US20070255317A1 - Suture passer devices and uses thereof - Google Patents

Abstract

Systems, apparatuses and methods for securing tissue to bone using a bone anchoring system are described. Methods and apparatuses may allow transformation between locked and unlocked states, thereby allowing adjustment of the tension in the suture. The apparatus and/or methods may allow unidirectional movement of a suture, while preventing slippage or movement of the suture and tissue in the opposite direction. Ends of a suture may be individually tensioned to adjust positioning of a tissue with respect to a bone.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• The present application claims the right of priority under 35 U.S.C. § 119 to U.S. provisional application No. 60/784,679, filed Mar. 22, 2006. The prior application is commonly owned with the present application and the entire contents thereof are hereby expressly incorporated by reference in its entirety as though fully set forth herein.
BACKGROUND
• 1. Field of the Invention
• The present invention relates to systems, methods and apparatus for securing tissue to bone. More particularly, the invention relates to apparatus and methods for facilitating the attachment of tissue to bone using a bone anchoring system. The present invention further relates to a suture passer instruments for retrieving a suture loop.
• 2. Description of the Related Art
• Many attempts have been made to provide devices that allow the arthroscopic securing of torn tissue to a human bone. For example, numerous devices have been designed to allow a torn rotator cuff to be secured to a humeral head of the shoulder.
• Typically, in a first step, a hole is drilled into the bone under arthroscopic visualization. A length of a suture length is threaded through a portion of a tissue, and then coupled to a bone anchor configured. One or more sutures may be manipulated outside of the arthroscopic site. Once the suture is coupled between the tissue and the bone anchor, the bone anchor may be inserted into the hole. The bone anchor may be configured to lock itself within the hole in the bone upon deployment therein. Several means for securing the bone anchor within the hole of a bone are known in the art.
• Once the bone anchor is secured within the hole in the bone, one or both ends of the suture may be tensioned to approximate the positioning of the tissue with respect to the bone. Once the tissue is positioned as desired, the suture may be locked in place to maintain the tension in the suture. The free end or ends of the suture may be clipped under arthroscopic visualization to complete the procedure.
• An example of a previously known method and apparatus for attaching tissue to bone is described in U.S. Pat. No. 6,585,730 to Foerster, which is incorporated by reference herein. Foerster describes devices and methods for securing sutures to a bone anchor without the requirement of knot tying. In Foerster, 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 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. 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.
• 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.
• Another previously known knotless suture anchor is described in U.S. Pat. No. 6,692,516 to West et al. (“West”), which is incorporated by reference herein. West describes a knotless suture anchor and method for knotlessly securing. The suture anchor has a deformable portion for engaging with a wall of a borehole in a first tissue member, a shaft for providing a force to the deformable portion to deform the deformable portion to cause the deformable portion to engage the wall of the borehole, a suture retaining portion in at least one of the deformable portion and the shaft for retaining two suture portions in the retaining portion with a loop formed between the two suture portions. The loop is adapted to traverse a second tissue member to be attached to the first tissue member. Application of the force to deform the deformable portion causes engagement of the deformable portion with the borehole to secure the suture anchor to the first tissue and clamping of at least one of the two suture portions in the suture retaining portion thereby to secure the suture forming the loop in the suture retaining portion and secure the second tissue to the suture anchor.
• Systems, apparatus and methods are desired for securing tissue to bone that allow direct tactile feedback of the tension in the suture between the tissue and bone. During securing tissue to bone, it is desired to be able to adjust positioning of the tissue with respect to the bone. In securing the tissue to bone, the suture may be locked in place without tying a knot.
• Endoscopic suturing techniques and instruments have been developed to facilitate the suturing of tissue during endoscopic surgical procedures. Access to a surgical work site within a patient's body is normally provided through one or more portals formed directly in the patient's body or through one or more cannulas inserted into the patient's body through small incisions. A chosen surgical procedure is carried out by a surgeon through the use of elongated instruments inserted through these cannulas and it often becomes necessary to suture selected tissue at the surgical work site.
• The arthroscopic work site is typically accessible only through a small portal or cannula. Since it is very difficult to tie sutures within the body, various devices and techniques have been developed to enable the surgeon to tie sutures endoscopically. For example, some procedures enable the surgeon to pass a suture through the target tissue and form a surgical knot extracorporeally and then move the knot with a knot pusher through the portal or cannula into position adjacent the desired tissue to be sutured. Formation of the knot requires the surgeon to manually retrieve and tie a knot on the suture after the suture is threaded through the tissue(s). This procedure is often tedious and time-consuming. The procedure further requires that a mechanical means of retrieving the suture be provided. Most devices require the use of a separate tool to grab onto and retrieve the suture, thereby further reducing the working space and adding risk of contamination, or leading to a tendency for the suture to deform or collapse suture is manually retrieved. In addition, tying the knot in this manner is particularly difficult during endoscopic surgeries, where the visual field for the surgeon is severely limited by the narrow surgical area. As a result of these setbacks, there is a need for an improved method of retrieving a suture, as well as for surgical devices that will facilitate such method.
SUMMARY OF THE INVENTION
• In an embodiment, a suture passer may include a proximal end having a handle, an elongated central portion coupled to the proximal end and extending distally from the handle; a distal end comprising an upper jaw and a lower jaw and being configured to reversibly grasp tissue, the upper jaw and lower jaw each comprising at least one suture passage, wherein the upper jaw and lower jaw are configured to reversibly engage a suture; and a suture capture element disposed at the distal end, wherein the suture capture element is configured to reversibly engage a suture loop passing through at least one of the suture passages.
• A suture passer may include a suture engaging element moveably coupled to the handle such that the suture engaging element can be reversibly moved between a fist position and a second position A suture engaging element may be functionally coupled to the suture capture element such that when the suture engaging element is in the first position, the suture engaging element does not engage a suture loop passing through the suture passage of at least one of the upper or lower jaws, and such that when the suture engaging element is in the second position, the suture engaging element engages a suture loop passing through the suture passage.
• A suture passer may include a reversibly extendable suture threader disposed at the distal end thereof. A suture threader may be configured to pass a loop of suture through the suture passage of at least one of the upper or lower jaws when extended.
• In an embodiment, a suture passer may include a proximal end having a handle and a suture engaging element moveably coupled to the handle. A suture engaging element may be configured to slide between a first position and a second position. A suture passer may include an elongated central portion coupled to the proximal end and extending distally from the handle. A suture passer may include a distal end having an upper jaw and a lower jaw and being configured to reversibly grasp tissue. The jaws may include a suture passage passing through the upper jaw and the lower jaw. A suture passing may include a suture capture element.
• In an embodiment, a suture capture element may be configured to engage a suture loop passing through the suture passage when the suture engaging element is substantially in the second position. A suture passer may further include a reversibly extendable suture threader disposed at the distal end. A suture threader may be configured to pass a loop of suture through the suture passage of at least one of the upper or lower jaws when extended.
BRIEF DESCRIPTION OF THE DRAWINGS
• Other objects and advantages of the invention will become apparent upon reading the following detailed description and upon reference to the accompanying drawings in which:
• FIG. 1 is a schematic of a bone and tissue interface;
• FIG. 2A is a perspective front view of an embodiment of a bone anchor;
• FIG. 2B is a perspective side view of the bone anchor along line A-A ofFIG. 2A;
• FIG. 2C is a cross-sectional view of the bond anchor depicted inFIG. 2A;
• FIG. 3A is a perspective side view of bone anchor;
• FIG. 3B is exploded side view along line B-B ofFIG. 3A;
• FIG. 3C is perspective top view of the bone anchor depicted in3A;
• FIG. 3D is a perspective view of the top of the bond anchor depicted in3C in an open state;
• FIG. 3E is a cross-sectional view of the bone anchor depicted inFIG. 3A;
• FIG. 4A is a cross-sectional view of an embodiment of an apparatus that includes bone anchor member and a plug portion;
• FIG. 4B is a perspective side view of the plug portion depicted inFIG. 4A;
• FIG. 4C is a perspective side view of an opposing side of the plug portion depicted inFIG. 4A;
• FIG. 5A is a cross-sectional view of an embodiment of a bone anchor that includes bone anchor member and a plug portion;
• FIG. 5B is a perspective side view of the plug portion depicted inFIG. 5A;
• FIG. 5C is a perspective side view of an opposing side of the plug portion depicted inFIG. 5A;
• FIG. 6A is a perspective side view of an embodiment of plug portion in a closed state;
• FIG. 6B is a perspective side view of the plug portion depicted inFIG. 6A in a partially open state;
• FIG. 6C is perspective a top view of the plug portion depicted inFIG. 6B;
• FIG. 6D is a cross-sectional view of the bone anchor depicted inFIG. 6A;
• FIG. 7 is perspective side view of an embodiment of a plug portion in a partially open state;
• FIG. 8A is a perspective side view of an embodiment of a plug;
• FIG. 8B is a perspective side view of the plug depicted inFIG. 8A in a partially open state;
• FIG. 8C is a perspective top view plug depicted inFIG. 8A in a fully open state;
• FIG. 9 is a cross-sectional view of an embodiment of a bond anchor having at least one adhesive delivery channel;
• FIG. 10A is a cross-sectional view of a bone anchor that includes a bone anchor member and a plug portion;
• FIG. 10B is a perspective view of the bone anchor ofFIG. 10A positioned in a hole of a bone;
• FIG. 11 is a cross-sectional view of an embodiment of a bone anchor that includes a bone anchor member and a plug portion;
• FIG. 12 is perspective side view of an embodiment of a bone anchor positioned in a bone with two openings;
• FIG. 13A is a cross-sectional view of an embodiment of a bone anchor that includes a bone anchor member and a plug portion;
• FIGS. 13B and 13C are illustrations of usage of the bone anchor depicted inFIG. 13A;
• FIG. 14 is a cross-sectional view of an embodiment of an apparatus that includes a bone anchor member with a spring element;
• FIG. 15A is perspective top view of top view of an embodiment of a bone anchor that includes a bone anchor and a plug portion;
• FIG. 15B is a cross-sectional view of the bone anchor depicted inFIG. 15A along line15C-15C;
• FIG. 15C is perspective top view of the bone anchor ofFIG. 15A in a locked state;
• FIG. 16 is a perspective view illustrating use of a suture in connection with the bone anchor depicted inFIGS. 15A-15C;
• FIGS. 17A and 17B are cross-sectional views of embodiments of a bone anchor in an unlocked state and a locked state, respectively;
• FIGS. 18A and 18B are cross-sectional views of embodiments of a bone anchor in an unlocked state and a locked state, respectively;
• FIGS. 19A and 19B are cross-sectional views of an alternative embodiment of the bone anchor depicted inFIGS. 17A and 17B;
• FIGS. 20A and 20B are, respectively, a cross-sectional view and a perspective side view of an embodiment of an unlocked state of a bone anchor that includes a bone anchor member and a plug portion;
• FIGS. 21A and 21B are, respectively, a cross-sectional view and a perspective side view depicted inFIGS. 20A and 20B in a locked state;
• FIG. 22A is a cross-sectional view of an embodiment of a bone anchor that includes a bone anchor member and a plug portion;
• FIG. 22B is a cross-sectional view of the plug portion inserted in the bone anchor member depicted inFIG. 22A;
• FIG. 23A is a cross-sectional view of an embodiment of the plug depicted inFIGS. 22A and 22B;
• FIG. 23B is a perspective side view of the plug depicted inFIG. 23A;
• FIG. 23C is a perspective bottom view of the plug depicted inFIG. 23A;
• FIG. 24A is a cross-sectional view of an embodiment of a bone anchor that includes a bone anchor member and a plug portion;
• FIG. 24B is a cross-sectional view of a plug portion inserted into the bone anchor member depicted inFIG. 24A;
• FIGS. 25A and 25B are illustrations of the bone anchor depicted inFIGS. 24A and 24B employing two sutures;
• FIG. 26A depicts an embodiment of a bone anchor;
• FIG. 26B is a cross-sectional view depicting a suture locking mechanism of the bone anchor depicted inFIG. 26A in a closed position;
• FIG. 26C is a cross-sectional view depicting the suture locking mechanism depicted inFIG. 26B in an open position;
• FIG. 26D is an exploded view of the bone anchor depicted inFIG. 26A;
• FIG. 27A is a perspective view of an embodiment of a bone anchor;
• FIG. 27B is a cross-sectional view of the bone anchor depicted inFIG. 27A;
• FIG. 27C is an exploded view of the bone anchor depicted inFIG. 27A;
• FIG. 28A is a perspective view of an embodiment of a bone anchor;
• FIGS. 28B and 28C are cross-sectional views of the bone anchor depicted inFIG. 28A with release elements in the locked and unlocked positions, respectively;
• FIG. 28D is an exploded view of the bone anchor depicted inFIG. 28A;
• FIG. 29A depicts an embodiment of a bone anchor having a cam with a suture positioned between the cam and a surface at the distal end of the bone anchor;
• FIG. 29B is a cross-sectional view of the embodiment depicted inFIG. 29A;
• FIG. 29C is a perspective front view of the bone anchor depicted inFIG. 29A;
• FIG. 29D is an exploded view of the bone anchor and suture depicted inFIG. 29A;
• FIG. 30A depicts an embodiment of a bone anchor having a suture locking assembly;
• FIG. 30B is a cross-sectional view of the bone anchor depicted inFIG. 30A;
• FIG. 30C is a perspective side view of the bone anchor depicted inFIG. 30A;
• FIG. 30D is an exploded view of the bone anchor depicted inFIG. 30A;
• FIG. 31A depicts an alternate embodiment of a bone anchor having a suture locking assembly;
• FIG. 31B is a cross-sectional view of the bone anchor depicted inFIG. 31A;
• FIG. 31C is an exploded view of the bone anchor depicted inFIG. 31A;
• FIG. 32A depicts a further alternate embodiment of a bone anchor having a suture locking assembly;
• FIG. 33 depicts an alternate embodiment of a bone anchor having a fixed suture coupling;
• FIG. 34 is an alternate embodiment of that shown inFIG. 33;
• FIG. 35A-FIG. 35G depict a variety of alternate bone anchor embodiments;
• FIG. 36 depicts an embodiment of a bone anchor installer for use in a bone anchor system;
• FIG. 37A is a schematic representation of an anchor holder according to an embodiment of a bone anchor installer;
• FIG. 37B is an exploded view of the anchor holder depicted inFIG. 37A;
• FIG. 38A is a side sectional view of an anchor holder according to an embodiment;
• FIG. 38B is an oblique view of the anchor holder depicted inFIG. 38A;
• FIG. 39A is a depiction of a bone anchor installer according to an embodiment;
• FIG. 39B is an enlarged view showing the anchor holder at the distal end of the bone anchor installer depicted inFIG. 39A;
• FIG. 40A-40F depict a sequence of steps to use the bone anchor installer depicted inFIG. 39A;
• FIG. 41A depicts an anchor installer according to alternate embodiment;
• FIG. 41B shows the distal end of the anchor installer depicted inFIG. 461 with one half of the anchor holder removed;
• FIG. 42A shows the component forming the anchor loader portion of the installer shown inFIG. 41A;
• FIG. 42B shows the anchor loaderFIG. 42A in its assembled state with a bone anchor coupled to the distal end thereof by a tethering means;
• FIG. 42C is an enlarged view of the distal end of the loader and bone anchor tethered thereto depicted inFIG. 42B;
• FIG. 42D is an enlarged view of the proximal end of the loader and tethering means shown inFIG. 42B;
• FIG. 43 is a schematic depiction of a suture passer device according to an embodiment;
• FIGS. 44A through 44E depict a sequence of steps to operate the distal end of the suture passer depicted inFIG. 43;
• FIGS. 45A through 45D are schematic depictions of the proximal and distal ends of the suture passer depicted inFIG. 43 in the retracted (FIG. 45A andFIG. 45B) and engaged (FIG. 45C andFIG. 45D) states, respectively.
• While the invention is susceptible to various modifications and alternative forms, specific embodiments thereof are shown by way of example in the drawings and will herein be described in detail. It should be understood, however, that the drawing and detailed description thereto are not intended to limit the invention to the particular form disclosed, but on the contrary, the intention is to cover all modifications, equivalents and alternatives falling within the spirit and scope of the present invention as defined by the appended claims.
