Filamentary fixation device

Information

  • Patent Grant
  • 10448944
  • Patent Number
    10,448,944
  • Date Filed
    Monday, August 22, 2016
    8 years ago
  • Date Issued
    Tuesday, October 22, 2019
    5 years ago
Abstract
One embodiment of the present invention includes a filamentary fixation system including a sleeve formed of filamentary material including an interior and an exterior surface along a length defined between a first end and a second end, the sleeve having a coating adapted to allow for tissue ingrowth, and a filament formed of filamentary material including a first free end and a second free end, and a length therebetween, at least a portion of the filament positioned within the interior of the sleeve.
Description
BACKGROUND OF THE INVENTION

Traditional fixation devices, such as suture anchors or tissue anchors, are typically made of metal or hard plastic, and include a structure which connects or otherwise secures a filament, such as a suture, or a portion of tissue, to the body of the device. In certain applications, these devices have a diameter suitable to hold the devices within a bone. Such devices may also include additional structures to dig into the bone, such as wings, barbs, threads, or the like.


However, such traditional devices tend to be large in diameter, and must include sufficient material, or other additional structures, to withstand the forces pulling against the device, whether via a suture or directly against the device itself. The size of such devices may limit the possible implantation locations in the body, as sufficient bone mass is required to accommodate the device. Moreover, a large hole must be drilled into the bone to allow for passage of the device through the cortical layer and into the cancellous bone. The larger drill holes may be too invasive resulting in excessive loss of healthy bone, or creation of a large repair site, resulting in prolonged recovery time and higher incidence of infection and other complications.


A recent trend in fixation device technology is the “soft” device, also referred to as an “all-suture” fixation device, in which the device itself is constructed of suture-like material. Such all-suture fixation devices may provide solutions to the various problems encountered with traditional devices, as summarized above.


BRIEF SUMMARY OF THE INVENTION

The present invention concerns, generally, a soft fixation device constructed substantially of filamentary material, such as suture or other thread-like material, which is capable of providing high pull-out strength while requiring a small surgical site (e.g., bone hole) as compared to traditional fixation devices. The present invention also includes various embodiments of such soft fixation devices, methods of insertion and related instrumentation, systems and kits. While the majority of embodiments disclosed herein relate to the use of the fixation device of the present invention as a suture anchor for placement in bone, other uses of the fixation device are also possible, many of which are also described herein.


In one embodiment, the present invention includes a fixation device including a sleeve member including an interior and an exterior surface along a length defined between a first end and a second end, and at least two openings positioned along the length and extending from the interior and through the exterior surface; and a filament including a first end and a second end and a length therebetween, the filament positioned relative to the sleeve member such that the filament enters through the first end and into the interior, exits the sleeve member through one of the openings on the exterior surface of the sleeve, re-enters the sleeve member through the other opening on the exterior surface and into the interior, and exits the interior through the second end of the sleeve member. The sleeve member may also be substantially hollow. The filament may further be adapted to be slidable through the interior of the sleeve.


Additionally, the exterior surface of the sleeve member may have at least four openings positioned along its length, such that the filament may enter the interior through the first end, exit the sleeve member through one of the openings on the exterior surface, re-enter the sleeve member through a second opening on the exterior surface and into the interior, exit the sleeve member through a third opening on the exterior surface, re-enter the sleeve member through a fourth opening on the exterior surface and into the interior, and exit the interior through the second end of the sleeve member. Moreover, the exterior surface of the sleeve member may have at least six openings positioned along its length, such that the filament may enter the interior through the first end, exit the sleeve member through one of the openings on the exterior surface, re-enter the sleeve member through a second opening on the exterior surface and into the interior, exit the sleeve member through a third opening on the exterior surface, re-enter the sleeve member through a fourth opening on the exterior surface and into the interior, exit the sleeve member through a fifth opening on the exterior surface, re-enter the sleeve member through a sixth opening on the exterior surface and into the interior, and exit the interior through the second end of the sleeve member.


The sleeve may further be pliable and also expandable or compressible. The filament may also be adapted to be slidable through the sleeve member when the sleeve member is expanded or compressed. The filament may not overlap itself within the interior of the sleeve member. The filament may pass through the interior of the sleeve member in a single direction along the length of the sleeve member.


Moreover, at least one of the filament and the interior may include a coating adapted to improve sliding of the filament through the interior. The exterior surface of the sleeve may also include a coating which may be adapted to allow for tissue ingrowth. The filament may also include a coating adapted to promote healing in adjacent tissue. The filament may also include an at least one indicating marker along its length. Further, the filament may also include multiple colors or patterns along its length, wherein the filament may include one color along a portion of the filament and a second color along another portion of the filament, wherein the colors may provide a distinguishing feature between the two portions of the filament.


