US20200261209A1

US20200261209A1 - Tendon anchoring assembly and shoulder implant assembly

Info

Publication number: US20200261209A1
Application number: US16/796,458
Authority: US
Inventors: Robert Patrick Stchur; John D. Kuczynski
Original assignee: Sure Orthopedics LLC
Current assignee: Sure Orthopedics LLC
Priority date: 2019-02-20
Filing date: 2020-02-20
Publication date: 2020-08-20
Also published as: US20200261233A1; US11813171B2; US20200261247A1

Abstract

A tendon anchoring assembly that includes an anchor and a washer. The anchor includes an elongated body and a substantially circular head and the washer includes an inferior face having gripping protrusions, and a through hole sized to receive a portion of the substantially circular head. A shoulder implant assembly that can be used in conjunction with the tendon anchoring assembly is also disclosed.

Description

BACKGROUND OF THE DISCLOSURE

Exemplary embodiments of the subject disclosure relate generally to a tendon anchoring assembly and a shoulder implant assembly.
Surgical procedures often require that tendons be dislocated from their native location so that the surgeon can access particular body parts. For example, during shoulder arthroplasty procedures such as reverse shoulder arthroplasty (RSA), the subscapularis tendon is temporarily removed from its native location about the lesser tubercule of the humerus so that the surgeon can implant a humeral stem. Also, the long head of the biceps tendon is severed at its attachment into the glenoid and then secured to the lesser tuberosity of the humerus.
After the primary surgical procedure has been completed, tendons dislocated as a result of the surgical procedure must be repaired. Currently, these repairs involve time-consuming suturing operations that can lead to complications. There remains a need for simpler, less time-consuming ways to repair tendons dislocated during surgical procedures, particularly surgical procedures that involve orthopedic implants.

SUMMARY OF THE DISCLOSURE

In accordance with an exemplary embodiment, the subject disclosure provides a tendon anchoring assembly that includes an anchor and a washer. The anchor includes an elongated body and a substantially circular head. The washer includes an inferior face having gripping protrusions, and a through hole sized to receive a portion of the substantially circular head.
In exemplary embodiments of the subject disclosure, the through hole (e.g., a central through hole) is sized smaller than a maximum outer diameter of the substantially circular head. In an exemplary embodiment, the substantially circular head includes a plurality of grooves extending in a substantially longitudinal direction. In yet another exemplary embodiment, the washer includes a pawl to operatively engage one of the plurality of grooves on the substantially circular head.
In exemplary embodiments, the plurality of grooves can be asymmetrical, e.g., one sloped face of the groove is steeper than an opposing sloped face of the groove. In an exemplary embodiment, the pawl can be adjacent the through hole to operatively engage the substantially circular head. The substantially circular head can substantially spherical.
In yet another exemplary embodiment, the elongated body includes threads. In an exemplary embodiment, the gripping protrusions include knurling. In an exemplary embodiment, the washer includes at least one slot, or a plurality of slots, extending in a radial direction. The washer can be, according to exemplary embodiments, a concave washer, a conical washer, or a rectangular washer.
In accordance with an exemplary embodiment, the subject disclosure provides a shoulder implant assembly that includes a humeral stem having a bore, e.g., a threaded bore, and a tendon anchor assembly. The tendon anchor assembly includes an anchor having an elongated body for insertion within the bore, and a substantially circular head. The washer includes an inferior face having gripping protrusions, and a through hole sized to receive a portion of the substantially circular head. In one exemplary embodiment, the bore faces an anterior side of the humeral stem. In another exemplary embodiment, the elongated body includes threads, the gripping protrusions comprise knurling, and the washer includes at least one slot extending in a radial direction.
In accordance with yet another exemplary embodiment, the subject disclosure provides a shoulder implant system that includes a humeral stem having a bore, e.g., a threaded bore, a broaching handle engageable with the humeral stem, and an alignment guide. The alignment guide includes a first end engageable with the broaching handle, and an arm extending laterally and inferiorly, the arm having an aperture positionable colinearly with the bore of the humeral stem when the alignment guide is engaged with the broaching handle.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

The following detailed description of the exemplary embodiments of the subject disclosure will be better understood when read in conjunction with the appended drawings. For the purpose of illustrating the present disclosure, there is shown in the drawings exemplary embodiments. It should be understood, however, that the subject application is not limited to the precise arrangements and instrumentalities shown.