DETAILED DESCRIPTION
• FIG. 1 is an illustrative schematic of a bone and tissue interface. Tissue T has a torn end and it is desirable to secure the torn end to a section of bone B. In a first step, hole H having diameter d_Hmay be drilled in bone B, as depicted, using generally known bone drilling techniques.
• Bone anchor member20 may secure tissue T to bone B.Bone anchor member20 may be used in conjunction with a length ofsuture30.Suture30 hasfirst end32aandsecond end32b. Ends32a,32bmay be coupled tobone anchor member20. A central region ofsuture30forms loop34.Loop34 may be threaded through a section of tissue T near the torn end of the tissue using generally known threading techniques. In embodiments described herein tissue, hole, and bone refer to T, H, and B, respectively, as described inFIG. 1.
• FIG. 2A is a perspective front view of an embodiment of a bone anchor.FIG. 2B is a perspective side view of the bone anchor along line A-A shown inFIG. 2A.FIG. 2C is a cross-sectional view of the bond anchor depicted inFIG. 2A.Bone anchor member20 hasproximal region22 anddistal region24, as depicted inFIG. 2A.Bone anchor member20 includes a plurality ofcleated members42.Cleated members42 may be formed on or attached to an exterior surface ofbone anchor member20.Cleated members42 may securebone anchor member20 within a hole of a bone. In some embodiments,bone anchor member20 may include radially expandable members. Radially expandable members may embed into bone to secure the bone anchor member to the bone. In some embodiments,bone anchor member20 may include threaded exterior members. Threaded exterior members may screw into surrounding bone to secure the bone anchor member to the bone.
• Referring toFIGS. 2B-2C,bone anchor member20 includesfirst guide channel50 andsecond guide channel52.Guide channels50,52 are formed within opposing surfaces ofbone anchor member20.Guide channels50,52 are configured to accommodate regions ofsuture30, so that the suture regions do not extend outside of the confines of the guide channels when in use.
• Bone anchor member20 includesfirst passage60 andsecond passage70.Passages60,70 extend laterally through a main body ofbone anchor member20, as depicted inFIG. 2C.Passage60 communicates withfirst guide channel50 viaopening61, and further communicates withguide channel52 viaopening62. Similarly,passage70 communicates withguide channel50 viaopening71, and further communicates withguide channel52 viaopening72.
• Passage60 is shown disposed proximal tosecond passage70, i.e., thepassage60 is closer toproximal region22 ofbone anchor member20. However, as will be apparent to one skilled in the art, the passages also may be disposed adjacent one another, or otherwise positioned, to achieve the objects of the present invention.Passages60,70 include at least onecleated member74.Cleated member74 includesangled sections75 and substantiallyorthogonal sections76.Orthogonal sections76 are disposed adjacent one another, thereby forming a cleated shape, as shown inFIG. 2C.Angled sections75 are angled towards opening62 ofpassage60 andopening72 ofpassage70, as shown inFIG. 2C. In some embodiments,cleated passages60,70 are configured to permit one-way movement offirst suture end32aandsecond suture end32b. For example, when suture end32ais pulled in a proximal direction,angled sections75 allow movement of the suture end in the proximal direction, while inhibiting distally advancement ofsuture end32awithinpassage60.
• In certain embodiments, an outer diameter ofsuture30 may be slightly larger than an inner diameter ofcleated passages60 and70. Therefore, suture ends32aand32bcan pass throughcleated passages60 and70 in a proximal direction with relatively little resistance while the suture holds significantly greater force in the distal direction.
• In one embodiment, a method for couplingsuture30 between tissue T andbone anchor member20, a central region ofsuture30 can be looped through tissue T first, such that free ends32aand32bextend from the tissue.Free end32ais then threaded through one-way cleated passage60 in a proximal direction, whilefree end32bis threaded through one-way cleated passage70, also in a proximal direction. As will be apparent to one skilled in the art,suture30 may be coupled between tissue T andbone anchor member20 using other threading techniques, so long as the suture ultimately is situated in a manner depicted inFIG. 2C.
• First end32aofsuture30 is disposed throughfirst passage60, then transitioned intoloop portion34a.Loop portion34atransitions intoloop portion34b, formingloop34 therebetween, which is coupled to tissueT. Loop portion34btransitions intosecond end32b, which is disposed throughpassage70, as shown inFIG. 2C. Accordingly, first and second ends32a,32bofsuture30 may be independently manipulated for purposes described herein below.
• Aftersuture30 is coupled tobone anchor member20 and a tissue,bone anchor member20 is distally advanced into a hole of a bone under arthroscopic guidance. Exterior cleatedmembers42 ofbone anchor member20 allow the bone anchor member to be advanced distally within the bone hole when an appropriate force is applied, butexterior cleated members42 inhibit proximal movement ofbone anchor member20 to provide a secure anchor within the bone.
• Pulling one or both of suture ends32aand32bproximally throughcleated passages60 and70 may approximate the positioning of the tissue with respect to the bone. The use of two separate passages allows the surgeon to tension each end of the suture independently, which is often desirable when tissue is torn irregularly.
• Further, the use of a plurality ofcleated passages6070 permits incremental tensioning of first and second suture ends32a,32b. This allows incremental adjustment during positioning of the tissue, using tactile feedback as a guide. Once a desired tension is achieved, retraction of the suture ends is stopped, and the suture is automatically locked in place. Thus, there is no need to tie a knot.
• In some embodiments, guidechannels50 and52 permit the retraction of suture ends32a,32bwhenbone anchor member20 is secured within a hole of the bone by providing a clearance between the bone anchor member and the bone itself.
• Alternatively,suture30 may be coupled tobone anchor member20 using techniques described herein below with respect toFIGS. 3A-3E orFIGS. 6-8. These techniques allow the suture to be coupled tobone anchor member20 without the need to thread free ends32aand32bthroughpassages60 and70.
• FIGS. 3A-3E shows a further embodiment ofbone anchor20′.Bone anchor20′ includes afirst mating portion22aand asecond mating portion22b. In some embodiments,mating portions22a,22bare substantially symmetrical, except as noted below.
• Turning toFIG. 3B,mating portion22aincludes cleatedpassage portion60aandcleated passage portion70a.Mating portion22bincludes cleatedpassage portion60bandcleated passage portion70b. When assembled state as shown inFIG. 3A,cleated passage portion60aandcleated passage portion60bform cleatedpassage60′, whilecleated passage portions70aandcleated passage portion70bform cleatedpassage70′.
• Guide channel portions50aofmating portion22aandguide channel50bofmating portion22bform guide channel50′ in the assembled state as depicted inFIGS. 3A and 3C.Guide channel portion52aofmating portion22aandguide channel portion52bofmating portion52bform guide channel52′ in the assembled state as depicted inFIG. 3D.
• Mating portion22aincludes at least onemating pocket59, as depicted inFIG. 3E.Mating portion22bincludes at least oneprotrusion55, which is configured to securely engage acorresponding pocket59 in the assembled state ofFIGS. 3A and 3C.
• In a preferred embodiment,protrusion55 includesledge57, as shown in detail “B” ofFIG. 3D. Optionally,mating pocket59 may include a complementary recess having a slightly larger diameter (not shown), which is configured to receiveledge57. In this manner,ledge57 ofprotrusion55 may snap into engagement with the larger diameter recess ofpocket59, thereby securingmating portions22a,22b.
• During use, a first suture end may be positioned incleated passage portion60a, and a second suture end positioned incleated passage portion70aofFIG. 3E. Next,mating portion22bis secured tomating portion22a, (e.g., using a snap-lock engagement described above betweenprotrusion55 and pocket59).
• The first and second suture ends are disposed throughcleated passages60,70. Using the bone anchor describe inFIGS. 3A-3E, threading the suture ends throughcleated passages60 and70 is not necessary, thereby increasing the speed and ease of use of the device.
• An alternate embodiment ofbone anchor100 is described inFIGS. 4A-4C.FIG. 4A is a cross-sectional view of an embodiment of a bone anchor that includes bone anchor member and a plug portion.FIG. 4B is a side view of the plug portion depicted inFIG. 4A.FIG. 4C is a side view of an opposing side of the plug portion depicted inFIG. 4A.
• Referring toFIG. 4A,bone anchor100 includesbone anchor member102 and plugportion110.Bone anchor member102 includesmain body103 havingbore104 disposed therein.Main body103 may includecleated members106 disposed on the outer surface thereof. The shape and dimensions ofcleated members106 is not limited to that depicted inFIG. 4A. For example,cleated members106 may be shaped substantially similar to thecleated members42 ofbone anchor member20.Cleated members106 are configured to insert into a hole of a bone using a frictional force fit.
• During use, afterbone anchor member102 is secured in the hole,plug portion110 may be inserted intobore104 ofbone anchor member102.Plug portion110 may includecleated members116 on the outer surface thereof.Cleated members116 may be configured to permit the advancement of plug portion intobore104 and allowplug portion110 to engage and frictionally gripinner wall105, thereby securing theplug portion100 tobone anchor member102.
• Referring toFIGS. 4B and 4C,plug portion110 includes first andsecond passages118 and120. First and second suture ends32aand32bmay be coupled to plugportion110 ofapparatus100 in a manner similar to that described inFIG. 2C. First end32aofsuture30 is disposed throughfirst passage118. After exiting throughfirst passage118,first end32athen transitions intoloop portion34a, formsloop34, and transitions intoloop portion34b(e.g., as shown inFIGS. 2A-2C).Loop portion34btransitions intosecond end32b, which extends throughsecond passage120.
• Alternatively,suture30 may be coupled to plugportion110 using techniques described hereinbelow with respect toFIGS. 6-8. These techniques allow the suture to be coupled to plugportion110 without the need to thread free ends32aand32bthroughpassages118 and120, as set forth below. If desired,passages118 and120 ofFIGS. 4A-4C may includecleated members74, as described hereinabove with respect toFIG. 2C. If cleatedmembers74 are employed, then tissue may be secured to a bone (e.g., seeFIG. 1) by individually tensioning first and second ends32a,32bofsuture30, as described hereinabove.
• Plug portion110 preferably includes one ormore guide channels125 disposed in a lateral surface ofplug body113.Guide channel125 preferably is substantially similar to guidechannels50 and52 ofFIG. 2C. InFIG. 4C,guide channel125 is configured to permit retraction of first and second suture ends32aand32bwhenplug portion110 is secured withinbore104 by providing a clearance between the plug portion and the bone anchor member.
• Alternatively,passages118 and120 may be substantially smooth passages, such thatcleated members74 are not employed. In this case,passages118 and120 permit substantially unimpeded movement ofsuture30 through the passages. In operation, suture ends32aand32bmay be individually tensioned prior to insertion ofplug portion110 intobone anchor member102. When the tissue has been appropriately secured to the bone,plug portion110 is then forced intobore104 ofbone anchor member102. This causes suture ends32aand32bto be sandwiched betweenplug portion110 andbone anchor member102 whenguide channels125 are not present. Accordingly, the suture is secured between the two portions using a force fit.
• FIGS. 5A-5C show a further embodiment of a bone anchor apparatus.Bone anchor140 may includebone anchor member142 and plug portion a150 as shown inFIG. 5A.FIG. 5B is a side view of the plug portion depicted inFIG. 5A.FIG. 5C is a side view of an opposing side of the plug portion depicted inFIG. 5A.
• Referring toFIG. 5A,apparatus140 includesbone anchor member142 and plugportion150.Bone anchor member142 includesmain body143 havingbore144 disposed therein.Main body143 may include exteriorcleated members146 and interiorcleated members145 disposed on the inner surface ofbore144. Exterior cleatedmembers146 are configured to insert into a hole of a bone (e.g., seeFIG. 1) using a force fit, as described in earlier embodiments above.
• Plug portion150 includesmain body153. In an embodiment,main body153 may be substantially cylindrical in shape. In an embodiment, theexterior surface156 ofmain body153 may be substantially smooth.Main body153 may includetaper157 at the distal end thereof.
• Suture30 having first and second ends32a,32bis coupled to plugportion150. A method of coupling is described hereinbelow with respect toFIGS. 6-8.
• In operation,bone anchor member142 is advanced into a hole of a bone (e.g., seeFIG. 1). Exterior cleatedmembers146 ofbone anchor member142 permit one-way movement of the bone anchor member into the hole.
• Plug portion150 may be inserted intobore144 ofbone anchor member142. An outer diameter ofexterior surface156 ofplug portion150 may be slightly larger than an inner diameter ofbore144. Accordingly, whenplug portion150 is urged distally, a force fit is achieved to secureplug portion150 within the bore ofbone anchor member142.
• Taper157 ofplug portion150 facilitates the distal advancement of the plug portion with respect tobone anchor member142. Interior cleatedmembers145 are configured to permit advancement ofplug portion110 intobore144 in a distal direction only.
• First and second suture ends32aand32bmay be coupled to plugportion150 in a manner described hereinabove with respect toFIGS. 4A-4C. Specifically,first end32aofsuture30 is disposed throughfirst passage158, and forms a loop that is threaded through a tissue.Second end32bofsuture30 extends throughsecond passage160.
• First andsecond passages158,160 may include cleated members74 (seeFIG. 2C). If cleatedmembers74 are employed, then tissue may be secured to the bone by individually tensioning first and second ends32a,32bofsuture30.Cleated members74 permit incremental tensioning of each suture end, and serve to lock the suture ends within theirrespective passages158 and160, as generally set forth hereinabove with respect toFIG. 2C.
• Plug portion150 includes one ormore guide channels165 disposed in a lateral surface ofplug body153, as shown inFIG. 5C.Guide channel165 is configured to permit retraction of first and second suture ends32a,32bwhenplug portion150 is secured withinbore144. In some embodiments guidechannel165 is substantially similar to guidechannel50 ofFIG. 2C.
• Alternatively,passages158,160 may be smooth passages, such thatcleated members74 are not employed and guidechannels165 are not present. In some embodiments,passages158,160 may be substantially smooth. During use, suture ends32a,32bmay be individually tensioned prior to insertion ofplug portion150 intobone anchor member142. When tissue is appropriately secured to the bone, then plugportion150 is forced intobore144 ofbone anchor member142. This causes suture ends32a,32bto be sandwiched betweenplug portion150 andbone anchor member142. Accordingly, the suture is secured between the two portions using a force fit.
• Further embodiments of a plug portion are described inFIGS. 6A-6C. The plug portion may be used in bone anchors depicted inFIG. 4A-4C.FIG. 6A is a side view of an embodiment of plug portion in a closed state.
• FIG. 6B is a side view of the plug portion depicted inFIG. 6A in a partially open state.FIG. 6C is a top view of the plug portion depicted inFIG. 6B.
• Plug portion110′ includes first andsecond plug portions110a,110b, which are coupled together usinghinge member115.Hinge member115 may be integral to first andsecond plug portions110a,110b, or the hinge member may be a third element that couples two distinct portions together.
• Hinge member115 permits plugportion110′ to transition between a closed state, as shown inFIG. 6A, and a partially or fully open state, as depicted inFIGS. 6B-6C, respectively. In the open states ofFIGS. 6B-6C, a first suture end may be positioned (e.g., quickly positioned by a physician) inpassage118aand a second suture end positioned inpassage120a. Alternatively, the positioning of the suture ends may be reversed (e.g., first and second suture ends may be placed inpassages120band118b, respectively).
• With the suture ends in place,plug portion110′ may be transformed into a closed state, depicted inFIG. 6A, by rotating first andsecond plug portions110a,110btogether. In the closed state, first andsecond plug portions110a,110bform first andsecond passages118′,120′. With the sutures ends disposed in their respective passages, the apparatus may be actuated to secure tissue to bone.
• As will be apparent to one skilled in the art,hinge member115 serves to ensure proper alignment of first andsecond plug portions110a,110bin the closed state. If desired, a securing means, such asprotrusion55 andpocket59 ofFIGS. 3A-3E, may be employed to secureplug portions110aand110b. Further, as will be apparent to one skilled in the art, the securing means may be reversible, such that plug portions may be separated, as shown inFIGS. 6B-6C, to reposition the suture ends.
• FIG. 7 depicts a perspective view of a plug in a partially opened state.Plug portion110″ includes first andsecond plug portions110a′,110b′, which have different sizes.Hinge member115 is offset from the center ofplug portion110″. Further,passage portions118a′ and120a′ ofplug portion110a′ are each less than 180 degrees. By contrast,passage portions118b′ and120b′ ofplug portion110b′ are each greater than 180 degrees. During use, a first suture end may be positioned inpassage portion118b′, and then a second suture end is placed inpassage portion120b′. Since these passage portions are each greater than 180, the suture ends may be pressed into the passage portions. Using such a method the suture ends remain at least partially in place. With the suture ends in place,plug portion110″ is transformed to a closed state. In the closed state,passage portions118a′,118b′ form a first one-way, 360-degree passage through which the first suture end may pass. Thesecond passage portions120a′,120b′ form a second one-way, 360-degree passage through which the second suture end may pass.
