U.S. patent application number 17/332086 was filed with the patent office on 2021-11-25 for device, system, and method for delivery of a tissue fixation device.
The applicant listed for this patent is Medos International Sarl. Invention is credited to David B. Spenciner.
Application Number | 20210361409 17/332086 |
Document ID | / |
Family ID | 1000005749916 |
Filed Date | 2021-11-25 |
United States Patent
Application |
20210361409 |
Kind Code |
A1 |
Spenciner; David B. |
November 25, 2021 |
DEVICE, SYSTEM, AND METHOD FOR DELIVERY OF A TISSUE FIXATION
DEVICE
Abstract
Systems and methods for fixating a graft in a bone tunnel are
provided. In general, the system includes a tissue fixation device
having a delivery configuration and a deployed configuration, at
least one graft retention loop coupled to the tissue fixation
device, and a drill pin having a sidewall surrounding a cavity at a
proximal end of the pin and at least one longitudinally oriented
opening in the sidewall in communication with the cavity, the
cavity being configured to fully seat the tissue fixation device.
The drill pin is configured to substantially contain therein the
tissue fixation device when in the delivery configuration and to
enable deployment of the tissue fixation device through the
opening. Drill pins configured to contain a tissue fixation device
are also provided.
Inventors: |
Spenciner; David B.; (North
Attleboro, MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Medos International Sarl |
Le Locle |
|
CH |
|
|
Family ID: |
1000005749916 |
Appl. No.: |
17/332086 |
Filed: |
May 27, 2021 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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16109390 |
Aug 22, 2018 |
11045304 |
|
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17332086 |
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15154292 |
May 13, 2016 |
10085830 |
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16109390 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61F 2002/0817 20130101;
A61F 2/08 20130101; A61F 2002/0876 20130101; A61F 2002/0847
20130101; A61B 17/16 20130101; A61B 17/1714 20130101; A61F
2002/0882 20130101; A61F 2/0805 20130101; A61F 2/0811 20130101;
A61F 2002/0823 20130101; A61F 2002/0852 20130101; A61B 17/1764
20130101; A61F 2002/0829 20130101; A61M 2210/02 20130101; A61B
2017/00353 20130101; A61F 2002/0835 20130101; A61B 17/00234
20130101; A61B 17/1637 20130101; A61B 17/1615 20130101 |
International
Class: |
A61F 2/08 20060101
A61F002/08; A61B 17/16 20060101 A61B017/16; A61B 17/17 20060101
A61B017/17 |
Claims
1. A device, comprising: a drill pin having a proximal end and a
distal end that includes a tissue-penetrating tip, a cavity formed
within the drill pin at the proximal end thereof, the cavity being
defined in part by a sidewall of the drill pin, the sidewall being
interrupted by a longitudinally oriented opening in communication
with the cavity.
2. The device of claim 1, wherein the drill pin is configured to
substantially contain in the cavity an expandable tissue fixation
device when in an unexpanded configuration.
3. The device of claim 2, wherein the drill pin is configured to
enable deployment of the tissue fixation device through the
longitudinally oriented opening in the sidewall.
4-11. (canceled)
12. The device of claim 1, wherein the sidewall is interrupted by a
second longitudinally oriented opening in communication with the
cavity, the second longitudinally oriented opening opposite the
longitudinally oriented opening.
13. The device of claim 1, wherein the cavity is in communication
with an end opening formed in the proximal end of the drill
pin.
14. The device of claim 13, wherein the longitudinally oriented
opening is in communication with the end opening.
15. The device of claim 4, wherein the cavity is configured such
that the first and second elongate, substantially rigid support
members are disposed in a non-intersecting orientation relative to
one another when the tissue fixation device is contained in the
cavity.
16. The device of claim 14, wherein the end opening is sized to
prevent an implantable tissue fixation device disposed in the
cavity from passing therethrough, and wherein the longitudinally
oriented opening is sized to permit the implantable tissue fixation
device disposed in the cavity to pass therethrough.
17. The device of claim 1, further comprising an implantable tissue
fixation device disposed in the cavity.
18. The device of claim 17, wherein the tissue fixation device has
a first and a second elongate, substantially rigid support member
that are discrete elements separated from each other, and at least
one flexible member connecting the first and second rigid support
members.
19. The device of claim 17, wherein the tissue fixation device is
configured to change between a collapsed, delivery configuration
and an expanded, deployed configuration, wherein the tissue
fixation device is in the delivery configuration when disposed in
the cavity, and wherein the tissue fixation device has at least one
dimension that is smaller in the delivery configuration than in the
deployed configuration.
20. The device of claim 18, further comprising at least one graft
retention loop coupled to the tissue fixation device.
21. The device of claim 18, wherein the at least one flexible
member comprises a plurality of elongate connecting filaments
extending between the first and second rigid support members.
22. The device of claim 21, wherein the plurality of elongate
connecting elements comprise suture or wire.
23. The device of claim 21, wherein the first and second rigid
support members each include a plurality of retaining elements used
to couple the plurality of elongate connecting filaments to the
first and second rigid support members.
24. The device of claim 20, wherein the at least one graft
retention loop is coupled to the at least one flexible member and
disposed around the first and second rigid support members.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] The present application is a continuation of U.S. patent
application Ser. No. 16/109,390 entitled "Device, System, and
Method for Delivery of a Tissue Fixation Device" filed Aug. 22,
2018, which is a divisional of U.S. patent application Ser. No.
15/154,292, now U.S. Pat. No. 10,085,830 entitled "Device, System,
and Method for Delivery of a Tissue Fixation Device" filed May 13,
2016, which is hereby incorporated by reference in its
entirety.
FIELD
[0002] Implantable tissue fixation devices as well as devices,
systems, and methods for delivering such tissue fixation devices
are provided.
BACKGROUND
[0003] A ligament is a piece of fibrous tissue which connects one
bone to another within the body. Ligaments are frequently damaged
(e.g., detached, torn or ruptured) as the result of injury or
accident. A damaged ligament can impede proper stability and motion
of a joint and cause significant pain. A damaged ligament can be
replaced or repaired using various procedures, a choice of which
can depend on the particular ligament to be restored and on the
extent of the damage. When ligaments are damaged, surgical
reconstruction can be necessary, as the ligaments may not
regenerate on their own.
[0004] An example of a ligament that is frequently damaged as a
result of injury, overexertion, aging and/or accident is the
anterior cruciate ligament (ACL) that extends between a top of the
tibia and a bottom of the femur. Another ligament that is often
damaged and may need to be replaced is a posterior cruciate
ligament (PCL). A damaged ACL or PCL can cause instability of the
knee joint, arthritis, and substantial pain.
[0005] ACL reconstruction or repair typically includes the use of a
tendon graft replacement procedure which usually involves drilling
a bone tunnel through the tibia and up into the femur. Then a
graft, which may be an artificial ligament or harvested graft, such
as a tendon, is passed through a tibial portion of the tunnel
(sometimes referred to as "the tibial tunnel") across the interior
of the joint, and up into a femoral portion of a tunnel (sometimes
referred to as "the femoral tunnel"). One end of the ligament graft
can then be secured in the femoral tunnel and another end of the
graft is secured in the tibial tunnel, at the sites where the
natural ligament attaches.
[0006] A number of conventional surgical procedures exist for
re-attaching such ligament graft to bone, which have advantages and
certain drawbacks. For example, a fixation device in the form of an
elongate "button," sometimes referred to as a "cortical button" can
be used for an ACL fixation to the femur or tibia. However, such
devices are relatively wide, such that it is required to remove a
substantial amount of bone in the femur to drill a tunnel sized
sufficiently to receive the device therethrough. This can
complicate the surgery and extend its duration, as well as to cause
inconvenience to the patient and delay healing.
[0007] Delivery of tissue fixation devices can also be difficult.
For example, leading sutures that are wrapped around a tissue
fixation device may break. Also, during delivery, the tissue
fixation device may catch on the edge of the bone tunnel and become
embedded in the bone instead of residing on top of the lateral
cortex.
[0008] Accordingly, there is a need for improved tissue fixation
devices and techniques for using such devices. There is also a need
for improved devices, systems, and methods for delivering such
tissue fixation devices.
SUMMARY
[0009] A system for delivering an implantable tissue fixation
device is provided that in some embodiments includes a tissue
fixation device having first and second elongate, substantially
rigid support members that are discrete elements separated from
each other, at least one flexible member connecting the first and
second rigid support members, at least one graft retention loop
coupled to the tissue fixation device, and a drill pin. The tissue
fixation device has changeable dimensions such that the device has
a delivery configuration and a deployed configuration. The tissue
fixation device has at least one dimension that is smaller in the
delivery configuration than in the deployed configuration. The
drill pin has a sidewall surrounding a cavity at a proximal end of
the drill pin. The cavity is configured to fully seat the tissue
fixation device. The drill pin is configured to substantially
contain therein the tissue fixation device when in the delivery
configuration, and the drill pin is configured to enable deployment
of the tissue fixation device through the opening.
[0010] The system can vary in any number of ways. For example, the
drill pin can have at least one longitudinally oriented opening in
the sidewall in communication with the cavity. The drill pin can
have a proximal end wall in communication with the sidewall and the
proximal end wall has a slot therein. The slot can be in
communication with the opening and configured for passage of the at
least one graft retention loop during deployment. In another
example, the at least one flexible member can include a fabric.
[0011] The system can further include at least one third elongate,
substantially rigid support member, and at least one second
flexible member connecting the second and third rigid support
members.
[0012] In some embodiments, the at least one flexible member can
include a plurality of elongate connecting filaments extending
between the rigid support members. The plurality of elongate
connecting elements can include suture or wire. In one aspect, the
rigid support members each can include a plurality of retaining
elements used to couple the plurality of elongate connecting
filaments to the rigid support members.
[0013] In one embodiment, the at least one graft retention loop can
be coupled to the at least one flexible member and disposed around
the rigid support members.
[0014] The system can further include at least one of first and
second sutures removably coupled to opposite ends of the at least
one flexible member. The first and second sutures can extend in
opposite directions along a length of the at least one flexible
member.
[0015] In some aspects, a device for delivering an implantable
tissue fixation device is provided. The device includes a drill pin
having a proximal end and a distal end that includes a
tissue-penetrating tip, a cavity formed within the drill pin at the
proximal end thereof. The cavity is defined in part by a sidewall
of the drill pin. The sidewall is interrupted by a longitudinally
oriented opening in communication with the cavity.
[0016] The device can vary in a number of ways. For example, the
drill pin can be configured to substantially contain in the cavity
an expandable tissue fixation device when in an unexpanded
configuration. In another example, the drill pin can be configured
to enable deployment of the tissue fixation device through the
opening in the sidewall. In yet another example, the tissue
fixation device can have a first and a second elongate,
substantially rigid support member that are discrete elements
separated from each other, and at least one flexible member
connecting the first and second rigid support members.
