Deformable fastener system

Description

FIELD

The invention relates to apparatus and methods for surgery. More specifically, the invention relates to the guidance and positioning of tissue, an implant, or other surgical devices within the body.

BACKGROUND

In the medical arts, physicians use various methods and devices to attach soft tissue to other soft tissue, soft tissue to hard tissue, and hard tissue to other hard tissue. These same or similar techniques and devices are also used to position or fix an implant within the body. Such implants may include bone plates, fasteners, stents, filters, drug eluting implants, tissue alignment members, organ transplants, tissue scaffolding, tissue grafts, intervertebral disc replacement components, nucleus pulposus replacement component, and other joint replacements components, prostheses, robotic components, nanotechnology devices, sensors, emitters, radiofrequency emitting diodes, computer chips, RFID (radiofrequency identification) tags, adhesives, and sealants.

Applying pressure or compression to tissue and/or an implant helps during the healing process. Incised or torn soft tissue, for example, may be approximated with bandages, sutures, or staples. Proper and more rapid healing of broken or fractured bones likewise may be facilitated by applying constant pressure to the bone. For instance, physicians may insert pins, screws, or bolts in the area of the fracture in order to apply compression and stabilization to the fracture.

However, inserting screws through or around fractures can be complex and time-consuming. For example, the process of inserting a screw typically involves multiple steps conducted from multiple incisions or openings that provide access to the treated bone or tissue, including the steps of drilling holes, measuring the relevant distances to determine the appropriate screw selection, tapping the hole to establish threads, and screwing the screw into the hole.

In addition to the length and complexity of the process, bone screws also may lose their grip and strip out of the bone. Also, currently available lag screws typically provide only one side of cortex fixation and are generally not suited for percutaneus surgery. Moreover, when placing the screws in the bone, the physician may not accurately set the screw into the distal hole or may miss the distal hole completely, thereby resulting in the screw stripping the threads or breaking the bone.

Many devices and instruments have been disclosed to fasten soft and hard tissue for enhanced healing or tissue reconstruction. Examples of such devices include bone plates, bone wraps, external bone supports, and the like.

For example, U.S. Pat. No. 4,257,411 to Cho discloses a surgical drill guide tool adapted to be temporarily mounted about a distal portion of the femur for drilling a bony tunnel through a portion of the femur. The surgical tool allows for very precise location of the drill exit within the intercondylar notch, which is often critical in proper reconstruction of the anterior cruciate ligament of the knee. The surgical tool drill guide is characterized by having a first and second upright, with first and second drill sheaths located at their respective distal ends wherein transverse mounting means are provided to allow the surgeon to position the first and second drill sheaths tightly against opposite surfaces of the femur to provide a continuing and exact alignment for the drilling of the bony tunnel. The drill sheath at the distal end of the second upright is configured to fit inside the intercondylar notch, and allow exact placement of the exit of a bony tunnel which is drilled extra-articularly through the skin, and through the lateral femoral condyle.

U.S. Pat. No. 4,922,897 to Sapega et al. discloses a method and apparatus for the permanent surgical reconstruction of the anterior cruciate ligament in the human knee, which will stabilize the tibia and femur relative to each other and restore a full range of motion to the knee, by precisely locating the ends and angular relationship of a replacement ligament within the knee joint, at bone attachment sites such that the degree of shortening and lengthening experienced by the replacement ligament over the range of joint motion is either as close to zero (isometric) as possible, or closely matches that of the natural uninjured ligament (physometric), whichever the surgeon feels is most desirable.

U.S. Pat. No. 5,573,538 to Laboureau discloses ancillary instruments for the reconstruction of a posterior cruciate knee ligament by drilling one or two tibial canals using a surgical operation performed from the front. The instrument set includes a system for protecting the posterior surface of the upper tibia end and an aiming device for guiding at least one drill. The protection system includes at least one bent tube removably coupled by an extension portion to a locking handle for securing the tube through the intercondylar fossa of the femur on the posterior surface of the upper end of the tibia, so that the distal end of the bent tube serves as the stop to the drill guided by the aiming device and emerging from the tibial bone canal, and the bent tube can form, together with a rectilinear wire feed-through tube disposed in the place of the drill, a continuous canal for guiding a metallic loop used to draw the prosthetic posterior cruciate knee ligament from the anterior surface of the tibia to the femur insertion point.

U.S. Patent Publication No. 2003/0216742 to Wetzler et al. discloses a surgical drill guide generally including a handle connected to an arm with an end that contacts bone. The handle has a plurality of non-parallel channels therein for receiving a sleeve at different angles. Once properly positioned, the sleeve can be used to guide a K-wire into the bone, which can then be used as a guide for drilling a tunnel. The various angles allow the surgeon to achieve a range of tunnel lengths. In some embodiments, the guide has a locking mechanism for locking the sleeve in the channels.

Accordingly, a need exists for a method and device which can provide guided positioning and flexible or rigid fixation of tissue and/or an implant within the body while accessing the procedure site from a small skin portal.

SUMMARY

The present invention provides an instrument and method for guiding and positioning various implants within the body. The instrument may provide for the placement of a biocompatible implant within tissue and/or may provide for dynamic and rigid fixation of tissue. An implant guidance and positioning device includes a body member connected with a hook. The hook may have a lumen extending therethrough. The device also includes a guide channel disposed in the body member. The longitudinal axis of the guide channel may be generally aligned with or slightly offset from a distal end of the hook. The device may further include a pushrod for positioning a fastener and suture in the lumen of the hook. Furthermore, the device may include an elongated claw dimensioned for insertion through the guide channel. The claw may include means for grabbing the suture.

In another embodiment, the positioning device includes a body member, an elongated member connected with the body member, a socket member connected to the distal end of the elongated member, and a guide slot disposed in the body member. The longitudinal axis of the guide slot is generally aligned with or slightly offset with the socket member. The socket member may be dimensioned and configured for holding a fastener. The device may also include a fastening member dimensioned for insertion in the guide slot. The fastening member may include means for attaching the fastening member to the fastener, such as threads, ribs, magnets, adhesives, or expandable material.

In a related aspect of the present invention, the distal portion of the hook or elongated member is curved to be positionable at least partially on the distal or backside of the bone or tissue, while the proximal portion of the hook or elongated member may be generally parallel with the guide channel or slot. The hook or elongated member may be removeably connected with the body member with means for holding and releasing the hook or elongated member.

The positioning device may further include a drill system having a drill bit dimensioned for insertion through the guide channel or slot. The drill system may create a linear or non-linear passage in tissue. The drill system may be a cannulated drill system. The positioning device may also include means for clamping the device to tissue. Such means may include a threaded tube adjustably attached to the body member, a tube and a finger grip attached to the body member, or one or more pins placed between the positioning device and tissue. Furthermore, the device may include a tensioning mechanism for tensioning the suture or fastening member.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention, and the attendant advantages and features thereof, will be more readily understood by reference to the following detailed description when considered in conjunction with the accompanying drawings wherein:

FIG. 1 shows an exemplary embodiment of the guidance and positioning device of the present invention;

FIG. 2 illustrates a cannulated drill system inserted in the device;

FIG. 3 shows a pushrod configured for inserting a fastener and suture into a hook of the positioning device;

FIG. 4 illustrates a fastener and suture positioned in the hook;

FIG. 5 shows a suture claw positioned in the guide channel of the device;

FIG. 6 illustrates the suture claw withdrawn from the guide channel with the suture disposed in the guide channel;

FIG. 7 shows the suture connected with the fastener on the distal side of the bone and the suture extending from the drill system;

FIG. 8 illustrates a fractured bone with the suture extending therethrough;

FIG. 9 shows a fastener positioned on the proximal side of the bone and secured to the suture;

FIG. 10 illustrates another embodiment of the implant guidance and positioning device;

FIG. 11 shows a cannulated drill system disposed in a guide slot of the device;

FIG. 12 illustrates a fastener disposed in a socket on the distal end of a hookshaped member of the device;

FIG. 13 shows a fastening member positioned in the guide slot of the device;

FIG. 14 illustrates a threaded distal portion of the fastening member disposed in a threaded hole of the fastener;

FIG. 15 shows a fractured bone with the fastening member extending therethrough;

FIG. 16 illustrates a fastener positioned on the proximal side of the bone and secured to the fastening member;

FIG. 17 shows one embodiment of a clamping mechanism of the device;

FIG. 18 illustrates another embodiment of the clamping mechanism of the device;

FIG. 19 shows an embodiment of a tensioning mechanism of the device;

FIG. 20 illustrates a drill/sleeve combination in accordance with the present invention;

FIG. 21 is a cross sectional view of FIG. 20;

FIG. 22 shows the drill/sleeve combination in use to repair a fractured bone;

FIG. 23 illustrates the sleeve positioned across the fracture of the bone;

FIG. 24 shows another exemplary embodiment of the drill/sleeve combination;

FIG. 25 is a cross sectional view of FIG. 24;

FIG. 26 illustrates the drill/sleeve combination functioning as a fastener;

FIG. 27 shows an exemplary distal portion of the fastener;

FIG. 28 illustrates another exemplary distal portion of the fastener; and

FIG. 29 shows another embodiment of the guidance and positioning device having multiple hooks and guide channels.

DETAILED DESCRIPTION

The present invention provides an instrument and method for guiding and positioning tissue and/or an implant within the body. The instrument may provide for the placement of a biocompatible implant within tissue or may provide for dynamic and rigid fixation of tissue. The device can access and treat a fractured, incised or torn tissue, or the like, from one access area (i.e., from only one opening to the tissue to be fastened) instead of requiring two or more openings. That is, the device is a linear system that can be used with a single, small incision or portal in the skin or other soft tissue to gain access to the tissue, for example a fractured bone.

The guidance and positioning device may be an all-in-one system for creating a passage in tissue, positioning fasteners or other implants, and tensioning an elongated fastening member, like a suture, thread, wire, or pin. In some embodiments, the device may allow for the implantation of multiple sutures and fasteners in tissue with little or no repositioning of the device. For example, the device may have two or more of the elements described below connected to a single grip or handle. Likewise, the incision or opening providing access to the treated bone or tissue may extend at least partially in a direction along the length of the treated area so that the processes described below may be repeatedly performed on other, nearby portions of the bone or tissue in a similar manner.

Tissue Repair

Referring now to the drawing figures in which like reference designators refer to like elements, there is shown in FIG. 1 an exemplary embodiment of the guidance and positioning device 20. The device includes a generally cylindrical handle 22 and a hook 24 with a proximal end connected to the handle 22. In one embodiment, the hook has a tubular construction. An interior passageway may extend from the proximal end to the distal end. The hook 24 may be curved as illustrated in the Figures, may be angular (e.g., may have an open-sided geometric shape), or may have any other desired shape so that its distal end is disposed approximately around the bone or tissue to be treated or fastened.

The proximal portion of the hook 24 may be positioned generally parallel with the longitudinal axis of the handle 22. A plurality of interchangeable hooks 24 may be releasably and interchangeably connected to the handle. In this manner, hooks of different sizes, shapes, or other features may be selected and used as desired by a physician. Thus, the device 20 may have a lever, clip, set-screw, button, spring, match, or latch 26 that allows selective securing and releasing of hooks 24 to or from the handle 22. The lever 26 allows different sized hooks 24 to be placed in the handle 22. For example, the hook may include different sized lumens extending therethrough, may be different lengths, and/or may have different radii of curvature. The curved or angled portion 28 of the hook 24 may be configured for positioning around a fractured bone 30 (as seen in FIG. 1), multiple pieces of similar tissue, multiple pieces of different tissue, or a single tissue element. Examples of such tissue includes, not is not limited to, bone, muscle, cartilage, ligament, tendon, skin, etc. Also, the tissue may be stomach tissue, and the positioning device may be used during bariatric surgery, like gastric stapling. It is further contemplated that measurements such as the depth, angle, length, and/or compression of the hook be determined. The handle may include guides or indicia for measuring and displaying these measurements. Alternatively, the positioning device may include sensors for taking these measurements. For example, the handle of the device may include sensors and/or radiofrequency transmitters for determining and sending measurements to a computer and/or display.

A guide channel 32 extends through the handle 22. Preferably, the guide channel 32 extends generally parallel with the longitudinal axis of the handle 22. The longitudinal axis of the guide channel 32 is generally aligned with or is slightly offset from the distal end 34 of the hook 24. For instance, the shortest distance between the longitudinal axis of the guide channel and the distal end of the hook may be about 2 cm or less. In other embodiments, the shortest distance may be about 1 cm or less, or even about 0.25 cm or less.

Preferably, the guide channel 32 and hook 24 are configured so that the device can be used with a single, small incision in the skin or other soft tissue to gain access to the fractured bone or other tissue requiring fixation. For example, the portions of the guide channel 32 and hook 34 that are near the opening or incision may be spaced apart from each other by about 5 cm or less, and preferably are spaced about 2 cm or less from each other near the incision or opening. In one embodiment, the guide channel and hook are generally parallel and relatively close to each other for a substantial portion of the distance between the handle and the incision or opening.

In use, the device 20 is positioned with the curved portion 28 of the hook 24 placed next to and around the tissue to be fastened. The hook may be positioned subcutaneously, percutaneously, and/or minimally invasively. The tissue may be a fractured bone, a tissue fragment having tendon and bone or ligament and bone, or a tissue with avulsion type fragments. In FIG. 2, a curved portion 28 of the hook 24 is placed around a fractured bone 30 (fracture not shown) or tissue. A drill system 36 is positioned in the guide channel 32. The drill system 36 includes a headpiece 38 configured for attachment to a drill 40. A drill bit 42 is positioned at the distal end of the drill system 36. A drill stop 44 is located distal from the headpiece 38 and prevents the drill bit 42 from penetrating too far beyond the tissue to be drilled. The drill system 36 may be a cannulated drill system. A cannula or sleeve 46 may encircle the drill bit 42 or at least the shaft portion of the drill bit 42. As the drill bit 42 creates a passage 48 through the bone 30, the sleeve 46 is positioned in the passage 48 to link the bone passage 48 and the guide channel 32. The drill system 36 is used to create a passage 48 in the bone 30 from the proximal side of the bone 30 to the distal side of the bone 30, then the drill 40 and drill bit 42 are removed from the sleeve 46 and guide channel 32. The distal opening of the bone passage 48 is generally near the distal aperture 50 of the hook 24.

