SE1930099A1 - Instruments for attaching soft tissue to bone - Google Patents

Abstract

A surgical instrument for attaching soft tissue to bone tissue, the surgical instrument comprising a first part and a second part, each of the first and the second parts comprising an elongated member, each elongated member comprising a bore through the elongated member arranged to receive any of a drilling rod, a suture pusher device, and a suture retriever device at a receiving end of the bore, wherein the elongated member bore of the first part is arranged convergent with respect to the elongated member bore of the second part to form a first acute angle, wherein the first part is arranged to be releasably attached to the second part, thereby forming a dismantable rigid drill guide arrangement for drilling convergent holes with intersection angle corresponding to the first acute angle.

Description

TITLE INSTRUMENTS FOR ATTACHING SOFT TISSUE TO BONE TECHNICAL FIELD The present disclosure relates generally to surgical instruments, and more particularlyto arthroscopic assisted surgery for attaching or reattaching soft tissue to bone.

BACKGROUND Joint injuries may commonly result in the complete or partial detachment of ligaments,tendons and soft tissues from bone. These injuries are generally the result of excessstress or extraordinary forces being placed upon the tissues.

To assist the healing process, tendons and/or soft tissue can be re-sutured to the bone.One example of such an operation is the Bankart repair procedure which can be usedto, e.g., reattach a torn shoulderjoint capsule to the scapula.

US 4,744,353 discloses a surgical tool for attaching soft tissue to bone. The devicecomprises a rigid drilling guide by which intersecting bone channels can be formed atan acute angle. A suture thread or wire can then be introduced in the channel and usedto attach tissue to the bone.

SUMMARY lt is an object of the present disclosure to provide improved surgical instruments, kitsof parts and methods for attaching soft tissue to bone. This object is at least in partobtained by a surgical instrument for attaching soft tissue to bone tissue. The surgicalinstrument comprises a first part and a second part. Each of the first and the secondparts comprising an elongated member having a respective extension direction. Eachelongated member comprises a bore through the elongated member in the extensiondirection arranged to receive any of a drilling rod, a suture pusher device, and a sutureretriever device at a receiving end of the bore, wherein the elongated member bore ofthe first part is arranged convergent with respect to the elongated member bore of the second part to form a first acute angle. The first part is arranged to be releasably attached to the second part, thereby forming a dismantable rigid drill guidearrangement for drilling convergent holes with intersection angle corresponding to thefirst acute angle.

The disclosed surgical instrument enables passing sutures through bone tunnels byarthroscopic techniques with high precision. The instrument also simplifies surgicalprocedures involving attaching soft tissue to bone, and thereby enables increasedprocedural efficiency.

The instrument enables saving both time and work effort and also reduces costs associated with surgical procedures, e.g., by avoiding using anchors.

The disclosed instruments allow for performing surgery with only two or three smallincisions, which is beneficial for healing and reduces the risk of infection. lt is an advantage that the instrument only comprises a limited number of parts, whichcan be easily sterilized and used repeatedly. There is a minimum of moving parts. Thedesign is robust and allows for high precision surgery at low cost.

According to aspects, at least one of the elongated member bores is arranged toreceive a tubular sleeve having a length in the extension direction exceeding that ofthe elongated member bore. The tubular sleeve has an external dimension configuredto match an internal dimension of the bore, and an internal dimension configured tomatch an external dimension of any of the drilling rod, the suture pusher device, and the suture retriever device.

The tubular sleeve provides a temporary holding or anchoring means for anchoring theinstrument to the bone during the drilling and suturing procedure. This way theoperation may be performed by a single person without requiring assistance from otherstaff or from more advanced alignment devices.

The sleeves improve stability of the drill guide construct. This stability prevents bendingor breakage of suture pushing and retrieving instruments due to relative movementsof, e.g., bone and tissue, while instruments are inside the drilled tunnels.

According to aspects, the surgical instrument comprises a third part arranged toreplace the second part to form a dismantable rigid drill guide arrangement having adifferent geometry compared to when the second part is used. The third part comprisesan elongated member having a respective extension direction. The elongated member comprises a bore through the elongated member in the extension direction arrangedto receive any of a drilling rod, a suture pusher device, and a suture retriever device ata receiving end of the bore. The elongated member bore of the first part is arrangedconvergent with respect to the elongated member bore of the third part to form asecond acute angle, wherein the first part is arranged to be releasably attached to thethird part, and wherein the second acute angle has a different orientation compared tothe first acute angle when the first part is attached to the third part.

