Abstract:
The present disclosure relates to an anchor assembly. The anchor assembly includes an anchor defining a cavity and an opening to the cavity and an insertion member including a body having a proximal end portion and a flat distal end portion, and a head coupled to the proximal end portion of the body. The insertion member is configured for arrangement within the anchor cavity. A method of tissue repair and other anchor assemblies are also disclosed.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of U.S. Provisional Application No. 61/013,342, filed Dec. 13, 2007, the disclosure of which is incorporated herein by reference in its entirety. 
    
    
     BACKGROUND 
     1. Field of Technology 
     The present disclosure relates to tissue repair, and more specifically, to an anchoring system for securing tissue to bone. 
     2. Related Art 
     Arthroscopic procedures often require soft tissue to be reattached to bone. To achieve this, anchors are placed in the bone and sutures attached to the anchor are passed through the tissue to securely retain the tissue in place. When making a repair of soft tissue to bone, it is advantageous to have as large an area of contact between the bone and tissue as possible. Anchor points spaced from one another in rows result in a repair having a broader area of contact. A procedure, and components for use in such procedure, that securely attaches tissue to bone using a plurality of attachment points over a large area of contact is needed. Such procedure must be able to be done in a quick and efficient manner with a minimum of recovery time for the patient. 
     SUMMARY 
     In one aspect, the present disclosure relates to an anchoring system including an anchor having an internal bore, a plug disposed within the internal bore of the anchor and wherein the plug has an internal cavity, and a locking member disposed within the internal cavity of the plug. In an embodiment, the plug further includes a transverse hole. In another embodiment, the anchoring system further includes a flexible member disposed within the hole of the plug. In a yet another embodiment, the flexible member includes a suture. In a further embodiment, the transverse hole includes a through hole. In yet a further embodiment, the flexible member is disposed within the through hole of the plug. 
     In an further embodiment, the internal bore of the anchor is configured for receiving a delivery device. In another embodiment, the anchor includes a groove located on an inner wall of the anchor. In yet another embodiment, the plug is wedge-shaped. In a further embodiment, the plug includes at least one tab. In yet a further embodiment, the tab is expandable. In an embodiment, the plug includes at least two tabs, the tabs located on opposite sides of the plug. In another embodiment, the two tabs are expandable. In yet another embodiment, the internal cavity of the plug includes surface features. In a further embodiment, the surface features include threads. In yet further embodiment, the anchor includes surface features located on an outer surface of the anchor. In an embodiment, the surface features include threads. In another embodiment, the locking member includes a head and a shaft coupled to the head, wherein the shaft includes surface features configured for engagement with the surface features of the internal cavity of the plug. In yet another embodiment, the surface features of the shaft include threads. 
     In another aspect, the present disclosure relates to a method of tissue repair. The method includes inserting a first anchor into bone, wherein the first anchor includes a flexible member coupled thereto; passing ends of the flexible member through the tissue; inserting a second anchor into the bone, the second anchor including an internal bore; providing a plug including an internal cavity and a transverse hole; passing at least one end of the flexible member into the hole of the plug; and inserting the plug into the internal bore of the second anchor. 
     In an embodiment, the method further includes inserting a locking member into the internal cavity of the plug to secure the flexible member within the internal bore of the second anchor and the tissue to the bone. In another embodiment, the method further includes tensioning the flexible member before placing the locking member within the plug cavity. In yet another embodiment, the plug includes at least one tab. The tab expands into a groove located on an inner wall of the second anchor upon insertion of the locking member into the internal cavity of the plug. In a further embodiment, the transverse hole includes a through hole. In yet a further embodiment, the method further includes passing the one end of the flexible member into the through hole. In an embodiment, the plug includes at least two tabs, the tabs located on opposite sides of the plug and wherein the tabs expand into the groove upon insertion of the locking member into the internal cavity of the plug. In another embodiment, the method further includes removing the locking member from the plug and tensioning the flexible member. 
     Further areas of applicability of the present disclosure will become apparent from the detailed description provided hereinafter. It should be understood that the detailed description and specific examples, while indicating the preferred embodiment of the disclosure, are intended for purposes of illustration only and are not intended to limit the scope of the disclosure. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and form a part of the specification, illustrate the embodiments of the present disclosure and together with the written description serve to explain the principles, characteristics, and features of the disclosure. In the drawings: 
         FIG. 1A  shows a perspective view of the anchor of the present disclosure. 
         FIG. 1B  shows a top view of the anchor of the present disclosure. 
         FIG. 2A  shows an exploded view of the plug and locking member of the present disclosure. 
         FIG. 2B  shows a side view of the plug and locking member of the present disclosure. 