In another embodiment, the present invention may include a sleeve member including an interior and an exterior surface along a length defined between a first end and a second end, and at least two openings positioned along the length and extending from the interior and through the exterior surface; and a filament including a first free end and a second free end and a length therebetween, the filament positioned relative to the sleeve member such that the free ends extend from the sleeve member at the first and second ends of the sleeve member, the filament being disposed inside the interior from the first end to a first opening, outside the sleeve member from the first opening to a second opening, and inside the interior from the second opening to the second end of the sleeve member. The sleeve member may further be substantially hollow.


Moreover, the exterior surface of the sleeve member may have at least four openings positioned along its length, such that the filament may be disposed inside the interior from the first end to a first opening, outside the sleeve member from the first opening to a second opening, inside the interior from the second opening to a third opening, outside the sleeve member from the third opening to a fourth opening, and inside the interior from the fourth opening to the second end of the sleeve member. Alternatively, the exterior surface of the sleeve member may have at least six openings positioned along its length, such that the filament may be disposed inside the interior from the first end to a first opening, outside the sleeve member from the first opening to a second opening, inside the interior from the second opening to a third opening, outside the sleeve member from the third opening to a fourth opening, inside the interior from the fourth opening to a fifth opening, outside the sleeve member from the fifth opening to a sixth opening, and inside the interior from the sixth opening to the second end of the sleeve member.


The filament may further be adapted to be slidable through the interior of the sleeve member. At least one of the filament and sleeve member may also include a coating. For example, at least one of the filament and the interior may include a coating adapted to improve sliding of the filament through the interior. In addition to, or alternatively, the exterior surface of the sleeve may include a coating adapted to allow for tissue ingrowth. Further, the filament may include a coating adapted to promote healing in adjacent tissue.


Moreover, the sleeve member may be pliable and maybe expandable or compressible, wherein the filament may be adapted to be slidable through the sleeve member when the sleeve member is expanded or compressed.


Also, the filament may pass through the interior of the sleeve member in a single direction along the length of the sleeve member. The filament may further include an at least one indicating marker along its length. The filament may further include one color along a portion of the filament and a second color along another portion of the filament, wherein the colors provide a distinguishing feature between the two portions of the filament.


In yet another embodiment, the present invention may include a fixation device including a sleeve member including a length, an interior and an exterior surface defined along the length, and at least two openings positioned along the length through the exterior surface; and a filament comprising a first end and a second end and a length therebetween, the filament positioned relative to the sleeve member such that the filament exits the sleeve member through one of the openings on the exterior surface of the sleeve and re-enters the sleeve member through the other opening on the exterior surface and into the interior such that the filament passes through the interior of the sleeve member in a single direction and is adapted to be slidable through the interior of the sleeve member along the length of the filament. The sleeve member may also be substantially hollow and may further include a first end and a second end at respective ends of the length, and the filament may thus enter the interior of the sleeve member through the first end and exit through the second end.


Additionally, the exterior surface of the sleeve member may have at least four openings positioned along its length, such that the filament may enter the interior through the first end, exit the sleeve member through one of the openings on the exterior surface, re-enter the sleeve member through a second opening on the exterior surface and into the interior, exit the sleeve member through a third opening on the exterior surface, re-enter the sleeve member through a fourth opening on the exterior surface and into the interior, and exit the interior through the second end of the sleeve member. Moreover, the exterior surface of the sleeve member may have at least six openings positioned along its length, such that the filament may enter the interior through the first end, exit the sleeve member through one of the openings on the exterior surface, re-enter the sleeve member through a second opening on the exterior surface and into the interior, exit the sleeve member through a third opening on the exterior surface, re-enter the sleeve member through a fourth opening on the exterior surface and into the interior, exit the sleeve member through a fifth opening on the exterior surface, re-enter the sleeve member through a sixth opening on the exterior surface and into the interior, and exit the interior through the second end of the sleeve member.


In a further embodiment, the present invention may include a fixation device including a sleeve member including an interior and an exterior surface along a length defined between a first end and a second end, and at least two openings positioned along the length and extending from the interior and through the exterior surface; and a filament including a first end and a second end, a length therebetween, and an at least one indicating marker positioned along its length, the filament positioned relative to the sleeve member such that the filament enters through the first end and into the interior, exits the sleeve member through one of the openings on the exterior surface of the sleeve, re-enters the sleeve member through the other opening on the exterior surface and into the interior, and exits the interior through the second end of the sleeve member. The sleeve member may also be substantially hollow. The filament may further be adapted to be slidable through the interior of the sleeve. The indicating marker may be adapted to provide guidance to an operator that proper deployment of the device has occurred.


In yet a further embodiment, the present invention may include a fixation device including a sleeve member including an interior and an exterior surface along a length defined between a first end and a second end, and at least two openings positioned along the length and extending from the interior and through the exterior surface; and a filament including a first end and a second end and a length therebetween, the filament positioned relative to the sleeve member such that the filament enters through the first end into the interior, sequentially exits and re-enters the sleeve member through consecutive openings on the exterior surface of the sleeve, and exits the interior through the second end of the sleeve member such that the filament is disposed outside of the sleeve member in X regions along the length of the sleeve member, is disposed inside the interior in X+1 regions along the length or the sleeve member, and passes through openings numbering 2X, wherein X≥1. The sleeve member may also be substantially hollow. The filament may further be adapted to be slidable through the interior of the sleeve.


