Abstract
An apparatus for repairing an anatomical tear, such as a tear in the meniscus of a human knee. The apparatus includes a guide cannula directing a penetrating shaft through the meniscal tear and through the outer skin layer of the knee. The penetrating shaft pulls a line to the outside of the skin layer of the knee where it is used to pull or kedge a repair implant into position across the meniscal tear.
Claims
1-19. (canceled)
20. An apparatus comprising: a guide component configured for insertion into a human body proximate an anatomical structure; a penetrating shaft configured to pass through the guide component, the penetrating shaft configured for delivering a line through and extending beyond the anatomical structure so that the line exits the human body at an exit point; the line, capable of being connected to a delivery component, the line configured to be pulled from outside the exit point so as to move the delivery component from a first location in the human body to a second location in the human body proximate the anatomical structure; and the delivery component comprising a space for holding an implant, the implant capable of being implanted to repair a tear in the anatomical structure.
21. The apparatus of claim 20 in which the guide component comprises a guide cannula.
22. The apparatus of claim 20 in which the delivery component comprises a delivery cannula.
23. The apparatus of claim 20 in which the delivery component further comprises a handle.
24. The apparatus of claim 20 in which said penetrating shaft comprises a needle.
25. The apparatus of claim 21 in which the guide cannula comprises an angulated member.
26. The apparatus of claim 22 in which the delivery cannula comprises an angulated member.
27. The apparatus of claim 22 in which the delivery cannula further comprises a handle.
28. The apparatus of claim 22 in which the line further comprises a connector being configured to engage a delivery cannula fixture component.
29. The apparatus of claim 28 in which the delivery component further comprises a handle.
30. The apparatus of claim 28 in which the guide component further comprises an angulated member.
31. The apparatus of claim 30 in which the delivery component further comprises an angulated member.
32. The apparatus of claim 30 in which the delivery component further comprises a handle.
33. An apparatus comprising: a penetrating shaft configured to insert into a human body and pass through an anatomical structure of the human body; and a line configured to attach to the penetrating shaft, the line configured to pass through and extend beyond the human body proximate the anatomical structure, the line further configured to connect to a delivery component, the line capable of being pulled so as to move the delivery component from a first location in the human body to a second location in the human body proximate the anatomical structure for repairing a tear in the anatomical structure.
34. The apparatus of claim 33 comprising a guide component capable of passing through the anatomical structure, wherein the penetrating shaft is being passed through the guide component.
35. The apparatus of claim 33 in which the delivery component: a fixture component for linkage to the line, the delivery component further including a space for holding an implant.
36. The apparatus of claim 33 in which the penetrating shaft comprises a needle.
37. The apparatus of claim 34 in which the guide component comprises a guide cannula.
38. The apparatus of claim 34 in which the guide component further comprises a handle.
39. The apparatus of claim 34 in which the guide component further comprises an angulated member.
Description
DETAILED DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
[0035] FIG. 1 is a sectional view of human knee depicting a pair of menisci having exemplary tears.
[0036] FIG. 2 is a top plan view of a pair of menisci in a human knee illustrating available portals of entry into the interior of the knee for effecting repair of meniscal tears.
[0037] FIG. 3 is a top plan view of a delivery cannula utilizing a portal depicted in FIG. 2.
[0038] FIG. 4 is a top plan view showing the approach of a pair of delivery cannulas, partially illustrated, through a meniscal tear and the force vectors associated therewith.
[0039] FIG. 5 is a top plan view of a portion of a meniscal tear in which the penetrating device of the present invention has been inserted across the meniscus.
[0040] FIG. 6 is a sectional view taken along line 6-6 of FIG. 5.
[0041] FIG. 7 is a top plan view of a portion of a meniscus showing the line of the present apparatus in place across a meniscal tear and in which the penetrating shaft has been severed from the line.
[0042] FIG. 8 is a sectional view taken along line 8-8 of FIG. 7.
[0043] FIG. 9 is a broken partial top plan view of the delivery cannula of the present application.
[0044] FIG. 10 is a top plan view of a partial meniscus indicating the line of the present application passing across the meniscal tear and connected to a delivery cannula.
[0045] FIG. 11 is a sectional view taken along line 11-11 of FIG. 10.
[0046] FIG. 12 is a top plan view showing a partial meniscus with an implant cannula passing across a meniscal tear prior to delivery of an implant.
[0047] FIG. 13 is a sectional view taken along line 13-13 of FIG. 12.
[0048] FIG. 14 is a top plan view showing a partial meniscus with an implant having been delivered across a meniscal tear by the apparatus of the present application.
[0049] FIG. 15 is a sectional view taken along line 15-15 of FIG. 14.
