FR3048604A1 - ANCHOR FOR MEDICAL USE INTENDED TO BE INSERTED IN A BONE WALL - Google Patents

Abstract

This anchor (1) comprises two parts (2, 3) intended to be assembled to one another, namely: an outer part (2), forming at least a first wedging surface (16a) of suture (100); and an inner piece (3), intended to be inserted and retained in the outer piece (2), which forms a transverse duct (21) and at least one second suture wedging surface (25) (100).

Description

The present invention relates to an anchor for medical use, intended to be inserted into a bone wall.

This anchor makes it possible to fix one or more sutures to a bone, in particular to reinsert a tendon or a ligament on a bone; it is particularly intended to re-insert, on a humerus, one or more tendons of the rotator cuff of the shoulder joint.

It is well known, in various indications, to fix a tendon or a ligament on a bone by means of an anchor inserted into the wall of this bone, this anchor being connected to one or more sutures which allow the tendon to be sutured. or ligament to the bone.

To connect the suture to an anchor, it is known to provide a transverse passage arranged through the anchor, through which the suture is engaged. This type of assembly has the disadvantage of generating damage to the wire during the establishment of the anchor, due to friction between the anchor and the bone wall. These deteriorations can lead to a rupture of this thread.

It is also known to provide a proximal ring on an anchor, to which the suture is tied. This type of anchor has a significant risk of breaking the wire at the node.

To remedy this drawback, knotless anchors have been designed in which the yarn is held on the anchor by pinching or jamming. Existing anchors do not exclude, however, any risk of damage to the wire when placing the anchor, especially when the anchor is screwed, or the risk of severing the wire at its point of connection to the anchor .

The present invention aims to remedy this essential disadvantage.

In addition, a number of existing anchors have a relatively uncertain pull-out resistance. This problem arises in particular for anchors intended for the reinsertion of tendons of the rotator cuff of a shoulder joint, taking into account the significant tension exerted on the suture son or sutures, and therefore on the one or more anchors, by these tendons during the movement of the joint.

The present invention also aims to remedy this drawback. The main objective of the invention is therefore to provide an anchor to which one or more suture son can be perfectly fixed and retained, with a reduced risk of shearing or breaking of this or these son.

Another object of the invention is to provide an anchor capable of being perfectly fixed to a bone wall.

To achieve at least the principal objective mentioned above, the anchor concerned comprises two pieces intended to be assembled to one another, namely: an outer part, intended to be fixed to the bone, which forms an internal longitudinal cavity through it; this outer part forms at least a first wedging surface arranged longitudinally; and an inner part, intended to be inserted and retained in said cavity of the outer part, which forms a transverse duct passing right through it and at least one second wedging surface situated on the proximal side with respect to this duct, this second wedging surface being arranged longitudinally; at least one suture being intended to be engaged in said cavity by the proximal side of the outer piece, to extend along said first wedge surface and along said second wedge surface, to be engaged through said transverse duct and out of said outer part, by said proximal side; the inner piece is movable with respect to the outer piece between a distal non-locking position of the suture, wherein said second wedging surface is at a distance from said first wedging surface making no wedging thereof, and a proximal suture locking position, wherein said second wedging surface is at a distance from said first wedging surface jamming thereof.

It will be understood that the terms "proximal" and "distal" used above and throughout the present description are to be considered, conventionally, with respect to the direction of insertion of the anchor into a bone wall, the "proximal" term designating a location closer to a practitioner with respect to this direction of insertion and "distal" designating a location further away from this practitioner with respect to this same direction of insertion. The invention provides an anchor in which the strands of the suture thread (s) are inside the anchor when the anchor is put in place and are therefore preserved from damage which would otherwise be generated by the anchors. walls of the anchor and the bone during this setting up. The outer part can then externally comprise a structure allowing reinforced anchoring to the bone; it may be anchoring ribs having a large height, and / or a non-circular cross section of the outer part, in particular oblong, so that the outer part is able, in a first angular position, to be engaged in a receiving hole formed in the bone, and then to be pivoted by force in this hole, to another angular position, offset by about ninety degrees with respect to said first angular position, of way to trap the anchor in the hole.

Before placing the anchor, the inner part may not be assembled to the outer part, so that each suture can be easily engaged on the anchor.

