CA2563910A1 - Apparatus and methods for securing tissue to bone - Google Patents

Apparatus and methods for securing tissue to bone Download PDF

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Publication number
CA2563910A1
CA2563910A1 CA002563910A CA2563910A CA2563910A1 CA 2563910 A1 CA2563910 A1 CA 2563910A1 CA 002563910 A CA002563910 A CA 002563910A CA 2563910 A CA2563910 A CA 2563910A CA 2563910 A1 CA2563910 A1 CA 2563910A1
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CA
Canada
Prior art keywords
suture
passage
bone anchor
anchor member
plug portion
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CA002563910A
Other languages
French (fr)
Other versions
CA2563910C (en
Inventor
Gary S. Fanton
John F. Krumme
John E. Ashley
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
C2M Medical Inc
Original Assignee
Sapphire Medical, Inc.
Gary S. Fanton
John F. Krumme
John E. Ashley
C2M Medical, Inc.
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Application filed by Sapphire Medical, Inc., Gary S. Fanton, John F. Krumme, John E. Ashley, C2M Medical, Inc. filed Critical Sapphire Medical, Inc.
Publication of CA2563910A1 publication Critical patent/CA2563910A1/en
Application granted granted Critical
Publication of CA2563910C publication Critical patent/CA2563910C/en
Expired - Fee Related legal-status Critical Current
Anticipated expiration legal-status Critical

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0414—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having a suture-receiving opening, e.g. lateral opening
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0445—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors cannulated, e.g. with a longitudinal through-hole for passage of an instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0448—Additional elements on or within the anchor
    • A61B2017/045—Additional elements on or within the anchor snug fit within the anchor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0448—Additional elements on or within the anchor
    • A61B2017/0453—Additional elements on or within the anchor threaded elements, e.g. set screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0456—Surface features on the anchor, e.g. ribs increasing friction between the suture and the anchor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0458—Longitudinal through hole, e.g. suture blocked by a distal suture knot
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0459—Multiple holes in the anchor through which the suture extends and locking the suture when tension is applied

Abstract

The present invention relates to apparatus and methods for securing tissue to bone using a suture anchoring system that provides enhanced tactile feedback and does not require tying a suture knot. In each embodiment, a surgeon can individually tension the free ends of the suture to fine-tune the placement of the tissue with respect to the bone, and then secure the suture without tying a knot. In several embodiments of the present invention, the device may be transformed between locked and unlocked suture states, thereby allowing further fine-tuning of the tension in the suture.

Claims (132)

