal lumen18 and thetapered end22 of thewedge body20. As the tension in thebound leg30 of thesuture28 increases, the force on thewedge body20 increases. In turn, the pinching force on thesuture28 also increases, creating a self-locking mechanism. Thethreads14 on the exterior surface of thebody12 function to secure the bone anchor in surrounding bone material.
• Referring now to FIGS. 2, 2A, and[0065]2B, a second modified embodiment of the inventivebone anchor device110 is illustrated, wherein like elements to those shown in FIG. 1 are designated by like reference numerals, preceded by the numeral “1”. Thebone anchor device110 comprises a distalwedge anchor portion135 and aproximal driver portion137, which are secured together mechanically in a coaxial arrangement bycrimped segments139 or other suitable means. As in the FIG. 1 embodiment, the distalwedge anchor portion135 includes abody112 which comprises aproximal lumen116, a tapereddistal lumen118, and awedge body120 having atapered end122 and alarge blend radius126. Apin141 may be disposed in agroove142 on thewedge body120, which is complementary to agroove143 on an interior surface of thebody112 of the distalwedge anchor portion135. When thepin141 is disposed in thegroove142 and thegroove143, it functions as a retainer to keep thewedge body120 in position in thedistal lumen118 of thedevice110. This arrangement is particularly convenient when there is no suture threaded through the device, so that the device, though formed of separable elements, tends to remain unitary, thereby easing the already complicated job of the practitioner performing the repair procedure.
• A crimped flat[0066]145 on the surface of the distal portion of thebody112 creates the progressive proximal tapering in the tapereddistal lumen118, discussed supra in connection with the FIG. 1 embodiment, which is important to ensure that the suture becomes pinched between thewedge body120 and the interior surface of thebone anchor body112 in the tapereddistal lumen118 as thewedge body120 moves proximally under tension, as will be described more fully hereinbelow.
• Also on the outer surface of the[0067]body112 of thebone anchor portion135 are a plurality ofslots147, which are distributed in a spaced configuration about the entire circumference of thecylindrical body112. Theseslots147 are illustrated as being disposed at an acute angle with respect to alongitudinal axis149 of theinstrument110, although in other preferred embodiments the slots are oriented parallel to theaxis149. Such slots and their function are more fully described in U.S. patent application Ser. No. 09/616,802, which has already been expressly incorporated herein by reference. Their function will also be described in greater detail hereinbelow.
• Now with reference in particular to FIGS.[0068]3-7, a method for using thebone anchor device110 of FIGS. 2, 2A, and2B to secure soft tissue to bone, for example, will be described. Initially, asuture128, and particularly abound leg130 of thesuture128, is stitched in a suitable manner to a portion ofsoft tissue151, such as a tendon, which is to be secured to a bone (not shown). The stitching process may be accomplished by any known means, and any known suture stitch may be employed, the objective being to ensure a secure stitch so that the suture is not inadvertently separated from the tendon after completion of the repair procedure, necessitating reentry to the surgical site. In preferred approaches, the suture is attached to the soft tissue using a “mattress stitch”, which is well known in the art as being a particularly secure stitch which is unlikely to fail postoperatively. Of course, as discussed supra, the preferred repair procedure discussed herein is an arthroscopic procedure, wherein an initial access incision is made to the repair site, such as a shoulder, and a trocar is inserted into the access incision to provide access to the repair site for surgical instruments as well as optical instruments. Preferably, a suturing instrument is inserted into the trocar to perform the aforementioned suturing step. Of course, the inventive devices may also be utilized in an open surgical procedure, if desired, wherein the sutures are manually placed.
• Once the suturing process is completed, a[0069]free end132 of thesuture128 is removed proximally through the trocar from the patient's body, together with the suturing instrument. Thefree end132 of the suture is then threaded through alateral port153 and then through theproximal lumen116 of the bone anchor instrument110 (FIGS. 3, 3A, and3B). It is threaded distally through the tapereddistal lumen118 and around the distal end surface (large blend radius)126 of thewedge body120, then proximally back through the tapereddistal lumen118 and through thelumen116 to the proximal end of thedriver portion137. It is noted that, in this embodiment, thewedge body120 does not include a wedge lumen, as in the FIG. 1 embodiment. Rather, the suture is threaded about the wedge body, so that it is in physical contact with thelarge blend radius126, as well as with each opposingside surface154a, b(FIG. 4A) of the wedge body. However, the wedge body could be modified to include a wedge lumen, and the suture could be threaded therethrough, as in the FIG. 1 embodiment, if desired.
• Once the threading process is completed, the[0070]bone anchor instrument110 is returned through the trocar (not shown) to the repair site, and the distalwedge anchor portion135 is placed into a blind hole (not shown) which has been made, preferably by drilling, into the bone to which thesoft tissue151 is to be secured.