• Referring toFIGS. 8A-8C, yet another embodiment of a plug is described.FIG. 8A is a side view of an embodiment of a plug.FIG. 8B is a side view of the plug depicted inFIG. 8A in a partially open state.FIG. 8C is a top view plug depicted inFIG. 8A in a fully open state.
• Hinge member115 is located on a lateral surface ofplug portion110″, as opposed to on the distal end of the plug portion, as shown in detail “D”. Like the embodiment ofFIGS. 6A-6C, the embodiment ofFIGS. 8A-8C facilitates coupling of the suture to the plug portion. During use, threading of the suture throughpassages118 and120 of the plug portion is not required.
• As will be apparent to one skilled in the art,passage portions118aand120amay be larger thanpassage portions118band120b, respectively, as described with respect toFIG. 7 hereinabove. Referring toFIG. 9, an embodiment of a bone anchor is described.Bone anchor member180 is similar tobone anchor member20 ofFIGS. 2A-2C, except as noted hereinbelow.Cleated members182 ofbone anchor member180 are similar tocleated members42 ofbone anchor member20, as described hereinabove, and facilitate anchoring ofbone anchor member180 within a hole of a bone. Further, guidechannels190 and192 are similar to guidechannels50 and52 ofFIGS. 2A-2C.
• Unlike the embodiments described hereinabove,bone anchor member180 includes at least oneadhesive delivery channel188, which is provided withinmain body181.Adhesive delivery channel188 may be formed by drilling a hole into an upper surface ofmain body181, such that the hole extends throughfirst passage184 andsecond passage186. As will be apparent to one skilled in the art, however,channel188 may be formed using other known techniques.
• First andsecond passages184 and186 may includecleated members74 ofFIG. 2C, thereby permitting one-way movement of suture ends32aand32bthrough the passages. Alternatively,passages184 and186 may include substantially smooth inner surfaces that permit movement ofsuture30 through the passages in either direction.
• Afterbone anchor member180 is secured in a hole the bone, the position of tissue relative to the bone may be approximated by individually tensioning first and second ends32a,32bofsuture30, as described extensively above an incorporated herein. When the tissue has the desired placement, an adhesive may be delivered toadhesive delivery channel188. The delivery of an adhesive to channel188 may be facilitated using a needle-like tube (not shown) disposed within a working cannula. The needle-like tube has a distal opening that may be placed in close proximity to, or within,adhesive delivery channel188 to deliver an adhesive thereto.
• The adhesive is allowed to flow distally throughadhesive delivery channel188 and into portions of first andsecond passages184 and186. The adhesive may contact at least a portion ofsuture30 positioned in corresponding regions of first andsecond passages184 and186, thereby locking the suture in place. As will be apparent to one skilled in the art, although oneadhesive delivery channel188 is depicted inFIG. 9, multiple adhesive delivery channels may be employed to secure the suture, irrespective of whethercleated members74 are employed.
• Referring toFIG. 10A,apparatus200 includesbone anchor member202 and plugportion210.Apparatus200 is similar toapparatus140 ofFIGS. 5A-5C, except as noted below.
• Bone anchor member202 includesmain body203 havingbore204 disposed therein.Main body203 ofbone anchor member202 includes exteriorcleated members206, which are configured to be inserted into a hole of a bone (e.g., seeFIG. 1) using a force fit, as described hereinabove.
• Plug portion210 may be substantially cylindrical in shape and includesmain body213.Main body213 has smoothexterior surface216 andtaper217. Optionally,taper217 may be formed at the distal end ofmain body213.
• Suture30 having first and second ends32a,32bis coupled to plugportion210, preferably in a manner described hereinabove with respect toFIGS. 6-8.
• The outer diameter ofmain body213 may be sized slightly larger than an inner diameter ofbore204. The size of diameter is selected to allowmain body213 ofplug portion210 to be distally advanced intobore204 when forced.Taper207 ofbone anchor member202 is facilitates advancement ofplug portion210 intobore204.
• In operation,bone anchor member202 is secured within a hole of a bone when the bone anchor member is distally advanced into the hole, as depicted inFIG. 10B. Exterior cleatedmembers206 ofbone anchor member202 permit one-way movement of the bone anchor member into the hole.
• Plug portion210 is advanced distally intobore204 ofbone anchor member202 and secured therein using a force fit, as described hereinabove. At this time, surrounding regions of the bone may apply a compressive force uponbone anchor member202, as indicated by the larger directional arrows inFIG. 10B. This compressive force uponbone anchor member202 in turn causes compression uponplug portion210, as indicated by the smaller directional arrows inFIG. 10B, thereby securely retaining the plug portion withinbore204.
• In some embodiments,passages218 and219 may includecleated members74 as described hereinabove with respect toFIG. 2C. Alternatively,passages218 and219 may include substantially smooth interior surfaces that permit advancement ofsuture30 in either direction.
• In certain embodiments, the position of the tissue relative to the bone may be approximated by individually tensioning suture ends32aand32bprior to insertion ofplug portion210 intobone anchor member202. In some embodiments, the tissue position is approximated whenpassage219 is disposed just abovebore204. Once the desired positioning of the tissue is achieved,plug portion210 is advanced distally intobore204, thereby locking the suture. Specifically, the suture will be sandwiched betweenexterior surface216 ofplug portion210 andinner wall205 ofbone anchor member202.
• Referring toFIG. 11,apparatus220 may include abone anchor member222 and aplug portion230.Apparatus220 is similar toapparatus200 ofFIGS. 10A-10B, except as noted below.
• Bone anchor member222 includesmain body223 havingbore224 disposed therein, as depicted inFIG. 11. Further,main body223 includes exteriorcleated members226, which are configured to be inserted into a hole of a bone (e.g., seeFIG. 1) using a force fit, as described hereinabove.Bone anchor member222 includes a proximal protrusion havinginward taper227.Proximal stop228 is formed betweeninward taper227 andinner wall225 ofbone anchor member222.
• Plug portion230 includesmain body233 havingproximal region235,central region234 and tapereddistal region237. Tapereddistal region237 is sized to pass throughtaper227 ofbone anchor member222 when a distally directed force is applied to plugportion230. When further force is applied,central region234 ofplug portion230 is advanced intobore224 viataper227. When further force is applied to plugportion230,proximal region235 is advancedpast taper227. Onceproximal region235 is fully inserted intobore224,proximal stop228 is configured to abutproximal edge236 ofplug portion230, thereby securing the plug portion withinbone anchor member222.
• As will be apparent to one skilled in the art,apparatus220 may further include any of the other features described above with respect to the embodiments ofFIGS. 2-10. For example,passages238 and239 may includecleated members74 ofFIG. 2C, or alternatively may include substantially smooth interior surfaces. Further, the operation ofapparatus220 preferably is substantially similar to the methods described hereinabove with respect to the embodiments ofFIGS. 2-10.
• In some embodiments, a bone anchor may be positioned in bone throughole H_T, which has two openings to the surface of the bone. Referring toFIG. 12,bone anchor240 is similar tobone anchor member20 ofFIGS. 1-2, but is configured for use in applications where through hole H_Tis employed.
• Bone anchor240 includesmain body242 having proximal and distal ends.Flange245 disposed at the proximal end and taper246 formed at the distal end ofmain body242.Main body242 includesexterior surface243 disposed betweenflange245 andtaper246.
• Bone anchor240 includes first andsecond passages250 and252, each having a plurality ofcleated members254. Each of the cleated members includesangled sections255 and substantiallyorthogonal sections256, which are disposed adjacent one another thereby forming a cleated shape, as described hereinabove with respect tocleated members74 ofFIG. 2C.
• During use, a loop ofsuture30 may be coupled through tissue T first, with free ends32aand32bextending from the tissue.Free end32athen is threaded throughfirst passage250 in a proximal direction.Free end32bis threaded throughsecond passage252, also in a proximal direction. The suture may be threaded throughpassages250,252 and tissue T by arthroscopically operating on one or both sides of bone B.
• As will be apparent to one skilled in the art,suture30 may be coupled between tissue T andbone anchor240 using other arthroscopic threading techniques, so long as the suture ultimately is situated in a manner depicted inFIG. 12.
• Once the suture is threaded as shown inFIG. 12, first and second suture ends32aand32bmay be proximally retracted, one at a time, to approximate the position of tissue T with respect to bone B. As the suture ends are tensioned,flange245, which has an outer diameter larger than the diameter of through hole H_T, abuts bone B. The system becomes tensioned becauseflange245 and tissue T are drawn against the bone from opposing directions.
• In accordance with one aspect of the present invention,cleated passages250 and252 are configured to permit one-way movement of first and second suture ends32aand32b, respectively. For example, whenfirst end32ais pulled in a proximal direction, angledsections255 permit movement of the suture end in the proximal direction. However, suture end32ais inhibited from distally advancing withinpassage250. The use of two separate passages allows each end of the suture to be separately tensioned, which is often desirable when tissue T is torn irregularly.
• As will be apparent to one skilled in the art, the methods described inFIG. 12 may be accomplished using a separate bone anchor member and plug portion. For example, the principles of the embodiments inFIGS. 4-5 andFIGS. 10-11, in which separate bone anchor and plug portions are employed, may be implemented in lieu of one-piece bone anchor240.
• Further, the suture securing methods described inFIG. 12 may be accomplished using substantiallysmooth passages250 and252. Where substantially smooth passages are employed, an interference fit or an adhesive may be employed in lieu of the cleated passages to facilitate securing of the suture. The interference fit or adhesive may be used, for example, as described hereinabove with respect to the embodiments ofFIGS. 4-5 andFIGS. 10-11.
• FIG. 13A is a cross-sectional view of an embodiment of an apparatus that includes a bone anchor member and a plug portion. As shown inFIG. 13A,apparatus270 includesbone anchor member272 and plugportion280.Bone anchor member272 includesmain body273 havingbore274 disposed therein.Main body273 includes exteriorcleated members276, which are configured to be inserted into a hole of a bone (e.g., seeFIG. 1) using a force fit, as described hereinabove.Bone anchor member272 includes a proximal protrusion havinginward taper277.Proximal stop278 is formed betweeninward taper277 and an inner wall ofbone anchor member272.
• Bone anchor member272 includes first andsecond spring elements292aand292b, which are disposed at a distal region ofbore274. First andsecond spring members292aand292bmay be integrally formed withbone anchor body273, or may be separate elements coupled tobody273. First andsecond spring elements292aand292bmay be deformed to accommodateplug portion280 withinbore274, and also to enable locking and unlocking of a suture (not shown inFIGS. 13A-13C) used in conjunction withapparatus270. As will be apparent to one skilled in the art, one or more spring elements may be employed.
• First andsecond passages298 and299 extend laterally throughmain body273 ofbone anchor member272. First andsecond passages298 and299 are configured to selectively align with first andsecond passages288 and289 ofplug portion280, for the purposes described hereinafter.
• Plug portion280 ofapparatus270 includesmain body283 having proximal and distal ends. The proximal end includesflange284.Taper286 is disposed betweenflange284 andmain body283.Distal taper287 is disposed at the distal end ofplug portion280.
• Plug portion280 includes first andsecond passages288 and289, which extend laterally throughmain body283. In some embodiments, first andsecond passages288 and289 include substantially smooth interior surfaces.
• FIG. 13B illustrates use ofapparatus270. First, plugportion280 is inserted intobore274 ofbone anchor member272, usinginsertion tool294. When an appropriate force is applied to plugportion280, tapereddistal end287 passes throughtaper277 ofbone anchor member272. When further force is applied, a central region ofplug portion280 is advanced intobore274 viataper277. When further force is applied to plugportion280, the proximalregion having taper286 andflange284 is then advancedpast taper277.
• Whenplug portion280 is fully inserted intobore274, first andsecond spring elements292aand292bare inclined to urgeplug portion280 in a proximal direction, to allowflange284 to abut proximal stop278 (seeFIG. 13C). However, when a sufficient distally directed force is applied to plugportion280, (e.g., using insertion tool294) first and second spring elements may be deformed distally (seeFIG. 13B).
• Insertion tool294 may be a rod or other substantially rigid member configured to transfer a distally directed force from a physician to plug portion290. In some embodiments,insertion tool294 is engagesmating slot295, as shown inFIG. 13B.
• The provision of distally directed force acting onplug portion280 causes first andsecond passages288 and289 to become substantially aligned with first andsecond passages298 and299 of bone anchor member27, respectively, as shown inFIG. 13B. At this time, a suture may be threaded through alignedfirst passages288 and298. The suture may be threaded through a tissue, as described hereinabove, and then threaded back through alignedsecond passages289 and299. First suture end32aextends throughfirst passages288 and298, whilesecond suture end32bextends throughsecond passages289 and299.
• Once the suture is coupled toapparatus270,apparatus270 is inserted into a hole of a bone under arthroscopic guidance.Cleated members276secure apparatus270 within the hole, as described hereinabove. At this time, first and second suture ends32aand32bwill extend outside of the arthroscopic field of vision.
• First and second suture ends32aand32bmay be selectively tensioned to approximate the positioning of the tissue with respect to the bone when first andsecond passages288 and289 are aligned with first andsecond passages298 and299, respectively. During tensioning of the suture ends,insertion tool294 urges plug portion distally to cause the passages to align, as shown inFIG. 13B.
• When a desired positioning of the tissue is achieved, the force applied to plugportion280 is removed (e.g., by proximally retractinginsertion tool294, as shown inFIG. 13C). At this time, first andsecond spring elements292aand292bare inclined to bias proximally, thereby urgingflange284 ofplug portion280 againstproximal stop278 ofbone anchor member272. This movement ofplug portion280 with respect tobone anchor member272 causes a misalignment betweenfirst passage288 ofplug portion280 andfirst passage298 ofbone anchor member272. Also, a misalignment occurs betweensecond passages289 and299. Accordingly, the misalignments causefirst suture end32ato become pinched betweenfirst passages288 and298, whilesecond suture end32bis pinched betweensecond passages289 and299. These misalignments lock the suture in place.
• If it becomes necessary to adjust the positioning of the tissue with respect to a bone during use, theninsertion tool294 may be inserted intomating slot295, as shown inFIG. 13B, to urgeplug portion280 distally. As described hereinabove, when first and second passages ofplug portion280 andbone anchor member272 are aligned (seeFIG. 13B), suture ends32aand32bmay be manipulated to adjust the positioning of the tissue.
• FIG. 14 is a perspective cross-sectional view of an embodiment of an apparatus that includes a bone anchor member and a plug portion. The apparatus is similar to the apparatus described inFIG. 13, except as described.
• Bone anchor member272′ includesspring element292′ disposed at a distal end ofmain body273.Spring element292′ includes a distally concave configuration having acentral region293.Bone anchor member272′ is used in conjunction withplug portion280 in a manner similar to that described hereinabove with respect toFIGS. 13A-13C. Specifically, afterplug portion280 is inserted intobore274, the provision of a further distally-directed force acting onplug portion280 causescentral region293 ofspring element292′ to be deformed in a distal direction. When the central region ofspring element292′ is deformed distally, first andsecond passages288 and289 ofplug portion280 are substantially aligned with first andsecond passages298 and299 ofbone anchor member272′, respectively. In this state,first suture end32amay move substantially unimpeded through alignedfirst passages288 and298, whilesecond suture end32bmay move through alignedsecond passages289 and299, respectively, as described hereinabove with respect toFIG. 13B.
• When a desired positioning of tissue is achieved, the force imposed uponplug portion280 is removed (e.g., by proximally retractinginsertion tool294, as described inFIG. 13C) andcentral region293 ofspring elements292′ returns in a proximal direction to its preferred orientation. This causesflange284 ofplug portion280 to be urged againstproximal stop278 ofbone anchor member272′. As described hereinabove, the movement ofplug portion280 with respect tobone anchor member272′ causes a misalignment betweenfirst passages288 and298, and also a misalignment betweensecond passages289 and299. These misalignments pinch suture ends32aand32bto lock the suture in place.