         FIG. 3A  shows perspective view of a delivery device having the anchor of the present disclosure disposed on a shaft of the delivery device. 
         FIG. 3B  shows a side view of the anchor of the present disclosure disposed on the shaft of the delivery device. 
         FIGS. 4A-4E  show use of the anchoring system of the present disclosure in repairing tissue. 
         FIG. 5  shows a cross-sectional view of the anchoring system of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
     The following description of the preferred embodiment(s) is merely exemplary in nature and is in no way intended to limit the disclosure, its application, or uses. 
       FIGS. 1A and 1B  show the anchor  10  of the present disclosure. The anchor  10  includes an outer wall  11  having a proximal portion  11   a  including surface features, such as threads, and a distal portion  11   b . The anchor  10  also includes an internal bore  12  extending a length of the anchor  10 . A wall  13  of the bore  12  includes a proximal portion  14  and a distal portion  15 . The proximal portion  14  includes a groove  16 . The distal portion  15  includes a first surface  17  and a second surface  18 . The first surface  17  is flat and the second surface  18  is arc-shaped. The distal portion  15  is configured for receiving a delivery device and a plug, as further discussed below. 
       FIGS. 2A and 2B  show the plug  20  and the locking member  30  of the present disclosure. The plug  20  is substantially wedge-shaped and includes a proximal end  20   a  and a flat distal end  20   b . An outer wall  21  of the plug  20  includes a first surface  22  and a second surface  23 . The first surface  22  is substantially flat and includes a slot  24 . The second surface  23  includes a proximal end  23   a  and a distal end  23   b . The distal end  23   b  is substantially arc-shaped and the proximal end  23   a  includes tabs  25  and a recessed portion  26  located between the tabs  25  and the distal end  23   b . The recessed portion  26  allows the tabs  25  to expand, as will be further described below. Although  FIGS. 2A and 2B  show two tabs  25 , a higher or lesser number of tabs  25  may be present. The first and second surfaces  22 , 23  are configured to allow the surfaces  22 , 23  to conform to the surfaces  17 , 18  of the plug distal portion  15 , thereby allowing for easier receipt of the plug  20  into the internal bore  12  of the anchor  10 , as will be further described below. The plug  20  also includes an internal cavity  27  having surface features  28 , such as threads, and a transverse through hole  29 . The cavity  27  extends into the through hole  29 . 
     The locking member  30  includes a head  31  and a shaft  32  coupled to the head  31 . The shaft  32  includes surface features  33 , such as threads, configured for engagement with the threads  28  of the plug  20  when the locking member  30  is disposed within the plug  20 , as shown in  FIG. 2B . 
     The anchor  10  of the present disclosure may be used in conjunction with another anchor to repair soft tissue.  FIGS. 3A and 3B  show the anchor  10  located on the shaft  41  of a delivery device  40  in preparation for insertion of the anchor  10  into bone, as will be more fully described below. The delivery device  40  includes the shaft  41  having a distal portion  41   a , configured for engagement with the internal bore  12  of the anchor  10 , and a proximal portion  41   b  coupled to a handle  42 . As shown in  FIG. 3B , the distal portion  41   a  includes a pointed end  41   a   1 , a first surface  41   a   2 , and a second surface  41   a   3 . The first and second surfaces  41   a   2 , 41   a   3  are configured to allow the surfaces  41   a   2 , 41   a   3  to conform to the surfaces  17 , 18  of the internal bore  12 , thereby allowing for easier receipt of the internal bore  12  onto the distal portion  41   a.    
       FIGS. 4A-4E  show the anchoring system  50  in use during arthroscopic repair of the rotator cuff. However, the anchoring system  50  may be used in the repair of soft tissue in other parts of the body.  FIG. 4A  shows a first anchor  60  that has been inserted into the lateral aspect of a bone  70 , such as a humeral bone. The anchor  60 , which has a flexible member  80 , such as a suture, coupled thereto, is inserted into the bone  70 , a soft tissue  90 , such as a rotator cuff tendon, is placed on the bone  70  to be located adjacent to the anchor  60 , and the ends  81  of the flexible member  80  are placed through the soft tissue  90 . 
     Next, the delivery device  40  is used to place a second anchor, such as the anchor  10  of the present disclosure, into the medial aspect of the bone  70 . The pointed end of  41   a   1  of the shaft  41  is used as an awl to start the hole  71 , by tapping the handle  42  with a surgical mallet, or other axially oriented, advancement force. The delivery device  40  is axially advanced into the hole  71  until the distal portion  11   b  of the anchor  10  is no longer exposed, as shown in  FIG. 4A . The delivery device  40  is then rotated until the proximal portion  11   a  of the anchor  10  is no longer exposed, as shown in  FIG. 4B . The delivery device  40  allows for the creation of the hole  71  and insertion of the anchor  10  in one step, rather than multiple steps. The delivery device  40  and anchor  10  are shown in an enlarged view compared to  FIGS. 4C-4E  where the anchor  10  is much smaller in size. The anchor  10  and delivery device  40  are shown in an enlarged view merely for the purposes of an increased level of detail and for further understanding of the repair process. 