In another embodiment, the present invention may include a system including a fixation device including a sleeve member including an interior and an exterior surface along a length defined between a first end and a second end, and at least two openings positioned along the length and extending from the interior and through the exterior surface; and a filament including a first end and a second end, and a length therebetween, the filament positioned relative to the sleeve member such that the filament enters through the first end and into the interior, exits the sleeve member through one of the openings on the exterior surface of the sleeve, re-enters the sleeve member through the other opening on the exterior surface and into the interior, and exits the interior through the second end of the sleeve member; and an inserter. The inserter may include a distal tip which engages a portion of the fixation device. Further, the distal tip may engage, directly, both a portion of the sleeve and a portion of the filament which has exited the sleeve member through one of the openings.


In yet another embodiment, the present invention may include a method for securing a filament in a hole in a bone, including: accessing the bone and preparing a bone hole; inserting a fixation device into the bone hole, the device including a sleeve member including an interior and an exterior surface along a length defined between a first end and a second end, and at least two openings positioned along the length through the exterior surface; and a filament including a first end and a second end and a length therebetween, the filament positioned relative to the sleeve member such that the filament enters through the first end and into the interior, exits the sleeve member through one of the openings on the exterior surface of the sleeve, re-enters the sleeve member through the other opening on the exterior surface and into the interior, and exits the interior through the second end of the sleeve member; and compressing the sleeve member within the bone hole. As to the compressing step, the two ends of the filament may be pulled. Alternatively, the compressing step may include sequentially pulling on one end of the filament and pulling on the other end of the filament. This method may further include the step of adjusting the filament by pulling on at least one of the two ends of the filament to slide the filament through the sleeve member. Further, the step of compressing the sleeve member may change the shape of the sleeve member from a substantially U-shape to a substantially W-shape. In a further step, this method may include using the filament secured in bone to thereby secure tissue to the bone, including the steps of passing at least one end of the filament through the tissue and securing the tissue to the bone by securing the filament thereto. The filament may be secured to the tissue, to thereby secure the tissue to bone, through a knot or the like.


In a further embodiment, the present invention may include a method for securing a tissue to a bone, including: accessing the bone and preparing a bone hole; inserting a fixation device into the bone hole, the device including a sleeve member having an interior and an exterior surface along a length defined between a first end and a second end, and at least two openings positioned along the length through the exterior surface; and a filament including a first end and a second end and a length therebetween, the filament positioned relative to the sleeve member such that the filament enters through the first end and into the interior, exits the sleeve member through one of the openings on the exterior surface of the sleeve, re-enters the sleeve member through the other opening on the exterior surface and into the interior, and exits the interior through the second end of the sleeve member; pulling on the two ends of the filament to compress the sleeve member within the bone hole; adjusting the filament by pulling on at least one of the two ends of the filament; passing at least one end of the filament through the tissue; and securing the tissue to the bone by securing the filament thereto. The tissue may be a portion of a rotator cuff, a portion of a shoulder labrum, a portion of a hip labrum, or another soft tissue, any of which may be reattached to the bone at a reattachment site at or adjacent to the bone hole. This device can also be deployed into soft tissue to secure soft tissue to soft tissue such as meniscal repair or the like. Furthermore, this device can also be deployed into bone to secure bone to bone such as fracture fixation or the like.





BRIEF DESCRIPTION OF THE DRAWINGS


FIG. 1 illustrates one embodiment of a fixation device of the present invention.



FIG. 2 illustrates the fixation device of FIG. 1 after tensioning of the filament 20.



FIG. 3A illustrates one embodiment of a method of insertion of the fixation device of FIG. 1, wherein the fixation device is positioned within a hole prepared in a bone; FIG. 3B illustrates the fixation device of FIGS. 1 and 2, in which the filament 20 is tensioned and the fixation device is compressed; and FIG. 3C illustrates potential migration of the fixation device proximally, towards the cortical bone.



FIG. 4 illustrates one embodiment of a method of insertion of the fixation device of FIGS. 1 and 2, in which an insertion tool is used to implant the fixation device within a hole prepared in a bone.



FIG. 5 illustrates another embodiment of a fixation device of the present invention.



FIG. 6 illustrates the fixation device of FIG. 5 after tensioning the filament 120.



FIGS. 7A-C illustrate a further embodiment of a fixation device of the present invention.



FIGS. 8A-B illustrate an alternative configuration of the fixation device of FIGS. 7A-C.



FIGS. 9A-C illustrate yet another embodiment of a fixation device of the present invention.



FIGS. 10A-C illustrate another embodiment of a fixation device of the present invention.



FIGS. 11A-C illustrate a further embodiment of a fixation device of the present invention.



