WO2015164342A1 - Système d'insertion par torsion - Google Patents

Système d'insertion par torsion Download PDF

Info

Publication number
WO2015164342A1
WO2015164342A1 PCT/US2015/026826 US2015026826W WO2015164342A1 WO 2015164342 A1 WO2015164342 A1 WO 2015164342A1 US 2015026826 W US2015026826 W US 2015026826W WO 2015164342 A1 WO2015164342 A1 WO 2015164342A1
Authority
WO
WIPO (PCT)
Prior art keywords
handle
guide
insertion shaft
anchor
bore
Prior art date
Legal status (The legal status 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 status listed.)
Ceased
Application number
PCT/US2015/026826
Other languages
English (en)
Inventor
Rick LUNN
Timothy Young
Wei Li Fan
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Smith and Nephew Inc
Original Assignee
Smith and 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 and Nephew Inc filed Critical Smith and Nephew Inc
Publication of WO2015164342A1 publication Critical patent/WO2015164342A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods 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
    • A61B2017/0409—Instruments for applying suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods 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
    • A61B2017/0411—Instruments for removing suture anchors

Definitions

  • Modern surgical techniques often secure skeletal members such as bone, tissue, ligaments, and cartilage to other skeletal members or surgical appliances. It is often desirable to provide attachment to a bone or cartilage structure, based on the inherent rigidity of these skeletal members. Due to the sheer surface of most skeletal structures, drilled holes facilitate attachment. The drilled holes are occupied by a surgical anchor that is frictionally or threadedly engaged for providing a secure attachment point for connective elements such as tendons, ligaments and prosthetic appliances. Surgical anchors may therefore be subject to substantial and varying forces, primarily while being inserted due to transmission of loads through the insertion instruments used for delivery.
  • a surgical anchor insertion device provided for soft tissue repair employing a guide and an inserter mating via a controlled insertion region, such as a threaded engagement, in contrast to purely impact based approaches.
  • a predetermined shaft length based on the anchor size and desired depth of insertion ensures that the threads engage for driving the anchor and that the depth of insertion is limited by the handle contacting the guide.
  • a surgeon or operator securely disposes the tip of the guide against the insertion surface for fixing the guide and regulating insertion force such that the guide neither "backs out” nor over inserts the anchor. Surgeons use a variety of anchors to conduct soft tissue repair.
  • the disclosed approach provides an insertion system including an inserter, guide, and anchor responsive to insertion driven by axial and threaded mechanisms, or a combination of rotational and impact approaches, for achieving precise insertion without excessive axial or rotational forces resulting in anchor failure.
  • configurations herein depict a surgical anchor insertion device, including an inserter having a handle and an insertion shaft extending from a distal end of the handle, in which the handle is responsive to rotational forces, a guide having a bore therethrough sized to receive the insertion shaft, and a controlled engagement region on the insertion shaft adjacent to the handle for engaging with the guide in a depth controlled manner.
  • the controlled insertion region is defined by a threaded engagement between the handle and the guide responsive to rotation of the handle for providing incremental insertion and avoiding sudden and forceful movement of conventional hammer driven approaches.
  • Fig. 1 is a perspective view of the surgical anchor insertion device as disclosed herein;
  • Fig. 2 is a side cutaway view of the insertion device of Fig. 1 ;
  • Figs. 3A and 3B show surgical anchor deployment using the device of Fig. 2;
  • Fig. 4 shows a drill stop for establishing a predetermined depth in the installation of Figs. 3 A and 3B;
  • Figs. 5A-5E show an insertion sequence using the device of Figs. 3A and 3B
  • Figs. 6A-6C show the guide of Figs. 3A and 3B used for establishing the predetermined depth of Fig. 4;
  • Fig. 7 shows an alternate course thread configuration of the threaded region of Figs. 3A and 3B.
  • the disclosed insertion system employs modified guide/inserter using a guide tapped with internal threads as to mate with a threaded inserter. These two devices mate circumferentially with each other, creating linear motion along the axial direction of the shaft. This axial motion by circumferential rotation is used to insert the anchor in a controlled manner.
  • Fig. 1 is a perspective view of the surgical anchor insertion device as disclosed herein.
  • a surgical insertion device 100 includes a guide handle 110 having a bore 112 therethrough, and an insertion shaft 121 extending from a handle 140 through a cannulated shaft 120 and responsive to rotational 124 and impact 122, or axial, forces exerted on the handle 140.
  • the insertion shaft 121 has a controlled engagement region such as a threaded portion 118 for engaging a threaded portion 116 of the guide handle 110.
  • the guide handle 110 includes a receptacle 114, which extends into the bore 112 and has a diameter defining the threaded portion 116.
