U.S. patent application number 12/270492 was filed with the patent office on 2010-05-13 for device for drilling angled osteal tunnels.
Invention is credited to Rajiv D. Pandya.
Application Number | 20100121337 12/270492 |
Document ID | / |
Family ID | 42170678 |
Filed Date | 2010-05-13 |
United States Patent
Application |
20100121337 |
Kind Code |
A1 |
Pandya; Rajiv D. |
May 13, 2010 |
DEVICE FOR DRILLING ANGLED OSTEAL TUNNELS
Abstract
A surgical drill guide device for drilling an angled osteal
tunnel having an support rack having a first end and a second end;
a drill guide sleeve having a passage for receiving a drill
therethrough, the drill guide sleeve being adjustably securable and
positionable on the rack between the first end and the second end
of the rack; and a guide component secured on the first end of said
rack, the guide component having a suture seizing mechanism for
seizing a suture.
Inventors: |
Pandya; Rajiv D.; (Atlanta,
GA) |
Correspondence
Address: |
DAVID L. KING, SR.
5131 N.E. COUNTY ROAD 340
HIGH SPRINGS
FL
32643
US
|
Family ID: |
42170678 |
Appl. No.: |
12/270492 |
Filed: |
November 13, 2008 |
Current U.S.
Class: |
606/96 |
Current CPC
Class: |
A61B 17/0482 20130101;
A61B 17/1684 20130101; A61B 17/0483 20130101; A61B 2017/0454
20130101; A61B 17/04 20130101; A61B 17/1714 20130101; A61B 17/1778
20161101 |
Class at
Publication: |
606/96 |
International
Class: |
A61B 17/58 20060101
A61B017/58 |
Claims
1. A surgical drill guide device for drilling an angled osteal
tunnel comprising: a) an support rack having a first end and a
second end; b) a drill guide sleeve having a passage for receiving
a drill therethrough, the drill guide sleeve being adjustably
securable and positionable on the rack between the first end and
the second end of the rack; and c) a guide component secured on the
first end of said rack, the guide component having a suture seizing
mechanism for seizing a suture.
2. The surgical drill guide device as claimed in claim 1, wherein
the suture seizing mechanism comprises a suture seizing pestle and
a target ring having an opening.
3. The surgical drill guide device as claimed in claim 1, wherein
the guide component comprises an interior end to be inserted into
the osteal tunnel and an exterior end attached to the rack.
4. The surgical drill guide device as claimed in claim 1, further
comprising an activating mechanism on the exterior end of the guide
component for engaging the suture seizing mechanism.
5. The surgical drill guide device as claimed in claim 1, further
comprising a clamp and tightening screw whereby the positioning of
the drill guide sleeve is adjustable about the length of the
rack.
6. The surgical drill guide device as claimed in claim 3, wherein
the suture seizing mechanism is located on the interior end.
7. The surgical drill guide device as claimed in claim 3, wherein
the drill guide sleeve comprises a generally cylindrical structure
through which a drill can be inserted and guided to drill into the
bone.
8. The surgical drill guide device as claimed in claim 7, wherein
the drill guide sleeve and the guide component cooperate with each
other to allow the drilling of the second tunnel portion and to
guide the drill bit so that the second tunnel portion intersects at
an angle with the first tunnel portion within the bone.
9. The surgical drill guide device as claimed in claim 8, wherein:
the guide component and the drill guide sleeve are selectively
positionable relative to each other on the rack between the first
end and the second end of the rack such that when the interior end
of the guide component is located intraosteal within a first tunnel
portion drilled into the bone, the drill guide sleeve directs the
drill towards the target ring, whereby a second tunnel portion
drilled into the bone intersects at an angle to the first tunnel
portion.
10. The surgical device as claimed in claim 9, wherein the angle is
greater than 0.degree. and less than 180.degree..
11. The surgical device as claimed in claim 9, wherein the angle is
between approximately 10.degree. and approximately 170.degree..
12. The surgical device as claimed in claim 9, wherein the angle is
between approximately 45.degree. and approximately 135.degree..
13. The surgical device as claimed in claim 9, wherein the interior
end of the guide component comprises an awl tip and the exterior
end of the guide component comprises a tamping plate for forming
the tunnel portions.
14. The surgical drill guide device as claimed in claim 8, wherein
the suture seizing pestle is moved toward the target ring when the
activating mechanism is activated, wherein the movement of the
suture seizing pestle closes the opening of the target ring and
securely presses against the tip of the interior end of the guide
component or the edge of the target ring, whereby a suture is
pinched and secured between the suture seizing pestle and the tip
of the interior end of the guide component or the edge of the
target ring.
15. The surgical drill guide device as claimed in claim 2, further
comprising a suture feeding sleeve having a generally tubular
structure having a hollow interior, an outer diameter smaller than
the osteal tunnel, and an inner diameter large enough to
accommodate the sutures.
16. The surgical drill guide device as claimed in claim 15, wherein
the outer diameter of the suture feeding sleeve is larger than the
opening of the target ring.
17. A surgical drill guide device for drilling an angled osteal
tunnel comprising: a) an arcuate support rack having a first end
and a second end; b) a drill guide sleeve having a passage for
receiving a drill therethrough; and c) a guide component having an
interior end and an exterior end, wherein the interior end is for
inserting into an osteal tunnel and comprises a target ring and a
suture seizing mechanism, and wherein the exterior end comprises an
activating mechanism for activating the suture seizing mechanism,
wherein the guide component and the drill guide sleeve are
selectively positionable relative to each other on the rack between
the first end and the second end of the rack such that when the
interior end of the guide component is located within a first
tunnel portion drilled into the bone, the drill guide sleeve
directs the drill towards the target ring, whereby a second tunnel
portion drilled into the bone intersects at an angle to the first
tunnel portion.
18. The surgical drill guide device as claimed in claim 17, wherein
the guide component is a hollow cylinder.
19. The surgical drill guide device as claimed in claim 17, wherein
the activating mechanism can be squeezed to force the suture
seizing pestle axially in the cylinder and into the target ring so
as to pin a suture against an inner surface of the target ring,
thus seizing the suture.
20. The surgical drill guide device as claimed in claim 17, further
comprising a rack rigidly attached to the guide component, the rack
having a radius of curvature, and a drill guide sleeve attached to
the rack, wherein the drill guide sleeve is attached such that is
can be selectively positioned along the rack.
21. The surgical drill guide device as claimed in claim 18, wherein
the suture seizing mechanism comprises a suture seizing pestle
located within the cylinder, and wherein the target ring and suture
seizing pestle are structured to accommodate a drill bit and to
receive a suture.
22. The surgical drill guide device as claimed in claim 20, further
comprising a clamp and tightening screw whereby the positioning of
the drill guide sleeve is adjustable about the length of the
rack.
23. The surgical drill guide device as claimed in claim 21, wherein
said suture seizing pestle is moved toward the target ring when the
activating mechanism is activated, wherein the movement of the
suture seizing pestle closes the opening of the target ring and
securely presses against the tip of the interior end of the guide
component or the edge of the target ring, whereby a suture is
pinched and secured between the suture seizing pestle and the tip
of the interior end of the guide component or the edge of the
target ring.
24. The surgical device as claimed in claim 20, wherein the angle
is greater than 0.degree. and less than 180.degree..
25. The surgical device as claimed in claim 20, wherein the angle
is between approximately 10.degree. and approximately
170.degree..
26. The surgical device as claimed in claim 20, wherein the angle
is between approximately 45.degree. and approximately
135.degree..
27. The surgical drill guide device as claimed in claim 17, further
comprising a suture feeding sleeve having a generally tubular
structure having a hollow interior, an outer diameter smaller than
the osteal tunnel, and an inner diameter large enough to
accommodate the sutures.
28. The surgical drill guide device as claimed in claim 27, wherein
the outer diameter of the suture feeding sleeve is larger than an
opening of the target ring.
29. A surgical drill guide device for drilling osteal tunnels for
the repair of tom tendons and ligaments comprising: a) a rack
having a first and second end; b) a drill guide sleeve adjustably
secured on the rack, wherein the drill guide sleeve can be
positioned between the first end and the second end of the rack; c)
a guide component secured on the first end of the rack; d) a suture
seizing mechanism attached to the guide component, wherein the
suture seizing mechanism comprises a cooperating target ring and
suture seizing mechanism, and wherein the target ring has an
opening complimentary to a suture inserted therein; and e) an
actuating mechanism for causing the engagement of the suture
seizing mechanism and the target ring, wherein the suture seizing
mechanism is engaged when the actuating mechanism is activated.
30. The surgical drill guide device as claimed in claim 29, wherein
the guide component is a cylinder.
31. The surgical drill guide device as claimed in claim 30, further
comprising a clamp and tightening screw whereby the positioning of
the drill guide sleeve is adjustable about the length of the
rack.
