US20070213730A1 - Cannulated suture anchor system - Google Patents

Abstract

A system and associated method for arthroscopic repair is particularly adapted in reattaching a ligament and/or tendon to cortical bone of the shoulder. A suture anchor system includes a suture anchor, preferably, a screw anchor, and an installation tool for installing the suture anchor in tissue. The suture anchor defines a longitudinal axis and has a longitudinal cannulation for reception and passage of a guide wire. The suture anchor has trailing and leading ends, and an anchor head adjacent the trailing end thereof. The anchor head includes at least one eyelet for reception of a suture and an internal bore therein. The installation tool includes a main body and a driver head extending from the main body. The main body includes an outer surface having a longitudinal recess therein to accommodate the suture. The driver head is correspondingly dimensioned to be received within the internal bore of the anchor head of the suture anchor whereby movement of the installation tool about a longitudinal axis, e.g., rotational movement, thereof causes corresponding movement, e.g., rotational, of the suture anchor. The installation tool may also define a longitudinal cannulation for reception and passage of the guide wire.

Description

BACKGROUND OF THE INVENTION
• 1. Field of the Disclosure
• The present disclosure relates to orthopedic surgery and, more particularly, relates to a system and method for performing arthroscopy shoulder repair.
• 2. Description of the Related Art
• Shoulder arthroscopy involves the repair of tissue inside or around the shoulder joint. The procedure is typically performed under endoscopic visualization with, e.g., an arthroscope, which is introduced within a small incision in the skin. Various narrow diameter instruments are positioned within the tissue to perform the desired surgical procedure. A saline solution may be pumped into the shoulder to expand the joint to enhance visualization and facilitate manipulation of the instruments during the procedure.
• Common shoulder injuries requiring arthroscopy include a torn or damaged cartilage ring (labrum) or ligaments causing shoulder instability, a torn rotator cuff or a torn or damaged biceps tendon. Each of these injuries necessitates the reattachment of soft tissue, e.g., the ligaments or tendons, to bone. Various fixation devices and methodologies including sutures, screws, staples, wedges and plugs are known to effectuate the attachment. Most of these fixation devices have proven to be generally adequate for their intended purposes.
SUMMARY OF THE INVENTION
• Accordingly, the present disclosure is directed to further improvements in arthroscopic repair, particularly, repair of the shoulder. In one embodiment, a system and associated method for arthroscopic repair is particularly adapted in reattaching a ligament and/or tendon to cortical bone of the shoulder. In accordance with this preferred embodiment, a suture anchor system includes a suture anchor, preferably, a screw anchor, and an installation tool for installing the suture anchor in tissue. The suture anchor defines a longitudinal axis and has a longitudinal cannulation for reception and passage of a guide wire. The suture anchor has trailing and leading ends, and an anchor head adjacent the trailing end thereof. The anchor head includes at least one eyelet for reception of a suture and an internal bore therein.
• The installation tool includes a main body and a driver head extending from the main body. The main body includes an outer surface having a longitudinal recess therein to accommodate the suture. The driver head is correspondingly dimensioned to be received within the internal bore of the anchor head of the suture anchor whereby movement of the installation tool about a longitudinal axis, e.g., rotational movement, thereof causes corresponding movement, e.g., rotational, of the suture anchor. The installation tool may also define a longitudinal cannulation for reception and passage of the guide wire.
• In one preferred embodiment, the anchor head preferably includes first and second eyelets for reception of respective sutures. With this arrangement, the outer surface of the installation tool includes first and second longitudinal recesses for receiving respective sutures extending from the respective first and second eyelets of the anchor head. The first and second longitudinal recesses of the installation tool are in general alignment with the first and second eyelets of the anchor head when the suture anchor is mounted to the installation tool. In addition, the driver head of the installation tool may be dimensioned to define first and second clearances between respective outer surfaces of the driver head and internal surfaces of the internal bore of the anchor head when the driver head is mounted within the anchor head. The clearances accommodate suture portions of the sutures and are in general alignment with respective longitudinal recesses in the outer surface of the installation tool.
• The arrangement of the eyelets, longitudinal recesses of the installation tool and sutures within the recesses significantly reduces the profile of the system to thereby facilitate maneuvering of the system within the restricted surgical area. In addition, with the sutures accommodated within the recesses, the potential of entanglement of the sutures during manipulation and/or rotation of the insertion tool is greatly minimized.
• A method for attaching soft tissue to bone tissue within a bone area of a patient is also disclosed. The method includes the steps of:
• accessing an internal target of a bone area of a patient, preferably, the shoulder area;