Once the anchor is placed on the bone, traction exerted on the strands of the suture or suture to move the inner part relative to the outer part to said proximal locking position, realizing a blockage of this or these son by wedging between said first and second wedging surfaces.

These wedging surfaces, arranged longitudinally, allow to exert pressure on a relatively large portion of the son or son, ensuring perfect jamming of the son or son, without risk of shearing.

Preferably, said outer part comprises two said first wedging surfaces, diametrically opposed, and said inner part comprises two said second corresponding wedging surfaces.

Thus the two strands of each suture are wedged in the anchor by two pairs of wedging surfaces, one located before the passage of the son or son through said transverse conduit, and the other located after this passage.

Preferably, at least one of said first and second wedging surfaces is inclined with respect to the longitudinal axis of the anchor.

The jamming of the suture son or sutures is thus achieved by progressive reduction, during the displacement of said inner part towards said proximal locking position, of the space existing between said first and second wedging surfaces.

Preferably, said outer part forms at least a first engagement surface and said inner part forms at least a second engagement surface, said respective engagement surfaces engaging each other in said proximal locking position and providing immobilization of said inner part with respect to said outer part in this position.

A risk of returning said inner part to said distal non-locking position is thus eliminated.

Preferably, these first and second engagement surfaces are arranged so that their mutual engagement occurs before said respective jamming surfaces perform excessive crushing of the suture son or son.

The risk of excessive crushing or suture son is eliminated.

According to a preferred embodiment of the invention, said outer part and said inner part have respective means for positioning said inner part in said outer part, placing said transverse duct of the inner part in an angular position determined with respect to the outer room; said outer part has a female conical cavity in which are arranged two diametrically opposite ducts passing through the strands of the suture son or lines intended to be connected to the anchor; these ducts are arranged on a diameter which is parallel to the axis of said transverse duct when said inner part is in said determined angular position; the bottoms of these ducts form said first wedging surfaces and the surfaces of said female conical portion situated outside these ducts form two so-called first engagement surfaces; said inner part has a male frustoconical portion from which two diametrically opposed bosses protrude; these bosses are arranged on a diameter parallel to the axis of said transverse duct; these bosses are intended to engage in said conduits during the movement of said inner part of said distal non-locking position to said proximal locking position, and to wedge the strands of the suture son or s between them and the funds of said conduits ; the bosses constitute said second wedging surfaces, and the surfaces of said male frustoconical portion located outside these bosses form two so-called second engagement surfaces, intended to come into engagement with said first engagement surfaces in said proximal locking position .

Said respective positioning means may in particular be means for guiding said inner part in said outer part, for example constituted by two diametrically opposite longitudinal grooves formed in said outer part and by corresponding ribs arranged on the inner part, these ribs forming pads intended to be received in the slide formed by the grooves.

Advantageously, the outer part has two diametrically opposite longitudinal slots located opposite the openings of said transverse duct over the entire displacement of said inner part of said distal non-locking position to said proximal locking position.

These lights allow the passage of the son or son on either side of the inner part when the inner part has an outer diameter adjusted to the inner diameter of the cavity that forms the outer part.

Preferably, the inner part has two snap-in projections engageable behind the edges of the outer part delimiting the distal ends of said lumens.

Assembly and easy retention of the inner part in the outer part is thus obtained by snapping.

Preferably, said inner part has a pointed distal portion protruding beyond the outer part, distally, when said inner part is in said distal non-locking position.

This pointed distal end promotes insertion and progression of the anchor into the hole of the bone wall. The invention, as described above, will be well understood, and other features and advantages thereof will appear, with reference to the attached schematic drawing, which represents, by way of non-limiting example, a form of preferred embodiment of the anchor concerned.

