Patent ID: 12245759

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. It should be understood that throughout the drawings, corresponding reference numerals indicate like or corresponding parts and features.

FIG.2Arepresents a suture construction20according to the present teachings. Shown is a suture22having a first end24and a second end26. The suture22is formed of a braided body28that defines a longitudinally formed hollow passage30therein. First and second apertures32and34are defined in the braided body28at first and second locations of the longitudinally formed passage30.

Briefly referring toFIG.3, a first end24of the suture22is passed through the first aperture32and through longitudinal passage30formed by a passage portion and out the second aperture34. The second end26is passed through the second aperture34, through the passage30and out the first aperture32. This forms two structures or loops46and46′. Structures defined herein can be loops, knots or tangles, each having unique properties. As seen inFIG.2B, the relationship of the first and second apertures32and34with respect to the first and second ends24and26can be modified so as to allow a bow-tie suture construction36. As described below, the longitudinal and parallel placement of first and second suture portions38and40of the suture22within the longitudinal passage30resists the reverse relative movement of the first and second portions38and40of the suture once it is tightened.

The first and second apertures are formed during the braiding process as loose portions between pairs of fibers defining the suture. As further described below, the first and second ends24and26can be passed through the longitudinal passage30multiple times. It is envisioned that either a single or multiple apertures can be formed at the ends of the longitudinally formed passage.

As best seen inFIGS.4A and4B, a portion of the braided body28of the suture defining the longitudinal passage30can be braided so as to have a diameter larger than the diameter of the first and second ends24and26. Additionally shown are first through fourth apertures32,34,42, and44. These apertures can be formed in the braiding process or can be formed during the construction process. In this regard, the apertures2,34,42, and44are defined between adjacent fibers in the braided body28. As shown inFIG.4B, and described below, it is envisioned the sutures can be passed through other biomedically compatible structures.

FIGS.5-7represent alternate constructions wherein a plurality of loops46a-dare formed by passing the first and second ends24and through the longitudinal passage30multiple, times. The first and second ends24and26can be passed through multiple or single apertures defined at the ends of the longitudinal passage30. The tensioning of the ends24and26cause relative translation of the sides of the suture with respect to each other.

Upon applying tension to the first and second ends24and26of the suture22, the size of the loops46a-dis reduced to a desired size or load. At this point, additional tension causes the body of the suture defining the longitudinal passage30to constrict about the parallel portions of the suture within the longitudinal passage30. This constriction reduces the diameter of the longitudinal passage30, thus forming a mechanical interface between the exterior surfaces of the first and second parallel portions as well as the interior surface of the longitudinal passage30.

As seen inFIGS.8-11B, the suture construction can be coupled to various biocompatible hardware, in this regard, the suture construction20can be coupled to an aperture52of the bone engaging fastener54. Additionally, it is envisioned that soft tissue or bone engaging members56can be fastened to one or two loops46. After fixing the bone engaging fastener54, the members56can be used to repair, for instance, a meniscal tear. The first and second ends24,26are then pulled, setting the tension on the loops46, thus pulling the meniscus into place. Additionally, upon application of tension, the longitudinal passage30is constricted, thus preventing the relaxation of the tension caused by relative movement of the first and second parallel portions38,40, within the longitudinal passage30.

As seen inFIGS.9-11B, the loops46can be used to fasten the suture construction20to multiple types of prosthetic devices. As described further below, the suture22can further be used to repair and couple soft tissues in an anatomically desired position. Further, retraction of the first and second ends allows a physician to adjust the tension on the loops between the prosthetic devices.

FIG.11brepresents the coupling of the suture construction according toFIG.2Bwith a bone fastening member. Coupled to a pair of loops46and46′ are tissue fastening members56. The application of tension to either the first or second end24or26will tighten the loops46or46′ separately,

FIGS.12A-12Erepresent potential uses of the suture constructions20inFIGS.2A-7in an ACL repair. As can be seen inFIG.12A, the longitudinal passage portion30of suture construction20can be first coupled to a fixation member60. The member60can have a first profile which allows insertion of the member60through the tunnel and a second profile which allows engagement with a positive locking surface upon rotation. The longitudinal passage portion30of the suture construction20, member60, loops46and ends24,26can then be passed through a femoral and tibial tunnel62. The fixation member60is positioned or coupled to the femur. At this point, a natural or artificial64can be passed through a loop or loops46formed in the suture construction20. Tensioning of the first and second ends24and26applies tension to the loops46, thus pulling the ACL64into the tunnel. In this regard, the first and second ends are pulled through the femoral and tibial tunnel, thus constricting the loops46about the ACL64(seeFIG.12B).

