U.S. patent application number 13/738386 was filed with the patent office on 2013-05-30 for hallux valgus repairs using suture-button construct.
This patent application is currently assigned to Arthrex, Inc.. The applicant listed for this patent is Arthrex, Inc.. Invention is credited to Christian M. Baker, Christopher P. Chiodo.
Application Number | 20130138150 13/738386 |
Document ID | / |
Family ID | 44560682 |
Filed Date | 2013-05-30 |
United States Patent
Application |
20130138150 |
Kind Code |
A1 |
Baker; Christian M. ; et
al. |
May 30, 2013 |
HALLUX VALGUS REPAIRS USING SUTURE-BUTTON CONSTRUCT
Abstract
A technique and associated instrumentation for correcting large
intermetatarsal angles that result from hallux valgus. The system
includes a button and a suture loop attached to the button. A
suture strand is threaded through holes in the button to attach the
button to the suture. The suture ends are then brought together (by
being swaged, spliced or cinched together, for example) to form the
suture loop comprising a continuous, uninterrupted suture loop with
a single strand of swaged-together ends. The swaged-together ends
may be attached to a suture passing instrument such as a K-wire
(Kirschner wire) that may be further used to drill a hole through
the first and second metatarsals. The swaged-together ends of the
suture are then passed through the drill holes in the first and
second metatarsals; and the ends of the suture are pulled until the
button abuts the second metatarsal. The swaged together portion of
the suture loop is then cut, and the free suture ends are passed
through holes in another (second) button. The suture ends are
pulled to adjust the first metatarsal to a correct intermetatarsal
angle, and the first metatarsal is secured in place by tying the
ends of the suture together against the second button.
Inventors: |
Baker; Christian M.; (South
Weymouth, MA) ; Chiodo; Christopher P.; (Walpole,
MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Arthrex, Inc.; |
Naples |
FL |
US |
|
|
Assignee: |
Arthrex, Inc.
Naples
FL
|
Family ID: |
44560682 |
Appl. No.: |
13/738386 |
Filed: |
January 10, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
13033236 |
Feb 23, 2011 |
8398678 |
|
|
13738386 |
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|
61314015 |
Mar 15, 2010 |
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Current U.S.
Class: |
606/232 |
Current CPC
Class: |
A61B 17/84 20130101;
A61B 17/0469 20130101; A61B 17/06 20130101; A61B 17/683 20130101;
A61B 2017/0404 20130101; A61B 17/0401 20130101 |
Class at
Publication: |
606/232 |
International
Class: |
A61B 17/04 20060101
A61B017/04 |
Claims
1. A fixation system, comprising a button/loop construct having a
button with at least a pair of apertures designed to allow passage
of a flexible strand, and a loop construct connected to the button,
the loop construct comprising a continuous uninterrupted loop of a
flexible strand, with both opposing ends of the flexible strand
terminating in a single strand.
2. The fixation system of claim 1, wherein the flexible strand is a
suture strand.
3. The fixation system of claim 2, wherein the suture strand
comprises a plurality of fibers of ultrahigh molecular weight
polyethylene.
4. The fixation system of claim 1, wherein the loop has a fixed
length.
5. The fixation system of claim 1, wherein the loop and the single
strand have a combined length greater than a sum of a width of a
first metatarsal, a width of a second metatarsal, and a distance
between the first and second metatarsals.
6. The fixation system of claim 1, wherein both opposing ends are
swaged or cinched together to form the single strand.
7. The fixation system of claim 1, wherein the single strand is
formed by splicing both opposing ends of the flexible strand.
8. The fixation system of claim 1, wherein the button has two
apertures and the loop passes through the two apertures.
9. A suture-button construct, comprising: a suture strand; and a
button having a pair of apertures, the apertures being designed to
allow passage of the suture strand; and wherein the suture strand
is looped through the apertures of the button, and wherein both
free legs of the suture strand are brought together to form a
combined leg.