It is contemplated that the drill system may be used to create a non-linear passage in tissue. The non-linear passage may be formed to go around implants such as an intramedullary rod or prosthesis. The non-linear passage may also allow a physician to avoid critical body parts or tissues such as vessels or organs. Alternatively, no drill system may be employed to create a passage in the tissue. Rather, as described in more detail below, the guide channel may be used to guide and position a self-introducing elongate member like a guide wire, k-wire, claw, grabber, etc. The self-introducing member may be forced through the soft or hard tissue instead of pre-drilling a passage.

Next, as seen in FIG. 3, a fastener 52 is positioned at the distal end of a flexible pushrod 54. The fastener 52 may be connected with the pushrod 54 or may be loosely fitted with the distal end of the pushrod 54. A suture 56 is looped through or connected with the fastener 52 such that one, two, or more sections, legs, strands, or portions of the suture 56 extend from the fastener 52. Examples of fasteners may be found in U.S. Pat. Nos. 5,163,960 and 5,593,425 entitled “Surgical Devices Assembled Using Heat Bondable Materials” which disclose fasteners assembled from a plurality of discrete components, one of which includes a heat bondable material for bonding the components together. The heat bondable material is preferably a polymeric or composite material suitable for surgical applications and implantation in the human body. The heat bondable material may be a biodegradable material. A laser, hot air gun, welding gun, soldering gun, or Bovie tip may be used as a heat source for bonding the fastener. U.S. Pat. No. 6,368,343 entitled “Method of Using Ultrasonic Vibration to Secure Body Tissue” further discloses using ultrasonic vibration energy to bond the heat bondable material of the components of the fastener.

U.S. Pat. No. 5,403,348 entitled “Suture Anchor” discloses an anchor for securing a suture in the body. The anchor includes a tubular wall having a central axis. The tubular wall has a proximal end and a distal end each free of axially inwardly extending slots. The tubular wall also has an inner surface extending for the entire length of the tube and defining in the anchor a central opening extending between the proximal end and the distal end. The anchor has a width less than its length. A suture may extend through the anchor within the central opening. First and second end portions of the suture extend out of opposite ends of the anchor and are sufficiently long to project out of the body when the suture is secured in the body by the anchor. The anchor has an anchoring orientation in the body achieved by manipulation of the distal end of the anchor by pulling on the second end portion of the suture. Furthermore, the anchor has a removal orientation in the body achieved by manipulation of the proximal end of the anchor by pulling on the first end portion of the suture.

U.S. Pat. No. 5,464,426 entitled “Method of Closing Discontinuity in Tissue” discloses a suture anchor having a generally cylindrical configuration with a lumen extending therethrough. In use, a suture is inserted through openings in a plurality of anchors. Pulling on the suture presses the anchors against the body tissue and presses the body tissue together. The anchors may be pushed through the body tissue with a pusher member or by pushing the anchors against each other.

U.S. Pat. No. 5,549,630 entitled “Method and Apparatus for Anchoring a Suture” discloses a tubular anchor having a polygonal cross-sectional configuration with flat outer side surfaces areas connected by a plurality of outer corner portions. A passage through the anchor may be formed by flat inner side surfaces interconnected by inner corner portions. A suture is inserted through the passage. A concentrated force may be applied against a limited area on a trailing end of the anchor to rotate the anchor to move an outer corner portion of the anchor into engagement with body tissue. The suture may engage an inner corner portion of the anchor. The suture may be inserted through a plurality of anchors and the anchors moved through a tubular member into the body tissue under the influence of force transmitted from a trailing anchor to a leading anchor. When the leading anchor is moved into the body tissue, it is rotated under the influence of force applied against a trailing end of the leading anchor. If desired, two anchors may be interconnected. A groove may advantageously be provided along the leading end and side of an anchor to receive the suture.

U.S. Pat. No. 5,713,921 entitled “Suture Anchor” discloses a suture anchor formed from body tissue. The body tissue is shaped to a desired configuration for the anchor and defines a passage through the anchor. A suture is inserted into the passage in the body tissue of the anchor. The anchor is then positioned in a patient's body with a suture extending into the passage in the anchor. The anchor may be formed of osseous body tissue, hard compact bone, dense connective body tissue, or other body tissue. The body tissue may be dried so that it absorbs fluid and expands upon being inserted into a patient's body.

U.S. Pat. No. 5,718,717 also entitled “Suture Anchor” discloses an anchor formed of a material which absorbs body liquid when exposed to body liquid. The anchor may be at least partially formed of a material having a strong affinity for body liquids. This enables the anchor to absorb body liquid and expand upon being inserted into a patient's body. At least one embodiment of the suture anchor has portions formed of a relatively hard material which does not absorb body liquids and is pressed against body tissue by the material which absorbs body liquid to mechanically interlock the suture anchor and the body tissue. The anchor may be at least partially formed of a cellular material. The cells expand to absorb body liquid. At least one embodiment of the anchor has a pointed leading end portion to form an opening in an imperforate surface on body tissue. The configuration of the anchor may be changed by tensioning the suture while the anchor is disposed in body tissue.

U.S. Pat. No. 5,782,862 entitled “Suture Anchor Inserter Assembly and Method” discloses a suture anchor inserter assembly including a manually engageable handle and a shaft which extends axially outward from the handle. The shaft includes an inner member which is fixedly connected with the handle and an outer member which is retractable into the handle. An anchor is received in a chamber formed at the outer end of the shaft.

U.S. Pat. No. 5,814,072 entitled “Method and Apparatus for Use in Anchoring a Suture” discloses a suture anchor inserter including a manually engageable handle and a shaft which extends from the handle through a passage in the anchor. During insertion of the anchor into body tissue, an end portion of the shaft pierces the body tissue in advance of the anchor. At the same time, a pusher surface on the shaft applies force against a trailing end portion of the anchor to push the anchor into the body tissue. When the orientation of the anchor is to be changed, rotational force is applied to the anchor by tensioning the suture and pressing the end portion of the shaft against an inner surface of the passage in the anchor.

U.S. Pat. No. 5,814,073 entitled “Method and Apparatus for Positioning a Suture Anchor” discloses an inserter assembly operable between a closed condition blocking movement of a suture anchor through the inserter assembly and an open condition in which the inserter assembly is ineffective to block movement of the anchor.

U.S. Pat. No. 5,845,645 entitled “Method of Anchoring a Suture” discloses a process of fastening a suture to an anchor. The suture is inserted through passages which are spaced apart along and extend transversely to a longitudinal central axis of an anchor. When the anchor is moved into body tissue, a first portion of the suture extends from the first passage in the anchor through an opening in the body tissue to a location disposed to one side of the body tissue. A second portion of the suture extends from the second passage in the anchor through the opening in the body tissue. The suture is tensioned to apply force to the anchor. The force applied to the anchor by the suture initiates tipping of the anchor and movement of an end surface on the anchor across a leading end surface on an inserter member.

U.S. Pat. No. 5,921,986 entitled “Bone Suture” discloses an anchor connected with a suture moved through a passage between opposite sides of a bone. The anchor is then pivoted to change its orientation. A second anchor is connected with the suture. While tension is maintained in the suture, the suture is secured against movement relative to the anchors. This may be done by tying the suture or by using a suture retainer to hold the suture. A suture retainer may be used in place of the second anchor.

U.S. Pat. No. 5,948,002 entitled “Apparatus and Method for Use in Positioning a Suture Anchor” discloses an apparatus which includes a tubular outer member and an inner or pusher member. During assembly of the apparatus, a suture is positioned in a slot in the outer member. During use of the apparatus, the slot facilitates visualization of the position of the suture anchor relative to body tissue. In addition, the slot facilitates separation of the apparatus from the suture after the suture anchor has been positioned in the body tissue. A suture anchor retainer may be provided at one end of the tubular outer member to grip the suture anchor and hold the suture anchor in place during assembly. The tubular outer member may be utilized to guide a drill during formation of an opening in body tissue and may be subsequently utilized to guide movement of a suture anchor into the opening in the body tissue.

U.S. Pat. Nos. 6,010,525; 6,159,234; and U.S. Pat. No. 6,475,230 entitled “Method and Apparatus for Securing a Suture” disclose improved method to secure a suture relative to body tissue. A suture retainer is moved along first and second sections of a suture toward the body tissue. When a predetermined minimum force is being transmitted between the suture retainer and the body tissue, the first and second sections of the suture are gripped with the suture retainer by plastically deforming material of the suture retainer. The material of the suture retainer cold flows under the influence of force applied against the surface areas on the suture retainer. One or more bends are formed in each of the sections of the suture to increase the holding action between the suture retainer and the sections of the suture. The bends may be formed by wrapping a turn of the suture around a portion of the suture retainer. During movement of the suture retainer toward the body tissue, the bends are moved along the first and second sections of the suture.

U.S. Pat. No. 6,045,551 entitled “Bone Suture” discloses an anchor connected with a suture moved through a passage between opposite sides of a bone. The anchor is then pivoted to change its orientation. A second anchor is connected with the suture. While tension is maintained in the suture, the suture is secured against movement relative to the anchors. This may be done by tying the suture or by using a suture retainer to hold the suture. A suture retainer may be used in place of the second anchor. The passage may extend across a fracture in the bone. The passage may have either a nonlinear or linear configuration. A tubular member may be positioned in the passage with the tubular member extending into portions of the passage on opposite sides of the fracture. Opposite end portions of the tubular member may be disposed in a compact outer layer of the bone. If desired, a member other than a suture may be used as a force transmitting member between the two anchors. The tubular member may be formed of bone.

U.S. Pat. No. 6,447,516 entitled “Method of Securing Tissue” discloses a retainer member formed of bone which secures tissue against movement relative to a portion of a bone in a patient's body. The retainer member is utilized to form an opening in a compact outer layer of a portion of the bone in the patient's body. The retainer member formed of bone is advantageously enclosed in a tubular member or sleeve to prevent breaking of the retainer member during the forming of the opening in the bone. The extent of movement of the retainer member into the bone in the patient's body is determined as the retainer member is moved into the bone. A suture may be connected with the retainer member and used to connect tissue with the bone.

U.S. Pat. No. 6,592,609 entitled “Method and Apparatus for Securing Tissue” discloses an anchor having a pointed end portion may be utilized to form an opening in a bone in a patient's body. The anchor is moved into the opening formed in the bone in the patient's body with a suture connected to the anchor. The suture may then be utilized to retain body tissue in a desired position relative to the bone. The body tissue may be either hard or soft body tissue. If desired the anchor may be utilized in conjunction with layers of soft body tissue. When a suture is used it may be secured by connecting a retainer with the suture. Alternatively, sections of the suture may be interconnected. It is believed that it may be preferred to secure the suture in place after at least a predetermined tension has been established in the suture and/or a predetermined force has been transmitted to the body tissue. The suture may be secured in place by exposing a retainer to ultrasonic vibratory energy or by applying the ultrasonic vibratory energy directly to sections of the suture.

U.S. Pat. No. 6,635,073 entitled “Method of Securing Body Tissue” discloses a process to secure a first body tissue with a second body tissue. A first anchor is moved along a first path through the first body tissue into the second body tissue. A second anchor is moved along a second path through the first body tissue into the second body tissue. A suture extending between the anchors may be tightened by moving the second anchor along a path which extends transverse to the path of the first anchor. The suture which extends between the anchors may have free ends which are connected with a suture retainer. The free ends of the suture may be interconnected either before or after the anchors are moved along the first and second paths. Alternatively, the suture may be a continuous loop which extends between the two anchors. A guide assembly may be provided to guide movement of the anchors along the two paths. The paths along which the anchors move may intersect so that the anchors may be interconnected at the intersection between the two paths.

U.S. Pat. No. 6,719,765 entitled “Magnetic Suturing System and Method” discloses an instrument and method for passing a medical implement through tissue with magnetic forces. The implement can be an implant, either permanent or temporary, and is provided with a magnetic component. A magnetic field is established and the magnetic component and/or magnetic field is manipulated to drive the implant through tissue. Alternatively, the instrument itself is the implement and includes at least one magnetic element so that a magnetic field established by an external magnetic generator drives the instrument through tissue. In another embodiment, the instrument includes two magnetic elements that are moveable with respect to one another and interaction between the magnetic elements drives the instrument through the tissue. Examples of applications of the present invention include a suture passer and a tissue anchor.

Other fastener types and fastening methods are disclosed in U.S. patent application Ser. No. 10/102,413 entitled “Methods of Securing Body Tissue” which discloses an improved method of securing body tissue performed with a robotic mechanism. The robotic mechanism may be utilized to tension a suture with a predetermined force and urge a suture retainer toward body tissue with a predetermined force. Ultrasonic vibratory energy may be transmitted to the suture retainer to effect a gripping of the suture by the suture retainer. The body tissue may be secured with a staple. Legs of the staple may be bonded together to secure the staple. The legs of the staple may be bonded together by transmitting ultrasonic vibratory energy to the legs of the staple. A tissue positioning assembly may be used to hold the body tissue in a desired position. Images of the body tissue being secured may be obtained using various known devices including one or more endoscopes, a fluoroscope, a magnetic resonance imaging device, and/or other known imaging devices.