[0017] In other aspects, a method for fixating a graft ligament
into a bone tunnel is provided. The method includes forming a graft
construct by coupling the graft ligament to a tissue fixation
device via a graft retention loop of the tissue fixation device;
inserting the tissue fixation device in a collapsed, delivery
configuration into a cavity at a proximal end of a drill pin, the
cavity defined by a sidewall surrounding at least part of the
cavity, the cavity being configured to substantially contain the
tissue fixation device therein; drilling the drill pin into a bone
to form a bone tunnel; deploying the tissue fixation device through
the opening in the drill pin and passing the graft construct
through the bone tunnel with the tissue fixation device in the
delivery configuration; and positioning the tissue fixation device
over a first end of the bone tunnel in a deployed configuration.
The tissue fixation device includes first and at least one second
elongate, substantially rigid support members that are discrete
elements separated from each other and at least one flexible member
connecting the rigid support members. The tissue fixation device is
positioned over a first end of the bone tunnel in a deployed
configuration such that the rigid support members are spaced from
one another by a distance greater than in the delivery
configuration, and the graft retention loop and the graft ligament
extend into the bone tunnel.
[0018] The method can have any number of variations. For example,
the drill pin can have a proximal end surface in communication with
the sidewall, and the proximal end surface can have a slot therein.
The slot can be in communication with the opening. Prior to
deployment of the tissue fixation device, the at least one graft
retention loop can pass through the slot.
[0019] The method can further include pulling the drill pin through
the bone tunnel. The drill pin can be pulled using a pin
puller.
[0020] In some embodiments, when in the deployed configuration, the
tissue fixation device can be generally perpendicular with respect
to the first end of the bone tunnel. In other embodiments, the
drill pin has a longitudinal axis and the tissue fixation device
can be deployed through the opening at an angle with respect to the
longitudinal axis. In yet other embodiments, the at least one
flexible member can include a plurality of elongate connecting
filaments extending between the rigid support members.
BRIEF DESCRIPTION OF THE DRAWINGS
[0021] The embodiments described above will be more fully
understood from the following detailed description taken in
conjunction with the accompanying drawings. The drawings are not
intended to be drawn to scale. For purposes of clarity, not every
component may be labeled in every drawing. In the drawings:
[0022] FIG. 1A is a perspective view of one embodiment of a tissue
fixation device;
[0023] FIG. 1B is a top view of the tissue fixation device of FIG.
1A;
[0024] FIG. 1C is a exploded view of the tissue fixation device of
FIG. 1A;
[0025] FIG. 2A is a side cross-sectional view of the tissue
fixation device of FIG. 1A in an uncompressed configuration;
[0026] FIG. 2B is a side cross-sectional view of the tissue
fixation device of FIG. 2A in a compressed configuration;
[0027] FIG. 3A is a plan view of another embodiment of a tissue
fixation device in an undeployed configuration prior to the device
being passed through a femoral tunnel;
[0028] FIG. 3B is a perspective view representative of the tissue
fixation device of FIG. 3A in a deployed configuration after the
device is passed through a femoral tunnel;
[0029] FIG. 4 is a perspective view of an embodiment of a tissue
fixation device including multiple rigid support members;
[0030] FIG. 5 is a perspective view of another embodiment of a
tissue fixation device including multiple rigid support
members;
[0031] FIG. 6A is a schematic side view of the tissue fixation
device of FIG. 5 in an uncompressed configuration;
[0032] FIG. 6B is a schematic side view of the tissue fixation
device of FIG. 5 in a compressed configuration;
[0033] FIG. 6C is a schematic side view of the tissue fixation
device of FIG. 5 having a load applied thereto;
[0034] FIG. 7A is a partial side view of an embodiment of a drill
pin having an opening in a sidewall thereof;
[0035] FIG. 7B is an end view of the drill pin of FIG. 7A;
[0036] FIG. 8A is a side view of another embodiment of a drill pin
having an opening in a sidewall thereof;
[0037] FIG. 8B is a side view of the of the drill pin of FIG. 8A
with a tissue fixation device therein with a graft retention loop
extending from the end thereof;
[0038] FIG. 9A is a side view of a portion of another embodiment of
a drill pin having an opening therein;
[0039] FIG. 9B is an end view of the drill pin of FIG. 9A showing a
slot in the proximal end wall of the drill pin;
[0040] FIG. 10 is a proximal end view of an embodiment of a drill
pin having a tissue fixation device therein;
[0041] FIG. 11 is a proximal end view of another embodiment of a
drill pin having a tissue fixation device therein, wherein the
tissue fixation includes five rigid support members;
[0042] FIG. 12A is a partial schematic side view of the drill pin
of FIG. 7A with a tissue fixation device therein;
[0043] FIG. 12B is a schematic end view of the drill pin of FIG.
12A with the tissue fixation device therein;
[0044] FIG. 13 is a schematic side view of the drill pin of FIG.
12A with the tissue fixation device partially deployed from the
drill pin;
[0045] FIG. 14 is a schematic end view of the drill pin of FIG. 12A
with the tissue fixation device partially deployed from the drill
pin;
[0046] FIG. 15 is a schematic view of the drill pin of FIG. 12A
with the tissue fixation device almost fully deployed through the
end and opening in the sidewall of the drill pin;
[0047] FIG. 16 is a schematic side view of an embodiment of the
drill pin of FIG. 9A having an end surface with a slot therein and
a tissue fixation device seated in the cavity of the drill pin;
[0048] FIG. 17 is a schematic end view of the drill pin and tissue
fixation device of FIG. 16;
[0049] FIG. 18 is a side elevation cross-sectional view of a knee
having an ACL reconstruction procedure using a tissue fixation
device and the drill pin of FIG. 7A; and
[0050] FIGS. 19A-19G are sequential side cross-sectional views of
an embodiment of a drill pin and a tissue fixation device being
deployed to a bone during a surgical procedure.
DETAILED DESCRIPTION
[0051] Certain exemplary embodiments will now be described to
provide an overall understanding of the principles of the systems
and methods disclosed herein. One or more examples of these
embodiments are illustrated in the accompanying drawings. Those
skilled in the art will understand that the systems and methods
specifically described herein and illustrated in the accompanying
drawings are non-limiting exemplary embodiments and that the scope
of the embodiments is defined solely by the claims. Further, the
features illustrated or described in connection with one exemplary
embodiment may be combined with the features of other embodiments.
Such modifications and variations are intended to be included
within the scope of the described embodiments.
[0052] The embodiments described herein generally relate to
devices, systems, and methods for fixating tendon grafts during
ligament reconstruction or augmentation surgeries. The implantable
tissue fixation device is one that can move between different
configurations such that at least one of its dimensions can change.
At the same time, the device has sufficient rigidity that allows it
to withstand a load comparable to what larger devices could
withstand. The system includes a drill pin that can seat the tissue
fixation device during delivery. Methods of delivering the tissue
fixation device using such drill pin are also provided.
[0053] Before describing the delivery system, devices, and method,
we first describe exemplary tissue fixation devices to which the
system and method described herein are applicable. In particular,
the exemplary implantable tissue fixation device is one that
includes first and second elongate, substantially rigid support
members separate from one another and at least one flexible member
connecting the rigid support members. The tissue fixation device
further includes at least one graft retention loop coupled to the
tissue fixation device and configured to retain a tissue graft in
place when the device is implanted. At least one dimension of the
tissue fixation device can vary. Thus, in some embodiments, prior
to or following the tissue fixation device being deployed, the
rigid support members can be spaced apart at a distance that is
equal or approximately equal to a width of the flexible member. The
flexible member, which can be a single sheet or can be in the form
of one or more filaments, can also be bent, rolled, folded,
crimped, or otherwise manipulated so as to decrease a distance
between the rigid support members. For example, the rigid support
members can be brought closer together in a delivery configuration
for passing the tissue fixation device through a bone tunnel to a
point of fixation. In this way, a bone tunnel having a smaller
diameter, as compared to a bone tunnel diameter required to pass a
conventional device, can be formed.
[0054] In the delivery configuration, the rigid support members can
be disposed in a non-intersecting orientation with respect to one
another. The tissue fixation device is configured such that, after
it is passed through the bone tunnel, it is positioned over an
opening of the tunnel such that the rigid support members are
similarly disposed in the non-intersecting orientation with respect
to one another.
[0055] The devices and methods described herein provide a number of
advantages over existing techniques for fixating tendon grafts. For
example, as mentioned above, a bone tunnel of a reduced size can be
formed, which requires removing less bone from the patient's body.
This can decrease a possibility of complications at the surgical
site and can ultimately decrease morbidity associated with the
surgical procedure. In addition, because the overall tissue
fixation device is more flexible and the rigid support members can
move with respect to each other, the device can be positioned
against bone such that to better conform to the curved surface of
the bone. In this way, the tissue fixation device can be less
palpable by the patient, as compared to existing devices.
Furthermore, the described tissue fixation device is simplified and
it can be more cost-effective.
[0056] The described devices and methods can be used in conjunction
with a variety of tendon grafts, including hamstring tendon grafts,
and in a variety of different surgical contexts regardless of the
type of tendon graft being used in a particular surgical procedure.
The devices and methods described herein can be utilized in
connection with fixating grafts for repairing or replacing
ligaments in a variety of joints. In some embodiments, the devices
and methods described herein have particular utility in cruciate
ligament reconstruction procedures. In some embodiments, the
devices and methods described herein can be utilized for fixating
tendon grafts for reconstruction procedures such as, for example,
the cruciate ligaments of the knee.
[0057] FIGS. 1A-1C illustrate one embodiment of an implantable
tissue fixation device 100. The tissue fixation device 100 includes
first and second substantially rigid elongate support members 102,
104, and at least one flexible member 106 connecting the first and
second support members 102, 104. As shown, the tissue fixation
device 100 also has at least one graft retention loop 108 coupled
to the flexible member 106, as well as leading and trailing sutures
110, 111 also coupled to opposite ends of the flexible member 106.
It should be appreciated that, in some embodiments, the tissue
fixation device 100 can have one of the leading and trailing
sutures 110, 111 rather than both the leading and trailing sutures
110, 111.
[0058] As shown in FIGS. 1A-1C, the tissue fixation device 100 in
an uncompressed configuration (e.g., prior to delivery and
deployment) can be generally rectangular. However, a person skilled
in the art will appreciate that the tissue fixation device 100 can
have any other shape. For example, in some embodiments, the tissue
fixation device 100 can be square, circular or oval. The shape of
the tissue fixation device 100 can be regular or irregular.
