U.S. patent application number 09/865143 was filed with the patent office on 2002-02-07 for rotor blade anchor and tool for installing same particularlly for arthroscopic installation.
This patent application is currently assigned to Li Medical Technologies, Inc.. Invention is credited to Corrao, Ernie, Li, Lehmann K..
Application Number | 20020016602 09/865143 |
Document ID | / |
Family ID | 26910283 |
Filed Date | 2002-02-07 |
United States Patent
Application |
20020016602 |
Kind Code |
A1 |
Li, Lehmann K. ; et
al. |
February 7, 2002 |
Rotor blade anchor and tool for installing same particularlly for
arthroscopic installation
Abstract
A method for securing an anchor to biological tissue, the anchor
being detachably and pivotably mounted to an insertion tool, the
anchor having a longitudinal axis, the insertion tool having a
first axis that extends longitudinally with respect to the
insertion tool and a second axis which extends perpendicularly to
the first axis, the method including releasably holding the anchor
at a distal end of the insertion tool with the anchor being held at
least partly within a sheath member of the insertion tool;
inserting the anchor held by said insertion tool, with the
longitudinal axis of the anchor being disposed in an orientation
that is not perpendicular to the first axis, into a borehole in the
biological tissue; actuating a member at a proximal end of the
insertion tool thereby to move the anchor distally out of the
sheath member; applying a biasing force to the anchor to bias the
anchor toward a position that is substantially perpendicular to the
first axis; the biasing force causing said anchor to rotate about
the second axis and engage with a sidewall of the bore hole and to
penetrate into the sidewall; rotating the anchor about the first
axis, whereby the anchor is screwed into the biological tissue as
the insertion tool is rotated about the first axis and
simultaneously rotated about the second axis until the anchor
achieves an orientation substantially perpendicular to the first
axis; when the anchor is secured in the sidewall, releasing the
anchor from the insertion tool, leaving the anchor secured in the
biological tissue; and withdrawing the insertion tool. The method
and tool are particularly suitable for arthroscopic use.
Inventors: |
Li, Lehmann K.; (Milford,
CT) ; Corrao, Ernie; (Bethel, CT) |
Correspondence
Address: |
OSTROLENK FABER GERB & SOFFEN
1180 AVENUE OF THE AMERICAS
NEW YORK
NY
100368403
|
Assignee: |
Li Medical Technologies,
Inc.
|
Family ID: |
26910283 |
Appl. No.: |
09/865143 |
Filed: |
May 24, 2001 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
60215690 |
Jun 30, 2000 |
|
|
|
Current U.S.
Class: |
606/139 ;
606/232 |
Current CPC
Class: |
A61F 2/0805 20130101;
A61B 2017/0435 20130101; A61B 2017/0409 20130101; Y10S 606/916
20130101; A61F 2/0811 20130101; A61B 17/0401 20130101 |
Class at
Publication: |
606/139 ; 606/72;
606/232 |
International
Class: |
A61B 017/56 |
Claims
What is claimed is:
1. A method for securing an anchor to biological tissue, said
anchor being detachably and pivotably mounted to an insertion tool,
said anchor having a longitudinal axis, said insertion tool having
a first axis that extends longitudinally with respect to said
insertion tool and a second axis which extends perpendicularly to
said first axis, said method comprising the steps of: releasably
holding said anchor at a distal end of said insertion tool with
said anchor being held at least partly within a sheath member of
the insertion tool; inserting said anchor held by said insertion
tool, with said longitudinal axis of said anchor being disposed in
an orientation that is not perpendicular to said first axis, into a
borehole in said biological tissue; actuating a member at a
proximal end of said insertion tool thereby to move said anchor
distally out of said sheath member; applying a biasing force to the
anchor to bias said anchor toward a position that is substantially
perpendicular to said first axis; said biasing force causing said
anchor to rotate about the second axis and engage with a sidewall
of said bore hole and to penetrate into said sidewall; rotating
said tool about said first axis, whereby said anchor is screwed
into said biological tissue as said insertion tool is rotated about
said first axis and simultaneously rotated about said second axis
until said anchor achieves an orientation substantially
perpendicular to said first axis; when the anchor is secured in
said sidewall, releasing the anchor from said insertion tool,
leaving the anchor secured in the biological tissue; and
withdrawing the insertion tool.