U.S. patent application Ser. No. 10/228,855 entitled “Apparatus and Method for Securing a Suture” discloses a suture retainer having an upper or cover section and a lower or base section which cooperate to define passages through which portions of a suture extend. Projections on the cover section of the retainer extend into recesses on the base section of the retainer. A center projection on the base section extends between the two projections on the cover section. The projections cooperate with surfaces on body sections of the cover and base section of the retainer to position and grip portions of the suture. The retainer may be moved along the portions of the suture while the retainer is gripped by an applicator assembly. The applicator assembly is operable to apply energy to the retainer to bond end portions of the projections on the cover section to bottoms of recesses in the base section of the retainer.

U.S. patent application Ser. Nos. 10/779,978; 10/780,444; and Ser. No. 10/797,685 entitled “Method and Device for Securing Body Tissue” disclose sutures and suture retainers positioned relative to body tissue. Energy, such as ultrasonic vibratory energy, is utilized to heat the suture retainer and effect a bonding of portions of the suture retainer to each other and/or to the suture. Portions of the body tissue may be pressed into linear apposition with each other and held in place by cooperation between the suture and the suture retainer. The suture retainer may include one or more portions between which the suture extends. The suture retainer may include sections which have surface areas which are bonded together. If desired, the suture may be wrapped around one of the sections of the suture retainer. The suture retainer may be formed with a recess in which the suture is received. If desired, the suture retainer may be omitted and the sections of the suture bonded to each other.

The characteristics and features of the fasteners and fastening methods just described may be combined and integrated with the devices and methods of the present invention. The above cited patents and patent applications are incorporated herein by reference.

Furthermore, the fasteners may be, but are not limited to, degradable, biodegradable, bioerodible, bioabsorbable, mechanically expandable, hydrophilic, bendable, deformable, malleable, riveting, threaded, toggling, barbed, bubbled, laminated, coated, blocking, pneumatic, one-piece, Morse taper single piece, multi-component, solid, hollow, polygon-shaped, pointed, locking and unlocking, self-introducing, knotless, and combinations thereof. Also, the fasteners may include metallic material, polymeric material, ceramic material, composite material, body tissue, synthetic tissue, hydrophilic material, expandable material, compressible material, heat bondable material, biocompatible adhesive, and combinations thereof. Examples of body tissue include bone, collagen, cartilage, ligaments, or tissue graft material like xenograft, allograft, autograft, and synthetic graft material. The fasteners may also be made from a porous matrix or mesh of biocompatible and bioresorbable fibers acting as a scaffold to regenerate tissue.

The fasteners may also be made of or have a coating made of an expandable material. The material could be compressed then allowed to expand. Alternatively, the material could be hydrophilic and expand when it comes in contact with liquid. Examples of such expandable materials are PEEK, ePTFE, and desiccated body tissue. It is contemplated that the fasteners and implants of the present invention may include any combination of materials and agents disclosed herein. For example, a fastener may include combinations of hydrophilic material, synthetic body tissue, collagen, synthetic collagen, heat bonded material, biocompatible adhesive, and cells, such as stem cells.

Moreover, the fasteners described herein and incorporated by reference may include therapeutic substances to promote healing. These substances could include antibiotics, hydroxypatite, anti-inflammatory agents, steroids, antibiotics, analgesic agents, chemotherapeutic agents, bone morphogenetic protein (BMP), tissue inductive factors, demineralized bone matrix, collagen, growth factors, autogenetic bone marrow, progenitor cells, calcium sulfate, immo suppressants, fibrin, osteoinductive materials, apatite compositions, germicides, fetal cells, stem cells, enzymes, proteins, hormones, cell therapy substances, gene therapy substances, and combinations thereof. These therapeutic substances may be combined with the materials used to make the fasteners to produce a composite fastener or implant. Alternatively, the therapeutic substances may be impregnated or coated on the fastener. Time-released therapeutic substances and drugs may also be incorporated into or coated on the surface of the fastener. The therapeutic substances may also be placed in a bioabsorbable, degradable, or biodegradable polymer layer or layers.

In addition to including the materials and agents previously described, a fastener may take the configuration of an integrated fastener and arm member. The flexible arm may be incorporated into the fastener and extend therefrom. The arm may be connected with an end portion of the fastener or with any portion between the end portions, like the midpoint. The fastener and flexible arm may include the same or different materials and/or therapeutic agents. In use with the positioning device of the present invention, the fastener may be positioned at the distal end of the hook with the flexible arm extending from the fastener either within the lumen of the hook or exterior to the hook. Once the fastener is properly placed within the body, the flexible arm may be positioned through or around tissue and/or an implant and tensioned to compress and stabilize the tissue and/or implant. Another fastener may be connected with the flexible arm to maintain tension and position of the arm.

The sutures of the present invention may be made of metallic material, non-metallic material, composite material, ceramic material, polymeric material, copolymeric material, or combinations thereof. The sutures may be degradable, biodegradable, bioabsorbable, or nonbiodegradable. Examples of suture materials are polyethylene, polyester, cat gut, silk, nylon, polypropylene, linen, cotton, PLA, PGA, caprolactam, and copolymers of glycolic and lactic acid. Preferably, the sutures are flexible or bendable. They may be threadlike, monofilament, multifilament, braided, or interlaced. The sutures may have a coating of therapeutic substances or drugs. For example, the sutures may include antibiotics, hydroxypatite, anti-inflammatory agents, steroids, antibiotics, analgesic agents, chemotherapeutic agents, bone morphogenetic protein, demineralized bone matrix, collagen, growth factors, autogenetic bone marrow, progenitor cells, calcium sulfate, immo suppressants, fibrin, osteoinductive materials, apatite compositions, fetal cells, stem cells, enzymes, proteins, hormones, and germicides.

With the fastener 52 and suture 56 on the distal end of the flexible pushrod 54, the pushrod 54 is moved distally through the lumen of the hook 24 until the fastener 52 is positioned generally next to the distal opening of the bone passage 48, as seen in FIG. 4. The pushrod 54 may be advanced to push the fastener 52 beyond the distal aperture 50 of the hook 24 or may be advanced to position the fastener 52 partially in and partially out of the hook 24. In the latter configuration, the fastener 52 may be easily withdrawn, if necessary, from the hook 24 by moving the pushrod 54 proximally.

Alternatively, the fastener 52 and suture assembly may be assembled in the lumen prior to inserting the device in a patient. For example, a suture may be threaded into the lumen from the distal end of the hook 24, or may be inserted through the proximal end as described above before inserting the hook into the patient's body. This allows visual confirmation of that the fastener is in a desired position before introducing it into the patient's body. The hollow interior of the hook 24 may be sized to allow sutures to be placed therethrough, but sufficiently small to preclude the fastener 52 from entering it. The distal end may have a bracket or assembly that holds the fastener 52 in a desired position. The bracket or assembly may grip the fastener in place, such as by an interference fit or with friction. In one embodiment, application of tensioning forces to the suture helps hold the fastener 52 in a desired position relative to the distal end of the hook 24.

As illustrated in FIG. 5, a suture claw or grabber 58 is positioned in the guide channel 32 and through the bone passage 48. A hook, claw, or clip 60 is attached to the distal end of the suture claw 58. When the suture claw 58 is inserted distally into the guide channel 32, the hook or clip 60 exits or at least partially exits the distal opening of the bone passage 48. Since the fastener 52 is positioned near the distal opening of the bone passage 48, the hook or clip 60 of the suture claw 58 can grab or capture the suture 56 extending from the fastener 52. The suture 56 may be grabbed by rotating the suture claw 58 and allowing the suture 56 to wrap around the hook 60 at the distal end of the suture claw 58. Alternatively, the suture 56 may be grabbed with a clip 60, like an alligator clip, which may be activated from the proximal end of the suture claw 58. In another embodiment, a spiral member, like a corkscrew, may be disposed on the distal end of the suture claw. The suture claw may be twisted to thereby allow the spiral member to grab the suture. It should be understood that the suture claw should grab all the suture legs or portions attached to the fastener. For example, in FIG. 5, there are two suture legs extending from the fastener. Both legs should be captured by the suture claw either simultaneously or sequentially.

It is also contemplated that the fastener or suture may be pulled or placed in position using magnetic or electromagnetic force. For example, once a passage is drill through tissue or an implant, a magnetic may be used to pull a suture through the passage. Alternatively, when using a fastener with a flexible arm, the arm may be pulled through the passage. In these embodiments, the suture or flexible arm may include a material which is attracted to a magnet.

As previously described, a passage may not need to be pre-drilled into the tissue or bone. In this instance, the suture claw may include a distal tip configured for penetrating into and through the tissue. Using a self-introducing suture claw eliminates the need to bore a passage through the tissue before pulling the suture through the tissue.

In FIG. 6, the suture claw 58 is shown retracted from the guide channel 32. As the suture claw 58 is retracted, it pulls the suture and/or suture portions 56 from the lumen of the hook 24 and into the guide channel 32. As seen in FIG. 7, the proximal ends of the suture portions 56 may extend beyond the proximal end of the guide channel 32 when the suture claw is fully retracted.

As illustrated in FIG. 8, the hook, handle, and drill sleeve of the drill system are removed from the bone 30. The fastener 52 (not shown) is located on the distal side of the bone 30. The suture 56 extends from the fastener 52 through the bone passage and out the proximal opening of the bone or tissue passage. In FIG. 9, another fastener 62 is placed around or otherwise connected with the suture and/or suture portions 56. The suture 56 is tensioned, and the fastener 62 is secured to the suture 56 to thereby approximate the fracture and stabilize the bone 30. The tension of the suture pulls on the fasteners 52 and 62 generally towards each other, thereby applying pressure to the fractured bone or tissue.

Another exemplary embodiment of the guidance and positioning device 70 is illustrated in FIG. 10. The device 70 is shown positioned around a fractured bone 30. It should be understood that the device may be used to fasten any tissue type or combination of tissues as previously described. The device 70 includes a generally cylindrical handle 22 and a hookshaped elongated member 72 attached to the handle 22. In this embodiment, the hook-shaped elongated member 72 does not necessarily include a lumen extending therethrough. The proximal portion of the hook-shaped member 72 may be positioned generally parallel with the longitudinal axis of the handle 22. The device 70 may include a lever, clip, set-screw, button, spring, or latch 26 for securing and releasing the hook-shaped elongated member 72. The lever 26 allows different sized hooks to be placed in the handle 22. For example, the hooks may be of different lengths, have different radii of curvature, or have different types or sizes of bone engagement portions 28.

A guide slot 74 extends through the handle 22 generally parallel with the longitudinal axis of the handle 22. The longitudinal axis of the guide slot 74 is generally aligned with the distal end of the hook-shaped member 72. The guide slot 74 and hook-shaped member 72 are generally parallel and relatively close to each other at and just distal to the handle 22. In this configuration, a single, small, percutaneous incision may be made in skin or other soft tissue to gain access to the fractured bone or other tissue requiring fixation.

In use, the device 70 is positioned with the hook-shaped portion 76 of the hook-shaped elongated member 72 placed next to and around the tissue to be fastened. In FIG. 11, the hook-shape portion 76 is placed around a fractured bone 30 (fracture not shown). A drill system 36 is positioned in the guide slot. The drill system 36 includes a headpiece 38 configured for attachment to a drill 40. A drill bit 42 is positioned at the distal end of the drill system 36. A drill stop 44 is located distal from the headpiece 38 and prevents the drill bit 42 from penetrating too far beyond the tissue to be drilled. The drill system 36 may be a cannulated drill system. The drill system 36 is used to create a passage 48 in the bone 30 from the proximal side of the bone 30 to the distal side of the bone 30. The distal opening of the bone passage 48 is generally near a socket 78 at the distal end of the hook-shaped portion 76 of the elongated member 72.

As previously noted, a drill system may not be needed to form a passage in the tissue. An elongated member with a distal tip configured for penetrating through tissue may be placed in the guide slot and used for passage through tissue. The elongate member may be a guide wire, k-wire, needle, or like device.

FIG. 12 illustrates the socket 78 at the distal end of the hook-shaped portion 76 of the elongated member. The socket 78 is dimensioned and configured for holding and/or carrying a fastener 52. The socket 78 may be a hollow cylinder or any other configuration capable of accepting a fastener 52. As seen in FIG. 11, the socket 78 is positioned at the distal end of the hook-shaped member 72 such that the fastener 52 is generally aligned with the distal opening of bone passage 48. The fastener may include characteristics, materials, therapeutic substances, coatings, or any other features as previously described herein. It is contemplated that the socket may hold the fastener magnetically, frictionally, with an interlocking mechanism such as a snap, with adhesive, etc.

Next, as shown is FIG. 13, the drill system is removed from the guide slot 74. A fastening member 80 is placed in the guide slot 74 and through the passage in the bone 30. The fastening member 80 is moved distally through the passage and inserted into the fastener disposed in the socket at the distal end of the hook-shaped member 72. The fastening member may be made of metal, polymer, ceramic, composite, body tissue, or combinations thereof. The fastening member may also include features, therapeutic agents, and coatings similar to the fastener and suture previously described. FIG. 14 illustrates one exemplary embodiment of the connection between the fastening member 80 and the fastener 52. The distal end of the fastening member includes a threaded portion 82, and the fastener 52 includes a threaded hole. The fastening member 80 is screwed into the fastener 52. Other examples of connecting the fastening member and fastener include ball and socket, hook and loop, mechanical expansion, material expansion, dovetail, orientation change, heat bondable material, biocompatible adhesive, and other similar connection means.

In the embodiment wherein a drill system is not used create a passage in the tissue, the fastening member 80 may include a sharp or pointed distal tip to allow the member to be moved through the tissue, free of a passage. Using a self-introducing fastening member may eliminate the need to pre-drill the passage in the tissue.

As illustrated in FIG. 15, the guidance and positioning device is removed from the bone 30. The fastener 52 (not shown) is located on the distal side of the bone 30. The fastening member 80 extends through the bone passage and out the proximal opening of the bone passage. In FIG. 16, another fastener 62 is placed around the fastening member 80. The fastening member 80 is tensioned, and the fastener 62 is secured to the fastener member 80 to thereby approximate the fracture and stabilize the bone 30. Once again, the tension of the fastening member pulls the fasteners toward each other, which in turn causes pressure to be applied to the treated bone or tissue.