[0059] The tissue fixation device 100 has at least one changeable
dimension such that the device 100 has a delivery configuration and
a deployed configuration. The substantially rigid support members
102, 104 provide rigidity and structural support to the tissue
fixation device 100, while the flexible member 106 is able to
change its configuration to thereby allow the tissue fixation
device 100 to adopt different configurations. Thus, at least one
dimension (e.g., width) of the tissue fixation device 100 can be
smaller in the delivery configuration than in the deployed
configuration, as discussed in more detail below. Although the size
of the tissue fixation device 100 in the delivery configuration,
and, in some embodiments, in both the delivery and deployed
configurations can be generally smaller than that of existing
devices, the strength of the tissue fixation device 100 remains
sufficient to withstand the load to which it is subjected.
[0060] The substantially rigid first and second support members
102, 104 can vary in a number of ways. In the illustrated
embodiment, as shown in FIG. 1C, the first and second support
members 102, 104 are elongate discrete elements separated from each
other and that are configured to provide structural support to the
tissue fixation device 100 and thus to a graft. In the illustrated
embodiment, the first and second support members 102, 104 are
retained within retention passages or pockets 112, 114 formed from
the flexible member 106. In other embodiments, the first and second
support members 102, 104 can be coupled to the at least one
flexible member 106 in other ways, as discussed below.
[0061] The support members 102, 104 can be generally cylindrical
such that they can have a circular or oval cross-section. It should
be appreciated that the embodiments described herein are not
limited to a specific configuration of the support members 102,
104. For example, the support members 102, 104 can be generally
planar such that they can have a rectangular or square
cross-sectional shape. Furthermore, although each of the support
members 102, 104 is shown in FIG. 1C as an elongate component
having no features formed therethrough or thereon, in some
embodiments, each support member can have various features. For
example, in some embodiments, the first and second support members
can include one or more surface features (e.g., ridges, prongs or
other protrusions) that facilitate coupling of the support members
to the flexible member. Furthermore, in embodiments wherein the
flexible member is formed from multiple elongate filaments
extending between the support members, the first and second support
members can include retaining features to couple such elongate
filaments thereto, as described in more detail below.
[0062] The first and second support members 102, 104 can remain
substantially parallel to each other in both the delivery and
deployed configurations. In the illustrated embodiment, the tissue
fixation device 100 is configured such that the first and second
support members 102, 104 may not translate or translate only
slightly relative to one another. In other words, the first and
second support members 102, 104 can remain at the same position
with respect to one another along a length of the tissue fixation
device 100.
[0063] The size of the first and second support members 102, 104
can vary in a number of ways. For example, the length of the first
and second support members 102, 104, which determines the overall
length of the tissue fixation device 100, can vary depending on the
requirements of an intended application. Generally, the overall
length is in the range of about 5 mm to about 25 mm. In yet other
embodiments, the length can vary from about 10 mm to about 15 mm.
In one embodiment, the length is about 12 mm. In the illustrated
embodiments, the first and second support members 102, 104 have the
same length. However, it is understood that the first and second
support members 102, 104 can have different lengths. A diameter of
a widthwise cross-section of the first and second support members
102, 104 can vary depending on the requirements of an intended
application. In one aspect, the diameter can be in the range from
about 0.5 mm to about 2.0 mm. In another aspect, the diameter can
be in the range of about 1.0 to about 1.1 mm. When a widthwise
cross-sectional shape of the support members 102, 104 is different
from circular or oval, the size of the cross-section is similar to
the above.
[0064] The first and second support members 102, 104 can be formed
from any suitable material, and the individual members need not be
formed from the same material. For example, they can be formed from
a surgical stainless steel, titanium alloy, or another
biocompatible, sufficiently strong metal that allows the first and
second support members 102, 104 to withstand the load to which they
will be subjected. In some embodiments, the first and second
support members 102, 104 are formed from a Chromium Molybdenum
(Co--Mo) alloy. The first and second support members 102, 104 can
also be formed from non-metallic materials, which may be or may not
be biodegradable materials. Non-limiting examples of such
non-metallic materials include a polyether ether ketone (PEEK),
polylactic acid (PLA), biphasic tricalcium phosphate (bTCP), and
Biocryl.RTM. Rapide.RTM. material composed of 30% osteoconductive
.beta.-TCP and 70% poly-lactide co-glycolide (PLGA). In some
embodiments, the first and second support members 102, 104 can be
formed from ceramics, such as, for example, aluminum oxide. The
first and second support members 102, 104 can be formed from one
material or a combination of two or more materials. The materials
typically have a high strength such that the Ultimate Tensile
Strength is about 500 MPa and the Yield Strength is about 215 MPa.
However, the materials can be such that their Ultimate Tensile
Strength and the Yield Strength can have other values. The
materials used to form the first and second support members 102,
104 can be such that the tissue fixation device 100 has a yield
load in bending that varies from about 250 Newton (N) to about 2500
N, depending on a specific application. In one embodiment (e.g., in
which the tissue fixation device 100 is used for an ACL replacement
procedure), the yield load in bending of the tissue fixation device
100 can be about 1000 N.
[0065] The form and structure of the flexible member 106 connecting
the first and second support members 102, 104 can vary in a number
of ways. In the illustrated embodiment, as shown in FIG. 1A-1C, the
flexible member 106 is in the form of a fabric sheet. However, in
some embodiments, the flexible member 106 can be in the form of
elongate connecting filaments extending between the rigid support
members, as discussed in more detail below. Regardless of its
specific configuration, the flexible member can be manipulated so
as to change its configuration to thereby decrease a distance
between the first and second support members 102, 104. In the
illustrated embodiment, the flexible member 106 in the form of the
fabric sheet can be rolled, bent, folded, collapsed, crimped, or
otherwise manipulated so that a distance between the first and
second support members 102, 104 can be decreased. In this way, a
width of the tissue fixation device 100 can decrease. In such a
configuration, the tissue fixation device 100 can be passed through
a bone tunnel having a diameter that is less than a diameter that
would be required to pass a conventional tissue fixation device
therethrough.
[0066] The flexible member 106 can connect the first and second
support members 102, 104 such that a distance at which the first
and second support members 102, 104 are spaced apart is changeable
in a number of ways. As shown in FIGS. 1A-1C, in the illustrated
embodiment, the flexible member 106 has first and second retaining
passages or pockets 112, 114 formed on either side of a
longitudinal axis A of the tissue fixation device and which are
configured to retain the first and second support members 102, 104
therein. It should be appreciated that FIG. 1A shows the first and
second support members 102, 104 visible at the openings 112a, 114a
of the first and second pockets 112, 114 for illustration purposes
only. It is understood, however, that both openings of each of the
pockets 112, 114 can be closed or closeable. In this way, the first
and second support members 102, 104 are unable to slide out of the
pockets 112, 114.
[0067] In the illustrated embodiment, the first and second pockets
112, 114 are formed by configuring the fabric forming the flexible
member 106. For example, longitudinal sides of the fabric (which
can be rectangular or square) can be rolled or folded towards a
mid-portion of the fabric (which is also a mid-portion of the
flexible member 106), and the folds can be stitched or otherwise
secured to the remainder of the fabric to thereby form the
longitudinal pockets. As shown in FIGS. 1A-1C, longitudinal
stitches 116, 118 are formed at a distance spaced apart from
opposite sides of the flexible member 106 to form the pockets 112,
114, respectively. In addition, transverse stitches 120a, 120b are
formed to retain the first support member 102 within the first
pocket 112, and transverse stitches 122a, 122b are formed to retain
the second support member 104 within the second pocket 114.
However, it should be appreciated that the first and second pockets
112, 114 can be formed in other ways, as embodiments described
herein are not limited to a specific way of forming the pockets or
otherwise retaining the support members. For example, the flexible
member 106 can be manufactured such that it can have the pockets
112, 114 or other retaining features preformed and configured to
receive and hold therein the first and second support members 102,
104.
[0068] Forming the pockets can involve placing the first and second
support members 102, 104 at opposite longitudinal sides of the
fabric and rolling or folding the sides of the fabric over the
support members 102, 104, so as to enclose the support members 102,
104. Alternatively, the support members 102, 104 can be inserted
into the pockets after the pockets are formed. Regardless of the
specific way of forming the pockets, the first and second support
members 102, 104 can each be held tightly within a respective
pocket.
[0069] The flexible member can connect the first and second support
members in other ways as well. For example, in some embodiments,
the flexible member 106 can include a plurality of slits, holes or
other openings along longitudinal sides thereof. To couple the
first and second support members to one another, the flexible
member can be passed through the openings, e.g., by entering the
openings at alternating sides of the flexible member 106.
Additionally or alternatively, as mentioned above, the first and
second support members can include one or more surface features
(e.g., ridges, prongs or other protrusions) that can facilitate
interlocking between the support members and the flexible member.
The first and second support members can be coupled to the flexible
member in any other manner, such that the first and second support
members do not separate from the flexible member during delivery
and deployment of the device, and after the device is
implanted.
[0070] The flexible member 106 can have various sizes and are
dimensions (including length, width and thickness) and a person
skilled in the art can readily determine the appropriate size
depending on the requirements of a given application. The width (W)
of the flexible member 106 in the uncompressed configuration of the
tissue fixation device 100 (before delivery and deployment of the
device 100) is shown in FIG. 1A and the width can range from about
2 mm to about 8 mm. In one embodiment, the width can be about 5 mm.
The length (L) of the flexible member 106 shown in FIG. 1A can
depend on the length of the first and second support members 102,
104. Thus, the flexible member 106 can be long enough to retain the
first and second support members 102, 104 in the retaining pockets
112, 114. For example, the length (L) of the flexible member 106
can vary from about 5 mm to about 28 mm. In some aspects, the
length can vary from about 10 mm to about 18 mm. In some aspects,
the length can vary from about 12 mm to about 13 mm. In one aspect,
the length (L) can be about 12 mm.
[0071] The flexible member 106 can be made from a number of
suitable materials, such as biologically inert and biocompatible
fabrics. For example, the flexible member 106 can be manufactured
from fabrics such as polyethylene terepthalate (Dacron.RTM.) or
polytetrafluoroethylene (PTFE, or GORE-TEX.RTM.). Alternatively,
the flexible member 106 can be made from resorbable plastic fibers
such as, for example, polylactic acid (PLA).
[0072] Referring back to FIGS. 1A-1C, as mentioned above, the
tissue fixation device 100 includes the graft retention loop 108
coupled thereto. The graft retention loop 108 is configured (in
size, shape and strength) to hold a tissue graft passed through the
loop when the tissue fixation device 100 is implanted. In the
illustrated embodiment, the graft retention loop 108 is coupled to
the flexible member 106 and disposed around the rigid support
members 102, 104. The graft retention loop 108 can be coupled to
the flexible member 106 by passing therethrough. As shown in FIG.
