US20180008286A1 - Noncircular broach and methods of use - Google Patents

Abstract

The disclosure provides apparatus and methods of use pertaining to a surgical broach for creating a noncircular bore in bone. Embodiments include a surgical punch having a handle coupled with a broach shaft. The broach shaft features a cylindrical portion with a boss projecting radially from the cylindrical portion. When the broach shaft is pressed into bone, it creates a circular bone tunnel having a relief groove projecting radially from and in communication with the circular bone tunnel. Thus, when an implant such as a return anchor for a suture is pressed into the resulting noncircular bore, a return path of the suture passes through the relief groove projecting from the bone tunnel, thereby reducing suture traffic through an internal passage of the anchor and relieving the need for an outer sidewall of the anchor to accommodate the return suture path. Other embodiments are disclosed.

Description

REFERENCE TO PENDING PRIOR PATENT APPLICATIONS
• This application claims the benefit under 35 U.S.C. 119(e) of U.S. Provisional Patent Application Nos. 62/358,231, filed Jul. 5, 2016 by Justin Taber and T. Wade Fallin for “LIGAMENT REINFORCEMENT DEVICES AND METHODS,” 62/425,560 filed Nov. 22, 2016 by Justin Tabor, Phinit Phisitkul, and T. Wade Fallin for “LIGAMENT REINFORCEMENT DEVICES AND METHODS,” 62/456,217, filed Feb. 8, 2017 by Justin Taber and T. Wade Fallin for “PLATE AND LOOP CONSTRUCT,” and 62/458,975, filed Feb. 14, 2017 by Matthew Karam, Phinit Phisitkul, Justin Taber, and T. Wade Fallin for “PELVIC FRACTURE REPAIR,” all of which patent applications are hereby incorporated herein by reference.
REFERENCE TO CO-FILED APPLICATIONS
• This application was co-filed with the following U.S. patent application numbers on Jul. 5, 2017: Ser. No. 15/______, by Matthew Karam, Phinit Phisitkul, Justin Taber, and T. Wade Fallin for “INTRA JOINT STABILIZATION CONSTRUCT,” (Attorney Docket No. 81243.0001); 15/______ by Justin Taber and T. Wade Fallin for “EXTRA JOINT STABILIZATION CONSTRUCT,” (Attorney Docket No. 81243.0002); 15/______ by Phinit Phisitkul, Justin Taber, and T. Wade Fallin for “MULTIPLE SUTURE THREADER AND METHODS OF USE,” (Attorney Docket No. 81243.0004); and 15/______ by Justin Taber and T. Wade Fallin for “COMPRESSION AND TENSION INSTRUMENTS AND METHODS OF USE TO REINFORCE LIGAMENTS,” (Attorney Docket No. 81243.0005); all of which patent applications are incorporated herein by reference.
BACKGROUND
• Ligaments interconnect bones of the skeletal system and are involved with the stabilization and kinematics of skeletal joints. Various injuries may occur that result in compromised ligament function. Such injuries include, for example, partial and complete tears and avulsion of the bone where a ligament attaches to a bone. Ligament injuries occur throughout the skeletal system. To reinforce and/or repair injured ligaments, there is often a need to secure tissue, such as a tendon, ligament, bone, or allograft under tension to neighboring tissue or another medical device such as a bone plate. This tension is often maintained by securing a suture or other flexible strand to the neighboring tissue with a fixation device such as an anchor secured into bone. Such anchors are often attached to structurally sound bone by being lodged into a cavity or tunnel formed within the bone.
• To create the cavity, a surgeon may employ a shaped broach that is mounted upon a handle and hammered or otherwise driven (e.g., pneumatically driven, etc.) into the bone. Existing broaches typically conform to the shape of the anchor.
SUMMARY
• This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to identify key aspects or essential aspects of the claimed subject matter. Moreover, this Summary is not intended for use as an aid in determining the scope of the claimed subject matter.
• One embodiment provides an orthopedic surgical punch for creating a noncircular bore within a bone. The punch comprises a broach shaft including a cylindrical portion and a boss projecting radially from the cylindrical portion. Pressing the broach shaft into the bone forms a cylindrical bone tunnel in communication with a relief groove, where the cylindrical bone tunnel configured to receive and retain a press-in suture return implant having a sidewall that forms an internal passage with a proximal opening, the relief groove providing a clearance pathway for a return path of a suture exiting the suture return implant through the sidewall of the suture return implant.
• Another embodiment provides a method of anchoring a suture to a first bone portion, the suture having opposing first and second ends. The method using (a) a first fixation anchor having a sidewall that forms an internal passage having a proximal opening; and (b) a punch having a broach shaft including a cylindrical portion with a boss projecting radially from the cylindrical portion, where the method comprises the steps of: (i) pressing the broach shaft into the first bone portion to form a circular bone tunnel having a relief groove in communication with the circular bone tunnel; (ii) threading the first end of the suture through the first fixation anchor from the proximal opening, down the internal passage, and out through the sidewall of the first fixation anchor; and (iii) pressing the first fixation anchor into the circular bone tunnel such that the first end of the suture passes out of the first bone portion through the relief groove adjacent the sidewall of the first fixation anchor.