It is further contemplated that the guidance and positioning device 20, 70 may be used without a distal fastener. In this embodiment, the device 20,70 is used to position a suture on the backside or distal portion of the tissue. The suture claw, grabber, or elongate member may be placed in the guide channel or guide slot and moved distally toward the suture located at the distal end of the hook. Using the suture claw, one or two sections of the suture may be pulled through the tissue to the proximal side of the tissue. The suture or sutures may be pulled through a pre-drilled passage created by a drill system or may be pulled through a passage created by a self-introducing suture claw. Once a portion of the suture is positioned on the proximal side of the tissue, it may be tensioned and secured with a fastener. Alternatively, the proximally extending suture section may be fastened with another section of the suture extending from the distal end of the hook and around the tissue. In this embodiment a suture loop is formed with tissue caught or positioned in the middle of the loop. The two sections of the suture may be secured with a knot or a fastener.

FIGS. 17 and 18 illustrate exemplary embodiments of clamping mechanisms for the guidance and positioning device. FIG. 17 shows a tubular clamp member 84 connected with the handle 22 of the device 20,70. The clamp member 84 includes a lumen extending therethrough for allowing passage of the drill system, suture claw, and suture as previously described. The proximal portion of the clamp member 84 includes threads 86, a ratchet, or the like for advancing the clamp member 84 into and out of the handle 22. The distal end of the clamp member 84 may include a tissue pad 88 for contacting tissue.

The tissue pad 88 may be integrally formed on the distal end of the clamp member. For example, during fabrication of the clamp member, its cross-section may initially be relatively the same size along its length, including at the distal end. Subsequently, the distal end may be deformed or flattened to have a larger cross section.

Alternatively, the tissue pad 88 also may be connected to the clamp member in a manner that allows it to rotate and/or swivel. As the clamp member 84 is moved toward the bone or tissue, some areas of the tissue pad 88 may begin to make contact even though the clamp member 84 may require additional rotation or advancement in order to obtain a desired amount of contact. If the tissue pad 88 is able to rotate or swivel, it can adjust to the contours of the bone or tissue while also reducing potential abrasion.

The contact surface of the tissue pad 88 may be substantially flat, as shown in FIG. 17, but it also may be curved or have a different shape that may correspond generally to the curvature or shape of the bone or tissue that it may contact. The contact surface also may be deformable so that it can more easily conform to an uneven surface of bone or tissue. The deformable surface of the tissue pad may be formed from a layer of elastomeric material (e.g., rubber or urethane), foam material, or any other elastomeric material suitable for use in a surgical procedure.

In use, the device 20 is positioned about a bone, or other tissue. The clamp member 84 is moved or rotated distally so that the tissue pad 88 contacts the proximal side of the bone. Further advancement of the clamp member 84 causes the tissue pad 88 to apply pressure on the bone or tissue.

Teeth or other friction means 90 may be disposed on the distal portion of the hook 24 to make contact with the distal side of the bone so that when the clamp member 84 extended, the device 20 is clamped or held in position relative to the bone. The contacting surface of the hook also may be modified or configured in the manner described above for the tissue pad.

FIG. 18 shows another embodiment of a clamping mechanism. The tubular clamp member 84 is slideably disposed or connected with the handle 22 of the device 20,70. The clamp member 84 may also include a lumen extending therethrough. A squeeze/finger grip 92 is connected with the handle 22 for advancing and retracting the clamp member 84 relative to the handle 22. When the squeeze grip 92 is moved toward the handle 22, the clamp member 84 may be moved or ratcheted distally thereby pressing the tissue pad 88 against the bone or other tissue. In this configuration, the clamp member functions like a come-along with detents and/or teeth. The squeeze grip 92 may be moved away from the handle 22 to move the clamp member 84 proximally, or a release button or spring or clip may be activated to permit the clamp member 84 to move proximally. Teeth or other friction means 90 may be disposed on the proximal side of the socket 78. With the clamp member 84 extended, the device 70 is held to the bone or other tissue between the tissue pad 88 and teeth 90 or socket 78.

Other embodiments of the clamping mechanism are further contemplated. For example, the guidance and positioning device 20,70 may include one or more inflatable members, such balloons. An inflatable balloon may be positioned along the hook at a location where the hook passes near the proximal surface of the tissue. That is, the balloon may be located at the proximal end of the curved portion of the hook. In a deflated configuration, the device may be properly positioned by the physician. The balloon may then be inflated to press against the proximal side of the tissue causing the distal end of the hook to press against the distal side of the tissue and thereby hold or lock the device in place. The balloon may be inflated with air, gas, or liquid. Inflation may be made manually with a hand pump, electrically with an electric pump or battery-operated pump, or pneumatically with a pressure cartridge. The balloon may also help guide the distal end of the hook into the proper position. Multiple balloons may be inflated and/or deflated together or separately to guide the hook. Also, the balloon(s) may be used to create space in tissue.

In another example, the device 20,70 may include a balloon at the distal end of the hook. Operation of the balloon may be similar to as previously described; however, in the current embodiment, the balloon may inflate to press against the distal side of the tissue causing the proximal portion of the hook (which may include a tissue pad or gripping teeth) to press against the proximal side of the tissue to thereby hold the device in position. Furthermore, two or more balloons may be used to position and hold the device relative to the tissue. The plurality of balloons may be located along the hook or guide channel and inflated together or individually to properly align and hold the device in place. In addition to holding the device relative to the tissue, the balloon or balloons may compress the tissue, tissue elements, and/or implant. With the tissue and/or implant compressed, a fastener or other implant may be positioned within the body.

As illustrated in FIG. 19, the device 20,70 may include a tensioning mechanism 94 to tension the suture 56 or fastening member 80. The tensioning mechanism 94 may be attached to the handle 22, tubular member 24, elongated member 72, or other component of the device 20,70. After the suture 56 or fastening member 80 is inserted through the passage in tissue, like a fractured bone 30, the tensioning mechanism 94 may pull and tension the suture 56 or fastening member 80 while a proximal fastener 62 is positioned to maintain the tension in the suture 56 or fastening member 80. The tensioning mechanism 94 may be, but is not limited to, two elements which pinch the suture 56 or fastening member 80 to pull it proximally or a spool which rotates to pull the suture 56 or fastening member 80. A tension gauge, strain gauge, read-out display, tension limiter, and/or an audio or visual tension indicator may be used to apply the proper tension to the suture or fastening member. Also, measurement of the tension may be accomplished with a spring, a radiofrequency emitting device, and/or a sensor such as an electrical sensor, flexible sensor, compressive sensor, piezoelectric sensor. Other examples of tension applicators are disclosed in U.S. Pat. No. 6,010,525 entitled “Method and Apparatus for Securing a Suture”; U.S. Pat. No. 6,447,516 entitled “Method of Securing Tissue”; and U.S. Pat. No. 6,635,073 entitled “Method of Securing Body Tissue.” The above mentioned patents are hereby incorporated by reference.

As further shown in FIG. 19, the distal portion 96 of the tubular clamp member 84 may be offset or curved thereby exposing the suture 56 or fastening member 80 between the fractured bone 30 and clamp member 84. The tubular clamp member 84 may include a lumen extending therethrough with the lumen having an aperture at or near the proximal end of the offset portion 96 or the distal end of the straight section of the clamp member 84. The offset distal portion 96 allows a fastener 62 to be placed around the suture 56 or fastening member 80 adjacent to the proximal side of the bone 30. When the suture 56 or fastening member 80 is tensioned with the tensioning mechanism 94, the fastener 62 may be applied to maintain the tension in the suture 56 or fastening member 80.

It is contemplated that the guidance and positioning device of the present invention may include more than one hook or elongated member for positioning multiple fasteners at the distal side of tissue. For example, as illustrated in FIG. 29, the device 150 may include two hooks or elongated members 152 and 154 attached to the handle 156 and positioned generally parallel to each other. The handle 156 may then include two guide channels, slots, or pins 158 and 160, each being aligned with one of the distal ends of the hook shaped tubular or elongated members. In this configuration, two passages 162 and 164 may be drilled in tissue, like a fractured bone 166, and two sutures or fastening members may be positioned through the passages, tensioned, and secured. One passage 162 may be non-linear while the other passage 164 may be linear. Having multiple hooks and guide channels or slots allows a physician to implant multiple fasteners thereby producing compression on the implant or tissue, enhancing the healing environment, and allowing for tissue ingrowth. The device with multiple hooks or pins may also be used to position other implants disclosed herein, such as adhesives, tissue scaffolds, medicaments, etc.

It is also contemplated that the device of the present invention may be disposable or may be sterilized after use and reused. The device may be partly disposable and partly reusable. For example, the handle may be reusable and the hook and/or guide channel may be disposable. Alternatively, the handle may be disposable. The device, its components, fasteners, drill bits, sutures, and other apparatus disclosed herein may be package in a kit. The kit may be set-up of a specific procedure, such as repair of a fractured bone, securing of an implant, approximating body tissue, etc.

Positioning Implants

The present invention not only provides an instrument and method for dynamic and rigid fastening of tissue, but it also provides for the guidance and positioning of an implant within the body. For example, the present invention may be utilized with tissue scaffolds as described in U.S. patent application Ser. No. 10/457,100 entitled “Scaffold and Method for Implanting Cells” by Peter M. Bonutti. Viable cells may be positioned on a support structure then implanted within a body. One or more blood vessels may be connected with the support structure to provide a flow of blood through the support structure. The devices and methods of the present invention may be used to guide and position the support structure within the body and fasten the scaffold to tissue or another implant by way of a sling support and/or strut. The above mentioned application is hereby incorporated by reference.

Furthermore, the present invention may be used in combination with a medical system for the administration of a pharmaceutical agent in vivo to a patient. The medical system may include an implant positionable in a body of a patient. A pharmaceutical agent may be disposed on the medical implant and at least partially coated with a reactive coating. The reactive coating acts to control the release of the pharmaceutical agent. An energy unit may be provided for transmitting an energy signal to the reactive coating, wherein the reactive coating reacts to the energy signal to control the release rate of the pharmaceutical agent. Additionally, the energy unit may also heat up the treatment site, locally increasing vascularity at the treatment site and allowing thermal necrosis of tissue. The localized increasing in temperature increases the permeability of the local tissue, allowing for an increased and more efficient adsorption of the pharmaceutical agent into the treatment site. Additionally, in response to localized increase in temperature, which can be perceived as physical damage or an infection to the local area, the local cells may release beneficial proteins, enzymes, hormones, etc.

In another embodiment, a pharmaceutical agent, drug, or medicament may be delivered within the body using the positioning device described herein. The hook and/or guide channel of the positioning device may conduct the passage of a medicament to a specific location within the body. The drug may be transported through the lumen of the hook or guide channel or, alternatively, may be placed on the exterior of the hook or guide channel. When the positioning device has been properly aligned, the medicament may be released in a constant stream or in a pulsatile manner. Examples of medicaments that may be used with the present invention include those disclosed throughout this application and, additionally, but not limited to, an anti-inflammatory agent, non-proliferative agent, anti-coagulant, anti-platelet agent, Tyrosine Kinase inhibitor, anti-infective agent, anti-tumor agent, anti-leukemic agent, and combinations thereof. One or more medicaments may be placed in one or more reservoirs which are in fluid communication with the positioning device. The reservoir may be physically separate from the device with tubing interconnecting the device and reservoir. Alternatively, the reservoir may be integrated into or attached to the positioning device. Release of the medicament may be achieved through manual operation such as with a plunger, air pressure, or valve or through electrical operation such as with a pump or valve. The medicament may be released from the positioning device or remotely away from the device as with a radiofrequency or signal emitting device.

It is contemplated that an adhesive may be delivered within the body in the way a medicament is delivered as described above. The adhesive could a polysaccharide based adhesive, fibrin adhesive, mollusk based adhesive, cyanoacrylate based adhesive, polymeric based adhesive, or other biocompatible adhesive. The adhesive could be thermally activated or pH activated. The adhesive could be a single part adhesive or a two part adhesive requiring both parts to activate the adhesive. The adhesive may also be hydrophilic or include hydrophilic material. The hydrophilic adhesive/material may expand upon imbibing liquid, such as body fluid. In use, the adhesive may be delivered within the body to bond tissue together such as soft tissue to soft tissue, soft tissue to hard tissue, or hard tissue to hard tissue. For example, portions of a fractured bone may be adhered, a muscle may be bonded to other muscle or to a tendon, and a ligament may be adhered to another ligament, to muscle, and/or to bone. The adhesive may also be used to bond an implant with body tissue or to another implant. For example, a bone or joint replacement component may be adhered to another replacement component or to other bone, tissue scaffolding with cells may be bonded to other tissue or other scaffolding, and fasteners may be adhered to tissue or sutures.

In another embodiment, an energy sink, such as a pH sink, may be incorporated into a medical implant or be positioned separate from the medical implant. The pH sink is configured to absorb energy from the energy unit, releasing a chemical to either increase or decreasing the local pH. The change in local pH can either increase or decrease the degradation rate of a degradable polymer coating, which in turn can control the release rate of a pharmaceutical agent. The pH sink can be formed from calcium carbonate. Additionally, the localized change in pH created by the pH sink has beneficial effects, which include (but are not limited to): aiding in the alleviation of localized pain, fighting of local infections, and increasing vascular flow and permeability of vessels at the treatment site to control delivery of pharmaceutical agent.

For example, a localized increasing in pH increases the permeability of the local tissue, allowing for an increased and more efficient adsorption of the pharmaceutical agent into the treatment site. The energy sink may also be used to induce the release of beneficial enzymes, proteins, hormones, etc. from the cells in the treatment site. A localized increase in acidity and/or temperature can be perceived as a physical damage or an infection to the local area. In response, to the local cells may release beneficial proteins, enzymes, hormones, etc. The positioning device and method of the present invention may be used to guide and position a drug-eluting implant, a heat sink, or pH sink within the body.

