Suture anchors and method of use

Abstract

An anchoring system for securing tissue to bone includes an implant having a body through which a suture eyelet extends transversely, a suture recess extending along a portion of a length of the body, having a predetermined depth below an outer surface of the body, and a suture pinch ramp disposed at a proximal end of the suture recess. The suture pinch ramp has a depth approximately equal to the predetermined depth at a distal end thereof and sloping outwardly in a proximal direction so that a depth of a proximal end of the suture pinch ramp approaches zero. An insertion member includes an insertion tube and a handle which is engageable with the anchor body to deploy the anchor in a selected bone site.

Claims

1. A method of securing soft tissue to bone, comprising: passing at least a first suture through soft tissue; passing the first suture through an eyelet formed in an anchor, the eyelet located proximal of a distal end of the anchor; driving the anchor to a first location in the bone which positions the distal end of the anchor inside the bone and leaves a proximal end of the anchor outside the bone; pulling the first suture to tension the soft tissue after driving the anchor to the first location, wherein, during said pulling, a rod that is received in the anchor through an opening in the proximal end of the anchor blocks the first suture from entering a suture cleat that is positioned proximally of the eyelet; moving the rod a distance back through the anchor after said pulling so as to unblock the first suture from entering the suture cleat; and driving the anchor to a second location in the bone after said moving, wherein the first suture moves into the suture cleat while driving the anchor to the second location.

2. The method of claim 1, wherein at the second location a portion of the first suture is pinched between an outer surface of the anchor and surrounding bone proximal of the suture cleat.

3. The method of claim 1, wherein the rod includes a pair of projections at a distal end of the rod.

4. The method of claim 3, wherein said moving of the rod a distance back through the anchor positions the pair of projections on opposite sides of the suture cleat.

5. The method of claim 1, wherein at the first location the anchor applies an amount of pressure to the first suture between a ramped surface of the anchor and surrounding bone.

6. The method of claim 1, wherein the suture cleat is formed in the anchor.

7. The method of claim 1, wherein the tension placed on the soft tissue during said pulling is maintained as the anchor is being driven to the second location.

8. The method of claim 1, wherein the anchor is a one-piece anchor body.

9. The method of claim 1, wherein driving the anchor to the first location includes impacting the anchor.

10. The method of claim 1, wherein the eyelet includes a first opening and a second opening in an outer side wall of the anchor.

11. The method of claim 1, wherein the first suture slides between an exterior surface of the anchor and adjacent bone during said pulling.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) FIGS. 1-4 are isometric views of an implantable anchor constructed in accordance with the principles of the present invention, illustrating the anchor from four different perspectives;

(2) FIG. 5 is an elevational view of the anchor of FIGS. 1-4;

(3) FIG. 6 is an elevational view similar to FIG. 5, from an opposed orientation;

(4) FIG. 7 is an isometric view of the insertion system of the present invention;

(5) FIG. 8 is an isometric view similar to FIG. 7 illustrating the assembled insertion system and anchor of the present invention in position to be deployed;

(6) FIG. 9 is an isometric view similar to FIG. 8, wherein the assembly is being inserted into a desired bone location;

(7) FIGS. 10-13 are isometric views illustrating the insertion system of the present invention, including the handle portion;

(8) FIG. 14 is an elevational view illustrating a first step of a method of using the present invention;

(9) FIG. 15 is an isometric view showing the same step as that shown in FIG. 14;

(10) FIG. 16 is an elevational view similar to FIG. 14 with the suture removed for clarity;

(11) FIG. 17 is an isometric view similar to FIG. 15 with the suture removed for clarity;

(12) FIG. 18 is an elevational view showing a second step of the described inventive method;

(13) FIG. 19 is an isometric view of the step illustrated in FIG. 18;

(14) FIG. 20 is an elevational view similar to FIG. 18, with the suture removed for clarity;

(15) FIG. 21 is an isometric view similar to FIG. 19, with the suture removed for clarity;

(16) FIG. 22 is an elevational view showing a third step of the described inventive method;

(17) FIG. 23 is an isometric view of the step illustrated in FIG. 22;

(18) FIG. 24 is an elevational view similar to FIG. 22, with the suture removed for clarity;

(19) FIG. 25 is an isometric view similar to FIG. 23, with the suture removed for clarity;

(20) FIG. 26 is an elevational view of the anchor of the present invention showing a step which is performed prior to final deployment of the anchor;

(21) FIG. 27 is an elevational view similar to FIG. 26, showing the illustrated step from a different orientation;