• Yet another embodiment provides a knotless construct for bone or tissue reinforcement. The knotless construct comprises a returning fixation located at a first bone portion, the returning fixation including: (a) a noncircular bore formed within the first bone portion, the noncircular bore comprising a bone tunnel having a relief groove extending radially from the bone tunnel; (b) a first fixation anchor press fit within the bone tunnel, the first fixation anchor having a sidewall forming an internal passage with a proximal opening; and (c) a suture having first and second opposing ends, the first end threaded through the first fixation anchor from the proximal opening, distally down the internal passage, through the sidewall, and proximally out of the first bone portion through the relief groove adjacent the sidewall of the first fixation anchor.
• Additional objects, advantages and novel features of the technology will be set forth in part in the description which follows, and in part will become more apparent to those skilled in the art upon examination of the following, or may be learned from practice of the technology.
BRIEF DESCRIPTION OF THE DRAWINGS
• Non-limiting and non-exhaustive embodiments of the present invention, including the preferred embodiment, are described with reference to the following figures, wherein like reference numerals refer to like parts throughout the various views unless otherwise specified. Illustrative embodiments of the invention are illustrated in the drawings, in which:
• FIG. 1 illustrates a perspective view of a prior art example of a suture returning anchor having a notch in its sidewall for a suture return path;
• FIG. 2 illustrates a perspective view of one embodiment of a surgical punch having a noncircular broach shaft;
• FIG. 3 illustrates a lateral cross-sectional view of the noncircular broach shaft ofFIG. 2;
• FIG. 4 illustrates a perspective view of the surgical punch ofFIG. 2 pressed into bone to form a bone tunnel having a relief groove protruding radially from the bone tunnel;
• FIG. 5 illustrates a top view of the bone tunnel ofFIG. 4;
• FIG. 6 illustrates a cross-sectional view of the bone tunnel ofFIG. 5;
• FIG. 7 illustrates a suture returning anchor loaded upon an anchor driver and having a suture threaded therethrough;
• FIG. 8 illustrates a top view of the suture returning anchor ofFIG. 7 pressed into the bone tunnel ofFIG. 5;
• FIG. 9 illustrates a cross-sectional view of the suture returning anchor pressed into the bone tunnel, as shown inFIG. 8, prior to lockout of the suture via a set screw threaded into the anchor; and
• FIG. 10 provides a flowchart depicting a process for using the punch ofFIG. 2 to create a noncircular bone tunnel and install a suture returning anchor therein.
DETAILED DESCRIPTION
• Embodiments are described more fully below in sufficient detail to enable those skilled in the art to practice the system and method. However, embodiments may be implemented in many different forms and should not be construed as being limited to the embodiments set forth herein. The following detailed description is, therefore, not to be taken in a limiting sense.
• The technology discussed herein relates to apparatus and corresponding methods of use for creating a noncircular bore within bone for push-in suture fixation anchors. Existing fixation anchors are generally press fit into a bore formed in the bone that conforms to the circular or cylindrical shape of the anchor. As a result, and as shown in prior artFIG. 1, existing push-in anchors generally incorporate anotch968 in a sidewall of the anchor. The notch provides a relief for a return path of the suture returning anchor and limits a size potential of the anchor to a range that allows space for the suture-return notch968, thereby requiring a larger anchor than might otherwise be necessary.
• FIGS. 2-4 illustrate apunch970 that may be used with a suture returning and locking anchor similar to, for example, anchors 400, 500 disclosed in FIGS. 6-13 of U.S. patent application Ser. No. 15/______, entitled “EXTRA JOINT STABILIZATION CONSTRUCT” (Attorney Docket No. 81243.0002) and co-filed with this application on Jul. 5, 2017. Thepunch970 may be employed to provide a clearance groove in abone982, which allows a flexible strand such as a suture (hereinafter “suture”) to pass through the implant (e.g., the anchor) and alongside the implant without being pinched between the implant and the bone to permit tensioning.
• In this embodiment, thepunch970 may include ahandle972 and abroach shaft974. Thebroach shaft974 includes acylindrical portion976 with aconical end978. Arectangular boss980 projects radially from thecylindrical portion976, as detailed in the cross-sectional view of thebroach shaft974 provided inFIG. 3.