1. Apparatus suitable for coupling tissue to bone via a suture loop, the apparatus comprising:
a bone anchor member; and means for locking a suture coupled between the bone anchor member and tissue, wherein positioning of the tissue with respect to the bone is effected by individually tensioning first and second ends of the suture.
2. The apparatus of claim 1 further comprising a plurality of cleated members disposed on an exterior surface of the bone anchor member and configured to secure the bone anchor member within a hole drilled in the bone.
3. The apparatus of claim 1 wherein the means for locking comprises a first passage disposed laterally through the bone anchor member.
4. The apparatus of claim 3 wherein the first passage comprises at least one cleated member configured to permit incremental tensioning of the first suture end.
5. The apparatus of claim 4 wherein the cleated member permits movement of the first end of the suture in a proximal direction only.
6. The apparatus of claim 5 wherein the cleated member comprises an angled section disposed adjacent to a substantially orthogonal section.
7. The apparatus of claim 3 wherein the means for locking further comprises a second passage disposed laterally through the bone anchor member.
8. The apparatus of claim 7 wherein the second passage comprises at least one cleated member configured to permit incremental tensioning of the first suture end.
9. The apparatus of claim 8 wherein the cleated member permits movement of the second end of the suture in a proximal direction only.
10. The apparatus of claim 1 further comprising a first guide channel disposed in an outer surface of the bone anchor, wherein the first guide channel is configured to permit movement of the suture when the bone anchor member is disposed within the hole of the bone.
11. The apparatus of claim 10 further comprising a second guide channel disposed in an outer surface of the bone anchor at a location substantially diametrically opposing the first guide channel.
12. The apparatus of claim 1 wherein the bone anchor member comprises at least one adhesive delivery channel.
13. The apparatus of claim 1 wherein the hole drilled in the bone is a through hole, and the bone anchor member further comprises a proximal end having a flange configured to abut the bone when a main body of the bone anchor member is disposed in the through hole.
14. The apparatus of claim 13 wherein the bone anchor member further comprises first and second passages configured to receive the first and second suture ends.
15. The apparatus of claim 14 wherein the first and second passages each comprise at least one cleated member configured to permit proximal retraction of the first and second suture ends.
16. The apparatus of claim 1 wherein the means for locking comprises:
a locking member having a cylindrical body, a distal protrusion, and at least one support member, wherein the locking member is configured to be received within a bore of the bone anchor member; and at least one passage extending laterally through the bone anchor member, the passage disposed distal to the cylindrical body of the locking member, wherein distal advancement of the locking member is configured to cause the distal protrusion to extend into the passage to lock the suture in place.
17. The apparatus of claim 16 further comprising:
a support ledge disposed between the cylindrical body and the passage, the support ledge having an aperture through which the distal protrusion at least partially extends, wherein the support members are configured to rest upon the support ledge in an unlocked state to permit movement of the suture within the passage.
18. Apparatus suitable for facilitating attachment of tissue to bone, the apparatus comprising:
a bone anchor member having a bore; and a plug portion configured to be inserted into the bore of the bone anchor member, wherein positioning of the tissue with respect to the bone is effected by individually tensioning first and second ends of a suture coupled between the plug portion and the tissue.
19. The apparatus of claim 18 wherein the plug portion has an outer surface having at least one cleated member, wherein the cleated member is configured to secure the plug portion within the bore of the bone anchor member.
20. The apparatus of claim 18 wherein the plug portion has a substantially smooth exterior surface configured to engage at least one interior cleated member disposed in the bore of the bone anchor member.
21. The apparatus of claim 18 wherein the plug portion comprises a first passage extending laterally therethrough, wherein the first passage is sized to allow passage of the first end of the suture therethrough.
22. The apparatus of claim 21 wherein the first passage comprises at least one cleated member.
23. The apparatus of claim 21 wherein the plug portion further comprises a second passage extending laterally therethrough, wherein the second passage is sized to allow passage of the second end of the suture therethrough.
24. The apparatus of claim 23 wherein the second passage comprises at least one cleated member.
25. The apparatus of claim 18 further comprising a first guide channel disposed in an outer surface of the plug portion and configured to permit movement of the suture when the plug portion is disposed within the bone anchor member.
26. The apparatus of claim 25 wherein the plug portion comprises a second guide channel substantially opposing the first guide channel.
27. The apparatus of claim 18 wherein an outer diameter of the plug portion is slightly larger than an inner diameter of the bore of the bone anchor member to permit a frictional fit therebetween.
28. The apparatus of claim 27 further comprising:
a taper disposed at a distal end of the plug portion; and a taper disposed at a proximal end of the bore to facilitate insertion of the plug portion into the bore.
29. The apparatus of claim 18 further comprising:
an inward taper disposed at a proximal region of the bone anchor member; and a proximal stop formed between the inward taper and an inner wall of the bore, wherein the proximal stop is configured to retain the plug portion within the bore after the plug portion is advanced distally beyond the inward taper.
30. The apparatus of claim 18 further comprising:
a circumferential protrusion disposed near a distal end of the bore; and a circumferential recess disposed at a distal region of the plug portion, wherein the circumferential protrusion is configured to be secured within the circumferential recess when the plug portion is inserted into the bone anchor member.
31. The apparatus of claim 30 further comprising a passage extending laterally though a central region of the plug portion, the passage configured to receive the first and second suture ends.
32. The apparatus of claim 30 further comprising a distal passage formed as a slot in a distal end of the plug portion, the distal passage configured to receive the first and second suture ends.
33. Apparatus suitable for facilitating attachment of tissue to bone, the apparatus comprising:
a bone anchor member;