1C, the graft retention loop 108 can be formed from a suture or a
similar material having its opposite free ends coupled together at
a knot 109. It should be appreciated that, the knot 109 can be
formed after the suture is passed through the flexible member 106.
It should also be appreciated that the graft retention loop 108 can
be coupled to the flexible member 106 using techniques that may not
involve forming a knot. For example, the loop can be a continuous
loop, or the ends of the suture forming the loop can be joined
together using a lap joint, splice joint, or other technique.
Additionally or alternatively, the ends of the suture can be glued
together. Any other technique can be used as embodiments are not
limited in this respect.
[0073] The graft retention loop 108 can have any suitable
dimensions. In some embodiments, it can have a length (before
forming a loop) in the range of about 10 mm to about 60 mm. In some
embodiments, the length can range from about 15 mm to about 25 mm.
In one embodiment, the length can be about 15 mm. The length of the
graft retention loop 108 can be fixed. Alternatively, in some
embodiments, the length of the graft retention loop 108 can be
adjustable such that it can be changed by a user when the tissue
fixation device 100 is in use. For example, the graft retention
loop 108 can be manipulated to increase its length when a longer
loop is desired. As another example, a length of the graft
retention loop 108 can be decreased if the uncompressed length is
longer than desired.
[0074] The thickness (diameter) of the material forming the loop
can also vary and it is typically in the range from about 1 mm to
about 4 mm. Also, the graft retention loop 108 can be formed from
any suitable material(s) and it can be formed in a number of ways.
For example, it can be a continuous loop or it can be braided,
woven, or otherwise formed construct. A person skilled in the art
will appreciate that any variety of materials (including
ultra-high-molecular-weight polyethylene (UHMWPE)) can be used to
form the loop, including those typically used to form sutures.
Further, the tensile strength at break can be about 50 MPa and the
tensile strength at yield can be about 20 MPa such that the
material is sufficiently strong to serve its intended purpose of
graft retention. The maximum tensile load of the entire construct
can be in the range from about 250 N to about 2500 N. It should be
appreciated that the described embodiments are not limited to any
specific graft retention loop.
[0075] The graft retention loop 108 can be formed from any suitable
materials. For example, the loop 108 can be formed from a suture
that can be any type of suture. For example, the suture can be from
size 0 to size 5, such as Orthocord.RTM. suture or Ethibond.RTM.
suture. In some embodiments, the suture can be formed from
ultra-high-molecular-weight polyethylene (UHMWPE). In some
embodiments, the suture can include high-molecular
weight-polyethylene (HMWPE) or HMWPE with a co-braid (e.g.,
monofilament polypropylene, nylon or other co-braid). In some
embodiments, monofilament sutures such as, for example,
Monocryl.RTM. available from Ethicon, Inc., may be utilized. As
another example, an absorbable suture such as Vicryl.RTM. (a
copolymer made from 90% glycolide and 10% L-lactide) also available
from Ethicon, Inc. may be used. The sutures used herein can have
any suitable amount and type of bioabsorbable material, which can
depend on a particular surgical procedure and/or surgeon
preferences.
[0076] As shown in FIGS. 1A-1C, the flexible member 106 includes
apertures or openings 124, 126, formed at opposite sides of the
longitudinal axis A of the flexible member 106, and these are
intended for passing the graft retention loop 108 therethrough so
as to couple the loop 108 to the tissue fixation device 100. The
openings 124, 126 can be pre-formed or they can be formed as a
suture forming the graft retention loop 108 is passed through the
flexible member 106. The openings 124, 126 can be reinforced by
additional sutures placed around their perimeter, or in any other
manner, so as to prevent fabric forming the flexible member 106
from fraying and improve the rigidity of the openings.
[0077] It should be appreciated that the two openings 124, 126
formed through the flexible member 106 are shown by way of example
only, as a single openings can be formed. As another example, the
loop 108 can wrap around the tissue fixation device 100, without
passing through the flexible member. In some embodiments, a tissue
fixation device can include a graft retention loop can be formed
from a flexible member. For example, the flexible member can be
tied to form a loop and it can be otherwise configured into a
loop-like shape.
[0078] The tissue fixation device 100 also includes leading and
trailing sutures 110, 111 that assist in passing the device 100
through the bone tunnel and in "flipping" device 100 (i.e.,
transferring the device 100 from a delivery configuration to a
deployed configuration) after it is passed through the tunnel, as
discussed in more detail below. The leading and trailing sutures
110, 111 can have any suitable length and can be formed from any
suitable materials. For example, in some embodiments, the leading
suture 110 can be formed from ultra-high-molecular-weight
polyethylene (UHWMPE) high strength Orthocord.RTM. suture size 5,
and the trailing suture 111 can be formed from
ultra-high-molecular-weight polyethylene (UHWMPE) high strength
Orthocord.RTM. suture size 2. In some embodiments, one or both of
the leading and trailing sutures can be from size 0 to size 5, such
as Orthocord.RTM. suture commercially available from DePuy Mitek,
and Ethibond.RTM. suture available from Ethicon, Inc. However, a
person skilled in the art will appreciate that the leading and
trailing sutures 110, 111 can be formed from any suitable
materials, including from the same type of suture.
[0079] The leading and trailing sutures 110, 111 can be coupled to
the tissue fixation device 100 in a number of ways. In the
illustrated embodiment, as shown in FIGS. 1A-1C, the flexible
member 106 includes apertures or openings 130, 131 for passing the
leading and trailing sutures 110, 111 therethrough. As shown, the
openings 130, 131 are formed at opposite sides thereof and disposed
approximately along the longitudinal axis A of the flexible member
106. Like openings 124, 126 for retaining the loop 108, the
openings 130, 131 can be pre-formed in the flexible member 106 or
they can be formed as the leading and trailing sutures 110, 111 are
passed through the flexible member 106 (e.g., using a needle). The
openings 130, 131 can be reinforced in a suitable manner.
Alternatively, the leading and trailing sutures can pass through a
single aperture or opening.
[0080] As indicated above, the tissue fixation device 100 is
configured such that the flexible member 106 can be folded,
crimped, compressed, or otherwise deformed and the distance between
the rigid support members 102, 104 can thus decrease relative to
the original (undeformed or uncompressed) configuration of the
device to facilitate delivery. FIGS. 2A and 2B illustrate the
tissue fixation device 100 in an original, uncompressed
configuration (FIG. 2A) and in a compressed configuration (FIG.
2B), which can be a deployed and/or delivery configuration. As
shown, in the original, uncompressed configuration, the rigid
support members 102, 104 can be disposed such that a distance D1
between their mid-points is greater than a distance D2 between the
mid-points in the compressed configuration. The tissue fixation
device 100 can be passed through a bone tunnel in the compressed
delivery configuration in which the rigid support members 102, 104
maintained in a non-intersecting orientation with respect to one
another, as shown in FIG. 2B. In the delivery configuration, the
rigid support members 102, 104 are disposed close to each other
such that the tissue fixation device 100 can be passed through a
bone tunnel having a reduced diameter.
[0081] After the tissue fixation device 100 is passed through the
bone tunnel, as discussed in more detail below, it is placed over
an opening in a bone tunnel (not shown) in the compressed deployed
configuration such that the graft retention loop 108 is used to
retain a tissue graft 202. Thereafter, the device can be rearranged
in a manner desired by the surgeon. Typically, because the tissue
graft 202 is tensioned due to load applied thereto such that the
graft retention loop 108 extends into the bone tunnel, the rigid
support members 102, 104 tend to be brought closer together as the
flexible member 106 forms one or more folds 204. As the rigid
support members 102, 104 come closer together, they are maintained
in a non-intersecting orientation with respect to one another. It
should be appreciated that, in the delivery configuration, the
rigid support members 102, 104 can be positioned closer to one
another as compared to their relative positions in the original,
uncompressed configuration. Thus, a distance between the mid-points
of the rigid support members 102, 104 in the delivery configuration
can be equal or greater than D2 and less than D1. However, in some
embodiments, in the delivery configuration, the rigid support
members 102, 104 can be positioned with respect to one another such
that a distance between their mid-points is approximately equal to
the distance D1 in the uncompressed configuration of the tissue
fixation device 100.
[0082] FIGS. 3A and 3B illustrate another embodiment of a tissue
fixation device 300 including first and second substantially rigid
support members 302, 304 and a flexible member 306 in the form of a
plurality of elongate connecting filaments 306a-306e extending
between the rigid support members 302, 304. Like tissue fixation
device 100 (FIGS. 1A-1C), the tissue fixation device 300 also
includes a graft retention loop 308 coupled thereto such that it
passes around both sides of the device, and leading and trailing
sutures 310, 311 also coupled thereto.
[0083] The first and second rigid support members 302, 304 are
substantially elongate elements coupled to one another via the
flexible member 306 such that a distance between the support
members 302, 304 is changeable. Each of the rigid support members
302, 304 can include a plurality of retaining elements used to
couple the elongate connecting filaments 306a-306e thereto. Thus,
as shown in FIGS. 3A and 3B, the first support member 302 includes
first retaining elements 312a-312e, and the second support member
304 includes second retaining elements 314a-314e. In the
illustrated embodiment, the first and second retaining elements
312a-312e, 314a-314e are in the form of openings formed in the
rigid support members 302, 304 and longitudinally spaced along a
length of the support members 302, 304. The first retaining
elements 312a-312e can be spaced the same distance apart along the
first support member 302, and the second retaining elements
314a-342e can be similarly spaced the same distance apart along the
second support member 304.
[0084] The openings can have a round or oval cross-sectional shape,
and they can be formed such that, in the uncompressed
configuration, an opening in one of the support members is disposed
opposite to an opening in another one of the support members. A
person skilled in the art will appreciate, however, that the
retaining elements 312a-312e, 314a-314e can be formed in the rigid
support members 302, 304 in other manners, as embodiments are not
limited in this respect. Furthermore, retaining elements having
other configurations (e.g., hooks, protrusions or other structures)
can be formed on or within the support members 302, 304.
[0085] The first and second rigid support members 302, 304 can be
sized and constructed similar to first and second rigid support
members 102, 104 (FIGS. 1A-1C), as discussed above. Also, the first
and second rigid support members 302, 304 can be formed from
materials similar to those used to form the first and second rigid
support members 102, 104 which are also discussed above.
[0086] In the illustrated embodiment, the elongate connecting
filaments 306a-306e connecting the first and second rigid support
members 302, 304 can each be formed from a separate element (e.g.,
suture or wire) such that the tissue fixation device 300 has an
overall "ladder-like" configuration. However, in some embodiments,
a single suture or wire element can be passed through the retaining
elements 312a-312e, 314a-314e or coupled to via other retaining
elements to the rigid support members 302, 304. The single suture
can be used to form a tissue fixation device having "ladder-like"
configuration or a tissue fixation device in which elongate
connecting filaments from a crisscrossed pattern between the
support members.
