# Patent

## Title
Arthroscopic tenodesis tool

## Abstract

An arthroscopic tenodesis kit, including a guide with an elongate member having a length with a distal portion having a notch configured to releasably engage a suture; a cannulated fixation screw having a longitudinal cannula configured to receive the guide; and an inserter. The inserter includes an elongate cannulated body having an interior bore having a blind end and an open end configured to slidingly receive the guide. The body of the inserter has a length that is shorter than the length of the guide, so that the distal portion of the guide remains spaced from the bore when the guide is fully received within the bore.

## Background
FIELD
This disclosure relates generally to methods and apparatus for fixation of a tendon to bone. More particularly, this disclosure relates to arthroscopic methods and apparatus for fixation of a tendon to bone.
BACKGROUND
Improvement is desired in the field of tenodesis or surgical fixation or anchoring of tendons to bone. Improvement is particularly desired in regards to arthroscopic fixation of tendons to bone.
Current devices often require a dedicated interference screw or fixation device and cannot be used with a wide variety of cannulated interference screws. Current devices also are hampered by the large size of the inserter and implant assembly that blocks arthroscopic view of the tunnel and impedes surgeon performance. Currently available devices also do not enable temporary fixation of the tendon to bone prior to implant insertion. Therefore, the tendon has a tendency to wrap around the interference screw as it is being inserted. This makes insertion of the screw more complex and also impedes visibility of the surgeon. Alternatively, current devices undesirably utilize a second separate implant (other than the fixation screw) which adds cost to the procedure, and is undesirable in that a second implant remains in the body after the procedure.
The disclosure advantageously provides apparatus and methods for arthroscopic tenodesis that does not require a dedicated interference screw or fixation device, but is suitable for use with a wide variety of cannulated interference screws. The apparatus and methods according to the disclosure also advantageously enable temporary distal fixation to the bone, avoid the need for any implant beyond the fixation screw, improve surgeon visibility, and reduce operating room time and costs by reducing the number of steps required as compared to conventional tenodesis procedures.
SUMMARY
The present disclosure relates to methods and apparatus for arthroscopic tenodesis.
In one aspect, there is disclosed an arthroscopic guide for use in installing a cannulated fixation screw for attaching a tendon to a bone. The guide is provided by an elongate member having a major outer dimension smaller than the cannula of the fixation screw and a distal portion having a notch configured to releasably engage a suture.
In another aspect, the disclosure relates to an arthroscopic tenodesis kit for use in installing a cannulated fixation screw for attaching a tendon to a bone. The kit includes a guide with an elongate member having a length with a distal portion having a notch configured to releasably engage a suture; and an inserter. The inserter includes an elongate cannulated body having an interior bore having a blind end and an open end configured to slidingly receive the guide. The body of the inserter has a length that is shorter than the length of the guide, so that the distal portion of the guide remains spaced from the bore when the guide is fully received within the bore.
In another aspect, there is disclosed a method for performing arthroscopic tenodesis on a joint having a tendon. The method includes the steps of: severing the tendon, withdrawing a severed end of the tendon and attaching a suture to the severed end of the tendon to provide a loop in the suture; using a guide provided by an elongate member having a length with a distal portion having a notch, and capturing the loop of suture within the notch. A tunnel or channel may be formed into the joint from a location at the outside of the joint to a bone within the joint, as by use of a drill or reamer. The guide is then used to urge the suture and the tendon down the tunnel or channel to the bone. A force is applied to the guide to imbed an end of the guide into the bone. A cannulated fixation screw is passed along the guide to the bone and the fixation screw is rotated to seat the fixation screw into the bone and fix the tendon to the bone. The suture is then released from the guide, and the guide is removed in its entirety from the bone and withdrawn in its entirety from the joint.
In yet a further aspect, there is disclosed a method for performing arthroscopic tenodesis on a body portion having a tendon and a bone. The method includes the steps of severing the tendon and attaching a suture to the severed end of the tendon to provide a loop in the suture; using a guide provided by an elongate member having a length with a distal portion having a notch, and capturing the loop of suture within the notch; forming a tunnel or channel into the bone; using the guide to urge the suture and the tendon down the tunnel or channel to the bone; sliding a cannulated fixation screw along the guide to the bone and rotating the fixation screw to seat the fixation screw into the bone and fix the tendon in the bone; releasing the suture from the guide; and removing the guide in its entirety from the body portion.