Figure 1 is a perspective view, with an inner part that includes an out position relative to an outer part that it also includes; Figure 2 is a longitudinal sectional view in a median plane passing through the axis of a transverse duct that forms said inner part, the inner part being output relative to said outer part; Figure 3 is a view similar to Figure 2, in a sectional plane perpendicular to that of Figure 2; Figure 4 is a view similar to Figure 1, after placing suture son and with the inner part placed in the outer part, the inner part being in a distal position of non-locking suture son; Figure 5 is a view similar to Figure 4, according to a sectional plane identical to that of Figure 2; this Figure 5 also shows an end portion of a bar and a portion of a rod that comprises an instrument for placing the anchor in a bone wall; the end portion of the bar is partially seen in longitudinal section and partly outside; Figure 6 is a view of the anchor similar to Figure 4, according to a sectional plane identical to that of Figure 3; Figure 7 is a view with said inner part in a proximal locking position of the suture son, according to a sectional plane identical to that of Figure 2; and FIG. 8 is a similar one to FIG. 7, in a plane of section identical to that of FIG.

Figures 1 to 3 show an anchor 1 for medical use, intended to be inserted into a bone wall and thus to fix one or more son of suture 100 to this bone. This anchor 1 is particularly intended to re-insert on one humerus one or more of the tendons of the rotator cuff of the shoulder joint. The anchor 1 comprises an outer part 2 and an inner part 3 intended to be assembled to one another.

The outer part 2 is intended to be fixed to the bone. Apart from a conical distal portion, it has a cross-section in the form of a flattened ring, so that it has two flats 5 on two opposite sides and two curved faces between these flats 5. In these curved faces, are arranged series of deep grooves 6, defining series of ribs 7 between them. The piece 2 is capable, in a first angular position of insertion into a hole in the bone wall, to be engaged in this hole, then to be pivoted in force in this hole, to another angular position, offset by the order of ninety degrees with respect to said first angular position, so as to wedge the anchor 1 in the hole.

The outer part 2 forms an internal longitudinal cavity passing right through it, delimiting a proximal cavity 10, an intermediate portion 11 and a distal cavity 12.

The proximal cavity 10 forms, along the flats 5, two lateral housings intended to receive the suture threads, as can be seen in FIG. 4, and a central mounting cavity including two lateral grooves, intended to fitably receive the end distal of the bar 101, corresponding section.

The intermediate portion 11 delimits a female conical cavity 15 having a low slope, of the order of 5 to 10 degrees, this cavity 15 being adapted to receive in it, with jamming, a male frustoconical portion 20 that comprises the inner part 3, described later. It forms two diametrically opposed ducts 16 located below the flats 5 and situated in the extension of the two aforementioned lateral housings that form the cavity 10. These ducts 16 communicate with these lateral housings and with the distal cavity 12, as can be seen in FIG. 2 and thus allow the strands of the suture threads 100 to pass through them, as can be seen in FIG. 5.

It appears in FIG. 2 that the walls 16a delimiting the bottoms of these ducts 16 are parallel to the longitudinal axis of the outer part 2.

The distal cavity 12 communicates with the outside of the workpiece 2 by two lumens 17, extending through the flats 5, and forms two diametrically opposed grooves 18 extending in a diametral plane perpendicular to the plane in which they extend. the lights 17.

The inner part 3 is intended to be inserted and retained in the distal cavity 12 and in the female cavity 15 of the outer part 2. On the proximal side to the distal side, it has the aforementioned male frustoconical portion 20, a portion traversed by a conduit transverse 21, a snap portion 22 and a distal portion 23.

The male frustoconical portion 20 has a slope corresponding to that of said female cavity 15, so as to be able to be received with jamming in this cavity. It forms a proximal face perpendicular to its longitudinal axis, against which the rod 102 sliding in the bar 101 is able to bear, as described below. It also has two diametrically opposed bosses 25 arranged on a diameter of the portion 20 parallel to the axis of the transverse duct 21; these bosses 25 are intended to engage in said ducts 16 during the passage of the inner part 3 from the distal non-locking position shown in FIGS. 5 and 6 to the proximal locking position shown in FIGS. 7 and 8, thus wedging the strands of the suture threads 100 between them and the walls 16a forming the bottoms of the conduits 16.

The transverse duct 21 passes through the inner part 3 from one side to the other and has, in the example shown, a square cross section. It is intended to be traversed by the suture threads 100, as visible in FIGS. 5 to 8.

The detent portion 22 has two snap-fastening projections 26 adapted to snap behind the edges of the outer part 2 delimiting the distal ends of the slots 17, as can be seen in FIG.

The conical distal portion 23 is pointed and its peripheral wall comes, in the distal non-locking position shown in FIG. 5, in the extension of the wall of the conical distal portion of the outer part 2.