(22) FIG. 28 is an elevational view illustrating the first step of the inventive method which is also shown in FIGS. 14-17, with the suture removed for clarity;

(23) FIG. 29 is an elevational view similar to FIG. 28, illustrating the second step of the inventive method which is also shown in FIGS. 18-21, with the suture removed for clarity;

(24) FIG. 30 is an elevational view similar to FIGS. 28 and 29, illustrating the third step of the inventive method which is also shown in FIGS. 22-25, with the suture removed for clarity;

(25) FIG. 31 is an elevational view similar to FIG. 30, showing the proximal withdrawal of the suture pulley rod in accordance with the method of the present invention; and

(26) FIG. 32 is an elevational view similar to FIGS. 28-31, showing the final completed deployment of the inventive anchor.

DESCRIPTION OF THE PREFERRED EMBODIMENT

(27) The inventive system and methods disclosed herein comprise a simple-to-insert suture anchor which allows adjustment of suture or tissue tension prior to deployment, does not change the tension on the suture or tissue (and as a result, the captured tissue) when it is deployed, does not require a knot to secure the suture or tissue, and accepts multiple suture ends.

(28) Referring now more particularly to the drawings, there is shown in FIGS. 1-6 a suture anchor 10 constructed in accordance with the principles of the present invention. The anchor 10 comprises a body 12 having a plurality of proximal suture barbs 14, as well as bone barbs 16. A portion of the outer surface of the body 12 comprises a suture recess 18. An inner cavity 20 (FIG. 3) is provided for accommodating a suture pulley rod, to be described below. The distal end of the anchor body 12 includes bone displacement tabs 22.

(29) Within the suture recess 18 are disposed a suture pinch ramp 24, a suture cleat 26, and a suture eyelet 28, which extends transversely through a width of the body 12 so that it is open to opposing sides of the body.

(30) Now with reference to FIGS. 7-13, the insertion system 30 for the anchor 10 will be described. The insertion system or inserter 30 comprises a suture pulley rod 32 (FIG. 7), suture cleat retainers 34 on the distal end of the pulley rod 32 (also FIG. 7), and an insertion tube 36. In some embodiments, an optional metal distal tip 38 (FIG. 9) may be employed.

(31) A handle portion 40 of the insertion system 30 is illustrated in FIGS. 10-13. The handle portion 40 comprises a knob release slide 42 and a proximal knob 44.

(32) The anchor 10 has a number of features that are important to its innovative function. For example, the suture barbs 14 pinch the suture against the surrounding bone when the implant is deployed. The remaining barbs are the bone barbs 16, distal to the suture barbs 14, function to engage the bone during the initial and final deployment. The suture recess 18, because of its recessed profile relative to remaining portions of the outer surface of the body 12, allows the suture to slide between the anchor body and adjacent bone during the initial deployment. The inner cavity 20 for the suture pulley rod 32, allows for the metal suture pulley rod 32 to support the anchor during initial deployment. The bone displacement tabs 22 displace the bone distal to the suture to allow for optimal suture sliding during initial deployment.

(33) The suture pinch ramp 24 helps to maintain tension during individual tensioning of the suture. It is configured to slope outwardly in a proximal direction, so that its distal end is at a depth approximating the depth of the suture recess 18 and its proximal end is at the outer surface of the implant body 12, i.e. a depth of approximately zero. The suture cleat 26 pinches the suture to increase the suture pullout strength of the construct. The suture eyelet 28 allows for one or more suture ends to be placed in the implant. Each suture end is individually tensionable, as well be described below. Though the tip 46 of the anchor 10 is illustrated as being closed, as shown in FIG. 9, the optional metal tip 38 may be added to the anchor 10 to allow for the anchor to be inserted directly into bone without the requirement of a pilot hole.

(34) The insertion system 30, as well, has several important features which contribute to the innovative function of Applicant's inventive system. In particular, the suture pulley rod 32, in the initial deployment stage, allows the suture to move freely in the suture eyelet 28, by preventing the suture from entering the suture cleat 26. The pulley rod 32 also increases the strength of the anchor 10 by extending to the distal tip 46 of the anchor body 12 during initial deployment. The insertion tube 36, as well as the pulley rod 32, transmits the insertion force from a mallet to the anchor during initial deployment. Rotation of the proximal knob 44 actuates a mechanism that retracts the pulley rod 32 between initial and final deployment stages. The knob release slide 42 releases the knob 44 to allow for removal of the inserter 30 after final deployment. The suture cleat retainers 34 maintain a set gap in the suture cleat 26 during final deployment.