• Referring toFIG. 15, an embodiment of an apparatus that includes a bone anchor member and a plug portion is described.FIG. 15A is top view of top view of an embodiment of an apparatus that includes a bone anchor and a plug portion.FIG. 15B is a cross-sectional view of the bone anchor depicted inFIG. 15A along line15C-15C.FIG. 15C is top view of the bone anchor depicted inFIG. 15A in a locked state.
• Apparatus300 includesbone anchor member302 and plugportion310.Bone anchor member302 is similar to the bone anchor members described hereinabove and includesmain body303 having plurality ofcleated members306, which are configured to anchorplug portion302 within a hole of a bone (e.g., seeFIG. 1).Bone anchor member302 includescentral bore304, which is configured to receiveplug portion310.
• Plug portion310 ofapparatus300 includesmain body311 havingdistal region318 andcentral bore312, as shown inFIG. 15B.Main body311 has an outer diameter that is slightly smaller than an inner diameter ofbore304. Accordingly, plugportion310 is configured for circumferential rotation withinbore304 ofbone anchor member302.
• Bone anchor member302 includes first and secondsemi-circular channels305aand305b, which are formed at diametrically opposing surfaces ofmain body303, as shown inFIGS. 15A and 15B. Further,plug portion310 includes first and secondsemi-circular channels315aand315b, which are formed at diametrically opposing surfaces onmain body311, as shown inFIGS. 15A and 15B.
• Apparatus300 also includesactuation knob321, which is disposed on an outer surface ofplug portion310, as shown inFIG. 15A.Actuation knob321 is configured to be disposed withinfirst recess322 ofbone anchor member302 in an unlocked state, and disposed withinsecond recess323 in a locked state.
• Whenactuation knob321 is disposed withinfirst recess322, first and secondsemi-circular channels305aand305bofbone anchor member302 are aligned with first and secondsemi-circular channels315aand315bofplug portion310, respectively, thereby forming first and second circular channels, as shown inFIGS. 15A and 15B.
• Whenactuation knob321 is disposed withinsecond recess323, first and secondsemi-circular channels305aand305bofbone anchor member302 are not aligned withcorresponding channels315aand315bofplug portion310, as shown inFIG. 15C.
• During use,suture30 is coupled toapparatus300 in a manner shown inFIG. 16. Specifically,first suture end32aextends throughcentral bore312 ofplug portion310. First suture end32apasses throughaperture327 in plug portion310 (seeFIG. 15B) and transitions intoloop portion34a.Loop portion34ais threaded through the first circular channel formed bysemi-circular channels305aand315a.
• Loop portion34athen is threaded through a tissue and transitions intoloop portion34b.Loop portion34bis threaded through the second circular channel formed bysemi-circular channels305band315b.Loop portion34bpasses through asecond aperture327 and transitions intosecond suture end32b.Second suture end32bextends throughcentral bore312 ofplug portion310.
• During use, first and second suture ends32aand32bmay be selectively tensioned whenactuation knob322 is disposed withinfirst recess322, as shown inFIGS. 15A-15B. This is because first and secondsemi-circular channels305aand305bofbone anchor member302 are aligned with first and secondsemi-circular channels315aand315bofplug portion310; respectively, to form the first and second circular channels through which the suture can freely pass.
• It should be noted that, as first and second ends32aand32bare individually tensioned, roundededges328 of plug portion310 (seeFIG. 15B) serve to reduce the shear stresses imposed upon the suture ends as they pass throughapertures327.
• To lock the suture in place,plug portion310 is rotated with respect tobone anchor member302 to causeactuation knob321 to be advanced intosecond recess323. The rotation ofplug portion310 may be achieved by inserting an actuation tool such as a hexagonal key (not shown) intomating slot325. Onceknob321 is secured withinsecond recess323, as shown inFIG. 15C, the suture will be locked in place because the misaligned semi-circular channels pinch the first and second ends of the suture.
• The positioning of tissue may be optimized (e.g., tweaked) with respect to bone after the suture has been locked, the actuation tool may be inserted intomating slot325 and force applied to causeknob322 to rotate in an opposing direction intofirst recess322. As described above, this forms two fully circular channels through which the suture may be advanced or retracted to facilitate positioning of the tissue with respect to the bone.
• FIGS. 17A and 17B depict cross-sectional views of embodiments of a bone anchor in unlocked and locked states, respectively. Referring toFIG. 17A,bone anchor member340 includesmain body343 having proximal and distal regions.Bone anchor member340 includes a plurality ofcleated members346, and opposingguide channels348 and349. In some embodiments, guidechannels348 and349 are similar to guidechannels50 and52 ofFIG. 2C.
• Bone anchor member340 includes at least onepassage352 andflexible member350.Passage352 extends laterally throughmain body343.Flexible member350 is disposed proximal topassage352.Flexible member350 has a relaxed configuration in which it assumes a convex shape (e.g., bowed away from passage352). In the relaxed configuration, shown inFIG. 17A, there is sufficient clearance betweenflexible member350 andpassage352 to permitsuture30 to move substantially unimpeded through the passage.
• In use, beforebone anchor member340 is inserted into a hole of a bone,first suture end32ais passed throughpassage352. The first suture end then becomesloop portion34a, which is threaded through the tissue, as described hereinabove.Loop portion34aextends through the tissue to becomeloop portion34b.Loop portion34bpasses back throughpassage352 and becomessecond suture end32b. First and second suture ends32aand32bextend outside of the arthroscopic site and may be individually tensioned during use.
• Aftersuture30 is coupled toapparatus340 and the tissue,bone anchor member340 is advanced distally into a hole of a bone (e.g., seeFIG. 1), wherebycleated members346 serve to anchor the device in the hole. As described above, first and second suture ends32aand32bmay be individually tensioned to approximate the positioning of the tissue with respect to the bone. During this time, no external forces are applied toflexible member350, thereby permitting movement of the suture withinpassage352.
• Once a desired tissue positioning is achieved, the suture may be locked in place by apply a distally directed force uponflexible member350, as depicted inFIG. 17B.Flexible member350 preferably assumes a concave shape in whichdistal knob354 is urged towardscorresponding pocket355 in bone anchor member342. The distally directed force locks the suture in place by pinching the suture and inhibiting its movement withinpassage352.
• As will be apparent to one skilled in the art, any number of mechanisms may be employed to apply a distally directed force uponflexible member350, and further, to lock the flexible member in the concave position depicted inFIG. 17B. For example, a plug may be inserted intobore358, and then wedged againstflexible member350 to hold the flexible member in place. Alternatively,bone anchor member340 may includetaper277 and proximal stop278 (seeFIG. 17A) to allow the plug to remain in place withinbore358. In either case, the plug serves to apply a compressive force to hold the suture in the locked state.
• Alternatively, the flexible member may be “bi-stable,” such that the flexible member has only two stable states. In the first state, the flexible member is positioned as shown inFIG. 17A. When a sufficient distally directed force is applied, the flexible member is configured to “snap” from the first state into a second state, as shown inFIG. 17B. There are no stable positions between the first and second state. Accordingly, the flexible member is either provided in a locked or unlocked state. Means for applying a proximally-directed force to the flexible member may be used to cause the flexible member to snap from the second state, shown inFIG. 17B, to the first state, shown inFIG. 17A, thereby unlocking the device.
• In some embodiments, a threaded member may be used to hold the suture in a locked state. As shown inFIGS. 18A-18B, threadedcap360 hasexterior thread361, which is adapted to engage groovedinterior section371 ofbore358′. In certain embodiments, threadedcap360 includes a proximal region havingmating slot365 and a distal region havingdistal protrusion362.
• In an unlocked state, threadedcap360 is situated proximally withinbore358′, as shown inFIG. 18A. To lock the suture in place, lockingtool375 may be inserted intomating slot365 and then rotated clockwise to advance threaded cap in a distal direction (e.g., in a manner similar to tightening a screw). This causes a distal region of threadedcap360, anddistal protrusion362, to urgeflexible member350 distally, thereby impinging upon a suture length disposed throughpassage352. This locks the suture in place.
• If re-adjustment of the suture, then lockingtool375 may be rotated counterclockwise withinmating slot365 to proximally retract the threaded cap. This will remove the forces imposed upon the suture, as depicted inFIG. 18A.
• In some embodiments,flexible member350 is omitted entirely. In this case, threadedcap360 may directly pinch the suture inpassage352 to lock the suture in place.
• Referring now toFIGS. 19A-19B, an alternative embodiment of the bone anchor ofFIGS. 17A-17B is described. Operation ofbone anchor member340″ is substantially the same as that ofbone anchor340, with the main exception that lockingmember380 is provided in lieu offlexible member350.
• Lockingmember380 includescylindrical body381, which is configured to be confined withinrecess391 ofmain body343″, as shown inFIG. 19A. Lockingmember380 includesdistal protrusion382, which is configured to extend at least partially throughaperture390 ofmain body343″.
• First andsecond support members383aand383bare disposed beneathcylindrical body381, and may be formed integrally with lockingmember380. As shown inFIG. 19A, the first andsecond support members383aand383brest onsupport ledge395 ofmain body343″, thereby elevating lockingmember380 withinrecess391.
• During use,suture30 is secured to a tissue and disposed throughpassage352″, as described hereinabove with respect toFIGS. 17A-17B.Bone anchor member340″ then is advanced distally into a hole of a bone (e.g., seeFIG. 1), such thatcleated members346 anchor the device in the hole.
• When lockingmember380 is elevated withinrecess391,distal protrusion382 may not substantially extend intopassage352″, thereby permitting movement of the suture withinpassage352″. At this time, first and second suture ends32aand32bmay be individually tensioned to approximate the positioning of the tissue with respect to the bone.
• Once a desired positioning is achieved, the suture may be locked in place by any number of techniques that cause first andsecond support members383aand383bto be lowered or eliminated, thereby loweringcylindrical body381 withinrecess391 and urgingdistal protrusion382 towardscorresponding pocket355″, as depicted inFIG. 19B. The distally directed force applied bydistal protrusion382 secures the suture in place.
• In certain embodiments, first andsecond support members383aand383bmay be fused withsupport ledge395 ofmain body343″. In some embodiments, ultrasonic energy is delivered to a proximal surface of lockingmember380, viabore358″, using techniques that are known in the art. The provision of ultrasonic energy causes first andsecond support members383aand383bto fuse withsupport ledge395, thereby loweringlocking device380 and locking the suture disposed withinpassage352″ in place.
• In the embodiments ofFIGS. 17-19, while only onepassage352 is depicted, it will be apparent to one skilled in the art that a second passage may be provided, (e.g., disposed adjacent to the first passage). If twoadjacent passages352 are provided, then the suture can be threaded through the first passage, through the tissue, and threaded back through the second passage.
• Further, it will be apparent to one skilled in the art that an adhesive, for example, cyanoacrylate, epoxy, bone cement and so forth, may be employed in conjunction with any of the embodiments described inFIGS. 17-19.
• Such an adhesive may be used in conjunction with apparatus including, but not limited to,flexible member350, threadedcap360, lockingmember380, and any associated components.
• FIGS. 20A and 20B are, respectively, a top-sectional view and a side view of embodiments of a locked state of an apparatus that includes a bone anchor and a plug portion.FIGS. 21A and 21B are, respectively, a top-sectional view and a side view depicted inFIGS. 20A-20B in a locked state. Apparatus400 (seeFIG. 20A) includesbone anchor member402 and plugportion410.
• Bone anchor member402 includesmain body403 having cleatedmembers406, which are configured to securebone anchor member402 in a hole of a bone, as described hereinabove.Bone anchor member402 also includes first andsecond passages408 and412, which extend laterally throughmain body403.
• Bone anchor member402 further includesguide channels409a,409b,413aand413b, which are disposed in exterior surfaces ofmain body403. The guide channels preferably are similar to guidechannels50 and52 ofFIGS. 2A-2C, except that four guide channels are employed in the present embodiment.
• In use,first suture end32apasses throughguide channel409a, throughpassage408 and throughguide channel409b. The first suture end then transitions intoloop34, which is threaded through a tissue.Loop34 ofsuture30 then transitions intosecond suture end32b.Second suture end32bpasses throughguide channel413b, throughpassage412, and throughguide channel413a. Accordingly, the suture is coupled between the tissue andapparatus400.
• Plug portion410 havingmain body411 is configured to be disposed within a central bore ofbone anchor member402.Plug portion410 includesactuation knob422, which is configured to be disposed infirst recess423 ofbone anchor member402 in an unlocked state, and disposed withinsecond recess424 in a locked state.
• In the unlocked state, (e.g., whenknob422 is disposed within first recess423)plug portion410 is oriented such thatmain body411 does not substantially overlap with first andsecond passages408 and412 ofbone anchor member410.
• In some embodiments, first and second ends32aand32bofsuture30 are selectively tensioned whenknob422 is disposed withinfirst recess423. This is because first andsecond passages408 and412 provide a substantially unimpeded circular channel within which the suture can pass.
• To lock the suture in place,plug portion410 is rotated to causeknob422 to be advanced intosecond recess424. The rotation ofplug portion410 with respect tobone anchor member402 may be achieved by inserting an actuation tool (e.g., a rectangular key) intomating slot427. Onceknob422 is secured withinsecond recess424, the suture is locked in place becausemain body411 ofplug portion410 impinges uponpassages408 and412.
• To adjust (e.g., tweak) the positioning of the tissue with respect to the bone after the suture is in the locked state, the actuation tool may be inserted intomating slot427 to causeknob422 to rotate back into first recess423 (seeFIGS. 20A-20B). This removes the compressive forces imposed upon the suture, to allow the first and second ends of the suture to be individually tensioned, thus facilitating re-positioning of the tissue.
• FIGS. 22A and 22B are cross-sectional views of an embodiment of an apparatus that includes a bone anchor member and a plug portion.
• Referring toFIG.22A apparatus440 includesbone anchor member442 and plugportion450.Bone anchor member442 includes main body443 having cleatedmembers446, which are configured to securebone anchor member442 in a hole of a bone (e.g., seeFIG. 1). Further,bone anchor member442 includescentral bore444 andcircumferential protrusion449, which is disposed near a distal end ofbore444.
• Plug portion450 hasmain body451 having proximal and distal regions. The proximal region includes first andsecond guide channels456 and457, which are recessed in opposing lateral surfaces ofmain body451. The distal region ofmain body451 includescircumferential recess453 anddistal taper454.Plug portion410 also has a centralregion having passage448 disposed laterally therethrough.
• Beforeplug portion450 is inserted intobore444,first suture end32ais passed throughpassage448. The first suture end then becomesloop portion34a, which is threaded through a tissue.Loop portion34aextends through the tissue to becomeloop portion34b.Loop portion34bpasses back throughpassage448 and becomessecond suture end32b. First and second suture ends32aand32bmay be manipulated during use.
• Alternatively, as described hereinabove, a central region ofsuture30 may be threaded through the tissue, and the free ends of the suture then may be passed throughpassage448 in a proximal direction to achieve the depicted position of the suture.
• In some embodiments,bone anchor member442 is inserted into a hole of the bone beforeplug portion450 is inserted intobore444. Oncebone anchor member442 is securely disposed within the hole,plug portion450 is positioned slightly abovebone anchor member442, so thatpassage448 is proximal to bore444. At this time, first and second suture ends32aand32bmay be individually tensioned to approximate the positioning of the tissue with respect to the bone (e.g., seeFIG. 1).
• Once the desired positioning is achieved,plug portion450 may be advanced distally intobore444 ofbone anchor member442. An insertion tool, such asinsertion tool294 ofFIGS. 13A-13C, may be inserted intomating slot458 to advanceplug portion450 distally. The provision of a sufficient distally directed force urges taper454 overcircumferential protrusion449, thereby locking the plug portion within the bone anchor member, as shown inFIG. 22B.
• At this time, first and second suture ends32aand32bare compressed withinguide channel456, whilesuture loop portions34aand34bare compressed withinguide channel457.Guide channels456 and457 may be sized to ensure that the suture is completely locked in place whenplug portion450 is inserted into bore444 (seeFIG. 22A). Alternatively, guidechannels456 and457 may be sized to permit incremental adjustments of the suture, such that applying a sufficient tension to free ends32aand32bwill overcome the frictional forces between the suture,plug portion450 andbone anchor member442.