     Subsequent to the anchor  10  being placed in the bone  70 , the delivery device  40  is removed, and at least one end  81  of the flexible member  80  is passed through the transverse through hole  29  of the plug  20 . The plug  20  is then placed into the internal bore  12  of the anchor  10 , as shown in  FIG. 4C , such that the ends  81  extend out of the hole  71 . After placement of the plug  20  into the anchor  10 , the ends  81  of the flexible member  80  may be pulled to provide a preferred amount of tension on the flexible member  80  and the soft tissue  90 . This tension on the flexible member  60  can be seen in  FIG. 4D , especially when comparing these figures to  FIG. 4C . As shown in  FIGS. 4D and 4E , after insertion of the plug  20  into the inner bore  12  of the anchor  10 , the locking member  30  is advanced into the internal cavity  27  of the plug  20 , such that, as will be further described below, the plug  20  expands to lock the plug  20  within the inner bore  12  of the anchor  10 . In addition, advancement of the locking member  30  secures the flexible member  80  within the through hole  29  and the internal bore  12  and secures the tissue  90  to the bone  70 . 
     As shown in  FIG. 5 , advancement of the locking member  30  into the inner bore  12  causes the tabs  25  to expand outward  25   a  and into the groove  16  of the bore  12 , thereby locking the plug  20  within the bore  12 . Also shown is the impingement of the locking member  30  on the flexible member  80 , which secures the flexible member  80  within the through hole  29 . Both the plug  20  and the locking member  30  are advanced via delivery tools that provide for axial and rotary advancement. The suture  80  may need to be retensioned subsequent to placing the locking member  30  into the plug  20 . If re-tensioning is necessary, the delivery tools may be used to remove the locking member  30 , so that tension mat be applied to the suture  80 . The locking member  30  would then be re-inserted into the plug  20 . 
     The anchor  10  and plug  20  of the present disclosure and the first anchor  60  are made from a bioabsorbable polymer material via an injection molding process. However, other materials and processes may be used. In addition, the suture material is made from a bioabsorbable polymer material, but other material may be used. Also, the initial anchor, such as the first anchor  40  shown above, may include more than one suture and the sutures may be secured together at one attachment point, such as within the second anchor  10  shown above, or independently at more than one attachment point. For the purposes of this disclosure, the locking member  30  is made from a biocompatible material, such as titanium, stainless steel, or polyetheretherketone (PEEK). However, the locking member  30  may be made from other absorbable or non-absorbable material. 
     Furthermore, the proximal portion  11   a  of the anchor  10  may include features other than threads to reduce the possibility of removal of the anchor  10  and the threads may extend the entire length of the anchor  10 . Similarly, the outer wall  21  of the plug  20  and the internal bore  12  of the anchor  10  may include surface features other than those shown and described to facilitate insertion and removal of the anchor  10  onto the shaft  41  and the plug  20  within the internal bore  12  of the anchor  10 . In addition, the inner cavity  27  of the plug  20  and the shaft  31  of the locking member  30  may include surface features other than threads  28 , 33  for engagement of the locking member  30  with the plug  20 . Also, for the purposes of this disclosure, the location of the through hole  29  may be anywhere along the length of the plug  20 . The shaft  41  of the delivery device  40  is made from a biocompatible material, such as stainless steel, and is coupled to the handle  42  by having the proximal portion  41   b  press-fit into a through hole  43  of the handle  42 . However, other materials and methods of coupling may be used. 
     The anchoring system  50  of the present disclosure allows a surgeon to load a suture from a previously placed anchor and secure the suture in the system  50  at a preferred tension. Furthermore, the system  50  allows for one or more sutures to be secured together at one attachment point, such as described above with the second anchor  10 , or independently at several attachment points. This allows for a large area of contact between the tissue and the bone and results in a better repair. 
     As various modifications could be made to the exemplary embodiments, as described above with reference to the corresponding illustrations, without departing from the scope of the disclosure, it is intended that all matter contained in the foregoing description and shown in the accompanying drawings shall be interpreted as illustrative rather than limiting. Thus, the breadth and scope of the present disclosure should not be limited by any of the above-described exemplary embodiments, but should be defined only in accordance with the following claims appended hereto and their equivalents.