32. The surgical drill guide device as claimed in claim 31, wherein
the suture seizing mechanism comprises a suture seizing pestle that
is movable toward the target ring when the activating mechanism is
activated, wherein the movement of the suture seizing pestle closes
the opening of the target ring and securely presses against the tip
of the interior end of the guide component or the edge of the
target ring, whereby a suture is pinched and secured between the
suture seizing pestle and the tip of the interior end of the guide
component or the edge of the target ring.
33. The surgical device as claimed in claim 32, wherein the angle
is greater than 0.degree. and less than 180.degree..
34. The surgical device as claimed in claim 32, wherein the angle
is between approximately 10.degree. and approximately
170.degree..
35. The surgical device as claimed in claim 32, wherein the angle
is between approximately 45.degree. and approximately
135.degree..
36. The surgical drill guide device as claimed in claim 29, further
comprising a suture feeding sleeve having a generally tubular
structure having a hollow interior, an outer diameter smaller than
the osteal tunnel, and an inner diameter large enough to
accommodate the sutures.
37. The surgical drill guide device as claimed in claim 36, wherein
the outer diameter of the suture feeding sleeve is larger than the
opening of the target ring.
Description
BACKGROUND OF THE INVENTION
[0001] 1. Technical Field
[0002] The present invention generally is related to the field of
osteal guides, surgical drilling systems and methods and devices
for drilling osteal tunnels, and more particularly is related to
osteal guides capable of being used for drilling angled osteal
tunnels.
[0003] 2. Related Art
[0004] The anterior and posterior cruciate ligaments in the knee
assist in providing stability to the function of the knee. The
cruciate ligaments control gliding, sliding, and rotation of the
knee. To accomplish this, the anterior and posterior cruciate
ligaments function according to the principles of a crossed four
bar linkage, which is closely related to and dependent upon the
bony constraints of the surrounding bones. Thus, the anatomic
origin and insertion of both of the ligaments is crucial. Often the
anterior cruciate ligament (ACL) becomes ruptured or torn,
requiring replacement and reconstruction of the ligament in order
to restore normal usage of the knee. When the ACL is restored or
replaced, the ACL or a substitute synthetic or harvested graft must
be reattached to the bone. The ACL graft is anchored in place
either inside or outside of osteal tunnels or passages formed in
the tibia or femur. It is preferential to locate and drill the
tunnels at precise locations so the ACL will be reattached at the
natural location or so the graft will be implanted in the optimum
position. If a ligament reconstruction is performed in the
appropriate location, then normal motion and stability can be
restored. Otherwise, the ligament will eventually be too loose or
too tight for normal function.
[0005] Similarly, tissue repair to the shoulder area, such as
reattaching torn rotator cuff tendons to bone, also can be
accomplished through open surgery or arthroscopic surgery. Because
open surgery introduces potential problems with the trauma
associated with the large area of skin, muscle and tissue that must
be incised to perform such surgery, arthroscopic surgery is
preferred because it has the advantages of requiring only a small
incision, thus reducing the risk of infection, blood loss and the
like sometimes caused by open surgery. The rotator cuff can be
reattached to the humerus by suturing the tendon to the bone by
passing the suture through a transosteal tunnel drilled through the
proximal portion of the humerus. The location at which the tunnel
is to be drilled is paramount because the axillary nerve, a major
nerve which innervates the deltoid muscle, lies close to the
preferred reattachment site. Movement of the shoulder may be
impaired if the axillary nerve is damaged. Often, this results in a
tunnel being close to the surface of the bone, which tunnel may
have a thin wall and therefore be relatively weak and subject to
breaking.
[0006] The repair of torn ligaments by anchoring them into an
osteal tunnel created within the affected bone is dependent upon
complex interdependencies between the ligaments of a human body.
Not only must an osteal tunnel be created so as to provide optimal
positioning and tension, but avoidance of major nerves, blood
vessels, and other anatomical obstructions also dictate the
positioning of the tunnels. Further, while it may be desirable for
surgeons to employ their discretion in selecting the entrance site
of the osteal tunnel, limitations in visibility and accuracy
considerations dictate that surgical positioning instruments are
needed to ensure that an osteal tunnel has a precise drill exit
point. Often, surgeons are required to work in an area that is
"boxed in" by nerves, which gives rise to a need for surgeons to
forego the use of conventional surgical positioning instruments
that might interfere with these delicate areas.
[0007] There are several limitations to current techniques of
fixing soft tissue to bone. The primary methods can be divided into
two categories, the implementation of bone tunnels or the use of
fixation devices such as suture anchors. The latter carries the
risk of implant complications including infection and bony
osteolysis in addition to failure of fixation. Transosseous tunnels
are a more attractive option. Current transosseous tunnel
techniques can be divided into two types. The first involves the
creation of a straight tunnel using guides placed on the surface of
the bone and drilling from one point to the other. The second
involves the creation of curved tunnels using drilling or awling
devices that begin at both entry point of the tunnel and meet in
the middle. However, these techniques are limited by technical
constraints including the size of the bony bridge, surgical
exposure required to allow for access to the bone, and anatomical
constraints such as nerve and vessel proximity. As such, these
limitations further limit the use of transosseous techniques in the
setting of arthroscopic surgery, especially in the shoulder. This
is because such this type of surgery is performed through limited
exposure and is technically constrained by anatomic landmarks.
[0008] Surgical drill guides for use in drilling precision
transosteal tunnels through bone are known in the art. For example,
U.S. Pat. Nos. 5,163,940, 5,330,468 and 6,120,511 all disclose
surgical drill guides. Drill guide devices, such as those taught in
the above-referenced patents, generally comprise a housing having
an axial opening, a probe connected to the housing and having a tip
that is adapted to be disposed within the interior of the joint at
the distal point where one end of the tunnel is to exit the target
bone, and a guide wire sleeve for directing a guide wire into
position on the surface of one of the bones of the joint. The
housing is connected to the probe by an adjustable rack that is
generally of a circular arc configuration. The housing is arranged
so that its axial opening is more or less aligned to intersect with
the aforementioned probe tip, and the guide wire sleeve is
generally slidable or variable in position within the housing's
axial opening. The relative angular position of the probe and the
guide wire sleeve contained within the housing is slidably
adjustable on the rack in order to accommodate differently sized
human bones and joints. All of the aforementioned parts are held in
relation to one another by releasable locking means known in the
art.
[0009] The guide wire sleeve is positioned such that a guide wire
can be inserted into the bone in order to properly position a
drill. Once the guide wire is inserted, the sleeve is removed from
the guide wire, leaving the guide wire embedded in the bone. A
cannulated drill bit is then positioned about the guide wire and a
straight hole is drilled to the exit point initially marked by the
tip of the probe. A suture is then affixed to, through, or around
the torn ligament, and the suture or both are drawn into the osteal
tunnel by a needle eye or alligator clamp that is run through
either the sleeve, the osteal tunnel, or both. The suture is then
tied in a knot, stapled to the bone, or the instrument used to pull
the suture through the osteal tunnel remains in the tunnel as an
anchor which must later be removed from the bone.
[0010] In use, the drill guide device tip is placed at the desired
exit point of the tunnel and the guide wire sleeve is positioned at
the desired entry point of the tunnel. A drill bit is inserted
through the guide wire sleeve and a tunnel is drilled through the
bone from the guide wire sleeve (entry point) to the tip (exit
point). Generally, the tunnel is a straight bore in the form of a
hypotenuse across the corner of the bone. With smaller bones, this
tunnel can be very close to the surface of the bone, and therefore
the tunnel wall closest to the surface of the bone can be thin and
weak.
[0011] Each of the disclosed prior art guides are for performing
straight transosteal tunneling, which can result in a weakening of
the bone, especially when the tunnel created is close to the bone
surface, or the guides require entry or exit points for the tunnel
which are difficult to access. Further, prior art guides do not
allow for flexibility in the positioning on the entrance point of
the osteal tunnel, which is desirable when a surgeon meets with
biological obstacles such as nerves or blood vessels. Also, many
different and complex instruments are required to perform the
completed surgery, which makes the surgery more difficult and
susceptible to error. Finally, prior art methods of attaching the
suture to or within the bone often require either a complex
procedure to secure the suture, or a second surgery to remove an
embedded anchoring device.
[0012] Accordingly, there is a need for an improved osteal guide,
more particularly an osteal guide with improved stability and
performance, resulting in improved tunnel strength. There is also a
need for an improved method for drilling osteal tunnels, more
particularly angled osteal tunnels, which allows a surgeon to be
both flexible and accurate in the placement of the osteal tunnels.
Further, there is a need for improved osteal guide components that
simplify surgery while maintaining accuracy. Finally, there is a
need for an improved device for securing or anchoring sutures used
in ligament reconstruction. It is to these and other needs that the
present invention is directed.