In addition, the inner part 3 forms, on its portion delimiting the duct 21 and on its detent portion 22, two diametrically opposed elongated ribs 27 situated in a plane perpendicular to the plane in which the axis of the duct 21 extends. These ribs 27 form pads to be received in the slide formed by the grooves 18, as shown in Figures 6 and 8.

The bar 101 has a square cross-section and, as can be seen in FIG. 5, at its distal end portion, two lateral ribs 103. This distal portion of the bar 101 is adapted to be engaged in the above-mentioned mounting cavity. that forms the proximal cavity 10, with the ribs 103 received in the two aforementioned lateral grooves of this cavity.

The bar 101 is pierced longitudinally with a bore 104 in which the rod 102 above is slidably engaged. The rod 102 is movable in this bore 104 between a distal position, in which it bears against the proximal face of the inner part 3 while the bar 101 is inserted into said mounting cavity, and a proximal position, in which it is retracted vis-à-vis this proximal face. In its distal position, the rod 102 holds the inner piece 3 in the distal non-locking position and, in its proximal position, does not prevent the displacement of the inner piece 3 towards the proximal locking position visible in FIGS. 8. The instrument comprises means (not shown) for selectively locking the rod 102 vis-à-vis the bar 101 in said distal position of this rod. These means may in particular be in the form of a drawer carried transversely by a handle integral with the bar 101, this drawer being movable transversely to the longitudinal axis of the bar 101; the slide has a solid wall portion and a wall portion pierced with a hole of greater section than that of the rod 102; in a sliding position, said solid wall portion of this drawer is in the immediate vicinity of the proximal end of the rod 102 and thus blocks any retreat of this rod, and in another sliding position of this drawer, the hole that form this drawer is facing the rod 102 and allows the recoil of this rod.

In practice, the suture threads 100 are engaged through the outer part 2, then through the transverse duct 21 and then again through the outer part 2, and the inner part 3 is engaged in the distal cavity 12, with the ribs 27 in the grooves 18, until latching projections 26 beyond the edges of the part 2 defining the distal ends of the slots 17. The anchor 1 is then in the visible state in Figures 4 to 6.

To effect the insertion of the anchor 1 into a bone cavity, the free end portion of the bar 101 is engaged in said mounting cavity and the rod 102 is locked in its distal position, thus maintaining the inner part 3 in said distal non-locking position visible in Figures 5 and 6.

Once the insertion of the anchor 1 into the bone made, the retraction of the rod 102 is unlocked, which allows the displacement of the inner part 3 to the proximal locking position visible in Figures 7 and 8 when traction is exerted on the threads 100, in particular when the ligaments are put back on the bone. In this position, the suture threads 100 are clamped between the bottoms 16a of the ducts 16 and the radially outer faces of the bosses 25, these bottoms and faces constituting respective jamming surfaces of the threads 100.

Simultaneously, the portions of the male frustoconical portion 20 not facing the ducts 16 engage in the parts of the cavity 15 located outside the ducts 16, until jamming, ensuring immobilization of the inner part 3 relative to the outer part 2 in this proximal position. The invention provides an anchor for medical use having decisive advantages over homologous anchors of the prior art, in particular those of: - preserving the strands of suture son or s 100 100 deteriorations resulting from the establishment of the anchor because these wires are placed inside the anchor 1; - Outwardly understand a structure for the perfect anchoring of the anchor 1 in a bone, in particular by wedging resulting from pivoting over a quarter turn; - Keep a relatively easy implementation of the son or sutures in it, because of its structure in two parts 2, 3 assemblies; - have an easy assembly of these two parts; - Allow to exert pressure on a relatively large portion of the suture son or 100, ensuring perfect jamming of the son or son, without risk of shearing. Anchor 1 has been described above with reference to a preferred embodiment; it goes without saying that this description is in no way limiting.