[0050] For a better understanding of the invention references made to the following detailed description of the preferred embodiments thereof which should be referenced to the prior described drawings.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0051] Various aspects of the present application will evolve from the following detailed description of the preferred embodiments thereof.
[0052] With respect to FIG. 1, it may be observed that a schematic view of a section of a human knee 12 is shown. Knee 12 includes a skin layer 14 and a pair of menisci 16 and 18. A plurality of representative meniscal tears 20 are also illustrated and are generally located in the peripheral third of each meniscus 16, 18. For example, meniscus 16 includes a posterior horn tear 22, a mid-body tear 24, and an anterior horn tear 26. Likewise, meniscus 18 exhibits a mid-body posterior tear 28 and an anterior mid-body tear 30. Again, the plurality of tears 20 exhibited in FIG. 1 are simply being employed as models for the following discussion of the novel apparatus of the present application. Portion 32 of knee 12 represents other anatomical structures within the knee such as bones, blood vessels, ligaments, and the like. Needless to say, knee 12 is represented in FIG. 2 and is oriented such that knee 12 includes an anterior portion 34 and a posterior portion 36.
[0053] Again, referencing FIG. 2, it may be observed that cross-hatched areas 38 and 40 depict portals which are entry points for surgical instruments used to perform all-inside meniscal repairs. In other words, all other entry points along skin periphery 14 are precluded for surgical penetration because of anatomic obstructions or vulnerable structures within knee 12 which are a portion of schematically depicted anatomical structures 32 of FIG. 1. A prior art straight shaft repair device 42 is shown in FIG. 2 as passing through portal 40 and approaching tear 24 of meniscus 16. Repair device 42 includes a delivery shaft tip 44 housing a conventional repair implant 46 which may be in the form of a dart, clamp, anchor, suture, or similar known structures which are employed to repair meniscal tears. Repair device 42 also includes a delivery shaft 48 having a distal portion 50. Handle 52 is fixed to delivery shaft 48. Repair device 42 is representative of push motivated prior repair devices in the art of knee repair techniques. It should be noted that fixation implant 46 has been depicted in solid line for the sake of clarity in FIG. 2. Vectors 54 and 56 indicate that repair device 42 may be pushed through tears 58 and 22 perpendicular to the long edges of tears 58 and 22. Such a path of travel for repair device 42 would result in an optimal placement of fixation implant 46 across tears 58 and 22. However, the movement of repair device 42 across tear 24 results in an oblique alignment of repair device 42 with tear 24. The placement of fixation implant across tear 24 would ultimately result in an unacceptable buckling of the meniscal tear, since the delivery shaft tip 44 of repair device 42 does not enter the repair site of tear 24 at a perpendicular angle. With reference to FIG. 3, a repair device 60 is shown having a delivery shaft 60 with an angulated distal end 64. Again, repair device 60 is known in the art. Directional arrow 66 shows the direction of the force applied to repair device 42. Viewing now FIG. 4, it may be seen that the use of a prior art straight shaft repair device 42 or an angulated shaft repair device 60 still results in a shearing or lateral force across meniscus tear 24, represented by force arrow 68. Vector 70 represents the force exerted on straight shaft repair device 42 while vector 66 refers to the force applied by angulated repair device 60.
[0054] Referring to FIG. 5, the apparatus 10 of the present application is illustrated in part. Apparatus 10 includes as one of its elements a guide which is in the form of a guide cannula 70. Guide 70 may also be fashioned as a chute, a rod, and the like. Guide cannula 70 may take the form of a straight cannula or an angulated cannula 70 as illustrated in FIG. 5. Also, a penetrating or pointed shaft or needle 72 is employed with guide cannula 70. Penetrating shaft 72 may take the form of a needle-like structure. Once guide cannula 70 is inserted into the knee structure through any of the portal zones 38 or 40, FIG. 2, penetrating shaft 72 is passed through guide cannula 70 and across tear 24 and through or closely adjacent to anatomical structure such as meniscus 16. Penetrating shaft 72 placement is usually accomplished by the practitioner utilizing an arthroscope to visualize the tear repair procedure. Since guide cannula 70 is used to control placement of penetrating shaft across tear 24, guide cannula is placed closely adjacent to and aligned perpendicularly to axis 96 of tear 24. As shown in FIG. 5, guide cannula 70 is angulated as necessary to establish the correct path for penetrating shaft 72 across tear 24. It should be realized that penetrating shaft may be formed of flexible materials such as nitinol and the like in order to be accommodated by angulated cannula 70. In certain cases, penetrating shaft 72 may be employed without guide cannula 70 for placement across tear 24.