• With reference now to FIGS. 4, 4A, and[0071]4B, once the distalwedge anchor portion135 is satisfactorily disposed within the bone (not shown), the driver portion is actuated to radially outwardly deploy a plurality ofribs157 which comprise the portions of thebody112 which lie between the aforementioned spacedslots147. This procedure is more fully described in co-pending U.S. patent application Ser. No. 09/616,802, already incorporated herein by reference, but, essentially, the deployment is made by axially compressing the distal wedge anchor portion to thereby force theribs157 radially outward. In a preferred embodiment, wherein, as mentioned supra, theslots147 lie at an angle with thelongitudinal axis149 of thedevice110, the resulting “petals” formed by the radially outwardly extendingribs157 take on a semi-circular shape, with the “petals” overlapping one another to create an extraordinarily strong anchor body. The soft cancellous bone into which the anchor body is radially extended tends to flow between the “petals” as well, further strengthening the achieved anchoring effect both axially and radially. The anchor should be radially deployed beneath the cortical bone surface, so that it is virtually impossible to retract the distal wedge anchor portion from the bone proximally past the cortical outer surface thereof without breaking the native bone.
• A unique and important feature of the present invention is the provision of a[0072]stress point159 in the junction between the distalwedge anchor portion135 and theproximal driver portion137. The reason for this is that, once the driver portion has been utilized to position the wedge anchor portion, and then actuated to axially compress the wedge anchor portion, so that theanchor ribs157 are radially extended, there is no more purpose for the driver portion. As mentioned supra, thewedge anchor portion135 anddriver portion137 are mechanically joined by, for example, a plurality of crimpedsegments139, which create an interfering fit between the axially overlapping cylindrical bodies of each of the twoportions135,137. Of course, many other equivalent joinder means may be employed as well, and these means will be well known to those of ordinary skill in the art. In the presently preferred embodiment, however, thestress point159 is co-located with the crimpedsegments139, and designed so that, as the compressing force is applied by thedriver portion137 to thewedge anchor portion135, to radially deform and extend theribs157, when it reaches a level somewhat above the force level required to complete the anchor deployment, the stress point which is a pre-designed point of weakness or “failure point”, will break, physically separating thedriver portion137 from theanchor portion135. FIGS. 5 and 5A illustrate thedevice110 after thedriver portion137 has been separated from thewedge anchor portion135 and withdrawn proximally from the patient's body through the trocar (not shown).
• Thus, the[0073]wedge anchor portion135 is now permanently deployed in the bone, to thereby securely anchor thesuture128 therein, and thus permanently secure thesoft tissue151 to the bone.
• With reference now to FIGS. 6, 6A, and[0074]6B, it will be seen that, once thedistal anchor portion135 is secured within the bone, it is time for the practitioner to pull the free ends132 of thesuture128 proximally, to draw thesoft tissue151 toward the bone until it is snugly situated in desired proximity thereto, thereby creating a tight and secure connection between the soft tissue and the bone. As discussed supra, with respect to the FIG. 1 embodiment, thebound leg130 of the suture follows through the bone anchor, about thewedge body120, until such time as thetissues151 binding in thebound leg130 of thesuture128 create a tension in thesuture128. This will occur when thesoft tissue151 has been drawn toward the bone and is snugly situated with respect thereto. At this point, tension in thesuture128 tends to urge thewedge body120 proximally, up into the tapereddistal lumen118, as shown in FIG. 6A, pinching thesuture128 between an inwardly sloping surface161 (FIG. 4A) on thebody112 and the slopingaxial surface154aon thetapered end122 of thewedge body120, within the tapereddistal lumen118. As the tension in thebound leg130 of thesuture128 increases, the proximal force on thewedge body120 increases. In turn, the pinching force on thesuture128 also increases, creating a self-locking mechanism.
• It may be helpful to discuss in some detail this self-locking suture mechanism. One of the significant advantages of this mechanism is its reversibility; i.e. its ability to permanently lock the bound end of the suture in position, but to permit continued adjustability of the suture loop by applying a tensile force to the free end of the suture. This is important, because a practitioner will often find that, during the course of a procedure, after the tendon/[0075]soft tissue151 has been brought into what is believed to be a desired position relative to the bone to which it is being secured, and the suture has been locked into place to retain the tendon in that orientation, a further adjustment is necessary or desired to optimize the outcome. Using existing prior art solutions, though, wherein the suture is knotted into position and fixed at a particular length, it would be necessary to either forego the desired adjustment or, alternatively, to cut the suture and resuture the tendon. In some instances, it may be necessary to abandon the suture anchor, leaving the useless (and expensive) anchor in position, and locating a new anchor in the bone to re-suture the tendon.