FIG. 1 is a perspective view of a tendon anchoring assembly in accordance with an exemplary embodiment of the subject disclosure;

FIG. 2 is a perspective view of an anchor of the tendon anchoring assembly of FIG. 1;

FIG. 3 is a perspective view of a washer of the tendon anchoring assembly of FIG. 1;

FIG. 4 is a bottom perspective view of the tendon anchoring assembly of FIG. 1;

FIG. 5 is an enlarged top perspective view of the tendon anchoring assembly of FIG. 1;

FIG. 6 is a cross-sectional view of the tendon anchoring assembly of FIG. 1;

FIG. 7A is a perspective view of a tendon anchoring assembly in accordance with another exemplary embodiment of the subject disclosure;

FIG. 7B is a perspective view of an anchor of the tendon anchoring assembly of FIG. 7A;

FIG. 8 is a bottom perspective view of the tendon anchoring assembly of FIG. 7;

FIG. 9A is a perspective view of a tendon anchoring assembly in accordance with yet another exemplary embodiment of the subject disclosure;

FIG. 9B is a perspective view of a washer of the tendon anchoring assembly of FIG. 9A;

FIG. 9C is a perspective view of an anchor of the tendon anchoring assembly of FIG. 9A;

FIG. 10 is a bottom perspective view of the tendon anchoring assembly of FIG. 9;

FIG. 11 is a perspective view of a humeral stem and the tendon anchoring assembly of FIG. 9;

FIG. 12 is a side view of a humeral stem in accordance with an exemplary embodiment of the subject disclosure;

FIG. 13 is a perspective view of the tendon anchoring assembly of FIG. 1 anchoring tendons to a humerus;

FIG. 14 is a lateral view of FIG. 13;

FIG. 15 is a perspective view of the tendon anchoring assembly of FIG. 7 anchoring tendons to a humerus;

FIG. 16 is a lateral view of FIG. 15;

FIG. 17 is a perspective view of the tendon anchoring assembly of FIG. 9 anchoring tendons to a humeral bone;

FIG. 18 is a perspective view of a broach handle engaged with a humeral implant to implant the humeral implant into a humerus; and

FIG. 19 is a perspective view of an alignment guide for drilling a bore in a humerus that is receiving a humeral implant in accordance with the subject disclosure.