  • Rotational insertion force can therefore be generated from rotation of the handle 140 such that the threaded portion 118 of the insertion shaft 121 engages the threaded portion 116 of the guide handle 110 and generates axial force 122 when the guide handle 110 is held against a surgical surface such as a bone.
  • the inserter 140 will have a threaded portion 118 which mates with a tapped guide defined by the threaded portion 116.
  • the inserter 140 When the inserter 140 is screwed into the guide handle 110, it drives the anchor 132 (Fig. 2, below) into a drilled hole without the need for impact forces from a hammer.
  • the guide handle 110 should be firmly held or affixed against the bone or other surgical surface by the surgeon.
  • Fig. 2 is a side cutaway view of the insertion device of Fig. 1.
  • the insertion shaft 121 includes an interface tip 130 for engaging a bone anchor 132
  • the cannulated shaft 120 extends from the guide handle 110 for slidable and rotational communication with the insertion shaft 121 passing through the bore 112.
  • the cannulated shaft 120 may have a set of prongs 126 on a distal end 128 of the cannulated shaft 120, such that the prong 126 is adapted for engaging a surgical surface for insertion of the bone anchor 132.
  • the cannulated shaft 120 therefore extends the bore 112 through the guide handle 110, and the insertion shaft 121 extends from the handle 110 in a rigid coupling for transmitting axial, impact and rotations forces to the insertion shaft 121 running through the cannulated shaft 120.
  • the handle 110 is therefore responsive to rotational and impact forces, and the insertion shaft 121 extending from the handle 110 is responsive to rotation from the handle for engaging the guide handle 110 and incrementally disposing the insertion shaft 121 through the guide handle 110.
  • the receptacle 114 on the guide handle 110 is responsive to the controlled engagement region defined by the threaded portion 118, such that the receptacle 114 defines a proximate end 113 of the bore 112 adapted to receive the insertion shaft 121.
  • the depth controlled manner provided by the threaded portion therefore allows incremental travel based on rotation of the handle 140.
  • the threaded portion 118 on the shaft 121 and the threaded portion 116 receptacle 112 have a thread pitch adapted for incremental depth travel proportional to rotation of the handle 140 and insertion shaft 121. Depending on the thread depth, each rotation of the handle 140 draws the insertion shaft axially 122 one thread width.
  • the controlled engagement region is a threaded portion 118 disposed on the insertion shaft adjacent to the handle.
  • corresponding receptacle 114 is defined by the threaded portion 116 of the bore 112 at the proximate end 113 for engagement with the threaded portion 118 on the insertion shaft 121.
  • the controlled engagement portion may be provided.
  • a rubber or resilient material may be provided such that the controlled engagement region includes a resilient region adapted to provide frictional force for controlling insertion. Resistance, tension and/or deformation of the controlled engagement region would provide frictional limitation to sudden forces and mitigate impact type anomalies in the insertion process.
  • Figs. 3A and 3B show surgical anchor deployment using the device of Fig. 2.
  • Fig. 3A shows a pre-insertion stage
  • Fig. 3B depicts full insertion after deployment via the threaded regions 116, 118.
  • a surgical tunnel 160 has been previously drilled to a predetermined depth 162.
  • the surgical tunnel 160 may have a tapered or narrowed region 160' at its terminus (bottom) sized for the anchor 132, or it may be uniform.
  • a length 164 of the insertion shaft 121 defines an extent of anchor movement into the surgical tunnel 160; this distance less the length 166 of the guide handle 110 and the cannulated shaft 120 (extending from the guide handle 110) determines the insertion depth 162 of the anchor 132, once the handle 140 is drawn adjacent to the guide handle 110 from full engagement of the threaded regions 116, 118.
  • Fig. 3B illustrates the insertion shaft 121 fully deploying the anchor 132 in the surgical tunnel 160 as rotation 124 applied to the handle 140 fully engages the threaded region 118 on the shaft 121 within the threaded region 116 of the receptacle 114 such that the distal end 119 of the handle 140 is drawn flush with the proximal end 114 of the guide handle 110.
  • the prongs 126 engage only with the surface of the bone, and may slightly embed themselves in the surface of the bone to provide sufficient grip while drilling the bone tunnel or inserting the anchor.
  • the prongs 126 engage the insertion surface 150 as the fully engaged threaded regions 116, 118 dispose the anchor 132 flush with the surface 150.
  • the insertion shaft 121 has an engaging tip 130 for mating with a surgical anchor 132, such that the insertion shaft 121 is adapted to dispose a surgical anchor 132 to a predetermined depth 162 based on a length 164 of the insertion shaft and a length 166 of the bore through the guide handle 110.
  • the guide handle 110 has a cannulated shaft 120 extending the bore 112 from a distal end 111 of the guide handle 110 opposed from the handle 140.
  • the insertion depth 164 from the handle 140 is defined by the length of the insertion shaft 121 that exceeds the guide handle 110 and the cannulated shaft 120 as the handle 140 is drawn flush with the proximate end 113 of the guide.