BRIEF SUMMARY OF THE INVENTION
[0013] Briefly, the present invention comprises:
[0014] (a) Osteal guides capable of facilitating the accurate
drilling of an angled osteal tunnel, namely, an osteal tunnel
having an angle or turn within the bone, which guides also can
allow for the preparation or creation of an angled osteal tunnel
having an intraosseous angle;
[0015] (b) Methods for drilling an angled osteal tunnel in which a
first tunnel portion can be drilled free-hand into the bone, a
second tunnel portion can be drilled into the bone using a guide
component to guide the drill bit to the interior end (the end of
the tunnel within the bone, the exterior being at the surface of
the bone), such that the two portions of the tunnel intersect and
connect at an angle, which methods also can include the
intraosseous (that is, blind or without direct visualization)
retrieval of sutures from within the osteal tunnel;
[0016] (c) Guide components that can be inserted into the first
tunnel portion and can function as a guide into which the drill bit
is aimed for drilling the second tunnel portion and for receiving
and seizing a suture or another feeding device, such as a wire,
inserted through the second tunnel portion (or alternatively if the
suture is inserted through the first tunnel portion, the guide
component can be inserted into the second tunnel portion for
receiving and seizing a suture inserted through the first tunnel
portion);
[0017] (d) Retrieving systems to grab or seize a suture or another
suture-feeding device, which retrieving systems also can allow for
the intraosseous (that is, blind or without direct visualization)
retrieval of sutures from within a bone; and
[0018] (e) Suture anchoring methods and components that can secure
or anchor a suture from within or outside of an osteal tunnel when
a suture is positioned within an anchor and the anchor is
compressed and deformed tightly about the suture.
[0019] For the purposes of this specification, the term "drilling"
includes all forms of tunnel creation performed by physicians, such
as, but not limited to, drilling with bits or wires, tamping,
punching, and using awls.
[0020] As shown in FIG. 1, a typical prior art surgical drill guide
comprises three primary components: a guide sleeve through which a
drill bit is passed for drilling the osteal tunnels through a bone,
a guide tip for guiding the drilling direction of the drill bit,
and a rack onto which the guide sleeve and the guide tip are
mounted. The guide sleeve and/or guide tip are typically slidably
mounted on the rack, which may be arcuate, such that different
angles of osteal tunnels can be drilled through the bone. The guide
sleeve also can be displaceably mounted on the rack such that
different sized bones can be accommodated and different lengths of
osteal tunnels can be drilled.
[0021] In the device of the present invention, the typical guide
tip is replaced with a novel guide component that facilitates the
drilling of an angled osteal tunnel, namely an osteal tunnel having
a first portion drilled from one surface of the bone, a second
portion drilled from a second surface of the bone, wherein the
first portion and the second portion intersect and connect at an
angle in the interior of the bone. This guide component is
structured to be insertable into the first tunnel portion so as to
guide the drilling of the second tunnel portion at the appropriate
angle and depth to connect and intersect with the first tunnel
portion within the interior of the bone. The resulting tunnel
generally will have straight or approximately straight first and
second portions intersecting at an angle such that the tunnel as a
whole will be more within the interior of the bone and farther away
from the surface of the bone than a typical transosteal tunnel,
resulting in a stronger tunnel. An angled osteal tunnel created in
this manner gives a surgeon the ability to allow small distances
between the entry sites into the bone and at the same time have a
sufficiently strong bony bridge to maintain the integrity of the
surgical site.
[0022] In the method of the present invention, the first tunnel
portion can be and preferably is drilled or punched free-hand at a
predetermined distance into any bone in a human body located a
suitable distance from a torn tendon or ligament, such as those in
the hand, elbow, shoulder, ankle, and knee. Various devices can be
used in conjunction with the free-hand drilling or punching such
that the first tunnel is drilled in a proper direction, at a proper
angle and for a proper distance. For example, drill stops known in
the art can be attached to the drill bit or the drill guide to set
or limit the depth of the drilling.
[0023] After the first tunnel portion is drilled or punched into
the bone, the guide component is inserted into the first tunnel
portion a certain distance, usually a distance equal or
approximately equal to (but not necessarily) the length of the
first tunnel portion. The guide sleeve then is adjusted on the rack
to allow for a drilling angle and distance desired for the second
tunnel portion. The second tunnel portion then is drilled or
punched using the guide sleeve, guide component, and rack
configuration (that is, not free-hand) whereby the second tunnel
portion is drilled or punched at a specific angle and length so as
to intersect and connect with the first tunnel portion. The
configuration of the guide sleeve and guide component on the rack
provides that the guide sleeve is angled directly at the interior
(inserted) end of the guide component such that the second tunnel
is drilled directly at the interior end of the guide component. The
guide component can include a target at the interior end,
specifically, a hole or open area, such that the drill bit passes
through the target and does not contact the guide component. The
devices and methods of this invention thus can allow the surgeon to
drill an angled osteal tunnel without direct visualization of the
intersection of the first tunnel portion and the second tunnel
portion.
[0024] After the second tunnel is drilled, the guide component can
be left in place in the first tunnel portion such that a suture or
wire inserted into the length of the second tunnel portion can
reach the guide component. The guide component also can have a
suture seizing mechanism, so that the suture or wire can be seized
by this suture seizing mechanism, and the suture or wire can be
pulled through the first tunnel portion. Thus, the present guide
component can allow for the retrieval of a suture from within a
bone without direct visualization of the interior of the osteal
tunnel or the osteal tunnel end points. Alternatively, a wire
having a loop at one end can be pulled through the osteal tunnels
so that a suture can be inserted into the loop and pulled back
through the osteal tunnels. One end of the suture or wire can be
attached to the ligament or muscle in known manners, and another
end of the suture can be attached to the bone in known manners, or
tied together to the ends of other sutures emanating from other
tunnels, or anchored together with sutures emanating from other
tunnels using the novel anchor and anchoring method of the present
invention. A suture also can be tied off in a "mattress" tying
method, by looping a suture around a torn ligament or tendon in a
mattress suture pattern, and then pulling the suture, and often
with it, a portion of the tendon, into the tunnel. In another
illustrative embodiment, one or more ends of a suture that have
been drawn through an angled osteal tunnel can be wrapped around
both the torn ligament or tendon and the bony bridge between the
tunnel entrances and tied or stapled off.
[0025] In the guide component of the present invention, the
interior end (the end that is inserted into the osteal tunnel)
comprises a target and a suture seizing ring. For example, the
guide component can be a cylinder having a grip and trigger
mechanism on the exterior end and a target ring and piston or
pestle on the interior end. Alternatively, hinged scissor handles
can be used on the exterior end. The target ring can be structured
to accommodate the drill bit exiting the second tunnel portion as
the drill bit causes the second tunnel portion to intersect and
connect with the first tunnel portion. The trigger mechanism or
scissor handles can be squeezed or engaged to force the piston or
pestle axially in the cylinder and into the target ring so as to
pin a suture or wire against the inner surface of the target ring,
thus seizing the suture. Thus, the suture can inserted into the
second tunnel portion, or can be gripped by a suture inserter and
inserted into the second tunnel portion, a distance where the
suture interacts with the guide component such that the suture can
be seized by the guide component. As the guide component is removed
from the first tunnel portion, the captured suture or wire is
pulled through the tunnel. Suture inserters are known and can have
a mechanism for gripping and releasing the suture, such as a claw
grip.
[0026] An illustrative alternative of the method for creating
osteal tunnels includes drilling or punching multiple second tunnel
portions all intersecting and connecting with a single first tunnel
portion. For example, a single first tunnel portion can be drilled
as disclosed previously. After the first tunnel portion is drilled,
the guide component is inserted into the first portion a certain
distance as disclosed previously. The guide sleeve is then moved to
a first location on the surface of the bone and is adjusted on the
rack to allow for a drilling angle and distance desired for a first
second tunnel portion. This first second tunnel portion then is
drilled using the guide sleeve, guide component, and rack
configuration as disclosed previously so as to intersect and
connect with the first tunnel portion. The guide sleeve then is
moved to a second location on the surface of the bone and is
adjusted on the rack to allow for a drilling angle and distance
desired for a second second tunnel portion. This second second
tunnel portion then is drilled using the guide sleeve, guide
component, and rack configuration in the same manner as the first
second tunnel portion so as to intersect and connect with the first
tunnel portion. The guide sleeve then can be moved to drill third
and additional second tunnel portions, all of which intersect with
the first tunnel portion.
[0027] A suture or wire is inserted into each of the second tunnel
portions so as to reach the guide component. The sutures are seized
by the suture seizing mechanism of the guide component, preferably
all at once but potentially individually, and are pulled through
the first tunnel portion. One end of each of the sutures can be
attached to the ligament or muscle in known manners, and other ends
of the sutures can be attached to the bone in known manners, or
tied together to ends of other sutures emanating from other
tunnels, or anchored together with sutures emanating from other
tunnels using the novel anchor and anchoring method of the present
invention. Sutures also can be tied off in the "mattress" tying
method, or by wrapping the suture around both the torn ligament or
tendon and the bony bridge between the tunnel entrance and tied or
stapled off, as disclosed earlier. The second tunnel portions can
be in a fan-shaped configuration or in a linear configuration, or
any geometric configuration, relative to the first tunnel
portion.