• Referring toFIGS. 23A-23C, an embodiment of the450 ofFIGS. 22A-22B is described.FIG. 23A is a cross-sectional view of an embodiment of the plug depicted inFIGS. 22A and 22B.FIG. 23B is a perspective side view of the plug depicted inFIG. 23A.FIG. 23C is a bottom view of the plug depicted inFIG. 23A.
• InFIG. 23A,plug portion450′ includesdistal passage466, in lieu ofpassage448 ofFIGS. 22A-22B.Distal passage466 is formed as a slot recessed in the distal end ofmain body451.Distal passage466 may communicate with opposingguide channels456 and457.
• The operation of a bone anchor system usingplug portion450′ is substantially similar to the steps described inFIGS. 22A-22B, with the exception that first and second suture ends32aand32bare disposed withindistal passage466. Specifically, during use, suture ends32a,32bcan be looped around the distal end ofplug portion450′, and need not be inserted by threading throughcentral passage448. Once the suture ends are looped around the distal end ofplug portion450′ and confined withinpassage466, then the suture may be held in place while insertingplug portion450′ intobone anchor member442. Once the plug portion is locked into place via circumferential protrusion449 (e.g., as described inFIG. 22B), then the suture is compressed betweenplug portion450′ andbone anchor member442.
• Referring toFIG. 24A, an apparatus includes alternativebone anchor member442″ andalternative plug portion450″.Bone anchor member442″ andalternative plug portion450″ are similar tobone anchor member442 and plugportion450 ofFIGS. 22A-22B, except as noted below.
• Plug portion450″ includesmain body451′ having firstsuture clearance channel456′ formed in a first lateral surface of the body, and secondsuture clearance channel457′ formed in an opposing lateral surface of the body.Plug portion450″ also includesclearance recess455 on a distal region ofmain body451′, along withsuture channel466′.
• Main body451′ includes a plurality ofcleated members459a, which are formed adjacent tosuture channel466′. Also,bone anchor portion442″ includes a plurality ofcleated members459bformed inbore444.Cleated members459bare configured to opposecleated members459awhenplug portion450″ is disposed inbore444 ofbone anchor member442″, as shown inFIG. 24B.
• During use,suture length30ais coupled tobone anchor member442″ by first formingloop470 betweenregions35aand35bof the suture. A central portion ofsuture30athen is looped aroundsuture channel466′ ofplug portion450″. At this time, proximal suture ends33aand33bareproximate clearance channel456′, whilesuture regions35aand35bare in the vicinity ofclearance channel457′.Plug portion450″ then is lowered intobore444 ofbone anchor member442″, as depicted inFIG. 24B.
• When an appropriate force is applied,distal taper454 ofplug portion450″ passes overprotrusion449 ofbone anchor member442″. At this time,protrusion449 is confined withinrecess453, as shown inFIG. 24B, to substantially inhibit movement ofplug portion450″ with respect tobone anchor member442″. Proximal suture ends33aand33bare disposed withinclearance channel456′, whilesuture regions35aand35bare disposed withinclearance channel457′.
• In certain embodiments,suture loop470 may be coupled directly to a tissue, as generally set forth hereinabove. Tensioning of suture ends33aand33bmay directly effect positioning of the tissue. Further, as set forth above,cleated members459aand459bmay form a one-way channel that facilitates tensioning of the suture ends, and locks the suture ends in place.
• In some embodiments, a second suture length may be employed to anchor a tissue to a bone.FIGS. 25A-25B are illustrations of the bone anchor depicted inFIGS. 24A and 24B employing two sutures.
• InFIG. 25A,second suture length30bhasloop471, which is coupled directly totissue T. Loop471 is formed betweensuture portions34aand34b. Proximal to sutureportions34aand34b,second suture30bincludes proximal ends32aand32b, which are configured to be manipulated during use.
• Second suture30bis coupled tofirst suture30aby pulling proximal ends32aand32bthroughloop470. At this time, four proximal suture ends will extend proximally from an access cannula (not shown). Specifically, proximal ends32aand32bofsecond suture30b, along with proximal ends33aand33boffirst suture30a, all extend from the access cannula. Each of the four suture ends may be individually tensioned during use.
• As each of the four suture ends32a,32b,33aand33bare selectively tensioned,loop470 andsuture regions35aand35bare urged towardsclearance channel457′, as shown inFIG. 25B. Whenloop470 is drawn towardsclearance channel457′,second suture30balso is drawn towards the clearance channel (i.e., because proximal ends32aand32bof the second suture have been previously pulled through loop470).
• At this time, the various suture regions that are drawn towardsclearance channel457′ become inserted within the clearance channel to effectively lock the sutures in place. In effect, as tension is applied to the four suture ends32a,32b,33aand33b, tissue T is approximated to bone, and ultimately, the sutures are locked in place.
• The use of the described method may save considerable time and effort during a surgical procedure. For example,bone anchor member442″,plug portion450″ andfirst suture30a(including loop470) may be provided in an already assembled state, as shown inFIG. 24B. These components need not be assembled during the surgical procedure.
• At an appropriate time,second suture30bis coupled to tissue T vialoop471. Using this method, it is not necessary to thread proximal suture ends32aand32bthroughplug portion450″ orbone anchor member442″ aftersuture30bis coupled to tissue T. Rather, suture ends32aand32bare pulled throughloop470 offirst suture30a. In short,first suture30ais coupled to tissue T, and then proximal ends32aand32bare guided through previously providedloop470, thereby saving operating time and effort.
• Referring toFIGS. 26A-26D, an apparatus that includes a bone anchor is described.FIG. 26A depicts an embodiment ofbone anchor500.FIG. 26B is a cross-sectional view depicting a suture locking mechanism of the bone anchor depicted inFIG. 26B in a locked position.FIG. 26C is a cross-sectional view depicting the suture locking mechanism depicted inFIG. 26B in an unlocked position.FIG. 26D is an exploded view of the bone anchor of depicted inFIG. 26A.
• Bone anchor500 includesmain body502 and insert504.Main body502 hascleats506, which are used to secure thebone anchor500 to bone as discussed above.Main body502 may have any other suitable feature to secure theanchor500 to bone, such as an expandable portion, without departing from the scope of the invention.
• Insert504 is positioned inrecess508 inmain body502. The suture entersapparatus500 through the proximal end ofrecess508 and extends through a space betweenmain body502 and insert504. The suture then passeshole510 ininsert504.Hole510 is, in some embodiments, triangular shaped to accommodate different size suture as shown inFIG. 26D.
• Insert504 is movable between the closed position ofFIG. 26B and the open position ofFIG. 26C.Recess508 has beveledsurface512 on each side facing thehole510 in theinsert504. The suture is captured betweenbeveled surface512 andupper end514 ofhole510 wheninsert504 is in the closed position ofFIG. 26B.Insert504 may be biased toward the closed position byspring portion516 oninsert504.Spring portion516 is formed byspiral cut518 ininsert504.Insert504 also has pinnedconnection520 withmain body502 near the distal end.Pin522 extends throughhole524 ininsert504 to provide pinnedconnection520. Althoughspring portion516 is formed integral with insert504 a separate spring may also be provided similar to other embodiments described herein.
• Insert504 may be moved to the unlocked position ofFIG. 26C by pulling oninsert manipulator524.Manipulator524 may simply beflexible tether526, which is pulled to moveinsert504 to the unlocked position. When the procedure is completed,tether526 may be cut and removed.Manipulator524 provides the user with the ability to adjust suture tension as needed.Bone anchor500 is used in the same or similar manner as the other apparatuses described herein.
• Referring toFIGS. 27A-27B,bone anchor530 is described.FIG. 27A is a perspective view of an embodiment of a bone anchor.FIG. 27B is a cross-sectional view of the bone anchor depicted inFIG. 27A.FIG. 27C is an exploded view of the bone anchor depicted inFIG. 27A.
• Bone anchor530 hasmain body532 withcleats531 used to secure the bone anchor to bone although any other feature may be provided to securebone anchor530 to bone. The suture is locked with a suture lock533. Suture lock533 permits the suture to be advanced in the direction ofarrow556, but prevents movement in the other direction. The suture extends around bearingsurface534.Bearing surface534 may beroller536 although a non-rotating member may also be used.Roller536 is mounted withinhole538. Suture lock533 has first lockingportion540 andsecond locking portion542, but may include any number of locking portions.
• The first andsecond locking portions540,542 are integrally formed asring clip550.Ring clip550 seats within annular recess552 inmain body532. Suture locks540,542 includesuture engaging portion554 extending fromring clip550.Locks540,542 may include an integrally formed livinghinge556. Livinghinge556 may permit thesuture engaging portion554 to deflect inwardly when suture is pulled in the direction ofarrow556. Suture lock533 permits the suture to be pulled in the direction ofarrow556 and prevents the suture from being moved in the opposite direction.Bone anchor530 is used in the same manner as bone anchors described herein.
• Referring toFIGS. 28A-28D,bone anchor560 is described.FIG. 28A is a perspective view of an embodiment ofbone anchor560.FIGS. 28B and 28C are cross-sectional views illustrating the use of a release element in conjunction with the bone anchor depicted inFIG. 28A.FIG. 28D is an exploded view of the bone anchor depicted inFIG. 28A.Bone anchor560 is used in the same manner or similar manner as other bone anchors described herein.
• Bone anchor560 includessuture lock564.Suture lock564 allows a suture to be pulled in the direction ofarrow566, and prevents movement in the other direction.Suture lock564 includescam568 having pinnedconnection570 formed bypin571 rotatable within hole573 (seeFIG. 28D). The suture is locked when the suture is trapped betweencam568 andinner surface574 ofmain body572.
• Bone anchor560 includesrelease element576 for releasingsuture lock564.Release element576 may be part ofintroducer578.Introducer578 may be used when advancingbone anchor560 into bone.Release element576 extends through a channel ofintroducer578.Release element576 andmain body572 may be configured (e.g., threaded) to allow the release element to be rotated and advanced to a desired position (e.g., as depicted inFIG. 28B).Release element576 contacts upper portion ofcam568 and pivots the cam (e.g., as depicted inFIG. 28C). Pivoting the cam permits manipulation of the suture in one or more desired directions.
Further Improvements
• Referring toFIG. 29, an alternate non-limiting embodiment of abone anchor600 is shown.FIG. 29A depicts an embodiment of a bone anchor having a cam with a suture positioned between the cam and a surface at the distal end of the bone anchor.FIG. 29B is a cross-sectional view of the embodiment depicted inFIG. 29A.FIG. 29C is a frontal view of the bone anchor depicted inFIG. 29A.FIG. 29D is an exploded view of the bone anchor and suture depicted inFIG. 29A.
• It will be apparent to practitioners of ordinary skill in the art that, while the non-limiting embodiment ofbone anchor600 depicted inFIG. 29A-29D has a substantially flattened profile, such a configuration is merely meant to be illustrative of the many alternate shapes that the presently described bone anchors may take. In different embodiments,bone anchor600 may be configured to have cross sectional shapes and/or dimensions different from that depicted here, without departing from the spirit or scope of the embodiments set forth herein.
• Bone anchor600 may includemain body610 withsides611.Sides611 may formcavity612.Sides611 may entirely or at least partially enclosecavity612. The cavity may extend distally along the entire length of the main body, or may optionally extend along only a portion of the length of the main body.Cavity612 extends to the proximal end of the main body to form opening613.
• Main body610 hasinner surface615 positioned at the distal end of end ofcavity612.Inner surface615 may be formed from the main body at the time of its manufacture, or may be formed bycoupling block616 to the distal end of main body610 (seeFIG. 29D).
• In some embodiments, opening613 may be fully surrounded at the proximal end ofmain body610. In certain embodiments, side surfaces640 are coupled tomain body610 to encloseopening613. Side surfaces640 may be formed from the main body at the time of its manufacture, or may be formed bycoupling retainer645 to the proximal end ofmain body610, as depicted inFIG. 29D.
• Referring toFIG. 29A,bone anchor600 may includecam650 pivotally positioned incavity612.Cam650 is pivotally coupled tomain body610 using, without limitation, any suitable art-recognized means of forming a rotatable connection. (e.g., a pin). In one non-limiting embodiment,cam650 may be positioned incavity612 such thathole651 is aligned withholes652 onopposite sides611, as depicted inFIG. 29D.Pin653 may be inserted through the aligned holes to couplecam650 tomain body610. This connection enablescam650 to rotate (e.g., pivot) about the axis ofpin653, as shown inFIG. 29B.
• In some embodiments,cam650 may be configured to have an irregular cross sectional shape. FIGS.29A-D depicts an embodiment where the cross sectional shape ofcam650 is substantially ovoid (e.g., see particularlyFIG. 29B andFIG. 29D). It will apparent to a practitioner of ordinary skill in the art however, that the configuration of the cam presently described embodiment is exemplary only and serves to illustrate one of the many configurations of cams suitable for use with the subject bone anchors. It will be apparent to ordinary practitioners of the art that cams configured with any cross sectional shape may be substituted for that described herein without departing from the scope of the presently described embodiments.
• Coupling cam650 tomain body610 as described above allows the cam to freely pivot incavity612. In an embodiment,cam650 may pivot in a first direction (e.g. downward) untilouter cam surface667 comes into contact with inner surface615 (e.g., as depicted inFIG. 29B). After contact, further rotation ofcam650 in the first direction is blocked.Cam650 may, however still pivot in the opposite direction (e.g. upward).
• In some embodiments,cam650 may be configured such thatcam surface667 is biased towardinner surface615. Any suitable art-recognized means may be used to biascam surface667 towardinner surface615. Examples of methods to bias a cam include, but are not limited to, coupling the cam to a spring bias assembly, or by forming at least a portion of cam and/or inner surface of the main body from a magnetized material.
• Referring toFIG. 29A, one ormore coupling members630 may be disposed on the exterior surface ofmain body610. Coupling members may be used to securebone anchor600 to an opening in a bone in which the bone anchor is positioned.Main body610 may include any other suitable feature to secure thebone anchor600 to bone, such as an expandable portion, without departing from the scope of the invention.
• In an embodiment,coupling members630 may extend radially from the main body. In an embodiment,coupling members630 may be configured to reversibly engage a bone surface. Typically, coupling members may be formed, at least in part, of a substantially rigid or deformable material. In an embodiment, the coupling members are formed from the main body during the time of its manufacture. In some embodiments, coupling members may be manufactured separately and coupled to the exterior surface of the main body. In some embodiments, the main body may be coupled to the coupling members at the in a point of care setting. The main body may be configured to fit to a variety of coupling members, each having unique features suited to particular applications. A choice of coupling members may be provided to the physician at the point of care and coupled to the main body. Such a system allows the physician to choose the coupling member(s) best suited to a particular patient and application (e.g., size, depth and/or width of the bone hole), without having to interrupt and prolong the procedure underway in order to choose an alternate bone anchor and prepare it for implantation. The coupling of a main body to coupling members may be by any suitable means generally known in the art. By way of non-limiting examples, a main body may be coupled to coupling members using a snap-locks, screws, adhesives, or any other suitable means described above or generally known in the art. A non-limiting example is depicted inFIG. 29A. A physician may chooseclip620, which includes one or more radiallyextendable coupling members630. After the choice is made, the bone anchor is readied for use bycoupling clip620 tomain body610. In an embodiment, a pinned connection may be formed by aligninghole623 withhole622 and insertingpin621 through the aligned holes, as depicted inFIG. 29D. Couplingmembers630 extend radially frommain body610.
• In an embodiment, a bone anchor may be positioned in an opening in a bone by first retracting the coupling members. Retraction may be accomplished using a device (e.g., an inserter) that is capable of grasping the coupling members and compressing them toward the main body. When the bone anchor is suitably positioned in the bone opening, the inserter releases coupling members, allowing them to move radially outward and engage the surface of the bone opening. Alternatively, the bone anchor may be inserted into a bone opening without retracting the coupling members, and allowing the coupling members to grip the surface of the opening in which the bone anchor is placed.
• Suture660 may be positioned inbone anchor600 to allow tensioning one or both ends of the suture to optimize positioning of the tissue relative to the bone.Suture660 includesdistal loop portion665, which is coupled to the tissue, andsuture end portions662a,662b, which are coupled tobone anchor600. During use,suture end portions662aand662bmay be tensioned so that the tissue is drawn toward the bone anchor.Suture end portions662a,662bmay be coupled tobone anchor600 by entering throughopening613.