2. The method as claimed in claim 1, wherein in said inserting
step, said longitudinal axis of said anchor is more closely
parallel to said first axis.
3. The method as claimed in claim 1, wherein in said inserting
step, the biasing force is prevented from exerting a force on the
anchor.
4. The method as claimed in claim 1, wherein said step of applying
a biasing force to cause rotation of said anchor about said second
axis comprises activating a biasing member disposed in said
insertion tool to cause said anchor to rotate about the second
axis.
5. The method as claimed in claim 1, wherein said biological tissue
has an outer layer and an inner layer, said outer layer having a
strength that is greater than a strength of said inner layer, and
wherein said step of inserting includes inserting said anchor into
said inner layer.
6. The method as claimed in claim 1, wherein said biological tissue
is bone.
7. The method as claimed in claim 5, wherein: said biological
tissue is bone; said outer layer is cortical tissue of said bone;
and said inner layer is cancellous tissue of said bone.
8. The method as claimed in claim 1, wherein said anchor includes
at least one cutting edge disposed thereon to penetrate into said
sidewall.
9. The method as claimed in claim 1, further comprising holding at
least a portion of said anchor at the distal end of said insertion
tool in a first position in the sheath member of the insertion tool
such that the anchor is more closely aligned with a longitudinal
axis of the sheath member, applying a pushing force to the anchor
whereby the anchor slides with respect to the sheath member into a
second position whereby the anchor is not protected by the sheath
member, and causing a biasing member to exert the biasing force on
the anchor when the anchor is in the second position thereby
causing the anchor to rotate about the second axis.
10. The method as claimed in claim 9, wherein the step of applying
the pushing force comprises applying the pushing force to a holder
element for the anchor.
11. The method as claimed in claim 10, wherein the step of applying
the pushing force causes the biasing member to apply the biasing
force to the anchor.
12. The method as claimed in claim 9, wherein said step of
inserting further includes holding said biasing member in a
compressed state in said sheath member so that an outer periphery
of said anchor in said first position is smaller than an outer
periphery of said anchor when said sheath member does not compress
said biasing member when said anchor is in said second
position.
13. A tool for securing an anchor to biological tissue, said tool
comprising: a handle, a hollow sheath member coupled to the handle
having a first axis that extends longitudinally with respect to
said handle, and a second axis that extends perpendicularly to said
first axis; the distal end of said sheath member being adapted to
pivotably and releasably hold an anchor so that said anchor is
pivotable about said second axis, and being adapted to hold the
anchor being at least partly surrounded by said sheath member in a
first position; a biasing member adapted to bias said anchor about
said second axis toward a position which is substantially
perpendicular to said first axis; a pusher member adapted to apply
a force to said anchor to cause said anchor to move from said first
position to a second position distally out of said sheath member;
said handle being rotatable about said first axis to allow said
anchor, once in said second position out of the sheath member, to
rotate about said first axis, said biasing member causing said
anchor to penetrate into a bore hole in said biological tissue by
pivoting about said second axis, thereby to screw into said bore
hole to attain a position which is substantially perpendicular to
said first axis when said anchor is inserted into said bore hole in
said biological tissue.
14. The tool as claimed in claim 13, wherein said sheath member
further comprises a shoulder protrusion extending outwardly from
said sheath member to limit a depth of insertion of said anchor
into said bore hole.
15. The tool as claimed in claim 13, further comprising said anchor
and wherein said anchor further comprises a hub at a center
thereof, said hub including an opening for attachment of sutures
therein.
16. The tool as claimed in claim 13, further comprising said anchor
and wherein: said anchor further includes a leading side and a
trailing side, said leading and trailing sides being disposed so
that when said anchor is inserted into said biological tissue, said
leading side is inserted into said biological tissue before said
trailing side; and at least one of said leading side and said
trailing side includes a cutting portion thereon.
17. The tool as claimed in claim 16, wherein both of said leading
side and said trailing side of said anchor include said cutting
portion.
18. The tool as claimed in claim 16, wherein said biasing member is
a spring.
19. The tool as claimed in claim 18, wherein the spring comprises a
leaf spring.