As shown, the suture construction20allows for the application of force along an axis61defining the femoral tunnel. Specifically, the orientation of the suture construction20and, more specifically, the orientation of the longitudinal passage portion30, the loops46, and ends24,26allow for tension to be applied to the construction20without applying non-seating forces to the fixation member60. As an example, should the loops24,26be positioned at the member60, application of forces to the ends24,26may reduce the seating force applied by the member60onto the bone.

As best seen inFIG.12C, the body portion28and parallel portions38,40of the suture construction20remain disposed within to the fixation member60. Further tension of the first ends draws the ACL64up through the tibial component into the femoral component. In this way, suture ends can be used to apply appropriate tension onto the ACL64component. The ACL64would be fixed to the tibial component using a plug or screw as is known.

After feeding the ACL64through the loops46, tensioning of the ends allows engagement of the ACL with bearing surfaces defined on the loops. The tensioning pulls the ACL64through a femoral and tibial tunnel. The ACL64could be further coupled to the femur using a transverse pin or plug. As shown inFIG.12E, once the ACL is fastened to the tibia, further tensioning can be applied to the first and second ends24,26placing a desired predetermined load on the ACL. This tension can be measured using a force gauge. This load is maintained by the suture configuration. It is equally envisioned that the fixation member60can be placed on the tibial component66and the ACL pulled into the tunnel through the femur. Further, it is envisioned that bone cement or biological materials may be inserted into the tunnel62.

FIGS.13A-13Drepresent a close-up of a portion of the suture20. As can be seen, the portion of the suture defining the longitudinal passage30has a diameter d1which is larger than the diameter d2of the ends24and26. The first aperture32is formed between a pair of fiber members. As can be seen, the apertures32,34can be formed between two adjacent fiber pairs68,70. Further, various shapes can be braided onto a surface of the longitudinal passage30.

The sutures are typically braided of from 8 to 16 fibers. These fibers are made of nylon or other biocompatible material. It is envisioned that the suture22can be formed of multiple type of biocompatible fibers having multiple coefficients of friction or size. Further, the braiding can be accomplished so that different portions of the exterior surface of the suture can have different coefficients of friction or mechanical properties. The placement of a carrier fiber having a particular surface property can be modified along the length of the suture so as to place it at varying locations within the braided constructions.

FIGS.14A and148represent the coupling of soft tissue to a bone. Shown is a plurality of bone engaging fasteners60coupled to suture constructions22shown inFIG.2AorFIG.4. Each fastener60is coupled to a bone by being pressed into or threaded into an aperture formed within the bone. Adjoining fasteners are coupled together using loops46from an adjacent suture construction22.

The fasteners60define a locking feature92which is used to couple the fastener60to the bone. Disposed on a first end of the fastener60is an aperture94configured to hold the suture construction22. Additionally, in the fastener60is a locking feature100configured to engage with one of the first or second loops46or47of an adjacent suture construction22. Returning briefly toFIG.14A, a suture end26and first loop46can be passed around or through an aperture84in soft tissue.

The first loop46is then fed around or through a second aperture84′ formed in the soft tissue80. After passing through the aperture84′, the first loop46is coupled to the coupling feature100in an adjacent bone coupling fastener60. At this point, the first and second ends24,26of the suture22are pulled tight, tightening the suture loop46about the soft tissue80. This pulls the soft tissue80against a surface of the bone. This can be used to couple soft tissue in an anatomy such in the repair of a rotator cuff.

It is envisioned that a plurality of fasteners60can have associated suture constructions22which can similarly be coupled to adjacent fasteners60. Alternatively, the loops46,47can looped around or passed through the soft tissue80and then can be coupled to the coupling feature100of its fastener60.