• On the other hand, in the present invention, after the[0076]free end132 has been pulled, as described above, sufficiently that a tension is created in the bound end130 (due to approximation of thetendon151 to the bone), and thesuture128 has been clamped in the tapereddistal lumen118, only thebound end130 is anchored in a fixed position. This ensures that the tendon is not movable relative to the bone after completion of the procedure, which, of course, is desirable. On the other hand, thefree end132 continues to be movable, to thereby permit adjustment of the size of the suture loop through thetendon151, which in turn permits adjustment or “fine tuning” of the position of thetendon151 with respect to the bone.
• To understand this advantageous feature, it may be helpful to review in a bit more detail the functionality of the inventive device and method. Again with reference to FIGS.[0077]2-6B, it may be seen that, in the early procedural steps, both the free and bound suture legs are freely movable to slide thesuture128 about the free-floatinganchor wedge120. However, once tension develops in thebound leg130 as thetendon151 approximates the bone, thewedge120 is pulled proximally to clamp a length of thesuture128 within the tapereddistal lumen118, as discussed in detail supra. Applying a tensile force to the bound leg at this juncture only enhances the clamping effect by proximally pulling thewedge120 even more tightly against the clamped length ofsuture128. FIGS. 6C and 6D illustrate the effect of this clamping force on the clamped length ofsuture128, as observed by the inventor. In the case where #2 round suture is utilized, having a cross-sectional width of 0.023 inches, as shown in FIG. 6C, the clamping force exerted by thewedge block120 against the clamped length of suture causes it to flatten and compress to a width of approximately 0.011 inches.
• On the other hand, now the[0078]free leg132 of thesuture128 may continue to be manipulated to adjust the size of the suture loop at the bound end. Applying a tensile force to thefree leg132, once the suture is clamped by thewedge120, causes thewedge120 now to move again in a distal direction, thereby increasing the cross-sectional area of the taperedlumen118, so that the clamped length of suture may slide to adjust the positioning of the bound suture end. There are two apparent reasons for this response. One is that, when thefree end132 is pulled, the clamped length ofsuture128 wants to straighten out, so that it pushes against the angled inner lumen wall which forms, in part, the tapereddistal lumen118. Since this wall is fixed in position, a reactive force pushes against the tapered face of thewedge120, pushing it a modest distance distally. Another reason is that continued tension on the free end of the suture results in a return of the cross-sectional area of the clamped suture portion from a reduced flat cross-section to the original larger round cross-section. This rounding effect reduces the surface contact of the suture with the adjacent lumen walls (and resultant frictional interface), making it easier for the suture to slide through the tapered lumen. Also, the increased suture diameter pushes the wedge120 a slight distance distally. The resultant larger tapered lumen permits free sliding of thesuture128 until a desired adjustment has been made, after which thetendon151 is again clamped as explained supra.
• Now referring to FIG. 7, the final step in the sequence of permanently anchoring the[0079]soft tissue151 to bone is illustrated, wherein, once the suture is locked in place by virtue of the proximal positioning of thewedge body120 within theanchor portion135, thefree end132 is cut off near the proximal end of theanchor portion135, and the incision is closed. Thefree end132 is only cut off after all final adjustments have been made, as discussed above, so that the tendon is precisely positioned as desired.
• FIGS.[0080]8-15 illustrate a procedure similar to that shown in FIGS.2-7, but specifically adapted for repair of a patient's rotator cuff, arthroscopically. Accordingly, like elements to those illustrated in previous figures will be designated by the same reference numerals, preceded by the numeral “2”.
• Thus, there is shown in FIG. 8 a[0081]shoulder261, which comprises ahumeral head263, including an outercortical bone layer265, which is hard, and innercancellous bone267, which is relatively soft. As is typically the case for rotator cuff injuries, in this instance thesupraspinatus tendon251 has become separated from thehumeral head263, and the objective of the rotator cuff repair procedure is to reattach thetendon251 to thehumeral head263.
• Alternate rotator cuff repair procedures are also discussed in co-pending U.S. patent application Ser. No. 09/475,495, filed on Dec. 30, 1999, and entitled Method and Apparatus for Attaching Connective Tissues to Bone Using a Knotless Suture Anchoring Device, which is herein expressly incorporated by reference.[0082]