  • the guide handle 110 and cannulated shaft 120 are in a fixed arrangement, as are the handle 140 and insertion shaft 121, and the insertion shaft 121 slideably engages the bore 112 extending through the guide handle 110 and cannulated shaft 120.
  • the cannulated shaft 120 may also have a set of prongs 126 at a distal end
  • the prongs would most commonly engage the flush insertion surface 150 but an alternative technique could encompass the prongs 126 extending to a shoulder defined by a tapered portion 160' of a surgical tunnel 160.
  • Fig. 4 shows a drill stop for establishing a predetermined depth 162 in the installation of Figs. 3A and 3B.
  • the predetermined depth 162 is typically established by a drill bit 123 having a drill tip 123', which has a hard stop 125 is disposed at a location based on the depth 162.
  • the same guide handle 110 is also employed with the drill bit 123 as with the insertion shaft 121, and the hard stop 125 placed such that the length of the drill bit that extends through the guide handle 110 (length 166 of guide) will define the predetermined depth 162.
  • Figs. 5A-5E show an insertion sequence using the device of Figs. 3A and 3B.
  • the guide handle 110 and attached cannulated shaft 120 define the length 166 from the guide handle 110 to the insertion surface 150 upon full deployment.
  • the cannulated shaft 120 is held against the surgical surface 150 by the guide handle 110, optionally aided by the prongs 126.
  • the drill bit 123 guided by the guide handle 110 and cannulated shaft 120 drills a hole 160 in the surgical surface 150, typically bone or hard tissue.
  • a surgeon drills the tunnel 160 through the guide until the drill stop 125 bottoms out on the proximate end 113 of the guide handle 110.
  • Alternative embodiments of defining insertion depth may be aligning markings on the guide and inserter devices.
  • the drill stop 125 prevents the drill bit 123 from drilling beyond the intended depth 162 when it engages the proximate end 113 of the bore 112 on the guide handle 110.
  • the drill bit 123 is removed, and in Fig. 5D the engaged handle 140 drives the anchor 132 into the surgical tunnel 160 defined by the depth 162 of the drill hole of Fig. 5B.
  • This depth 162 is predetermined by the relative working lengths of the guide handle 110/cannulated shaft 120 assembly and the insertion shaft 121 extending from the handle 140.
  • a countersunk depth 150' may he achieved if the inserter working length 164' including the interface tip 130 so allows.
  • Figs. 6A-6C show the guide of Figs. 3A and 3B used for establishing the predetermined depth of Fig. 4.
  • a drill 190 locks the drill bit 123 for rotation in the cannulation defined by the bore 112.
  • Fig. 7 shows an alternate course thread configuration of the threaded region of Figs. 3A and 3B.
  • the insertion shaft 121 may have a more course mating thread 118' on the threaded portion 118 which mates with the threaded portion 116' of the guide.
  • a smaller number of threads per inch (TPI) allows the insertion shaft 140 to be inserted via an impact force via a hammer 192, but still exert at least some control over the insertion rate due to the threaded rotation.
  • some surgical anchors 132 may employ angled threads, rather than parallel, transverse ribs.
  • Selection of an insertion thread angle 180 to match an anchor thread angle 182 may allow the insertion shaft 121 and anchor 132 to rotate similarly for providing the same axial movement.
  • the threaded portion 118' and the receptacle 116' may therefore have a steep thread pitch 180 adapted for rotation of the insertion shaft in response to impact forces on the handle 140 from a hammer 192.
  • the insertion shaft 121 remains rigidly coupled to the handle 140 for transmission of both the rotational and impact force.
  • the insertion system may therefore be responsive to a thread angle 182 on the anchor 132, such that steeper thread angles are responsive to axial insertion and shallower thread angles are responsive to rotational insertion.
  • the interface tip 130 may be adapted for at least one of rotational and axial insertion based on axial force 122 or rotational force 124.
  • An alternate arrangement may also provide for a gear system in the handle and inserter, or combination of both, for augmenting the rotational force of the insertion shaft based on handle rotation.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un dispositif d'insertion d'ancre chirurgical pour la réparation de tissus mous au moyen d'un guide et d'un couplage d'instrument d'introduction par une région d'insertion contrôlée, comme un couplage fileté, plutôt que par des approches à base d'impact purement axial. Une longueur d'arbre prédéterminée basée sur la taille de l'ancre et la profondeur d'insertion souhaitée assure le contact des filets pour diriger l'ancre et la limitation de la profondeur d'insertion par le contact de la poignée avec le guide. Un chirurgien ou un opérateur place le guide contre la surface d'insertion pour fixer le guide et réguler la force d'insertion, de telle sorte que le guide n'extirpe pas, et n'insère pas non plus trop loin l'ancre. La poignée utilise une région d'introduction contrôlée tel qu'un couplage fileté pour introduire un arbre d'insertion en mode de profondeur contrôlée, pour faire varier précisément la profondeur d'insertion en fonction de la rotation de la poignée.
PCT/US2015/026826 2014-04-21 2015-04-21 Système d'insertion par torsion Ceased WO2015164342A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US201461981885P 2014-04-21 2014-04-21
US61/981,885 2014-04-21