Thus, advantageously, a plurality of convergent channels may be formed in the bonefor receiving suture thread or wire. This allows for an increased strength attachment ofthe soft tissue to bone. Also, the third part allows for different geometries to be selectedaccording to scenario, which is an advantage. For instance, different values of theacute angle can be selected by choosing between second and third parts.

According to aspects, the first part and/or the second part and/or the third partcomprises a handle section having an arcuate form. The first part is arranged to bereleasably attached to the second or third part at two or more different locations alongthe arcuate form, thereby providing a configurable first and/or second acute angle.

Thus, advantageously, the acute angle is here configurable, allowing for an adaptationof the angle to different patients and to different surgical operation scenarios. The angleadaptation allows for modification of the distance between the drill holes at the surfaceof the bone, e.g., to maximize the surface contact area of the sutured tissues to bone, which improves healing and strength of the repaired tissues.

According to aspects, the elongated member of any of the first, second and/or thirdparts has a configurable length in the extension direction.

Thus, advantageously, the length of the elongated member is here configurable,allowing for an adaptation of the surgical instrument geometry to different patients and to different surgical operation scenarios.

A variable acute angle and/or elongated member length allows for reaching deep jointparts such as the acetabular rim for fixing pathologies at this level by modifying theneeded alpha angle or the length of the elongated member.

There is also disclosed herein a surgical instrument kit of parts comprising the surgicalinstrument discussed above. The kit also comprises the drilling rod, the tubular sleeve,the suture pusher device, and the suture retriever device.

According to aspects, the drilling rod comprises a rod with a distal sharp end and atleast one lateral projection member, wherein the lateral projection is arranged to couplewith a corresponding slot in a respective tubular s|eeve.

Thus, the drilling rod couples with the s|eeve in order to rotate the s|eeve as it entersthe bone. This way the instrument is temporariiy attached to the bone during thesuturing procedure.

According to aspects, the suture pusher device comprises an elongated memberarranged with at least one distal u-shaped member terminated with eye|ets configured to receive a suture thread or wire.

The distal u-shaped member allows for an efficient suturing procedure, which is anadvantage.

According to aspects, the u-shaped members are made of a flexible material.

The flexible material allows the u-shaped member to flex as it enters the bone channel,which is an advantage.

According to aspects, the suture pusher device comprises an elongated memberarranged with a distal mesh element attachable to the suture thread or wire.

The mesh element allows for an efficient suturing procedure, since it allows forefficiently retrieving the suture thread by the suture retriever device, which is anadvantage.

According to aspects, the suture pusher device comprises an elongated memberarranged with a distal oval element attachable to the suture thread or wire.

The distal oval element also allows for an efficient suturing procedure, since it allowsfor efficiently retrieving the suture thread by the suture retriever device, which is anadvantage.

Methods for attaching tissue to bone associated with the above advantages are also disclosed herein.

Generally, all terms used in the claims are to be interpreted according to their ordinarymeaning in the technical field, unless explicitly defined otherwise herein. All referencesto "a/an/the element, apparatus, component, means, step, etc." are to be interpreted openly as referring to at least one instance of the element, apparatus, component, means, step, etc., unless explicitly stated otherwise. The steps of any methoddisclosed herein do not have to be performed in the exact order disclosed, unlessexplicitly stated. Further features of, and advantages with, the present invention willbecome apparent when studying the appended c|aims and the following description.The ski||ed person rea|ize that different features of the present invention may becombined to create embodiments other than those described in the following, withoutdeparting from the scope of the present invention.

BRIEF DESCRIPTION OF THE DRAWINGS The present disclosure will now be described more in detail with reference to the appended drawings, where: Figures 1-2 schematically illustrate surgical kits of parts; Figures 3-4 show example surgical instruments; Figures 5-7 schematically illustrate example suture pushing devices; Figures 8-13 schematically illustrate a surgical procedure; Figures 14-15 schematically illustrate means for releasably attaching two parts;Figure 16 shows an example surgical instrument; and Figure 17 is a flow chart illustrating methods.