• To effect the rotator cuff repair, the practitioner will first create an incision in the patient's[0083]shoulder261, into which will be inserted atrocar269, as shown in FIG. 8. The trocar permits access to the procedural site for visualization instruments, as well as working instruments, and permits the procedure to be completed arthroscopically.
• Again, as in the embodiment shown in FIGS.[0084]3-7, once the trocar has been inserted, the first procedural step is to suture thetendon251, using desired techniques which are beyond the scope of this patent application, creating a bound suture end230 (FIGS. 8 and 9). Once this suturing step is completed, as with the FIGS.3-7 embodiment, the free end232 (FIG. 9) of thesuture228 is removed proximally through the trocar from the patient's body, together with the suturing instrument (not shown). Thefree end232 of the suture is then threaded through the proximal lumen216 of thebone anchor instrument210 through alateral port253, distally through the tapereddistal lumen218 and around thelarge blend radius226 of thewedge body220, then proximally back through the tapereddistal lumen218 and through the lumen216 to the proximal end of adriver portion237. Once the threading process is completed, thebone anchor instrument210 is returned through thetrocar269 to the repair site, and the distalwedge anchor portion235 is placed into ablind hole271 which has been made, preferably by drilling, into thebone263 to which thesoft tissue tendon251 is to be secured.
• With reference now to FIG. 10, once the distal[0085]wedge anchor portion235 is satisfactorily disposed within thebone263, beneath thecortical layer265, thedriver portion237 is actuated to radially outwardly deploy a plurality ofribs257 to create a “flower” comprised of a plurality of “petals”, which have a diameter substantially larger than the diameter of thehole271, thereby preventing “backout” of theanchor portion235 from thehole271. Although many different actuation mechanisms may be employed, the illustrated embodiment shows a handle portion273 (FIG. 8) including atrigger275, which may be squeezed by the practitioner to axially compress theanchor portion235 and thereby deploy the “flower” anchor. This procedure is the same as that employed in the FIGS.3-7 embodiment.
• As in the FIGS.[0086]3-7 embodiment, astress point259 is provided in the junction between the distalwedge anchor portion235 and theproximal driver portion237. Referring now to FIG. 11, then, as in the prior embodiment, once the wedge anchor portion has been fully compressed to fully radially extend theanchor ribs257, thetrigger275 continues to be squeezed for a period of time to exert continuing axial compression force on the column of thewedge anchor portion235. This continued force application will cause the column to fail at its designed failure point, namely, thestress point259, so that thedriver portion237 becomes physically separated from theanchor portion235. As shown in FIG. 11, once thedriver portion237 is physically separated from theanchor portion235, it is withdrawn proximally through thetrocar269, out of the patient's body. In FIG. 11, thedriver portion237 is shown partially withdrawn, and in FIG. 12 it is fully withdrawn. It is noted that, in this embodiment, asuture channel277 is disposed coaxially about thedriver portion237, as shown.
• Thus, the[0087]wedge anchor portion235 is now permanently deployed in thebone263, to thereby securely anchor thesuture228 therein, and thus permanently secure thesoft tissue251 to thebone263.
• With reference now to FIGS. 12 and 13, it will be seen that, once the[0088]distal anchor portion235 is secured within thebone263, it is time for the practitioner to pull thefree end232 of thesuture228 proximally, to draw thetendon251 toward thebone263 until it is snugly situated in desired proximity thereto, thereby creating a tight and secure connection between the tendon and the bone. As discussed supra, with respect to prior embodiments, thebound leg230 of the suture follows through the bone anchor, about thewedge body220, until such time as thetendon251 binding in thebound leg230 of thesuture228 creates a tension in thesuture228. At this point, tension in thesuture228 tends to urge thewedge body220 proximally, up into the tapereddistal lumen218, as shown in FIG. 12, pinching thesuture228 between the tapereddistal lumen218 and thetapered end222 of thewedge body220. As the tension in thebound leg230 of thesuture228 increases, the proximal force on thewedge body220 increases. In turn, the pinching force on thesuture228 also increases, creating a self-locking mechanism.
• Now referring to FIG. 13, once the[0089]suture228 is locked in place within thebone anchor portion235, thesuture channel277 is proximally withdrawn through thetrocar269. Then, as shown in FIGS. 14 and 15, the excess suture material on thefree leg232 is cut off, the trocar is removed, and the incision is closed to complete the procedure.
• Accordingly, although an exemplary embodiment of the invention has been shown and described, it is to be understood that all the terms used herein are descriptive rather than limiting, and that many changes, modifications, and substitutions may be made by one having ordinary skill in the art without departing from the spirit and scope of the invention. In particular, it is noted that the procedures, while oriented toward the arthroscopic repair of the rotator cuff, are applicable to the repair of any body location wherein it is desired to attach or reattach soft tissue to bone, particularly using an arthroscopic procedure.[0090]