[0028] Another illustrative alternative of the method for drilling
osteal tunnels includes drilling a number of second tunnel portions
for intersecting with a smaller number of first tunnel portions
such that at least one first tunnel portion intersects and connects
with at least two second tunnel portions. This alternative is
similar to the alternative disclosed above, but at least two first
tunnel portions are drilled, and at least three second tunnel
portions are drilled, with at least two of the second tunnel
portions intersecting and connecting with one of the first tunnel
portions.
[0029] In the anchor component of the present invention, at least
one suture extending through the tunnel can be secured using an
anchor, thus avoiding the use of knots or a staple into the bone.
An illustrative anchor is an oval device through which one or more
sutures can extend. The anchor is then compressed or deformed to
anchor the suture, thus preventing the suture from being pulled
back through the tunnel. In the multi-tunnel embodiments, the
multiple sutures all can be passed through a single anchor.
Alternatively, knots can be used to secure a suture in accordance
with the present invention.
[0030] The present invention, including both the devices and the
methods, can be performed during open surgery and during
arthroscopic surgery. The present invention also can be used or
performed generally anywhere on a human body affected by a torn
muscle, ligament or tendon.
[0031] The present invention involves both methodology and tools
necessary to allow for the creation of angled tunnels, including
the blind creation of angled osteal tunnels, and the intraosseous
retrieval of sutures from osteal tunnels. This entails the use of
an intraosseous guide, a feeder and retrieval system. The resultant
tunnels provide robust bony bridges even with minimal distance
between the surface points of entry and exit on the bone, can be
created through limited exposure, and the technique may be
performed arthroscopically, especially in the shoulder.
Arthroscopic surgery of the shoulder to repair a torn rotator cuff
involves fixation of the torn tendon to bone. Straight tunnels are
precluded because the closer the point of entry and exit, the more
shallow the tunnel and the weaker the bony bridge. The setting of
arthroscopic rotator cuff repair allows for an excellent example of
the utility of the present invention.
[0032] These features, and other features and advantages of the
present invention will become more apparent to those of ordinary
skill in the art when the following detailed description of the
preferred embodiments is read in conjunction with the appended
figures.
BRIEF DESCRIPTION OF THE DRAWINGS
[0033] FIG. 1 is a prior art surgical drill guide device.
[0034] FIG. 2A is an elevational view of an embodiment of the
present invention having a movable drill guide.
[0035] FIG. 2B is a top plan view of the present invention shown in
FIG. 2A, further showing the attachment of the drill guide.
[0036] FIG. 2C is bottom plan view of an embodiment of the guide
component with suture seizing mechanism of the present
invention.
[0037] FIG. 3 is a perspective view of a human bone showing an
angled osteal tunnel drilled using the method and device of present
invention and having a single entrance and exit point.
[0038] FIG. 4 is a perspective view of a human bone with an angled
osteal tunnel similar to that shown in FIG. 3, showing the typical
positional relationships of both the drill guide and guide
component with suture seizing mechanism of FIG. 2A and showing
scissor handles on the suture seizing mechanism.
[0039] FIG. 4A is a top cross-sectional view of a human bone as
shown in FIG. 4 showing the typical positional relationship of the
guide component with suture seizing mechanism within the angled
osteal tunnel.
[0040] FIG. 5 is a schematic cross-sectional view of a human bone
showing an embodiment of the suture seizing mechanism and method of
the present invention in use prior to the seizing of a suture.
[0041] FIG. 6 is a schematic cross-sectional view of a human bone
showing an embodiment of the suture seizing mechanism and method of
the present invention in use subsequent to the seizing of a
suture.
[0042] FIG. 7 is a schematic cross-sectional view of a human bone
showing osteal tunnels having one entrance point and multiple exit
points formed by an alternate embodiment of the method of the
present invention.
[0043] FIG. 8 is a perspective view of a human bone showing osteal
tunnels having multiple entrance points and one exit point formed
by an alternate embodiment of the method of the present
invention.
[0044] FIG. 9 is a perspective view of a human bone showing osteal
tunnels having one entrance point and multiple exit points formed
by an embodiment of the method of the present invention.
[0045] FIG. 10 is a perspective view of an embodiment of the anchor
of the present invention showing the typical positioning of a
suture to be anchored.
[0046] FIG. 11 is a perspective view of an embodiment of the anchor
of the present invention showing an alternate method for anchoring
multiple sutures within the same anchor.
[0047] FIG. 12 is a perspective view of the anchor of FIG. 10 in a
deformed and anchored position about a suture.
[0048] FIG. 13 is a perspective view of a human bone showing the
anchor and alternate method for anchoring multiple sutures within
the same anchor of FIG. 11 in use, with multiple sutures emerging
from multiple osteal tunnel exit points.
[0049] FIG. 14 is a perspective view of a human bone, anchor, and
sutures of FIG. 13, showing the anchor in a deformed and anchored
position about the multiple sutures.
[0050] FIG. 15A is a cross-sectional side view of an embodiment of
a guide component showing an illustrative suture seizing
mechanism.
[0051] FIG. 15B is a top plan view of an illustrative insertion end
of an embodiment of a guide component with the seizing pestle in
the retracted position.
[0052] FIG. 15C is a top plan view of an illustrative insertion end
of an embodiment of a guide component with the seizing pestle in
the extended or seizing position.
[0053] FIG. 16 is an alternate embodiment of the invention shown in
FIG. 2A having a movable guide component and showing a straight rod
and plunger suture seizing mechanism.
[0054] FIG. 17 is an alternate embodiment of the invention shown in
FIG. 2A having a movable drill guide and a movable guide
component.
[0055] FIG. 18A is a perspective view of a clamp and tightening
screw that can be used with the movable drill guide and/or movable
guide component.
[0056] FIG. 18B is a cross-sectional side view of a clamp and
tightening screw shown in FIG. 18A.
[0057] FIG. 19 is a perspective view of a human bone showing an
alternate method for tying and anchoring a ligament with a suture
between osteal tunnels.
[0058] FIG. 20 is a perspective view of a suture feeding sleeve as
part of the present invention.
[0059] FIG. 21 is a cross-sectional side view of the suture feeding
sleeve of FIG. 20 in use.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
[0060] The following detailed description of preferred embodiments
is presented only for illustrative and descriptive purposes and is
not intended to be exhaustive or to limit the scope and spirit of
the invention. The embodiments were selected and described to best
explain the principles of the invention and its practical
applications. One of ordinary skill in the art will recognize that
many variations can be made to the invention disclosed in this
specification without departing from the scope and spirit of the
invention.
[0061] Illustrative embodiments of a device and method for drilling
angled osteal tunnels and anchoring sutures therein according to
the present invention are shown in FIGS. 2A through 9. FIG. 2A is
an elevation view of an embodiment of the present invention having
a movable drill guide. FIG. 2B is a top plan view of the present
invention shown in FIG. 2A, further showing the attachment of the
drill guide. FIG. 2C is bottom plan view of an embodiment of the
guide component with suture seizing mechanism of the present
invention.
[0062] FIG. 3 is a perspective view of a human bone showing an
angled osteal tunnel drilled using the method and device of present
invention and having a single entrance and exit point. FIG. 4 is a
perspective view of a human bone with an angled osteal tunnel
similar to that shown in FIG. 3, showing the typical positional
relationships of both the drill guide and guide component with
suture seizing mechanism of FIG. 2A and showing scissor handles on
the suture seizing mechanism. FIG. 4A is a top cross-sectional view
of a human bone as shown in FIG. 4 showing the typical positional
relationship of the guide component with suture seizing mechanism
within the angled osteal tunnel.
[0063] FIG. 5 is a schematic cross-sectional view of a human bone
showing an embodiment of the suture seizing mechanism and method of
the present invention in use prior to the seizing of a suture. FIG.
6 is a schematic cross-sectional view of a human bone showing an
embodiment of the suture seizing mechanism and method of the
present invention in use subsequent to the seizing of a suture.
FIG. 7 is a schematic cross-sectional view of a human bone showing
osteal tunnels having one entrance point and multiple exit points
formed by an alternate embodiment of the method of the present
invention. FIG. 8 is a perspective view of a human bone showing
osteal tunnels having multiple entrance points and one exit point
formed by an alternate embodiment of the method of the present
invention. FIG. 9 is a perspective view of a human bone showing
osteal tunnels having one entrance point and multiple exit points
formed by an embodiment of the method of the present invention.
[0064] FIG. 10 is a perspective view of an embodiment of the anchor
of the present invention showing the typical positioning of a
suture to be anchored. FIG. 11 is a perspective view of an
embodiment of the anchor of the present invention showing an
alternate method for anchoring multiple sutures within the same
anchor. FIG. 12 is a perspective view of the anchor of FIG. 10 in a
deformed and anchored position about a suture. FIG. 13 is a
perspective view of a human bone showing the anchor and alternate
method for anchoring multiple sutures within the same anchor of
FIG. 11 in use, with multiple sutures emerging from multiple osteal
tunnel exit points. FIG. 14 is a perspective view of a human bone,
anchor, and sutures of FIG. 13, showing the anchor in a deformed
and anchored position about the multiple sutures.