means for locking a suture having first and second ends; and means for unlocking the suture to enable movement of the first and second ends.
34. The apparatus of claim 33 further comprising a plurality of cleated members disposed on an exterior surface of the bone anchor member and configured to secure the bone anchor member within a hole drilled in the bone.
35. The apparatus of claim 33 wherein the means for locking and the means for unlocking comprises:
a flexible member formed in a bore of the bone anchor member; and at least one passage extending laterally through the bone anchor member, the passage disposed distal to the flexible member, wherein the suture is configured for movement within the passage in an unlocked state.
36. The apparatus of claim 35 wherein the application of a distally-directed force acting upon the flexible member is configured to lock the suture within the passage.
37. The apparatus of claim 36 wherein removal of the distally-directed force is configured to permit movement of the suture within the passage.
38. The apparatus of claim 36 wherein the flexible member comprises a distal knob configured to pinch the suture in a locked state.
39. The apparatus of claim 35 wherein the flexible member has only two stable states.
40. The apparatus of claim 39 wherein the application of a distally-directed force acting upon the flexible member is configured to transform the flexible member to a second stable state that substantially inhibits movement of the suture.
41. The apparatus of claim 40 wherein the application of a proximally-directed force acting upon the flexible member is configured to transform the flexible member to a first stable state that permits movement of the suture.
42. The apparatus of claim 33 further comprising first and second guide channels disposed in opposing outer surfaces of the bone anchor member and configured to permit movement of the suture when the bone anchor member is disposed in the hole in the bone.
43. The apparatus of claim 33 wherein the means for locking and the means for unlocking comprises:
a threaded cap;
a grooved interior section disposed in a bore of the bone anchor member, the grooved interior section configured to receive the threaded cap;
and a passage extending laterally through the bone anchor member, the passage disposed distal to the threaded cap, wherein distal advancement of the threaded cap within the grooved interior section is configured to pinch the suture to lock the suture in place.
44. The apparatus of claim 43 wherein proximal movement of the threaded cap within the grooved interior section is configured to unlock the suture to allow movement of the suture within the passage.
45. The apparatus of claim 43 further comprising:
a mating slot disposed in a proximal surface of the threaded cap; and a locking tool configured to engage the mating slot, wherein rotation of the locking tool in a first direction is configured to cause rotation of the threaded cap to lock the suture in place.
46. The apparatus of claim 45 wherein rotation of the locking tool in a second direction is configured to cause rotation of the threaded cap to unlock the suture.
47. The apparatus of claim 33 wherein the bone anchor member further comprises:
a bore; and first and second passages extending laterally through the bone anchor member.
48. The apparatus of claim 47 wherein the means for locking and the means for unlocking comprises:

a plug portion configured to be received within the bore of the bone anchor member, the plug portion having first and second passages extending laterally therethrough, wherein the first end of the suture is configured to be threaded through the first passage of the bone anchor member and the first passage of the plug portion, and the second end of the suture is configured to be threaded through the second passage of the bone anchor member and the second passage of the plug portion.
49. The apparatus of claim 48 wherein the first passage of the bone anchor member and the first passage of the plug portion are configured to be substantially aligned to permit movement of the first end of the suture in an unlocked state.
50. The apparatus of claim 49 wherein the second passage of the bone anchor member and the second passage of the plug portion are configured to be substantially aligned to permit movement of the second end of the suture in the unlocked state.
51. The apparatus of claim 49 wherein the first passage of the bone anchor member and the first passage of the plug portion suture are configured to be misaligned to prohibit movement of the first end of the suture in a locked state.
52. The apparatus of claim 51 wherein the second passage of the bone anchor member and the second passage of the plug portion suture are configured to be misaligned to prohibit movement of the second end of the suture in the locked state.
53. The apparatus of claim 48 further comprising at least one spring member disposed near a distal region of the bore, the spring member configured to affect the positioning of the plug portion with respect to the bone anchor member.
54. The apparatus of claim 53 wherein the spring member has a first state in which the plug portion is disposed proximally within the bore to lock the suture in place.
55. The apparatus of claim 54 wherein the spring member has a second state in which the spring member is deformed distally to permit movement of the suture.
56. The apparatus of claim 55 wherein the plug portion comprises a proximal flange configured to hold the plug portion within the bore of the bone anchor member.
57. The apparatus of claim 47 wherein the means for locking and the means for unlocking comprises:
a plug portion configured to be received within the bore of the bone anchor member, wherein the first end of the suture is configured to be threaded through the first passage of the bone anchor member, and the second end of the suture is configured to be threaded through the second passage of the bone anchor member, wherein the plug portion is configured to be rotated circumferentially within the bone anchor.
58. The apparatus of claim 57 wherein the plug portion is configured to be rotated in a first direction to lock the first and second suture ends within the first and second passages, respectively.
59. The apparatus of claim 58 wherein the plug portion is configured to be rotated in a second direction to unlock the first and second suture ends, thereby permitting movement of the first and second suture ends within the first and second passages, respectively.
60. The apparatus of claim 59 wherein the plug portion comprises an actuation knob configured to engage a first recess of the bone anchor member in a locked state.
61. The apparatus of claim 60 wherein the actuation knob is configured to engage a second recess of the bone anchor member in an unlocked state.
62. The apparatus of claim 33 wherein the means for locking and the means for unlocking comprises:
a first semi-circular channel formed in a main body of the bone anchor member; and a plug portion having a first semi-circular channel, wherein the first semi-circular channel of the bone anchor member is configured to be aligned with the first semi-circular channel of the plug portion to form a first circular channel, wherein the first circular channel is configured to permit movement of the first suture end therein.
63. The apparatus of claim 62 wherein rotation of the plug portion with respect to the bone anchor member is configured to misalign the first semi circular channel of the plug portion and the first semi-circular channel of the bone anchor member to lock the first suture end in place.
64. The apparatus of claim 62 further comprising:
a second semi-circular channel formed in the main body of the bone anchor member; and a second semi-circular channel formed in the plug portion, wherein the second semi-circular channel of the bone anchor member is configured to be aligned with the second semi-circular channel of the plug portion to form a second circular channel, wherein the second circular channel is configured to permit movement of the second suture end therein.
65. The apparatus of claim 64 wherein rotation of the plug portion with respect to the bone anchor member is configured to misalign the second semi-circular channel of the plug portion and the second semi-circular channel of the bone anchor member to lock the second suture end in place.
66. A method for facilitating attachment of tissue to bone, the method comprising:
providing apparatus comprising a bone anchor member having first and second passages extending laterally therethrough;
inserting a first end of a suture through the first passage and a second end of the suture through the second passage to form a loop therebetween, wherein the loop is coupled to tissue; and tensioning the first end of the suture to draw the tissue towards the bone.
67. The method of claim 66 further comprising tensioning the first end of the suture prior to insertion of the bone anchor member into a hole drilled in the bone.
68. The method of claim 66 further comprising tensioning the first end of the suture after insertion of the bone anchor member into a hole drilled in the bone.
69. The method of claim 66 further comprising tensioning the second end of the suture to draw the tissue towards the bone.
70. The method of claim 66 further comprising:
providing at least one cleated member in the first passage;
incrementally tensioning the first suture end; and locking the first suture end within the first passage using the cleated member.
71. The method of claim 70 further comprising:
providing at least one cleated member in the second passage;
incrementally tensioning the second suture end; and locking the second suture end within the second passage using the cleated member.
72. A method for facilitating attachment of tissue to bone, the method comprising:
providing apparatus comprising a bone anchor member having a first passage extending laterally therethrough;
threading a suture through the first passage;
coupling the suture to tissue to form a loop;
guiding the suture back through the first passage, so that first and second ends of the suture may be manipulated by a physician; and tensioning the first end of the suture to draw the tissue towards the bone.
73. The method of claim 72 further comprising:
providing a flexible member at a location proximal to the first passage; and causing distal advancement of the flexible member to pinch the suture and lock the suture in place.
74. The method of claim 73 further comprising permitting proximal movement of the flexible member to unlock the suture.
75. The method of claim 72 further comprising:
providing a threaded cap configured for proximal and distal movement within a grooved interior section of the bone anchor member, wherein the threaded cap is disposed proximal to the first passage; and distally advancing the threaded cap to pinch the suture and lock the suture in place.
76. The method of claim 75 further comprising proximally retracting the threaded cap to unlock the suture.
77. The method of claim 72 further comprising:
providing a locking member having a cylindrical body, a distal protrusion, and at least one support member, wherein the locking member is configured to be received within a bore of the bone anchor member; and distally advancing the locking member to cause the distal protrusion to pinch the suture and lock the suture in place.
78. A method for facilitating attachment of tissue to bone, the method comprising:
providing apparatus comprising a bone anchor member and a plug portion;
inserting the bone anchor member into a hole drilled into the bone;
inserting the plug portion into a bore of the bone anchor member; and tensioning at least one end of a suture coupled between the plug portion and the tissue.
79. The method of claim 78 further comprising:
threading a first end of the suture through a first passage in the plug portion and a first passage in the bone anchor member;
threading a second end of the suture through a second passage in the plug portion and a second passage in the bone anchor member; and aligning the first passage in the plug portion with the first passage in the bone anchor member to permit movement of the first end of the suture.
80. The method of claim 79 further comprising misaligning the first passage in the plug portion with the first passage in the bone anchor member to lock the first end of the suture.
81. The method of claim 79 further comprising aligning the second passage in the plug portion with the second passage in the bone anchor member to permit movement of the second end of the suture.
82. The method of claim 81 further comprising misaligning the second passage in the plug portion with the second passage in the bone anchor member to lock the second end of the suture.
83. The method of claim 79 further comprising deforming at least one spring member disposed near a distal region of the bore to cause the first passage of the plug portion to become aligned with the first passage of the bone anchor member.
84. The method of claim 78 further comprising:
threading a first end of the suture through a first passage of the bone anchor member;
threading a second end of the suture through a second passage of the bone anchor member; and rotating the plug portion circumferentially with respect to the bone anchor member to lock the suture in place.
85. The method of claim 84 wherein the plug portion is rotated in a first direction to lock the first and second suture ends within the first and second passages, respectively.
86. The method of claim 85 further comprising rotating the plug portion in a second direction to unlock the first and second suture ends, thereby permitting movement of the first and second suture ends within the first and second passages, respectively.
87. The method of claim 86 further comprising securing an actuation knob of the plug portion within a first recess of the bone anchor member in a locked state.
88. The method of claim 87 further comprising securing the actuation knob of the plug portion in a second recess of the bone anchor member in an unlocked state.
89. The apparatus of claim 1 wherein the bone anchor member comprises first and second mating portions.
90. The apparatus of claim 89 wherein the first mating portion comprises first and second cleated passage portions.
91. The apparatus of claim 90 wherein the second mating portion comprises first and second cleated passage portions that are configured to be in communication with the first and second cleated passage portions, respectively, of the first mating portion.
92. The apparatus of claim 89 wherein the first mating portion comprises at least one mating pocket, and wherein the second mating portion comprises at least one protrusion configured to securely engage the mating pocket.
93. The apparatus of claim 92 wherein the protrusion comprises a ledge to enhance the engagement between the first and second mating portions.
94. The apparatus of claim 18 wherein the plug portion comprises first and second plug portions.
95. The apparatus of claim 94 wherein the first and second plug portions are coupled together using a hinge member.
96. The apparatus of claim 95 wherein the hinge member is coupled between distal ends of the first and second plug portions.
97. The apparatus of claim 95 wherein the hinge member is coupled between lateral surfaces of the first and second plug portions.
98. The apparatus of claim 94 wherein the first plug portion comprises first and second cleated passage portions.
99. The apparatus of claim 98 wherein the second plug portion comprises first and second cleated passage portions that are configured to be in communication with the first and second cleated passage portions, respectively, of the first plug portion.
100. The apparatus of claim 99 wherein the first and second cleated passage portions of the first plug portion are larger than the first and second cleated passage portions of the second plug portion.
101. Apparatus suitable for facilitating attachment of tissue to bone, the apparatus comprising:
a bone anchor member having a bore;
a plug portion configured to be inserted into the bore of the bone anchor member;
a first suture length having first and second ends and a loop disposed therebetween, wherein the first suture length is coupled to the bone anchor member; and a second suture length having first and second ends and a loop coupled to tissue, wherein the second suture length is coupled to the first suture length.
102. The apparatus of claim 101 wherein the second suture length further is coupled between the plug portion and the loop of the first suture length.
103. The apparatus of claim 101 wherein a physician may individually tension any of the first and second ends of the first suture length, or the first and second ends of the second suture length, to approximate positioning of the tissue with respect to a bone.
104. The apparatus of claim 101 further comprising a clearance channel formed between the bone anchor member and the plug portion.
105. The apparatus of claim 104 wherein the first and second ends of the second suture length are locked in place by jamming the second suture length within the clearance channel.
106. A method of securing suture to bone, comprising the steps of:
providing an anchor having a main body and an insert, the insert having a throughhole, the insert being movable relative to the main body between an open position and a closed position, the insert being biased by a spring force toward the closed position;