20. The tool as claimed in claim 16, wherein said biasing member is
in contact with said anchor and said sheath member and is initially
held in a compressed state by said sheath member in said first
position of the anchor and moves to an extended state when the
anchor moves out of said sheath member to said second position.
21. The tool as claimed in claim 20, wherein, upon insertion of
said anchor into said biological tissue, said anchor compresses
said biasing member due to engagement of said anchor with said bore
hole.
22. The tool as claimed in claim 21, wherein said anchor compresses
said biasing member so that an outer periphery of the combination
of said anchor and said biasing member is smaller than an outer
periphery of said combination when said anchor does not compress
said biasing member.
23. The tool as claimed in claim 13, further comprising a suture
coupled to said anchor.
24. The tool as claimed in claim 13, further wherein the biasing
member is a leaf spring having an extendible portion; and further
comprising a cam member holding the extendible portion of the leaf
spring in a compressed state when the anchor is in the sheath
member and when the anchor is pushed out of the sheath member, said
extendible portion of the leaf spring is allowed to extend to an
uncompressed state because said cam member no longer acts on the
extendible portion.
25. The tool as claimed in claim 13, further comprising the
anchor.
26. The tool as claimed in claim 13, wherein the sheath member and
pusher member are flexible.
Description
CROSS-REFERENCE RELATED APPLICATIONS
[0001] This application claims priority to U.S. provisional
application No. 60/215,690 filed Jun. 30, 2000.
BACKGROUND OF THE INVENTION
[0002] The invention relates to fasteners or anchors and, more
particularly, to fasteners or anchors for securement into
biological tissue, particularly bone. The invention finds
particular application in the securement of sutures to bone, such
as the attachment of torn ligaments or ligament replacements to the
bone through attachment of the suture to the anchor.
[0003] In the medical field, it is frequently necessary to securely
attach elements such as ligaments (e.g. rotator cuff ligaments,
anterior cruciate ligaments) and prosthetics, to a bone. Such
attachment requires, initially, that an anchor be secured within
the bone itself. Once the anchor is secured, the ligament or
prosthetic can be attached to the anchor through, for example,
sutures extending from the anchor.
[0004] Various techniques exist for securing an anchor within a
bone. In U.S. Pat. No. 6,117,616, assigned to Li Medical
Technologies, Inc., for example, a longitudinally extending groove
is first made in the bone. An anchor, disposed perpendicularly to
an insertion handle, is then inserted into the groove and screwed
into the bone until the anchor is held securely therein. Since the
anchor is disposed perpendicularly to the handle, it is necessary
to prepare a groove large enough to accommodate the size of the
anchor including its entire length.
[0005] Bones are made of a relatively hard outer layer of tissue
made of cortical bone cells and a softer inner layer of tissue made
of cancellous cells. By making such grooves in the bone, a larger
amount of the harder cortical bone cells must be removed thereby
decreasing the affixing strength available for securing the anchor
within the bone.
[0006] In U.S. Pat. No. 6,102,934, also assigned to Li Medical
Technologies, Inc., a rotor blade inserter includes a pushing
member having a cam surface thereon that engages with an anchor.
The pushing member slides in a channel of a shaft. A collar is
disposed on and threaded with a stationary gripping member of a
handle. When the handle is rotated and the gripping member is held
stationary, the channel of the shaft also rotates, imparting this
rotation to the pusher member and thus the collar. The threads of
the collar then move with respect to the threads of the stationary
gripping member, causing the collar to traverse along the handle,
transferring the translational motion to the pushing member, which
in turn produces a rotational movement of the anchor about an axis
perpendicular to the shaft axis through the engagement of the
anchor with the cam surface. In order to insert the anchor into a
bone, the surgeon must rotate a handle of the device and also hold
the stationary gripping member to allow the collar to traverse the
handle. This operation can be cumbersome and difficult to
effectuate. An embodiment is disclosed where a spring trigger can
be used to apply a force upon the pushing channel when the spring
trigger is actuated. However, actuation of the trigger is an
additional manipulation which must be performed. In many surgical
applications, a surgeon's hands are occupied by numerous tasks and
so it is important to provide a device which can be actuated with
as few movements as possible and/or with one hand.