• positioning a guide wire in relation to the internal target of the shoulder area;
• mounting a cannulated anchor, preferably, a screw anchor onto the guide wire, the cannulated anchor having at least one suture connected thereto;
• advancing the cannulated anchor along the guide wire to the internal target;
• securing the cannulated anchor within bone tissue of the internal target; and
• securing soft tissue to the cannulated anchor with the at least one suture.
BRIEF DESCRIPTION OF THE DRAWINGS
• Preferred embodiments of the present disclosure will be more readily appreciated by reference to the drawings wherein:
• FIGS. 1-3 are perspective views of the suture anchor system of the present disclosure;
• FIG. 4 is a cross-sectional view taken along the lines4-4 ofFIG. 1 illustrating the arrangement of the insertion tool within the screw head of the screw anchor; and
• FIGS. 5-6 illustrate a preferred method of use of the suture anchor system in shoulder repair.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• The suture anchor system of the present disclosure is intended for use in arthrosopic procedures and has particular application in securing soft tissue including tendons, ligaments etc. to hard cortical bone. The system may be used in conjunction with surgery performed on the knee, back, ankle, elbow etc. and has particular application in shoulder repair, particularly, arthroscopic shoulder repair. Such shoulder repair operations are inclusive, but, not limited to, reattachment of a torn or damaged cartilage ring (labrum) or ligaments, reattachment of a torn rotator cuff or reattachment of a torn or damaged biceps tendon. Other procedures are also envisioned.
• Referring now to the drawings wherein like reference numerals identify similar or like elements throughout the several views,FIGS. 1-3 illustrate, each in perspective view, the novel suture anchor system in accordance with the principles of the present disclosure.Suture anchor system10 generally includes three components, namelyscrew anchor12,insertion tool14 for mounting thescrew anchor12 into bone and a pair ofsutures16 connected to thescrew anchor12 for securing the soft tissue to thescrew anchor12.
• Screw anchor12 includesanchor body18 defining longitudinal axis “a” and having leading and trailingends20,22.Anchor body18 includeslongitudinal cannulation24 which extends the length of theanchor body18.Cannulation24 is dimensioned to receive a guide wire.Anchor body18 further includesscrew head26 adjacent leadingend20. Screwhead26 includesinner wall portions28 defininginternal bore30 which communicates with cannulation24 (FIG. 4). Screwhead26 further has first and second diametrically opposedeyelets32 which extend through the outer wall of thescrew head26.Internal bore30 is dimensioned to cooperate withinsertion tool14. Althoughinternal bore30 may take various geometrical shapes including, e.g., square, rectangular, triangular or any other polygonal arrangement, in a preferred embodiment, theinternal bore30 is generally of hexagonal configuration. First andsecond eyelets32 are adapted to receivesutures16.
• With reference again toFIGS. 1-3,anchor body18 has anexternal thread34 commencingadjacent screw head26 and terminating in leadingend22.External thread34 may be continuous along the length ofanchor body18 or alternatively be interrupted to define a plurality of thread segments.External thread34 is preferably self-tapping although it is envisioned that the external thread may be configured for advancement within a pre-tapped bore in bone.External thread34 further includes a plurality of flutes or cut-outs36 in the thread.Flutes36 collect bone tissue during the initial self-tapping advancement of the anchor body to facilitate the anchoring process.
• Sutures16 may be fabricated from any biocompatible material. The preferred materials forsutures16 include synthetic bioabsorbable materials such as polymers or copolymers of glycolide, lactide, trimethylene carbonate, dioxanone, caprolactone or blends thereof. Other suitable materials for the components ofsutures16 include nonabsorbable materials such as polycarbonate, polyester, polyethylene, polyamide, polypropylene, polytetrofluoroethylene (PTFE), polysulfone and acrylic.
• Referring still toFIGS. 1-3,insertion tool14 will be discussed.Insertion tool14 includesmain body38 defining longitudinal axis “b” and havingdriver head40 at the end of themain body38. It is noted that in the Figures only the distal end portion ofmain body38 is illustrated.Main body38 includes a pair oflongitudinal recesses42 within the outer surface of themain body38 and extending fromdriver head40 along at least a portion of the length preferably, the entire length of themain body38.Longitudinal recesses42 define an arc section removed from the outer surface ofmain body38. The radius of the arc section preferably at least approximates the diameter of thesutures16 to ensure that the sutures are fully accommodated within the longitudinal recesses during use of thesystem10. Preferably,longitudinal recesses42 are arranged in diametrical opposed relation as shown and are in alignment witheyelets32 ofanchor screw14 when theanchor screw12 is mounted toinsertion tool14 as depicted inFIG. 1.