DETAILED DESCRIPTION The invention will now be described more fully hereinafter with reference to theaccompanying drawings, in which certain aspects of the invention are shown. Thisinvention may, however, be embodied in many different forms and should not beconstrued as limited to the embodiments and aspects set forth herein; rather, theseembodiments are provided by way of example so that this disclosure will be thoroughand complete, and will fully convey the scope of the invention to those ski||ed in theart. Like numbers refer to like elements throughout the description.

Arthroscopy, sometimes also called arthroscopic or keyhole surgery, is a minimally invasive surgical procedure on, e.g., a joint in which an examination and sometimes treatment of damage is performed using an arthroscope. An arthroscope is anendoscope that is inserted into the joint through a small incision.

An advantage of arthroscopy over traditional open surgery is that the joint does nothave to be opened up fully. For knee arthroscopy only two or three small incisions aremade, one for the arthroscope and one or two for the surgical instruments to be usedin the knee cavity. This reduces recovery time and may increase the rate of successdue to less trauma to the connective tissue.

The surgical instrument disclosed in US 4,744,353 is designed for open surgery. lt isnot possible to insert the disclosed instrument into the narrow channels formed by thesmall incisions. This is a drawback associated with the prior art.

The present disclosure relates to a new type of surgical device which comprises twoparts that are releasably attachable to each other. Herein, releasably attachable means that the two parts can be separated, and then put back together to form a rigid object.

Each of the two parts comprises an elongated member which can be inserted into theincisions used during arthroscopy. After insertion, the two parts can be attachedtogether to form a rigid object extending into, e.g., the joint to be repaired. Thus,differently from the prior art, the surgical instruments disclosed herein are suitable forarthroscopy. lt is appreciated that, although the disclosed instruments and methods are describedmainly in relation to arthroscopy, they can be used in a number of different surgicalprocedures where it is desired to suture soft tissue to bone by using arthroscopicassisted surgery to access the bone. Thus, the surgical instruments disclosed hereinare suitable for attaching soft tissue to bone in general, and particularly for attachingtorn capsule ligaments to the rim of the glenoid cavity of the scapula, torn rotator cufftendons to their humeral attachment, torn hip labral tears to their acetabular attachment.

The disclosed surgical instruments are also suitable for attaching and broken bonetissue pieces to each other in fractures.

The methods presented herein comprises passing a suture or wire through bonetunnels created by the help of a drill guide made of convergent cylinders andcorresponding handles that can be assembled and locked together outside the bodyafter introducing the cylinders in the corresponding arthroscopic port sites, that is followed by drilling a sheath coupled to a trochar (or trocar) through the cylinders intothe bone which locks the dri|| guide-sheaths in the bone by the penetrating sheaths.Afterfixing the construct in place in bone a suture is pushed by a suture pusher throughthe sheaths in one bone tunnel to retrieve it from the other by the help of a hookretriever. The end result will be a suture passed through bone by arthroscopic assisted surgery.

Herein, the term distal is to be interpreted as situated away from the center of a mainpart of a tool. Thus, a member having a distal end corresponds to a member having aremote end. On an elongated member, a distal end may correspond to an end sectionpart of the elongated member.

Figures 1 and 2 schematically illustrate surgical kits of parts. The kit comprises a drillingrod 140, one or more tubular sleeves 170, a suture pusher device 150, and a suture retriever device 160.

Figures 1 and 2 also show a surgical instrument 101 for attaching soft tissue to bonetissue. The surgical instrument comprises a first part 110 and a second part 120. Eachof the first and the second parts comprises an elongated member 111, 121 having arespective extension direction 114, 124. The elongated members are here shown ascylinders having a circular cross-section, but other geometrical shapes are alsopossible, such as hexagonal cross-sections, oval cross-sections, and the like. Theelongated members are configured to enter a narrow incision made in soft tissue in order to make contact with bone embedded in the soft tissue.

Each elongated member comprises a bore 113, 123 through the elongated member inthe extension direction. The bore is essentially a straight hole or conduit extendingthrough the elongated member. The bore is arranged to receive any of the drilling rod140, the suture pusher device 150, and the suture retriever device 160 at a receivingend of the bore 115, 125. This means that the different implements can be insertedinto the bore such that one end of, e.g., the suture pusher device or drilling rod exitsthe bore from the other end. Consequently, the outside diameter of the different partsconfigured to be received in the bore cannot be larger than the internal dimension ofthe bore. Also, the difference in dimension cannot be too large, which would negativelyimpact precision. Suitable dimensions for the different parts in the kit of parts can be arrived at by experimentation.