DETAILED DESCRIPTION OF THE DISCLOSURE

Reference will now be made in detail to the exemplary embodiments of the subject disclosure illustrated in the accompanying drawings. Wherever possible, the same or like reference numbers will be used throughout the drawings to refer to the same or like features. It should be noted that the drawings are in simplified form and are not drawn to precise scale. In reference to the disclosure herein, for purposes of convenience and clarity only, directional terms such as upper, lower, top, bottom, above, below and diagonal, are used with respect to the accompanying drawings. Such directional terms used in conjunction with the following description of the drawings should not be construed to limit the scope of the subject disclosure in any manner not explicitly set forth. Additionally, the term “a,” as used in the specification, means “at least one.” The terminology includes the words above specifically mentioned, derivatives thereof, and words of similar import.
“About” as used herein when referring to a measurable value such as an amount, a temporal duration, and the like, is meant to encompass variations of ±20%, ±10%, ±5%, ±1%, or ±0.1% from the specified value, as such variations are appropriate.
“Substantially” as used herein shall mean considerable in extent, largely but not wholly that which is specified, or an appropriate variation therefrom as is acceptable within the field of art.
As used herein, the term “adjacent” refers to being near or adjoining. Adjacent components (which can be integral or separate) can be spaced apart from one another, or can be in actual or direct contact with one another (i.e., directly adjacent).
Throughout the subject application, various aspects thereof can be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the subject disclosure. Accordingly, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 2.7, 3, 4, 5, 5.3, and 6. This applies regardless of the breadth of the range.
Furthermore, the described features, advantages and characteristics of the exemplary embodiments of the subject disclosure may be combined in any suitable manner in one or more embodiments. One skilled in the relevant art will recognize, in light of the description herein, that the subject disclosure can be practiced without one or more of the specific features or advantages of a particular exemplary embodiment. In other instances, additional features and advantages may be recognized in certain embodiments that may not be present in all exemplary embodiments of the present disclosure.
Referring now to the drawings, FIGS. 1-6 disclose a tendon anchoring assembly 100 according to an exemplary embodiment of the subject disclosure. The tendon anchoring assembly includes an anchor 102 and a washer 108. The anchor 102 includes an elongated body 104 and a substantially circular head 106. The anchor is received by the washer 108. The washer 108 includes an inferior face 110 having gripping protrusions 112, and a through hole 114 sized to receive a portion of the substantially circular head 106. The tendon anchoring assembly 100 further includes a cap 116, optionally provided positioned about an outer face 118 of the washer 108 for capping the washer (see FIG. 6).
Shown in isolation in FIG. 2, the anchor includes an elongated body 104 in the form of a shaft with a circular longitudinal cross-sectional shape, though other configurations could be provided. In this particular embodiment, the elongated body includes threads 120 along its longitudinal length (e.g., substantially along its entire longitudinal length) of the elongated body 104 to provide a threaded shaft. The elongated body comprises a taper 122 about a distal end 124 of the elongated body to define a truncated conical tip 126, which can alternatively be provided as an untruncated pointed tip.
The elongated body extends from or is attached to the substantially circular head 106, which is provided about a proximal end 128 of the elongated shaft. In this exemplary embodiment, the substantially circular head 106 is integrally formed with the elongated body, though they alternatively could be provided as separate components and connect together. Proceeding proximally from the truncated conical tip, the elongated body has a constant diameter to its proximal end 128 (e.g., the elongated body has a constant diameter substantially over its entire length). Alternatively, the elongated body may be configured to have a tapered body, or a taper lock configuration, or a slotted feature as shown in U.S. patent application Ser. No. 16/796,029, the entire disclosure of which is hereby incorporated by reference.
In this exemplary embodiment, the substantially circular head 106 has a circular shape when a cross-section is taken along its longitudinal direction 130, shown in FIG. 6, or when a cross section is taken along a plane 131 perpendicular to a central axis of the elongated body. The substantially circular head is a substantially spherical head, however, other configurations can be provided in accordance with the disclosed subject matter.
