US20070288027A1 - Bioabsorbable tissue tack with oval-shaped head and method of tissue fixation using the same - Google Patents

Abstract

A bioabsorbable, cannulated tissue tack having an oblong head is used in sutureless soft tissue fixation to bone, particularly in arthroscopic shoulder surgery. A plurality of ribs are formed along the shaft of the tack. Repair of the glenohumeral joint is performed by installing the tack through a hole formed through the soft tissue of the labrum and into the cancellous bone of the glenoid rim. Aligning the oblong head of the tack lengthwise along the glenoid rim provides a low profile that avoids articular impingement on the tack head.

Description

• This application is a continuation-in-part of U.S. application Ser. No. 10/083,568, filed Feb. 27, 2002, which is a continuation-in-part of U.S. application Ser. No. 09/495,816, filed Feb. 2, 2000, now U.S. Pat. No. 6,517,564, which claims the benefit of U.S. Provisional Application Ser. No. 60/118,228, filed Feb. 2, 1999 and U.S. Provisional Application Ser. No. 60/125,781, filed Mar. 23, 1999, the entire disclosures of which are incorporated herein by reference.
BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• The present invention relates to sutureless fixation of tissue to bone. More specifically, the present invention relates to a bioabsorbable cannulated tissue tack with an angled or straight oval-shaped head for sutureless tissue fixation in the shoulder.
• 2. Description of the Related Art
• When soft tissue tears away from bone, reattachment becomes necessary. Various fixation devices, including sutures, screws, staples, wedges, and plugs have been used in the past to secure soft tissue to bone. More recently, various types of threaded suture anchors have been developed.
• The known suture anchors generally require that the surgeon tie knots in the suture to secure tissue to the bone. Tying surgical knots is tedious and time-consuming. It would be preferable to be able to secure the soft tissue to the bone in one step without having to tie knots.
• Accordingly, a need exists for a bioabsorbable anchor for soft tissue fixation that can be installed to secure tissue easily and effectively without sutures. A need also exists for a soft tissue fixation device having a low profile configuration particularly suited for reattachment of tissue to the glenoid rim.
SUMMARY OF THE INVENTION
• The present invention overcomes disadvantages of the prior art and fulfills the needs discussed above by providing a bioabsorbable tissue tack for sutureless fixation of soft tissue to bone. The tissue tack is cannulated and has a tack-shaped configuration. The head of the tack is oblong to provide a low-profile, and is mounted on a cannulated shaft. The head is mounted at a perpendicular angle to the shaft, or, alternatively, at an anatomic angle.
• Preferred indications for the tissue tack of the present invention include arthroscopic or open repair of glenohumeral joint pathologies. These include reattachment of the glenoid labrum or inferior glenohumeral ligament in patients with primary or recurrent anterior dislocation or subluxation of the shoulder, in association with adequate post-operative immobilization.
• The oblong shape of the tack head provides a narrow profile in one direction to allow head alignment along the glenoid rim. In a preferred embodiment, the heads are oval or elliptical in shape, although a rectangular or diamond oblong shape, for example, also could be used. The oblong head of the installed tack is aligned with the glenoid rim in shoulder repairs, for example, to present a low profile that prevents contact of the tack with articular surfaces.
• Advantageously, according to an alternative embodiment, the oblong head is disposed on the shaft in an angled configuration for situations in which the insertion portal of the tack is not perpendicular to the glenoid rim. Accordingly, both of the extended sides of the oblong head will sit flush with the tissue along the glenoid rim.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a perspective scale view of a bioabsorbable tissue tack with a straight head according to the present invention.
• FIG. 2 is a perspective scale view of a bioabsorbable tissue tack with a straight head according to an alternative embodiment of the present invention.
• FIG. 3 is a plan scale view of a bioabsorbable tissue tack with an angled head according to the present invention.
• FIGS. 4-6 are schematic views illustrating a preferred method of shoulder repair according to the present invention.
• FIG. 7 is a plan view of a tissue tack driver according to the present invention.
• FIG. 8 is an end view detailing the head of the tissue tack driver ofFIG. 7.
• FIG. 9 is a cross-sectional plan view of a centering sleeve according to the present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• A straight-headed bioabsorbable tissue tack2 according to the present invention is shown inFIGS. 1-2. Atissue tack22 having an angled head according to the present is shown inFIG. 3.
• Referring toFIGS. 1-2, tissue tack2 includes a cannulated shaft4 with an oval-shaped cannulated head6 disposed on the proximal end of the shaft. Tissue tack2 has a blunt (i.e., flat) tip5. In the embodiment of the invention shown inFIGS. 1-2, the head6 is formed at a perpendicular angle with respect to the shaft4. Anchoring barbs7 are disposed on the longitudinal ends of oval-shaped head6 and have pointed tips which extend distally toward the tip5 of tack2 to engage the labrum upon insertion. A cannula8 extends continuously through the entire length of the tack2, i.e., through both the head6 and the tip5 as well as the shaft4. The cannula is 2.4 mm in diameter.
• Tack2 is provided withslotted ribs10 formed circumferentially at least partially around and partially along the length of shaft4.Ribs10 have a truncated, conical shape, increasing in diameter toward the head of the tack at an angle of preferably 15° with respect to the longitudinal axis of tack2, and reaching a major diameter of 3.0 mm.Slots12 are formed inribs10 on alternating sides of shaft4. The slots provide access for ingrowth of bony tissue for enhanced pullout strength.