The present invention may also be used with the disclosure of U.S. Provisional Patent Application No. 60/622,095 entitled “Devices and Methods for Stabilizing Tissue and Implants” by Peter M. Bonutti. The provisional application discloses various procedures for repairing, reconstructing, and stabilizing tissue and implants within the body. Examples of such tissue include bone, muscle, ligament, tendon, skin, organ, cartilage, and blood vessels. Examples of implants include an organ, partial organ grafts, tissue graft material (autogenic, allogenic, xenogenic, or synthetic), a malleable implant like a sponge, mesh, bag/sac/pouch, collagen, or gelatin, or a rigid implant made of metal, polymer, composite, or ceramic. Other implants include breast implants, biodegradable plates, metallic fasteners, rods, plates, screws, screw strips, spacers, cages, compliant bearing implants for one or more compartments of the knee, nucleus pulposus implant, stents, meniscal implants, tissue grafts, tissue scaffolds, biodegradable collagen scaffolds, polymeric or other biocompatible scaffolds, abdominal hernia meshes, cochlear implants, tracheal implants, small intestine submucosal grafts, TISSUEMEND scaffolds, prostheses, nanotechnology devices, sensors, emitters, radiofrequency emitting diodes, computer chips, RFID (radiofrequency identification) tags, adhesives, and sealants.

The guidance and positioning device of the present invention may be used to stabilize or fasten these implants and tissues. For example, the spine may be repaired or stabilized with fasteners, sutures, and cables to provide flexible or rigid reinforcement of the joints of the spine. Also, the nucleus pulposus of an intervertebral disc may be repaired or replaced using the guidance and positioning device of the present invention. For example, a prosthetic disc nucleus is positioned between two vertebral bodies and may be secured to surrounding tissue with fasteners and sutures. Additionally, the annulus may be repaired following a nucleus pulposus repair or replacement. The positioning device of the present invention may be used to position a fastener and suture on the internal side of the annulus. The suture may be pulled proximally through the annulus, tensioned, and secured with another fastener. Finally, the tissue alignment sleeves disclosed in the provisional application may be guided and positioned with the instrument and methods of the present invention. The above mentioned provisional application is incorporated herein by reference.

It is contemplated that the present invention may be utilized with the tracheal tube positioning apparatus of U.S. patent application Ser. No. 09/728,553 entitled “Tracheal Intubation” by Peter M. Bonutti. That application discloses positioning apparatus located relative to a patient's trachea by engaging the patient's trachea. Indicia on relatively movable sections of the positioning apparatus provide an indication of the distance between the patient's mouth and the patient's larynx. A flexible guide rod is moved through a distance corresponding to the distance between the patient's mouth and larynx, as determined by the positioning apparatus. A magnet is utilized to attract a leading end portion of the guide rod. A plurality of emitters may be disposed in an array around the patient's trachea. Outputs from the emitters are detected by a detector connected with the tracheal tube. The above mention patent application is hereby incorporated by reference.

Drill/Sleeve Combination

In another embodiment of the present invention, a drill bit and sleeve combination 100 is provided. In the following description, the drill bit and sleeve combination or system 100 is explained with reference to the fixation of two bones, like two portions of a fractured bone. It should be understood that the present embodiment may be utilized for fastening or securing tissue to tissue, an implant to tissue, or an implant to an implant.

In FIG. 20 the system 100 includes a tubular member or sleeve 102 for aligning two portions of bone located on opposite sides of a fracture. A drill bit 104 extends through the longitudinal lumen of the sleeve 102. The distal portion 106 of the drill bit 104 has one or more pivoting blades 108. The system 100 may also include a pusher means 110 for inserting the sleeve 102 into the bone passage created by the drill bit 104. The pusher means 110 may be connected to the sleeve, bit, or the drill. Preferably, a portion of the pusher means 110 does not rotate with the bit or drill so that the sleeve 102 is not rotated as the pusher means 110 contacts the sleeve 102 during the drilling operation. Examples of the pusher means 110 include a washer-shaped member or donut-shaped member positioned over the bit or a U-shaped fork positionable around the shaft of the bit. The lower side of the pusher means 110 may be configured for contact with the proximal end of the sleeve, while the upper side of the pusher means 110 may be configured of applying a distal force with a hand, hammer, or press.

As seen in FIG. 21, the blades 108, when extended from the bit 104, increase the drilling diameter of the bit 104. The bone passage created by the drill bit 104 and the extended blades 108 has a diameter generally equal to the outside diameter of the sleeve 102. The blades 108, when retracted, pivot into or against the distal portion 106 of the bit 104. The diameter of the drill bit 104 with the blades 108 retracted is slightly less than the inside diameter of the sleeve 102.

The pivoting blades 108 of the system 100 may be connected with the distal portion 106 of the bit 104 in a variety of ways, but preferably, the blades 108 are pivotally attached to the bit 104. In one exemplary embodiment as seen in FIGS. 20 and 21, the blades 108 extend and retract along radial axes of the bit 104. The blades 108 may pivot downwardly or distally into an extended configuration and may pivot upwardly or proximally into a retracted configuration. In the retracted state, the blades 108 may be positioned within a groove or notch within the distal portion 106 of the bit 104. Furthermore, the blades 108 may be spring loaded to normally reside in the retracted configuration. When the drill bit 104 is rotated with a drill, the centrifugal force generated by the drill may cause the blades 108 to pivot into the extended configuration. Once in the extended position, the blades 108 may be locked into position to allow drilling or cutting of the bone.

In another exemplary embodiment, the blades 108 may be manually pivoted distally and proximally. A pin or shaft may extend along the center of the drill bit 104 with the distal end of the pin in contact with the blades 108. As the pin moved longitudinally, the blades 108 may extend and retract. The proximal portion of the pin may include a lever or other means for moving or advancing the pin along the center axis of the bit 104.

It is further contemplated that the blades 108 may be extended and retracted radially in and out of the distal portion of the bit 104 along a linear path instead of being pivoted as previously described. In this embodiment, the blades 108 may extend with centrifugal force and retract with a spring-like mechanism or may be manually extended and retracted with a pin or shaft along the central axis of the bit 104. Furthermore, other embodiments of the blades are contemplated. For example, the blades may be generally arch-shaped to conform to the outside circumference of the bit. The distal ends of the blades may be pivotally attached to the bit allowing the blades to extended radially outward for maximum cutting diameter or retract against the outer surface of the bit to minimize the bit diameter.

FIGS. 22 and 23 illustrate the drill bit and sleeve system 100 in use to repair a fractured bone 112. The drill bit 104 is inserted into the lumen of the sleeve 102. The distal portion 106 of the bit 104 and the pivoting blades 108 extend beyond the distal end of the sleeve 102. Preferably, the amount of bit 104 extending from distal end of the sleeve 102 is minimized to prevent damage to soft tissue of the distal side of the bone 112. The proximal portion of the bit or shank 114 extends from the proximal end of the sleeve 102 and is connected to a drill 116. The pivoting blades 108, located beyond the distal end of the sleeve 102, are in the extended configuration. The bit 104 is rotated and advanced distally through the fractured bone 112. As the bit 104 advances and creates a passage in the bone 112, the sleeve 104 is moved distally into the passage with the pusher means 110. The sleeve 102 is tight or snug within the passage since the diameter of the passage is generally equal to the outside diameter of the sleeve 102. When the sleeve 102 is in its proper position securing the bone portions 118 and 120 of the fractured bone 112, and the drill bit 104 may be removed from the lumen of the sleeve 102. The bit 104 may be pulled from the lumen of the sleeve 102 because the blades 108 may be positioned in the retracted configuration giving the drill bit 104 a diameter generally smaller than the diameter of the lumen of the sleeve 102. With the sleeve 102 in place, the bone is compressed, and the fracture is stabilized.

In another embodiment of the present invention, the drill bit and sleeve combination or system 100 is dimensioned and configured for transformation into a fastener. As shown in FIGS. 24 and 25, the system 100 includes the tubular member or sleeve 102, the pusher means 110, and a drill bit 104 with an expanding distal portion 122. The drill bit 104 extends through the lumen of the sleeve 102 with the distal portion 122 of the bit 104 extending beyond the distal end of the sleeve 102. The cutting diameter of the distal portion 122 of the bit 104 is generally equal to the outside diameter of the sleeve 102. In this embodiment, the distal portion 122 of the bit 104 does not include pivoting cutting blades. However, the distal portion 122 does include means for expansion to a diameter greater than the cutting diameter.

Some examples of expansion means are shown in FIGS. 26-28. In FIG. 26 the expansion means includes one or more mechanically extending barbs 126 from the distal portion 122 of the bit 104. When extended or expanded, the barbs 126 increase the overall diameter of the drill bit 104. The barbs 126 may extend to the outside diameter of the sleeve 102, but preferably the barbs 126 extend beyond the outside edge of the sleeve 102. Most preferably, the barbs 126 extend over or into the distal side of the fractured bone 112. In the expanded configuration, the drill bit 104 is prevented from being pulled proximally out of the sleeve 102.

In FIG. 27, the expansion means includes a distal portion 128 of the drill bit 104 which pivots. In a first orientation during a drilling procedure, the distal portion 128 of the bit 104 is generally in-line with rest of the drill bit 104. After drilling, the distal portion 128 of the bit 104 is rotated about a pivot point into a second orientation. In the second orientation, the distal portion 128 is generally perpendicular to the rest of the drill bit 104. As a result, the end sections 132 and 134 of the pivoted distal portion 128 of the bit 104 extend beyond the outer diameter of the sleeve 102. Preferably, the end sections 132 and 134 extend over or into the distal side of the fractured bone 112 to prevent the bit 104 from being pulled from the sleeve 102.

In FIG. 28, the expansion means includes a distal portion 136 of the bit 104 which has two or more longitudinal sections 138 and 140 that are biased radially outward. The longitudinal sections 138 and 140 may be normally biased outward but held together by the lumen of the sleeve 102 when drilling through the bone 112. Alternatively, the longitudinal sections 138 and 140 may be normally in a non-biased configuration. After the passage is drilled in the bone 112, a plunger 142 within the drill bit 104 may be moved distally biasing the longitudinal sections 138 and 140 radially outward. With the longitudinal sections 138 and 140 biased, the distal portion 136 of the bit 104 may extend over or into the distal side of the fractured bone 112 to secure the bit 104 within the sleeve 102 and bone passage.

The drill bit and sleeve system 100 which transforms into a fastener may be utilized to secure various tissue and implants. Generally, in use, the drill bit 104 is inserted into the lumen of the sleeve 102 with the distal portion of the bit 104 extending beyond the distal end of the sleeve 102. The proximal portion of the bit or shank 114 extends from the proximal end of the sleeve 102 and connects to a drill. The bit 104 is rotated and advanced distally through the fractured bone 112. As the bit 104 advances and creates a passage in the bone 112, the sleeve 102 is moved distally into the passage with the pusher means 110. When the sleeve 102 is in its proper position connecting the two portions 118 and 120 of a fractured bone 112, the shank 114 of the drill bit 104 is removed from the drill. The distal portion of the bit 104, which extends just beyond the distal surface of the bone 112, is expanded with the expansion means.

Once expanded, the drill bit 104 is prevented from being pulled out of the bone passage. A retainer 144 may then be placed around the shank 114 of the bit 104 and moved distally to engage the proximal side of the bone 112. The retainer 144 is secured to the shank 114. With the distal portion of the bit expanded and the retainer connected to the shank, the drill bit (and the sleeve) is transformed into a fastener which holds the fractured bone in compression. It is also contemplated that the drill bit may be used without the sleeve so that the drill bit alone becomes a fastener.

The tubular member or sleeve of the present invention is generally tubular shaped having a wall with an inner surface and an outer surface. The inner surface defines a lumen which is dimensioned and configured for receiving a drill bit, suture, cable, K-wire, or similar device. The sleeve may include a slit through the tubular wall. The slit allows the sleeve to be decreased in diameter for implantation and increased in diameter after implantation for proper alignment of the implantation site. In a further embodiment, the sleeve may include two slits in the tubular wall thereby forming two semi-tubular members. The semi-tubular members may be placed separately at the implantation site then aligned to form a complete tubular member. In another embodiment, the tubular member is a solid member.

The tubular member or sleeve may be flexible to enable the tubular member to be inserted into a linear or nonlinear passage through the bone. The tubular member may be formed of metallic material, composite material, ceramic material, polymeric material, or combinations thereof. The sleeve may be made from a degradable, biodegradable, bioerodible, or bioabsorbable material, such as a polymer, composite, or ceramic. The tubular member may also include a therapeutic substance to form a composite tubular member, or the therapeutic substance may be coated onto the tubular member. Furthermore, therapeutic substances or graft material (autogenic, allogenic, xenogenic, or synthetic) may be packed into the sleeve.

Additionally, the outer surface of the tubular member may include a friction or gripping means. A portion of the outer surface of the tubular member may include threads, raised pebbles, bumps, raised ridges, or hills. In addition to a friction means on the outer surface of the tubular member, the wall of the sleeve may include openings for tissue ingrowth. The tubular member of the present invention is further described in U.S. Provisional Patent No. 60/622,095 entitled “Devices and Methods for Stabilizing Tissue and Implants,” which is hereby incorporated by reference.

Guidance and Navigation

The guidance and positioning device of the present invention may be placed within the body of a patient with precise navigation. For example, one or more guide wires or k-wires may be utilized—one to hold the device in position and a second wire to drill or pass through tissue toward the distal end of the hook of the device. One of the guide wires or an additional wire can be used to pull a suture or fastener through the tissue. Alternatively, the positioning device may be positioned through an expanding retractor with percutaneous guidance.

