|Publication number||CA2197830 C|
|Application number||CA 2197830|
|Publication date||8 Feb 2000|
|Filing date||18 Feb 1997|
|Priority date||20 Feb 1996|
|Also published as||CA2197830A1, EP0791331A1, US5814070|
|Publication number||CA 2197830, CA 2197830 C, CA 2197830C, CA-C-2197830, CA2197830 C, CA2197830C|
|Inventors||Rocco R. Borzone, John S. Crombie, David L. Nelson|
|Applicant||Stryker Technologies Corporation, Rocco R. Borzone, John S. Crombie, David L. Nelson, Howmedica Inc.|
|Export Citation||BiBTeX, EndNote, RefMan|
|Classifications (11), Legal Events (2)|
|External Links: CIPO, Espacenet|
The preser,l invention generally relates to suture anchors and drivers.
Specifically, the present invention relates to a suture anchor and driver device that 10 allows for the improved implantation of suture anchors in an t~i ~ ~ ,t, simple manner.-There are several existing devices that can be used to secure soft tissue to bone. Devices such as screws and staples have been known in the art for several years, but are difficuH to insert, and can cause damage to the bone tissue when they are inserted. In addition, if the devices must be later removed, they can cause further damage to the bone and surrounding tissue. More recently, suture anchors have been desiy"ed that are specifically adapted to secure a suture to attach soft tissue such as ligaments, to bone.
For example, in U.S. Patent No. 5,370,662 to Stone et al., a suture 20 anchor assel"bly is described in which the suture anchor has a threaded portion with a self-tapping screw at one end for attachment to the bone, and an eyelet at the other end for receiv;"g a suture. The suture anchor is also designed to be coupled to a rotating driver device. The suture anchor and driver fit together in an interlocking fashion. The disadvantage of the Stone patent is the way in which the suture itself is lhreaded through an eyelet and then threaded inside the driver. The actual threading of the suture inside the driver is a difficuH additional step for a surgeon or nurse to perform, and must be pe, Ft,r")ed for every suture anchor to be implanted. This design also creates a single point of stress on the suture ",alerial at the eyelet of the suture anchor, which increases the chance of breakage. In addition, because the suture 30 material is within the driver, the status of the suture material cannot be monitored by a surgeon during the surgical procedure.
Thus, the prior art has failed to provide a suture anchor that can provide a secure fixation to a bone that allows for simple and efficient implantation.
SUMMARY OF INVENTION
The object of the present invention is to provide a suture anchor and driver with a novel design that allows a surgeon to easily implant a suture anchor using a novel i, llerlGcki"g driver to create a secure base for a suture.
Spo 'i~lally, it is an object of the present invention to provide a suture anchor and driver device that allows a surgeon to view the suture material during the i"~plantalion ;;rocess.
It is a further object of the invention to provide a suture anchor and driver device that is capable of securing more than one strand of suture n,al~lial.
It is a further object of the invention to provide a suture anchor and driver device that is ~F -~'e of being ~pre-loaded~ with suture " ,~lerial, to allow a surgeon to implant a number of suture anchors during a single operative procedure.
It is a further object of the present invention to provide a suture anchor which eng~es a length of suture material at the distal end over a distributed area to minimize the chance of suture breakage.
It is a further object of the present invention to provide a suture anchor that does not requirè suture material to be threaded through a small opening.
These and other objects are achi~.,ed with a suture anchor and driver device that includes a suture anchor with a proximal end for insertion into bone tissue, a central tl ,re&ded portion, and a distal end of subsl~r,lially cylindrical shape having a diameter through a central axis. The distal end defines a pACsAge that passes through the diameter, and is pr~er~ly large enough to allow at least two strands of suture l"alerial to pass through freely. The driver is r~'----hly engaged with the distal end of the suture anchor.
The suture anchor and driver define a suture path along the outside surface of the driver in a longitudinal fashion, through the pACsAge defined by the distal end of said suture anchor, and returning along the outside surface of the driver in a longitudinal fashion.