The substantially circular head defines a maximum outer diameter 132 substantially at a mid-point 134 of its height, and curves or tapers uniformly in opposite directions from the midpoint 134 to its proximal and distal ends. The outer perimeter or surface of the substantially circular head 106 is provided with a plurality of grooves 138 (FIG. 2) extending in the longitudinal direction 130 of the head.
The grooves 138 in this particular embodiment are asymmetrical. As shown best in FIG. 5, each of the longitudinal grooves 138 are cut or otherwise provided along the perimeter of the substantially circular head 106 to provide two faces, one face (e.g., a tightening face 140) being provided at a shallower angle than a second face (e.g., a locking face 142), which has a steeper angle than the first face. As will be discussed below in greater detail below, the asymmetrical grooves are provided such that the substantially circular head 106 can be rotated in a tightening direction 144, but rotation in the loosening direction 146 is curtailed, or, in certain embodiments, completely arrested by the locking face 142.
The proximal end 136 of the substantially circular head 106 is defined by a substantially planar face 148. The planar face is provided with a counter bore recess 150, having contours 152, configured to receive a tool (e.g., a rotating device such as a torque or screw driver) that is provided with complimentarily shaped contours to engage the substantially circular head 106.
The washer 108 is shown in FIG. 3. In this exemplary embodiment, the washer is a concave washer, in which the inferior face 110 and the outer face 118 are concave in shape. The inferior face 110 of the washer is provided with a plurality of gripping protrusions 112, which in this particular embodiment is configured, for example, as knurling. As shown in FIG. 3, the gripping protrusions are in the form of truncated pyramids, though as shown below, the gripping protrusions can alternatively be provided with a pointed tip to provide a desired grip on the tendon while avoiding tearing or puncturing of the tendon.
The washer 108 has a circular outer perimeter 154, though other configurations could be provided. The through hole 114 is centrally located with respect to the outer perimeter of the washer. A plurality of slots 156 can be arranged about the washer and extend from the outer perimeter 154 in a radial direction to allow the washer to pivot or flex upon use.
The washer 108 includes a pawl insert 162 mounted to a ridge 158 of the washer. The ridge 158 contains a recess or seat 160 along a circumferential section for receiving the pawl insert 162. The pawl insert 162 is configured as best shown in FIG. 3 and includes a substantially circular body sized to match the opening of the washer and a pawl 170 connected thereto.
As shown best in FIGS. 3 and 5, the pawl 170 is an elongated pawl that extends from the body and is movable between a first position in which the pawl engages the groove 138 and a second position in which the pawl is disengaged from the groove 138. The pawl 170 is spaced from the body by a void 168 and includes an elongated pawl arm 149 that is curved to match the opening of the washer. The pawl 170 further includes an engaging end 172 that extends radially inwardly of the central through hole 114 for ratchet engagement with the grooves 138 of the substantially circular head 106.
The engaging end 172 is located adjacent the central through hole 114 to operatively engage the substantially circular head 107. More particularly, the engaging end 172, which comprises an integral spring, normally engages the grooves 138 in the first position. When a rotational force sufficient to overcome the spring bias is applied to the substantially circular head 107 in the tightening direction 144, the engaging end 172 of the pawl 170 is moved to the second position, in which the engaging end 172 is positioned off the groove 138 to allow the anchor 102 to be tightened. The anchor is easily tightened until the engaging end 172 engages the next groove, in which rotation of the anchor in the loosening direction 146 is arrested, owing to the asymmetric locking face 142. The process is repeated to tighten the anchor 102 while preventing it from being loosened.
The through hole 114 is sized smaller than a maximum outer diameter 132 of the substantially circular head 106. When the elongated body 104 is introduced through the through hole 114 of the washer, the substantially circular head 106 will seat upon the washer. Owing to the curvature provided by the substantially circular head 106, which in this particular embodiment is a substantially spherical head, the head 106 teeters on the washer 108 to support and retain the elongated body 104 while offering the elongated body play to allow it to pivot relative to the washer at an angle, a, which defines the angle of a longitudinal axis of the elongated body 174 with respect to a distal plane 176 defined by the washer. The extent to which the substantially circular head 106 can pivot (e.g., the deviation of alpha from perpendicular) in all directions can be adjusted based on sizing of the diameter 166 of the washer through hole 114 with respect to the sizing of the maximum outer diameter 132 of the substantially circular head 106, and the curvature of the substantially circular head.