Other navigation techniques for precise placement of the positioning device of the present invention include endoscopic guidance, magnetic resonance imaging, CT scan, ultrasound, fluoroscopy, X-ray, computer assisted navigation, magnetic guidance, electromagnetic guidance, radiofrequency guidance, optical guidance, and laser guidance. For example, the hook and/or guide channel of the positioning device may include a magnet, a radiofrequency emitter, or a thermal emitter/sensor. U.S. patent application Ser. No. 10/191,751 entitled “Method of Performing Surgery” discloses computer assisted navigation. In using computer assisted navigation with the present invention, emitters, receivers, and/or reflectors may be attached to the positioning device and/or tissue. The computer navigation system may utilize multiple separate registers which have optical feedback to a central unit. The computer navigation system may utilize electromagnetic or photo-optical feedback. U.S. Pat. No. 5,329,924 entitled “Sequential Imaging Apparatus”; U.S. Pat. No. 5,349,956 entitled “Apparatus and Method for Use in Medical Imaging”; and U.S. Pat. No. 5,542,423 entitled “Indexing Assembly for Joint Imaging” disclose further devices and methods for use in medical imaging. Also, the present invention may be performed using robotics, such as haptic arms or similar apparatus. The above mentioned patents and applications are hereby incorporated by reference.

It is contemplated that the device and method of the present invention be applied using minimally invasive incisions and techniques to preserve muscles, tendons, ligaments, bones, nerves, and blood vessels. A small incision(s) may be made adjacent the target area to be repaired, and a tube, delivery catheter, sheath, cannula, or expandable cannula may be used to perform the methods of the present invention. U.S. Pat. No. 5,320,611 entitled “Expandable Cannula Having Longitudinal Wire and Method of Use” discloses cannulas for surgical and medical use expandable along their entire lengths. The cannulas are inserted through tissue when in an unexpanded condition and with a small diameter. The cannulas are then expanded radially outwardly to give a full-size instrument passage. Expansion of the cannulas occurs against the viscoelastic resistance of the surrounding tissue. The expandable cannulas do not require a full depth incision, or at most require only a needle-size entrance opening. The above mentioned patent is hereby incorporated by reference.

Also, U.S. Pat. Nos. 5,674,240; 5,961,499; and 6,338,730 disclose cannulas for surgical and medical use expandable along their entire lengths. The cannula has a pointed end portion and includes wires having cores which are enclosed by jackets. The jackets are integrally formed as one piece with a sheath of the cannula. The cannula may be expanded by inserting members or by fluid pressure. The cannula is advantageously utilized to expand a vessel, such as a blood vessel. An expandable chamber may be provided at the distal end of the cannula. The above mentioned patents are hereby incorporated by reference.

The present invention may also be utilized with minimally invasive surgery techniques disclosed in U.S. patent application Ser. No. 10/191,751 and U.S. Pat. Nos. 6,702,821 and 6,770,078. These patent documents disclose, inter alia, apparatus and methods for minimally invasive joint replacement. The femoral, tibial, and/or patellar components of a knee replacement may be fastened or locked to each other and to adjacent tissue using fasteners disclosed herein and incorporated by reference. Furthermore, the methods and devices of the present invention may be utilized for repairing, reconstructing, augmenting, and securing tissue or implants during and “on the way out” of a knee replacement procedure. For example, the anterior cruciate ligament and other ligaments may be repaired or reconstructed; quadriceps mechanisms and other muscles may be repaired. The patent documents mentioned above are hereby incorporated by reference.

Furthermore, it is contemplated that the present invention may be used with bariatric surgery, gastric stapling, colorectal surgery, plastic surgery, gastroesophageal reflex disease (GERD) surgery, ligament reconstruction surgery (such as the anterior cruciate ligament, ACL), or for repairing hernias. A band, mesh, or cage of synthetic material or body tissue may be placed around an intestine or other tubular body member. The band may seal the intestine. This method may be performed over a balloon or bladder so that anastomosis is maintained. The inner diameter of the tubular body part is maintained by the balloon. The outer diameter of the body part is then closed or wrapped with a band, mesh, or patch. The inner diameter of the tubular body member may be narrowed or restricted by the band. The band may be secured to the tubular body part or surrounding tissue with the device and method of the present invention.

It is further contemplated that the present invention may be used in conjunction with the devices and methods disclosed in U.S. Pat. No. 5,329,846 entitled “Tissue Press and System” and 5,269,785 entitled “Apparatus and Method for Tissue Removal.” For example, an implant secured within the body using the present invention may include tissue harvested, configured, and implanted as described in the patents. The above mentioned patents are hereby incorporated by reference.

Additionally, it is contemplated that the device and method of the present invention may be used with heat bondable materials as disclosed in U.S. Pat. No. 5,593,425 entitled “Surgical Devices Assembled Using Heat Bondable Materials.” For example, fasteners may include heat bondable material. The material may be deformed to secure tissue or hold a suture or cable. The fasteners made of heat bondable material may be mechanically crimped, plastically crimped, or may be welded to a suture or cable with RF (Bovie devices), laser, ultrasound, electromagnet, ultraviolet, infrared, electro-shockwave, or other known energy. The welding may be performed in an aqueous, dry, or moist environment. The welding device may be disposable, sterilizable, single-use, and/or battery-operated. The above mentioned patent is hereby incorporated by reference.

Moreover, the device and method of the present invention may be used for the repair and reconstruction of a tubular pathway like a blood vessel, intestine, urinary tract, esophagus, or similar tubular body parts. For example, a blood vessel may be intentionally severed during a surgical operation, or the blood vessel may be damaged or torn as a result of an injury. Flexible fixation of the vessel would permit the vessel to function properly and also compress and stabilize the vessel for enhanced healing. To facilitate the repair or reconstruction of a body lumen, a balloon may be inserted into the lumen and expanded so the damaged, severed, or torn portion of the vessel is positioned against the outer surface of the inflated balloon. In this configuration, the positioning device of the present invention may be used then to approximate the damaged portion of the vessel.

Radiofrequency Identification

The devices, fasteners, and other apparatus disclosed herein may include RFID (radiofrequency identification) tags. Moreover, any surgical device, described herein or not, such as surgical instruments, implants, trays, sponges, screws, bolts, plates, knives, scalpels, etc. may include RFID emitting chips. RFID provides for inventory control before, during, and after surgery. Objects with RFID chips/tags which are located under sterile drapes or within sterile containers may be easily located without having to break the sterile environment. Also, surgical devices and instruments stored in cabinets or placed in an operating room may be scanned with an RFID receiver to help technicians and nurses quickly identify location, type, and quantity. RFID chips/tags placed on surgical objects may save significant time and money during surgery and inventory. Furthermore, matching RFID chips/tags may be placed on an instrument/device and on the tray which holds the device. Using the RF scanner/transmitter, the correct placement of the device can be determined. It is further contemplated that the kits previously described may include RFID chips/tags placed on the container and the components therein.

Surgical Tools

In another exemplary embodiment, the guidance and positioning device of the present invention may be used with pneumatic operated surgical instruments. For example, a gas-powered drill may be couple with the channel guide and/or handle of the positioning device. A surgeon may operate the drill by activating a switch to start the fluid of gas which rotates an air motor thereby rotating a drill bit. The drill may be connected to a compressed gas source with tubing. However, preferably, the drill includes a connecting port for attaching a gas cartridge or canister. Such a drill would be free from electrical and battery power and free from encumbering wires and hoses. The gas cartridge may be sized to fit within the drill body or attached externally on the drill body. The cartridge may be refillable or disposable. In addition to the drill being gas-powered, the clamping mechanism of the positioning device may be gas-powered. By activating the flow of gas, the clamp may be moved to engage and compress tissue and/or an implant, holding the tissue and/or implant in place until fasteners may be inserted. It is further contemplated that other surgical tools, such as saws, shavers, reamers, grinders, etc., may include gas cartridges as previously described. These gas-powered tools may also include a microprocessor for control and feedback.

All references cited herein are expressly incorporated by reference in their entirety.

It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described herein above. In addition, unless mention was made above to the contrary, it should be noted that all of the accompanying drawings are not to scale. A variety of modifications and variations are possible in light of the above teachings without departing from the scope and spirit of the invention.

Claims

1. A fastener system comprising: a flexible hollow fastener comprising a mesh of biocompatible fibers; anda flexible elongate fastening member configured to extend through the flexible hollow fastener, wherein legs of the flexible elongate fastening member are configured to extend from the flexible hollow fastener,wherein the flexible hollow fastener is configured to deform from a first configuration to a second configuration to secure the flexible hollow fastener in a first body tissue when at least one of the legs of the flexible elongate fastening member is tensioned relative to the body tissue,wherein the flexible elongate fastening member is configured to slide through the flexible hollow fastener under tension when the flexible hollow fastener is in the first configuration and the second configuration, andwherein the flexible elongate fastening member is configured to secure a second body tissue to the first body tissue.
2. The fastener system of claim 1, wherein the flexible hollow fastener is a suture anchor.
3. The fastener system of claim 1, wherein the flexible elongate fastening member includes a suture.
4. The fastener system of claim 1, wherein at least one leg of the flexible elongate fastening member is fixed to the flexible hollow fastener.
5. The fastener system of claim 1, further comprising a second fastener configured to connect to at least one leg of the flexible elongate fastening member and configured to at least one of retain tension in the flexible elongate fastening member and secure the flexible elongate fastening member in a position.
6. The fastener system of claim 1, wherein at least one of the flexible hollow fastener and the flexible elongate fastening member are biodegradable.
7. The fastener system of claim 1, wherein at least one of the flexible hollow fastener and the flexible elongate fastening member are biologically inductive.
8. The fastener system of claim 1, wherein at least a portion of the elongate fastening member is fabricated in part with polyethylene.
9. A fastener system comprising: a flexible hollow fastener comprising biocompatible material;a flexible elongate fastening member configured to extend through the flexible hollow fastener, wherein legs of the flexible elongate fastening member are configured to extend from the flexible hollow fastener; anda second fastener configured to connect to at least one leg of the flexible elongate fastening member,wherein the flexible hollow fastener is configured to deform from a first configuration to a second configuration to secure the flexible hollow fastener in a first body tissue when at least one of the legs of the flexible elongate fastening member is tensioned relative to the body tissue,wherein the flexible elongate fastening member is configured to slide through the secured flexible hollow fastener under tension when the flexible hollow fastener is in the first configuration and the second configuration,wherein the flexible elongate fastening member is configured to secure a second body tissue to the first body tissue, andwherein the second fastener is configured to at least one of retain tension in the flexible elongate fastening member and secure the flexible elongate fastening member in a position.
10. The fastener system of claim 9, wherein the flexible hollow fastener is a suture anchor.
11. The fastener system of claim 9, wherein the flexible elongate fastening member includes a suture.
12. The fastener system of claim 9, wherein at least one leg of the flexible elongate fastening member is fixed to the flexible hollow fastener.
13. The fastener system of claim 9, wherein at least one of the flexible hollow fastener and the flexible elongate fastening member are biodegradable.
14. The fastener system of claim 9, wherein at least one of the flexible hollow fastener and the flexible elongate fastening member are biologically inductive.
15. The fastener system of claim 9, wherein at least a portion of the elongate fastening member is fabricated in part with polyethylene.
16. A fastener system comprising: a flexible hollow fastener comprising biocompatible material; anda flexible elongate fastening member configured to extend through the flexible hollow fastener, wherein legs of the flexible elongate fastening member are configured to extend from the flexible hollow fastener,wherein the flexible hollow fastener is configured to deform from a first configuration to a second configuration to secure the flexible hollow fastener in a first body tissue when at least one of the legs of the flexible elongate fastening member is tensioned relative to the body tissue,wherein the flexible elongate fastening member is configured to slide through the secured flexible hollow fastener under tension when the flexible hollow fastener is in the first configuration and the second configuration,wherein the flexible elongate fastening member is configured to secure a second body tissue to the first body tissue, andwherein at least one of the flexible hollow fastener and the flexible elongate fastening member comprises a biodegradable material.
17. The fastener system of claim 16, wherein the flexible hollow fastener is a suture anchor.
18. The fastener system of claim 16, wherein the flexible elongate fastening member includes a suture.
19. The fastener system of claim 16, wherein at least one leg of the flexible elongate fastening member is fixed to the flexible hollow fastener.
20. The fastener system of claim 16, further comprising a second fastener configured to connect to at least one leg of the flexible elongate fastening member and configured to at least one of retain tension in the flexible elongate fastening member and secure the flexible elongate fastening member in a position.
21. The fastener system of claim 16, wherein at least one of the flexible hollow fastener and the flexible elongate fastening member are biologically inductive.
22. A fastener system comprising: a flexible hollow fastener comprising biocompatible material; anda flexible elongate fastening member configured to extend through the flexible hollow fastener, wherein legs of the flexible elongate fastening member are configured to extend from the flexible hollow fastener,wherein the flexible hollow fastener is configured to deform from a first configuration to a second configuration to secure the flexible hollow fastener in a first body tissue when at least one of the legs of the flexible elongate fastening member is tensioned relative to the body tissue,wherein the flexible elongate fastening member is configured to slide through the secured flexible hollow fastener under tension when the flexible hollow fastener is in the first configuration and the second configuration,wherein the flexible elongate fastening member is configured to secure a second body tissue to the first body tissue, andwherein at least one of the flexible hollow fastener and the flexible elongate fastening member comprises a biologically inductive material.
23. The fastener system of claim 22, wherein the flexible hollow fastener is a suture anchor.
24. The fastener system of claim 22, wherein the flexible elongate fastening member includes a suture.
25. The fastener system of claim 22, wherein at least one leg of the flexible elongate fastening member is fixed to the flexible hollow fastener.
26. The fastener system of claim 22, further comprising a second fastener configured to connect to at least one leg of the flexible elongate fastening member and configured to at least one of retain tension in the flexible elongate fastening member and secure the flexible elongate fastening member in a position.
27. The fastener system of claim 1, wherein the fastener system is knotless.
28. The fastener system of claim 9, wherein the fastener system is knotless.
29. The fastener system of claim 16, wherein the fastener system is knotless.
30. The fastener system of claim 22, wherein the fastener system is knotless.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No. 15/726,503 filed Oct. 6, 2017, issued as U.S. Pat. No. 10,376,259, which is a continuation of U.S. application Ser. No. 13/871,892 filed Apr. 26, 2013, issued as U.S. Pat. No. 9,814,453, entitled “DEFORMABLE FASTENER SYSTEM”, which is a continuation of U.S. application Ser. No. 11/202,294 filed Oct. 5, 2005, issued as U.S. Pat. No. 9,463,012, entitled “APPARATUS AND METHODS FOR SURGERY”, each of which is incorporated herein by reference in its entirety.