FIGS. 12A-C illustrate an additional embodiment of a fixation device of the present invention.



FIGS. 13A-C illustrate yet another embodiment of a fixation device of the present invention.



FIGS. 14A-C illustrate a further embodiment of a fixation device of the present invention.



FIGS. 15A-C illustrate still another embodiment of a fixation device of the present invention.



FIGS. 16A-C illustrate another embodiment of a fixation device of the present invention.





DETAILED DESCRIPTION

The fixation device, and associated systems, kits and methods, of the present invention are intended for use in tissue, such as bone or soft tissue. Soft tissue may be, for example, meniscus, cartilage, ligaments and tendons, or the like. While many of the exemplary methods disclosed herein are directed towards its use as a suture anchor for implantation into a bone hole, other uses, some of which are described herein, are also envisioned. As used herein, “proximal” or “proximally” means closer to or towards an operator, e.g., surgeon, while “distal” or “distally” means further from or away from the operator.


In a first embodiment, illustrated in FIGS. 1 and 2, the fixation device 10 of the present invention includes a sleeve member 11 and a filament 20. The sleeve member 11 includes an interior 15 and an exterior surface 16, both of which extend along a length defined between a first end 14 and a second end 13. The sleeve member 11 may be substantially hollow. The exterior surface also includes at least two openings 12c, 12d positioned along the length of the exterior surface 16, each of which form a passageway through the exterior surface and into the interior 15. As illustrated, though, the exterior surface may include more than two openings, and may include four openings (for example, 12a, 12b, 12e, 12f), six openings (for example, 12a, 12b, 12c, 12d, 12e, 12f), or any other number of openings in any configuration positioned along the length of the exterior surface. The various openings 12 may be prepared, for example, during the weaving process forming the sleeve 11 or, alternatively, the openings may be formed after the sleeve has been woven, such as by the use of a needle, knife, or other tool capable of forming the openings.


The filament 20 includes a length and at least a portion of the length of the filament is positioned within the interior 15 of sleeve 11. The filament also includes first and second free ends 21, 22. The filament is slidable within the interior 15. The filament may also pass through at least one of the openings 12 along the exterior surface 16 of the sleeve 11. For example, as in FIG. 1, filament 20 may exit the interior 15 through opening 12c and re-enter the interior through opening 12d.


In one embodiment, the fixation device 10 of the present invention may include a sleeve member 11 including an interior 15 and an exterior surface 16 along a length defined between a first end 14 and a second end 13, and at least two openings 12 positioned along the length and extending from the interior and through the exterior surface; and a filament 20 including a first free end 22 and a second free end 21 and a length therebetween, the filament positioned relative to the sleeve member such that the free ends extend from the sleeve member at the first and second ends of the sleeve member, the filament being disposed inside the interior from the first end 14 to a first opening 12a, outside the sleeve member from the first opening to a second opening 12b, and inside the interior from the second opening to the second end 13 of the sleeve member. The sleeve member may further be substantially hollow.


Put another way, in one embodiment, the present invention may include a fixation device including a sleeve member including an interior and an exterior surface along a length defined between a first end and a second end, and at least two openings positioned along the length and extending from the interior and through the exterior surface; and a filament including a first end and a second end and a length therebetween, the filament positioned relative to the sleeve member such that the filament enters through the first end into the interior, sequentially exits and re-enters the sleeve member through consecutive openings on the exterior surface of the sleeve, and exits the interior through the second end of the sleeve member such that the filament is disposed outside of the sleeve member in X regions along the length of the sleeve member, is disposed inside the interior in X+1 regions along the length or the sleeve member, and passes through openings numbering 2X, wherein X≥1. The various exemplary embodiments illustrated in this application show that, for example, X=2 (as in FIGS. 5-6, for example); X=3 (as in FIGS. 1-4, 7-13 and 16, for example); X=4 (as in FIGS. 14A-C, for example); X=5 (as in FIGS. 15A-C).


The filament 20 may be, for example, a length of suture or other such material. The filament may be substantially hollow or substantially solid, and may further have a substantially round or substantially flat (e.g., tape) shape. The filament may also include, for example, a relatively stiff portion, relative to the rest of the filament, which can provide beneficial uses such as for simpler threading through small devices, such as a fixation device like a ReelX suture anchor (Stryker Endoscopy, San Jose, Calif.), or to provide a stiff portion which may be pushed through a cannula or other instrument, such as a suture passer. The sleeve 11 may also be, for example, a suture or other such material that is substantially hollow forming the interior 15. The sleeve, like the filament, may also include a stiff portion or portions which may provide for better placement on an inserter, such as by helping the sleeve to fold around the end of the inserter. Both the sleeve and the filament may be constructed by known means, such as by braiding multiple filaments together, as is the normal manufacturing process of sutures and the like. Either or both of the filament and sleeve may be constructed of synthetic material (e.g., PLGA, UHMWPE, or the like) or of organic material (silk, animal tendon, or the like).