10. The suture-button construct of claim 9, wherein the suture
strand comprises a plurality of fibers of ultrahigh molecular
weight polyethylene.
11. The suture-button construct of claim 9, wherein the button is
made of a material comprising one of titanium, stainless steel,
PEEK, or PLLA.
12. The suture-button construct of claim 9, wherein the button is
substantially oblong-shaped with chamfered or rounded corners and
edges.
13. The suture-button construct of claim 9, wherein the free legs
of the suture strand are cinched or swaged together to form the
combined leg.
14-19. (canceled)
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of U.S. Provisional
Application No. 61/314,015, filed Mar. 15, 2010, the entire
disclosure of which is incorporated by reference herein.
FIELD OF THE INVENTION
[0002] The present invention relates to the field of surgery and,
in particular, to a bunion repair technique using a suture-button
construct and to a device.
BACKGROUND OF THE INVENTION
[0003] Hallux valgus, more commonly known as bunions, is a
condition where the first metatarsal deviates inward toward the
second metatarsal. This results in an intermetatarsal angle that is
too large. Bunions are caused when certain tendons, ligaments, and
supportive structures of the first metatarsal no longer function
correctly causing the first metatarsal to be misaligned. Bunions
may be caused by a variety of conditions intrinsic to the structure
of the foot, such as flat feet, excessive ligamentous flexibility,
abnormal bone structure, and certain neurological conditions.
[0004] Bunions are commonly associated with arthritis of the first
metatarsal, diminished and/or altered range of motion and
discomfort when pressure is applied to the first metatarsal or with
motion of the joint. Treatments of bunions vary and, depending on
severity of the misalignment, can range from rest, medication,
orthotics and, in extreme cases, surgery.
[0005] Numerous techniques have been used during surgery to correct
the intermetatarsal angle, including the reshaping or removal of
part of the first metatarsal bone. Other techniques have also been
used to reduce the intermetatarsal angle to a normal angle of less
than 9.degree. to 11.degree.. One way to reduce the intermetatarsal
angle is by connecting the first and second metatarsals together
with a suture, to secure the first metatarsal at a proper
angle.
[0006] One such technique for hallux valgus repairs employs a
suture-button construct as detailed in U.S. Patent Publ. No.
2008/0208252 (filed on Jan. 17, 2008 and assigned to Arthrex,
Inc.). According to U.S. Patent Publ. No. 2008/0208252, a suture
strand is double looped through first and second buttons, and a
pull-through suture is attached to one of the buttons and to a
needle. This technique requires one large diameter hole, drilled
through both the first and second metatarsals, to allow passage of
the button.
[0007] Another technique employs a deconstructed suture-button
construct sold by Arthrex, Inc. of Naples, Fla. under the tradename
Mini TightRope.RTM.. The deconstructed Mini TightRope.RTM.
technique involves drilling two small drill holes through the first
and second metatarsal, and passing sutures through each hole,
thereby connecting the first and second metatarsals. This procedure
requires a higher degree of technical difficulty, however, since
both drill holes must be parallel and in the same plane. What is
needed is a simpler technique but with equivalent strength. Also
needed is a technique that requires only one small hole in lieu of
multiple holes drilled through the first and second
metatarsals.
BRIEF SUMMARY OF THE INVENTION
[0008] The present invention provides systems and methods for
correcting large intermetatarsal angles that result from hallux
valgus. The system includes a button and a suture loop attached to
the button. According to an exemplary embodiment, a suture strand
is woven through holes in the button to attach the button to the
suture. The suture ends are then brought together (by being swaged,
spliced or cinched together, for example) to form the suture loop
comprising a continuous, uninterrupted suture loop and a single
strand of swaged-together ends attached to the loop. The
swaged-together ends may be attached to a suture passing instrument
such as a K-wire (Kirschner wire) that may be further used to drill
the hole.