BRIEF DESCRIPTION OF THE DRAWINGS
Further advantages of the disclosure are apparent by reference to the detailed description in conjunction with the figures, wherein elements are not to scale so as to more clearly show the details, wherein like reference numbers indicate like elements throughout the several views, and wherein:
FIG. 1 shows a tenodesis tool according to the disclosure.
FIG. 2 shows an exploded view of the tool of FIG. 1.
FIG. 3 is an enlarged view of a distal end of a guide component of the tool of FIG. 1.
FIG. 4 is an enlarged view of a distal end of an alternate embodiment of a guide component.
FIG. 5 shows a handle of an inserter component of the tool of FIG. 1.
FIGS. 6-13 show steps in accomplishing a bicep tenodesis arthroscopic procedure utilizing the tool of FIG. 1 in accordance with the disclosure.
FIG. 14 shows a distal end of an alternate embodiment of an inserter.
FIG. 15 shows use of the inserter of FIG. 14.



DETAILED DESCRIPTION
The disclosure describes an arthroscopic tenodesis tool 10 having a guide 12 and an inserter 14.
In brief overview, the guide 12 is configured to releasably engage a suture secured to a tendon to be affixed to a bone with the suture. The inserter 14 telescopically receives the guide 12 that serves to stiffen the guide 12 for inserting the guide 12 into the bone for desirably positioning the tendon and the suture. The inserter 14 is then removed and the guide 12 is utilized to guide a cannulated interference screw to the site for installation, with the guide 12 thereafter being withdrawn in its entirety, such that only the tendon, suture, and the interference screw remain in the patient at the conclusion of the procedure.
The guide 12 is provided as by an elongate rod 16 having a distal portion 16a configured to releasably engage a suture attached to a tendon. The rod 16 is preferably of solid construction and has a length of from about 200 mm to about 375 mm and a diameter of from about 1 mm to about 3 mm. The diameter of the rod 16 is desirably small enough to enable commonly available cannulated fixation screws to receive the rod 16. Thus, the rod 16 preferably has an outer diameter or outer major dimension of no more than about 1.6 mm so as to be receivable by commonly available cannulated fixation screws. The rod 16 is preferably of circular cross-section, but may be of other cross section. The rod 16 is made of a surgically compatible material, such as stainless steel. Because the outer major dimension of the rod 16 is relatively small compared to the length of the rod 16, the rod 16 tends to flex. Thus, as described below, the inserter 14 is provided for use with the guide 12 to add rigidity in inserting the guide 12.
With reference to FIG. 3, an enlarged view of the distal portion 16a of the rod 16 is shown. The distal portion 16a defines an open notch 18 having an entrance 20 and an opposite bottom or nadir 22. The notch 18 is configured to releasably hold a portion of the suture attached to the tendon. The structure of the notch 18 is distinguishable from a closed structure such as an eyelet. For example, it will be appreciated that a closed structure such as an eyelet will not permit a suture to be releasably held in the manner of the open notch 18.
The notch 18 is configured so that the entrance 20 is dimensioned smaller than a greatest diameter D of the notch 18, with the width of the entrance 20 dimensioned approximately the same as or slightly smaller than the diameter or width dimension of the suture, and the width of the notch 18 dimensioned slightly larger than the diameter or width dimension of the suture. This configuration of the notch 18 advantageously enables a portion of the suture, such as a loop of suture affixed to the tendon, to be frictionally retained by the notch 18, yet subsequently released back out when desired.
For the purpose of example only, for use with a non-absorbable suture of a size of 2 to about 5 for use in tendon attachment, such sutures have a diameter of from about 0.5 mm to about 0.7 mm, and the notch 18 is dimensioned and configured so that the entrance 20 is about 0.6 mm, and the greatest diameter of the notch 18 is about 0.76 mm.
An alternate embodiment of a distal portion 16a′ of the rod 16 is shown in FIG. 4, having an open notch 18′ having an entrance 20′ and an opposite bottom or nadir 22′. Additionally, the entrance in this embodiment has an inset 24 which yields a larger opening, such as a mouth 26. The open notch 18′ is configured with the mouth 26 dimensioned larger than a greatest diameter D′ of the notch 18′, the entrance 20′ dimensioned the same as or slightly smaller than the diameter or width dimension of the suture, and the width of the greatest diameter D′ of the notch 18′ dimensioned slightly larger than the diameter or width dimension of the suture. Additionally, the notch 18′ of the distal portion 16a′ is preferably angled about 45 to 60 degrees from the length axis of the rod 16 to ensure securement of the suture during delivery of the suture and tendon construct, and to aid in release of the suture upon withdrawal of the rod 16 from the bone. The distal portion 16a′ may also include a sharp point 28 on the end thereof to facilitate penetration of the guide 12 into the bone.
The inserter 14 is provided by an elongate cannulated or cylindrical body 30 having a uniform interior bore 32 configured to slidingly receive the guide 12. The body 30 of the inserter 14 has a length that is shorter than the length of the guide 12, preferably from about 10 to 25 mm shorter, most preferably from about 15 to 20 mm shorter. Thus, as shown in FIG. 1, when the guide 12 is fully received by the inserter 14, the notch 18 is exposed.
