Methods and devices for attaching or reattaching soft tissue to bone

Patent metadata

Field	Value
Publication number	US-12127751-B2
Application number	US-202117552740-A
Country	US
Kind code	B2
Filing date	Dec 16, 2021
Priority date	May 8, 2014
Publication date	Oct 29, 2024
Grant date	Oct 29, 2024

Abstract

Embodiments of the invention include implants, instruments, and methods for attaching or reattaching soft tissue ( 200, 2200 ) to a bone ( 100 ), that enable independent tensioning of multiple connectors such as sutures ( 60, 160, 2060, 2160 ) and enable redundant fixation between bone ( 100 ) and soft tissue ( 200, 2200 ). Some embodiments provide for improved accuracy of the placement of substantially parallel tunnels through which soft tissue ( 200, 2200 ) to bone ( 100 ) connectors such as sutures ( 60, 160, 2060, 2160 ) are passed.

First claim

What is claimed is:

1. A method of reattaching a first and a second portion of soft tissue to a bone comprising:
creating a first tunnel through the bone such that an exit of the first tunnel is near the first portion of soft tissue to be reattached;
placing a first instrument through the first tunnel, wherein the first instrument includes a distal mark near its distal end to designate a radial position of the first instrument and a proximal mark near its proximal end that correlates with the distal mark;
observing a radial position of the distal mark on the first instrument and orienting the first instrument such that the distal mark indicates a desired radial position to a second tunnel to be created through the bone such that an exit of the second tunnel is near the second portion of soft tissue to be reattached;
and while the distal mark is oriented to indicate the desired radial position to the second tunnel, observing a radial position of the proximal mark that correlates with the distal mark and creating the second tunnel relative to the first tunnel at a radial direction from the first tunnel indicated by the proximal mark;
coupling a first suture to the first portion of soft tissue to be reattached and passing the first suture through one of the first or second tunnels;
coupling a second suture to the second portion of soft tissue to be reattached and passing the second suture through the other of the first or second tunnels;
tensioning the first suture to bring the first portion of soft tissue into contact with the bone;
securing the first suture relative to the bone;
tensioning the second suture to bring the second portion of soft tissue into contact with the bone; and
securing the second suture relative to the bone.

2. The method of claim 1 further comprising placing a drill guide relative to the first tunnel and using the drill guide to guide creating the second tunnel.

3. The method of claim 2 further comprising aligning the proximal mark with one of at least two indicia on the drill guide to radially align the position of the second tunnel relative to the first tunnel.

4. The method of claim 2 further comprising sliding a central hole of the drill guide over the first instrument while the first instrument is placed through the first tunnel and aligning the proximal mark with one of a plurality of guide holes of the drill guide before creating the second tunnel.

5. The method of claim 4 wherein the plurality of guide holes are each disposed at different radial distances from the central hole and wherein the method includes determining a radial distance between the exit of the first tunnel and the desired radial position of the second tunnel and aligning one of the plurality of holes that corresponds to the radial distance determined, with the proximal mark.

6. The method of claim 1 wherein coupling the first suture to the first portion of soft tissue includes coupling the first suture to the first portion of soft tissue that is a first distance and first direction away from the exit of the first tunnel from the bone, wherein coupling the second suture to the second portion of soft tissue includes coupling the second suture a second distance and second direction away from the exit of the second tunnel from the bone, and wherein the first direction and the second direction are substantially opposite directions; such that when one or both of the first suture and the second suture are tensioned, the first portion of soft tissue and the second portion of soft tissue are drawn at least in part toward one another.

7. The method of claim 1 wherein observing the distal mark includes observing via an endoscopic camera.

8. The method of claim 1 wherein the first instrument includes a sleeved drill and wherein passing the first suture includes passing the first suture through the first tunnel and also the sleeved drill.

9. The method of claim 1 wherein creating the second tunnel including passing another sleeved drill through the second tunnel and wherein passing the second suture includes passing the second suture through the second tunnel and also the another sleeved drill.

10. A method of placing two substantially parallel tunnels in a hone with a controlled distance and relative radial position between the two tunnels comprising:
creating a first tunnel in the bone;
placing a first instrument through the first tunnel, wherein the first instrument includes a distal mark near its distal end to designate a radial position of the first instrument and a proximal mark near its proximal end that correlates with the distal mark;
observing a radial position of the distal mark on the first instrument and orienting the first instrument such that the distal mark indicates a desired radial position to a second tunnel to be created in the bone;
measuring a distance from the exit of the first tunnel to a desired location of the second tunnel;
observing a radial position of the proximal mark that correlates with the oriented distal mark; and
creating the second tunnel relative to the first tunnel at a radial direction indicated by the proximal mark.

11. The method of claim 10 wherein a drill guide is positioned relative to the first tunnel and used to guide the creation of the second tunnel.

12. The method of claim 11 wherein the proximal mark is aligned with an indicia on the drill guide to radially align the position of the second tunnel relative to the first tunnel.

13. The method of claim 11 wherein the proximal mark is aligned with a cylindrical drill guide having a central hole that is configured to concentrically align with the first tunnel and includes two or more guide holes at different radial directions and different distances form the central hole.

14. The method of claim 13 wherein the central hole is configured to fit over at least a portion of the first instrument.

15. The method of claim 10 further comprising:
coupling a first suture to a first portion of soft tissue and passing the first suture through one of the first tunnel or the second tunnel; and
coupling a second suture to a second portion of the soft tissue and passing the second suture another of the first or second tunnels.

16. A method of attaching a tissue to bone at a first and a second portion of the tissue comprising:
creating a first tunnel in the bone with an exit location near the first portion of the tissue;
placing a first sleeved drill through the first tunnel, wherein the first sleeved drill includes a distal mark near its distal end to designate a radial position of the first sleeved drill and a proximal mark near its proximal end that correlates with the distal mark;
observing a radial position of the distal mark on the first sleeved drill and orienting the distal mark towards a desired radial position of an exit of a second tunnel to be created in the bone, the exit of the second tunnel near the second portion of the tissue;
measuring a distance from the exit of the first tunnel to the desired radial position of the exit of the second tunnel; and
while the first sleeved drill is oriented towards the desired radial position, observing a radial position of the proximal mark, and creating the second tunnel relative to the first tunnel aligned with a radial direction indicated by the proximal mark and also at the distance measured.

17. The method of claim 16 further comprising sliding a central hole of a drill guide over the first sleeved drill and aligning the proximal mark with one of the plurality of holes through the drill guide to create the second tunnel relativ

Assignees

• Smith & Nephew Inc

Inventors

• Laprade Robert
• Wijdicks Coen
• Santangelo Stephen Anthony

Classifications

• A61B17/16

  Instruments for performing osteoclasis; Drills or chisels for bones; Trepans {(arthroscopic bone cutters A61B17/320016)} · CPC title

• A61F2240/005

  Templates · CPC title

• A61B2017/0404

  Buttons · CPC title

• A61B17/0401 Primary

  Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors (A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811) · CPC title

• A61F2250/0097

  Visible markings, e.g. indicia · CPC title