As shown in FIGS. 1 and 6, the tendon anchoring assembly 100 can include a cap 116 that can be secured (e.g., welded or press-fit) over the ridge 158 of the washer 108 to cover the pawl 170 and further prevent the anchor from backing out relative to the washer. The cap includes an inner aperture 180 centrally located about the cap that is sized to align with the through hole 114 of the washer. As shown in FIG. 6, the cap 116 includes a flare 178 that curves inward toward a center of the inner aperture. That is the cap includes curved inner walls that substantially align with the curvature of the substantially circular head of the anchor. As assembled, the flare 178 to the cap 116 obturates a declined end 182 of the substantially circular head 106.
FIGS. 7A, 7B and 8 depict a tendon anchoring assembly 700 according to an alternative, exemplary embodiment of the subject disclosure. Tendon anchoring assembly 700 is similar to the tendon anchoring assembly 100, with like reference numbers used throughout these drawings to refer to the same or like features and the accompanying description of these features. The tendon anchoring assembly 700 includes all the features as those described above for tendon anchoring assembly 100, and only those features that differ will be described below for tendon anchoring assembly 700.
As shown in FIG. 7A, the inferior face 710 of the washer 708 is substantially planar. The superior face 718 of the washer is convex to provide a conical-like washer. The inferior face includes gripping protrusions 712 in the form of pyramids with a conical point. The cap 716, which includes a flare 778, in this particular embodiment substantially covers an entirety of the washer.
FIGS. 9A, 9B, 9C and 10 depict a tendon anchoring assembly 900 according to an alternative, exemplary embodiment of the subject disclosure. Tendon anchoring assembly 900 is similar to the tendon anchoring assembly 100, with like reference numbers used throughout these drawings to refer to the same or like features and the accompanying description of these features.
As shown in FIG. 9A, the inferior face 910 and the superior face 918 of the washer 908 are substantially planar and define a rectangular washer. The gripping protrusions 912 are each in the form of a conical tip. As noted above with respect to the gripping protrusions 112, the gripping protrusions 912 in this exemplary embodiment could alternatively be provided with a truncated tip.
In the exemplary embodiment shown in FIGS. 9A-10, the substantially circular head 906 includes a first cylindrical section 933 of an intermediate outer diameter, and a second cylindrical section 935, proximal to the first cylindrical section, and having a maximum outer diameter 932 of the substantially circular head 906. The first cylindrical section 933 is sized to be received by the through hole 914 of the washer 908. The second cylindrical section 935 is sized to be seated on the washer 908. The diameter 966 of the through hole 914 of the washer is smaller than the maximum outer diameter 932 of the second cylindrical section 935.
The tendon anchor assembly 900 includes a pawl 970 configured as shown in FIGS. 9A-9C. The pawl 970 is located adjacent the through hole 914 of the washer such that the substantially circular head engages the pawl upon searing within the washer. The pawl 970 operatively engages one of the plurality of grooves 938 that is provided on the second cylindrical section 935 of the substantially circular head 906 about its perimeter. The pawl extends from the superior face 918 of the washer. A void 968 extends along a section of the washer adjacent the pawl.
As shown in FIG. 9B, the washer 918 is in the shape of a rectangle. Alternatively, the washer 918 could be provided in another polygonal shape, such as a triangle, square, pentagon, hexagon or other regular or irregular polygonal shape.
As with the grooves 138, the grooves 938 in this exemplary embodiment are asymmetrical, having a steeper locking face 942 than the tightening face 940. The asymmetrical grooves are provided such that the substantially circular head 906 can be rotated in a tightening direction 944, but rotation in the loosening direction 946 is curtailed, or, in certain embodiments, completely arrested. That is the substantially circular head engages the pawl in a substantially ratcheting fashion.
FIG. 11 depicts the tendon anchoring assembly 900 engaged with an orthopedic implant, which in this particular embodiment is a humeral stem 151 that can be used in reverse shoulder arthroplasty. This exemplary embodiment is provided for illustration, not limitation. The tendon anchoring assembly of the subject disclosure can be provided for use with any medical device to anchor a tendon or like anatomical feature.
The humeral stem 151 includes a tray 157 located adjacent to a proximal end 159 of the humeral stem 151. The tray is a circular tray for receiving a polymer bearing component (not shown) and a circular ring 163 about its perimeter. A plurality of suture holes 165 are provided around the perimeter of the tray 157 to provide an anchor for suturing procedures (e.g., suturing involving the greater tuberosity). In this exemplary embodiment, the tray 157 is integrally formed with a shaft of the humeral stem.