[0007] In co-pending U.S. application Ser. No. 09/580,777 filed May
26, 2000, a rotor blade anchor and tool therefor is described. The
tool and anchor comprises a handle having a first axis that extends
longitudinally with respect to the handle, and a second axis that
extends perpendicularly to the first axis, an anchor pivotably
coupled to the handle so that the anchor is pivotable about the
second axis and a biasing member disposed on the handle, the
biasing member biasing the anchor toward a position which is
substantially perpendicular to the first axis, the handle being
rotatable about the first axis to allow the anchor to rotate about
the first axis, the biasing member causing the anchor to penetrate
into a bore hole in the biological tissue by pivoting about the
second axis, and to screw into the bore hole to attain a position
which is substantially perpendicular to the first axis when the
anchor is inserted into the bore hole in the biological tissue.
[0008] In U.S. Pat. No. 5,203,787 to Noblitt et al., a hole is
drilled in a bone and then an anchoring device is inserted into the
hole so that a longitudinal axis of the anchoring device is
parallel to a longitudinal axis of the hole. A force is then
applied to a suture coupled to the anchoring device thereby causing
the anchoring device to rotate within the cancellous cells of the
bone so that the anchor extends perpendicularly to the longitudinal
axis of the hole. The anchor is then held within the bone by
abutting against the inside of the harder cortical bone cells. The
technique of Noblitt et al., however, requires complex manipulation
of the suture to achieve the desired orientation of the anchor.
[0009] See also U.S. Pat. No. 5,569,302 to Johnson for an apparatus
and method for attaching an object to bone.
[0010] Moreover, modem trends in surgery include the restoration of
bodily function and form, or repair of anatomical structures
through the use of minimally invasive surgical techniques. The
ability to surgically repair damaged tissues or joints creating as
few and as small incisions as possible, and with ease of
manipulation, produces less trauma to the patient, less pain and
generally better clinical outcomes.
[0011] Thus, there exists a need in the art for a minimally
invasive method and device which more securely attaches an anchor
within a bone than devices and techniques of the prior art, which
does so using a minimum of operator steps and which can be used
arthroscopically, employing minimally invasive surgical
techniques.
[0012] The present invention is an improvement to the above devices
in that the anchor is at least partially concealed and spring
loaded such that direct axial insertion and arthroscopic use are
possible.
SUMMARY OF THE INVENTION
[0013] It is, therefore, an object of the present invention to
provide an apparatus and minimally invasive method for delivering
an anchor simply and securely into human tissue.
[0014] A further object of the invention is to provide an apparatus
and method for emplacing an anchor into a borehole in substantial
alignment with the borehole and once inserted, activated so that it
engages with the walls of the borehole by moving to a position
substantially perpendicular to the borehole.
[0015] Such an anchor would be suitable, for example, to repair
rotator cuff and other ligament injuries such that the appropriate
attachment strength is provided.
[0016] It is a further object of the invention to provide such an
apparatus which is suitable for arthroscope use in body tissue.
[0017] The present invention is directed to an apparatus and a
method for delivering an anchor member which sets in biological
tissue. The method for delivering the anchor member into biological
tissue comprises the following basic steps:
[0018] (a) accessing and preparing the intended insertion site;
[0019] (b) inserting into the site, through a cannula or otherwise,
an anchor member that is set through applying a rotational
motion;
[0020] (c) after insertion into the site, the anchor member engages
the tissue by moving from a first position substantially aligned
with a borehole at the site to a substantially perpendicular
position (to the insertion angle) through a rotational force. Steps
(a) through (c) may be performed through open or minimally invasive
surgical techniques, i.e., arthroscopic techniques.
[0021] According to a further aspect, the invention comprises a
method for securing an anchor to biological tissue, said anchor
being detachably and pivotably mounted to an insertion tool, said
anchor having a longitudinal axis, said insertion tool having a
first axis that extends longitudinally with respect to said
insertion tool and a second axis which extends perpendicularly to
said first axis, said method comprising the steps of: releasably
holding said anchor at a distal end of said insertion tool with
said anchor being held at least partly within a sheath member of
the insertion tool; inserting said anchor held by said insertion
tool, with said longitudinal axis of said anchor being disposed in
an orientation that is not perpendicular to said first axis, into a
borehole in said biological tissue; actuating a member at a
proximal end of said insertion tool thereby to move said anchor
distally out of said sheath; applying a biasing force to the anchor
to bias said anchor toward a position that is substantially
perpendicular to said first axis; said biasing force causing said
anchor to rotate about the second axis and engage with a sidewall
of said bore hole and to penetrate into said sidewall; rotating
said tool about said first axis, whereby said anchor is screwed
into said object as said insertion tool is rotated about said first
axis and simultaneously rotated about said second axis until said
anchor achieves an orientation substantially perpendicular to said
first axis; when the anchor is secured in said sidewall, releasing
the anchor from said insertion tool, leaving the anchor secured in
the biological tissue; and withdrawing the insertion tool.