[0087] The connecting filaments 306a-306e can be rigid such that,
in a delivery configuration, the distance between the rigid support
members 302, 304 can decrease as they translate with respect to
each other, as shown in FIG. 3B. In embodiments in which the
connecting filaments 306a-306e are formed from a flexible suture,
wire, or other material(s), the connecting filaments 306a-306e can
be compressed in a manner similar to flexible member 206 (FIGS. 2A
and 2B) to allow the rigid support members 302, 304 to come closer
together without translating with respect to each other.
[0088] As mentioned above, the connecting filaments 306a-306e of
the flexible member 306 can be formed from a suture or wire. The
suture can be any type of suture. For example, the suture can be
from size 0 to size 5, such as Orthocord.RTM. suture or
Ethibond.RTM. suture. In some embodiments, the suture can be formed
from ultra-high-molecular-weight polyethylene (UHMWPE). In some
embodiments, the suture can include high-molecular
weight-polyethylene (HMWPE) or HMWPE with a co-braid (e.g.,
monofilament polypropylene, nylon or other co-braid). In some
embodiments, monofilament sutures such as, for example,
Monocryl.RTM. available from Ethicon, Inc., may be utilized. As
another example, an absorbable suture such as Vicryl.RTM. (a
copolymer made from 90% glycolide and 10% L-lactide) also available
from Ethicon, Inc. may be used. The sutures used herein can have
any suitable amount and type of bioabsorbable material, which can
depend on a particular surgical procedure and/or surgeon
preferences. In embodiments in which the connecting filaments
306a-306e are formed from a wire, the wire can be formed from
surgical stainless steel, titanium alloy, or other biocompatible
metal, or polymer.
[0089] As shown in FIGS. 3A and 3B, the graft retention loop 308
can be coupled to the tissue fixation device 300 by being disposed
around the rigid support members 302, 304. The graft retention loop
308 can additionally or alternatively be coupled to the rigid
support members 302, 304 in a number of other ways. For example,
the graft retention loop 308 can be coupled to a feature (not
shown) formed on or in one or both of the support members 302, 304.
As another example, the graft retention loop 308 can be coupled to
the rigid support members 302, 304 by passing around or through one
of the flexible connecting filaments 306a-306e, for example, around
or through the filament 306c or one or more of other filaments.
[0090] The leading and trailing sutures 310, 311 can be coupled to
the tissue fixation device 300 in a number of ways. For example,
the leading and trailing sutures 310, 311 can pass around one or
more of the elongate connecting filaments 306a-306e. Thus, in the
illustrated embodiment, as shown in FIGS. 3A and 3B, the leading
and trailing sutures 310, 311 are coupled to the tissue fixation
device 300 such that the leading suture 310 passes (e.g., loops)
around the connecting filament 306e at one end of the device 300
and the trailing suture 311 passes (e.g., loops) around the
connecting filament 306a at the opposite end of the device 300. It
should be appreciated that the locations of the leading and
trailing sutures can be reversed such that the leading suture 310
passes around the connecting filament 306a and the trailing suture
311 passes around the connecting filament 306e. Furthermore, as a
person skilled in the art will appreciate, the leading and trailing
sutures 310, 311 can be coupled to the tissue fixation device 300
in other ways. For example, one or both of the leading and trailing
sutures 310, 311 can pass through one or more of the elongate
connecting filaments 306a-306e. Also, the leading and trailing
sutures can loop more than one time about one or more of the
elongate connecting filaments 306a-306e.
[0091] The leading and trailing sutures 310, 311 can be formed from
materials similar to those used to form leading and trailing
sutures 110, 111 of tissue fixation device 100 (FIGS. 1A-1C), as
discussed above.
[0092] In some embodiments, a tissue fixation device has more than
two rigid support members. In such embodiments, the rigid support
members can have a reduced diameter such that the tissue fixation
device can move to a compressed configuration by being rolled into
a tube-like configuration. FIG. 4 illustrates an implantable tissue
fixation device 400 that includes a plurality of substantially
rigid elongate support members 402a-402g and a plurality of
flexible members 406a-406f each connecting two of the support
members 402a-402g. Although not shown, the tissue fixation device
400 also has at least one graft retention loop (which can be
similar to graft retention loop 108 of FIGS. 1A-1C) coupled to one
or more of the flexible members 406a-406g in a suitable manner. The
tissue fixation device 400 can also have one or both of leading and
trailing sutures coupled to opposite ends thereof.
[0093] As mentioned above, the rigid support members 402a-402g can
have a small diameter, for example, about 0.1 mm. It should be
appreciated that seven rigid support members 402a-402g are shown in
FIG. 4 by way of example only, since the tissue fixation device 400
can have other number of rigid support members (e.g., three, four,
five, six, eight or more than eight). The larger the number of the
rigid support members, the smaller the diameter of each of the
rigid support members. The rigid support members 402a-402g are
connected to each other via flexible members 406a-406g such that
the rigid support members 402a-402g remain in a non-intersecting
orientation with respect to one another in uncompressed and
compressed configurations.
[0094] As shown in FIG. 4, each of the flexible members 406a-406g
connecting respective two of the rigid support members 402a-402g
includes multiple filaments. For example, the flexible member 706a
can be in the form of a plurality of filaments 407a-407h as shown
in FIG. 4. In the illustrated embodiment, the filaments 407a-407h
can be spaced at approximately equal distances away from each other
along a length of the rigid support members 402a-402g. However, the
filaments 407a-407h can be disposed along a length of the rigid
support members 402a-402g at other intervals.
[0095] As shown, each of the filaments 407a-407h can include one or
more elements movably coupled to each other. In the illustrated
embodiment, each of the filaments is in the form of two
triangular-shaped elements connected to one another so as to form a
cross-hatching pattern. The filaments can also be formed by
interconnected rings or any other elements. It should be
appreciated that eight filaments 407a-407h together forming a
flexible member are shown in FIG. 4 by way of example only, as the
rigid support members 402a-402g can be coupled to one another using
any suitable number of any other type(s) of filaments. The
filaments can be formed from a metal, fabric or any other
material.
[0096] The support members 402a-402g are connected via the flexible
members 406a-406g such that adjacent support members can be
displaced with respect to each other. The support members 402a-402g
can be connected via the flexible members 406a-406g such that the
support members 402a-402g at least partially restricted from
translating with respect to one another. Alternatively, the
flexible members 406a-406g can connect the support members
402a-402g such that adjacent support members 402a-402g can be
translated with respect to one another.
[0097] The tissue fixation device 400 can move from an uncompressed
to a compressed configuration by being rolled into a tube-like
configuration. In such configuration, the tissue fixation device
400 can be passed through a bone tunnel (e.g., a femoral tunnel)
having a relatively small diameter. For example, the tissue
fixation device 400 can be passed in the compressed configuration
through a femoral socket and a passing tunnel which will be
discussed in more detail with respect to FIGS. 18 and 19A-G. After
the tissue fixation device 400 passes through the bone tunnel, the
device 400 can be moved to an uncompressed or partially
uncompressed configuration to support the tissue fixation loop and
a graft coupled thereto. For example, the tissue fixation device
400 can be unrolled into a flat or partially flat
configuration.
[0098] FIG. 5 illustrates another embodiment of a tissue fixation
device 500 which is similar to tissue fixation device 400 (FIG. 4).
As shown, the tissue fixation device 500 includes a plurality of
substantially rigid elongate support members collectively referred
to as rigid elongate support members 502 and a plurality of
flexible members each connecting two of the support members 502 and
collectively referred to as flexible members 506. The flexible
members 506 can be similar to the flexible members 406a-406g (FIG.
4) or they can have other configuration.
[0099] In the illustrated embodiment, as shown in FIG. 5, a
distance between each adjacent support members 502 can be
relatively small. The width (W1 in FIG. 5) of the tissue fixation
device 500 in the uncompressed configuration (before delivery and
deployment of the device 500) can range from about 2 mm to about 8
mm. In one embodiment, the width can be about 5 mm. The length (L1
in FIG. 5) of the tissue fixation device 500 can depend on the
length of the rigid elongate support members 502 and it can vary
from about 5 mm to about 28 mm. In some embodiments, the length L1
can vary from about 10 mm to about 18 mm. In some embodiments, the
length can vary from about 12 mm to about 13 mm. In one embodiment,
the length L1 can be about 12 mm. A width of each of the flexible
members 506 can depend on a diameter of the support members
402a-402g. For example, in embodiments in which the diameter of
each of the support members 702a-702g is about 0.1 mm, the width of
each of the flexible members 506 can vary from about 0.03 mm to
about 0.08 mm.
[0100] FIG. 6A shows the tissue fixation device 500 in an
uncompressed configuration, and FIG. 6B shows an exemplary
embodiment of the tissue fixation device 500 in a compressed
(rolled-up) configuration. The tissue fixation device 500 can be
delivered to an implantation site in such a configuration.
[0101] FIG. 6C illustrates the tissue fixation device 500 in the
deployment configuration, with a graft retention loop 508 coupled
thereto in a suitable manner. As shown in FIG. 6C, because a tissue
graft (not shown) coupled to the graft retention loop 508 is
tensioned due to load applied thereto, the rigid support members
502 tend to be brought closer together as the flexible members 506
allow the rigid support members 502 to be replaced with respect to
one another. Thus, in such configuration, the tissue fixation
device 500 is no longer in the rolled-up into a tube and, at the
same time, the device 500 has a configuration different from a
fully flattened configuration, as shown in FIG. 6B. A person
skilled in the art will appreciate that the tissue fixation device
500 is shown in FIGS. 6B and 6C by way of example only and that the
tissue fixation device 500 can be compressed in different other
ways in its deployment and delivery configurations.
[0102] Tissue fixation devices of the type described above can be
implanted according to various techniques. Particularly useful
techniques are described in U.S. patent application Ser. No.
14/730,484, entitled "Tissue Fixation Device," which is hereby
incorporated by reference in its entirety. Additional devices,
systems, and methods for delivering an implantable tissue fixation
device are described below.
[0103] In one aspect, a suitable delivery device generally includes
a drill pin having a proximal end and a distal end that includes a
tissue-penetrating tip. A cavity is formed within the drill pin,
such as at the proximal end thereof. The cavity is defined in part
by a sidewall of the drill pin and the sidewall is interrupted by a
longitudinally oriented opening in communication with the cavity.
The drill pin is configured to substantially contain in the cavity
an expandable tissue fixation device (such as one of the type
described above), which can be housed in the cavity in an
unexpanded or delivery configuration. In some embodiments, the
cavity is configured to fully seat the tissue fixation device.
