Abstract:
A method for repairing a cartilage defect according to an exemplary aspect of the present disclosure includes, among other things, preparing a cartilage defect for implantation of a cartilage graft and attaching the cartilage graft via a transosseus tunnel.

Description:
BACKGROUND 
       [0001]    This disclosure relates to a surgical method for fixating a cartilage graft to bone to repair a cartilage defect. 
       SUMMARY 
       [0002]    Disclosed herein are methods regarding repairing a cartilage defect. For example, method(s) as described herein include, inter alia, preparing a cartilage defect for implantation of a cartilage graft and attaching the cartilage graft to bone. The cartilage graft can be attached to a bone via a fixation device(s). A fixation device can include, but is not limited to, a button, an anchor, a screw, a suture construct (e.g., a bone bridge). A suture constructed can be either knotted or knotless. Methods can further include creating one or more transosseus tunnels. 
         [0003]    In an embodiment, a method of repairing a cartilage defect includes creating at least one transosseus tunnel; attaching a flexible strand to a cartilage graft; transiting the cartilage graft through the at least one transosseus tunnel; and fixating the cartilage graft to bone. 
         [0004]    In a further non-limiting embodiment of the foregoing method, the preparing step includes creating vertical margins around a periphery of the cartilage defect. 
         [0005]    In a further non-limiting embodiment of either of the foregoing methods, the preparing step includes removing at least a portion of the cartilage defect. In an illustrative embodiment, a portion of the cartilage can be removed with a curette. 
         [0006]    In a further non-limiting embodiment of any of the foregoing methods, the preparing step includes performing bone marrow stimulation to the cartilage defect. 
         [0007]    In a further non-limiting embodiment of any of the foregoing methods, the step of performing the bone marrow stimulation includes performing a microfracture procedure. 
         [0008]    In a further non-limiting embodiment of any of the foregoing methods, the preparing step includes drying the cartilage defect. 
         [0009]    In a further non-limiting embodiment of any of the foregoing methods, the attaching step includes passing a flexible strand through the cartilage graft, loading a free end of the flexible strand through a portion of the at least one fixation device, tensioning the flexible strand to approximate the cartilage graft to the bone and inserting the fixation device into the bone to fixate the cartilage graft to the bone. 
         [0010]    In a further non-limiting embodiment of any of the foregoing methods, the inserting step includes moving fixation device toward the portion inside the bone to trap the flexible strand between the bone and the fixation device. 
         [0011]    In a further non-limiting embodiment of any of the foregoing methods, the attaching step includes implanting at least one fixation device into the bone, passing a flexible strand of the at least one fixation device through the cartilage graft and tensioning the flexible strand to approximate the cartilage graft to the bone. 
         [0012]    In a further non-limiting embodiment of any of the foregoing methods, the tensioning step includes shuttling a free end of the flexible strand through the flexible strand to create a spliced loop around the cartilage graft. 
         [0013]    In a further non-limiting embodiment of any of the foregoing methods, the at least one fixation device includes a first knotless suture anchor and a second knotless suture anchor. The attaching step includes implanting the first knotless suture anchor into the bone, passing a flexible strand connected to the first knotless suture anchor through the cartilage graft and tensioning the flexible strand to approximate the cartilage graft to the bone. 
         [0014]    In a further non-limiting embodiment of any of the foregoing methods, the attaching step includes passing a second flexible strand through the cartilage graft, loading the second flexible strand through a portion of the fixation device, tensioning the second flexible strand and inserting the fixation device into bone. 
         [0015]    In a further non-limiting embodiment of any of the foregoing methods, at least one fixation device is a soft knotless anchor assembly. 
         [0016]    In a further non-limiting embodiment of any of the foregoing methods, at least one knotless suture anchor includes an eyelet. 
         [0017]    In a further non-limiting embodiment of any of the foregoing methods, at least one knotless suture anchor and the second knotless suture anchor includes a shuttle device configured to shuttle the flexible strand. 
         [0018]    A method for repairing a cartilage defect according to another exemplary aspect of the present disclosure includes, among other things, passing a flexible strand through a cartilage graft, tensioning the flexible strand to approximate the cartilage graft relative to bone associated with the cartilage defect and inserting a knotless suture anchor into the bone to knotlessly fixate the cartilage graft to the bone. 
         [0019]    In a further non-limiting embodiment of the foregoing method, the method includes creating a pilot hole in the bone prior to the step of inserting the knotless suture anchor. 
         [0020]    In a further non-limiting embodiment of either of the foregoing methods, the tensioning step occurs before the inserting step. 
         [0021]    In a further non-limiting embodiment of any of the foregoing methods, the tensioning step occurs after the inserting step. 
         [0022]    In a further non-limiting embodiment of any of the foregoing methods, the method includes loading a free end of the flexible strand through a portion of the knotless suture anchor. 