Publications (1)

Publication Number Publication Date
WO2015164342A1 true WO2015164342A1 (fr) 2015-10-29

Family

ID=53175619

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2015/026826 Ceased WO2015164342A1 (fr) 2014-04-21 2015-04-21 Système d'insertion par torsion

Country Status (1)

Country Link
WO (1) WO2015164342A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US12588914B2 (en) 2023-06-30 2026-03-31 Arthrex, Inc. Meniscal allograft transplantation system and methods for use

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999062410A1 (fr) * 1998-06-02 1999-12-09 Li Medical Technologies, Inc. Ancre, outil et procede et appareil de placement d'une ancre dans un trou alese
US20040153074A1 (en) * 2003-02-05 2004-08-05 Bojarski Raymond A. Tissue anchor and insertion tool
EP2149339A2 (fr) * 2008-07-31 2010-02-03 Olympus Medical Systems Corporation Instrument de suture
US20110224742A1 (en) * 2009-12-04 2011-09-15 Thomas Weisel Methods and devices for accessing and retracting a capsule of a joint
US20120143215A1 (en) * 2010-04-27 2012-06-07 Ernie Corrao Insertion instrument for anchor assembly
US20120179163A1 (en) * 2010-03-10 2012-07-12 Smith & Nephew, Inc. Composite Interference Screws and Drivers

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1999062410A1 (fr) * 1998-06-02 1999-12-09 Li Medical Technologies, Inc. Ancre, outil et procede et appareil de placement d'une ancre dans un trou alese
US20040153074A1 (en) * 2003-02-05 2004-08-05 Bojarski Raymond A. Tissue anchor and insertion tool
EP2149339A2 (fr) * 2008-07-31 2010-02-03 Olympus Medical Systems Corporation Instrument de suture
US20110224742A1 (en) * 2009-12-04 2011-09-15 Thomas Weisel Methods and devices for accessing and retracting a capsule of a joint
US20120179163A1 (en) * 2010-03-10 2012-07-12 Smith & Nephew, Inc. Composite Interference Screws and Drivers
US20120143215A1 (en) * 2010-04-27 2012-06-07 Ernie Corrao Insertion instrument for anchor assembly

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US12588914B2 (en) 2023-06-30 2026-03-31 Arthrex, Inc. Meniscal allograft transplantation system and methods for use

Similar Documents

Publication Publication Date Title
US12127775B2 (en) Targeted torque relief for torque-based instruments
AU2013277412B2 (en) Modular reamer retrograde attachment
CN100581491C (zh) 用于空心紧固件的可调节工具
US8425573B2 (en) Method and system for attaching a plate to a bone
EP3113690B1 (fr) Élément d'ancrage de suture sans noeud en deux parties
US5683401A (en) Method and apparatus for installing a suture anchor through a hollow cannulated grasper
US10258479B2 (en) Devices, methods, and systems to implant and secure a fusion cage or intervertebral prosthesis for spinal treatment
US10980586B2 (en) Driver device with anti-rotation feature
JP2018532492A5 (fr)
JP2016511064A (ja) 一体化された誘導先端部を備えた骨アンカー及び手術用器具
JP2022185084A (ja) 容易に開始できるカニューレ状骨スクリュー
US20160374740A1 (en) Retractable screw guide
CN108135703A (zh) 用于髋臼杯紧固件的钻孔引导件
WO2015164342A1 (fr) Système d'insertion par torsion
JP2021146209A (ja) アンカ送達システム
DE102008011286B4 (de) Orthopädische Lehre und Stift
EP3216402B1 (fr) Système et outil pour inserer une ancre dans un os
US9655714B1 (en) Arthroscopic tenodesis tool
EP3796848B1 (fr) Système de distribution d'ancrage
US11246700B1 (en) Arthroscopic tenodesis tool

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 15722307

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 15722307

Country of ref document: EP

Kind code of ref document: A1