Patent Application
20250177117
To re-establish stability within a shoulder joint after injury, for example, autograft tissue can be employed to span the humerus and the glenoid cavity of the scapula and repair the rotator cuff. Allograft tissue and synthetic grafts are alternate options.
This disclosure details compression systems and corresponding methods. An example compression system is configured to embed at least a portion of a graft, such as autograft, allograft, or a synthetic graft, into a surgical implant, such as suture or mesh. The combined construct, which is formed by embedding at least a portion of the graft into the surgical implant, is then used for a surgical repair or reconstruction procedure in a patient's body. This disclosure also relates to the method of embedding at least a portion of a graft into a surgical implant, as well as the method of performing a surgical procedure including one or more steps associated with the graft, surgical implant, and/or the combined construct.
The systems and methods of this disclosure permit a user readily create a construct including a surgical implant and a graft. The construct promotes healing following a surgical procedure, such as a soft tissue repair. These and other benefits will be appreciated by the below description.
In some aspects, the techniques described herein relate to a system, including: a first press component defining a cavity configured to receive a graft and a surgical implant, wherein the first press component includes at least one slot configured to facilitate routing of suture in and out of the cavity; and a second press component including a projection insertable into the cavity.
In some aspects, the techniques described herein relate to a surgical method, including: placing a surgical implant into a cavity of a first press component; placing a graft into the cavity of the first press component; and embedding at least a portion of the graft into the surgical implant by applying a force to the graft by moving a second press component relative to the first press component, wherein the second press component includes a projection insertable into the cavity of the first press component.
This disclosure details compression systems and corresponding methods. With reference to the drawings,
The press 12 may be manually operated in this example. However, one or more components of the press 12 could be controlled using an electromechanical and/or hydraulic device, such as an actuator. Further, while one example press 12 is shown in
In this example, the press 12 includes a stand 18 configured to rest on a worktop 20 or other surface, such as a table. The press 12 also includes a base 22 mounted above the stand 18. With reference to directional terms, the “upward” and “downward” directions are labeled in
The press 12 further includes a pair of support arms 24, 26 projecting from opposite sides of the stand 18 and converging on a nut 28 spaced upward of the base 22. The nut 28 may be configured to remain stationary during use of the press 12. The nut 28 includes a threaded through-bore which receives a shaft 30. The shaft 30 may be at least partially threaded, and the threads of the shaft 30 cooperate with threads of the nut 28 such that rotation of the shaft 30 results in movement of the shaft 30 in either the upward or downward direction relative to the nut 28 depending on the direction of rotation.
Below the nut 28, the shaft 30 may be connected to the second press component 16 via a connector 32, which may be mounted adjacent an end of the shaft 30. The connector 32 may be configured to transmit vertical movement of the shaft 30 to the second press component 16 without transmitting rotational movement of the shaft 30 to the second press component 16. The connector 32 can be integrally formed with the second press component 16. Above the nut 28, the shaft 30 may be connected to a handle 34. The handle 34 permits a user, such as a surgeon or surgical assistant, to apply a rotational force to the shaft 30 via the handle 34. Ultimately, the user is able to selectively raise and lower the second press component 16 relative to the first press component 14 by rotating the handle 34. In other embodiments, the second press component 16 is not attached to the connector 32, but is rather formed separately from the connector 32. In that embodiment, the connector 32 may still be able to contact the second press component 16 and to apply force to the second press component 16 to apply force to objects between the first and second press components 14, 16.
Example first and second press components 14, 16 are shown relative to one another in an exploded view in
The first press component 14 includes a first cavity 42A and a second cavity 42B. While two cavities 42A, 42B are shown in the embodiment of
The first and second cavities 42A, 42B are defined by the first press component 14. Specifically, in this example, the first and second cavities 42A, 42B are recessed downward, toward the bottom surface 36, from the top surface 38. The majority of a bottom surface of the cavities 42A, 42B are defined and bound by respective, upward-facing forming surfaces 44A, 44B. The forming surfaces 44A, 44B are recessed by a height H2, which is less than H1, from the top surface 38. Cavity 42A is bound by side walls 45A, 45B and end walls 45C, 45D, in this example, which provide the cavity 42A with a rectangular shape having a length L1 greater than a width W1. Cavity 42B is bound by side walls 46A, 46B and end walls 46C, 46D, in this example, which provide the cavity 42B with a rectangular shape having the length L1 and the width W1. Other cavity shapes come within the scope of this disclosure. The walls 45A-45D, 46A-46D exhibit the height H2 and may be oriented at 90° angles relative to adjacent walls. Further, there may be rounded corners to provide smooth transitions between the walls 45A-45D, 46A-46D.