[0065] FIG. 15A is a cross-sectional side view of an embodiment of
a guide component showing an illustrative suture seizing mechanism.
FIG. 15B is a top plan view of an illustrative insertion end of an
embodiment of a guide component with the seizing pestle in the
retracted position. FIG. 15C is a top plan view of an illustrative
insertion end of an embodiment of a guide component with the
seizing pestle in the extended or seizing position.
[0066] FIG. 16 is an alternate embodiment of the invention shown in
FIG. 2A having a movable guide component and showing a straight rod
and plunger suture seizing mechanism. FIG. 17 is an alternate
embodiment of the invention shown in FIG. 2A having a movable drill
guide and a movable guide component.
[0067] FIG. 18A is a perspective view of a clamp and tightening
screw that can be used with the movable drill guide and/or movable
guide component. FIG. 18B is a cross-sectional side view of a clamp
and tightening screw shown in FIG. 18A.
[0068] FIG. 19 is a perspective view of a human bone showing an
alternate method for tying and anchoring a ligament with a suture
between osteal tunnels.
[0069] FIG. 20 is a perspective view of a suture feeding sleeve as
part of the present invention. FIG. 21 is a cross-sectional side
view of the suture feeding sleeve of FIG. 20 in use.
[0070] The present invention is an improved drill guide device for
drilling osteal tunnels and methods for using the same, and
components to be used therewith. The present invention is suitable
for use in conjunction with ACL and rotator cuff ligament repair
surgery in humans, as well as other human ligament, muscle and
tendon repairs. Currently, there is a need for devices and methods
for creating angled osteal tunnels in conjunction with human
ligament, muscle and tendon repair that allows users to be both
accurate and flexible, as wells as devices to simplify surgery,
improve surgical results, and minimize errors. There is a further
need for intraosseous devices and methods for creating osteal
tunnels and retrieving sutures from within osteal tunnels without
having to see or visualize within the bone or osteal tunnels.
[0071] FIG. 1, shows is an illustrative example of a known surgical
drill guide 201 comprising three primary components: a drill guide
sleeve 202 through which a guide wire and/or drill bit 203 is
passed for drilling the osteal tunnel 204 through the bone 205; a
guide tip 206 for guiding the drilling direction of the drill bit
203 or guide wire; and a rack 207 onto which the drill guide sleeve
202 and the guide tip 206 are mounted, which may be arcuate in
shape. The drill guide sleeve 202 and/or guide tip 206 are
typically slidably mounted on the rack 207 such that different
angles of osteal tunnels 204 can be drilled through the bone 205.
The drill guide sleeve 202 also can be displaceably mounted on the
rack 207 such that different sized bones 205 can be accommodated
and different lengths of osteal tunnels 204 can be drilled.
[0072] Referring now to FIGS. 2A, 2B and 2C, an illustrative
example of the surgical tool 8 of the present invention comprises a
guide component 10 mounted to an end of rack 7 which may be arcuate
in shape, and a drill guide sleeve 2 slidably or removably mounted
to the rack 7, which is capable of being securely positioned about
the rack 7, toward either end. The guide component 10 facilitates
the drilling of an angled osteal tunnel 11 (FIG. 3), namely an
osteal tunnel 11 having a first tunnel portion 12 drilled from a
first surface 12a of the bone 5, a second tunnel portion 13 drilled
from a second surface 13a of the bone 5, wherein the first tunnel
portion 12 and the second tunnel portion 13 meet at an intersection
14 and connect at an angle 15 in the interior of the bone 5. The
guide component 10 is structured to be insertable into the first
tunnel portion 12 (FIG. 4) so as to guide the drilling of the
second tunnel portion 13 at the appropriate angle 15 and depth to
connect with the first tunnel portion 12 at the intersection 14
within the interior of the bone 5. The resulting osteal tunnel 11
generally will have straight or approximately straight first and
second portions 12, 13 intersecting at an angle 15 such that the
osteal tunnel 11 as a whole tends to be situated deeper within the
interior of the bone 5 and farther away from the surface of the
bone 5 than a typical transosteal tunnel, resulting in a stronger
osteal tunnel 11.
[0073] The guide component 10 of one embodiment of the surgical
tool 8 comprises an interior end 16, which is inserted into an
osteal tunnel 11 within a bone 5 during a surgical procedure. The
interior end 16 comprises a target ring 17 and a suture seizing
pestle 18. The guide component 10 further comprises an exterior end
19, which is mounted on an end of rack 7. A grip 20 and a trigger
mechanism 21 facilitate the operation of the target ring 17 and
suture seizing pestle 18, such that a suture 22 (see FIG. 5) or
wire can be seized within an osteal tunnel 11 and pulled from an
entrance point at the surface of the bone 5 to an exit point at
another location at the surface of the bone 5. For example, the
guide component 10 can be a hollow cylinder attached to the rack 7
at the exterior end 19 and having a blunt or rounded tip. The guide
component 10 also has an opening near the tip of the interior end
16 that forms the target ring 17. The opening within the target
ring 17 may be round, oval, or otherwise shaped so as to
accommodate a suture.
[0074] The guide component 10 of another embodiment of the surgical
tool 8 comprises an interior end 16 having an awl tip 16a and an
exterior end 19 having a tamping plate 19a. Depending on the
conditions and quality of the bone 5 in which the osteal tunnel is
formed, it may be preferable to tamp or punch any portion of the
angled osteal tunnel 4 using a punching device with a sharp tip,
such as an awl. A surgeon can punch an osteal tunnel 4 by either
pushing the awl tip 16a into the bone 5, or using a hammer or other
suitable object to tap the tamping plate 19a, thus driving the awl
tip 16a of the guide component 10 into the bone 5. The guide
component 10 can remain in a tamped or punched first tunnel portion
12, and the drill guide sleeve 2 can be coupled with a drill to
create a second tunnel portion 13. Alternatively, a second tunnel
portion 13 is tamped or punched in a similar manner using a
punching device, such as an awl tip 16a with a tamping plate
19a.
[0075] In a preferred embodiment, the drill guide sleeve 2 is a
hollow tube through which an osteo drill can be operated, and is of
a structure generally known in the art. In an embodiment in which
the drill guide sleeve 2 is movable on the rack 7, the drill guide
sleeve 2 is slidably mounted on the rack 7 by a clamp 23 and
tightening screw 24 so that the positioning of the drill guide
sleeve 2 is adjustable about the length of the rack 7.
Alternatively, the drill guide sleeve 2 can be fastened to the rack
7 by a clip, a bolt, or any other means known in the art to
securely fix the drill guide sleeve 2 in the desired position on
the rack 7. In the present invention, and as is disclosed in more
detail below, it is preferable that the drill guide sleeve 2 is
movable on the rack 7 and that the guide component 10 is fixed on
the rack 7 because, as the guide component 10 is placed into a
first tunnel portion 12 that has been drilled free-hand without the
use of a drill guide sleeve 2, the guide component 10 supports the
rack 7 so that the drill guide sleeve 2 can be moved to any
convenient position about the rack 7 for drilling the second tunnel
portion 13. The preferably rigid attachment of the guide component
10 to the rack 7 assists in ensuring that the second tunnel portion
13, when drilled, will accurately intersect the first tunnel
portion 12 without regard to the position of the first tunnel
portion 12, forming a functional angled osteal tunnel 4. However,
as disclosed in conjunction with FIGS. 16 and 17, in alternate
embodiments either or both of the drill guide sleeve 2 and guide
component 10 can be slidably mounted on the rack 7.
[0076] Referring now to FIG. 3, in a preferred embodiment of the
method of the present invention, the first tunnel portion 12 is
drilled from a preferred first surface 12a of the bone 5 to a
predetermined depth into the bone 5. Drilling can be performed
free-hand or with a drill guide. Free-hand drilling is performed
without the aid of a drill guide, where a first tunnel portion 12
is created by any means known in the art, but preferably using a
surgical drill and drill bit 3 or by punching or tamping a tamping
plate 1 9a to create a hole with an awl tip 16a. After a preferred
first surface 12a of the bone 5 is chosen, a first tunnel portion
can be created by positioning the drill bit 3 over the first
surface 12a and engaging the drill. The first tunnel portion 12 is
drilled to a predetermined depth, which may be gauged by indicia on
the drill or the drill bit 3. The depth of the first tunnel portion
12 is limited to avoid drilling from one surface to an opposing
surface of the bone 5.
[0077] Referring now to FIG. 4, which shows the surgical tool 8 of
the present invention in use, after the first tunnel portion 12 is
drilled, the guide component 10 is positioned in the first tunnel
portion 12, and the drill guide sleeve 2 is placed at the desired
position at the second surface 13a of the bone 5. A drill bit 3,
sometimes referred to as an osteo drill bit, is aimed by the drill
guide sleeve 2 and can be used to drill a measured distance into
the bone 5 to create the second tunnel portion 13, which intersects
within the interior of the bone 5 at an angle 15 with first tunnel
portion 12. The target ring 17 on the interior end 16 of the guide
component 10 can be structured to accommodate a drill bit 3
drilling the second tunnel portion 13 through to the first tunnel
portion 12. More specifically, and as disclosed in more detail in
conjunction with FIG. 15, when the drill bit 3 exits the second
tunnel portion 13 and enters the first tunnel portion 12, the drill
bit 3 can pass into and through the center of the target ring 17
without touching the guide component 10.