The distal end of the body 30 receives the proximal end of the rod 16. The proximal end of the body 30 is seated in a T-shaped handle 34. For example, the handle 34 may be configured to have a blind bore 36 that retains the rod 16. The interior bore 32 may have a blind end adjacent the blind bore 36 of the handle, or the blind bore 36 of the handle 34 may serve to provide a blind end for the interior bore. Thus, the distal portion of the guide 12 remains spaced from the open end of the inserter 14 when the guide 12 is fully received by the inserter 14. The bore 36 may be of adjustable depth. This is advantageous to allow the surgeon to adjust the amount that the rod 16 extends from the inserter 14 and thereby select how deep the distal end is embedded in the bone.
The inserter 14 functions to stiffen the rod 16, as the rod 16 is of a small diameter due to the cannulation diameter of interference screws with which it is intended to be used. The interior bore 32 preferably has a diameter of from about 2 mm to about 3 mm. The exterior diameter of the cylindrical body 30 is preferably from about 2.5 mm to about 4 mm, such that the sidewall of the cylindrical body 30 is sufficient to provide strength against bending during use, such as when hammering the guide 12 into the bone, as described more fully below. Both the cylindrical body 30 and the handle 34 are made of a strong and surgically compatible material, such as stainless steel.
The tool 10 is particularly configured for use in an arthroscopic bicep tenodesis procedure according to the disclosure and depicted in FIGS. 6-13. In overview, the tendon T is delivered using the tool 10 into a bony tunnel or socket, and the tendon is fixed temporarily in the bottom of the tunnel or socket. The tool 10 then is used to facilitate passage of a fixation screw for fixation of the tendon in the tunnel or socket. The procedure accomplished using the tool 10 advantageously facilitates installation of the tendon and suture, as well as the fixation screw and avoids rotation or winding of the tendon around the screw as it is inserted by means of the temporary distal fixation.
With reference to FIG. 6, in an initial step according to the disclosure, there is shown a shoulder joint with a biceps tendon T, and the surgeon will arthroscopically cut the biceps tendon T at location designated generally by reference character X.
Next, as shown in FIG. 7, the biceps tendon T is retrieved out of the shoulder, and a suture S is attached to the biceps tendon T as by use of a whip stitch, and in a manner so as to provide a loop L in the suture S at the end of the biceps tendon T for engaging the tool 10.
Turning to FIG. 8, the tool 10, with the guide 12 located in the inserter 14 with the notch 18 exposed, is positioned adjacent the loop L of the suture S. The tool 10 is manipulated to capture the loop L within the notch 18. The surgeon will also form a tunnel or channel C into a bone B, such as the humerus bone of the shoulder, as by use of a drill or reamer.
Next, as shown in FIG. 9, the tool 10 with the loop L of the suture S captured in the notch 18, is manipulated to urge the biceps tendon T with the attached suture S into and down the channel C to a desired location within the bone B. A hammer or the like is preferably used to pound on the handle 34 of the inserter 14 to drive and imbed the distal end of the guide 12 adjacent the distal portion 16a/16a′ into the bone B at the desired location to temporarily locate the distal end of the guide 12 in the bone B.
Following this, as shown in FIG. 10, the inserter 14 is withdrawn from the channel C and the guide 12 remains imbedded in the bone B. Next, as shown in FIGS. 11 and 12, a cannulated fixation screw FS, generally as mounted on a cannulated screw driver SD, is passed over the guide 12, and then rotated until fully seated into the bone B. Following this, as depicted in FIG. 13, the cannulated screw driver SD is removed from the guide 12. The guide 12 is then removed from the bone B and withdrawn from the surgical site, with the fixation screw FS secured into the bone B and securing the biceps tendon T to the bone B. The surgical site may then be closed to complete the biceps tenodesis procedure.
With reference to FIG. 14, there is shown a distal end 40 of an inserter 14′ in accordance with an alternate embodiment. The inserter 14′ is substantially similar to the inserter 14, except the distal end 40 of the inserter 14′ at the entrance to the bore 32 is configured to have an enlarged diameter lip 42. The lip 42 is configured to provide an enlarged area to serve as a stop for inserting the guide 12 into the bone. This is advantageous to enable a repeatable and consistent depth of penetration of the guide 12 and to avoid having the distal end of the inserter become embedded in bone B, such as shown in FIG. 15.
The apparatus and methods described herein for arthroscopic tenodesis are advantageous in that they do not require a dedicated interference screw or fixation device, but enable use of a wide variety of cannulated interference screws. The apparatus and methods also advantageously enable temporary fixation of the tendon to the bone, avoid the need for any implant beyond the fixation screw, improve surgeon visibility, and reduce operating room time and costs by reducing the number of steps required as compared to conventional tenodesis procedures.
The foregoing description of preferred embodiments for this disclosure has been presented for purposes of illustration and description. The description and embodiments are not intended to be exhaustive or to limit the disclosure to the precise forms disclosed. Obvious modifications or variations are possible in light of the above teachings. The embodiments are chosen and described in an effort to provide the best illustrations of the principles of the disclosure and its practical application, and to thereby enable one of ordinary skill in the art to utilize the disclosure in various embodiments and with various modifications as are suited to the particular use contemplated. All such modifications and variations are within the scope of the disclosure as determined by the appended claims when interpreted in accordance with the breadth to which they are fairly, legally, and equitably entitled.