Further, the drill pin is configured to enable deployment of the
tissue fixation device through the opening. The delivery system
generally includes a tissue fixation device such as described
herein, at least one graft retention loop coupled to the tissue
fixation device, and a drill pin having a cavity configured to seat
the tissue fixation device therein. Methods of fixating a graft
ligament into a bone tunnel using such devices and systems are also
provided and are discussed below.
[0104] The disclosed devices, systems, and methods for delivering a
tissue fixation device have a number of advantages. For example,
fewer surgical steps, such as reaming steps, are required when
using the drill pin described herein, and the tissue fixation
device can be deployed during the drilling step. As another
example, a surgeon has more control when pulling the tissue
fixation device through the bone tunnel because the tissue fixation
device is seated in a drill pin and is thus not susceptible to
being caught on the bone tunnel wall during deployment. As such,
the deployment location of the drill pin is more certain. Tissue
fixation device delivery can also be effected in a more controlled
manner because instead of winding suture around a pair of forceps,
a pin pusher can be used to pull the drill pin along with the
tissue fixation device and graft retention loop through the bone
tunnel.
[0105] FIGS. 7A and 7B illustrate one embodiment of a drill pin 700
for delivering a tissue fixation device such as tissue fixation
devices 100, 300, 400, 500 described above. The drill pin 700 is
generally an elongate structure having a proximal end 702 and a
distal end having a tissue-penetrating tip (not shown) and a cavity
704 therein. The longitudinally oriented opening 708 leading to
cavity 704 is defined at its lateral edges by sidewalls 706 and may
be defined by an endwall 707 at its distal edge. There is no
proximal boundary for the opening in the embodiment of FIGS. 7A and
7B.
[0106] With further reference to FIGS. 7A and 7B, the drill pin 700
has two longitudinally oriented openings 708 that are on opposite
sides of the drill pin 700 and extend to the open proximal end 702
of the drill pin 700. That is, there is no proximal wall abutting
the openings 708. In other embodiments, the drill pin 700 can have
a single opening, or three or more openings. Multiple openings 708
can be positioned in any configuration along the circumference or
outer edges of the drill pin 700, and the opening(s) 708 can have
any suitable dimensions such that drill pin 700 is configured to
enable deployment of a tissue fixation device through the opening
708 in the sidewall 706. Thus, generally, opening 708 is elongate
and sized and shaped so that the tissue fixation device can be
inserted into and delivered from opening 708.
[0107] Although shown to be at the proximal end of the drill pin
700, opening 708 can be located in any portion of the drill pin
700. For example, one or more openings can be positioned in a
distal portion, a proximal portion, or a middle portion of the
drill pin. In one embodiment, at least one opening is positioned in
the proximal portion of the drill pin as shown, for example, in
FIG. 7A.
[0108] The proximal end of the drill pin can have various
configurations. For example, the proximal end of the drill pin 700
shown in FIG. 7A is open. In other embodiments, the proximal end of
the drill pin can include a proximal end wall, which can be closed
or which can possess one or more openings therein. In another
aspect, the one or more openings in the proximal end wall can be in
the form of an eyelet or slot or any other desired size or shape
that is configured to accommodate passage of at least one graft
retention loop coupled to the tissue fixation device during
deployment of the tissue fixation device.
[0109] FIGS. 8A and 8B illustrate another embodiment of a drill pin
800 for delivering a tissue fixation device. As shown in FIGS. 8A
and 8B, the drill pin 800 has a proximal end 802 and
tissue-penetrating tip 812 at a distal end 814 thereof. Like the
drill pin described above with respect to FIGS. 7A and 7B, drill
pin 800 has a cavity 804 formed at least in the proximal end 802
thereof, and at least one longitudinally oriented opening 808
formed in sidewall 806 of the drill pin is in communication with
cavity 804. Opening 808 is defined by lateral sidewalls 806, distal
endwall 807, and proximal end wall 816 of the drill pin 800. In
this embodiment, the proximal end wall 816 is partially open to
accommodate the graft retention loop 810, which as shown in FIG.
8A, has a graft retention loop 810 extending through proximal
endwall 816 from a tissue fixation device (not shown) contained in
a cavity 804 of the drill pin 800. Like the drill pin described
above with respect to FIGS. 7A and 7B, cavity 804 and opening 808
can also be positioned in the middle portion 816 of the drill pin
or closer to the distal end of the drill pin. Moreover, drill pin
800 can have more than one opening 808 that communicates with
cavity 804.
[0110] FIGS. 9A and 9B show yet another embodiment of a drill pin
900 in which an opening 908 in drill pin 900, in the form of a
window in sidewall 906 of the drill pin 900, communicates with an
internal cavity of the drill pin. Moreover, a proximal portion of
the opening is defined by a proximal end wall 916. Like proximal
end wall 816 of FIG. 8A, proximal end wall 916 of drill pin 900 is
partially open. However, as shown in FIGS. 9A and 9B, proximal end
wall 916 of has an opening in the form of slot 918 that
communicates with opening 908, whereas opening 808 in sidewall 806
of FIG. 8A is not in communication with an opening in the proximal
end wall 816.
[0111] Regardless of which variation of the drill pin is utilized,
the tissue fixation device can be inserted into the drill pin in
various ways. For example, the tissue fixation device can be
inserted into the drill pin via the distal end, proximal end, or
through the opening in the sidewall. In designs where the proximal
end of the drill pin is open, the tissue fixation device can be
inserted through the open proximal end. The tissue fixation device
can also be angularly oriented and inserted into the cavity
directly through the opening in the event that the tissue fixation
device has a length that is greater than the length of the opening.
The tissue device can also be deployed from the drill pin in
similar manners, as described in more detail below.
[0112] FIGS. 10-17 show exemplary embodiments of tissue fixation
devices at least partially seated within the drill pins of the type
described herein. It is understood that FIGS. 10-17 are intended to
generally illustrate the manner in which the tissue fixation
devices is seated within the drill pins, but for ease of
illustration the tissue fixation devices are shown to be spaced
away from inner walls of the drill pin, a condition that is not
likely to occur in reality.
[0113] FIG. 10 illustrates an embodiment of drill pin 900, viewed
from its proximal end, having a tissue fixation device 500 disposed
therein and configured in an unexpanded or delivery configuration
and contained within cavity 904 of drill pin 900. Although not
shown in FIG. 10, the sidewall 906 of the drill pin 900 has a
longitudinal opening 908 formed therein as shown, for example, in
FIG. 9A. In the illustrated embodiment the tissue fixation device
500 includes support members 502 connected by flexible members 506.
Although tissue fixation device 500 is shown in FIG. 10 to have
seven rigid support members 502, it is understood that the tissue
fixation device 500 can include less than or more than seven
support members 502. In the embodiment illustrated in FIG. 10, the
graft retention loop 508 that is coupled to the tissue fixation
device 500 is also contained within the cavity 904 of the drill pin
900. As explained below, however, other configurations can be used
for the tissue fixation device and the drill pins.
[0114] FIG. 11 illustrates another embodiment of a drill pin 900,
viewed from its proximal end, having a tissue fixation device 1100
therein. As illustrated, tissue fixation device 1100 includes five
rigid support members 1102a-1102e connected by flexible members
1106, and in FIG. 11 it is disposed in its delivery configuration
as it is rolled up inside the drill pin 900.
[0115] When the tissue fixation device is disposed within the drill
pin in a delivery configuration, the rigid support members are
typically disposed in a non-intersecting orientation relative to
one another. Thus, the rigid support members can be substantially
parallel to one another. As so configured, the rigid support
members are disposed a first distance away from one another that is
less than a distance between the rigid support members in an
uncompressed configuration. This reduced distance between
substantially rigid support members allows the support members and
flexible member coupled therebetween to have a reduced diameter so
as to enable the tissue fixation device to be housed within the
drill pin.
[0116] One skilled in the art will appreciate that dimensions of
the drill pin and tissue fixation device can be any that are
suitable for a desired application. Moreover, the dimensions of the
tissue fixation device in its delivery configuration will depend on
the dimensions of the drill pin through which it is delivered, and
the dimensions of the tissue fixation device in its deployed
configuration will depend on the requirements of the surgical
procedure with which it is used and the anatomy in which it is
placed. In one embodiment, the tissue fixation device has a length
of about 12 mm, each rigid support member of the tissue fixation
device has a diameter of about 0.5 mm, and the drill pin has an
outer diameter of about 2.4 mm and an inner diameter of about 2 mm.
The diameter of a widthwise cross-section of the support members of
the tissue fixation device contributes to the overall size of the
tissue fixation device and this dimension can vary. In the example
of FIG. 11, the drill pin 900 has an inner diameter I.sub.D and an
outer diameter O.sub.D. In the illustrated delivery configuration,
the three rigid support members 1102 e, a, c of the tissue fixation
device 1100 are disposed within inner cavity 904 of drill pin 900
and extend along the length of the drill pin. As shown, rigid
support members 1102 e, a, c are separated by each other and inner
surface 920 of the sidewall 906 by distances D.sub.1-D.sub.4. The
inner diameter of the drill pin should be large enough to
accommodate the tissue fixation device in a clearance fit. In one
embodiment, inner diameter I.sub.D can at least be equal to the sum
of the distances D.sub.1-D.sub.4 between support members 1102e,a,c
and inner surface 920 of sidewall 906 of drill pin 900 plus the
number of rigid support members along a diameter of the drill pin
multiplied by the maximum diameter of the rigid support member
(X.sub.max). In other words,
I.sub.D=(D.sub.1+D.sub.2+D.sub.3+D.sub.4)+3(X.sub.max).
[0117] The length of the tissue fixation device can also vary.
Although the length of the tissue fixation device is less than the
length of the cavity of the drill pin, the length of the tissue
fixation device can be greater than the length of an opening in the
sidewall of the drill pin as long as the tissue fixation device can
be inserted into the cavity when in the delivery configuration.
[0118] FIGS. 12A and 12B illustrate an embodiment of drill pin 700
of FIGS. 7A and 7B having tissue fixation device 1100 of FIG. 11
disposed therein. In this embodiment, like FIGS. 7A and 7B, drill
pin 700 has an open proximal end 702 with two longitudinal openings
708 in sidewall 706 of the drill pin, as shown in FIG. 12A. As
explained above, sidewall 706 surrounds cavity 704 of the drill
pin, and the longitudinally oriented openings 708 in the sidewall
706 are in communication with the cavity 704. As shown in FIG. 12A,
drill pin 700 is configured to substantially contain therein the
tissue fixation device 1100 when it is in the delivery
configuration.