The filament 20 may also optionally include at least one indicating marker 17a, 17b, 17c and 17d which may indicate to an operator, such as a surgeon, whether or not the device 10 is properly positioned and/or compressed, as will be explained in greater detail below. The indicating marker may be, for example, a spot (as illustrated), a radial ring, a portion having a differing color from the rest of the filament, or the like. In another example, the indicating markers 17a-d of the filament 20 may be a portion of the filament 20 being of a different color than the rest of the filament. In this example, the portion of filament 20 between reference numbers 17a and 17b, and between 17c and 17d, may be of a different color than the remainder of the filament 20. Such contrasting colors of these portions may provide a clear indication to the operator when performing a surgical procedure, and may be of particular use in arthroscopic procedures.


Further, the filament 20 may also include a color or other pattern along its length. For example, the filament 20 may be of a certain color such that an operator may know which suture, among numerous others which may be present at the surgical site, is the filament 20. Moreover, filament 20 may have multiple colors or patterns along its length, other than those represented as the at least one indicating marker. For example, one half of the filament 20 may be one color, and the other half of the filament may be a different color. If the particular surgery requires that the two ends of filament 20 be tied together, such as by a slip knot, the two different colors may assist the operator in knowing which half of the filament should be used as the post and which half should be used to tie the slip knot around the post. Such a decision would be based on the particular surgical procedure being performed. Of course, the two differing colors may cover different amount of the length of the filament, however, the differing colors may be most useful if they cover at least the two free ends or end portions 21, 22 of the filament such that an operator can easily differentiate between the two lengths of the filament.


The sleeve has a diameter at least as large as the filament such that the sleeve has an inner diameter of sufficient size to allow the filament to pass therethrough and be slidable therein. Various arrangements of sizes of filament and sleeve are envisioned, so long as the filament remains slidable through the sleeve. For example, in one embodiment, the filament 20 may be a #2 suture while the device 10, positioned on an inserter, may have a diameter of about 1.2 mm. In one exemplary use of the device, where the device is positioned within a bore hole in tissue, such as bone, this sized device 10 may be positioned within a bore hole in tissue having a diameter of about 0.8-1.6 mm, preferably about 1.20-1.45 mm. In an alternative embodiment of the device 10, two filaments 20 may be included within a single sleeve 11, where the filaments are both #2 suture and the device 10, positioned on an inserter, may have a diameter of about 1.8-2.6 mm, and preferably about 1.9 mm. This sized device may also be positioned, for example, within a bore hole in tissue having a diameter of about 1.5-3.0 mm, preferably about 1.9-2.3 mm. This size of a bore hole may also be used for an alternative embodiment of the device 10 including three filaments 20 within a single sleeve 11. During use, the sleeve, being a length of filamentary material, may stretch or otherwise expand such that the effective diameter of the sleeve may be larger than the examples provided above. Of course, many other configurations of filament and sleeve sizes are envisioned depending on the surgical location and procedure.


Additionally, the sleeve is flexible and is further expandable and compressible which may allow the sleeve, upon tensioning of the filament to, for example, adjust from a substantially U-shape (e.g, FIGS. 1, 3A) and compact or crush, or otherwise compress, to a substantially W-shape (e.g., FIGS. 2, 3B-C). As the sleeve compresses, the diameter of the sleeve may increase and the height of the sleeve may decrease. This shape change during compression provides for increased pullout strength as the sleeve further engages the cancellous bone and/or cortical bone in this compressed shape, as seen for example in FIGS. 3B-C.


The pullout strength may also depend on the positioning of the openings 12 along the sleeve, and particularly, the positioning of the middle openings, which are positioned toward the base of the U-shape, prior to compression of the sleeve, and which, during compression, assist in forming the W-shape of the sleeve. For example, as to the embodiment of FIGS. 1-4, the openings 12c and 12d may be spaced apart at a distance such that at least 3 mm of filament spans the distance between the openings 12c, 12d, and more preferably, at least 6 mm of filament span the distance between the openings 12c, 12d. Such distance between openings 12c, 12d may allow for a larger amount of sleeve material to be present between the openings, such that as the sleeve is compressed, this larger amount of material creates a W-shape, as in FIG. 3B-C, which may affect an increased pullout strength of the device. If less than 3 mm of filament spans between openings 12c, 12d, there will also be less sleeve material between the openings, which may result in decreased pullout strength due to less material forming the middle of the compressed W-shape. Moreover, as discussed in greater detail below, the span of filament, outside of the sleeve, between openings 12c and 12d may allow for better seating on an insertion device 30 (FIG. 4) such that, for example, the device 10 may fit through a smaller bore hole in a tissue than if the filament were positioned within the sleeve between openings 12c and 12d.


Similarly, the openings near the ends of the sleeve, for example, openings 12a, 12f of FIG. 1, may be positioned at least 3 mm from the ends 13, 14 of the sleeve to maintain sleeve strength. If the openings 12a, 12f are placed too close to the ends, such as less than 3 mm away from the ends, the sleeve may break during compression, which may result in decreased pullout strength.