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4781182	Purnell	Nov 1988	A
4790303	Steffee	Dec 1988	A
4792336	Hlavacek	Dec 1988	A
4817591	Klaue	Apr 1989	A
4822224	Carl	Apr 1989	A
4823794	Pierce	Apr 1989	A
4832025	Coates	May 1989	A
4832026	Jones	May 1989	A
4834752	Van Kampen	May 1989	A
4841960	Garner	Jun 1989	A
4843112	Gerhart	Jun 1989	A
4846812	Walker	Jul 1989	A
4862882	Venturi	Sep 1989	A
4869242	Galluzzo	Sep 1989	A
4870957	Goble	Oct 1989	A
4883048	Purnell	Nov 1989	A
4890612	Kensey	Jan 1990	A
4895148	Bays	Jan 1990	A
4898156	Gatturna	Feb 1990	A
4899729	Gill	Feb 1990	A
4899744	Fujitsuka	Feb 1990	A
4901721	Hakki	Feb 1990	A
4921479	Grayzel	May 1990	A
4922897	Sapega	May 1990	A
4924866	Yoon	May 1990	A
4932960	Green	Jun 1990	A
4935026	McFadden	Jun 1990	A
4935028	Drews	Jun 1990	A
4945625	Winston	Aug 1990	A
4946468	Li	Aug 1990	A
4950285	Wilk	Aug 1990	A
4954126	Wallsten	Sep 1990	A
4955910	Bolesky	Sep 1990	A
4957498	Caspari	Sep 1990	A
4961741	Hayhurst	Oct 1990	A
4963151	Ducheyne	Oct 1990	A
4966583	Debbas	Oct 1990	A
4968315	Gatturna	Nov 1990	A
4968317	Tormala	Nov 1990	A
4969888	Scholten	Nov 1990	A
4969892	Burton	Nov 1990	A
4990161	Kampner	Feb 1991	A
4994071	MacGregor	Feb 1991	A
4997445	Hodorek	Mar 1991	A
4998539	Delsanti	Mar 1991	A
5002550	Li	Mar 1991	A
5002563	Pyka	Mar 1991	A
5009652	Morgan	Apr 1991	A
5009663	Broome	Apr 1991	A
5009664	Sievers	Apr 1991	A
5013316	Goble	May 1991	A
5019090	Pinchuk	May 1991	A
5021059	Kensey	Jun 1991	A
5035713	Friis	Jul 1991	A
5037404	Gold	Aug 1991	A
5037422	Hayhurst	Aug 1991	A
5041093	Chu	Aug 1991	A
5041114	Chapman	Aug 1991	A
5041129	Hayhurst	Aug 1991	A
5046513	Gatturna	Sep 1991	A
5047055	Bao	Sep 1991	A
5051049	Wills	Sep 1991	A
5053046	Janese	Oct 1991	A
5053047	Yoon	Oct 1991	A
5059193	Kuslich	Oct 1991	A
5059206	Winters	Oct 1991	A
5061274	Kensey	Oct 1991	A
5061286	Lyle	Oct 1991	A
5064286	Ai	Nov 1991	A
5069674	Fearnot	Dec 1991	A
5078731	Hayhurst	Jan 1992	A
5078744	Chvapil	Jan 1992	A
5078745	Rhenter	Jan 1992	A
5084050	Draenert	Jan 1992	A
5084051	Tormala	Jan 1992	A
5085660	Lin	Feb 1992	A
5085661	Moss	Feb 1992	A
5098433	Freedland	Mar 1992	A
5098434	Serbousek	Mar 1992	A
5098436	Ferrante	Mar 1992	A
5100405	McLaren	Mar 1992	A
5100417	Cerier	Mar 1992	A
5102417	Palmaz	Apr 1992	A
5102421	Anspach	Apr 1992	A
5108399	Eitenmuller	Apr 1992	A
5120175	Arbegast	Jun 1992	A
5123520	Schmid	Jun 1992	A
5123914	Cope	Jun 1992	A
5123941	Lauren	Jun 1992	A
5133732	Wiktor	Jul 1992	A
RE34021	Mueller	Aug 1992	E
5141520	Goble	Aug 1992	A
5147362	Goble	Sep 1992	A
5154720	Trott	Oct 1992	A
5156613	Sawyer	Oct 1992	A
5156616	Meadows	Oct 1992	A
5158566	Pianetti	Oct 1992	A
5158934	Ammann	Oct 1992	A
5163960	Bonutti	Nov 1992	A
5171251	Bregen	Dec 1992	A
5176682	Chow	Jan 1993	A
5179964	Cook	Jan 1993	A
5180385	Sontag	Jan 1993	A
5180388	DiCarlo	Jan 1993	A
5183464	Dubrul	Feb 1993	A
5192287	Fournier	Mar 1993	A
5192326	Bao	Mar 1993	A
5197166	Meier	Mar 1993	A
5197971	Bonutti	Mar 1993	A
5203784	Ross	Apr 1993	A
5203787	Noblitt	Apr 1993	A
5208950	Merritt	May 1993	A
5209776	Bass	May 1993	A
5217493	Raad	Jun 1993	A
5219359	McQuilkin	Jun 1993	A
5226899	Lee	Jul 1993	A
5234006	Eaton	Aug 1993	A
5234425	Fogarty	Aug 1993	A
5234443	Phan	Aug 1993	A
5236438	Wilk	Aug 1993	A
5236445	Hayhurst	Aug 1993	A
5242902	Murphy	Sep 1993	A
5254113	Wilk	Oct 1993	A
5258007	Spetzler	Nov 1993	A
5258015	Li	Nov 1993	A
5258016	DiPoto	Nov 1993	A
5261886	Chesterfield	Nov 1993	A
5266325	Kuzma	Nov 1993	A
5269783	Sander	Dec 1993	A
5269785	Bonutti	Dec 1993	A
5269809	Hayhurst	Dec 1993	A
5281235	Haber	Jan 1994	A
5282832	Toso	Feb 1994	A
5290281	Tschakaloff	Mar 1994	A
5304119	Balaban	Apr 1994	A
5306280	Bregen	Apr 1994	A
5306301	Graf	Apr 1994	A
5315741	Dubberke	May 1994	A
5318588	Horzewski	Jun 1994	A
5320611	Bonutti	Jun 1994	A
5324308	Pierce	Jun 1994	A
5328480	Melker	Jul 1994	A
5329846	Bonutti	Jul 1994	A
5329924	Bonutti	Jul 1994	A
5330468	Burkhart	Jul 1994	A
5330476	Hiot	Jul 1994	A
5330486	Wilk	Jul 1994	A
5336231	Adair	Aug 1994	A
5336240	Metzler	Aug 1994	A
5339799	Kami	Aug 1994	A
5349956	Bonutti	Sep 1994	A
5352229	Goble	Oct 1994	A
5354298	Lee	Oct 1994	A
5354302	Ko	Oct 1994	A
5366480	Corriveau	Nov 1994	A
5370646	Reese	Dec 1994	A
5370660	Weinstein	Dec 1994	A
5372146	Branch	Dec 1994	A
5374235	Ahrens	Dec 1994	A
5376126	Lin	Dec 1994	A
5382254	McGarry	Jan 1995	A
5383883	Wilk	Jan 1995	A
5383905	Golds	Jan 1995	A
5391173	Wilk	Feb 1995	A
5395308	Fox	Mar 1995	A
5397311	Walker	Mar 1995	A
5400805	Warren	Mar 1995	A
5403312	Yates	Apr 1995	A
5403348	Bonutti	Apr 1995	A
5405359	Pierce	Apr 1995	A
5411523	Goble	May 1995	A
5413585	Pagedas	May 1995	A
5417691	Hayhurst	May 1995	A
5417701	Holmes	May 1995	A
5417712	Whittaker	May 1995	A
5423796	Shikhman	Jun 1995	A
5431670	Holmes	Jul 1995	A
5439470	Li	Aug 1995	A
5441538	Bonutti	Aug 1995	A
5443512	Parr	Aug 1995	A
5447503	Miller	Sep 1995	A
5449372	Schmaltz	Sep 1995	A
5449382	Dayton	Sep 1995	A
5451235	Lock	Sep 1995	A
5453090	Martinez	Sep 1995	A
5456722	McLeod	Oct 1995	A
5458653	Davidson	Oct 1995	A
5462561	Voda	Oct 1995	A
5464424	O'Donnell	Nov 1995	A
5464426	Bonutti	Nov 1995	A
5464427	Curtis	Nov 1995	A
5470337	Moss	Nov 1995	A
5472444	Huebner	Dec 1995	A
5474554	Ku	Dec 1995	A
5478351	Meade	Dec 1995	A
5478353	Yoon	Dec 1995	A
5480403	Lee	Jan 1996	A
5486197	Le	Jan 1996	A
5487844	Fujita	Jan 1996	A
5488958	Topel	Feb 1996	A
5496292	Burnham	Mar 1996	A
5496318	Howland	Mar 1996	A
5496335	Thomason	Mar 1996	A
5496348	Bonutti	Mar 1996	A
5500000	Feagin	Mar 1996	A
5501700	Hirata	Mar 1996	A
5504977	Weppner	Apr 1996	A
5505735	Li	Apr 1996	A
5507754	Green	Apr 1996	A
5522844	Johnson	Jun 1996	A
5522845	Wenstrom	Jun 1996	A
5522846	Bonutti	Jun 1996	A
5527341	Gogolewski	Jun 1996	A
5527342	Pietrzak	Jun 1996	A
5527343	Bonutti	Jun 1996	A
5529075	Clark	Jun 1996	A
5531759	Kensey	Jul 1996	A
5534012	Bonutti	Jul 1996	A
5534028	Bao	Jul 1996	A
5540718	Bartlett	Jul 1996	A
5542423	Bonutti	Aug 1996	A
5545178	Kensey	Aug 1996	A
5545180	Le	Aug 1996	A
5545206	Carson	Aug 1996	A
5549630	Bonutti	Aug 1996	A
5549631	Bonutti	Aug 1996	A
5556402	Xu	Sep 1996	A
5569252	Justin	Oct 1996	A
5569305	Bonutti	Oct 1996	A
5569306	Thal	Oct 1996	A
5573517	Bonutti	Nov 1996	A
5573538	Laboureau	Nov 1996	A
5573542	Stevens	Nov 1996	A
5575801	Habermeyer	Nov 1996	A
5578046	Liu	Nov 1996	A
5580344	Hasson	Dec 1996	A
5584835	Greenfield	Dec 1996	A
5584839	Gieringer	Dec 1996	A
5584860	Goble	Dec 1996	A
5584862	Bonutti	Dec 1996	A
5589176	Seare	Dec 1996	A
5591206	Moufarrege	Jan 1997	A
5593422	Muijs Van de Moer	Jan 1997	A
5593425	Bonutti	Jan 1997	A
5593625	Riebel	Jan 1997	A
5601557	Hayhurst	Feb 1997	A
5601558	Torrie	Feb 1997	A
5601595	Smith	Feb 1997	A
5607427	Tschakaloff	Mar 1997	A
5609595	Pennig	Mar 1997	A
5618314	Harwin	Apr 1997	A
5620461	Muijs Van De Moer	Apr 1997	A
5626612	Bartlett	May 1997	A
5626614	Hart	May 1997	A
5626718	Philippe	May 1997	A
5628751	Sander	May 1997	A
5630824	Hart	May 1997	A
5634926	Jobe	Jun 1997	A
5643274	Sander	Jul 1997	A
5643293	Kogasaka	Jul 1997	A
5643295	Yoon	Jul 1997	A
5643321	McDevitt	Jul 1997	A
5645553	Kolesa	Jul 1997	A
5645597	Krapiva	Jul 1997	A
5645599	Samani	Jul 1997	A
5649955	Hashimoto	Jul 1997	A
5649963	McDevitt	Jul 1997	A
5651377	O'Donnell	Jul 1997	A
5658313	Thal	Aug 1997	A
5660225	Saffran	Aug 1997	A
5662658	Wenstrom	Sep 1997	A
5665089	Dall	Sep 1997	A
5665109	Yoon	Sep 1997	A
5667513	Torrie	Sep 1997	A
5669917	Sauer	Sep 1997	A
5674240	Bonutti	Oct 1997	A
5681310	Yuan	Oct 1997	A
5681333	Burkhart	Oct 1997	A
5681351	Jamiolkowski	Oct 1997	A
5681352	Clancy	Oct 1997	A
5685820	Riek	Nov 1997	A
5688283	Knapp	Nov 1997	A
5690654	Ovil	Nov 1997	A
5690655	Hart	Nov 1997	A
5690676	DiPoto	Nov 1997	A
5693055	Zahiri	Dec 1997	A
5697950	Fucci	Dec 1997	A
5702397	Goble	Dec 1997	A
5702462	Oberlander	Dec 1997	A
5707395	Li	Jan 1998	A
5713903	Sander	Feb 1998	A
5713921	Bonutti	Feb 1998	A
5718717	Bonutti	Feb 1998	A
5720747	Burke	Feb 1998	A
5720753	Sander	Feb 1998	A
5725541	Anspach	Mar 1998	A
5725556	Moser	Mar 1998	A
5725582	Bevan	Mar 1998	A
5730747	Ek	Mar 1998	A
5733306	Bonutti	Mar 1998	A
5735875	Bonutti	Apr 1998	A
5735877	Pagedas	Apr 1998	A
5735899	Schwartz	Apr 1998	A
5741282	Anspach	Apr 1998	A