• As best depicted inFIGS. 3-4,driver head40 defines a general rectangular cross-section having first and second cross-sectional dimensions “d1, d2” each being transverse to longitudinal axis “b”. Second cross-sectional dimension “d2” is greater than first cross-sectional dimension “d1”.Driver head40 includes opposedouter surfaces44 and opposedouter surfaces46, and chamfered surfaces48 interconnecting thesurfaces44,46. Whendriver head40 is mounted withinscrew head26, a clearance orgap50 is defined betweenouter surfaces44 andinner surface portions30 of thescrew head26. (FIG. 4) Theclearances50 are in general longitudinal alignment withrespective eyelets32 ofscrew head26 and respectivelongitudinal recesses42 ofinsertion tool14. The distances betweeninner surface portions30 and surfaces44 withinclearances50 are each preferably dimensioned to at least be equal to, preferably, slightly greater than, the diameters ofsutures16. With this arrangement, thesutures16 may slide within theclearance area50 during manipulation of thesystem10. Furthermore, the overall axial profile ofsystem10 is reduced by virtue oflongitudinal recesses42 to facilitate use during a minimally invasive or laparoscopic procedure.
• Insertion tool14 further defineslongitudinal cannulation52 extending along the length of theinsertion tool14.Longitudinal cannulation52 is dimensioned for receiving a guide wire.
• The use of thesystem10 during repair of a detached soft tissue in the shoulder will now be discussed. The following discussion of the use of the system will be described in terms of the performance of an arthroscopic procedure within the shoulder, particularly, a procedure utilizing reattaching soft tissue, e.g., a tendon or ligament to cortical bone in the shoulder. Such tendon or ligament may be the labrum, rotator cuff or bicep tendon.
• Referring now toFIG. 5, an internal target area is accessed through a small incision in the tissue adjacent the shoulder. An arthroscope may be utilized and introduced through a cannula as is conventional in the art to visualize the target area. Saline solution may then be pumped within the shoulder joint to expand the joint to provide more room to perform the procedure. Aguide wire100 is advanced through the shoulder joint to contact thecortical bone150. Theguide wire100 may be at least partially embedded within thecortical bone150 to positively fix theguide wire100 to facilitate advancement of the remaining instruments. Theguide wire100 may be driven into thecortical bone100 or alternatively, a drill may be introduced through a cannula to drill a bore for reception of the distal end of the guide wire. Theguide wire100 may optionally be driven through the tendon/ligament to be reattached and then secured to the cortical bone as discussed hereinabove.
• With theguide wire100 secured within thecortical bone150, a cannulated drill (not shown) may be advanced along theguide wire100 to core a hole in the targetedcortical bone150 for subsequent positioning ofscrew anchor12. The hole within the cortical bone may be tapped if desired with a tapping instrument. Thescrew anchor12 with mountedinsertion tool14 are positioned over theguide wire100 with theguide wire100 being accommodated withincannulations24,52 of thescrew anchor12 and theinsertion tool14, respectively.
• With reference now toFIG. 6, thescrew anchor12 is positioned within the hole in thecortical bone150 by rotating theinsertion tool14 to cause corresponding rotational movement of thescrew anchor12 to advance thescrew anchor12 within thecortical bone150. Once thescrew anchor12 is secured in place within the bone, theguide wire100 is removed.Sutures16 are then passed through the tendon/ligament200 and tied off (by knotting) to secure theligament200 to thescrew anchor12 andcortical bone150. It is appreciated that sutures16 may be passed through the tendon/ligament200 and then loaded ontosuture anchor16 followed by placement of thescrew anchor12 in the cortical bone if desired. As a further alternative, thescrew anchor12 with mountedsutures16 may be punched through the tendon/ligament200 and advanced within thecortical bone150 followed by subsequent tying-off of thesutures16. Over time, sufficient tissue growth/regrowth occurs to affix the natural tendon/ligament200 to the cortical bone.
• As appreciated, during advancement and rotation ofinsertion tool14 andscrew anchor12, sutures16 are accommodated withinlongitudinal recesses42 of theinsertion tool14. Thus, the overall profile of the system is reduced. Moreover, with thesutures16 accommodated within thelongitudinal recesses42, the potential of entanglement of thesutures16 is significantly reduced during rotational movement of theinsertion tool14.
• While the invention has been particularly shown, and described with reference to the preferred embodiments, it will be understood by those skilled in the art that various modifications and changes in form and detail may be made therein without departing from the scope and spirit of the invention. For example, the system and method for shoulder repair may incorporate a screwless anchor, i.e., an anchor devoid of an external screw thread. Anchors suitable for this purpose are disclosed in commonly assigned U.S. Pat. No. 5,720,753 to Sander et al. and U.S. Pat. No. 5,948,000 to Larsen et al., the contents of each being incorporated herein by reference. The anchors disclosed in the '753 and '000 patents incorporate expandable legs with anchoring means to engage the bone and may be deployed through non rotational longitudinal movement of a drive element. Another anchor which may be adapted for use in the system and method of shoulder repair of the present invention is disclosed in U.S. Pat. No. 5,980,558 to Wiley, the contents of which are incorporated herein by reference. The anchor disclosed in the '558 patent incorporates a rigid spear for driving into the bone and a plurality of wings which engage the bone upon deployment with a drive instrument.
• Other modifications such as those suggested above, but not limited thereto, are to be considered within the scope of the invention.