introducing the main body into a bone;
positioning a suture in the throughhole;
moving the insert to the open position by overcoming the spring force;
tensioning the suture after the moving step; and permitting the insert to move back toward the closed position after the tensioning step.
107. The method of claim 107, wherein:
the providing step is carried out with the main body having longitudinal axis, the insert moving longitudinally when moving between the open and closed positions.
108. The method of claim 107, wherein:
the providing step is carried out with the insert including a spring portion which creates the spring force.
109. The method of claim 107, wherein:
the providing step is carried out with the insert having a pinned connection with the main body.
110. The method of claim 107, wherein:
the providing step is carried out with the suture anchor having an insert manipulator coupled to the insert; and the moving step is carried out by tensioning the insert manipulator to move the insert toward the open position.
111. The method of claim 111, wherein:
the providing step being carried out with the insert manipulator being a flexible tether.
112. The method of claim 112, wherein:
the moving step is carried out with the flexible tether being free to extend from the proximal end of the main body in any direction.
113. The method of claim 107, further comprising the step of:
removing the manipulator from the anchor.
114. The method of claim 114, wherein:
the removing step is carried out by cutting and removing the manipulator.
115. A device for securing suture to bone, comprising:
a main body having a recess; and an insert positioned in the recess, the insert being movable within the recess between an unlocked position and a locked position, the insert being biased by a spring force toward the locked position, the, insert having a throughhole which receives suture, wherein suture in the throughhole is locked when the insert is in the locked position and is free to move in the throughhole when the insert is in the unlocked position.
116. The device of claim 116, wherein:
the main body has longitudinal axis, the insert being longitudinally movable within the recess when moving between the locked and unlocked positions.
117. The device of claim 116, wherein:
the insert includes a spring portion which creates the spring force.
118. The device of claim 116, wherein:
the insert has a pinned connection with the main body.
119. The device of claim 116, further comprising:
a manipulator coupled to the insert, the manipulator being tensioned to move the insert to the locked position.
120. The device of claim 120, wherein:
the manipulator is a flexible tether.
121. The device of claim 112, wherein:
the flexible tether is free to extend from the proximal end of the main body in any direction.
122. The device of claim 116, wherein:
the manipulator is removable.
123. A method of securing suture to bone, comprising the steps of:
providing a bone anchor.and a length of suture, the bone anchor having a first suture lock, a proximal end, a distal, end and a first suture passage;
positioning a first suture portion from the length of suture in the first suture passage, the length of suture having a first side and a second side extending from each side of the first suture portion, the first and second sides extending from the proximal end of the anchor;
coupling the first side of the length of suture to a tissue structure;
introducing the bone anchor into bone in a distal direction so that the distal end is embedded in the bone;
pulling the second side to increase tension in the first side of the length of suture after the introducing step, the first and second sides extending from the proximal end of the bone anchor; and releasing tension on the first side of the length of suture, the first suture portion being automatically locked by the suture lock upon releasing tension on the first suture.
124. The method of claim 124, wherein:
the providing step is carried out with the bone anchor having a main body, the main body having a bearing surface;
the positioning step is carried out with the suture extending around the gearing surface, the first suture lock permitting the suture to be pulled in one direction and preventing the suture from being pulled in the other direction.
125. The method of claim 125, wherein:
the providing step is carried out with the bone anchor having a second suture lock;
the positioning step is carried out with the first suture lock positioned between the bearing surface and the proximal end, the first side of the length of suture extending from the first suture lock, the second suture lock positioned between the bearing surface and the proximal end, the second side of the length of suture extending from the second suture lock.
126. The method of claim 126, wherein:
the providing step is carried out with the first and second suture locks being integrally formed with one another.
127. The method of claim 124, wherein:
the providing step is carried out with the first suture lock having an integrally formed hinge section;