[0078] After the first tunnel portion 12 is drilled, the guide
component 10 is inserted into the first tunnel portion 12 a certain
distance, usually a distance equal or approximately equal to (but
not necessarily) the length of the first tunnel portion 12 (see
also FIG. 4A). The interior end of guide component 10 is within the
bone and generally cannot be seen with the naked eye. The drill
guide sleeve 2 then is adjusted on the rack 7 so that the drill
guide 2 is located proximal to the position on the second surface
13a of the bone 5 where it is desired to drill the second tunnel
portion 13. The positioning of the surgical tool 8 with the guide
component 10 within the first tunnel portion 10 and the drill guide
sleeve 2 proximal to the surface of the bone 5 where the second
tunnel portion 13 is to be drilled allows for a proper drilling
location and angle for the second tunnel portion 13. This feature
is advantageous because regardless of the relative position or
length of the first tunnel portion 12, a user is able to use the
surgical tool 8 to achieve any desired entrance or exit point into
or out of the bone 5 for the second tunnel portion 13 such that a
suture 22 can be threaded and to avoid encountering impediments
such as nerves or blood vessels. In other words, the location of
the second surface 13a is not dependent upon the location of the
first surface 12a and provides a user a great amount of freedom in
selecting the entrance and exit points of the angled osteal tunnels
4.
[0079] After the drill guide sleeve 2 is positioned at the chosen
second surface 13a and clamped into place on the rack 7, the second
tunnel portion 13 then is drilled using a drill bit 3 inserted
through the drill guide sleeve 2. The rack 7 is structured, and the
drill guide sleeve 2 and guide component 10 attached to rack 7,
such that the guide sleeve 2 points towards the target ring 17.
Thus, the positioning of the drill guide sleeve 2, the guide
component 10, and the rack 7 provides for a drilling configuration
(that is, not free-hand) whereby the second tunnel portion 13 is
drilled at a specific angle 15 and length so as to intersect and
connect with the first tunnel portion 12 at a point 14. The drill
bit 3 then is removed from the drill guide sleeve 2. The drill
guide sleeve 2 also can be removed from the second tunnel portion
13. The target ring 17 now is generally aligned with the axis of
the second tunnel portion 13. Alternatively, use of an awl or an
awl-tipped guide component 10 or other drilling or tunneling
devices and methods can be used.
[0080] The guide component 10 and the drill guide sleeve 2
preferably are selectively positionable relative to each other on
the rack 7 between the first end and the second end of the rack 7
such that when the interior end of the guide component 10 is
located within a first tunnel portion 12 drilled into the bone 5,
the drill guide sleeve 2 directs the drill towards the target ring
17, whereby a second tunnel portion 13 drilled into the bone 5
intersects at an angle 15 to the first tunnel portion 12.
Preferably, the angle 15 is greater than 0.degree. and less than
180.degree.. More preferably, the angle 15 is between approximately
10.degree. and approximately 170.degree.. The angle 15 also can be
between approximately 45.degree. and approximately 135.degree..
[0081] In one embodiment of the method of the present invention,
once the second tunnel portion 13 of the angled osteal tunnel 4 has
been completed, the drill bit 3 is removed, and the guide component
10 and the drill guide sleeve 2 can be left in place. Referring now
to FIGS. 5 and 6, a suture 22, which may or may not be attached to
a torn or synthetic ligament, is fed into the drill guide sleeve 2
and through the second tunnel portion 13. Alternatively, the drill
guide sleeve 2 can be removed and the suture 22 fed directly into
the second tunnel portion 13. The suture 22 or wire may be fed into
the second tunnel portion 13 by any appropriate suture inserter
known in the art, including a needle, an alligator clamp, a wire
loop, or other known means. The suture 22 is inserted a distance
such that the suture 22 interacts with the guide component 10 such
that the suture 22 can be seized by the guide component 10. In a
preferred embodiment, the suture 22 interacts with the target ring
17 on the interior end 16 of the guide component 10, namely is
inserted through the target ring 17, and is seized when a suture
clamping component, such as suture seizing pestle 18, in effect
clamps the suture 22 against the target ring 17, as disclosed below
in conjunction with FIG. 15. Trigger mechanism 21 or scissor
handles 40 move the suture seizing pestle 18 into the fixed target
ring 17, or alternatively, move the target ring 17 toward the fixed
suture seizing pestle 18. The suture 22 seized by the guide
component 10 is pulled through and out of the angled osteal tunnel
4 when the guide component 10 is removed from the second tunnel
portion 13 while the trigger mechanism 21 or the scissor handles 40
are engaged or squeezed. Such a guide component 10 therefore allows
for the intraosseous retrieval of sutures. This is, the suture 22
is within the bone 5, in the angled osteal tunnel 12, 13, and the
guide component 10 allows for the retrieving of the suture 22 from
within the bone 5 without having to look within the bone 5.
[0082] In one illustrative embodiment, the suture seizing mechanism
of the guide component 10 is a grip and trigger mechanism 21,
wherein the trigger is movable relative to the grip and the trigger
is operatively connected to the suture seizing component, such as
suture seizing pestle 18, whereby moving the trigger relative to
the grip causes the movement of the suture seizing component. In
another illustrative embodiment, the suture seizing mechanism is a
hinged scissors handle 40 mechanism wherein one scissor handle is
movable relative to another scissor handle and one scissor handle
is operatively connected to the suture seizing component, such as
suture seizing pestle 18, whereby moving the scissor handles
relative to each other grip causes the movement of the suture
seizing component.
[0083] Referring now to FIG. 5, the guide component 10 is left in
place in the first tunnel portion 12 and a suture 22 is inserted
into the length of the second tunnel portion 13, in a manner and/or
using a device as already disclosed, so as to reach the guide
component 10 (see FIG. 4). Once inserted into and through the
second tunnel portion 13, the suture 22 passes into the target ring
17, which has been left in place in the first tunnel portion 12.
Once the first tunnel portion 12 is drilled and the guide component
10 is inserted, the target ring 17 is aligned with the direction of
the drill guide sleeve 2 such that both a drill bit 3 and a suture
22 fed into the second tunnel portion 13 through the drill guide
sleeve 2 will communicate with and be inserted into the target ring
17 when inserted to the proper depth.
[0084] Referring now to FIG. 6, once the suture 22 is inserted to a
proper depth so as to enter into the target ring 17, the suture 22
is seized and firmly held by the interaction of the target ring 17
and the suture seizing pestle 18 when the grip 20 and trigger
mechanism 21 are engaged by squeezing them together, or
alternatively, when the scissor handles 40 are engaged. It should
be understood that other preferred embodiments of the suture
seizing mechanism may employ other means known in the art to move
the suture seizing pestle 18 within the target ring 17 to grasp a
suture 22 including electronically-operated mechanisms. With the
grip 20 and trigger mechanism 21 in the engaged or squeezed
position, the suture 22 is pulled through and out of the first
tunnel portion 12 where it can be tied or otherwise secured within
the osteal tunnel 4 or outside of the bone 5. For example, one end
of the suture 22 can be attached to the ligament or muscle in known
manners, and another end of the suture 22 can be attached to the
bone 5 in known manners. Alternatively, the attachment methods and
means of the present invention, as disclosed in conjunction with
FIGS. 10-14 and 19, are preferred.
[0085] FIGS. 7, 8, and 9 show illustrative alternatives of the
method for drilling or punching osteal tunnels 4, including
drilling multiple osteal tunnels 4 connected by one intersecting
osteal tunnel 4 and drilling multiple angled osteal tunnels 4
emanating from one entrance point at the surface of the bone 5. The
present invention allows the user to more easily drill multiple
osteal tunnels 4 and multiple intersecting osteal tunnels 12, 13 so
as to provide a better anchor for ligaments, tendons and
muscle.