## Claims

1. A method for performing arthroscopic tenodesis on a joint having a tendon, comprising the steps of:
a. severing the tendon, withdrawing a severed end of the tendon and attaching a suture to the severed end of the tendon to provide a loop in the suture;
b. using a guide consisting essentially of an elongate member having a length with a distal portion having a notch, and capturing the loop of suture within the notch;
c. forming a tunnel or channel into the joint from a location at the outside of the joint to a bone within the joint;
d. using the guide to urge the suture and the tendon down the tunnel or channel to the bone;
e. applying force to the guide to imbed an end of the guide into the bone;
f. sliding a cannulated fixation screw along the guide to the bone and rotating the fixation screw to seat the fixation screw into the bone and fix the tendon to the bone;
g. releasing the suture from the guide; and
h. removing the guide in its entirety from the bone and withdrawing the guide in its entirety from the joint.

2. The method of claim 1, wherein the steps of using the guide to urge the suture and the tendon down the tunnel or channel to the bone and applying force to the guide to imbed an end of the guide into the bone, comprises seating the guide within an elongate cannulated body and applying force to the cannulated body to urge the guide down the tunnel or channel and to imbed the end of the guide into the bone.

3. A method for performing arthroscopic tenodesis on a body portion having a tendon and a bone, comprising the steps of:
a. severing the tendon and attaching a suture to the severed end of the tendon to provide a loop in the suture;
b. using a guide consisting essentially of an elongate member having a length with a distal portion having a notch, and capturing the loop of suture within the notch;
c. forming a tunnel or channel into the bone;
d. using the guide to urge the suture and the tendon down the tunnel or channel to the bone;
e. sliding a cannulated fixation screw along the guide to the bone and rotating the fixation screw to seat the fixation screw into the bone and fix the tendon to the bone;
f. releasing the suture from the guide; and
g. removing the guide in its entirety from the body portion.

4. The method of claim 3, wherein the steps of using the guide to urge the suture and the tendon down the tunnel or channel to the bone comprises seating the guide within an elongate cannulated body and applying force to the cannulated body to urge the guide down the tunnel or channel.