[0009] A method for correcting intermetatarsal angles that result
from hallux valgus employing the suture-button construct of the
present invention (with a continuous suture loop attached to a
button) includes inter alia the steps of: (i) providing a suture
construct attached to a button by swaging or cinching together ends
of a suture strand woven through holes of the button to form a
button/suture loop system; (ii) passing the swaged-together ends of
the suture through drill holes in the first and second metatarsals;
(iii) pulling the ends of the suture until the button abuts the
second metatarsal; (iv) removing (by cutting, for example) the
swaged together portion of the suture; (v) attaching the suture
ends to another (second) button; and (vi) adjusting the first
metatarsal to a correct intermetatarsal angle, and securing the
first metatarsal in place by the suture-button construct and the
second button.
BRIEF DESCRIPTION OF THE DRAWINGS
[0010] FIG. 1 illustrates a schematic perspective view of an oblong
button which forms part of the suture-button construct of the
present invention;
[0011] FIG. 2 illustrates an embodiment of a suture-button
construct of the present invention;
[0012] FIG. 3 illustrates a schematic view of a patient's foot with
a hallux valgus repair according to a first embodiment of the
present invention (and illustrating the suture-button construct of
the present invention and another button, one each against the
first and second metatarsals).
[0013] FIG. 4 illustrates a schematic view of a patient's foot with
a hallux valgus repair according to a second embodiment of the
present invention.
[0014] FIGS. 5-12 illustrate subsequent steps of a method of
correcting problems associated with hallux valgus employing the
suture-button construct of the present invention.
DETAILED DESCRIPTION OF THE INVENTION
[0015] FIG. 1 illustrates button 120 used in corrective surgery for
hallux valgus. Button 120 is an oblong shaped plate with chamfered
or rounded corners and edges. Button 120 has a length that extends
from proximal end 125 to distal end 126. Button 120 further has a
width that is shorter than the length. Button 120 also has front
face 127 and back face 128, wherein the distance between the front
and back face 127, 128 is smaller than the width of button 120. In
another embodiment, the distance between front and back face 127,
128 is greater than the width of button 120.
[0016] Button 120 further includes holes 122 and 124 that extend
from front face 127 to back face 128. Hole 122 is located near
distal end 126. Hole 124 is located near proximal end 125. Holes
122 and 124 are of sufficient diameter to allow suture 110 to pass
through, but not so large as to severally compromise the integrity
and strength of button 120.
[0017] FIG. 2 illustrates suture-button construct 200 (attachment
200) that includes a suture 110 and a button 120. Suture 110 is a
threadlike material that is commonly employed in surgery to hold
tissue or bone together. In this embodiment, suture 110 is #2
FiberWire.RTM. from Arthrex. In other embodiments, different types
of sutures and different sizes of sutures may be used.
[0018] As shown in FIG. 2, suture 110 passes through first hole 122
of button 120 and through second hole 124. As a result, suture 110
includes first leg 112 that passes through hole 122 and extends
away from back face 128 and second leg 114 that passes through hole
124 and also extends away from back face 128. Suture 110 also
includes connecting leg 113 that extends between first hole 122 and
second hole 124 along front face 127 of button 120.
[0019] In suture-button construct 200, first leg 112 and second leg
114 of suture 110 are swaged together to form combined leg 116
(single tail 116) of suture 110. As a result, part of suture 110 is
formed into a continuous, uninterrupted loop with the loop portion
of suture 110 passing through holes 122 and 124 of button 120.
[0020] A method of conducting surgery to reduce the intermetatarsal
angle by fixating the first metatarsal using suture-button
construct 200 (attachment 200) is now described. Preparation for an
exemplary surgical technique relies upon radiographic film,
surgical templates, and trial implants to determine and select the
appropriate combination of suture 110 and button 120 that meets the
patient's anatomical requirements.