• Suture end portions662a,662bextend toward the distal end ofmain body610. To engagecam650,suture end portions662a,662bmay be wrapped around at least a portion of outer surface ofcam surface650. Optionally,cam650 may be textured on at least a portion of its outer surface. The texturing may allow the cam surface to frictionally grip the suture. The sutures may be wrapped aroundcam650 such that the suture contacts at least about 30%, at least about 40%, at least about 50%, at least about 60%, or at least about 70% of the outer surface ofcam650. In an embodiment,suture end portions662a,662bmay be wrapped aroundcam650 in a hairpin configuration as shown inFIGS. 29A and 29B. By wrappingsuture end portions662a,662baround the lower surface of the cam, the suture ends are positioned inspace666 betweenouter cam surface667 andinner surface615. Wrapping the suture around the cam in a hairpin configuration may maximize contact between the suture length and the outer surface of the cam. Thus, traction between the cam surface and the suture length is enhanced. After being coupled tocam650, suture end portions662 and663 may extend toward the proximal end ofmain body610 and exit throughopening613. In an embodiment,side surface640 may hold suture end portions662 and663 in place at opening613 (SeeFIG. 29B), allowingthe physician greater access to the suture and ease of manipulation of the suture during use.
• In an embodiment, a suture puller (not shown) may facilitate threading of the suture ends through the bone anchor described above and shown in FIGS.29A-D. The suture puller may be similar in shape and size to the suture coupled to the tissue. In some embodiments, the suture puller is substantially S-shaped.
• The suture puller may be threaded through the bone anchor in the same manner as the suture, prior to the positioning of the anchor in a bone opening. The distal end of the suture puller couples to ends of the suture. During use, a loop of suture may pass through a tissue of interest. The end portions of the suture may couple to the distal end of the suture puller. Pulling a proximal end of the suture puller passes the suture puller through the main body of the bone anchor and threads a portion of the suture end through the opening in the main body, around the cam, between the outer cam surface and the inner surface of the main body, and out through the opening in the cavity.
• When the suture is coupled to tissue and appropriately threaded throughbone anchor600, the sutured tissue may be drawn toward the bone by individually, or together, tensioning suture end portions662 and663 in the direction indicated byarrow690 shown inFIG. 29B. Tensioning the suture causescam surface667 to move (e.g., pivot) away frominner surface615, allowing movement of suture end portions662 and663 in the direction indicated byarrow690. It will noted however that, due to the configuration ofcam surface667 relative toinner surface615, after the tension applied to suture end portions662 and663 is released,cam surface667 returns to its position adjacent toinner surface615. Tension applied to suture end portions662 and663 in the direction indicated byarrow695 locks the suture in place by compressing end portions662 and663 betweencam surface667 andinner surface615. Thus, movement of a tissue coupled to a suture is allowed only in a desired direction, while slippage or movement of the tissue back to its original position is substantially prevented.
• FIGS.30A-D describebone anchor700.FIG. 30A depicts an embodiment of the bone anchor having a suture locking assembly.FIG. 30B is a cross-sectional view of the bone anchor depicted inFIG. 30A.FIG. 30C is a side view of the bone anchor depicted inFIG. 30A.FIG. 30D is an exploded view of the bone anchor depicted inFIG. 30A.
• Bone anchor700 includesinsert710 andmain body715.Insert710 includes one or more (e.g., a plurality) of flange members711 (seeFIG. 30D).Flange members711 may extend proximally frominsert710.Cavity720 is formed betweenflange members711. Distal end ofcavity720 includes inner surface719 (seeFIG. 30B).
• In some embodiments,main body715 may be configured to couple to insert710. As depicted inFIG. 30B,main body715 is configured to accept and encircleflange members711 andcavity720.Main body715 may couple to insert710 by aligninghole701ainmain body715 withholes701bin flange members711 (seeFIG. 30D).Pin705 may then be inserted though the aligned holes. Any alternate configurations ofinsert710 andmain body715 that allow coupling thereof are possible and their means of coupling, without departing from the spirit and scope of the embodiments provided herein may be used.
• Main body715 may optionally include a plurality ofradial coupling members716.Radial coupling members716 may securebone anchor700 to bone as described herein.Main body700 may employ any art-recognized means for securing theanchor700 to bone including, but not limited to, cleats.
• Bone anchor700 may also include lockingassembly740. Lockingassembly740 includes a plurality of locking elements750. InFIG. 30D, locking elements750 are depicted as locking rings750aand750b. Locking rings750aand750bincludeupper bar751aand751bandlower bar752aand752b, respectively. Locking rings750aand750bare sized to allow, when the locking rings are positioned parallel to each other,lower bars752aand752bto entercavity720 as depicted inFIG. 30B. Locking rings750aand750bmay be positioned parallel to each other whenlower bars752aand752bare disposed incavity720. In some embodiments, the locking rings are substantially parallel to each other.Lower bars750aand750bmay be individually disposed at various positions or at the same position relative toinner surface719 ofcavity720. InFIG. 30B,lower bar752bis positioned adjacent to or in contact withinner surface719. In some embodiments,lower bar752ais positioned substantially adjacent to or in direct contact withinner surface719. In contrast,lower bar752ais positioned along the longitudinal axis ofcavity720, at a distance farther frominner surface719 thanlower bar752b. Similarly,upper bar751bis closer to the opening ofcavity720 thanupper bar751a.Suture gap760 lies betweenupper bars751aand751band is sized to accommodate the thickness of a suture. The locking assembly described above may be referred to in some embodiments as a “two bar locking assembly.”
• In one embodiment, one or more of locking elements750 may be axially movable incavity720. Moving locking element750 in an axial direction may, in some embodiments, allow the locking elements to interact with each other to either lock or release a suture length positioned ingap760 by compressing the suture length betweenupper bars751aand751b. In some embodiments, locking element750 may be moved axially after desired positioning of a sutured tissue (e.g., after fine-tuning placement of the tissue), in order to reversibly lock the suture in place. Axial movement of locking elements750 may be accomplished using any art-recognized means, including those described in detail above.
• Suture780 is positioned inbone anchor700 to allow optimal positioning of a tissue relative to the bone by individually tensioning the ends of the suture, while substantially inhibiting movement of the suture and tissue coupled thereto in the opposite direction.
• In some embodiments,suture780 is configured to have adistal loop portion785 and proximalsuture end portions781aand781b.Distal loop portion785 couples to tissue.Suture end portions781aand781bmay be treaded through the locking assembly ofbone anchor700, and when tensioned in the direction indicated byarrow790, draw the tissue toward the bone anchor. In some embodiments,suture end portions781aand781bmay be threaded through a two bar locking assembly as depicted inFIGS. 30A and 30B.Loop portion785 is positioned distally tobone anchor700, at the tissue.Suture end portions781aand781bmay couple to lockingassembly740 by passing the suture end portions through the opening ofring750aand underupper bar751b.Suture end portions781aand781bare wrapped upward aroundupper bar751b, passed thoughsuture gap760 and wrapped upward aroundupperbar751a. Suture endportions781aand781bare then available for facilitation of positioning of the sutured tissue (seeFIG. 30B).
• In certain embodiments, a suture puller may facilitate threading of the suture ends through the two bar locking assembly as described above. The suture puller may be similar in shape and size to the suture coupled to the tissue, and may be threaded through the bone anchor in the same manner as the suture, prior to the positioning of the anchor in a bone opening. The distal end of the suture puller couples to sutureend portions781aand781b. During use, a loop of suture passes through a tissue. The end portions of the suture are coupled to the distal end of the suture puller. Pulling the proximal end of the suture puller in a desired direction (e.g., direction790) passes the suture puller through the locking assembly and threads sutureend portions781aand781bthroughring750a, under and aroundupper bar751b, passed thoughsuture gap760 and finally wrapped aroundupper bar751a.
• When the suture is coupled to tissue and appropriately threaded through the locking assembly of the bone anchor, the sutured tissue may be drawn toward the bone by individually or together tensioningsuture end portions781aand781bin the direction indicated byarrow790 shown inFIG. 30B. Tensioning the suture ends thus allows the threaded suture to move through the locking assembly indirection790, thus drawing tissue toward the bone. It will noted however that, due to the configuration of the two bar locking assembly relative to the threaded suture, movement or slippage of the tissue in an opposite direction is substantially inhibited. Tensioning the suture distally, in the direction indicated byarrow795, causes the suture to apply an upward force toupper bar751b, causingupper bar751band751ato interact such that the suture length positioned ingap760 is compressed between the upper bars, thus substantially locking the suture in place.
• Turning now toFIG. 31, an alternate view of abone anchor800 is shown.FIG. 31A showsbone anchor800 in whichupper bars851a/bof twobar locking assembly840 are configured to be substantially straight.FIG. 31B shows a cross sectional view ofbone anchor800.FIG. 31C shows an exploded view ofbone anchor800, including twobar locking assembly840 havinglocking elements850a/bwith straightupper bars851a/b.
• The bone anchor embodiments depicted inFIGS. 30 and 31 may be preferred for applications in which the bone anchor is to be inserted in soft bone. For example,radial coupling members716 and816 may be preferable when bone anchors700 and800 are to be inserted into a bone tunnel in soft bone. It will be understood by an ordinary practitioner of the art however, that other means of engaging the bone of a bone tunnel may be used in applications in which the bone anchor is to be inserted in harder bone, without departing from the spirit and scope of the presently described embodiments. It will further be understood that the material from which the above-described locking assemblies are made is not limited to any preferred material. However, in certain embodiments, locking rings may be made from an appropriate biocompatible memory material, such as nitinol.
• FIG. 32 shows an alternate embodiment of that depicted inFIG. 31.FIG. 32A shows an embodiment of abone anchor assembly900 in whichradial coupling members816 are replaced by one or morecleated members946.Cleated members946 may facilitate the insertion ofbone anchor assembly900 into a bone tunnel in hard bone, and aid in the engagement thereof with bone on the surface of the tunnel.FIG. 32B shows a cross sectional view ofbone anchor900.FIG. 32C shows an exploded view ofbone anchor900, including twobar locking assembly940 having locking elements950a/bwith straightupper bars951a/b.
• FIGS. 33 and 34 show further alternate embodiments of bone anchor assemblies1000 and1100 in which suture1060 is coupled to bone anchors1000 and1100, respectively, in a fixed position rather than being coupled thereto using a two bar locking assembly. In the non-limiting embodiments depicted inFIGS. 33 and 34, a middle portion ofsuture1060 is coupled tobody1070 or1170, and suture ends1062a/bextend distally therefrom toward the surgeon.
• FIG. 35A-35G show various alternate embodiments of bone anchors suitable for use with the presently described systems and methods.
• Modular Design
• Bone anchor600 described certain embodiments where the main body is configured to be used with a variety of different coupling members, each having features suited to particular applications. It will be readily appreciated by ordinary practitioners of the art however, that this feature is not limited to the embodiments ofbone anchor600. Neither is this feature meant to be limited to the coupling of an internal portion to an external portion. In the contrary, components of the bone anchor assemblies described above are designed with the feature of modularity in mind. The ability to mix-and-match different features of an internal portion of a bone anchor assembly with a wide variety of features of external portions of the bone anchor is intended to be applied, without limitation, to all the embodiments described herein.
• Incorporating the feature of modularity into the bone anchor assembly design parameters provides the following advantages: (a) maximized versatility in surgical applications without having to redesign bone anchor suited to such applications; (b) maintaining flexibility of the surgical procedure at the point-of-care; (c) full interchangeability of any component with any other component; (d) adjustability of each bone anchor component independent of the choice or position of other bone anchor components being used in a single surgical application; (e) allows the surgeon to tailor the assembly to the individual anatomy of the patient even in the face of a revision of the surgical procedure that might otherwise damage the bone or tissue; and (f) the use of all styles and sizes of interior and exterior components. The feature of modularity allows the physician to dedicate his or her full attention the procedure at hand, improving the prognosis and healing of the patient.
• Securing a bone anchor member within a hole of a bone may be employed as previously described or using generally known bone securing techniques. For example,cleated members42 ofFIG. 2A, may be used means for securing the bone anchors. Other alternative means for securing may be used in conjunction with the apparatus and methods of the present invention. As an example, the bone anchor member may employ one or more radially expandable members that extend into the surrounding bone.
• Further, while some of the embodiments of the present invention describe use of a bone anchor member only, and other embodiments describe use of a bone anchor member and a plug portion, many of these features may be interchanged. It will be apparent to one skilled in the art that many embodiments depicting a bone anchor member only may be performed using a bone anchor member and plug portion, and vice versa.
• Also, for those embodiments described above having a bone anchor member and a plug portion, it will be apparent to those skilled in the art that the suture ends may be tensioned either before or after the plug portion is inserted into the bore of the bone anchor member.
• It will also be apparent to one skilled in the art that the plug portion may be securely disposed within the bore of the bone anchor member using various means not specifically disclosed herein. For example, after the plug portion is inserted into the bore of the bone anchor member, an adhesive, for example, cyanoacrylate, epoxy, bone cement and so forth, may be delivered to affix the plug portion to the bone anchor member. Alternatively, an exterior surface of the plug portion may be coated with a biocompatible adhesive that affixes to the bone anchor member after the plug portion is inserted into the bore of the bone anchor member. In some embodiments, heat may be applied to fuse the plug portion to the bone anchor member. It will be apparent to one skilled in the art that still further means for securing the plug portion to the bone anchor member may be employed.
• It should be understood that multiple bone anchor members, or multiple bone anchor members coupled to respective plug portions may be used. One or more sutures may be coupled between a desired tissue region and the bone anchor member or plug portion. If multiple sutures and bone anchor members are employed, enhanced sequential tensioning of the tissue may be achieved.
• Finally, while the above-described embodiments reference use of apparatus and methods for facilitating attachment of tissue to bone, it will be apparent to one skilled in the art that such apparatus and methods may also be used to secure tissue-to-tissue and bone-to-bone.
• Bone Anchor Inserter Systems and the Uses Thereof
• The presently described embodiments may optionally be provided in combination with an installer system adapted for use in deploying the presently described bone anchors to the operative site.
• A system for deploying a bone anchor to an operative site may include a bone anchor installer device.FIG. 36 shows a boneanchor installer device1200 according to a first non-limiting embodiment.Bone anchor installer1200 may includeanchor loading tool1205 having aproximal handle portion1210 and an elongatedanchor loading portion1220 extending distally therefrom. In an embodiment, a bone anchor installer may further include ananchor holder1230 coupled to the distal end ofanchor loading portion1220.Anchor holder1230 may be configured to hold a bone anchor in place at the distal end of the installer prior to the deployment thereof in a bole prepared in bone. In an embodiment,anchor holder1230 may includepin1235 detachably coupled thereto. During use, a bone anchor loaded toinstaller1200 may be deployed by detachingpin1235 fromanchor holder1230. Detachingpin1235 in this way may allow the uncoupling ofanchor housing1230 from the distal end ofinstaller loading portion1220, and exposing the bone anchor loaded on the distal end thereof (described below). In an embodiment, a system for deploying a bone anchor may optionally includesuture puller1240 pre-loaded through the bone anchor in the anchor holder.Suture puller1240 may be pre-loaded to the installer device in such a way as to facilitate the threading of one or more suture ends through a two bar locking assembly, as described above.Suture puller1240 may include graspingportion1250, which extends proximally from anchor holder and is readily accessible to the surgeon during use.Suture puller1240 may further includeloop portion1245 at its distal end.Loop portion1245 may be configured to hold suture ends while they are being pulled throughanchor holder1230 and loaded to the bone anchor residing therein as described in greater detail below.