FIGS.15A-15Drepresent an alternate method of coupling soft tissue80to a bone. As shown inFIG.15A, a first bone coupling fastener60is coupled to an aperture63formed in the bone. The bone coupling fastener60defines a fastener accepting bore96. The bore96may be a through bore or may terminate within the fastener96. The fastener accepting bore96is configured to accept a suture bearing fastener98. The first loop46can be coupled to the second loop47to fix the soft tissue80.

The suture bearing fastener98defines an aperture104configured to accept the suture construction22according to any of the present teachings. As described below, the fastener98can also have a concave suture locking feature100. Disposed at a proximal end102of the fastener96can be soft tissue piercing feature105which can be an acute angle. Additionally, the suture bearing fastener98can have locking features to facilitate the coupling to the bore96of the bone coupling fastener60.

As seen inFIG.15B, the suture construction ofFIGS.1-7can be coupled to the suture bearing fastener98through the suture bearing aperture104using a knot. After the suture bearing fastener98is pressed through or adjacent to the soft tissue80, the suture construction22can be looped over the soft tissue80and engaged with the concave locking feature100. The suture bearing fastener98can be pressed into the fastener60to lock the suture22into place. Tension can then be applied to the suture22construction to constrict the loop46or loops46and47about the soft tissue80.

As seen inFIGS.15C and15D, the soft tissue80can be threaded through the loops46and47prior to or after the coupling of the suture bearing fastener98to the bone engaging fastener60. A guide wire99can be coupled to the bone through the fastener bore96. The guide wire99is then used to align the suture bearing fastener98through the soft tissue80and into the bore96of fastener60.

As shown inFIG.16A-16C, one loop46of the suture construction22can have a fastening element112coupled thereto. This fastener element112can take the form of a hook having an aperture which accepts the suture from a loop47. The loop46of the suture construction can be passed through the aperture84formed in the soft tissue80.

FIG.16Dshows the fastener element112can be coupled to the first loop46. After the first and second loops46and47are coupled together about the soft tissue80, tension can be applied to the ends of the construction to pull the soft tissue to the bone.

As shown inFIG.17, bone engaging fastener60can have a bore96defined therein. The bore96can have a defined fastening loop114which is used to couple a suture construction22to the fastener60. In this regard, it is envisioned the passage portion30of the suture construction can be fixed within the fastening loop. One or both loops46and47can then be passed through an aperture84defined in the soft tissue80. These loops of material can be hooked to a hook116defined within the bore96. The application of tension to the ends pulls the soft tissue to the bone without the use of knots or additional fasteners.

FIGS.18A and18Brepresent an alternate method of coupling soft tissue80to bone. Shown is a bone engaging fastener60defining an internal bore96. The internal bore96defines a locking mechanism such a through pin120. Disposed about the locking mechanism is a suture construction22having a single loop46. Disposed on the loop46is a locking hook122.

As shown inFIG.18B, the locking hook122can be used to couple the fastener60to a suture loop124passed through an aperture84formed in soft tissue80. The application of tension to the ends22and26of the suture construction22pulls the locking hook122and suture124into the bore96, thus locking the soft tissue80to the bone.

As seen inFIGS.19A-19C, the fastener60can have a pair of suture constructions22and22′. The first suture22can have a locking member122, while the second suture22′ can have a loop46threaded through the soft tissue80. After the loop46is threaded through or around the soft tissue, the locking member122is coupled to the loop46. The application of tension to the ends26of the suture constructions22and22′ pull the locking member122into a bore96formed by the fastener60. This locks the loop46into position. Tension on the end26of suture22then pulls the soft tissue to the bone.

It should be noted that while the interior bore of the fasteners60is shown as being smooth, it is envisioned that the interior surface can have features such as barbs or locking tabs to facilitate the coupling of the suture engaging fastener98with the bone engaging fastener60. Additionally, the interior bores can define driving surfaces or features such as a hex head.

The description of the invention is merely exemplary in nature and, thus, variations that do not depart from the gist of the invention are intended to be within the scope of the invention. For example, any of the above mentioned surgical procedures is applicable to repair of other body portions. For example, the procedures can be equally applied to the repair of wrists, elbows, ankles, and meniscal repair. The suture loops can be passed through bores formed in soft or hard tissue. It is equally envisioned that the loops can be passed through or formed around an aperture or apertures formed in prosthetic devices, e.g. humeral, femoral or tibial stems. Such variations are not to be regarded as a departure from the spirit and scope of the invention.