U.S. patent application number 11/157631 was filed with the patent office on 2007-01-04 for arthoscopic method and apparatus for tissue attachment to bone.
Invention is credited to Brian Dross.
Application Number | 20070005067 11/157631 |
Document ID | / |
Family ID | 37038362 |
Filed Date | 2007-01-04 |
United States Patent
Application |
20070005067 |
Kind Code |
A1 |
Dross; Brian |
January 4, 2007 |
Arthoscopic method and apparatus for tissue attachment to bone
Abstract
Bone constructs of a patient are used to arthroscopically attach
sutures to torn or dysfunctional tissue. Suture is passed through
intersecting tunnels formed in the bone. An end of the suture
extends from each of the tunnels, and the ends are used to secure
the tissue to the bone, such as by arthroscopic tying of the ends,
and pulling the tissue against the bone. Devices for achieving the
process are also described.
Inventors: |
Dross; Brian; (Mount
Pleasant, SC) |
Correspondence
Address: |
B. Craig Killough;Barnwell Whaley Patterson & Helms, LLC
P.O. Drawer H
Charleston
SC
29402
US
|
Family ID: |
37038362 |
Appl. No.: |
11/157631 |
Filed: |
June 21, 2005 |
Current U.S.
Class: |
606/232 |
Current CPC
Class: |
A61B 17/0483 20130101;
A61B 17/0485 20130101; A61B 17/1642 20130101; A61B 17/17 20130101;
A61B 17/1778 20161101; A61B 2017/0608 20130101; A61B 17/1684
20130101; A61B 2017/06028 20130101; A61B 17/1714 20130101; A61B
17/0487 20130101; A61B 17/1796 20130101 |
Class at
Publication: |
606/072 |
International
Class: |
A61B 17/58 20060101
A61B017/58 |
Claims
1. A method of attachment of tissue to bone, comprising the steps
of: a) arthroscopically forming a first tunnel in a bone; b)
arthroscopically forming a second tunnel in said bone, wherein said
first tunnel intersects said second tunnel; c) passing a suture
though said first tunnel and said second tunnel, wherein an end of
said suture extends from an opening to said first tunnel and an
opposite end of said suture extends from an opening to said second
tunnel; and d) securing said first end of said suture and said
second end of said suture over tissue to pull said tissue against
said bone.
2. A method of attachment of tissue to bone as described in claim
1, wherein at least a portion of said first tunnel is not parallel
to said second tunnel.
3. A method of attachment of tissue to bone as described in claim
1, wherein said first tunnel is not linear.
4. A method of attachment of tissue to bone as described in claim
1, wherein said first tunnel does not pass through to an opposite
side of said bone from a side of entry into said bone.
5. A method of attachment of tissue to bone as described in claim
1, wherein said first tunnel does not pass through to an opposite
side of said bone from a side of entry into said bone, and said
second tunnel does not pass through to an opposite side of said
bone from said side of entry into said bone.
6. A method of attachment of tissue to bone as described in claim
1, wherein said first tunnel and said second tunnel intersect
within said bone.
7. A method of attachment of tissue to bone as described in claim
1, wherein a portion of said first tunnel is not parallel to said
second tunnel at a point of intersection of said first tunnel and
said second tunnel.
8. A method of attachment of tissue to bone, comprising the steps
of: a) arthroscopically forming a first tunnel in a bone using a
first drill guide; b) arthroscopically forming a second tunnel in
said bone using a second drill guide, wherein said first tunnel
intersects said second tunnel; c) passing a suture though said
first tunnel and said second tunnel, wherein an end of said suture
extends from an opening to said first tunnel and an opposite end of
said suture extends from an opening to said second tunnel; and d)
securing said first end of said suture and said second end of said
suture over tissue to pull said tissue against said bone.
9. A method of attachment of tissue to bone as described in claim
8, wherein said first tunnel is formed using an arcuate drill guide
having a lumen therein.
10. A method of attachment of tissue to bone as described in claim
9, wherein said second tunnel is formed using a drill guide having
a lumen therein.
11. A method of attachment of tissue to bone as described in claim
8, wherein said first tunnel is formed by a flexible stylus that is
inserted through said drill guide.