• Turing toFIG. 37,anchor holder1230 is shown in greater detail. In an embodiment, an anchor holder coupled to the distal end of an installer may include afirst holder portion1231 and asecond holder portion1232 configured to be reversibly coupled to each other so as to defineanchor holder1230. First andsecond holder portions1231 and1232 may definechannel1234 along the longitudinal axis of the anchor holder.Channel1234 may be sized to acceptbone anchor700 and the distal end ofloading portion1220 ofanchor loading tool1205.
• In an embodiment, first andsecond holder portions1231 and1232 may be coupled to each other by way ofpin1235 as depicted inFIG. 37A. In an alternate embodiment, first andsecond holder portions1231 and1232 may be held together throughslideable ring1236, when engaged encompasses the holder portions.Pin1235 andring1236 may be used as a means of keepinganchor holder1230 assembled.Pin1235 andring1236 may be used either alone or in combination. First andsecond holder portions1231 and1232 may be configured to definecanal1234 when they are coupled, as shown inFIG. 37A.Canal1234 extends substantially along the longitudinal axis ofanchor holder1230. The diameter ofcanal1234 is sized to acceptbone anchor700, or any of the previously disclosed alternate bone anchor embodiments. Though not shown here, the diameter of canal1243 is also sized to accept the distal end ofanchor loading portion1220.
• As discussed above, first andsecond holder portions1231 and1232 may be coupled by way ofpin1235.Pin1235 may reside in a channel defined by bore1236 (FIG. 37B), which extends through at least a portion of the body ofanchor holder1230, at an axis substantially perpendicular to that ofcanal1234. To uncouple first andsecond holder portions1231 and1232,pin1235 may be removed frombore1236. Alternatively,slidable ring1236 may be moved in such a way (e.g.,FIG. 37B) that first andsecond holder portions1231 and1232 are no longer coupled together.
• FIG. 38A shows an enlarged cross sectional view of the distal end of boneanchor installer device1200 according to an embodiment, where a portion ofanchor holder1230 is removed.Bone anchor700 may be loaded to the distal end ofanchor loading portion1220 and help in place byanchor holder1230. Optionally,anchor700 may be tethered to the proximal end ofanchor loading tool1205 by way oftether1260 located inlumen1221, which may extend along the longitudinal axis ofanchor loading portion1220 and optionally as far ashandle portion1210. In an embodiment, one end oftether1260 may be coupled to a portion of the bone anchor (e.g., to one of the two rings defining the two bar locking mechanism) and the other end may extend to the proximal end of the anchor loading tool. In an embodiment,tether1260 may be accessible to the surgeon during use. In an embodiment, the tension oftether1260 may be varied so as to keepbone anchor700 loaded on the anchor loading tool afteranchor holder1230 has been removed.
• In an embodiment, a bone anchor installer system may also includesuture puller1240 pre-loaded through the bone anchor in the anchor holder.Suture puller1240 may be pre-loaded to the installer device in such a way as to facilitate the threading of one or more suture ends through a two bar locking mechanism of a bone anchor, at the time of its deployment. In an embodiment,suture puller1240 may include graspingportion1250 at one end.Grasping potion1250 may be exterior to anchorholder1230 and be readily accessible to the surgeon during use.Suture puller1240 may further includeloop portion1245 at the other end. Loop portion may also be exterior to the anchor holder, such that it is accessible for coupling to suture ends. In an embodiment, the central portion ofsuture passer1240 may be substantially disposed inanchor holder1230, and threaded through at least the two bar locking mechanism of a bone anchor in such a way to enable the suture ends to be properly loaded thereto. As shown inFIG. 38A, a portion ofsuture puller1240 closer toloop portion1245 may pass under the lower bar of the locking assembly, and a portion ofsuture puller1240 closer to graspingportion1250 may pass between the two bars of the locking assembly. Optionally, the intervening portion of the suture puller may be looped aroundpin1235.
• FIG. 38B is a side sectional view of the device shown inFIG. 38A, in which the arrangement ofbone anchor700 andanchor loading portion1220 relative to each other and to anchorholder1230 is shown. In this view,suture puller1240 is not shown.
• FIG. 39 shows boneanchor installer device1200 prior to deployment.FIG. 39B shows an enlarged view of the distal end of the installer, includingsuture puller1240 threaded through bone anchor700 (not seen) as described above. In an embodiment,anchor holder1230 may include slit1233, through whichloop portion1245 and graspingportion1250 may pass.
• FIG. 40 depicts a procedure for deploying a bone anchor using a bone anchor installer device according to an embodiment. Turning toFIG. 40A,cannula1260 may be placed intissue1275 so as to make accessible the site into which a bone anchor will be installed.Cannula1260 will be sized such that the distal end ofanchor loading portion1220 with the bone anchor loaded to the end thereof may be readily passed through the cannula to the site of bone anchor implantation. In an embodiment,suture1265, which will be used to couple tissue to the bone anchor, may be coupled to the appropriate tissue. Suture ends1270 may then be passed through the cannula where they will be accessible to the surgeon. In an embodiment, a suture passer device as described below may be used to suture the tissue and to retrieve and pass suture ends1270 throughcannula1275 as depicted inFIG. 40A.FIG. 40B shows an enlarged view of the distal end of boneanchor installer device1200 andcannula1260 with suture ends1270. Tothread suture1265 through a bone anchor, suture ends1270 may be passed throughloop portion1245 of the suture puller. Next, the surgeon pullssuture puller1240 out ofanchor holder1230 in the direction ofarrow1280 inFIGS. 40C and D, thereby threading the suture ends that are coupled toloop portion1240 through the locking assembly of the bone anchor. In a final step shown inFIG. 40, the surgeon removespin1235 fromanchor holder1230, thereby releasing first andsecond holder portions1231 and1232 from the distal end ofanchor loader portion1220 and exposing the threaded bone anchor ready for installation in a bone hole. As described above,bone anchor700 remains tethered to the distal end of anchor loading portion1120 bytether1260, as described above. The threaded anchor shown inFIG. 40F then be passed through thecannula1275 and installed at the operative site.
• FIG. 41 depicts abone anchor installer1200′ according to an alternate embodiment.Bone anchor installer1200′ may be substantially similar thebone anchor installer1200 already described, with the following differences. In an embodiment,proximal handle portion1210′ ofanchor loading tool1205′ may be configured such that the proximal end oftether1260′ is made accessible to the surgeon. In an embodiment, this may be accomplished by forming, for example, a bore (not seen here) through the length ofhandle portion1210′, along its longitudinal axis. The bore may start at the proximal tip ofhandle portion1210′ and extend to handleportion tip1212′, which couples handleportion1210′ to the proximal end ofanchor loading portion1220′. Attip1212′ the bore may form a continuous passage withlumen1221′ extending alonganchor loading portion1220, through which the free end oftether1260′ is passed, as shown inFIG. 41A.End cap1211′ may be reversibly couplable to the proximal end ofhandle portion1210′. When coupled to handleportion1210′ as shown,end cap1211′ may securetether1260′ such that the tethercoupling bone anchor700′ to the distal end ofanchor loader portion1220′ is kept taught.
• In an embodiment, graspingportion1250′ ofsuture passer1240′ may be substantially ring shaped. In an embodiment,ring portion1250′ may includeclip1251′, which is configured to couplering portion1250′ to the distal end ofanchor loading portion1220′ such thatring portion1250′ is able to slide along the longitudinal axis ofanchor loading portion1220′ as depicted inFIG. 41B.FIG. 41B also shows a view of a portion oftether1260′ residing within the lumen ofanchor loader portion1220′.
• FIGS.42A-D show how a bone anchor may be tethered to anchorloading tool1205′ during use in accordance with one embodiment. Turning toFIG. 42A,anchor loading tool1205′ may includehandle portion1210′ that is couplable to anchorloading portion1220′.Handle portion1210′ may include fastening means1214′ disposed at its proximal end, andtip1212′ and it distal end. Fastening means1214′ may be configured such thatcap1211′, shown inFIG. 42B may be reversibly coupled thereto. In an embodiment, fastening means1214′ may include screw threads.
• Anchor loading portion1220′ may be substantially tubular in shape, withlumen1221′ extending along its length.Anchor loading portion1220′ may includeloading tip1225′ disposed at the distal end thereof.FIG. 42C is an enlarged view of distal end of the anchor loading tool shown inFIG. 42B.Loading tip1225′ may be formed withflange members1226′ which are configured to engagebone anchor700 during use (see, e.g.,FIG. 38B).
• Handle portion1210′ may also includebore1215′ extending from fastening means1214′ to tip1212′. When the handle portion and anchor loading portions are coupled to formanchor loading tool1205′ shown inFIG. 42B, bore1215′ is continuous withlumen1221′ ofanchor loading portion1220, thereby defining a passage in whichtether1260′ is disposed.Tether1260′ may be made of any thread or line suitable for use in surgical applications.Tether1260′ may be used to engage a portion ofanchor700′ and couple it toloading tip1225′. In an embodiment, a portion oftether1260′ may be folded around a portion of the bone anchor locking assembly (see, e.g.,FIG. 42C,element1260a). The ends oftether1260′ pass throughlumen1221′ and bore1215′ of the anchor loading portion and handle portion, respectively, and emerge from fastening means1214′ as shown inFIGS. 42B and 42D. To load the anchor toloading tip1225′, the ends oftether1260′ are tensioned. The tether is kept taught bycoupling cap1211′ to fastening means1214′.
• Suture Passer Devices and the Uses Thereof
• In some embodiments, a bone anchor inserter system may include a suture passer device. Turning toFIG. 43, an embodiment of asuture passer2000 is shown.Suture passer2000 may include aproximal end2010 havinghandle2011 that is pivotable about joint2012.Proximal end2010 may further includegrip2012 coupled to at least a portion of the handle.Proximal end2010 may be configured to allow a surgeon to operate the suture passer, including distal components thereof, during use. Likewise,grip2013 may be configured to control one or more mechanisms located at the distal end of the suture passer when a surgeon compresses the grip during use.Proximal end2010 may include a slidableengaging element2015 coupled to at least a potion ofhandle2011. In an embodiment, engagingelement2015 may be configured to slide along the longitudinal axis of the suture passer between a first position and a second position (shown by the double-headed arrow inFIG. 43).Engaging element2015 may be operable coupled to one or more elements located distally toproximal end2010 as discussed below. In an embodiment, positioning engagingelement2015 from the first position to the second position may allow the engagement of one or more distal elements of the suture passer.
• In an embodiment,suture passer2000 may include a rigid or semi-rigid elongatedcentral portion2020 extending distally fromproximal end2010.Central portion2020 may be configured to allow the operable coupling of one or more elements ofproximal end2010 with one or more elements disposed atdistal end2030 of the suture passer.
• In an embodiment,distal end2030 may include a may include a tissue grasping means2035. A tissue grasping means2035 may be configured to reversibly grasp a tissue. In an embodiment, tissue-grasping means2035 may include alower jaw2038 and anupper jaw2037 rotatable coupled to the lower jaw through hingedconnection2012. Rotatable couple means2012 may be configured to enable the reversible grasping of a tissue between the upper and lower jaws when a surgeon engages a controlling means (e.g., handle2013) located at the proximal end. In an embodiment,upper jaw2037 andlower jaw2038 may each be configured to have at least one suture passage2040 extending therethrough. Suture passage2040 may be sized to allow passage of a suture segment and/or asuture loop2060 through the passage.
• Turning now toFIG. 44, a closer view ofdistal end2030 ofsuture passer2000 is shown.FIG. 44A shows tissue grasping means2035 in a retracted state, whereupper jaw2037 is disengaged fromlower jaw2038. In this view,suture passage2040apassing throughupper jaw2037 andsuture passage2040bpassing throughlower jaw2038 can be seen.
• During operation, a suture length is passed though at least one of the distally located suture passages. Advantageously, the device may be configured such that the suture may be passed through the suture passage in either of the jaws.FIG. 44B shows an embodiment, wherein asuture2045 is passed throughsuture passage2040bthroughlower jaw2038, although it will be recognized that the suture may also be passed through the asuture passage2040awithout departing from the spirit or scope of the presently described embodiments. Passage of the suture throughsuture passage2040boccurs whenupper jaw2037 is still in a retracted state. Engagement of tissue grasping means2035 may be operably controlled from one or more controlling mechanisms disposed at proximal end2010 (not shown). Engagement of tissue grasping means2035 movesupper jaw2037 in the direction indicated by the curved arrow inFIG. 44B, and compressessuture2045 between the upper and lower jaws.
• Proceeding toFIG. 44D,distal end2030 may further include a reversiblyextendable suture threader2050.Suture threader2050 may be made of a rigid or semi-rigid, resilient material.Suture threader2050 may be configured to be reversibly extended in the directions indicated by the double-headed arrow inFIG. 44D when an extending mechanism controllable fromproximal end2010 is engaged. In an embodiment,suture threader2050 may be configured such that, when extended, the distal portion thereof engages at least a portion ofsuture2045 passing through the suture passage, and extends the engaged portion ofsuture2045 though one of thesuture passages2040a/bto formsuture loop2060. Disengagement ofsuture threader2050 allows the retraction thereof back thoughsuture passage2040a/b, and leavessuture loop2060 protruding through the suture passage, as depicted schematically inFIG. 44E.
• In an embodiment,suture passer2000 may include a reversibly engageable mechanical means to retrieve the suture or suture loop after is passed though the suture passer. Engagement of the mechanical suture retrieval means during use may obviate the need for a separate device with which to retrieve the suture loop, thereby improving efficiency, maximizing working volume, and minimizing risk of contamination. In an embodiment, a mechanical suture retrieval means may include a suture capture element. Turning toFIG. 45, a top view ofdistal end2030 withsuture loop2060 protruding fromsuture passage2040ais shown inFIG. 45A. In an embodiment,suture capture element2070 may be disposed at the distal portion ofdistal end2030 and be moveably coupled thereto such thatsuture capture element2070 may be moved along a longitudinal axis between a first retractedposition2070′ shown inFIG. 45A and a secondengaged position2070″ shown inFIG. 45D.Suture capture element2070 may be operably coupled to engagingelement2015 so that manual movement of the engaging element in the distal element tofirst position2015′ shown inFIG. 45B positions suture capture element at retractedposition2070′, and movement of the engaging element in the proximal direction tosecond position2015″ shown inFIG. 45C positions the suture capture element atengaged position2070″ shown inFIG. 45D. When engaged,suture loop2060 may be compressed betweenedge2071 of the suture capture element, andedge2072 ofsuture passage2040a/ballowing the facile retrieval of the suture and/or suture loop.
• While preferred illustrative embodiments of the invention are described above, it will be apparent to one skilled in the art that various changes and modifications may be made therein without departing from the spirit and scope of the invention. The appended claims are intended to cover all such changes and modifications that fall within the true spirit and scope of the invention.
• In this patent, certain U.S. patents, U.S. patent applications, and other materials (e.g., articles) have been incorporated by reference. The text of such U.S. patents, U.S. patent applications, and other materials is, however, only incorporated by reference to the extent that no conflict exists between such text and the other statements and drawings set forth herein. In the event of such conflict, then any such conflicting text in such incorporated by reference U.S. patents, U.S. patent applications, and other materials is specifically not incorporated by reference in this patent.
• Further modifications and alternative embodiments of various aspects of the invention may be apparent to those skilled in the art in view of this description. Accordingly, this description is to be construed as illustrative only and is for the purpose of teaching those skilled in the art the general manner of carrying out the invention. It is to be understood that the forms of the invention shown and described herein are to be taken as the presently preferred embodiments. Elements and materials may be substituted for those illustrated and described herein, parts and processes may be reversed, and certain features of the invention may be utilized independently, all as would be apparent to one skilled in the art after having the benefit of this description to the invention. Changes may be made in the elements described herein without departing from the spirit and scope of the invention as described in the following claims. In addition, it is to be understood that features described herein independently may, in certain embodiments, be combined.