The fixation device is constructed, in one embodiment, by weaving two separate filament-like structures, the sleeve 11 and the filament 20, using known materials (such as sutures or the like) in a specific weaving process. In one example, a needle (not shown) may be used to pass the filament 20 (attached to the needle) through the interior 15 of the sleeve, from the first end 14 to the second end 13. The filament may be directed through the various openings 12 through the sleeve 11 and finally be pulled out through the second end 14. Following assembly, the fixation device 10 is now ready for packaging, sterilization, and subsequent use. In order to allow for proper sliding of the filament 20 through the sleeve 11, the filament may be passed through the interior of the sleeve such that the filament does not overlap itself, as can be seen in the various embodiments illustrated in the figures. As can also be seen in the various figures, in order to allow for the sliding of the filament 20, the filament is passed through the interior of the sleeve member in a single direction along the length of the sleeve member. Such configurations of the sleeve and filament may provide decreased friction between the sleeve and filament such that the filament has an increased ability to slide, even when the sleeve is compressed.


Sliding of the filament 20 within the sleeve 11 may be improved through the introduction of a coating on at least one of the interior 15 of the sleeve and the filament 20. Suitable coatings may include PTFE or the like which minimizes friction between the filament and the sleeve and improves sliding.


Other coatings may also be applied to at least one of the filament and sleeve. For example, the exterior surface 16 of the sleeve 11 may have a coating suitable for allowing tissue ingrowth. Such a suitable coating may be hydroxyapatite powder or tricalcium phosphate for promoting bone ingrowth. Other coatings may include collagen-based additives, platelet-rich plasma, bioactive glass, or the like, to be used depending on the type of tissue into which the device 10 is being placed.


The device 10 may be positioned on an inserter 30 which may assist an operator in positioning the device within a bone hole. The inserter 30 may include a distal end 31 on which the device 10 is positioned. The distal end 31 may be a blunt end, as illustrated in FIG. 4. Alternatively, the inserter distal end may be a forked end, such that the sleeve 11 nests within the fork, or may have an active clamping structure, similar to a forceps or the like, which can optionally engage or disengage the sleeve 11 as needed. Of course, the distal end 31 must have a sufficiently small size to maintain the usefulness of the small diameters of the fixation device, and the intended benefit of the device being implanted into a smaller diameter bone hole, particularly when the fixation device is to be implanted using an arthroscopic technique.


Furthermore, as illustrated in FIG. 4, this embodiment of fixation device may provide for better loading onto an inserter due to at least the relationship between the sleeve and the filament between openings 12c and 12d. Specifically, because the filament is outside the sleeve between these openings, the device may be more easily loaded onto the inserter because the sleeve and filament can be stacked atop one another. Additionally, for example, such a setup may allow the operator to prepare an even smaller tissue hole for implantation of the device 10 since the device, between openings 12c and 12d, has an even smaller diameter than, for example, other embodiments, such as for example the embodiment of FIGS. 5 and 6, where the filament 120 is inside the sleeve between openings 112b and 112c, such that the sleeve and filament are instead, effectively, a single larger structure.


As mentioned above, other embodiments of the fixation device may include a single sleeve having two or more filaments positioned within its interior. In one example of a sleeve having two filaments positioned therethrough, a first filament may, similar to filament 20 of FIG. 1, pass through the various openings of the sleeve. The second filament, however, may either also pass through the openings of the sleeve, or stay within the interior of the sleeve along the entire length of the sleeve. In a further example, where three sutures are positioned within a single sleeve, the first filament may pass through the sleeve, and openings, therein, as illustrated in FIG. 1. The second filament may either stay entirely within the interior of the sleeve along the length of the sleeve or may also pass through the openings of the sleeve, as in FIG. 1. The third filament may also either stay entirely within the interior of the sleeve along the length of the sleeve or may also pass through the openings of the sleeve, as in FIG. 1. Of course, further alternative arrangements are envisioned, including, for example, arrangements where one of the filaments only passes through a couple of the openings present in the sleeve.