The disW end of the suture anchor also helps define the suture path 30 through the provision of two grooves located at the ends of the pAesa~e, which aid in guiding the suture material from the pACsAge in a longitudinai distai direction. The distal end is further provided with a U-shaped groove to mate with the proximal end of the driver, which has a U-shaped protrusion.
2 1 97~3û
The driver also includes a flange adapted to aid the user in positioning said suture anchor and driver device by preventing the driver from being inserted too far. A tissue protector tube is also provided to fit over the anchor and driver device to help with the initial insertion of the device through soft tissue and to engage the bone surface. The driver also includes a suture retainer to hold the ends of the suture material in place, and a handle which may be coupled to the distal end.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a side plan view of the preferred embodi-ment of the suture anchor and driver device;
FIG. 2A is a side plan view of the suture anchor;
FIG. 2B is a side plan view of a first alternative embodiment of the suture anchor;
FIG. 3 iS a side plan view of the suture anchor, rotated 90 degrees from FIG. 2;
FIG. 4 is a perspective view of the distal end of the suture anchor;
FIG. 5A is an end view of the distal end of the suture anchor;
FIG. 5B is an end view of the distal end of the first alternative embodiment of the suture anchor;
FIG. 6 is a side plan view of the second alternative embodiment of the suture anchor;
FIG. 7 is a side plan view of the driver;
FIG. 8 is a perspective view of the proximal end of the driver shown in FIG. 7;
2 1 9~830 ~ .
FIG. 9 is a cross-sectional view through line 9-9 of FIG. 7;
FIG. 10 is a cross-sectional view through line 10-10 of FIG. 7;
FIG. 11 is a cross-sectional view of the suture retainer through the central axis of the driver;
FIG. 12 is a side plan view of the tissue protector;
FIG. 13 is a side plan view of the tissue protector on the driver; and FIG. 14 is a side plan view of the driver coupled with a handle.
The preferred embodiment of suture anchor 10 and driver 12 are illustrated in FIG. 1, coupled together for use in anchoring a suture to a bone.
The suture anchor 10, shown in FIGS. 2-5, has a proximal region 14 which is inserted into the desired bone, and a distal region 16 which is adapted to secure a suture or other desired thread-like material and to engage the driver 12.
At the farthest proximal end of the proximal region, the suture anchor 10 is provided with a cutting tip 18 to facilitate the insertion into the bone. Cutting tips are generally known, and the cutting tip 18 used for the present invention may be of any design known in the art.
The proximal region 14 of the suture anchor 10 further comprises a threaded portion, so that once the tip 18 is engaged with the surface of the bone, rotation of the suture ' 2t97830 anchor 10 will cause the anchor 10 to enter the bone tissue.
The threaded portion can be constructed in any manner known in the art of suture anchors.
The distal region 16 has a novel design intended to facilitate both the securing of the suture material to the anchor and the engagement of the suture anchor with the driver.
The securing of the suture material is achieved through the provision of a cradle 20 which defines a U-shaped passage through the diameter of the distal region 16. The cradle 20, as shown in FIGS. 2 and 4, preferably defines a passage that has a diameter sufficiently large to allow at least one strand of suture material to pass through freely, and preferably large enough to allow two strands of suture material to pass through the distal region 16 freely. By allowing two strands of suture material to be secured by the suture anchor, the surgeon may use the device for attachments that have a particular need for an extremely strong connection between the suture anchor and the soft tissue. The cradle 20 also provides an advantage in that the area of stress of the suture material is maximized along the curved length of the cradle 20. This design minimizes the risk of breakage of the suture material, which would be increased in conventional eyelet designs. The two exit holes of the cradle, 22 and 24, are located on opposing sides of the distal region of the anchor.
The novel suture anchor design allows for the suture material to be located at the outside diameter of the distal region 16 of the anchor 10 (where the exit holes 22 and 24 are -4a-located). From the outside diameter, the suture material is guided out the exit holes 22 and 24, and along grooves 23, 25, which are located at each exit hole and extend longitudinally in the distal direction (towards the driver). The area where the grooves 23, 25 meet the distal end of the suture is preferably curved, as shown in FIGS. 2A and 5A, to allow some lateral movement of the suture without the risk of catching the suture on a corner. If easier construction is desired, however, the first alternative embodiment, shown in FIGS. 2B
and 5B, illustrate the form of the distal end of the alternative suture in which the corners where the grooves 23, 25 meet the distal end are -4b-not curved. The path of the suture then extends along the outside surface of the driver 12, which is described in more detail below.