Claims (8)

1. A suture passer comprising:

a proximal end comprising a handle,

an elongated central portion coupled to the proximal end and extending distally from the handle;

a distal end comprising an upper jaw and a lower jaw and being configured to reversibly grasp tissue, the upper jaw and lower jaw each comprising at least one suture passage, wherein the upper jaw and lower jaw are configured to reversibly engage a suture; and

a suture capture element disposed at the distal end, wherein the suture capture element is configured to reversibly engage a suture loop passing through at least one of the suture passages.

2. The suture passer ofclaim 1, further comprising a suture engaging element moveably coupled to the handle such that the suture engaging element can be reversibly moved between a fist position and a second position, wherein the suture engaging element is functionally coupled to the suture capture element such that when the suture engaging element is in the first position, the suture engaging element does not engage a suture loop passing through the suture passage of at least one of the upper or lower jaws, and such that when the suture engaging element is in the second position, the suture engaging element engages a suture loop passing through the suture passage.

3. The suture passer ofclaim 1, further comprising a reversibly extendable suture threader disposed at the distal end, wherein the suture threader is configured to pass a loop of suture through the suture passage of at least one of the upper or lower jaws when extended.

4. A suture passer comprising:

a proximal end comprising a handle and a suture engaging element moveably coupled to the handle, wherein the suture engaging element is configured to slide between a first position and a second position;

an elongated central portion coupled to the proximal end and extending distally from the handle; and

a distal end comprising an upper jaw and a lower jaw and being configured to reversibly grasp tissue, a suture passage passing through the upper jaw and the lower jaw, and a suture capture element.

5. The suture passer ofclaim 4, wherein the suture capture element is configured to engage a suture loop passing through the suture passage when the suture engaging element is substantially in the second position.

6. The suture passer ofclaim 4, further comprising a reversibly extendable suture threader disposed at the distal end, wherein the suture threader is configured to pass a loop of suture through the suture passage of at least one of the upper or lower jaws when extended.

7. A method of passing a suture through a suture passer comprising:

providing a suture passer, the suture passer comprising:

a proximal end comprising a handle and a suture engaging element slidably coupled to the handle, wherein the suture engaging element is configured to slide between a first position and a second position;

an elongated central portion coupled to the proximal end and extending distally from the handle; and

a distal end comprising: an upper jaw and a lower jaw, the upper jaw and a lower jaw being reversibly engageable; a suture passage passing through the upper jaw and the lower jaw; a suture capture element; and a reversibly extendable suture threader;

passing a suture through one of the suture passages;

engaging the upper and lower jaws such that a length of suture passing through the suture passage is grasped therebetween;

extending the suture threader such that a suture loop passes though the remaining suture passage; and

sliding the suture engaging element from the first position to the second position thereby engaging the suture capture element.

8. The method ofclaim 7, further comprising retracting the suture loop in a direction proximal to the proximal end of the suture passer.

Images