12. A method of attachment of tissue to bone as described in claim
8, wherein said second tunnel is formed by a stylus that is
inserted through said drill guide.
13. A method of attachment of tissue to bone as described in claim
8, wherein said second tunnel is formed by a trephine that is
inserted through said drill guide.
14. A method of attachment of tissue to bone as described in claim
11, wherein said flexible stylus has a cutter formed on an end
thereof.
15. A method of attachment of tissue to bone as described in claim
13, wherein said suture is passed through a lumen in said
trephine.
16. A method of attachment of tissue to bone as described in claim
15, wherein, after said trephine is fully advanced to form said
second tunnel, and prior to passing said suture through said lumen
in said trephine, said trephine is partially retracted.
Description
FIELD OF THE INVENTION
[0001] The invention relates to methods and devices and more
specifically relates to the arthroscopic fixation of tissue to bone
using sutures.
BACKGROUND OF THE INVENTION
[0002] Invasive and open surgery methods of attachment of tissue to
bone to repair tissue is known and used. An example of this method
is rotator cuff surgery. In some processes, foreign objects, such
as suture anchors, staples or screws, are implanted and used to
connect tissue to bone.
SUMMARY OF THE INVENTION
[0003] The present invention overcomes the invasive nature of
tissue repairs by open surgical processes, and reduces the reliance
on implants associated with arthroscopic repairs. The invention
uses the bone constructs of the patient to attach sutures to torn
or dysfunctional tissue. Suture is passed through intersecting
tunnels formed in the bone. An end of the suture extends from each
of the tunnels, and the ends are used to secure the tissue to the
bone, such as by arthroscopic tying of the ends, and pulling the
tissue against the bone.
DESCRIPTION OF THE DRAWINGS
[0004] FIG. 1 illustrates a rotator cuff drill guide in place with
a trephine piercing a torn rotator cuff. A single stand of suture
is shown passing through the drill guide, rotator cuff tissue, into
and out of the humeral head, and exiting the central lumen of the
trephine.
[0005] FIG. 2 illustrates three arthroscopic simple stitches, a
repaired rotator cuff, and two lateral vertical portals.
[0006] FIG. 3 illustrates two arthroscopic mattress stitches where
the initial suture in the center bone tunnel was used to pass two
sutures.
[0007] FIG. 4A is the drill guide assembly having an arcuate drill
guide, a straight drill guide and a handle.
[0008] FIG. 4B is the stylus for the arcuate drill guide lumen.
[0009] FIG. 4C is the trephine guide pin that will fit into the
straight drill guide lumen with enough clearance for the
trephine.
[0010] FIG. 4D is the arthroscopic trephine.
[0011] FIG. 4E is an offset hook probe that will pass into the
trephine.
[0012] FIG. 4F is a suture stylus with suture loosely attached.
[0013] FIG. 5 illustrates insertion of the arcuate lumen rotator
cuff drill guide leading with the stylus.
[0014] FIG. 6 illustrates the stylus that has been passed through
the straight drill guide lumen.
[0015] FIG. 7 illustrates the trephine inserted to a calibration
point that advances the tip past the bone void left by the
stylus.
[0016] FIG. 8 illustrates the trephine partially retracted to a
second calibration mark, the suture stylus with suture being
advanced and the hook probe in a readied position.
[0017] FIG. 9 illustrates the suture lodged in the bone void left
by the stylus after being left behind by the suture stylus, and the
hook probe which has been passed through the trephine to capture
the suture.
[0018] FIG. 10 demonstrates an embodiment of the device using
straight, but non-parallel drill guides.
[0019] FIG. 11 demonstrates an embodiment of the device showing an
additional configuration of an arcuate drill guide.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0020] A preferred embodiment of the invention is demonstrated in
repairing a rotator cuff. Two arthroscopic portals 30,32 are formed
in the shoulder 34, such as by a scalpel. The humeral head 36 and
rotator cuff tendons 38 are present. An arcuate drill guide 16
having a central lumen is inserted into one of the portals. If
required, cortical bone may be removed prior to insertion of the
arcuate drill guide.