[0119] As shown in the proximal end view of the drill pin 700 in
FIG. 12B, the tissue fixation device 1100 has five generally
parallel rigid support members 1102 that are connected by flexible
members 1106. In this embodiment, two legs of a graft retention
loop 1108 are coupled to the tissue fixation device 1100 and are
also shown in FIG. 12B. The tissue fixation device 1100 is shown in
an unexpanded, delivery configuration within drill pin 700. In this
undeployed configuration, the tissue fixation device 1100 has a
diameter that is less than the diameter of the drill pin 700 so
that it is able to fit within the drill pin in a clearance fit.
Further, in this embodiment, the tissue fixation device 1100 has a
length that is greater than the length of the openings 708 in the
sidewall 706 of the drill pin 700. In other embodiments, however,
the tissue fixation device 1100 can have a length that is the same
as or less than the length of the opening 708 in the sidewall
706.
[0120] FIGS. 13-15 illustrate an embodiment of tissue fixation
device 1100 being partially deployed from drill pin 700, which is
further illustrated in FIGS. 12A and 12B. As shown in FIG. 13,
tissue fixation device 1100 is being partially deployed through
opening 708 in sidewall 706 and the open proximal end 702 of drill
pin 700. FIG. 14 shows tissue fixation device 1100 being partially
deployed through the proximal end 702 of the drill pin of FIG. 12A.
As shown, rigid support members 1102 are oriented at an angle such
that they are not parallel to longitudinal axis 720 of drill pin
700 during the deployment process. In FIG. 15, tissue fixation
device 1100 is almost fully deployed through proximal end 702 and
opening 708 in sidewall 706 of drill pin 700. Only the ends of
support members 1102 are shown in FIG. 15 as the tissue fixation
device 1100 is oriented upon deployment so as to be generally
perpendicular to longitudinal axis 720 of drill pin 700.
[0121] A person skilled in the art will appreciate that tissue
fixation device 1100 can be deployed at various angles with respect
to the longitudinal axis of the drill pin. In one embodiment, the
tissue fixation device 1100 can be deployed through opening 708 in
drill pin 700 at an angle so as to facilitate rotating the tissue
fixation device 1100 into an orientation that is perpendicular to
the drill pin so that the tissue fixation device spans a bone
tunnel upon implantation. Tissue fixation device 1100 can also be
deployed at an angle to prevent the tissue fixation device 1100
from entering the bone tunnel. Once the tissue fixation device is
at least partially deployed, graft retention loop 1108 can be
pulled to rotate the tissue fixation device 1100 into a desired
final position. A person skilled in the art will appreciate that
other suitable methods of creating a downward force can be employed
to facilitate rotation of the tissue fixation device 1100 during
deployment.
[0122] FIGS. 16 and 17 show another embodiment of tissue fixation
device 1100 disposed in drill pin 900, which is a drill pin of the
type illustrated in FIGS. 9A and 9B having a proximal end wall 916
with a slot 918 therein. As shown in FIG. 16, tissue fixation
device 1100 has a length that is less than the length of opening
908 in sidewall 906 of drill pin 900 and when the tissue fixation
device is in its rolled, unexpanded configuration within the drill
pin it has a diameter that is less than the inner diameter of drill
pin 900. Thus, in its unexpanded configuration, tissue fixation
device 1100 can easily be inserted through opening 908 in sidewall
906 and into cavity 904 of the drill pin. Because slot 918 in the
proximal end 902 of drill pin 900 is not sufficiently large for
deployment of the tissue fixation device therethrough, tissue
fixation device 1100 can only be deployed through opening 908 in
sidewall 906 for the embodiment of FIGS. 16 and 17. During
deployment of tissue fixation device 1100 from drill pin 900, at
least one graft retention loop 1108 can pass through slot 918 while
tissue fixation device 1100 can pass through opening 908 in
sidewall 906, which is in communication with the slot 918. As
discussed above with respect to FIGS. 13-15, tissue fixation device
1100 can likewise be deployed from drill pin 900 at an angle to
facilitate rotating the tissue fixation device 1100 into the
perpendicular orientation relative to the longitudinal axis of the
drill pin so that the tissue fixation device lies across a bone
tunnel following implantation.
[0123] Some embodiments provide a method for fixating a graft
ligament within a bone tunnel using the tissue fixation device and
the drill pins described herein. In one embodiment, the method
generally includes forming a graft construct by coupling the graft
or graft ligament to a tissue fixation device via a graft retention
loop of the tissue fixation device. Any suitable tissue fixation
device and graft including those disclosed herein may be used to
form the graft construct. The method also includes utilizing a
drill pin of the type shown, for example, in the embodiments of
FIGS. 7A-9B that has a tissue fixation device disposed in a cavity
of the drill pin in a collapsed, delivery configuration. During
such a procedure the drill pin is embedded into a bone to form a
bone tunnel, the tissue fixation device is deployed through the
opening in the drill pin, and the graft construct is passed through
the bone tunnel with the tissue fixation device in the delivery
configuration, and the tissue fixation device is positioned over a
first end of the bone tunnel in a deployed configuration. These
steps can be performed in any suitable order. For example, in one
embodiment described below, the graft can be coupled to the tissue
fixation device via the graft retention loop after formation of the
bone tunnel.
[0124] The methods described herein can be used in various surgical
procedures including, for example, ligament reconstruction surgery
involving fixation of anterior or posterior cruciate ligaments. The
disclosed techniques can be adapted for other surgical procedures
as well. For example, the described devices and methods can be used
for acromioclavicular joint reconstruction and ankle syndesmosis.
The devices and methods can be used for anastomosis and other
surgeries where it is required to bring together two (or more) soft
tissues, soft tissue and bone tissue, or two bone tissues need to
be brought or held together.
[0125] FIGS. 18 and 19A-G illustrate the use of the drill pin and
tissue fixation devices described herein in a ligament
reconstruction surgery involving fixation of the anterior cruciate
ligament. FIG. 18 illustrates a patient's leg 1801 in the course of
an ACL reconstruction procedure performed thereon using a tissue
fixation device 1800, such as tissue fixation device 100 (FIGS. 1A,
1B, 2A, and 2B) or tissue fixation device 300 (FIGS. 3A and 3B),
and drill pin 700 (FIGS. 7A and 7B). In some embodiments, other
drill pins such as drill pins 800, 900, described above, can be
used in accordance with this method. FIG. 18 shows tissue fixation
device 1800 deployed on the lateral femoral cortex 1840 and a graft
or graft tendon 1806 disposed in femoral bone socket 1824 and
tibial bone tunnel 1828.
[0126] Surgical techniques for ligament reconstruction are well
known. Generally, the method includes forming a bone tunnel to
receive the graft tendon 1806 therein. A bone tunnel for an ACL
reconstruction procedure in a patient's leg can be formed by
drilling a tibial tunnel through the tibia, as known in the art. A
femoral tunnel is then drilled such that the diameters of the
femoral and tibial tunnels are appropriate to snugly fit the graft
construct therethrough. In the embodiments described herein,
because of the smaller size of tissue fixation device 1800 itself
as well as drill pin 700 containing the tissue fixation device 1800
as compared to existing devices, a passing tunnel having a diameter
that is less than a diameter of a passing tunnel required to pass
therethrough a conventional device can be formed.
[0127] In the illustrated embodiment, as shown in FIGS. 18, 19A,
19B, and 19C, a bone tunnel 1820 in the patient's leg 1801 is
formed that includes a femoral tunnel or socket 1824 and a tibial
bone tunnel 1828. In the illustrated embodiment, a drill pin 700 is
used to drill a relatively small diameter bone tunnel through the
femur 1822. A diameter of such bone tunnel drilled using the drill
pin 700 can be in the range of about 1 mm to about 5 mm. In one
embodiment, the tunnel diameter is about 2.4 mm. This step forms a
passing bone tunnel 1826 shown in FIGS. 18, 19A, and 19B that
extends from the condylar notch of the femur laterally to the
lateral cortex.
[0128] FIGS. 19A and 19B generally show an enlarged view of drill
pin 700 forming femoral bone tunnel 1826. FIG. 19A shows the tissue
penetrating tip 712 at the distal end 714 of the drill pin 700
being introduced into a bone such as femur 1822, shown in FIG. 18,
to form bone tunnel 1826. Drill pin 700 has tissue fixation device
1800 seated therein at its proximal end (not shown). FIG. 19B shows
drill pin 700 inserted a further distance into the bone and through
the opposite side, e.g., the lateral cortex 1840, of the femur 1822
to complete bone tunnel 1826.
[0129] Next, the larger diameter femoral bone socket 1824 can be
formed through the femur 1822, sized so as to receive the graft
tendon 1806 therein. The femoral bone tunnel 1826 can be formed
using, for example, a cannulated drill or reamer advanced over the
drill pin 700, or using any other suitable technique. The drill pin
700 can remain in the bone tunnel 1826 during formation of the
femoral bone socket 1824. FIG. 19C shows drill pin 700 extending
through bone tunnel 1826 with a femoral bone socket 1824 formed in
a portion of the femur 1822 closer to the proximal end of the drill
pin 700. FIG. 18 illustrates a tunnel 1820 in femur 1822 including
femoral bone socket 1824 sized to accommodate graft tendon 1806 and
a smaller diameter superior portion or passing channel or bone
tunnel 1826 formed by drill pin 700 that houses tissue fixation
device 1800 in a delivery configuration. The diameter of the
femoral bone socket 1824 can be in the range of about 6 to about 12
mm. In one embodiment, the diameter of the femoral bone socket 1824
is about 9 mm.
[0130] Once the femoral bone socket 1824 is created, the formation
of the bone tunnel for the procedure is complete. As indicated
above, the passing bone tunnel 1826 is formed in the femur
superiorly to the femoral bone socket 1824 by drilling the drill
pin 700 through the femur. Thus, it is not required to form a
separate passing tunnel. In contrast, a technique using a
conventional tissue fixation device without the drill pin 700
described herein would require an additional step of forming a
larger passing tunnel having a diameter of about 4.5 mm. With the
techniques described herein, the passing bone tunnel 1826 can have
a diameter in the range of about 2.4 mm to about 4.4 mm, for
example, which corresponds to an outer diameter of a drill pin used
to form the passing bone tunnel 1826.
[0131] The above steps can be applied when the tissue fixation
device is delivered via a transtibial (TT) portal approach which
can be used, for example, when delivering a tissue fixation device
having a fixed or adjustable graft retention loop. In the TT portal
approach, as discussed above, a tibial tunnel can be drilled in a
desired manner. The drill pin described herein can then be drilled
into the femur at a desired location via the tibial tunnel, as
generally shown in FIGS. 19A and 19B.
[0132] In another embodiment, tissue fixation device 1800 can be
delivered via an anteromedial (AM) portal approach which can be
used, for example, when delivering the tissue fixation device with
an adjustable graft retention loop 1808. The AM portal approach
involves first drilling drill pin 700 into femur 1822 at the center
of the ACL footprint or at another desired location via the AM
portal and then drilling a tibial bone tunnel 1828 into tibia 1830.