In use, one embodiment of which is illustrated in FIGS. 1-3, the sleeve 11 may be used in a method of anchoring a filament 20 in a bone. Using a drill and drill guide (not shown), such as that found in U.S. application Ser. No. 12/821,504, filed Jun. 23, 2010, the entirety of which is incorporated by reference herein as if fully set forth herein, or other drill and drill guide known in the art, a drill hole 51 is prepared in bone 50 where it is desired to anchor a filament 20. The drill and drill guide may include a laser etching, or similar marking, or alternatively a hard stop between the drill and drill guide, to ensure proper drilling depth. For example, the hole may be prepared in the shoulder joint to repair labral tissue which has separated from the glenoid. The diameter of the hole may be, for example, about equal to the diameter of the sleeve itself, such that, the device, folded on itself, will compress and fit snuggly within the bone hole, even prior to deployment of the device, as will be discussed below. Thus, for example, for a 1.2 mm sleeve, the drill hole may have a diameter of about 1.2 mm, and for a 1.8 mm sleeve, the diameter of the drill hole may be about 1.8 mm. Such matching of drill hole to device diameter may create a press-fit connection between the device the bone hole, providing initial contact between the device and the bone, prior to deployment of the device. The depth of the drill hole is dependent on the particular anatomy in which the device is to be implanted, but the depth may be, for example, typically between about 13-25 mm. In any event, the drill hole should pass through the cortical bone and enter into the cancellous bone 52. It should be noted that, if a straight guide, as is known in the art, is used, then these measurements should be used, depending on the size of the sleeve. However, if a curved guide is used, such as the above guide incorporated by reference, then the operator may, optionally, wish to make the bore hole slightly larger to ensure placement of the sleeve completely into the bore hole upon exiting the curved guide. As discussed below, upon deployment of the device, sufficient contact between the bone hole and the device may still be achieved to attain required pullout strength.


Once the hole is prepared, the drill is removed from the drill guide, and the drill guide may remain firmly in place at the bone hole. The device 10, positioned on an insertion tool 30, may then be passed through the drill guide (not shown) and to the hole in the bone, as illustrated in FIG. 4, for example. The sleeve 11 is then pressed into the bone hole, with the filament 20 positioned through the interior as illustrated, and may optionally be placed in the bone hole by lightly malleting using a mallet or like instrument to firmly seat the sleeve in the bone hole. Optionally, the inserter may have a laser etching, or other marking, which may assist the operator in accomplishing a proper insertion depth into the bone hole. At this point in the procedure, as illustrated in FIGS. 3A and 4, the device 10 is substantially folded in half within the bone hole, such that the two halves contact the bone hole side walls along a portion of their length. Such initial contact may achieve a press-fit engagement between the bone hole and the device such that the device is frictionally engaged by the bone hole which may provide initial friction to maintain the device within the bone hole, particularly, as below, when the inserter 30 is being removed from the bone hole. As in FIG. 3A, the fixation device may be placed as deeply as possible into the bone hole such that a portion of it may contact the floor of the bone hole. While not necessary, such placement may allow for maximum room for any potential upward migration of the fixation device within the bone hole.


Once the bone hole has been prepared, and the fixation device is positioned within the bone hole, the fixation device may then be deployed. As illustrated in FIGS. 3A and 3B, the inserter tool has been removed from the drill guide by pulling the inserter directly back through and out of the guide. The operator may then grasp the ends 21, 22 of the filament 20 which are extending from sleeve 11. Optionally, these filament ends may be removably secured to the handle (not shown) of the inserter for ease of locating and for organizational benefits. The operator then may tension the ends of the filament 20, which may be accomplished with a single, continuous pull on the filament ends, to compress and set the sleeve 11 within the hole in the bone such that the sleeve compresses from its U-shape of FIG. 1 towards the W-shape of FIG. 2. Such compression occurs from the bottom of the U-shape upwards, as in FIGS. 3A-B, such that the bottom of the U-shape compresses towards the ends 13, 14 (although some downward compression of the ends 13, 14 towards the bottom of the U-shaped sleeve may also occur). Such compression may, as illustrated for example in FIG. 3A, lift the sleeve 11 from the floor of the bone hole. Further tensioning on the filament ends 21, 22 may result, as illustrated in FIG. 3C, in migration of the fixation device 10 proximally within the bone hole and towards the cortical bone 50. Such proximal migration of the fixation device may result in even further compression of the sleeve 11 as well as additional frictional engagement with the bone hole walls. In a further example, the sleeve 11 may migrate proximally until it contacts the underside of the cortical bone layer 50, such that the sleeve 11 may be prevented from further movement, e.g., out of the bone hole, by its engagement against the underside of the cortical bone layer. Such engagement may create additional resistance against pullout.


The operator may then verify that the sleeve 11 is set in the bone hole, by performing a tug on the filament ends 21, 22, and may additionally verify that the filament 20 can still slide through the sleeve 11 by pulling on one of the ends 21, 22. The filament 20 should still be slidable through sleeve 11, even when the sleeve is compressed, in order to perform manipulation of the filament 20 in order to, for example, gather and/or pierce tissue to thereby secure tissue to, or adjacent to, the implantation site. For example, such ability to manipulate the filament after deployment of the sleeve is important in rotator cuff surgery as the filament must be manipulable to properly reattach the cuff tissue back to or adjacent to the implantation site.


Alternatively, when tensioning the filament ends 21, 22, rather than pulling both ends simultaneously until the device is completely deployed, the operator, while holding both ends to prevent sliding of the filament, may instead pull on the ends sequentially, such that first, one of the ends 21 or 22 is pulled, and subsequently, the other of the ends 22 or 21 is pulled, to deploy the device.