• FIG. 3 shows an embodiment in which atissue tack22 of the present invention is provided with an angled head. Specifically,tissue tack22 has acannulated shaft24 provided with a cannulated oval-shaped head26 disposed at an angle of 30° from the perpendicular with respect to theshaft24. The 30° angle allows flush seating of the tack in the three o'clock to five o'clock positions, or the posterior superior labral positions, of the glenoid rim. As in the embodiment ofFIGS. 1-2, acannula28 extends through the entire length of thetack22, andtack22 is provided withribs30 havingslots32 disposed on alternating sides ofshaft24.
• The head is provided in 3.0 mm and 4.5 mm sizes (widths) to accommodate different anatomies. The 4.5 mm tissue tack is preferably provided with four barbs (two at each end of the oval), whereas the 3.0 mm tissue tack has only two barbs (one at each end). In both cases, the major (end-to-end) length of the head is 7.0 mm, and the head is 1.65 mm thick. The working length of the implant, from the underside of the head to the distal tip, is 12.34 mm for the 3.0 mm head, and 14.7 mm for the 4.5 mm head. There is a smooth area of 3.07 mm from the most proximal edge of the most proximal rib to the underside of the head in both cases.
• The preferred material for the tack is a non-crystalline, amorphous poly (L-lactide-co-D,L-lactide) 70%:30% (PLDLA) copolymer. This material reduces tissue reaction. The tack becomes encapsulated by fibrous tissue within six weeks after implantation, and generally degrades within 12 to 16 months. Although PLDLA is the most preferred material, other bioabsorbable materials known in the art can be utilized. As used herein, bioabsorbable is considered to be interchangeable with biodegradable, resorbable and absorbable to mean that the device can be absorbed by the body over time.
• The tissue tack of the present invention is particularly well suited for reattachment of the glenoid labrum or inferior glenohumeral ligament in patients with primary or recurrent anterior dislocation or subluxation of the shoulder in association with adequate post-operative immobilization.
• A preferred method of installing the tack is described in connection with performing an arthroscopic Bankart repair will now be described with reference toFIGS. 4-9.
• Referring initially toFIG. 4, the arthroscopic procedure is performed within the shoulder through anaccess cannula38. A 2.4 mm cannulatedspear40, such as that disclosed in pending U.S. Pat. No. 5,951,559, the disclosure of which is incorporated herein by reference, is inserted through theglenoid labrum42 using an obturator (not shown).Laser markings44 on the spear are referenced to confirm a perpendicular pilot hole for the straight or angled tissue tack. The labrum is shifted to theglenoid rim46 using the spear.
• The obturator is removed, leaving the spear in place holding the labrum proximate the glenoid rim. A non-cannulated 2.4 mm drill (not shown) is inserted into the spear. Awindow48 in the spear provides arthroscopic control and visualization of the drill. Apilot hole50 is drilled to a depth of 13 mm using a laser line (not shown) located distally on the drill as a depth stop reference.
• The drill is removed, and a cannulated centering sleeve52 (see alsoFIG. 9) is inserted into the spear (1 mm ID). The centering sleeve is pushed or tapped into thepilot hole50. This allows central placement of anitinol guide wire54 into the pilot hole.
• The 1mm guide wire54 is drilled or pushed, preferably using an insertion cap (not shown) such that the guide wire advances past the end of the centering sleeve up to a laser line on the guide wire. This locates the guide wire5 mm further into cancellous bone to prevent the wire from coming out.
• Once theguide wire54 is secured in the base of thepilot hole50, the centeringsleeve52 and thespear40 are removed, leaving theguide wire54 in position.
• Referring toFIG. 5, atissue tack22 according to the present invention is installed over theguide wire54. A cannulatedtissue tack driver56, having a 30° angled head as shown inFIG. 5, and described more fully below, is placed over the guide wire and engages thetack22. Using the driver, the tack is advanced along the guide wire and into thepilot hole50. Rotational adjustments can be made while the implant is partially seated, beforebarbs27 tack into thelabrum42.
• Referring toFIG. 6, further tissue tacks can be inserted in a similar manner to further secure the labrum. Accordingly, straight headed tack2 is inserted into asecond pilot hole60 using a straight-headeddriver70 as shown inFIGS. 7 and 8.Driver70 is similar to angle-headeddriver56 described above. The tissue driver has a cannulatedhandle72 disposed on a cannulatedshaft74. Thedrive head76 has a recessedportion78 having a size and shape that corresponds to the head of the associated tissue tack. Therecess78 is flanked by twocurved walls80 separated byslots82 engage either side of the tissue tack head and allow for proper alignment of the tissue tack with the glenoid rim during insertion, as noted above.
• Once the tack has been properly aligned, a tamp84 is driven with a mallet (not shown) to fully seat the tack with the long axis of the oblong head of the tissue tack aligned along the rim of the glenoid. The head of the tack is brought into flush proximity with the tissue surface, the tack slightly compressing the labrum.Tack22 is shown having been seated using a tamp with an angled offset head. Placement of each tack is finalized by remove the guide wire and the driver.
• Advantageously, the method and instrumentation of the present invention provide for placement of the guide wire after formation of the drill hole. This eliminates the possibility that the guide wire is inadvertently removed. In addition, the tack driver fully encloses the guide wire during insertion, thus eliminating the chance of surgical glove penetration. Repair of SLAP (superior labrum anterior posterior) lesions can be effected in a similar manner.
• Although the present invention has been described in relation to particular embodiments thereof, many other variations and modifications and other uses will become apparent to those skilled in the art.