• FIG. 10 provides a flowchart depicting anexemplary process1300 for using thepunch970 with a fixation anchor to anchor a suture to thebone982, whileFIGS. 5-9 illustrate corresponding steps of theprocess1300. To begin,FIGS. 5-6 illustrate respective top and cross-sectional views of thebone982, into which thepunch970 has been pushed to form atunnel984 having a clearance orrelief groove986 communicating with the tunnel984 (FIG. 10, 1302).
• FIG. 7 illustrates push-inreturn anchor988 loaded upon ananchor driver990 similar to, for example, the counter-torque driver 570 disclosed in FIGS. 15-18 of U.S. patent application Ser. No. 15/______, entitled “EXTRA JOINT STABILIZATION CONSTRUCT” (Attorney Docket No. 81243.0002) and co-filed with this application on Jul. 5, 2017 (FIG. 10, 1304). Asuture992 has been threaded through theanchor988 from a proximal opening, down an internal passage and out through a sidewall with an appropriate suture threader similar to, for example, the multiple suture threaders 1000, 1050 disclosed in FIGS. 1-2 of U.S. patent application Ser. No. 15/______, entitled “MULTIPLE SUTURE THREADER AND METHODS OF USE” (Attorney Docket No. 81243.0004) and co-filed with this application on Jul. 5, 2017 (FIG. 10, 1306).
• InFIGS. 8-9, theanchor988 has been pushed into the bone tunnel984 (FIG. 10, 1308). Afirst end996 of thesuture992 passes out of thebone982 through therelief groove986 such that with thefirst end996 of the suture affixed with an appropriate locking fixation to another bone, soft tissue, and/or anchor (FIG. 10, 1310), asecond end998 of the suture may be pulled to tension the suture using a tension instrument such as, for example, the tension instrument 700 disclosed in FIGS. 12-15 of U.S. patent application Ser. No. 15/______, entitled “COMPRESSION AND TENSION INSTRUMENTS AND METHODS OF USE TO REINFORCE LIGAMENTS” (Attorney Docket No. 81243.0005) and co-filed with this application on Jul. 5, 2017 (FIG. 10, 1312). Atapered set screw999 may then be rotationally driven to reversibly and knotlessly lock the suture via an interference fit between theset screw999, thesuture992, and the sidewall at the proximal opening of theanchor988, as in similar examples discussed in U.S. patent application Ser No. 15/______, entitled “COMPRESSION AND TENSION INSTRUMENTS AND METHODS OF USE TO REINFORCE LIGAMENTS” (Attorney Docket No. 81243.0005), Ser. No. 15/______, entitled “INTRA JOINT STABILIZATION CONSTRUCT” (Attorney Docket No. 81243.0001), and Ser. No. 15/______, entitled “EXTRA JOINT STABILIZATION CONSTRUCT” (Attorney Docket No. 81243.0002), all co-filed with this application on Jul. 5, 2017 (FIG. 10, 1314), thereby resulting in a returning and locking fixation at theanchor988 within thebone tunnel984. In another exemplary embodiment, an operative sequence of steps may include one or more of the following steps, which may or may not occur in the following order. First, place a first anchor with pre-attached suture in a first bone location. Second, broach the non-circular bore with the broach. Third, pass the suture extending from the first anchor into the proximal end of the knotless anchor and out the hole in the sidewall. Fourth, place the knotless anchor into the boar with the trailing suture positioned in the suture relief space. Fifth, tension the suture. Sixth, lock the suture.
• Thedriver990 has been omitted fromFIG. 9. However, it should be understood that thedriver990 would preferably remain engaged with theanchor988 until after thesuture992 is tensioned and theset screw999 is seated in order to provide counterforce against suture tensioning and counter torque against set screw insertion.
• Using thepunch970 having thebroach shaft974 discussed herein, a user may create a noncircular bore having atunnel984 with arelief groove986 that provides an open path between the outer sidewall of theanchor988 and thebone982. Because the return path of thesuture992 passes through the open path of therelief groove986 on the outside of theanchor988, there is a 50% reduction in suture traffic passing through the center bore of theanchor988. This routing of thesuture992 results in a smaller anchor, both because of the reduced suture traffic, or the reduced number of suture thicknesses passing through the center bore of theanchor988, and because there is no longer a need for a sidewall sized to accommodate a notch formed within the outer sidewall of the anchor to provide the return suture path.
• While thepunch970 is described herein in use with a suture returning and locking anchor, thepunch970 may be used with any appropriate surgical implant and/or fixation hardware that benefits from a relief groove in communication with the bone tunnel to accommodate the suture return path.
• Although the above embodiments have been described in language that is specific to certain structures, elements, compositions, and methodological steps, it is to be understood that the technology defined in the appended claims is not necessarily limited to the specific structures, elements, compositions and/or steps described. Rather, the specific aspects and steps are described as forms of implementing the claimed technology. Since many embodiments of the technology can be practiced without departing from the spirit and scope of the invention, the invention resides in the claims hereinafter appended.

