Surgery – Instruments – Suture retaining means
Reexamination Certificate
2000-02-25
2003-02-04
Reip, David O. (Department: 3731)
Surgery
Instruments
Suture retaining means
C606S064000
Reexamination Certificate
active
06514274
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates generally to a method and apparatus for use in an orthopedic surgical procedure and, more particularly, to a method and apparatus for rotator cuff repair.
2. Discussion of the Related Art
A natural shoulder may undergo degenerative changes due to a variety of etiologies. For example, patients that perform various repetitive shoulder movements in which the humerus is raised upward in a repetitive manner may cause impingement of the rotator cuff between the humerus and the clavicle of the patient. Overtime, this may cause a bone spur to be formed in this area. The resulting bone spur may abrade the rotator cuff during further shoulder movement, particularly upon raising the humerus. This abrasion may cause the rotator cuff to tear or become detached along the greater tuberosity of the humerus.
In order to reattach and secure the rotator cuff relative to the greater tuberosity of the humerus or repair the tear, several techniques have been employed. In one technique, a bone trough or groove is formed laterally across the greater tuberosity for placement of the rotator cuff. The rotator cuff is positioned within this bone trough and sutured in place by way of passing sutures through the rotator cuff and within bores drilled through the greater tuberosity. The sutures are weaved or stitched through the rotator cuff and passed through the multiple bores to retain the rotator cuff relative to the humerus. However, since the suture is passed directly through the bone from one bore into another, this may result in cutting of the bone along the bore and in worst case conditions, cutting right through the bone, thereby potentially causing the rotator cuff to again separate from the humerus. This condition may be further aggravated by braided sutures which may cause further abrasion to the bone.
Another technique utilizes suture anchors that are secured within the trough with the sutures passing out through the trough and into the rotator cuff. The sutures are then secured or tied relative to the rotator cuff to retain the rotator cuff relative to the humerus. However, in some patients, bone deterioration may exist in this area of the humerus, thereby inhibiting or providing less than optimal securement of the suture anchors within the trough. The sutures are also simply passed through the rotator cuff which may cause additional abrading or tearing of the rotator cuff since there is a point contact of the suture relative to the rotator cuff itself.
In yet another technique, cylindrical grommet shaped devices are inserted into enlarged bores passing through the humerus. As the suture is secured to the rotator cuff and passed through these enlarged bores, the suture is guided through the grommets. The grommets thus act to inhibit the suture from engaging the internal edges of the bores to reduce the cutting action of the suture relative to the bone. However, this technique also presents several disadvantages. For example, several individual grommet shaped devices are required for insertion into each bore formed into the humerus which may increase surgical time, cost and complexity. Additionally, since the grommets are inserted into enlarged bores and include only a slight lip adjacent the edge of the bores, the grommets may, in fact, be pulled within the bores, thereby reducing or eliminating the effect of the grommets from preventing cutting of the bone tissue. Likewise, a relative point contact is maintained between the suture and the grommet so that the suture force is not dispersed over a relatively large area, thereby potentially causing migration of the grommets in these areas. Finally, larger bores must be made to receive the grommets, thereby requiring additional bone to be removed which is generally not desired.
What is needed then is a method and apparatus for rotator cuff repair which does not suffer from the above mentioned disadvantages. This, in turn, will reduce or eliminate pull-out of sutures relative to the humerus, reduce or eliminate cutting of bone tissue by the sutures, distribute suture force or load over a large area both at the bone surface and at the rotator cuff surface, reduce or eliminate rotator cuff tearing from suture penetration and provide a cost effective and less complex surgical technique to repair rotator cuff tears. It is, therefore, an object of the present invention to provide such a method and apparatus for rotator cuff repair having the above benefits.
SUMMARY OF THE INVENTION
In accordance with the teachings of the present invention, a method and apparatus for rotator cuff repair is disclosed. The method and apparatus employs a rotator cuff buttress plate that supports and disperses a load from sutures employed to secure a rotator cuff relative to a humerus.
In one preferred embodiment, a rotator cuff buttress plate adapted to support a load from at least one suture used in securing a rotator cuff relative to a humerus includes an inner surface, an outer surface, a sidewall and a plurality of apertures. The inner surface is adapted to engage an outer portion of the humerus. The outer surface is opposite the inner surface and is adapted to support the load from the at least one suture. The sidewall is positioned between the inner surface and the outer surface. The at least one suture is passed through at least one aperture to distribute the suture load over the buttress plate.
In another preferred embodiment, a rotator cuff buttress plate system adapted to support a load from at least one suture used in securing a rotator cuff relative to a humerus includes a first buttress plate and a second buttress plate. The first buttress plate defines a plurality of apertures and is adapted to engage an outer portion of the humerus. The second buttress plate defines a second plurality of apertures and is adapted to engage an outer portion of the rotator cuff. The suture is passed through at least a first aperture from the first plurality of apertures and a second aperture from the second plurality of apertures to distribute the load from the suture over the first and second buttress plates.
In yet another preferred embodiment, a method for attaching a rotator cuff to a humerus includes forming a plurality of bone tunnels through the humerus, each having an entrance opening and an exit opening. The rotator cuff is then positioned atop the humerus adjacent to the entrance opening of the bone tunnels. A rotator cuff buttress plate is provided that defines a plurality of apertures that pass therethrough. The rotator cuff buttress plate is positioned adjacent the exit openings of the bone tunnels and a suture is passed through the rotator cuff, a first bone tunnel and a first aperture in the buttress plate. The suture is then secured relative to the rotator cuff and the buttress plate.
Use of the present invention provides a method and apparatus for rotator cuff repair. As a result, the aforementioned disadvantages associated with the currently available rotator cuff procedures and techniques have been substantially reduced or eliminated.
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“Single Incision Fixation . . . EndoButton. As Easy as Passing the Graft”, by Acufex Microsurgical, Inc. from The Journal of Arthroscopic & Related Surgery, vol. 11, No. 5; Oct. 1995 (2 sheets).
Cuff Link, Bone Tunnel Augmentation Device by Innovasive Devices, Inc.; copyright 19
Boucher James
Kessler Kevin J.
Arthrotek Inc.
Davis D. Jacob
Harness & Dickey & Pierce P.L.C.
Reip David O.
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