5752952	Adamson	May 1998	A
5752974	Rhee	May 1998	A
5755809	Cohen	May 1998	A
5762458	Wang	Jun 1998	A
5766221	Benderev	Jun 1998	A
5769894	Ferragamo	Jun 1998	A
5772672	Toy	Jun 1998	A
5776151	Chan	Jul 1998	A
5779706	Tschakaloff	Jul 1998	A
5782862	Bonutti	Jul 1998	A
5785713	Jobe	Jul 1998	A
5792096	Rentmeester	Aug 1998	A
5797931	Bito	Aug 1998	A
5800537	Bell	Sep 1998	A
5807403	Beyar	Sep 1998	A
5810849	Kontos	Sep 1998	A
5810853	Yoon	Sep 1998	A
5810884	Kim	Sep 1998	A
5814072	Bonutti	Sep 1998	A
5814073	Bonutti	Sep 1998	A
5817107	Schaller	Oct 1998	A
5823994	Sharkey	Oct 1998	A
5824009	Fukuda	Oct 1998	A
5830125	Scribner	Nov 1998	A
5836897	Sakurai	Nov 1998	A
5839899	Robinson	Nov 1998	A
5843084	Hart	Dec 1998	A
5843178	Vanney	Dec 1998	A
5845645	Bonutti	Dec 1998	A
5851185	Berns	Dec 1998	A
5865834	McGuire	Feb 1999	A
5866634	Tokushige	Feb 1999	A
5868749	Reed	Feb 1999	A
5874235	Chan	Feb 1999	A
5879372	Bartlett	Mar 1999	A
5891166	Schervinsky	Apr 1999	A
5891168	Thal	Apr 1999	A
5893880	Egan	Apr 1999	A
5897574	Bonutti	Apr 1999	A
5899911	Carter	May 1999	A
5899921	Caspari	May 1999	A
5906579	Vander Salm	May 1999	A
5906625	Bito	May 1999	A
5908429	Yoon	Jun 1999	A
5911721	Nicholson	Jun 1999	A
5918604	Whelan	Jul 1999	A
5919193	Slavitt	Jul 1999	A
5919194	Anderson	Jul 1999	A
5919208	Valenti	Jul 1999	A
5919215	Wiklund	Jul 1999	A
5921967	Sadowski et al.	Jul 1999	A
5921986	Bonutti	Jul 1999	A
5925064	Meyers	Jul 1999	A
5928244	Tovey	Jul 1999	A
5928267	Bonutti	Jul 1999	A
5931838	Vito	Aug 1999	A
5931869	Boucher	Aug 1999	A
5940942	Fong	Aug 1999	A
5941900	Bonutti	Aug 1999	A
5941901	Egan	Aug 1999	A
5944750	Tanner	Aug 1999	A
5945002	Leukes	Aug 1999	A
5947982	Duran	Sep 1999	A
5948000	Larsen	Sep 1999	A
5948001	Larsen	Sep 1999	A
5948002	Bonutti	Sep 1999	A
5951590	Goldfarb	Sep 1999	A
5957953	DiPoto	Sep 1999	A
5961499	Bonutti	Oct 1999	A
5961521	Roger	Oct 1999	A
5961554	Janson	Oct 1999	A
5964765	Fenton	Oct 1999	A
5964769	Wagner	Oct 1999	A
5968046	Castleman	Oct 1999	A
5968047	Reed	Oct 1999	A
5980520	Vancaillie	Nov 1999	A
5980559	Bonutti	Nov 1999	A
5984929	Bashiri	Nov 1999	A
5989282	Bonutti	Nov 1999	A
5993458	Vaitekunas	Nov 1999	A
5993477	Vaitekunas	Nov 1999	A
6007567	Bonutti	Dec 1999	A
6007580	Lehto	Dec 1999	A
6010525	Bonutti	Jan 2000	A
6010526	Sandstrom	Jan 2000	A
6017321	Boone	Jan 2000	A
6033429	Magovern	Mar 2000	A
6033430	Bonutti	Mar 2000	A
6045551	Bonutti	Apr 2000	A
6050998	Fletcher	Apr 2000	A
6056751	Fenton	May 2000	A
6056772	Bonutti	May 2000	A
6056773	Bonutti	May 2000	A
6059797	Mears	May 2000	A
6059817	Bonutti	May 2000	A
6059827	Fenton	May 2000	A
6063095	Wang	May 2000	A
6066151	Miyawaki	May 2000	A
6066160	Colvin	May 2000	A
6066166	Bischoff	May 2000	A
6068637	Popov	May 2000	A
6068648	Cole	May 2000	A
6077277	Mollenauer	Jun 2000	A
6077292	Bonutti	Jun 2000	A
6080161	Eaves	Jun 2000	A
6083522	Chu	Jul 2000	A
6086593	Bonutti	Jul 2000	A
6086608	Ek	Jul 2000	A
6090072	Kratoska	Jul 2000	A
6099531	Bonutti	Aug 2000	A
6099537	Sugai	Aug 2000	A
6099550	Yoon	Aug 2000	A
6099552	Adams	Aug 2000	A
6102850	Wang	Aug 2000	A
6106545	Egan	Aug 2000	A
6117160	Bonutti	Sep 2000	A
6120511	Chan	Sep 2000	A
6120536	Ding	Sep 2000	A
6125574	Ganaja	Oct 2000	A
6126677	Ganaja	Oct 2000	A
6139320	Hahn	Oct 2000	A
RE36974	Bonutti	Nov 2000	E
6149669	Li	Nov 2000	A
6152949	Bonutti	Nov 2000	A
6155756	Mericle	Dec 2000	A
6159224	Yoon	Dec 2000	A
6159234	Bonutti	Dec 2000	A
6171299	Bonutti	Jan 2001	B1
6171307	Orlich	Jan 2001	B1
6174324	Egan	Jan 2001	B1
6179840	Bowman	Jan 2001	B1
6179850	Goradia	Jan 2001	B1
6187008	Hamman	Feb 2001	B1
6190400	Van De Moer	Feb 2001	B1
6190401	Green	Feb 2001	B1
6200322	Branch	Mar 2001	B1
6217591	Egan	Apr 2001	B1
6224593	Ryan	May 2001	B1
6224630	Bao	May 2001	B1
6228086	Wahl	May 2001	B1
6231592	Bonutti	May 2001	B1
6238395	Bonutti	May 2001	B1
6238396	Lombardo	May 2001	B1
6258091	Sevrain	Jul 2001	B1
6264675	Brotz	Jul 2001	B1
6267761	Ryan	Jul 2001	B1
6273717	Hahn	Aug 2001	B1
6280474	Cassidy	Aug 2001	B1
6286746	Egan	Sep 2001	B1
6287325	Bonutti	Sep 2001	B1
6293961	Schwartz	Sep 2001	B2
6306159	Schwartz	Oct 2001	B1
6309405	Bonutti	Oct 2001	B1
6312448	Bonutti	Nov 2001	B1
6338730	Bonutti	Jan 2002	B1
6340365	Dittrich	Jan 2002	B2
6348056	Bates	Feb 2002	B1
6358271	Egan	Mar 2002	B1
6364897	Bonutti	Apr 2002	B1
6368325	McKinley	Apr 2002	B1
6368343	Bonutti	Apr 2002	B1
6371957	Amrein	Apr 2002	B1
6409742	Fulton	Jun 2002	B1
6409743	Fenton	Jun 2002	B1
6419704	Ferree	Jul 2002	B1
6423088	Fenton	Jul 2002	B1
6425919	Lambrecht	Jul 2002	B1
6428562	Bonutti	Aug 2002	B2
6432115	Mollenauer	Aug 2002	B1
6447516	Bonutti	Sep 2002	B1
6450985	Schoelling	Sep 2002	B1
6461360	Adam	Oct 2002	B1
6468293	Bonutti	Oct 2002	B2
6475230	Bonutti	Nov 2002	B1
6488196	Fenton	Dec 2002	B1
6500195	Bonutti	Dec 2002	B2
6503259	Huxel	Jan 2003	B2
6511498	Fumex	Jan 2003	B1
6527774	Lieberman	Mar 2003	B2
6530933	Yeung	Mar 2003	B1
6535764	Imran	Mar 2003	B2
6544267	Cole	Apr 2003	B1
6545390	Hahn	Apr 2003	B1
6547792	Tsuji	Apr 2003	B1
6551304	Whalen	Apr 2003	B1
6551343	Törmälä	Apr 2003	B1
6554852	Oberlander	Apr 2003	B1
6557426	Reinemann	May 2003	B2
6558390	Cragg	May 2003	B2
6568313	Fukui	May 2003	B2
6569187	Bonutti	May 2003	B1
6572635	Bonutti	Jun 2003	B1
D477776	Pontaoe	Jul 2003	S
6585750	Bonutti	Jul 2003	B2
6585764	Wright	Jul 2003	B2
6592609	Bonutti	Jul 2003	B1
6594517	Nevo	Jul 2003	B1
6602293	Biermann	Aug 2003	B1
6605090	Trieu	Aug 2003	B1
6610080	Morgan	Aug 2003	B2
6618910	Pontaoe	Sep 2003	B1
6623486	Weaver	Sep 2003	B1
6623487	Goshert	Sep 2003	B1
6626944	Taylor	Sep 2003	B1
6632245	Kim	Oct 2003	B2
6635073	Bonutti	Oct 2003	B2
6638279	Bonutti	Oct 2003	B2
6641592	Sauer	Nov 2003	B1
6645227	Fallin	Nov 2003	B2
6666877	Morgan	Dec 2003	B2
6669705	Westhaver	Dec 2003	B2
6679888	Green	Jan 2004	B2
6685750	Plos	Feb 2004	B1
6699240	Francischelli	Mar 2004	B2
6702821	Bonutti	Mar 2004	B2
6705179	Mohtasham	Mar 2004	B1
6709457	Otte	Mar 2004	B1
6719765	Bonutti	Apr 2004	B2
6719795	Cornwall	Apr 2004	B1
6719797	Ferree	Apr 2004	B1
6722552	Fenton	Apr 2004	B2
6733531	Trieu	May 2004	B1
6764514	Li	Jul 2004	B1
6770078	Bonutti	Aug 2004	B2
6780198	Gregoire	Aug 2004	B1
6786989	Torriani	Sep 2004	B2
6796003	Marvel	Sep 2004	B1
6818010	Eichhorn	Nov 2004	B2
6823871	Schmieding	Nov 2004	B2
6830589	Erickson	Dec 2004	B2
6860885	Bonutti	Mar 2005	B2
6878167	Ferree	Apr 2005	B2
6890334	Brace	May 2005	B2
6893434	Fenton	May 2005	B2
6899722	Bonutti	May 2005	B2
6913666	Aeschlimann	Jul 2005	B1
6916321	TenHuisen	Jul 2005	B2
6921264	Mayer	Jul 2005	B2
6923824	Morgan	Aug 2005	B2
6932835	Bonutti	Aug 2005	B2
6942684	Bonutti	Sep 2005	B2
6944111	Nakamura	Sep 2005	B2
6955540	Mayer	Oct 2005	B2
6955683	Bonutti	Oct 2005	B2
6958077	Suddaby	Oct 2005	B2
6981983	Rosenblatt	Jan 2006	B1
6997940	Bonutti	Feb 2006	B2
7001411	Dean	Feb 2006	B1
7004959	Bonutti	Feb 2006	B2
7008226	Mayer	Mar 2006	B2
7018380	Cole	Mar 2006	B2
7033379	Peterson	Apr 2006	B2
7048755	Bonutti	May 2006	B2
7066960	Dickman	Jun 2006	B1
7087073	Bonutti	Aug 2006	B2
7090111	Egan	Aug 2006	B2
7094251	Bonutti	Aug 2006	B2
7104996	Bonutti	Sep 2006	B2
7128763	Blatt	Oct 2006	B1
7147652	Bonutti	Dec 2006	B2
7160405	Aeschlimann	Jan 2007	B2
7179259	Gibbs	Feb 2007	B1
7192448	Ferree	Mar 2007	B2
7217279	Reese	May 2007	B2
7217290	Bonutti	May 2007	B2
7241297	Shaolian	Jul 2007	B2
7250051	Francischelli	Jul 2007	B2
7252685	Bindseil	Aug 2007	B2
7273497	Ferree	Sep 2007	B2
7326200	Trieu	Feb 2008	B2
7329263	Bonutti	Feb 2008	B2
7335205	Aeschlimann	Feb 2008	B2
7429266	Bonutti	Sep 2008	B2
7445634	Trieu	Nov 2008	B2
7481825	Bonutti	Jan 2009	B2
7481831	Bonutti	Jan 2009	B2
7510895	Raterman	Mar 2009	B2
7597705	Forsberg	Oct 2009	B2
7854750	Bonutti	Dec 2010	B2
7879072	Bonutti	Feb 2011	B2
7891691	Bearey	Feb 2011	B2
7967820	Bonutti	Jun 2011	B2
8128669	Bonutti	Mar 2012	B2
8140982	Hamilton	Mar 2012	B2
8147514	Bonutti	Apr 2012	B2
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Continuations (3)

	Number	Date	Country
Parent	15726503	Oct 2017	US
Child	16510484		US
Parent	13871892	Apr 2013	US
Child	15726503		US
Parent	11202294	Oct 2005	US
Child	13871892		US

Deformable fastener system

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