The distal region 16 of the suture anchor is also designed to facilitate interconnection with the driver 12. For this purpose, the distal region 16 has a U-5 shaped groove 26, illustrated in FIGS. 3 - 5, that mates with a U-shaped protrusion on the proximal end of the driver 12, which will be ~liscussed below. The U-shaped groove has three components. There is a first side groove 28, which extends longitudinally along the distal region 16. The second side groove 30, extends along the opposite side of the distal region 16. Connecting these two grooves is a central end groove 32, 10 which runs along a diameter of the suture anchor.
An second alternative embodiment 34 of the suture anchor is shown in FIG. 6.
The alternative suture anchor 34 has a novel distal end 36 designed to engage the suture material without the need to thread the suture material through a small opening.
The anchor 34 is provided with slot 38 which defines the passage for the suture 15 material. The slot is preferdbly constructed so that the suture material will remain in the slot if the ends of the suture material are held in the distal direction. Therefore, the slot is should be designed to form at least a ninety degree angle with the central axis of the suture anchor, and prt:l~rclbly forms an angle of greater than ninety degrees with the central axis of the distal end of the suture anchor. The alternative anchor 34 provides 20 the same advantage of distributing the stress on the suture material over the diameter of the distal end, with the added advantage of elimination of the need to ~i,reau the suture l"alerial. A length of suture material is simply placed in the slot 38, and will remain securely attached to the anchor 34 as long as the two ends of the suture material are under tension in the distal direction. Therefore, when using the alternative 25 anchor 34, care must be taken that tension is maintained while the anchor 34 is implanted. As will be further ~liscussed below, the driver 12 is designed to maintain the suture ",alerial under tension during the implantation process.
The suture anchor 10 or alternative anchor 34 are preferably manufactured of a lightweight, biocompatible material, most preferably titanium. Alternatively, the suture 30 anchor 10 or 34 can be manufactured of a ti~-~sorbable material, or partially absorbable material of sufficient strength.
As seen in FIG. 7, the driver 12 has a proximal region 44 for engaging the suture anchor 10, an elongated central portion 46, a flange 48, and a distal region 50, adapted to secure the excess suture "~alerial and engage the driver to a handle 52.
The proximal region 44 of the driver 12, shown in FIG. 8, mates with the distal 5 region 14 of the suture anchor 10. As described above, the distal region 14 of the suture anchor 10 has a U-shaped groove 26. The proximal region 44 of the driver 12 accordingly has a U-shaped protrusion 54 at the most proximal end, which mates with the distal end of the anchor. The interlocking arrangemer,l allows the rotation of the driver to rotate the suture anchor 10 into the bone. The arrangement also allows the 10 driver to be quickly and easily released from the suture anchor once the anchor 10 is implanted in the bone.
The proximal region 44 has a generally rectangular cross-section, as shown in FIG. 9. The widest portion of the proximal region corresponds with the diameter of the distal end 16 of the suture anchor. Ther~fore, the circular profile of the suture anchor 15 defines the maximum size of the p~ss~ge created in tissue to use the anchor and driver device, which will minimize the trauma to surrounding tissue. This design also allows a user of the device to cou"tersi, ~k the hole created by the anchor and driver device, which was not possible in prior art devices in which the driver mechanism has a larger cross-sectional area. The present invention also allows a user to remove suture 20 anchors after bone tissue has grown around the anchor, and only a small driver could access the tip of the anchor.
The elonyaled central portion 46 extends longitudinally from the proximal region44 that engages the suture anchor. The elongated central portion has a generallycircular cross-section, which is of a smaller diameter than the suture anchor, to ensure 25 that the addition of suture material along the central portion will not create a cross-sectional profile larger than that of the suture anchor itself.