(35) The remaining FIGS. 14-32 will now be referenced in connection with a description of methods of using the inventive system to deploy an anchor 10 in bone 48.

(36) To deploy the anchor 10 in a suitable bone site, suture 50 is first passed through soft tissue (not shown) requiring repair. Viewing, for example, FIG. 19, the suture loops 51 in the suture 50 would normally be occupied by the soft tissue to be approximated against the bone 48, but that tissue is not shown, for clarity. Alternatively, soft tissue itself may be anchored directly in place within the desired bone site 48, rather than using suture 50, in which case the tissue is manipulated in the same way as the suture to be described in this explanation. For this reason, though the term suture is used throughout this specification, for convenience, the term should be considered sufficiently broad to include other media having similar functional characteristics, including soft tissue itself. A pilot hole 52 (FIGS. 9 and 28) is drilled or punched into the attachment site (bone 48), through the cortical bone layer 54 and into the cancellous bone layer 56. In some circumstances, the optional metal distal tip 38 may be employed (FIG. 9), in which case the step of drilling a pilot hole is unnecessary. The suture is then fed through the suture eyelet 28, as shown in FIGS. 14 and 15, directly or with a snare. One or more suture ends 58, 60 (FIG. 15) may be placed through the eyelet 28.

(37) With the anchor 10 and attached inserter 30 positioned at the desired bone site, as shown in FIGS. 14 and 15, initial deployment of the anchor 10 can occur. It should be noted that FIGS. 16 and 17, and FIG. 28, illustrate the same step as FIGS. 14 and 15, with the suture 50 removed for clarity. To initiate this initial deployment, a mallet is driven against the proximal end of the handle portion 40 to drive the anchor 10 distally to its initial deployment position, as shown in FIGS. 18 and 19, and also in FIGS. 20 and 21, and 29, with the suture again removed for clarity. At this juncture, the suture recess 18 is acting to apply pressure to the sutures or tissue 50 disposed between the outer surface of the anchor body 12 and the adjacent bone surface, as well as against the suture pinch ramp 24. This pressure maintains the tension on the suture 50.

(38) The free suture ends 58, 60 may be individually tensioned around the suture pulley rod 32 to approximate the tissue within the suture loops 51 up against the anchor and repair site and its surrounding bone 48. If the suture is over-tensioned, a probe may be used to loosen the tissue side of the suture.

(39) Once the desired tension is achieved, the suture pulley rod 32 is pulled proximally into the insertion tube 36, by rotating the threaded proximal knob 44 on the handle portion 40 until further rotation is prevented. When the tube 36 is retracted by the rotation of knob 44, the gap of the suture cleat 26 is exposed. At this point, the suture cleat retainers 34 are in position on either side of the suture cleat 26. This retracted pulley rod position is illustrated in FIGS. 26 and 27, which is the position required prior to the final insertion step. As noted above, the suture cleat 26 is exposed and held open by the suture cleat retainers 34, which thus allow the suture to pull into proper position during final insertion.

(40) At this juncture, the final deployment steps are initiated, as shown in FIGS. 22 and 23, and also in FIGS. 24 and 25, and 30, wherein the suture 50 has been removed for clarity. With the gap of the suture cleat 26 maintained by the suture cleat retainers 34, the inserter handle 40 is again malleted, directing insertion force into the insertion tube 36 until the anchor 10 rests below the surface of the bone, as shown in FIG. 30. Because the suture 50 has maintained an equal distance from the surface of the bone, post-tensioning and post-final deployment, the tension in the suture 50 is maintained. If additional tension is required, the anchor can be malleted deeper into the bone, pulling the suture ends with it, thereby increasing tension.

(41) The suture 50 is now pinched between the suture barbs 14 and the bone on the tissue side of the anchor, as shown in FIG. 23. It is also pinched between the suture cleats 26 on both sides of the anchor body 12. Finally, the free suture ends 58, 60 are pinched between the suture barbs 14 and the bone opposite to the tissued side of the anchor.

(42) The suture pulley rod 32 may now be pulled out of the anchor body 12, as shown in FIG. 31, releasing the inserter 30 by actuating the knob release slide 42 to allow the threaded knob 44 to be free to rotate. The knob 44 is then rotated until the inserter is released from the implant. At this juncture, the free suture ends can be cut, as shown in FIG. 32, which completes the repair.

(43) Accordingly, although an exemplary embodiment of the invention has been shown and described, it is to be understood that all the terms used herein are descriptive rather than limiting, and that many changes, modifications, and substitutions may be made by one having ordinary skill in the art without departing from the spirit and scope of the invention, which is to be limited only in accordance with the following claims.