According to an example, the length of an elongated member 111, 121 is between 8cm and 20 cm, and preferably about 9 cm. The elongated member outer dimension,measured e.g. as a cross section distance (or diameter in case of a circular cross-section) is about 5 mm. The diameter of an elongated member bore is about 4 mm,i.e., the elongated member material thickness is about 1 mm. The inner diameter ofthe bore is arranged to match an outer diameter of the tubular sleeve 170, providingfor some mechanical tolerance. The sleeve then has an inner diameter matched to adimension of the tools which are arranged to enter the elongated member, i.e., the drilling rod 140, the suture pusher device 150, and the suture retriever device 160. lt is appreciated that the above-mentioned dimensions are examples, and that other dimensions can be used depending or circumstances. lt is appreciated that the disclosed surgical instrument dimensions can be adapted toany given surgical procedure. For instance, in veterinary surgical procedures involving,e.g., horse bone, a larger instrument may be required. ln general, the dimensions ofthe surgical instrument and associated parts varies with application and can be optimized by experimentation and/or computer simulation.

According to some aspects, at least one of the elongated member bores 113, 123 isarranged to receive a tubular sleeve 170 having a length in the extension direction 114,124 exceeding that of the elongated member bore. The tubular sleeve has an externaldimension configured to match an internal dimension of the bore, and an internaldimension configured to match an external dimension of any of the drilling rod 140, thesuture pusher device 150, and the suture retriever device 160.

The drilling rod 140 may be realized in a number of different ways. According to oneexample the drilling rod comprises a distal sharp end 141 and at least one lateralprojection member 142. The lateral projection is arranged to couple with acorresponding slot 171 in a respective tubular sleeve 170. Thus, as the drilling rod isrotated, the sleeve also rotates. This way the sleeve can be temporarily anchored inthe bone during the surgical procedure, as will be exemplified in more detail below inconnection to Figures 8-13.

The elongated member bore of the first part is arranged convergent with respect to theelongated member bore of the second part to form a first acute angle a. This meansthat a straight line or axis drawn with respect to the bore of the first part intersects a straight line or axis drawn with respect to the second part at a point some distanceaway from the end points of the elongated members, as illustrated in Figure 1.Consequentiy, when the first part is attached to the second part, an implement similarto that described in US 4,744,353 is obtained. However, the present instrument differsfrom that in US 4,744,353 on a number of key points. One such key point is that thefirst part 110 is arranged to be releasably attached to the second part 120, therebyforming a dismantable rigid drill guide arrangement for dri||ing convergent ho|es withintersection angle corresponding to the first acute angle a. This means that the firstpart and the second part can be inserted independently into the soft tissue via narrowincisions, such as used during arthroscopic surgery. Once inserted, the first part canbe attached to the second part to form a rigid drill guide arrangement. After the suturingprocedure is completed, the first part can be released from the second part and extracted from the soft tissue.

According to some aspects, the elongated member bore 113 of the first part is arrangedconvergent with respect to the elongated member bore 123 of the second or third partto intersect at a location in the bone tissue.

According to some other aspects, the elongated member bore 113 of the first part isarranged convergent with respect to the elongated member bore 123 of the second orthird part to intersect at a location outside the bone tissue. lt is appreciated some, according to some embodiments, there are provided kits ofparts where some combinations of first and second or third parts yield an acute angleand an intersection inside the bone, while other combinations yield acute angle andintersection outside the bone. A combination of suturing in and outside the bone may be advantageous in some scenarios.The procedure will be exemplified below in connection to Figure 8-13.

Figures 1 and 2 illustrates a locking screw configured for releasably attaching the firstpart to the second part. One part has a hole configured to receive the locking screw,and the other part has a threaded hole configured to engage the locking screw. Thisway the first part can be releasably attached to the second part by the locking screw.Figures 14-15 schematically illustrate other means for releasably attaching two parts.Figure 14 shows a buckle mechanism 1400 by which the first part can be releasablyattached to the second part. One part of the mechanism is simply inserted into the other, whereby the buckle mechanism holds the two parts together. To release theparts, the buckle mechanism is operated such that the first part can be removed fromthe second part. Figure 15 shows a snap lock mechanism 1500 by which the first partcan be releasably attached to the second part. A spring loaded pin is configured toengage a corresponding recess in order to releasably attach the first part to the secondpart. A hasp mechanism can also be used for attaching the first part to the second part.