[0021] FIGS. 3 and 4 illustrate final hallux valgus repairs with
the suture-button construct 200 (attachment 200) of the present
invention. Referring to FIG. 3, in a first embodiment of the
invention, a surgeon drills a hole using a suture passing K-wire
through first metatarsal 310 and second metatarsal 320, drilling
from second metatarsal 320 to first metatarsal 310. Suture-button
construct 200 is loaded on the K-wire with combined leg 116 of
suture 110 attached to the K-wire. Combined leg 116 of suture 110
is shuttled completely through the holes in first metatarsal 310
and second metatarsal 320 by the K-wire. Suture 110 then continues
to be shuttled through until button 120 of attachment 200 rests
against the lateral cortex of second metatarsal 320.
[0022] With button 120 resting against second metatarsal 320, first
leg 112 and second leg 114 of suture 110 will have been shuttled
through the holes in first metatarsal 310 and second metatarsal
320. First and second legs 112, 114 of suture 110 are then cut from
combined leg 116, leaving first and second legs 112, 114 protruding
from the hole in first metatarsal 310.
[0023] A second button 350 (for example, a round or oblong button
350) is then placed over first and second legs 112, 114 protruding
from the hole in first metatarsal 310. First and second legs 112,
114 of suture 110 should be of sufficient length to extend through
both the first and second metatarsals 310, 320 and allow for the
surgeon to comfortable tie first and second legs 112, 114 over the
top of second button 350. The surgeon then adjusts first metatarsal
310 to achieve a proper intermetatarsal angle. First metatarsal is
secured in place by tying down second button 350 in standard
fashion as shown in FIG. 3. In this manner, suture-button construct
200 in combination with second button 350 secures first metatarsal
310 at a proper intermetatarsal angle.
[0024] In an alternative embodiment, a similar method is used but
in reverse order. In this embodiment, with the final step shown in
FIG. 4, a surgeon drills a hole using a suture passing K-wire (in a
method similar to the one described above), but drilling from first
metatarsal 310 to second metatarsal 320. Suture-button construct
200 is loaded on the K-wire and combined leg 116 of suture 110 is
shuttled through the holes in first metatarsal 310 and second
metatarsal 320 by the K-wire. Suture 110 is shuttled through the
holes in first metatarsal 310 and second metatarsal 320 until
button 120 rests against the medial cortex of first metatarsal 310.
First and second legs 112, 114 of suture 110 are cut from combined
leg 116. First metatarsal 310 is correctly positioned and second
button 350 is placed over first and second legs 112, 114 and tied
down in standard fashion between second metatarsal 320 and third
metatarsal 330 to secure first metatarsal 310.
[0025] FIGS. 5-12 illustrate in detail the steps of a method of
correcting problems associated with hallux valgus employing the
suture-button construct 200 of the present invention.
[0026] FIG. 5: For the distal approach, the first interspace
release is performed through the incision made between the distal
first and second metatarsals 310, 320. A dorsal medial and medial
incision can also be used with appropriate distraction of soft
tissues.
[0027] FIG. 6: To realign the fibular sesamoid, the adductor tendon
is detached from both the base of the proximal phalanx and the
fibular sesamoid. The deep intermetatarsal ligament and lateral
capsule are released. Any sesamoid adhesions to the intermetatarsal
ligament are freed.
[0028] FIG. 7: The medial capsule is incised, exposing the entire
medial eminence. The medial eminence is removed, preserving the
sesamoid groove on the plantar aspect of the first metatarsal
310.
[0029] FIG. 8: The second lateral metatarsal 320 is exposed for
placement of the construct 200 of the present invention. The first
metatarsal 310 is reduced with provisional fixation to the second
metatarsal 320. A C-arm is used to assure proper placement of a
suture passing instrument 313 (for example, a 1.1 mm tapered Suture
Passing K-wire 313) at the center of the second metatarsal shaft,
about 2-3 mm proximal to the neck of the second metatarsal 320. The
second metatarsal 320 is elevated and exposed with an elevator (for
example, a Freer Elevator) and a small rake retractor (soft tissue)
prior to K-wire insertion. The suture passing K-wire 313 is passed
from the second metatarsal 320 through the first metatarsal 310, in
the direction of arrow A. The wire should exit just proximal to the
excised medial eminence. For accurate placement of the K-wire 313,
the drill angle should be modified as shown in FIG. 8(a).
