WO1997029705A1 - Ancrage pour tissus - Google Patents

Ancrage pour tissus Download PDF

Info

Publication number
WO1997029705A1
WO1997029705A1 PCT/US1997/002085 US9702085W WO9729705A1 WO 1997029705 A1 WO1997029705 A1 WO 1997029705A1 US 9702085 W US9702085 W US 9702085W WO 9729705 A1 WO9729705 A1 WO 9729705A1
Authority
WO
WIPO (PCT)
Prior art keywords
tissue
axis
barbs
bone
anchor itself
Prior art date
Application number
PCT/US1997/002085
Other languages
English (en)
Inventor
Graham Smith
Original Assignee
Smith & Nephew Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Smith & Nephew Inc. filed Critical Smith & Nephew Inc.
Priority to AU23161/97A priority Critical patent/AU2316197A/en
Publication of WO1997029705A1 publication Critical patent/WO1997029705A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/0858—Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/0864—Fixation of tendon or ligament between anchor elements, e.g. by additional screws in the anchor, anchor crimped around tendon
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0876—Position of anchor in respect to the bone
    • A61F2002/0888—Anchor in or on a blind hole or on the bone surface without formation of a tunnel

Definitions

  • This invention relates to anchoring tissue.
  • a suture-carrying anchor is installed into bone, and the suture is threaded through the tissue (such as a ligament, tendon, or cartilage) which is to be attached to the bone.
  • the suture emerges from the articuliar surface of the tissue (e.g., the surface exposed to the joint) and is Knotted or otherwise secured to fasten the tissue in place.
  • the tissue may be staked in place by driving a pin through tiss e from its articular surface and into the bone.
  • This invention features attaching tissue in place with a device which does not disturb the articular surface of the tissue being attached.
  • the issuea . ttachment device comprises a body disposed along an axis between a plurality of ends, and each of the ends is configured to be inserted into tissue along the axis and to anchor itself within the tissue.
  • Preferred embodiments may include the following features.
  • Each end i:s configured to anchor itself within the tissue by frictionally engaging a portion of the tissue that lies solely beneath a surface of the tis ⁇ ue.
  • One or both ends of the device can be inserted into tissue through the tissue surface.
  • a first end of the device has an anchoring configuration selected to be anchored within bone
  • a second end of the device has an anchoring configuration selected to be anchored withii softer tissue. This embodiment is particularly useful in anchoring soft tissue such as a ligament, tendon, or cartilage to the bone.
  • this first end of the device may be inserted into the bone (either into a preformed hole or through the bone surface), and the second end of ihe device protrudes from the bone.
  • the softer tissue is pressed onto the second end of the device, which becomes anchored within the soft tissue, thereby securing the softer tissue in place against the bone.
  • t e second end of the device is anchored within the softer tissue, th>2 articular surface of the softer tissue (i.e., the surface opposite to the surface which is pressed against the bone over the seconc end of the device) is undisturbed.
  • the attachment thus does not cieate a site on the articular surface (such as the protrusion of sul.ure or an anchoring pin) where a defect may reform.
  • nothing which may interfere with the operation of the joint is left protruding from the articular surface. Accordingly, patient pain and healing time are significantly reduced.
  • the ends of the device may have the same or different anchoring configurations.
  • one of the ends includes at least one circumferential rib, while the other end is equipped with a pointed barb.
  • the ribbed end is particularly well-suited for attachment within a pre- rilled bone hole, and the pointed barb ea ⁇ ily pierces the softer tissue that is to be anchored in place against this bone.
  • each end includes a barb.
  • each end has a plurality of axial ly spaced barbs, and the barbs of the t ends are oriented in opposite directions.
  • each en is easily inserted into tissue in one axial direction and resists pull -out in the opposite axial direction.
  • This configuration is particularly useful in joining two segments of soft tissue (such as two pieces of cartilage) together.
  • the ends of the device can be of substantially the same size, or not. For exanple, one end may be enlarged relative to the other to provide a secure fit within, e.g., bone, while the opposite end may be relatively small to anchor itself within, e.g., a small-sized tissue plug that is to bis attached to the bone.
  • one particularly useful application of the attachment device is to secure disk-shaped cartilage grafts to bone to repair cartilage defects.
  • a shoulder may be disposed on the body between the ends.
  • the sho ⁇ Wer aids the surgeon in installing the device at the proper depth in the bass tissue (e.g., the bone). This helps assure that the exposed end of the device does not protrude too little (which might hamper anchoring effectiveness) or too far (which may cause the end to break the articular surface of the attached tissue).
  • the body preferably comprises biodegradable material such as polyglycolic acid, polylactic acid, polyglyeolide-co-lactide (VICRYL®, Ethicon Inc.), poly (p-dioxanone (PDS®, Ethicon), polyglycollde-co- trimethylene carbonate ( AXON®), Davis and Geek) and polytrimethylene carbonate (Boehringer Ingelheim).