Claims (20)

What is claimed is:

1. An orthopedic surgical punch for creating a noncircular bore within a bone, the punch comprising a broach shaft including:

a cylindrical portion; and

a boss projecting radially from the cylindrical portion, wherein pressing the broach shaft into the bone forms a cylindrical bone tunnel in communication with a relief groove, the cylindrical bone tunnel configured to receive and retain a press-in suture return implant having a sidewall that forms an internal passage with a proximal opening, the relief groove providing a clearance pathway for a return path of a suture exiting the suture return implant through the sidewall of the suture return implant.

2. The orthopedic surgical punch ofclaim 1, further comprising a handle affixed to a proximal end of the broach shaft.

3. The orthopedic surgical punch ofclaim 1, wherein the boss of the broach shaft is rectangular.

4. The orthopedic surgical punch ofclaim 1, wherein the cylindrical portion of the broach shaft tapers to a conical distal end.

5. The orthopedic surgical punch ofclaim 1, wherein the suture return implant comprises a suture returning and locking anchor.

6. The orthopedic surgical punch ofclaim 5, wherein the suture returning and locking anchor comprises a knotless and reversible locking mechanism.

7. The orthopedic surgical punch ofclaim 6, wherein the knotless and reversible locking mechanism comprises a set screw rotationally input into the proximal opening of the suture returning and locking anchor to form an interference fit between the set screw, the suture, and the sidewall of the suture returning and locking anchor.

8. A method of anchoring a suture to a first bone portion, the suture having opposing first and second ends, the method using:

a first fixation anchor having a sidewall that forms an internal passage having a proximal opening; and

a punch having a broach shaft including a cylindrical portion with a boss projecting radially from the cylindrical portion, the method comprising:

pressing the broach shaft into the first bone portion to form a circular bone tunnel having a relief groove in communication with the circular bone tunnel;

threading the first end of the suture through the first fixation anchor from the proximal opening, down the internal passage, and out through the sidewall of the first fixation anchor; and

pressing the first fixation anchor into the circular bone tunnel such that the first end of the suture passes out of the first bone portion through the relief groove adjacent the sidewall of the first fixation anchor.

9. The method ofclaim 8, further comprising:

affixing the first end of the suture to one or more of a second bone portion, a soft tissue portion, and a second fixation anchor;

pulling upon the second end of the suture to tension the suture between the first and the second ends; and

locking the second end of the suture relative to the first fixation anchor.

10. The method ofclaim 9, wherein the locking the second end of the suture relative to the first fixation anchor comprises knotlessly and reversibly locking the second end of the suture relative to the first fixation anchor.

11. The method ofclaim 10, wherein the locking the second end of the suture relative to the first fixation anchor comprises rotationally inserting a set screw into the proximal end of the first fixation anchor to form an interference fit between the set screw, the second end of the suture, and the sidewall of the first fixation anchor.

12. The method ofclaim 8, wherein the first fixation anchor comprises a suture returning and locking anchor.

13. The method ofclaim 8, wherein the punch further comprises a handle affixed to a proximal end of the broach shaft.

14. A knotless construct for bone or tissue reinforcement, the knotless construct comprising a returning fixation located at a first bone portion, the returning fixation including:

a noncircular bore formed within the first bone portion, the noncircular bore comprising a bone tunnel having a relief groove extending radially from the bone tunnel;

a first fixation anchor press fit within the bone tunnel, the first fixation anchor having a sidewall forming an internal passage with a proximal opening; and

a suture having first and second opposing ends, the first end threaded through the first fixation anchor from the proximal opening, distally down the internal passage, through the sidewall, and proximally out of the first bone portion through the relief groove adjacent the sidewall of the first fixation anchor.

15. The knotless construct ofclaim 14, wherein the noncircular bore is formed by pressing a broach shaft into the first bone portion, the broach shaft having a cylindrical portion with a boss projecting radially from the cylindrical portion.

16. The knotless construct ofclaim 15, wherein the boss projecting radially from the cylindrical portion of the broach shaft is a rectangular boss.

17. The knotless construct ofclaim 14, wherein the returning fixation comprises a returning and locking fixation and the first fixation anchor is a suture returning and locking anchor.

18. The knotless construct ofclaim 17, further comprising a locking fixation located at one or more of a second bone portion, a soft tissue portion, and a second fixation anchor, wherein the first end of the suture is attached at the locking fixation.

19. The knotless construct ofclaim 18, wherein a tensile force is placed upon the suture between the locking fixation and the returning and locking fixation.

20. The knotless construct ofclaim 19, the returning and locking fixation further comprising a set screw rotationally inserted into the proximal opening of the suture returning and locking anchor to reversibly lock the second end of the suture in relation to the suture returning and locking anchor.

Images