Claims (17)

1. A suture anchor system, which comprises:

a suture anchor defining a longitudinal axis and having a longitudinal cannulation for reception and passage of a guide wire, the suture anchor having trailing and leading ends, the suture anchor including an anchor head adjacent the trailing end thereof, the anchor head including at least one eyelet for reception of a suture and an internal bore; and

an installation tool for installing the suture anchor in tissue, the installation tool including a main body and a driver head extending from the main body, the main body including an outer surface having a longitudinal recess therein to accommodate the suture, the driver head being correspondingly dimensioned to be received within the internal bore of the anchor head of the suture anchor whereby movement of the installation tool about a longitudinal axis thereof causes corresponding movement of the suture anchor.

2. The suture anchor system according toclaim 1 wherein the suture anchor includes an external screw whereby rotational movement of the installation tool causes corresponding movement rotational movement of the suture anchor and advancement within tissue.

3. The suture anchor system according toclaim 1 wherein the anchor head includes first and second eyelets for reception of respective sutures.

4. The suture anchor system according toclaim 3 wherein the outer surface of the installation tool includes first and second longitudinal recesses for receiving respective sutures extending from the respective first and second eyelets of the anchor head.

5. The suture anchor system according toclaim 4 wherein the first and second longitudinal recesses of the installation tool are in general alignment with the first and second eyelets of the anchor head when the suture anchor is mounted to the installation tool.

6. The suture anchor system according toclaim 5 wherein the driver head of the installation tool is dimensioned to define first and second clearances between respective outer surfaces of the driver head and internal surfaces of the internal bore of the anchor head when the driver head is mounted within the anchor head, the clearances accommodating suture portions of the sutures and being in general alignment with respective longitudinal recesses in the outer surface of the installation tool.

7. The suture anchor system according toclaim 1 wherein the driver head of the installation tool is dimensioned to define a clearance between an outer surface of the driver head and an internal surface of the internal bore of the anchor head when the driver head is mounted within the anchor head, the clearance accommodating a suture portion of the suture and being in general alignment with the longitudinal recesses in the outer surface of the installation tool.

8. The suture anchor system according toclaim 1 wherein the installation tool defines a longitudinal cannulation for reception and passage of the guide wire.

9. A method for attaching soft tissue to bone tissue within a bone of a patient, comprising the steps of:

accessing an internal target of a bone area of a patient;

positioning a guide wire in relation to the internal target of the bone area;

mounting a cannulated anchor onto the guide wire, the cannulated anchor having at least one suture connected thereto;

advancing the cannulated anchor along the guide wire to the internal target;

securing the cannulated anchor within bone tissue of the internal target; and

attaching soft tissue to the cannulated anchor with the at least one suture.

10. The method according toclaim 9 wherein the cannulated anchor is a screw anchor and wherein the step of securing the cannulated anchor includes rotating the screw anchor to engage and advance the screw anchor within the bone tissue.

11. The method according toclaim 10 wherein the step of securing the cannulated anchor includes mounting a cannulated insertion tool to the screw anchor and onto the guide wire and rotating the insertion tool to cause corresponding rotational movement of the screw anchor.

12. The method according toclaim 11 wherein the cannulated insertion tool includes at least one longitudinal recess in an outer surface thereof and including the step of arranging a portion of the at least one suture within the at least one longitudinal recess of the insertion tool.

13. The method according toclaim 11 wherein the screw anchor has first and second sutures connected thereto and wherein the step of securing the cannulated anchor includes securing the first and second sutures to the screw anchor.

14. The method according toclaim 13 wherein the cannulated insertion tool includes first and second longitudinal recesses in the outer surface thereof and including the step of arranging a portion of each suture within a corresponding longitudinal recess of the insertion tool.

15. The method according toclaim 9 wherein the step of positioning the guide wire includes advancing the guide wire to contact the bone tissue.

16. The method according toclaim 15 wherein the step of advancing the guide wire includes embedding at least a portion of the guide wire into the bone tissue.

17. The method according toclaim 9 wherein the internal target includes the shoulder area of the patient and the step of accessing includes accessing the shoulder area.

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