[0055] A line 74, which may be formed of suture material, is connected to penetrating shaft 72. Line 74 may terminate in a connector 76 which is shown in FIGS. 5 and 6 as a ring. Connector 76 may also take the form of an end loop or a doubled over line forming a closed loop. Pointed or penetrating shaft 72 is then extended through skin layer 14 of the knee structure 12 partially shown in FIGS. 5 and 6. The movement of penetrating shaft 72 is represented by directional arrow 78. By this step, line 74 is also partially extended outside of the knee structure 12 beyond skin layer 14, FIGS. 7, 8, and 10. Penetrating shaft 72 is then severed from line 74. In other words, penetrating shaft 72 is advanced across tear 24 and outside knee joint 12 along with a portion of line 74. Thus, line 74 is established as a kedging, towing, or pulling line, and lies perpendicular to the axis 96 of tear 24.
[0056] With reference to FIGS. 9-11, it may be observed that apparatus 10 also includes a delivery element in the form of a delivery cannula 80. Delivery element 80 may also be fashioned as a chute, rod, or like structures. Delivery cannula 80 is shown as an angulated type. Delivery cannula 80 includes a delivery shaft 82 having a handle 84. Cannula 80 further is fashioned with a tip portion 86 which is capable of holding, in a space within cannula 80, a fixation implant 88 of known configuration, i.e. a dart, clamp, anchor, suture, and the like. Moreover, delivery cannula 80 is also provided with a fixture 90 which may be in the form of a cleat. It should be apparent that connector ring 76 of line 74 engages cleat 90 to allow kedging, pulling or towing of delivery cannula 80. In certain instances, line 74 may terminate in a bead that engages a slot on delivery cannula 80 to allow the pulling of delivery cannula 80 by line 74. Further, line 74 may be linked directly to implant 88 without the use of delivery cannula 80. Moreover, a deployment mechanism 92, of conventional configuration, serves as a directing mechanism for fixation of implant 88 within deployment cannula 80. It should be noted that line 74 delivered by penetrating shaft 72 has passed across meniscal tear 24 generally perpendicularly to the edge 94 thereof. In general, line 74 lies essentially perpendicular to axis 96. Kedger line 74 is then pulled according to directional arrow 98 from outside the knee structure 14. A counter traction may be applied to delivery cannula 80 to adjust the net force on delivery cannula 80 resulting from the pulling of line 74 and the traction exerted on delivery cannula 80. At this point, delivery cannula 80 is introduced into the knee joint 12. Line 74 is further pulled until the tip 86 of delivery cannula 80 lies at tear 24. The desired delivery cannula 80 alignment with tear is then confirmed. If axis 87 of tip is not perpendicular to axis 96 of tear 24, tip 86 is angulated to correct alignment. Such angulation of delivery cannula 80 may be achieved prior to insertion into knee 12. If guide cannula 70 was angulated to establish correct alignment with axis 96 of tear 24, guide cannula 70 can be used as template for angulation of delivery cannula tip 87 before insertion into joint 12. It should be noted that the position of tip 86 determines the access to tear 24 independently of the position of handle 84. Where a delivery cannula is not employed, implant 88 is pulled into place directly by line 74.
[0057] Thus, the anterior areas of meniscus 16, not reachable by prior art references, are now accessible by apparatus 10. At this point, delivery cannula 80 has advanced into knee joint 12, positioned at tear 26, and pulled by kedging or towing line 74 directly across tear 26. FIGS. 12 and 13 represent such movement of delivery cannula 80. The depth of insertion of delivery cannulas is controlled by the pull of line 74. Again, delivery cannula 80 can be restrained to provide counter-traction to the pull of line 74 to calibrate the net pulling force of line 74 and prevent inadvertent over penetration of delivery cannula tip 87. In certain embodiments, guide cannula 70 may be joined to delivery cannula to establish correct placement of penetrating shaft 72 and line 74.
[0058] At this point, fixation implant 88 is deployed by mechanism 92 from delivery cannula 80. Once deployed, FIGS. 14 and 15, delivery cannula 80 and line 74 are removed or retracted from tear 26, directional arrow 100. It should be realized that fixation implant 88 now lies directly across tear 26 and substantially perpendicular to axis 96, which provides a superior alignment of fixation implant with tear 26. Such positioning of implant 88 avoids the buckling of tear 26 resulting from push-type repair devices of the prior art. Needless to say, such prior art buckling resulted from fixation implant 88 being pushed across tear 26 at an oblique angle relative to the axis 96 or the edges of tear 26.
[0059] While in the forgoing embodiments of the present invention have been set forth in considerable detail for the purposes of making a complete disclosure of the invention, it may be apparent to those of skill of the art that numerous changes may be made without departing from the spirit and principles of the invention.