  • biodegradable material such as polyglycolic acid, polylactic acid, polyglyeolide-co-lactide (VICRYL®, Ethicon Inc.), poly (p-dioxanone (PDS®, Ethicon), polyglycollde-co- trimethylene carbonate ( AXON®), Davis and Geek) and polytrimethylene carbonate (Boehringer Ingelheim).
  • Non-biodegradable materials may also be used.
  • Fig. 1 shews a tissue attachment device.
  • Fig. 2 illustrates the use of the tissue attachment device of Fig. 1.
  • FIG. 3 shows another configuration of the tissue attachment device of Fig. 1.
  • Fig. 4 illustrates the use of the tissue attachment device of Fig.
  • a tack-shaped tissue attachment device 10 includes a cylindrical body 12 disposed along an axis 22 between a proximal end * * * ⁇ and a distal end 16. As discussed below, each end 14, 16 is configured to be inserted into tissue along axis 22 and to anchor itself witiin the tissue.
  • Device 10 is made from a bioabsorbabie material such as PGA (polygiycolic acid).
  • Distal end 16 includes three axiaily spaced circumferential ribs IB.
  • the sides 17 of ribs 18 are parallel to axis 22 and define a cylindrical shape;.
  • the distal surface 19 of each rib 18 is inclined with respect to axis 22 (e.g., at between ⁇ 10 degrees and 60 degrees, and preferably at about 30 degrees).
  • the proximal surface 21 of each rib 18 is oriented perpendicularly to axis 22. (Alternatively, surfaces 21 can be back-cut by a few degrees in the same direction as distal surfaces 19 so as to be oblique to axis 22.)
  • Proximal end 14 is equipped with a pointed barb 20.
  • the surfaces 23 of biirb define a pyramidal shape and converge at a sharp proximal tip 25.
  • the distal surface 27 of barb 20 i.e., the base of the pyramid
  • distal surface 27 can be back-cut at an oblique angle to axis 22.
  • cartilage plug 30 (e.g., a cartilage plug) to tissue 32 (e.g., bone) will be described.
  • tissue 32 e.g., bone
  • cartilage plug 30 will serve as a graft to repair defective or injured cartilage, which previously been removed.
  • the adjacent cartila e 31 is either healthy or includes other cartilage plugs that have been " attached to bone 32.
  • ribbed distal end 16 of device 10 is inserted into a preformed hole 34 in bone 32 along axis 22 (i.e., in the direction of arrow 36).
  • Boms hole 34 should be slightly smaller than the diameter of ribs 18 to ensure that end 16 fits tightly therein.
  • Inclined distal edges 19 of ribs 18 facilitate insertion.
  • flat (or back-cut) edges 21 frictionaily engage bone tissue at the sides 35 of hole 34 to resist pull out (in the direction of arrow 38).
  • the repair is made with minimal patient discomlort, decreased healing time, and reduced risk of defects subsequently reforming.
  • the anchoring configuration of the ends may be substantially the same.
  • Fig. 3 shows an example of a tissue attachment device in which the anchoring ends of the device are symmetrical.
  • Device 50 includes a cylindrical body 52 disposed along an axis 53 between a proximal end 54 and a distal end 56.
  • ends 54, 56 are each configured to be inserted into tissue along axis 53 and to anchor itself within the tissue.
  • An enlarged shoulder 55 is formed on body 52 ⁇ W-wa ⁇ between ends 54, 56 for purposed to be discussed.
  • Ends 54, 53 are respectively equipped with a set of axially spaced barbs 5E , 60.
  • Barbs 58 are oriented in an opposite direction along axis 53 from barbs 60.
  • each barb 58 has a proximal surface 59 which is inclined with respect to axis 53 so that barbs 58 can be inserted into tissue in the direction of arrow 62.
  • the distal surfacs 61 of each barb 58 is back-cut with respect to axis 53 to resist movement of device 50 in a direction opposite to arrow 62 after device 50 has been inserted into the tissue.
  • Barbs 60 are the mirror images of barbs 58.
  • the distal surface 63 of each barb 60 is inclined with respect to axis 53 to permit end 56 to be inserted into tissue in the direction of arrow 66.
  • proximal surface 65 of each is back-cut with respect to axis 53 to resist subsequent pull-out of end 56 from the tissue.
  • Fig. 4 shows attachment device 50 used to join together two segments of soft tissue (e.g., cartilage) 72, 74 (if required by the size of segments 72, 74, other attachment devices, not shown) may be used as well).
  • Distal end 56 is inserted into cartilage 72 through surface 76 in the direction of axis 53. Shoulder 55 limits the depth to which end 56 is inserted to ensure that proximal end 54 protrudes from cartilage 72 by the proper amount.
  • Cartilage 74 is then pressed onto proximal end 54 along device axis 53.
  • Barbs :58 enter tissue 74 through lower surface 77 and frictionaily anchor themselves within interior 78.
  • proximal end 54 lies completely within the attached tissue and does not pierce or otherwise disturb the articular surface 80 of cartilage 74.
  • ends 12, 14 and 54, 56 of the respective devices have been illustrated to be of the same size, either end may be enlarged relative to the other.
  • Other materials such as nonbiodegradable plastics and met ⁇ l, may be used.
  • the tissue attachment device can be used to secure any suitable kind of grafts, such as alografts, autografts, and xenografts.
  • the ends of devices 10, 50 can have other anchoring configurations. For example, different numbers of ribs 18 (Fig. 1 ) or barbs 58, 60 (Fig. 3) may be used. Barbs may be used in place of pyramidal barb 20 in device 10. Likewise, ribbed end 16 can be substituted for, e.g., barbs 56 of device 50.