The first and second cavities 42A, 42B exhibit substantially the same size and shape, and in this example are substantial mirror images of one another about a centerline C of the first press component 14. The first and second cavities 42A, 42B extend substantially parallel to one another, and further extend substantially parallel to the centerline C.
The first press component 14 includes two guide openings 50 on opposite sides of the cavities 42A, 42B, and on opposite sides of the centerline C. The guide openings 50 may be through-holes extending from the top surface 38 through to the bottom surface 36. The guide openings 50 are configured to receive guide pins of the second press component 16 to facilitate alignment of the first and second press components 14, 16 during use of the press 12.
The first press component 14 further includes four slots 48A-48D, each arranged adjacent a corresponding end wall of one of the cavities 42A, 42B. As will be explained below, the slots 48A-48D facilitate routing of suture in and out of the cavities 42A, 42B. With reference to one of the slots 48A, slot 48A includes a first section 49A leading from the cavity 42A, through wall 45C, and is open to the perimeter 40 of the first press component 14. The slot 48A further includes a second section 49B within the cavity 42A and extending substantially perpendicular to the first section 49A. The second section 49B extends between side walls 45A, 45B and exhibits a dimension less than the width W1. The first and second sections 49A, 49B extend through the entire height of the first press component 14. While only the slot 48A has been described, the remaining slots 48B-48D are configured similarly. Slots 48A-48D are not required in all examples. When slots 48A-48D are present, the second press component 16 could also include corresponding slots, sized and shaped to vertically overlap the slots 48A-48D of the first press component 14.
Additional detail of the second press component 16 is illustrated in
The second press component 16, in this example, includes one or more projections projecting downward from the bottom surface 54. In this example, the second press component 16 includes two projections 58A, 58B projecting downward from the bottom surface 54. The projection 58A is bound by side walls 60A, 60B and end walls 60C, 60D. The projection 58B is bound by side walls 61A, 61B and end walls 61C, 61D. The walls 60A-60D, 61A-61D each exhibit a height H4 and provide the projections 58A, 58B with a rectangular shape exhibiting a length L2 and a width W2. The walls 60A-60D, 61A-61D may be arranged at 90° relative to one another, with rounded corners. In this example, the height H4 is substantially equal to the height H2. In a particular example, the height H4 is slightly greater than the height H2. Further, in this example, the length L2 and width W2 are substantially equal to, but slightly less than, the corresponding length L1 and width W1 of the cavities 42A, 42B such that a corresponding one of the projections 58A, 58B fits into a corresponding cavity 42A, 42B to provide a sliding fit between the respective cavities 42A, 42B and projections 58A, 58B. The projections 58A, 58B each exhibit a main downward-facing forming surface 62A, 62B, which is spaced-apart from the bottom surface 54 by height H4, and exhibits the length L2 and the width W2.
In order to facilitate alignment of the first and second press components 14, 16, and to further facilitate a sliding fit between the cavities 42A, 42B and the projections 58A, 58B, the second press component 16 includes guide pins 66 on opposite sides of the projections 58A, 58B. The guide pins 66 are configured to align with and be received in the guide openings 50 of the first press component 14. The guide openings 50 and guide pins 66 are dimensioned so as to permit a sliding fit between the guide openings 50 and guide pins 66.
An aspect of this disclosure relates to interfacing a surgical device relative to the first press component 14, and routing suture carried by that surgical device into the cavities 42A, 42B. With reference to
The perimeter 40 of the first press component 14 includes a first groove 70 extending downwardly from the opening 68 and inclined toward the slot 48B, and, on an opposite side of the opening 68, the perimeter 40 includes a second groove 72 extending downwardly from the opening 68 and inclined toward and the slot 48D. The first and second grooves 70, 72 facilitate routing of suture relative to the cavities 42A, 42B. The first and second grooves 70, 72 may be configured such that suture can be routed into the cavities 42A, 42B without interfering with how the bottom surface 36 contacts the base 22.