[0022] The above and other objects are also achieved by a tool for
securing an anchor to biological tissue, said tool comprising: a
handle, a hollow sheath member coupled to the handle having a first
axis that extends longitudinally with respect to said handle, and a
second axis that extends perpendicularly to said first axis; the
distal end of said sheath member being adapted to pivotably and
releasably hold an anchor so that said anchor is pivotable about
said second axis and being adapted to hold the anchor at least
partly surrounded by said sheath member in a first position; a
biasing member adapted to bias said anchor about said second axis
toward a position which is substantially perpendicular to said
first axis; a pusher member adapted to apply a force to said anchor
to cause said anchor to move from said first position to a second
position distally out of said sheath member; said handle being
rotatable about said first axis to allow said anchor, once in said
second position out of the sheath member, to rotate about said
first axis, said biasing member causing said anchor to penetrate
into a bore hole in said biological tissue by pivoting about said
second axis, thereby to screw into said bore hole to attain a
position which is substantially perpendicular to said first axis
when said anchor is inserted into said bore hole in said biological
tissue.
[0023] These aspects, as well as others, will become apparent upon
reading the following disclosure and corresponding drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0024] For the purpose of illustrating the invention, there is
shown in the drawings a form which is presently preferred, it being
understood, however, that the invention is not limited to the
precise arrangements and instrumentalities shown in the
drawings:
[0025] FIG. 1 is cut away side view of an anchor insertion tool and
anchor in accordance with the invention;
[0026] FIG. 2 is an enlarged cut away side view of a distal end of
the tool and anchor of FIG. 1; and
[0027] FIG. 3 is a cut away side view of the tool and anchor of
FIG. 2 shown in the extended position.
DETAILED DESCRIPTION OF THE INVENTION
[0028] In FIG. 1, one preferred embodiment of an insertion tool and
anchor assembly is shown. The anchor 1 is attached to the distal
end 2 of an optionally disposable insertion tool 10. The tool 10
need not be disposable and may be reusable. A movable handle
element or trigger 3 is connected to a pusher element 4, which in
turn is releasably connected to the anchor 1. The pusher element 4
is housed in a sheath member or hollow shaft 6. A finger grip 7 is
provided for the surgeon's finger. The handle 3 is compressed
toward grip 7 to trigger actuation of the anchor 1. The anchor 1 is
threaded with suture 5 which is housed in a slot in the shaft 6. In
this embodiment, the anchor 1 is ready to be deployed by inserting
the generally axially aligned anchor 1 into a pre-drilled bone
hole. As shown, the anchor need only be "generally" aligned with
the shaft 6. In fact, it can be disposed at an acute angle to the
shaft 6, so long as it is substantially within the inner diameter
of the shaft 6 upon insertion into the tissue. As shown, the anchor
is partly contained within the hollow shaft 6 prior to securement
in tissue.
[0029] In FIGS. 2 and 3, a close up side view of the anchor 1 and
the distal end 2 of the insertion tool are shown. FIG. 2 shows the
anchor 1, as it may be positioned within the distal end 2 of the
insertion tool, prior to insertion into a pre-drilled bone hole.