Claims (10)

1. Anchor (1) for medical use, intended to be inserted into a bone wall, characterized in that it comprises two parts (2, 3) intended to be assembled to one another, namely: - a an outer piece (2) for attachment to the bone which forms an internal longitudinal cavity therethrough; this outer piece (2) forms at least a first wedging surface (16a) arranged longitudinally; and an inner part (3) intended to be inserted and retained in said cavity of the outer part (2), which forms a transverse duct (21) passing right through it and at least one second wedging surface (25). ) located on the proximal side relative to this duct (21), this second wedging surface (25) being arranged longitudinally; at least one suture (100) being intended to be engaged in said cavity by the proximal side of the outer piece (2), to extend along said first wedge surface (16a) and along said second wedging surface (25), to be engaged through said transverse duct (21) and to emerge from said outer part (2), by said proximal side; the inner piece (3) is movable relative to the outer piece (2) between a distal non-locking position of the suture (100), wherein said second wedging surface (25) is at a distance from said first surface clamping wedge (16a) which does not wedge this wire, and a suture locking proximal position (100), wherein said second wedge (25) is at a distance from said first wedge (16a) realizing a jamming of this thread. 2. Anchor (1) according to claim 1, characterized in that said outer part (2) comprises two said first wedging surfaces (16a), diametrically opposed, and said inner part (3) comprises two said second wedging surfaces ( 25). 3. Anchor (1) according to claim 1 or claim 2, characterized in that at least one of said first and second wedging surfaces (16, 25) is inclined relative to the longitudinal axis of the anchor (1 ). 4. Anchor (1) according to one of claims 1 to 3, characterized in that said outer part (2) forms at least a first engagement surface (15) and in that said inner part (3) forms the at least one second engagement surface (20), said respective engaging surfaces (15, 20) engaging each other in said proximal locking position and immobilizing said inner piece (3) with respect to said outer piece ( 2) in this position. 5. Anchor (1) according to claim 4, characterized in that said first and second engagement surfaces (15, 20) are arranged so that their mutual engagement occurs before said respective wedging surfaces (16a, 25a) ) perform excessive crushing of the suture (s) (100). 6. Anchor (1) according to claim 4 or claim 5, characterized in that: - said outer part (2) and said inner part (3) have respective means (18, 27) for positioning said inner part ( 3) in said outer piece (2), placing said transverse duct (21) of the inner piece (3) in a predetermined angular position with respect to the outer piece (2); said outer part (2) has a female conical cavity (15) in which are arranged two diametrically opposite conduits (16) for passing the strands of the suture thread (s) (100) intended to be connected to the anchor (1). ); these ducts (16) are arranged on a diameter which is parallel to the axis of said transverse duct (21) when said inner part (3) is in said determined angular position; the bottoms (16a) of these ducts (16) form said first wedging surfaces and the surfaces of said female conical portion located outside these ducts (16) form two said first engagement surfaces; - said inner part (3) has a male frustoconical portion (20) which project two protrusions (25) diametrically opposed; these bosses (25) are arranged on a diameter parallel to the axis of said transverse duct (21); these bosses (25) are intended to engage in said conduits (16) during displacement of said inner part (3) from said distal non-locking position to said proximal locking position, and to wedge the strands of the one or more wires suture (100) between them and the bottoms (16a) of said conduits (16); the bosses (25) constitute said second wedging surfaces, and the surfaces of said male frustoconical portion (20) located outside these bosses (25) form two said second engagement surfaces, intended to come into engagement with said first surfaces engaging in said proximal locking position. 7. Anchor (1) according to claim 6, characterized in that said respective positioning means are constituted by means (18, 27) for guiding said inner piece (3) in said outer piece (2), for example constituted by two diametrically opposed longitudinal grooves (18) formed in said outer part (2) and corresponding ribs (27) arranged on the inner part (3), these ribs (27) forming pads intended to be received in the slide which form the grooves (18). 8. Anchor (1) according to one of claims 1 to 7, characterized in that the outer part (2) has two diametrically opposite longitudinal slots (17) located opposite the openings of said transverse duct (21) on all moving said inner piece (3) from said distal non-locking position to said proximal locking position. 9. Anchor (1) according to claim 8, characterized in that the inner part (3) has two latching projections (26) adapted to snap behind the edges of the outer part (2) delimiting the distal ends. said lights (17). 10. Anchor (1) according to one of claims 1 to 9, characterized in that said inner part (3) has a pointed distal portion (23), protruding beyond the outer piece (2), on the side distal, when said inner piece (3) is in said distal non-locking position.