Claims (38)

What is claimed is:

1. A bone anchor device for attaching connective tissue to bone, comprising:

an outer body;

a lumen extending axially through said outer body, wherein inner walls which define said lumen in a proximal portion of said outer body extend inwardly relative to inner walls which define said lumen in a portion of said outer body distal to said proximal portion; and

a wedge member disposed in a distal end of said lumen, said wedge member having outer walls which taper inwardly in a proximal direction therealong, said wedge member being axially movable in said lumen distal end.

2. The bone anchor device as recited inclaim 1, said outer body having an outer surface and having a protrusion thereon extending outwardly to anchor said outer body in a bone.

3. The bone anchor device as recited inclaim 2, wherein said protrusion comprises a thread.

4. The bone anchor device as recited inclaim 2, wherein said protrusion comprises a plurality of outwardly extendable ribs.

5. The bone anchor device as recited inclaim 1, and further comprising a lumen extending axially through said wedge member, for receiving a suture therein.

6. The bone anchor device as recited inclaim 1, wherein said wedge member comprises a distal end having a curved surface.

7. The bone anchor device as recited inclaim 1, wherein the tapered proximal surface of said wedge member and said inwardly extending lumen internal wall together define a tapered distal lumen which communicates with said lumen.

8. The bone anchor device as recited inclaim 7, and further comprising a suture extending through said lumen and around a distal curved surface of said wedge member, said suture including a free end extending proximally out of said bone anchor device and a bound end attached to soft tissue to be secured to said bone, wherein when said free end is placed in tension by a proximally directed force, the suture travels about said wedge member until increased tension on said bound end causes said suture to move said wedge member axially in a proximal direction, the proximal axial travel of said wedge member continuing until the proximal surface of the wedge member has moved into sufficient proximity to the inwardly extending internal lumen wall to pinch a length of said suture in said tapered distal lumen.

9. A bone anchor device for attaching connective tissue to bone, comprising:

an outer body;

a lumen extending axially through said outer body, wherein inner walls which define said lumen taper in a proximal portion of said outer body extend inwardly relative to inner walls which define said lumen in a portion of said outer body distal to said proximal portion; and

a suture clamping member consisting of a wedge member which is axially movable in said lumen.

10. The bone anchor device as recited inclaim 9, and further comprising a lumen extending axially through said wedge member, for receiving a suture therein.

11. The bone anchor device as recited inclaim 9, wherein said wedge member comprises a distal end having a curved surface.

12. The bone anchor device as recited inclaim 9, and further comprising a suture extending through said lumen and around a distal curved surface of said wedge member, said suture including a free end extending proximally out of said bone anchor device and a bound end attached to soft tissue to be secured to said bone, wherein when said free end is placed in tension by a proximally directed force, the suture travels about said wedge member until increased tension on said bound end causes said suture to move said wedge member axially in a proximal direction, the proximal axial travel of said wedge member continuing until the proximal surface of the wedge member has moved into sufficient proximity to the inwardly extending internal lumen wall to pinch a length of said suture therebetween.