         [0023]    The embodiments, examples and alternatives of the preceding paragraphs, the claims, or the following description and drawings, including any of their various aspects or respective individual features, may be taken independently or in any combination. Features described in connection with one embodiment are applicable to all embodiments, unless such features are incompatible. 
         [0024]    The various features and advantages of this disclosure will become apparent to those skilled in the art from the following detailed description. The drawings that accompany the detailed description can be briefly described as follows. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0025]      FIGS. 1 and 2  schematically illustrate preparing a cartilage defect for implantation of a cartilage graft. 
           [0026]      FIG. 3  illustrates an exemplary cartilage graft. 
           [0027]      FIGS. 4A, 4B, 4C and 4D  schematically illustrate knotlessly fixating a cartilage graft to bone. 
           [0028]      FIGS. 5A, 5B and 5C  schematically illustrate knotlessly fixating a cartilage graft to bone. 
           [0029]      FIGS. 6A, 6B, 6C and 6D  illustrate exemplary fixation patterns for fixating a cartilage graft to a bone. 
       
    
    
     DETAILED DESCRIPTION 
       [0030]    This disclosure describes surgical methods for repairing cartilage defects. The surgical methods include attaching a cartilage graft to bone using at least one fixation device. In some embodiments, the fixation device is implanted into bone before tensioning a flexible strand, such as a suture, to approximate the cartilage graft to the bone. In other embodiments, the fixation device is implanted into bone after tensioning the flexible strand to approximate the cartilage graft to the bone. These and other features are described in greater detail in the following paragraphs of this detailed description. 
         [0031]    Repetitive trauma to a joint, such as a knee, ankle, hip, or shoulder joint, may cause cartilage defects. Cartilage defects include localized areas of damaged articular cartilage and, potentially, adjacent subchondral bone. Cartilage defects typically do not heal without treatment. If not treated, a defect can deteriorate articulate cartilage and/or underlying bone of the joint, thereby causing relatively significant arthritic pain. 
         [0032]      FIGS. 1-6  schematically illustrate methods of repairing a cartilage defect  10  located within a joint  12 . The methods are illustrated and described as an arthroscopic method; however, methods could alternatively be performed as an open procedure. The cartilage defect  10  can include osteochondral and/or chondral defects. In other words, a cartilage defect  10  may include localized areas of damaged articular cartridge and/or damaged subchondral bone of the joint  12 . In one embodiment, the joint  12  is a knee joint. However, methods of this disclosure may be used to repair cartilage defects located anywhere within the human body, including but not limited to, knee, talus, elbow, shoulder, hip, and temporomandibular joints. 
         [0033]    An exemplary repair method begins by prepping the cartilage defect  10  for receiving a cartilage graft  28  (shown in  FIG. 3 ). Referring first to  FIG. 1 , after a surgeon has identified a cartilage defect  10  within a joint  12 , the cartilage defect  10  may be debrided to a stable border having perpendicular margins. Tools, such as a curette  14  and an elevator  16 , can be used to create vertical margins around a periphery of the cartilage defect  10 . 
         [0034]    A cartilage defect  10  may be prepped with our without bone marrow stimulation. In an embodiment, a cartilage defect  10  is further prepared by performing bone marrow stimulation. For example, as shown in  FIG. 2 , a microfracture procedure or some other technique may optionally be performed to obtain a bleeding bone bed  18 . During microfracture surgery, multiple perforations  20  are created in subchondral bone  22  that extends beneath articular cartilage  24  associated with a cartilage defect  10 . A bleeding bone bed  18  may be created using a tool  26 , such as Arthrex&#39;s Powerpick™, to create perforations  20 . Formation of perforations  20  creates a bleeding bone bed  18 , which stimulates bone marrow seepage at the repair site. Other techniques can also be used to create a bleeding bone bed  18 , including but not limited to, drilling, hammering, curetting, scraping, etc. 
         [0035]    A cartilage defect  10  may also be dried to complete surgical preparation of the cartilage defect  10 . A cartilage defect  10  may be dried to remove excess moisture that could interfere with implantation of a cartilage graft  28 . The cartilage defect  10  may be dried using any known technique. 
         [0036]    In an illustrative embodiment, at least one transosseus tunnel (e.g., 1, 2, 3, 4, or 5) can be created in one or more bones adjacent a cartilage defect. In an embodiment, a transosseus tunnel can be created by drilling (e.g., an Arthrex Flipcutter®). In an embodiment, a transosseus tunnel can be created in the tibia, femur, calcaneus, humerus, acetabulum, mandible, temporal bone, or phalanges. In an illustrative embodiment, one or more transosseus tunnels can exit in a cartilage defect. 