The flange 48 extends radially from the central axis of the driver. The flange 48 is further provided with two grooves 56, 58, shown in FIG.10 that terminate slightly past the location of the flange 48. The grooves 56, 58 guide the suture material along the 30 driver without interruption by the flange 48. In use, the suture material will extend from exit holes of the cradle 20 of the suture anchor, along the grooves provided on the suture anchor, further along the flattened proximal portion of the driver 44, along the elongated central portion 46, and along the grooves 56, 58 formed by the flange 48.
The suture " ,alerial may also be wrapped around the central portion 46 if excess suture nlaterial is desired. The flange 48 also prevents the driver from being inserted too far into a patient when used in conjunction with the tissue protection tube 70, which will be described below.
The driver 12 is further provided with a suture retainer 80, which holds the ends of the suture malerial tautly during the implantation procedure. The suture retainer 80 has a spring-release arrangement with the driver 12, as shown in FIG. 7. The spring-release arrangement holds the suture material in place against the flange 48 when the retainer 80 is in the relaxed position. When the retainer 80 is moved in the distal direction, an opening is created between the retainer 80 and the flange 48, allowing the suture material to be released. The retainer 80 is pr~f~rably provided with grooves 82 to make movement of the retainer easier. The suture retainer 80 is shown in cross-section along the central axis of the driver in FIG. 11. FIG. 11 illustrates the spring 86 which maintains the suture retainer 80 in a relaxed position against the distal surface of the flange 48, and is compressed by the movement of the retainer against stop 84.
Alternative ways of securing the loose ends of the suture material could also beutilized in conjunction with the suture anchor and driver device of the preser,l invention.
For example, a suture retainer could also be designed to engage the driver with screw means, so that rotating the retainer would loosen the screw means to allow the suture material to be rele~sed. Other designs in which the suture n ,alerial could be held tautly and then r~ s9d when necess~ry could also be used.
The suture anchor and driver device is pr~ferably provided with a tissue protector tube 70. The tube 70, as shown in FIG. 12, is placed over the driver 12 after the suture malerial has been threaded through the suture anchor 10 and secured by the suture retainer of the driver. The tube 70, which is pr~f~rably made of stainless steel, is simply slipped over first the suture anchor 10 and then the driver 12, up to the flange 48, which acts as a 'stop~ to prevent the tube 70 from moving too far up the driver. The function of the tube 70 is to provide a smooth barrier between the driver 12 and suture material along the sides of said driver and the tissue of the patient. The tube 70 prevents the suture material or the anchor itself from being caught or snagged, and allows smooth entry through the tissue of the patient. The tube 70 also helps in the initial engagement of the bone surface, through the provision of teeth 72 on the proximal end of the tube 70. In use, the tube 70 may be first inserted into the patient to engage the bone tissue in the desired location, and then the suture and driver device can be i,lse,led from the back of the tube 70. The tube 70 is shown over the driver device in FIG. 13. The strong initial placement allows the surgeon to position the anchor and driver device in the desired location.
The distal end 50 of the driver 12 is designed to releasably engage a handle 52.The distal end 50 shown in FIG. 7 is specifically designed to engage a standard handle 52 available from HOWMEDICA, as shown in FIG. 14. The distal end 50 could, however, be designed to erlgage any particular type of handle. The quick releasecoupling design shown in FIG. 7 provides the surgeon with a particular advantage for procedures in which more than one suture anchor is to be i",plar,led. Several suture anchor and driver devices can be pre-loaded with suture ",aterial before an operation begins. Once the i, .~ s ~n is made, the first suture anchor is implanted using the driver and handle, and then the handle can be 1_'~--2d from the driver, and engaged with a second pre-loaded anchor and driver device for an additional implant. In addition, the distal end 50 can be attached to a power source, such as a power drill to aid ininserting the anchor.
|International Classification||A61B17/56, A61B17/04, A61B17/00|
|Cooperative Classification||Y10S606/916, A61B2017/0046, A61B2017/0409, A61B2017/044, A61B2017/0414, A61B2017/00004, A61B17/0401|