[0086] Referring now to FIG. 7, an alternate method for drilling
angled osteal tunnels 4 of the present invention is shown. A first
second tunnel portion 25 and a second second tunnel portion 26 can
be drilled in a linear configuration. The multiple second tunnel
portions 25, 26 intersect and connect with a single first tunnel
portion 12. For example, a single first tunnel portion 12 can be
drilled or punched free-hand as disclosed previously at a desired
first surface 12a of the bone. After the first tunnel portion 12 is
drilled, the guide component 10 is inserted into the first tunnel
portion 12 a certain first distance. The drill guide sleeve 2 then
is moved to a desired location at a first second surface 25 of the
bone 5 and is adjusted on the rack 7 at the desired first second
surface 25a of the bone 5 to allow for a drilling location, angle
and distance desired for a first second tunnel portion 25. This
first second tunnel portion 25 then is drilled using the drill
guide sleeve 2, guide component 10, and rack 7 configuration as
disclosed previously so as to intersect and connect with the first
tunnel portion 12 at a first intersecting point 4a. The guide
component 10 then can be moved axially within the first tunnel
portion 12 a certain second distance, different than the first
distance. The drill guide sleeve 2 then is moved to a second first
surface 26a of the bone 5 and is adjusted on the rack 7 to allow
for a drilling location, angle and distance desired for a second
second tunnel portion 26. This second second tunnel portion 26 then
is drilled using the drill guide sleeve 2, guide component 10, and
rack 7 configuration in the same manner as the first second tunnel
portion 25 so as to intersect and connect with the first tunnel
portion 12 at a second intersecting point 4b. The guide component
10 and the drill guide sleeve 2 then can be moved to drill third
and additional second tunnel portions (not shown), all of which can
intersect with the first tunnel portion 12 at other intersecting
points. Sutures 22 can be inserted into each of the second tunnel
portions 13, 25, 26, etc., seized one at a time by the suture
seizing mechanism, and pulled through the first tunnel portion 12,
to be secured using the methods and devices disclosed herein. The
second tunnel portions can be parallel to each other, as shown in
FIG. 7, in parallel planes to each other, or at angles to each
other, as desired or required by the circumstances.
[0087] Referring now to FIG. 8, another alternate method for
drilling angled osteal tunnels 4 of the present invention is shown.
A first second tunnel portion 25, a second second tunnel portion
26, and a third second tunnel portion 27 can be drilled in a
fan-shaped configuration, or any geometric configuration relative
to the first tunnel portion 12. This method includes drilling a
number of second tunnel portions 25, 26, 27, and more if desired,
for intersecting with a smaller number of first tunnel portions 12
such that at least one first tunnel portion 12 intersects and
connects with at least two second tunnel portions 25, 26, for
example. This alternative is similar to the alternative disclosed
above, but at least three second tunnel portions 25, 26, 27 are
drilled, with at least two of the second tunnel portions, 25, 26,
for example, intersecting and connecting with one of the first
tunnel portions 12. A third tunnel portion 28 also can be drilled
to intersect with one of the second tunnel portions. Various
configurations of intersecting first, second, and third tunnel
portions are envisioned to enhance the anchoring of the tendons,
ligaments or muscles. One limitation to the number of tunnels
drilled is, of course, the size and thickness of the bone 5 and the
available area with which to work, and the ability to pass sutures
through the connecting tunnel portions.
[0088] As shown in FIG. 8, third tunnel portion 28 intersects with
third second tunnel portion 27 but not with the first tunnel
portion 12. As described above, the first tunnel portion 12 is
drilled free-hand. The guide component 10 is inserted into the
first tunnel portion 12 and the drill guide sleeve 2 is positioned
to create third second tunnel portion 27. Then, the guide component
10 is inserted into third second tunnel portion 27 and the drill
guide sleeve 2 is positioned to create third tunnel portion 28
which does not intersect first tunnel portion 12. Sutures 22 then
can be pulled through the various tunnel portions as described
above.
[0089] Referring now to FIG. 9, in still another illustrative
alternate method for drilling angled osteal tunnels 4, multiple
first tunnel portions, 30, 31, 32, are drilled free-hand. The guide
component 10 is inserted into first first tunnel portion 30, and
the drill guide sleeve 2 is positioned above an entrance point 33
to create a first second portion 30a. The guide component 10 is
next inserted into second first tunnel portion 31, and the drill
guide sleeve 2 is again positioned above entrance point 33 to
create second second tunnel portion 31a. Similarly, the guide
component 10 is inserted into third first tunnel portion 32, and
the drill guide sleeve 2 is positioned above entrance point 33 so
that third second tunnel portion 32a can be drilled. Thus, all of
the second tunnel portions 30a, 31a, 32a exit the bone 5 at the
same location 33. This configuration also can be done in reverse,
with each of the first tunnel portions having the same entrance
point. In this example, first tunnel portions would be shown by
reference numerals 30a, 30b, 30c, and second tunnel portions would
be shown by reference numerals 30, 31, 32. Using entrance point 33,
first first tunnel portion 30a, second first tunnel portion 30b,
and third first tunnel portion 30c would all be drilled free-hand
from entrance point 33. Guide component 10 is inserted into first
first tunnel portion 30a, and the drill guide sleeve 2 is
positioned proximal to bone 5 so as to be able to drill first
second tunnel portion 30. Guide component 10 then is inserted into
second first tunnel portion 30b, and the drill guide sleeve 2 is
positioned proximal to bone 5 so as to be able to drill second
second tunnel portion 31. Guide component 10 then is inserted into
third first tunnel portion 30c, and the drill guide sleeve 2 is
positioned proximal to bone 5 so as to be able to drill third
second tunnel portion 32. Sutures 22 then can be pulled through the
various tunnel portions as described above.
[0090] In each of the preferred and alternate methods disclosed
herein, sutures 22 can be tied together to the ends of other
sutures 22 extending out of other osteal tunnels 4, or anchored
together with sutures 22 extending out of other osteal tunnels 4
using the novel anchor 29 (see FIGS. 10-14) and anchoring method of
the present invention. A suture can also by tied off in a
"mattress" tying method, by looping a suture around a torn ligament
or tendon in a mattress suture pattern, and then pulling the
suture, and with it, the tendon, into the tunnel.
[0091] Referring now to FIGS. 10-14, the present invention also
includes an anchor 29 and method for anchoring sutures. In the
anchor 29 and anchoring method, an anchor 29 is depressed or
deformed about a suture 22 needing to be anchored proximal to a
bone 5 to prevent the suture 22 from being pulled back through the
bone 5. This anchor 29 eliminates the need for the introduction of
an invasive anchoring device into the bone 5 itself, such as a
staple, or the elaborate tying of the ends of the sutures 22 in
knots or to other anchoring devices lodged within or outside of the
bone 5.
[0092] Referring now to FIG. 10, at least one suture 22 or a wire
extending through an angled osteal tunnel 4 can be secured using an
anchor 29, thus avoiding the use of knots or a staple into the bone
5. An illustrative anchor 29 is an oval device through which at
least one suture 22 can extend. As shown in FIG. 11, multiple
sutures 22 can be threaded through one anchor 29. As shown in FIG.
12, after at least one suture 22 is threaded through the anchor 29,
the anchor 29 is then compressed or deformed to anchor 29 the at
least one suture 22, thus preventing the at least one suture 22
from being pulled back through the osteal tunnel 4. In the
multi-tunnel embodiments, as depicted in FIGS. 7, 8, and 9, the
multiple sutures 22 all can be passed through a single anchor 29.
As shown in FIG. 13, after multiple sutures 22 are pulled through
an angled osteal tunnel 4, the ends of the sutures 22 are drawn
through the anchor 29. As shown in FIG. 14, when the anchor 29 is
depressed or deformed about sutures 22, the sutures 22 are
prevented from being pulled back into the osteal tunnels 4.
[0093] Anchor 29 preferably is manufactured out of a deformable or
malleable metal or material, which, after being deformed, resists
both further deformation and returning to the original shape.
Representative shapes of the anchor 29 include a round or oval
ring. Other preferred shapes include a U-shape or other open-ended
or self-threading shape. Any other shape known in the art suitable
for accommodating a suture 22 within is acceptable. The anchor 29
also can have a curved shape that mimics or is similar to the curve
of the surface of a bone 5, such that if the anchor 29 is pulled
back against the bone 5 by the sutures 22, the anchor 29 can lie
relatively flush against the surface of the bone 5. The anchor 29
can be deformed using pliers, forceps, tweezers, or other means for
applying pressure from opposing sides. The anchor 29 is deformed
until it tightly grips the suture 22.
[0094] In another exemplary alternate embodiment of the suture
anchoring method of the present invention, a suture 22 is threaded
through an anchor 29, and then a tendon, ligament or muscle is also
threaded through an anchor 29. The anchor 29 is then depressed or
deformed about the suture 22 and tendon, ligament or muscle. The
suture 22 may be threaded through an osteal tunnel 4, and the other
end of the suture 22 can be anchored on the outside of the bone 5
with another anchor 29. Also, an anchor 29 can be used to join
together to the ends of other sutures 22 to increase their length
by threading one end through the anchor 29 and then threading the
end of another suture 22 into the anchor 29 and deforming or
depressing the anchor 29 to secure the ends of the sutures 22.