         [0037]    A cartilage graft  28  may be implanted after adequately prepping a cartilage defect  10 . A cartilage graft  28  serves as a scaffold over a cartilage defect  10 , thereby providing a tissue network that can potentially signal autologous cellular interactions. The size and shape of a cartilage graft  28  may be selected using a template that is placed over the cartilage defect  10  and marked to indicate its general size. A template may then be used to trim a cartilage graft  28  down to the desired size and shape. 
         [0038]    One exemplary cartilage graft  28  is illustrated in  FIG. 3 . In one non-limiting embodiment, a cartilage graft  28  includes a cartilage disk  29  having a plurality of pores  31  formed through the cartilage disk  29 . The cartilage graft  28  may be made of human tissue (e.g., allograft cartilage), synthetic materials, xeno materials, etc. In one non-limiting embodiment, a cartilage graft  28  is made of a micronized cartilage matrix. Although shown as being porous, a cartilage graft  28  is not limited to such an embodiment. 
         [0039]    As shown in  FIG. 4A , a flexible strand  32 , such as a suture, can be passed through a cartilage graft  28 . A mattress stitch  33  may be formed to connect the flexible strand  32  to the cartilage graft  28 . A mattress stitch  33  is formed by inserting a flexible strand  32  through a pore  31 A in a direction from the bottom  35  toward a top  37  of the disk  29  of the cartilage graft  28  and then inserting the flexible strand  32  through an adjacent pore  31 B in a direction from the top  37  toward the bottom  35  of the disk  29 . Other suturing techniques and configurations are also contemplated within the scope of this disclosure. For example, in situations where the cartilage graft  28  is not porous, the flexible strand  32  may be simply threaded through the cartilage graft  28 . 
         [0040]    Next, as shown in  FIG. 4B , one or more free ends  34  of a flexible strand  32  are loaded through a portion  35  of a knotless suture anchor  30 A. In one non-limiting embodiment, the portion  35  includes an eyelet  36  of the knotless suture anchor  30 A. 
         [0041]    Knotless techniques are considered “knotless” because there is no need to tie knots in a flexible strand  32  in order to secure a cartilage graft  28  to bone. 
         [0042]    Multiple different fixation patterns may be used to secure the cartilage graft  28  to the bone B. For example, the cartilage graft  28  can be fixated by positioning flexible strands  32  at each of its four quadrants (see  FIG. 6A ), through its center and about its periphery (see  FIG. 6B ), through its top and bottom halves (see  FIG. 6C ), or at each third of the cartilage graft  28  (see  FIG. 6D ). Other fixation patterns could also be used. 
         [0043]    In another embodiment, a layer of fibrin may be applied over a cartilage graft  28  after it has been fixated to bone. Fibrin may be applied using an applicator. After the fibrin and the cartilage graft sit for a predefined amount of time, such as approximately five minutes, the joint  12  may be gently ranged before closure to assure adherence of the fibrin  50  and the cartilage graft  28  to the bone B. 
         [0044]    In an illustrative embodiment, a flexible strand can be passed through a cartilage graft and pulling the graft through the transosseus tunnel. Once through the transosseus tunnel, the flexible strand can be tensioned to approximate the cartilage graft to the bone. Once approximated, the cartilage graft can be fixated to the bone via one or more fixation devices. A fixation device can be an anchor, a screw, a button, or a suture construct. 
         [0045]    In an illustrative embodiment, method for repairing a cartilage defect includes drilling at least one transosseus tunnel; tensioning a flexible strand that is passed through a cartilage graft through at least one transosseus tunnel; and fixating the cartilage graft to bone. In an embodiment, a flexible strand is tensioned through more than one transosseus tunnels. In an illustrative embodiment, a cartilage graft can be fixated to bone via a fixation device, which can be a button, a screw, an anchor, or a suture construct. An embodiment includes a method comprising more than one fixation device, which can be a button, a screw, an anchor, a suture construct, or combinations thereof. A suture construct can be knotted or knotless. A suture construct can be a pattern of suture that secures the graft to a bone (e.g., SutureBridge®, SpeedBridge™, etc.). 
         [0046]    Although the different non-limiting embodiments are illustrated as having specific components, the embodiments of this disclosure are not limited to those particular combinations. It is possible to use some of the components or features from any of the non-limiting embodiments in combination with features or components from any of the other non-limiting embodiments. 
         [0047]    It should be understood that like reference numerals identify corresponding or similar elements throughout the several drawings. It should also be understood that although a particular component arrangement is disclosed and illustrated in these exemplary embodiments, other arrangements could also benefit from the teachings of this disclosure. 
         [0048]    The foregoing description shall be interpreted as illustrative and not in any limiting sense. A worker of ordinary skill in the art would understand that certain modifications could come within the scope of this disclosure. For these reasons, the following claims should be studied to determine the true scope and content of this disclosure.