The humeral stem 151 further includes a threaded bore 153 facing an anterior side 155 of the humeral stem. The threaded bore 153 is sized to receive the elongated body (e.g., elongated body 904) of the tendon anchoring assembly and is provided with threads complementary to the threads (e.g., threads 920) of the elongated body.
FIG. 12 depicts a humeral stem 251 according to an alternate exemplary embodiment that can also be used with the presently disclosed tendon anchoring assemblies (e.g., tendon anchoring assemblies 100, 700, 900).
The shaft 289 of the humeral stem 251 extends in a longitudinal direction 267 from the proximal end 259 of the stem 251. As shown best in FIG. 12, the shaft 289 includes a proximal section 269 adjacent the tray 257. The proximal section 269 of the shaft 159 further includes the threaded bore 253 adapted to receive a threaded shaft (e.g., elongated body 104, 704, 904).
A middle section 271 of the shaft proceeds from the proximal section 269. The middle section 271 has a narrowing profile as it proceeds from the proximal section 269, the profile being the widest along the proximal section where it forms a seat for an inferior portion 273 of the tray 257. The inferior portion 273 of the tray 257 further includes an overhanging portion 275 that is not supported by the shaft 289. A distal portion 277 of the shaft extends from the middle section 271 where the shaft is defined by a substantially circular or oval longitudinal cross-sectional shape.
As shown in FIG. 12, the proximal section 269, the middle section 271 and a portion of the distal section 277 of the shaft 289 can be provided with a porous or textured surface 279 to promote bone attachment, as represented by the diamond cross-hatching. As shown in FIG. 12, there is an absence of porous or textured surface 279 around the perimeter of the threaded bore 253.
Operation of the tendon anchoring assembly according to the subject disclosure (e.g., tendon anchoring assembly 100, 700, 900) will be described in connection with FIGS. 13-19 in the context of a reverse shoulder arthroplasty procedure according to an exemplary embodiment of the subject disclosure. The tendon anchoring assembly of the subject disclosure, in alternative embodiments, can be used in other procedures, and the corresponding orthopedic implants appurtenant thereto. These other procedures include tendon repairs in connection with total shoulder arthroplasty (TSA) and other shoulder procedures, knee replacement, hip replacements, and the like.
During a reverse shoulder arthroplasty procedure, an incision is made from the coracoid process down the axillary fold. A long head of the biceps tendon 381 is tenodesed in a sub-pectoralis position with suture and tagged for later repair. The subscapularis tendon 383 is taken down off its insertion and also tagged for later repair.
As shown in FIGS. 18-19, a broach handle 585 is inserted into a humeral stem 151 and the shaft 489 is positioned in its final place within a humerus 393 by means of applying a force in the longitudinal direction of the shaft 489. The broach handle 585 includes a shaft 587 that includes a fastener 591 in the form of an aperture.
After the humeral stem 151 is positioned in its final position, but before the broach handle 585 is removed, an end 695 to an alignment guide 697 is secured to the fastener 591 of the broach handle 585. The alignment guide 697 has an aperture, e.g., a drill guide aperture 699, located about a distal end of a drill guide arm 698 that extends laterally and inferiorly from the shaft 587 of the broach handle 585, as shown in FIG. 19. The drill guide aperture 699 is aligned with the threaded bore 453 of the humeral stem 151. A drill bit 696 is inserted into the drill guide aperture 699 and a through bore 692 is drilled into the humerus 393.
After the humeral implant has been implanted and engaged with the glenosphere, the subscapularis tendon 383 and the long head of the bicep tendon 381 are then repaired using the tendon anchoring assembly of the subject disclosure (e.g., 100, 700, 900). The subscapularis tendon 383 and the long head of the bicep tendon 381 are positioned over the through bore 692 in the humerus 393 created as discussed above, which is coaligned with the threaded bore 153, 253, located on the anterior side of the humeral stem 151. The anchor is then placed over the subscapularis tendon 383 and the long head of the bicep tendon 381. Then, using the distal end 124, 724, 924 of the elongated body 104, 704, 904, the bore is located and inserted therethrough and into the bore 153, 253. The anchor 102, 702, 902 is screwed in a tightening direction 144, 744, 944, into the through bore 692 and the threaded bore 153, 253. The subscapularis tendon 383 and the long head of the bicep tendon 381 are thereby secured to the humerus 393 as shown in FIGS. 13-19. After implantation, the pawl 172, 772, 972 of the washer 108, 708, 908 prevents the anchor from backing out due to possible loosening.
It will be appreciated by those skilled in the art that changes could be made to the exemplary embodiments described above without departing from the broad inventive concept thereof. It is to be understood, therefore, that this disclosure is not limited to the particular embodiments disclosed, but it is intended to cover modifications within the spirit and scope of the subject disclosure as defined by the appended claims.