Figure 2 illustrates a kit of parts further comprising a third part 130 arranged to replacethe second part 120 in the instrument. The third part also comprises an elongatedmember 131 having a respective extension direction 134. The elongated membercomprises a bore 133 through the elongated member in the extension directionarranged to receive any of a drilling rod 140, a suture pusher device 150, and a sutureretriever device 160 at a receiving end of the bore 135. The elongated member boreof the first part is arranged convergent with respect to the elongated member bore ofthe third part to form a second acute angle a”. The first part is arranged to be releasablyattached to the third part. Notably, the second acute angle has a different orientationcompared to the first acute angle when the first part is attached to the third part.

This way the acute angle can be varied according to desired intersection angle. Thesurgical instrument may comprise a plurality of parts, each having a difference distanceD1, D2 from locking screw hole to elongated member, where each combination of twoparts gives a certain acute angle.

Figures 3 and 4 show example surgical instruments where first 110, second 120, third130”, and also fourth 130” parts are selectable for different geometries. Theinstruments in Figure 3 an in Figure 4 provides different angles of the intersecting bone channels.

Figure 16 shows another example surgical instrument 1600. Here, the first and secondparts comprise handle section 116, 126 having an arcuate form 1610. The first part isarranged to be releasably attached to the second part at two or more different locationsalong the arcuate form, thereby providing a configurable first and/or second acuteangle a”. ln other words, the second part is arranged to be slidably received by the firstpart. A given angle is then configured, whereby the two parts are locked together bythe locking screw 180, providing a desired acute angle a”. 11 According to some aspects, the arcuate form handle section or sections comprises ascale 1630a, 1630b arranged to indicate a current value of the configurable first and/orsecond acute angle a'.

According to some other aspects, schematically illustrated in Figure 16, the elongatedmember 111, 121, 131 of any of the first 110, second 120 and/or third 130 parts has aconfigurable length 1620a, 1620b in the extension direction 114, 124.

The angle adaptation features illustrated in Figure 16 allows for modification of thedistance between the drill holes at the surface of the bone, e.g., to maximize thesurface contact area of the sutured tissues to bone, which improves healing andstrength of the repaired tissues. The configuration of acute angle and elongatedmember length can be done, e.g., to maximize contact area between bone and softtissue for each individual patient. A suitable elongated member length configurationand acute angle configuration can be determined, e.g., by an initial arthroscopicinspection.

Figures 5-7 schematically illustrate example suture pushing devices. These suturepushing devices can be used together with the surgical instruments discussed herein, or they can be used with some other type of surgical instruments.

Figure 5 illustrates a suture pusher device 500 comprising an elongated memberarranged with at least one distal u-shaped member 151 terminated with eyelets 510configured to receive a suture thread or wire 520. Thus, the suture thread can beinserted into the bone channel made by the drilling rod. A suture retriever devicecomprising, e.g. a hook like member, can engage the suture pushing device at thebone channel intersection to retrieve the suture thread. The u-shaped members 152may optionally be made of a flexible material.

Figure 6 illustrates a suture pusher device 600 comprising an elongated memberarranged with a distal mesh element 610 attachable to the suture thread or wire 520.This mesh element is arranged to be retrieved by a suture retrieving device comprisinga hook-like member. Thus, again, the suture thread can be inserted into the bonechannel made by the drilling rod. A suture retriever device comprising a hook likemember can engage the suture pushing device at the bone channel intersection toretrieve the suture thread by hooking on to the mesh element. 12 Figure 7 illustrates yet another example of a suture pusher device 700 comprising anelongated member arranged with a distal oval element 710 attachable to the suturethread or wire 520. The suture retriever device comprising a hook like member canengage the suture pushing device at the bone channel intersection to retrieve the suture thread by hooking on to the oval element.

Figures 8-13 schematically illustrate a surgical procedure comprising the disclosed instruments. ln Figure 8, two small incisions have been made through layers of soft tissue 820. Thefirst and the second part elongated members have been inserted into the incisions,whereby the two parts have been attached to each other, e.g., by the locking screw180 or by one of the other optional attachment mechanisms illustrated in Figures 14and 15. ln Figure 9, the drilling rod 140 is used to create intersection channels 910 in the bone810. As the drilling rod enters the bone, the sleeve 920 is also pushed into the bonechannel. This pushing of the sleeve into the bone channel can be achieved, e.g., bythe lateral projection members 142 of the drilling rod which couples to thecorresponding slots 171 in the tubular sleeve 170. Thus, the sleeve rotates with the drilling rod to enter the bone channel.