Abstract

Un dispositif de fixation (10) de tissus comprend un corps (12) disposé le long d'un axe (22) entre deux extrémités (14, 16) dont chacune est configurée pour être insérée dans des tissu, dans la direction de cet axe, et pour s'ancrer dans ces tissus. Une extrémité de ce dispositif peut par exemple être insérée dans un os de façon que son extrémité opposée dépasse de l'os. Un tissu mou (un ligament, un tendon ou du cartilage par exemple) est alors pressé sur l'extrémité exposée du dispositif qui s'ancre ainsi dans le tissu mou et le maintient en place contre l'os. La partie exposée du dispositif étant ancrée dans le tissu mou, la surface articulaire de ce tissu (celle à l'opposé de la surface pressée contre l'os sur l'extrémité exposée du dispositif) reste intacte, ce qui permet de réduire nettement la douleur et la durée de guérison du patient.
PCT/US1997/002085 1996-02-20 1997-02-12 Ancrage pour tissus WO1997029705A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU23161/97A AU2316197A (en) 1996-02-20 1997-02-12 Tissue anchor

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US60373696A 1996-02-20 1996-02-20
US08/603,736 1996-02-20

Publications (1)

Publication Number Publication Date
WO1997029705A1 true WO1997029705A1 (fr) 1997-08-21

Family

ID=24416705

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1997/002085 WO1997029705A1 (fr) 1996-02-20 1997-02-12 Ancrage pour tissus

Country Status (4)

Country Link
AR (1) AR005890A1 (fr)
AU (1) AU2316197A (fr)
WO (1) WO1997029705A1 (fr)
ZA (1) ZA971356B (fr)

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999037217A1 (fr) * 1998-01-27 1999-07-29 Scimed Life Systems, Inc. Element d'ancrage dans un os, avec dispositif d'implantation
US6468314B2 (en) * 1999-06-04 2002-10-22 Depuy Orthopaedics, Inc. Cartilage repair unit
EP1332729A1 (fr) * 2002-01-16 2003-08-06 Mikai Manufacturing Co. S.R.L. Dispositif de fixation fémorale du néoligament croisé antérieur ou postérieur pour la reconstruction arthroscopique du ligament croisé
US6974462B2 (en) 2001-12-19 2005-12-13 Boston Scientific Scimed, Inc. Surgical anchor implantation device

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5417692A (en) * 1994-01-04 1995-05-23 Goble; E. Marlowe Bone fixation and fusion system

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5417692A (en) * 1994-01-04 1995-05-23 Goble; E. Marlowe Bone fixation and fusion system

Cited By (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999037217A1 (fr) * 1998-01-27 1999-07-29 Scimed Life Systems, Inc. Element d'ancrage dans un os, avec dispositif d'implantation
US6468314B2 (en) * 1999-06-04 2002-10-22 Depuy Orthopaedics, Inc. Cartilage repair unit
US6974462B2 (en) 2001-12-19 2005-12-13 Boston Scientific Scimed, Inc. Surgical anchor implantation device
EP1332729A1 (fr) * 2002-01-16 2003-08-06 Mikai Manufacturing Co. S.R.L. Dispositif de fixation fémorale du néoligament croisé antérieur ou postérieur pour la reconstruction arthroscopique du ligament croisé

Also Published As

Publication number Publication date
AR005890A1 (es) 1999-07-21
ZA971356B (en) 1997-11-21
AU2316197A (en) 1997-09-02

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