The bone tunnel 1826 can be formed in the femur as described above
and shown in FIGS. 19A and 19B. After bone tunnel 1826 is formed,
the drill pin can then be overdrilled to a desired distance,
leaving adequate bone shelf laterally to form femoral bone socket
1824 as shown in FIG. 19C. Drill pin 700 can then be advanced
further into femur 1822 until the proximal end of the drill pin
containing tissue fixation device 1800 rests inside femoral bone
tunnel 1826, as shown in FIG. 19D. Drill pin 700 can remain in bone
tunnel 1826 as tibial bone tunnel 1828 shown in FIG. 18 is drilled
using any suitable technique.
[0133] Drill pin 700 can then be moved in a retrograde manner to
exit the knee joint via the AM portal. Graft retention loop 1808,
which is coupled to the tissue fixation device 1800, can then be
extended from tissue fixation device 1800 out of drill pin 700 and
into the femoral bone socket 1824, as shown in FIG. 19E.
[0134] Next, drill pin 700 can be advanced further through femur
1822 until graft retention loop 1808 is accessible in a joint. An
arthroscopic grasper or another suitable tool can be used to pull
graft retention loop 1808 inferiorly through tibial bone tunnel
1828. Graft tendon 1806 can then be loaded onto the graft retention
loop 1808, as shown in FIG. 19E. Graft tendon 1806 can be loaded in
any suitable manner, including by techniques described herein. For
example, as understood by a person skilled in the art, graft
construct 1804 can be formed by coupling graft tendon 1806 to
tissue fixation device 1800 via graft retention loop 1808 of tissue
fixation device 1800. This can be done after bone tunnel 1820 and
femoral bone socket 1824 are formed.
[0135] Once graft 1806 is loaded on graft retention loop 1808
(using the AM or TT portal approach or any other suitable method),
as shown in FIG. 19E, drill pin 700 can be advanced further into
femur 1822 so that graft 1806 passes through tibial bone tunnel
1828 and joint space, and into femoral bone socket 1824, as
generally shown in FIGS. 19D and 19E. FIG. 19D shows the proximal
end of drill pin 700 in femoral bone socket 1824 with tissue
fixation device 1800 seated in cavity 704 of drill pin 700. FIG.
19E illustrates the proximal end 702 of drill pin 700 and tissue
fixation device 1800 advanced further into femur 1822 with graft
retention loop 1808 and a portion of graft 1806 in femoral bone
socket 1824.
[0136] As shown in FIG. 19F, drill pin 700 is advanced through bone
tunnel 1826 until tissue fixation device 1800 contained therein
extends beyond femoral cortex 1840 above an opening 1832 of passing
bone tunnel 1826. Drill pin 700 can be pulled through the bone
tunnel 1826 using a pin puller or other suitable instrument.
[0137] When the proximal end of drill pin containing the tissue
fixation device has passed through the lateral cortex 1840, as
shown in FIG. 19F, tissue fixation device 1800 can be released from
the drill pin 700 and the drill pin 700 can be removed from the
femoral cortex 1840. In one embodiment, a loop adjustment suture
(not shown) can exit the skin with the drill pin. In another
embodiment, the loop adjustment suture can trail down past the
graft and through the tibial bone tunnel.
[0138] In this embodiment, tissue fixation device 1800 is deployed
through opening 708 in drill pin 700 as graft 1806 is pulled
through the femoral bone socket 1824 to opening 1832 of bone tunnel
1826. Tissue fixation device 1800 is deployed from cavity 704 of
drill pin 700 at an angle with respect to longitudinal axis 720 of
drill pin 700.
[0139] In embodiments where the drill pin has a slot on the end
surface thereof, graft retention loop 1808 can extend through the
slot and pass through the slot as tissue fixation device 1800 is
deployed.
[0140] Tissue fixation device 1800 is deployed by pulling on graft
retention loop 1808 that connects drill pin 700 to graft 1806.
Tissue fixation device 1800 can be released from drill pin 700 when
significant resistance is felt which indicates that graft 1806 is
fully engaged with the top of femoral bone socket 1824. At this
point, tissue fixation device 1800 is in a position to exit femoral
cortex 1840 and drill pin 700 can then be pulled out of femur 1822,
as shown in FIG. 19F. In one embodiment, the connection of drill
pin 700 and tissue fixation device 1800 can be configured such that
tissue fixation device 1800 automatically disengages from drill pin
700 at a specific tensile load.
[0141] In another embodiment, cavity 704 can be closer to the
middle of drill pin 700 with respect to longitudinal axis 720 of
drill pin 700. Cavity 704 can be positioned such that the proximal
end of drill pin 700 is positioned at the entrance to the femoral
tunnel prior to deploying tissue fixation device 1800 from drill
pin 700.
[0142] In some embodiments, cavity 704 of drill pin 700 need not
communicate with an opening in sidewall 706 of drill pin 700. In
fact, drill pin 700 need not have any openings in sidewall 706 of
drill pin 700 and instead cavity 704 communicates only with an
opening at the proximal end of drill pin 700. Drill pin 700 can be
sized so that there is a sufficient retention force to hold tissue
fixation device 1800 in place, but not dislodge the tissue fixation
device 1800 when a pulling force is applied to drill pin 700.
[0143] Upon deployment, tissue fixation device 1800 is "flipped"
such it is positioned over and across opening 1832, as shown in
FIG. 19G. The tissue fixation device can be flipped in any suitable
manner that moves the tissue fixation device from an angled
position as shown in FIG. 19F to the position shown in FIG. 19G
that is generally parallel to the surface of femur 1822. For
example, tension can be applied to a suture (not shown). Creating a
downward force vector, particularly one that is non-parallel to the
longitudinal axis of the drill pin, can facilitate maneuvering the
tissue fixation device.
[0144] As shown in FIG. 19G, in the deployed configuration, graft
retention loop 1808 with graft 1806 coupled thereto extend into
bone tunnel 1826. As explained above, when tissue fixation device
1800 is in the deployed configuration, it is generally
perpendicular with respect to the first end of bone tunnel 1826.
Also, the rigid support members (such as support member 102, 104
shown in FIGS. 1A and 1B) of the tissue fixation device 1800 are
disposed a second distance away from one another that can be
greater than the first distance between the rigid support members
when they are in the delivery configuration. In the deployed
configuration, the rigid support members remain disposed in the
non-intersecting orientation relative to one another.
[0145] While the distance between the rigid support members in the
deployed configuration is greater than that in the delivery
configuration, the distance between the rigid support members in
the deployed configuration can be less than a distance between the
rigid support members in the uncompressed configuration of the
tissue fixation device 1800. Tension applied to graft 1806 during
the procedure causes tension to be also applied to tissue fixation
device 1800 such that the rigid support members tend to move closer
together. It is to be understood that the flexible members can be
in a configuration (e.g., compressed, deformed, folded, crimped,
etc.) that is different from its uncompressed configuration so as
to allow the distance between the rigid support members to decrease
relative to that in the uncompressed configuration. However, in
some embodiments, the distance between the rigid support members in
the deployed configuration can be the same as that in the
uncompressed configuration of tissue fixation device 1800.
[0146] The support members can be in any orientation when they are
positioned over opening 1832, however they generally do not
intersect. Although the support members are substantially rigid,
they can have some degree of flexibility or malleability such that
tissue fixation device 1800 can be positioned over opening 1832 so
as to conform to the shape of the lateral cortex. In this way,
tissue fixation device 1800, once implanted, can be less palpable
as compared to existing devices. In the deployed configuration, as
shown in FIG. 19G, tissue fixation device 1800 sits on femur 1822
in a sideways orientation with graft retention loop 1808 and graft
1806 extending medially through passing bone tunnel 1826 and into
socket 1824. Graft retention loop 1808 passes around both sides of
tissue fixation device 1800 such that it is supported by both the
support members. However, in some cases, the graft retention loop
can pass over one side of the device so as to be supported by one
of the support members. An opposite end of graft 1806 can be placed
into a tibial bone tunnel 1828 in the leg's tibia 1830 and held in
place with a suitable anchor 1834. After tissue fixation device
1800 is implanted, any leading and trailing sutures can be
removed.
[0147] Graft 1806 can be held in place within bone socket 1824 by
graft retention loop 1808. In one embodiment, graft retention loop
1808 can be of a fixed length. Another embodiment can include a
loop adjustment suture that can exit the skin with drill pin 700,
or can trail past graft 1806 and through tibial bone tunnel 1828.
For adjustable loop tissue fixation devices, a loop adjustment
suture can be pulled until graft 1806 is fully engaged with the
femoral tunnel and tissue fixation device 1800 is resting on the
lateral cortex of femur 1822, as shown in FIGS. 18 and 19G.
[0148] After deployment of tissue fixation device 1800 and graft
1806 in bone socket 1824, a tibial fixation can then be performed
in any desired manner. An end of graft 1806 opposite bone socket
1824 can be placed into a tibial bone tunnel 1828 in the leg's
tibia and held in place with a suitable anchor 1834.
[0149] It is understood that graft tendon 1806 can be any suitable
type of graft. For example, an autograft, which is a portion of the
patient's own tissue that would replace the damaged natural
ligament, can be used. The autograft is often a hamstring tendon,
though other tendons can be used (e.g., a patellar tendon). The
tendon graft can also be an allograft obtained from a donor. The
graft tendon can be prepared in a suitable manner well known to
those skilled in the art, which can involve cleaning and measuring
the graft, and then reinforcing free ends thereof.
[0150] It is also to be understood that in various figures graft
tendon 1806 is not shown to scale as the graft tendon actually has
thicker dimensions such that it substantially entirely fills the
bone tunnel (e.g., femoral bone socket 1824) in which it is
received. Graft tendon 1806, once implanted, contacts the bone in
which the bone tunnel is formed such that graft 1806 grows into and
merges with the bone for a permanent repair.
[0151] It should be appreciated that although illustrated
embodiments provide systems, devices, and methods for orthopedic
surgeries, such as, for example, ligament reconstruction surgery
involving fixation of anterior or posterior cruciate ligaments, the
techniques can be adapted for other surgical procedures as well.
For example, the described devices and methods can be used for
acromioclavicular joint reconstruction and ankle syndesmosis. The
devices and methods can be used for anastomosis and other surgeries
where it is required to bring together two (or more) soft tissues,
soft tissue and bone tissue, or two bone tissues need to be brought
or held together.
[0152] Having thus described some examples of the described
embodiments, various alterations, modifications, and improvements
will readily occur to those skilled in the art. Such alterations,
modifications, and improvements are intended to be within the
spirit and scope of the described embodiments. Accordingly, the
foregoing description is by way of example only, and not intended
to be limiting.
* * * * *