Once the bone channels have been made, and the sleeves 920 are anchored in place,the drilling rod can be extracted from the elongated member bores. This is illustratedin Figure 10. Notably, the surgical instrument, i.e., the first and second parts, are hereheld in place by the sleeves. This provides stability of the drill guide construct assemblyto the bone allowing the introduction of the instruments without movements that can bend or damage the instruments, which is an advantage. ln Figure 11, the suture pusher device 150 is used to insert suture thread into one ofthe bone channels. The suture retriever device 160 can then be used to retrieve thesuture thread via the other bone channel. The suture pusher device is here the suturepusher device 500 illustrated in Figure 5, but any of the suture pusher devices 150,500, 600, 700 disclosed herein can be used. ln Figure 12, the suture pusher and retriever device have been extracted from the elongated members. 13 ln Figure 13, the first and second parts are disengaged, which allows them to be extracted from the soft tissue, and the suturing operation can be completed.

Figure 17 is a flow chart illustrating methods, such as that exempiified in Figures 8-13,where relevant method parts have been indicated by reference numerals. Figure 17shows a method for attaching soft tissue to bone tissue, the method comprisesconfiguring S1 a surgical instrument 101 comprising a first part 110 and a second part120, each of the first and the second parts comprising an e|ongated member 111, 121having a respective extension direction 114, 124, each e|ongated member comprisinga bore 113, 123 through the e|ongated member in the extension direction arranged toreceive any of a dri||ing rod 140, a suture pusher device 150, and a suture retrieverdevice 160 at a receiving end of the bore 115, 125, wherein the e|ongated memberbore of the first part is arranged convergent with respect to the e|ongated member boreof the second part to form a first acute angle opposite to the receiving ends of thebores, wherein the first part 110 is arranged to be releasably attached to the secondpart 120, thereby forming a dismantable rigid drill guide arrangement for dri||ingconvergent holes with intersection angle corresponding to the first acute angle. The method comprises;making first and second incisions S2 to provide respective passages to the bone tissue, inserting S3 the first part e|ongated member 111 into the first incision and the secondpart e|ongated member 121 into the second incision such that the e|ongated members contact the bone tissue, attaching S4 the first part to the second part, thereby forming the dismantable rigid drillguide arrangement for dri||ing convergent holes with intersection angle correspondingto the first acute angle, inserting S5 first and second tubular sleeves 170 into respective e|ongated memberbores 113, 123, dri||ing S6 by the dri||ing rod 140 first and second intersecting channels into the bonetissue using the first part e|ongated member 111 and the second part e|ongatedmember 121 as dri||ing guides, while pushing S7 each tubular sleeve into thecorresponding bone tissue channel, thereby temporarily anchoring the surgicalinstrument in the bone tissue, removing S8 the dri||ing rod from the tubular sleeves, 14 pushing S9 suture into the first tubular sleeve by the suture pushing device, retrieving S10 the suture via the second tubular sleeve using the suture retriever device160, releasing S11 the first part from the second part, and extracting the first and second parts from the incisions, and attaching S12 soft tissue to the bone tissue using the retrieved suture.

Claims (10)

1. A surgical instrument (101) for attaching soft tissue to bone tissue, thesurgical instrument comprising a first part (110) and a second part (120), each of thefirst and the second parts comprising an elongated member (111, 121) having arespective extension direction (114, 124), each elongated member comprising a bore(113, 123) through the elongated member in the extension direction arranged toreceive any of a dri||ing rod (140), a suture pusher device (150), and a suture retrieverdevice (160) at a receiving end of the bore (115, 125), wherein the elongated memberbore of the first part is arranged convergent with respect to the elongated member boreof the second part to form a first acute angle (a), characterized in that the first part(110) is arranged to be releasably attached to the second part (120), thereby forminga dismantable rigid dri|| guide arrangement for dri||ing convergent ho|es with intersection angle corresponding to the first acute angle (a).