Claims

1. A tendon anchoring assembly comprising:

an anchor that includes:

an elongated body, and

substantially circular head; and

a washer that includes:

an inferior face having gripping protrusions, and

a through hole sized to receive a portion of the substantially circular head.

2. The tendon anchoring assembly of claim 1, wherein the central through hole is sized smaller than a maximum outer diameter of the substantially circular head.

3. The tendon anchoring assembly of claim 1, wherein the substantially circular head includes a plurality of grooves extending in a substantially longitudinal direction.

4. The tendon anchoring assembly of claim 3, wherein the washer includes a pawl to operatively engage one of the plurality of grooves on the substantially circular head.

5. The tendon anchoring assembly of claim 3, wherein each of the plurality of grooves is asymmetrical.

6. The tendon anchoring assembly of claim 1, wherein the washer includes a pawl adjacent the central through hole to operatively engage the substantially circular head.

7. The tendon anchoring assembly of claim 1, wherein the elongated body includes threads.

8. The tendon anchoring assembly of claim 1, wherein the gripping protrusions comprise knurling.

9. The tendon anchoring assembly of claim 1, wherein the washer includes at least one slot extending in a radial direction.

10. The tendon anchoring assembly of claim 1, wherein the washer is a concave washer, a conical washer, or a rectangular washer.

11. The tendon anchoring assembly of claim 1, wherein the substantially circular head is a substantially spherical.

12. A shoulder implant assembly comprising:

a humeral stem having a bore; and

a tendon anchor assembly that includes:

an anchor having:

an elongated body for insertion within the bore, and

a substantially circular head, and

a washer having:

an inferior face having gripping protrusions, and

a central through hole sized to receive a portion of the substantially circular head.

13. The shoulder implant of claim 12, wherein the bore faces an anterior side of the humeral stem.

14. The shoulder implant assembly of claim 12, wherein the bore is a threaded bore.

15. The shoulder implant assembly of claim 12, the central through hole is sized smaller than a maximum outer diameter of the substantially circular head.

16. The shoulder implant assembly of claim 12, wherein the substantially circular head is substantially circular having a plurality of grooves extending in a substantially longitudinal direction, and the washer includes a pawl to operatively engage one of the plurality of grooves on the substantially spherical head.

17. The shoulder implant assembly of claim 16, wherein each of the plurality of grooves is asymmetrical wherein one sloped face of the groove is steeper than an opposing sloped face of the groove.

18. The shoulder implant assembly of claim 12, wherein the washer includes a pawl adjacent the central through hole to operatively engage the substantially circular head.

19. The shoulder implant assembly of claim 12, wherein the elongated body includes threads, the gripping protrusions comprise knurling, and the washer includes at least one slot extending in a radial direction.

20. A shoulder implant system comprising:

a humeral stem comprising a bore;

a broaching handle engageable with the humeral stem; and

an alignment guide that includes:

a first end engageable with the broaching handle, and

an arm extending laterally and inferiorly, the arm having an aperture positionable colinearly with the bore of the humeral stem when the alignment guide is engaged with the broaching handle.