the pulling step is carried out with the hinge section being elastically deformed to permit pulling the suture.
128. The method of claim 124, wherein:
the providing step is carried out with the anchor having a main body, the first suture lock including a cam pivotally coupled to the main body.
129. The method of claim 124, wherein:
the positioning step is carried out with the length of suture extending from the proximal end of the anchor distally to the cam, the length of suture extending from the cam proximally back to the proximal end of the anchor.
130. The method of claim 124, further comprising the step of:
pivoting the cam in an unlocking direction which releases the suture;
and adjusting tension on the length of suture during the pivoting step.
131. The method of claim 124, wherein:
the introducing step is carried out with the anchor mounted to an introducer;
the pulling step being carried out after removing the introducer; and the pivoting step being carried out by coupling the anchor to the introducer.
132. The method of claim 124, wherein:
the pivoting step is carried out by moving an actuating element into contact with the cam to pivot the cam.
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AU2005235305A1 (en) 2005-11-03
JP2007532269A (en) 2007-11-15
CA2563910C (en) 2012-09-25
WO2005102190A2 (en) 2005-11-03
WO2005102190A3 (en) 2006-05-26
JP4991976B2 (en) 2012-08-08
EP1740103A4 (en) 2011-09-14
EP1740103A2 (en) 2007-01-10
AU2005235305B2 (en) 2011-05-19
US20050245932A1 (en) 2005-11-03

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