The anchor 1 is at least partially contained within the distal end
2 of the insertion tool and is removably connected to a pusher
element 13. The trailing end of the anchor 1 is situated between
the inside wall of the sheath member 6 and the distal end of a
spring lever 14. The distal end of the spring lever 14 is biased
outwardly, but is restricted by elements 15. FIG. 3 shows the
anchor 1 during the deployment process (prior to the application of
a rotational force but while in a pre-drilled bone hole), having
been completely exposed from the distal end 2 of the insertion
tool. By moving the pusher element 13 far enough distally to expose
the trailing end of the anchor 1 and the leading end of the spring
lever 14 (by moving handle 3 toward finger grip 7), the anchor 1 is
positioned away from a near axial alignment to a more perpendicular
position. The proximal end of the spring lever or leaf spring 14 is
maintained under load by the restricting elements 15 so the distal
end of the spring lever 14 can exert sufficient force on the
trailing end of the anchor 1 to begin deployment. Once the anchor
tips 16 are forced against the inside walls of a predrilled bone
hole (shown by phantom lines 20), the application of a rotational
force to the tool will initiate the deployment process. The anchor
has cutting edges 18 disposed on opposite sides thereof, as also
shown, for example in U.S. Pat. No. 6,102,934, for cutting into the
borehole walls, as the tool, and thus anchor, are rotated. The
rotation causes the anchor to screw into the borehole. The spring
lever 14 imparts a biasing force to the anchor 1, causing the
anchor initially to engage the wall of the borehole when the spring
expands by moving outside the shaft 6, due to sliding motion of the
member 4 acting on pusher element 13.
[0030] In use, the surgeon inserts the anchor into the borehole in
the biological tissue, e.g. bone. The member 3 is compressed toward
grip 7, causing the anchor 1 to move distally out of the sheath.
The spring 14 biases the anchor, causing it to pivot about axis A
into an engagement with the boreholes. By rotating the tool 10, the
anchor is screwed into the borehole. Once the anchor is secured,
the tool is withdrawn, leaving the anchor, and any attached
sutures, secured in the borehole. The anchor is preferably not
fixed to the distal end 6 of the tool, so the tool will release the
anchor when it is withdrawn proximally. Alternatively, the anchor
may be held by the tool using a frangible or releasable (quick
disconnect) connection, as will be appreicated by those of skill in
the art.
[0031] The anchor may be shaped as a circular disc, oval, kidney,
pointed, polygonal, have any symmetrical or asymmetrical
geometrical configuration, or comprise a solid or have
fenestrations. Also, the anchor may be two dimensional, or three
dimensional. The anchor can be attached to a washer, button, or any
flexible element.
[0032] Additionally, the anchor may be made from metal, polymer,
bioabsorbable material, bone, or any other biocompatible material
or combination thereof.
[0033] To insert the anchor, a hole in the bone may or may not need
to be pre-drilled, depending on the sharpness of the leading point
of the anchor, or whether there may be cutting surfaces (such as
threads) on the anchor or the insertion tool.
[0034] The insertion tool may be designed as a single use,
disposable or a reusable instrument. Also, the insertion tool may
be designed for open or minimally invasive surgery. The activation
element to initiate the outward bias of the anchor, shown as spring
lever 14 in the described embodiment, may be a spring of another
type, lever, rod, or any other suitable design element. Near the
distal tip of the insertion tool may be a shoulder stop 22 to
indicate the maximum depth of anchor insertion into biologic tissue
for more precise and reliable engagement of the anchor in
tissue.
[0035] An advantage of the invention is that, since at least a
portion of the anchor is contained within the distal end of the
insertion tool, the anchor is better suited for arthroscopic usage.
The anchor will be protected such that it can be passed through
such obstructions as a flap in a cannula, or multiple layers of
soft tissue.
[0036] Another advantage is that only a small insertion opening (in
the form of a predrilled bone hole) is required to implant the
anchor, thus minimizing the trauma to the biological tissue and
enhancing the fixation capability of the anchor.
[0037] Yet another advantage of the anchor and insertion tool
assembly is the simplicity and convenience of a single use device.
Additionally, the rotation of a pitched cutting edge (Rotor Blade
Anchor) design allows the surgeon to have tactile feedback of the
anchor engagement into the bone hole, just as one would have while
emplacing a screw anchor into bone.
[0038] The sheath 6 as well as pusher element 4 can be rigid or may
have some degree of flexibility to allow bending thereof as
required, for example, for arthroscopic use.
[0039] While preferred embodiments of the invention have been
disclosed, various modes of carrying out the principles disclosed
herein are contemplated as being within the scope of the following
claims. Therefore, it is understood that the scope of the invention
is not to be limited except as otherwise set forth in the
claims.
* * * * *