13. A bone anchor device for attaching connective tissue to bone, comprising:

an outer body;

a lumen extending axially through said outer body, wherein inner walls which define said lumen in a proximal portion of said outer body extend inwardly relative to inner walls which define said lumen in a portion of said outer body distal to said proximal portion;

a suture clamping member comprising a wedge member which is axially movable in said lumen distal portion; and

a suture extending through said lumen and around a distal surface of said wedge member, said suture including a free end extending proximally out of said bone anchor device and a bound end attached to soft tissue to be secured to said bone, wherein when said free end is placed in tension by a proximally directed force, the suture travels about said wedge member until increased tension on said bound end causes said suture to move said wedge member axially in a proximal direction, the proximal axial travel of said wedge member continuing until the proximal surface of the wedge member has moved into sufficient proximity to the inwardly extending internal lumen wall to pinch a length of said suture therebetween.

14. The bone anchor device as recited inclaim 13, wherein said wedge member distal surface is curved.

15. The bone anchor device as recited inclaim 13, wherein said outer body has an outer surface, said outer surface having outwardly extendable ribs disposed thereon for anchoring said outer body in bone.

16. The bone anchor device as recited inclaim 13, and further comprising a lumen extending axially through said wedge member for receiving a suture therein.

17. A bone anchor device for attaching connective tissue to bone, comprising:

an outer body having an open distal end;

a lumen extending axially through said outer body, wherein inner walls which define said lumen in a proximal portion of said outer body extend inwardly relative to inner walls which define said lumen in a portion of said outer body distal to said proximal portion;

a suture clamping member having an outer surface, said suture clamping member being disposed in said lumen distal end and being axially movable therein; and

complementary engaging structure disposed on each of said suture clamping member outer surface and said lumen inner surface for retaining said suture clamping member in said lumen distal end when the bone anchor device is not in a portion of bone.

18. The bone anchor device as recited inclaim 17, wherein said complementary engaging structure comprises a pin disposed on one of said suture clamping member outer surface and said lumen inner surface, and a recess for receiving the pin disposed on the other of said suture clamping member outer surface and said lumen inner surface.

19. A bone anchor device for attaching connective tissue to bone, comprising:

an outer body having an outer surface;

a lumen extending axially through said outer body, wherein inner walls which define said lumen in a proximal portion of said outer body extend inwardly relative to inner walls which define said lumen in a portion of said outer body distal to said proximal portion;

a suture clamping member disposed in said lumen distal portion and being axially movable therein; and

at least one outwardly extendable rib disposed on said outer body outer surface for anchoring said outer body into surrounding bone.

20. The bone anchor device as recited inclaim 19, wherein said at least one outwardly extendable rib comprises a plurality of outwardly extendable ribs.

21. The bone anchor device as recited inclaim 19, said suture clamping member comprising a wedge member having outer walls which taper inwardly in a proximal direction therealong.

22. The bone anchor device as recited inclaim 19, and further comprising a suture extending through said lumen and around a distal surface of said suture clamping member, said suture including a free end extending proximally out of said bone anchor device and a bound end attached to soft tissue to be secured to said bone, wherein when said free end is placed in tension by a proximally directed force, the suture travels about said suture clamping member until increased tension on said bound end causes said suture to move said suture clamping member axially in a proximal direction, the proximal axial travel of said suture clamping member continuing until a proximal surface of the suture clamping member has moved into sufficient proximity to the inwardly extending internal lumen wall to pinch a length of said suture in a tapered distal lumen disposed between said suture clamping member proximal surface and the inwardly extending internal lumen wall.

23. The bone anchor device as recited inclaim 19, wherein said outer body comprises a distal anchor portion and said device further comprises a proximal driver portion connected to a proximal end of said distal anchor portion.

24. The bone anchor device as recited inclaim 23, wherein said proximal driver portion comprises an actuator for outwardly extending said at least one outwardly extendable rib.

25. The bone anchor device as recited inclaim 24, wherein the connecting joint between said distal anchor portion and said proximal driver portion includes a designed failure point, so that upon deployment of said at least one outwardly extendable rib to its extended position, additional force may be applied to separate the driver portion from the anchor portion so that only the driver portion may be proximally removed from the patient's body.

26. A bone anchor device for attaching connective tissue to bone, comprising:

a distal wedge anchor portion comprising an outer body having an outer surface, on which a outwardly deployable anchoring element is situated; and

a proximal driver portion connected to said distal wedge anchor portion at a proximal end thereof, said driver portion including an actuator for deploying said anchoring element outwardly, wherein the connection between said proximal driver portion and said distal wedge anchor portion is releasable once the anchoring element has been deployed.