2. The surgical instrument (101) according to claim 1, wherein at least oneof the elongated member bores (113, 123) is arranged to receive a tubular sleeve (170)having a length in the extension direction (114, 124) exceeding that of the elongatedmember bore, the tubular sleeve having an external dimension configured to match aninternal dimension of the bore, and an internal dimension configured to match anexternal dimension of any of the dri||ing rod (140), the suture pusher device (150), andthe suture retriever device (160).

3. The surgical instrument (101) according to any previous claim, whereinthe first part (110) is arranged to be releasably attached to the second part (120) byany of; a locking screw (180), a hasp mechanism (180'), a buckle (1400), or a snap- lock mechanism (1500).

4. The surgical instrument (101 ) according to any previous claim, comprisinga third part (130) arranged to replace the second part (120), the third part comprisingan elongated member (131) having a respective extension direction (134), theelongated member comprises a bore (133) through the elongated member in theextension direction arranged to receive any of a dri||ing rod (140), a suture pusherdevice (150), and a suture retriever device (160) at a receiving end of the bore (135),wherein the elongated member bore of the first part is arranged convergent with respect to the elongated member bore of the third part to form a second acute angle, wherein the first part is arranged to be releasably attached to the third part, whereinthe second acute angle has a different orientation compared to the first acute anglewhen the first part is attached to the third part.

5. The surgical instrument (101, 1600) according to any previous claim,wherein the first part and/or the second part and/or the third part comprises a handlesection (116, 126) having an arcuate form, wherein the first part is arranged to bereleasably attached to the second or third part at two or more different locations alongthe arcuate form, thereby providing a configurable first and/or second acute angle (a').

6. The surgical instrument (101) according to any previous claim, whereinthe elongated member (111, 121, 131) of any of the first (110), second (120) and/orthird (130) parts has a configurable length (1620a, 1620b) in the extension direction(114, 124).

7. A surgical instrument kit of parts (100) comprising the surgical instrument(101) according to any of claims 1-10, the drilling rod (140), the tubular sleeve (170),the suture pusher device (150), and the suture retriever device (160).

8. The kit of parts (100) according to claim 7, wherein the drilling rod (140)comprises a rod with a distal sharp end (141) and at least one lateral projectionmember (142), wherein the lateral projection is arranged to couple with acorresponding slot (171) in a respective tubular sleeve (170).

9. The kit of parts (100) according to claim 8, wherein the suture pusherdevice (150, 500) comprises an elongated member arranged with at least one distal u-shaped member (151) terminated with eyelets (510) configured to receive a suturethread or wire (520).

10. A method for attaching soft tissue to bone tissue, the method comprising; configuring (S1) a surgical instrument (101) comprising a first part (110) and a secondpart (120), each of the first and the second parts comprising an elongated member(111, 121) having a respective extension direction (114, 124), each elongated membercomprising a bore (113, 123) through the elongated member in the extension directionarranged to receive any of a drilling rod (140), a suture pusher device (150), and asuture retriever device (160) at a receiving end of the bore (115, 125), wherein theelongated member bore of the first part is arranged convergent with respect to theelongated member bore of the second part to form a first acute angle opposite to the receiving ends of the bores, wherein the first part (110) is arranged to be releasablyattached to the second part (120), thereby forming a dismantable rigid drill guidearrangement for drilling convergent holes with intersection angle corresponding to thefirst acute angle; making first and second incisions (S2) to provide respective passages to the bone tissue, inserting (S3) the first part elongated member (111) into the first incision and thesecond part elongated member (121) into the second incision such that the elongated members contact the bone tissue; attaching (S4) the first part to the second part, thereby forming the dismantable rigiddri|| guide arrangement for drilling convergent holes with intersection anglecorresponding to the first acute angle; inserting (S5) first and second tubular sleeves (170) into respective elongated memberbores (113, 123); drilling (S6) by the drilling rod (140) first and second intersecting channels into the bonetissue using the first part elongated member (111) and the second part elongatedmember (121) as drilling guides, while pushing (S7) each tubular sleeve into thecorresponding bone tissue channel, thereby temporarily anchoring the surgicalinstrument in the bone tissue; removing (S8) the drilling rod from the tubular sleeves;pushing (S9) suture into the first tubular sleeve by the suture pushing device; retrieving (S10) the suture via the second tubular sleeve using the suture retrieverdevice (160); releasing (S11) the first part from the second part, and extracting the first and secondparts from the incisions; and attaching (S12) soft tissue to the bone tissue using the retrieved suture.