Claims (8)

1. A bioabsorbable tissue tack for sutureless fixation of soft tissue to bone, comprising:

a cannulated, non-expandable shaft having a distal end and a proximal end;

a plurality of ribs formed circumferentially on the cannulated shaft and extending at least partially around the cannulated shaft; and

a cannulated, longitudinally oblong head, as viewed along a central axis of the shaft, disposed on the proximal end of the shaft.

2. The bioabsorbable tissue tack according toclaim 1, wherein the oblong head is disposed at an angle perpendicular to the central axis of the cannulated shaft.

3. The bioabsorbable tissue tack according toclaim 1, wherein the oblong head is disposed at a non-perpendicular angle to the central axis of the cannulated shaft.

4. The bioabsorbable tissue tack according toclaim 1, further comprising at least two barbs disposed on the head, at least one barb disposed at each longitudinal end of the oblong head, the barbs having respective pointed tips extending toward the distal end of the shaft for engaging the soft tissue upon insertion of the tack into bone.

5. The bioabsorbable tissue tack according toclaim 1, wherein the ribs have a truncated conical shape with a surface sloped at an angle with respect to the longitudinal axis of the tack, the ribs have a major diameter greater than the diameter of the shaft of the tack, and the slots formed in the ribs do not extend into the shaft.

6. The bioabsorbable tissue tack according toclaim 1, wherein a slot is formed in each of the ribs, such that the ribs extend less than completely circumferentially around the shaft of the tack, and slots in adjacent ribs are circumferentially offset.

7. A bioabsorbable tissue tack for sutureless fixation of soft tissue to bone, comprising:

a cannulated shaft having a distal end and a proximal end;

a plurality of ribs formed on the cannulated shaft and extending at least partially circumferentially around the cannulated shaft; and

a cannulated oblong head disposed on the proximal end of the shaft.

8-10. (canceled)

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