In the example of
A structure 84 forming an eyelet may be arranged at the distal end of driver 76. The structure 84 may be releasably attached to the driver 76. The structure 84 and the inner shaft 80 exhibit a diameter less than diameter D3 so the structure 84 and inner shaft 80 can fit into the opening 68. Suture 86 may be carried by the surgical device 74. The suture 86 freely slides through the eyelet of the structure 84.
As shown in
The suture 86 may be a strand of suture tape, such as FiberTape®. FiberTape® is a suture product marketed and sold by Arthrex, Inc. However, other types of suture come within the scope of this disclosure. In the example where the suture 86 is FiberTape®, the suture 86 lays relatively flat on the forming surfaces 44A, 44B of cavities 42A, 42B. The suture 86 may be a modified, more porous, version of FiberTape® in an example.
As shown in
In this respect, the opening 68 and the first and second grooves 70, 72 may be sized and shaped such that a length L3 of the suture 86 between the structure 84 and a point 92A, 92B where the suture 86 first enters one of the cavities 42A, 42B is substantially equal to a length of the interference device 82. In another embodiment the length L3 is substantially equal to a length of the interference device 82 plus the length of the structure 84. In this way, a graft can be embedded into the portion of the suture 86 that is intended to be outside a bone hole. The length L3 is schematically represented in
Because the single cavity 42 of
In this disclosure, at least one of the first press component 14 and the second press component 16 may be made of at least a semi-transparent material such that a graft and surgical implant can be viewed through the first press component 14 and/or the second press component 16 while the press 12 is in use. In a further aspect of this disclosure, at least one of the first press component 14 and the second press component 16 may be formed of a transparent material. An example transparent material may be a clear polycarbonate material. Other transparent materials come within the scope of this disclosure. In a specific example, at least the second press component 16 may be made of transparent material. In an even more specific example, both the first and second press components 14, 16 are made of transparent material. By providing at least one of the first and second press components 14, 16 of at least semi-transparent, if not fully transparent material, the graft and surgical implant are visible through at least one of the first and second press components 14, 16. When both the first and second press components 14, 16 are made of semi-transparent or fully transparent material, the vertical dimension, or height, of the graft may be more readily visible. Regardless, a user of the press 12 can monitor the reaction of the graft as compressive forces are applied to the graft to determine if the graft has been embedded into the surgical implant as desired such that the user can cease use of the press 12.
An example method of use will now be described relative to
Initially, a graft is provided. The graft may be allograft, autograft, or a synthetic graft. When the graft is an autograft, tissue is harvested from a first location in a body of a patient. In an example, the first location is one of the latissimus dorsi, pectoralis major, and fascia lata. This disclosure extends to other harvesting locations.
An example graft 96 is shown in
In this example, a surgical implant is arranged in the cavity. The surgical implant is represented in
In
In one example, when the surgical implant is suture,
Once the graft and surgical implant are arranged relative to the cavity, the user may begin rotating the handle 34 to apply force to the second press component 16 such that the forming surface, representative of forming surfaces 62 (
Embedding the graft(s) at least partially into the surgical implant promotes growth and healing. The method may also include soaking the surgical implant with platelet-rich-plasma (PRP), either before or after embedding the graft into the surgical implant, to further promote growth and healing.
The constructs including the surgical implant and graft may be used to provide a partial or full replacement for a torn rotator cuff. This disclosure is not limited to use in rotator cuff repairs/reconstructions, however, and extends to uses in other repair or reconstruction techniques, including techniques involving repair or reconstruction of the hand, wrist, toe, Achilles tendon, Peroneal/Tibial tendon, among others. As another example, the constructs may be used in a superior capsular reinforcement technique.
It should be understood that directional terms such as top, bottom, upward, downward, etc., are used herein consistent with their art-accepted meaning and with reference to the normal operational orientation of the relevant components. These terms should not otherwise be considered limiting.
Although the different examples have the specific components shown in the illustrations, embodiments of this disclosure are not limited to those particular combinations. It is possible to use some of the components or features from one of the examples in combination with features or components from another one of the examples. In addition, the various figures accompanying this disclosure are not necessarily to scale, and some features may be exaggerated or minimized to show certain details of a particular component or arrangement.
One of ordinary skill in this art would understand that the above-described embodiments are exemplary and non-limiting. That is, modifications of this disclosure would come within the scope of the claims. Accordingly, the following claims should be studied to determine their true scope and content.