[0021] The central lumen of the arcuate drill guide has a
protruding flexible stylus 4 therein that is advanced into the
humeral head lateral of the torn rotator cuff. The stylus may be
formed of nitinol. The stylus may have a cutter formed in an end
thereof, such as a drill or mill type cutter. In this embodiment,
the forward end of the arcuate drill guide is curved. Advancement
of the arcuate drill guide may be by manual pressure or by assisted
manual force using, for example, a mallet, or by a power tool, such
as a drill. The arcuate drill guide forms an arcuate tunnel in the
bone. After the arcuate drill guide is fully advanced, the drill
guide stylus is withdrawn, leaving a small void in the bone that is
present beyond the leading edge of the arcuate drill guide. FIG.
6.
[0022] As shown in FIG. 1, straight drill guide 2 is placed through
the other portal. The straight drill guide has a lumen therein. A
stylus is 24 positioned within this lumen. The stylus may be formed
of nitinol. Sufficient space is present within the lumen for
placement of the trephine 6, so that the stylus has a sloppy fit
within the drill guide. The stylus pierces the tissue.
[0023] The trephine is inserted into the lumen of the straight
drill guide. The trephine has a larger diameter than the stylus,
but will rotate within the lumen. The trephine enlarges the tunnel,
and is moved past the arcuate shaped tunnel formed using the
arcuate drill guide. FIG. 7.
[0024] The trephine is retracted. As shown in FIG. 8 the trephine
may have calibration marks 20, 22 to indicate the depth of
insertion and retraction of the trephine. The bone tunnels
intersect as shown.
[0025] With the trephine in place, but with the styli removed from
the drill guides, one or more strands of suture 14 are passed
through the lumens of the drill guides, through a reapproximated
rotator cuff tear, and through the two converging bone tunnels. The
suture also passes through the humeral head (bone), and exits the
central lumen of the trephine. The suture is advanced through the
arcuate drill guide by the suture stylus 12. The hook probe 10 is
inserted through the lumen of the trephine to hook the suture
advanced by the suture stylus at approximately the intersection of
the tunnels. FIG. 9.
[0026] Removal of the drill guides 2,16 leaves the suture in place
for tying. Multiple suture passes allow for tying of the suture
material. For example, three (3) suture passes allow tying three
(3) simple stitches 40 as shown in FIG. 2.
[0027] FIG. 3 shows two arthroscopic mattress stitches 42 where the
initial suture in the center bone tunnel was used to pass two
sutures. The two sutures were tied twice with their adjacent
sutures to form mattress stitches. Alternatively, the outside
suture strands could have been used to pull the corresponding
central suture into the outside tunnel, resulting in one less knot
left in the patient, and the opportunity to use a sliding knot.
[0028] The arcuate drill guide and the straight drill guide may be
connected by a handle 44. The handle positions the relative angles
of the drill guides for forming the tunnels as described. The drill
guides are positioned by the handle so that intersecting tunnels
are formed as disclosed herein. Both drill guides could be
straight, with the drill guides angled in a non-parallel fashion to
form intersecting tunnels. The handle may also be used to receive
and transfer a force for advancing the drill guides, such as by
striking the handle with a mallet.
[0029] Benefits of the present invention over the use of suture
anchors include the introduction of minimal foreign material in the
patient, a larger "healing footprint" (which is variable with the
distance between lumens) and the use of lumens as injection ports
for plate rich/poor blood/growth factors. This method of
arthroscopic bone/suture tunnel creation also has applications in
shoulder laberal repair and posterior cruciate ligament and
anterior cruciate ligament repair, without, or at least reducing,
the requirement of suture anchors, staples or screws. The geometry
of the apparatus relates to an arthroscopic creation of bone
tunnels and simultaneous suture passing to repair a torn or
partially torn rotator cuff.
[0030] FIG. 10 shows the method of arthroscopic attachment of
tissue to bone where different drill guide configurations are used
to address the anatomic structure of the genohumeral joint, which
are different that rotator cuff repair. FIG. 10 shows parallel
drill guide lumens 102,103 that are useful for superior labrum
deficiencies or tears.
[0031] FIG. 11 shows a drill guide that is similar to the rotator
cuff guide, having one arcuate lumen 216 and one straight lumen 202
but having a different converging angle for inferior laberal
repair. Aside from these differences in the apparatus, the method
of arthroscopic securing tissue to the glenoid is the same as
described for attaching the rotator cuff to the humeral head.
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