[0030] FIG. 9: With the first metatarsal 310 manually reduced, the
suture passing K-wire 313 is positioned so that the tapered
portions just exit the medial cortex of the first metatarsal 310
(where the pointed end of arrow B intersects the cortex of the
first metatarsal 310). This will allow easy passage of the suture
loop (#2 FiberWire) through the drill hole 314.
[0031] FIG. 10: Prefabricated loop 110 and leg 116 of the
suture-button construct 200 is fed through the loop 313a (Nitinol
loop portion 313a) of the K-wire 313. The suture passing K-wire 313
is pulled medially, passing the free end 116 of the suture
construct 200 through the 1.1 mm pilot hole 314.
[0032] FIG. 11: After the suture of construct 200 has been passed
from lateral to medial, the swaged portion (combined leg 116) is
cut and the ends of the #2 FiberWire 112, 114 are rethreaded
through opposite holes in a second button 350 (for example, an
oblong button). If a round button is used, the button is threaded
in the same way using opposite holes.
[0033] FIG. 12: If two constructs 200, 200a are employed for the
repair, the first of two suture-button constructs 200, 200a is tied
down with one knot while the second construct 200, 200a is placed
about 5-7 mm proximal from the first construct. The second
construct 200a is placed in a manner similar to that for the
placement of construct 200 (detailed above) with same drilling and
passing instructions. FIG. 12 illustrates suture-button constructs
200, 200a in combination with second buttons 350, 350a securing
first metatarsal 310 at a proper intermetatarsal (IM) angle. The IM
angular correction on the C-arm is checked prior to the final
tightening, preferably using three knots on button 350, 350a for
closure. FIG. 12(a) illustrates an X-ray depiction of the final
construct of FIG. 12.
[0034] FIGS. 10(a)-(d) illustrate subsequent steps that are
optional to the step illustrated in FIG. 10, i.e., instead of
positioning the suture knots on the medial side of the first
metatarsal 310, the knot(s) are placed lateral to the second
metatarsal 320, as detailed below.
[0035] FIG. 10a: One limb of a passing suture 315 (for example, a
2-0 FiberWire suture 315) is passed from lateral to medial through
the distal hole using the suture passing K-wire 313 with Nitinol
loop 313a (in the direction of arrow A).
[0036] FIG. 10b: Making sure to hold onto the free ends of the
suture 315 lateral to the second metatarsal 320, the suture passing
K-wire 313 is removed. The free end 116 of suture-button construct
200 is threaded through closed end 315a of the passing suture 315.
The construct 200 is pulled from medial to lateral back through the
hole. The loop 315a will act as a suture shuttle, pulling the
suture-button construct 200 from medial to lateral.
[0037] FIG. 10c: The passing suture 315 is removed. The construct
can now be completed with a second button 350 and at least one knot
(preferably three knots) lateral to the second metatarsal 320.
[0038] FIG. 10d: The final construct is illustrated with a knot
350a tied over the second button 350 on the lateral aspect of the
second metatarsal 320.
[0039] The attachment system of the present invention has the same
strength as the deconstructed Mini TightRope.RTM. from Arthrex, but
reduces time in the operating room, requires only one drilled hole
in lieu of multiples holes, makes the overall operation less
challenging, and allows patients to return to full activities
faster.
[0040] Although the present invention has been described in
relation to particular embodiments thereof, many other variations
and modifications and other uses will become apparent to those
skilled in the art. Therefore, the present invention is to be
limited not by the specific disclosure herein, but only by the
appended claims.
* * * * *