27. The bone anchor device as recited inclaim 26, and further comprising a designed failure point in the connection between the proximal driver portion and the distal wedge anchor portion, so that upon deployment of said anchoring element outwardly, additional force may be applied to separate the driver portion from the anchor portion so that only the driver portion may be proximally removed from the patient's body.

28. The bone anchor device as recited inclaim 26, said distal wedge anchor portion further comprising a lumen extending axially through said outer body, wherein inner walls which define said lumen in a proximal portion of said outer body extend inwardly relative to inner walls which define said lumen in a portion of said outer body distal to said proximal portion; and

a suture clamping member disposed in said lumen distal portion and being axially movable therein.

29. The bone anchor device as recited inclaim 28, and further comprising a suture extending through said lumen and around a distal surface of said suture clamping member, said suture including a free end extending proximally out of said bone anchor device and a bound end attached to soft tissue to be secured to said bone, wherein when said free end is placed in tension by a proximally directed force, the suture travels about said suture clamping member until increased tension on said bound end causes said suture to move said suture clamping member axially in a proximal direction, the proximal axial travel of said suture clamping member continuing until a proximal surface of the suture clamping member has moved into sufficient proximity to the inwardly extending internal lumen wall to pinch a length of said suture in a tapered distal lumen disposed between said suture clamping member proximal surface and the inwardly extending internal lumen wall.

30. A method for securing connective tissue to bone, comprising:

securing a first end of a length of suture to a portion of soft tissue to be attached to a portion of bone;

threading a second end of the length of suture through a lumen in an outer body of a bone anchor device and about an axially movable suture clamping member disposed in a distal portion of said lumen;

placing said outer body in a blind hole disposed in said portion of bone; and

pulling the second end of the length of suture proximally, so that the suture travels about the axially movable suture clamping member and draws the first end of the length of suture toward the bone anchor device, thereby securing the portion of soft tissue snugly to the portion of bone;

wherein when the tension on the first end of the length of suture increases, as the portion of soft tissue is bound to the portion of bone, the suture clamping member is pulled proximally toward inwardly extending walls defining a portion of said lumen, thereby clamping a portion of the length of suture between the inwardly extending lumen walls and the suture anchoring device.

31. The method as recited inclaim 30, and further comprising a step of anchoring said outer body in said blind hole.

32. The method as recited inclaim 31, wherein said anchoring step is accomplished by deploying ribs disposed on an outer surface of said outer body to an outwardly extended position.

33. The method as recited inclaim 30, and further comprising a step of cutting a portion of the suture second end to complete the procedure.

34. A method for securing connective tissue to bone, comprising:

securing a first end of a length of suture to a portion of soft tissue to be attached to a portion of bone;

threading a second end of the length of suture through a lumen in an outer body of a bone anchor device and about an axially movable suture clamping member disposed in a distal portion of said lumen;

inserting said bone anchor device into a blind hole disposed in said portion of bone;

extending a deployable anchoring member disposed on an outer surface of said outer body outwardly to secure said bone anchor device in surrounding bone;

separating a driver portion of said bone anchor device from said outer body and withdrawing said driver portion from the patient's body; and

pulling the second end of the length of suture proximally, to secure the portion of soft tissue properly to the portion of bone and to anchor the suture in said outer body by moving the suture clamping member axially to a suture clamping position.

35. A bone anchor device for attaching connective tissue to bone, comprising:

a body having a longitudinal axis, a distal end, and a proximal end;

a surface on said body distal end which slopes inwardly toward said axis from a distal portion of said surface toward a proximal portion thereof; and

a suture anchoring member which is movable axially toward and away from said sloping surface, said suture anchoring member having a distal end surface and opposing axial surfaces, said distal end and opposing axial surfaces all comprising suture receiving surfaces for contacting suture material wrapped thereabout.

36. The bone anchor device as recited inclaim 35, and further comprising a length of suture material wrapped about said suture anchoring member, said length of suture material being in physical contact with each of said distal end and opposing axial surfaces.

37. The bone anchor device as recited inclaim 35, wherein one of said opposing axial surfaces is sloped so that a width of said suture anchoring member tapers from a distal end to a proximal end thereof.

38. The bone anchor device as recited inclaim 37, wherein said sloped axial surface and said inwardly sloped body distal end surface together define a tapered distal lumen.

Images