[0095] FIG. 15A illustrates a cross-sectional side view of an
illustrative guide component 10 showing an illustrative suture
seizing mechanism. The scissor handles 40 are positioned on the
exterior end 19 and operate a suture seizing pestle 18 within the
guide component 10, preferably within a hollow cylinder or another
form suitably-shaped for insertion into an osteal tunnel 11. As
also shown in FIG. 15B, the suture seizing pestle 18 is within the
cylinder when the scissor handles 40 are not squeezed or engaged
such that it does not block the opening of the target ring 17. As
also shown in FIG. 15C, when engaged, the scissor handles 40 move
the suture seizing pestle 18 toward the awl tip 16a of the cylinder
and through the opening of the target ring 17, which securely
presses the suture seizing pestle 18 against the tip of the
cylinder or the edge of the target ring 17 on the interior end 16,
thus trapping the suture 22. As a result, the end of a suture 22
fed into an osteal tunnel 11 is directed into the target ring 17,
and can be gripped by the suture seizing pestle 18 when the suture
22 is pinched between the suture seizing pestle 18 and the wall,
ring, or tip of the interior end 16 when the scissor handles 40 are
engaged. This allows the suture 22 to be easily pulled through an
angled osteal tunnel 11. It should be understood to those skilled
in the art that the scissor handles 40 or grip 20 and trigger
mechanism 21 used to engage the suture seizing pestle 18 in the
target ring 17 are only examples of embodiments of the present
invention, and that any suitable means for engaging the suture
seizing pestle 18 can be used.
[0096] The target ring 17 is on the interior end 16 of the guide
component 10 and, in one embodiment of the surgical tool 8 of the
present invention, is a circular or oval hole in cylindrical guide
component 10 (FIGS. 2A and 4). The circular or oval void defined by
the target ring 17 is suitable for accommodating a typical drill
bit 3 so that the drill bit 3 is directed into the void so that the
drill bit 3 does not drill into or damage the body of the guide
component 10.
[0097] In an alternate embodiment of the present invention, the
suture seizing pestle 18 is stationary and fixed to the guide
component 10, and the target ring 17 is engaged by squeezing or
compressing the grip 20 and trigger mechanism 21 or scissor handles
40 to draw the target ring 17 toward the fixed suture seizing
pestle 18 so as to pin the suture 22 against the inner surface of
the target ring 17, thus seizing the suture 22. Similarly, as the
guide component 10 is removed from the first tunnel portion 12, the
suture 22 is pulled through the angled osteal tunnel 11.
[0098] FIG. 16 illustrates an alternate embodiment of the invention
shown in FIG. 2A having a movable guide component 10 and a straight
rod 41 and plunger 42 suture seizing mechanism. The guide component
10 is slidably or removably mounted to the rack 7, which may be
arcuate in shape, and is capable of being securely positioned about
the rack 7 toward either end. The guide component 10 can be fixed
into a desired position by engaging clamp 23 with tightening screw
24. In this embodiment, drill guide sleeve 2 remains fixed to an
end of the rack 7. In this alternate embodiment, the grip 20 and
trigger mechanism 21 is replaced with a straight rod 41 and plunger
42. The straight rod 41 functions as a suture seizing pestle 18 and
has one end attached to the plunger 42, and the other end is a free
end. The straight rod 41 is slidably received within a cylinder 43
and moves out through the cylinder 43 as the plunger 42 is pulled
outward, and moves into the cylinder 43 as the plunger 42 is
depressed. A suture 22 is seized within the target ring 17 by
squeezing the suture 22 between the target ring 17 and the free end
of the straight rod 41 as the plunger 42 is depressed.
[0099] FIG. 17 illustrates an alternate embodiment of the invention
shown in FIG. 2A having a movable drill guide sleeve 2 and a
movable guide component 10. The guide component 10 and the drill
guide sleeve 2 are each slidably or removably mounted to the rack
7, which may be arcuate in shape, and are capable of being securely
positioned about the rack 7 in a desired position. The guide
component 10 and the drill guide sleeve 2 can be fixed in a
position on the rack 7 by engaging clamp 23 with tightening screw
24.
[0100] FIGS. 18A and 18B are close-up views of the clamp 23 and
tightening screw 24 in accordance with the present invention. The
clamp 23 is attached to an adjustable portion of the surgical drill
guide 1. The adjustable portion preferably is the exterior end 19
of the guide component 10, but alternatively may be the drill guide
sleeve 2. Rack 7 is slidably disposed within clamp 23 such that
clamp 23 and guide component 10 can be positioned about rack 7.
Tightening screw 24 moves clamp 23 toward rack 7 as it is turned
one way, fixing clamp 23 and guide component 10 to the rack 7. When
turned in an opposite direction, the tightening screw 24 moves the
clamp 23 away from the rack 7, making the clamp 23 loose and
adjustable.
[0101] Referring now to FIG. 19, an alternate method for tying and
anchoring a ligament 44 with a suture 22 between osteal tunnels 4
is shown. Using this method, first tunnel portion 12 and second
tunnel portion 13 are drilled or punched in the manners described
above. A suture 22 or wire is drawn through the osteal tunnels 4,
with one free end of the suture 22 extending from the first tunnel
portion 12, and one free end of the suture 22 extending from the
second tunnel portion 13. The free end of suture 22 extending from
the second tunnel portion is wrapped around ligament 44 (or tendon
or muscle) and bone 5, such that ligament 44 is sandwiched between
suture 22 and bone 5 between the entrance points of the first
tunnel portion 12 and the second tunnel portion 13 on the surface
of the bone 5. The free end of the suture 22 extending from the
second tunnel portion 13 is then tied or anchored using the novel
anchor 29 of the present invention to the free end of the suture 22
extending from the first tunnel portion 12. Alternatively, the free
end of the suture 22 extending from the first tunnel portion 12 can
be drawn over the ligament 44, and the suture can be secured at any
point between the entrance points of the first tunnel portion 12
and second tunnel portion 13.
[0102] Other methods of fixating the sutures 22 also are
contemplated for use with the present invention. For example, one
can tie sutures exiting from different tunnels to each other. One
can use an interference type of device, such as a plug, placed in
the exiting tunnel so as to frictionally engage the suture against
the tunnel wall. One can tie the sutures form the exiting tunnel
over a button having a larger diameter than the tunnel. Various
other known methods for tying sutures also can be utilized.
[0103] Referring now to FIG. 20, a suture feeding sleeve 70 as a
part of the present invention is shown. Suture feeding sleeve 70 is
a generally tubular structure 72 having a hollow interior 82, an
outer diameter 74 smaller than tunnel portions 12, 13 in general,
and smaller than second tunnel portion 13 in particular, and an
inner diameter 76 large enough to accommodate a variety of sutures
22. Further, the outer diameter 74 also preferably is larger than
the diameter of the opening of target ring 17 to prevent the suture
feeding sleeve 70 from entering the target ring 17 when in use, as
disclosed in more detail below. Suture feeding sleeve 70 can have a
rounded insertion edge 78 for ease of insertion into tunnel portion
12, 13, and a flanged outer edge 80 for ease of gripping and
removing.
[0104] Referring now to FIG. 21, in one illustrative embodiment,
suture feeding sleeve 70 is inserted into either second tunnel
portion 13 or first tunnel portion 12 while guide component 10
remains in either first tunnel portion 12 or second tunnel portion
13, respectively. As the outer diameter 74 of suture feeding sleeve
is larger than the diameter of the opening of target ring 17,
suture feeding sleeve 70 will contact guide component 10, but will
not enter target ring 17. Suture 22 then can be fed down through
the hollow interior 82 of suture feeding sleeve 70 and into the
target ring 17 where suture 22 can be seized, as disclosed above.
In another illustrative embodiment, suture 22 can be fed down
through the hollow interior 82 of suture feeding sleeve 70 prior to
the insertion of the suture feeding sleeve 70 into the tunnel
portion 12, 13. In this embodiment, suture 22 can be fed through
the hollow interior 82 so as to extend out of the insertion edge 78
a certain desired distance, the distance being chosen to allow just
enough of the suture 22 to extend out of the hollow interior 82 so
that just enough of suture 22 can extend into target ring 17 and be
seized, without having to estimate the amount of suture 22 to be
fed into hollow interior 82. Suture feeding sleeve 70 can be
appropriately calibrated for such distances.
[0105] Thus, in use, the present devices and methods allow for
tunnels providing robust bony bridges even with minimal distance
between the surface points of entry and exit on the bone. The
osteal tunnels can be created through limited exposure of the
muscle, tendons, and bone (i.e., limited exposure of the subdermal
structures), and the technique may be performed arthroscopically.
For example, arthroscopic surgery of the shoulder to repair a torn
rotator cuff involves fixation of the torn tendon to bone. Straight
tunnels are precluded because the closer the point of entry and
exit, the more shallow the tunnel and the weaker the bony bridge.
The present invention addresses this issue.
[0106] Further, the present devices and methods allow for the blind
intraosseous preparation of osteal tunnels and retrieval of
sutures, without the need for direct visualization of the tunnels
or the sutures. The ability to prepare osteal tunnels and retrieve
sutures from within the tunnels without direct visualization can
help simplify this type of surgery and reduce surgical errors.
[0107] It is to be understood that the present invention is by no
means limited to the particular constructions and method steps
herein disclosed or shown in the drawings, but also comprises any
modifications or equivalents within the scope of the claims known
in the art. It will be appreciated by those skilled in the art that
the devices and methods herein disclosed will find utility with
respect to multiple bones, joints, and the like.
* * * * *