In another alternative, where the filament includes indicating markers 17a-d, the operator may use such markers as a guide in confirming proper deployment has occurred. As illustrated in FIGS. 1 and 2, markers 17a-d are initially positioned along the length of the sleeve, prior to deployment. As the filament ends 21,22 are pulled, to deploy the device, the markers 17a-d are pulled proximally, towards the operator, along with the filament ends. As illustrated, the sleeve 11 may also migrate proximally during this step. As the proximal markers 17a, 17d pass above the cortical bone 50, they may indicate to the operator that the device has properly deployed. The operator may continue to pull on the ends of the filament until fully deployed (e.g., the filament does not move proximally any further using typical pulling force on the filament ends). However, upon this subsequent pulling, if the distal markers 17b, 17c are exposed above the cortical bone surface 50, then they may indicate that the implant is very close to being pulled out of the bone and the operator should decide if the resistance they feel is adequate or if they would prefer to pull the implant out completely and attempt the procedure again.


In any event, as the filament ends are pulled and the device is deployed, the sleeve resists pullout from the bore hole due to the friction against the cancellous bone 52 surrounding bone hole 51, and such friction is increased as the sleeve is compressed further, as well as if the sleeve migrates proximally (and particularly if the sleeve contacts the underside of the cortical bone layer). Moreover, as the sleeve is compressed, the forces applied to the sleeve may also be transferred to the surrounding cancellous bone, as illustrated in FIGS. 3B-C. Such affect on the cancellous bone may create additional friction and thus anchorage for the sleeve in the bone hole, to resist potential pullout. Further, as the device compresses and further engages the walls of bone hole 51, the surrounding cancellous bone 52 may interdigitate with at least a portion of the sleeve to provide added anchorage of the device within the bone hole. Such interdigitation may include, for example, cancellous bone protrusions overlapping and/or passing between the filaments of the sleeve to engage the sleeve. Moreover, the compressed sleeve, as discussed above, may migrate and engage the underside of the cortical surface, and may through such migration compress even further, and in this more compressed shape will result in a very strong structure to resist being pulled out the small hole in the cortical bone, as illustrated in FIG. 3C.


In another alternative of this method, the insertion tool 30 may also remain within the bone hole during deployment (not shown), to assist in maintaining the sleeve within the bone hole as the filament ends are pulled and the sleeve is compressed.


Following deployment of the device 10, with the sleeve 11 and filament 20 fixedly secured within the bone hole, the device may achieve pullout strengths comparable to traditional metal and polymeric devices despite this device 10 being constructed solely of suture or like filament material. For example, the embodiment of FIGS. 1-4, utilizing #2 suture in a foam block, achieved pullout strengths of at least 60 lbf, though higher pullout strengths are likely depending on the strength of the underlying bone, the diameter of filament 20, and other such variables. Similarly, using the embodiment of FIGS. 1-4, with the addition of a second filament 20, of #2 suture, woven through sleeve 11, a pullout strength of at least 65 lbf was recorded prior to the test foam block fracturing.


In accordance with this embodiment of a method of use, the sleeve 11 is anchored in bone, thus securing the filament 20 to the bone, while still allowing the filament to be slidable through the sleeve. Such ability to maintain the filament in a sliding association to the sleeve, even after the sleeve has been compressed, is important in shoulder and hip surgery, among other surgeries, because the operator may require an adjustable suture length to secure soft tissue at the repair site adjacent to the hole in the bone. This is especially important in arthroscopic surgery because sliding knots are frequently used to secure tissue that is accessed through a cannula. Such sliding association is maintained at least in part by the setup of the filament relative to the sleeve in that the filament passes through the sleeve only once and in a single direction. For example, the filament enters from one end of the sleeve, passes in and out of the plurality of openings in sequential order along the length of the sleeve, and then exits out the second end of the sleeve. Thus, as the sleeve compresses to form a W-shape, as in FIG. 2, the various openings in the sleeve tend to align adjacent one another such that the filament maintains, substantially, a U-shape, and thus can slide through the ends and the openings along the length of the sleeve regardless of the shape of the sleeve.


In one example of the device 10 of FIGS. 1-4, the force required to slide the suture through the deployed sleeve was measured, following a deployment force, applied by tensioning of the ends of the filament, of about 12 lbs. Once the sleeve was deployed (e.g., in the W-shape), between about 1.75-2.75 lbf was required to slide the filament through the sleeve. Of course, alternative embodiments of filaments and sleeves may result in different sliding forces needed to manipulate the filament through the sleeve.


The present invention may also be used, in another embodiment, in a method of securing a tissue to a bone. After the filament has been tensioned and the sleeve anchored in the bone, as in the above embodiment of the method of securing a filament to bone, the filament may then be used to secure tissue to a reattachment site located on the bone at or adjacent to the bone hole. In one embodiment, the filament may be used to reattach rotator cuff tissue, and thus the filament may be manipulated to engage and/or collect the cuff tissue and may be tied or otherwise secured to hold the tissue at the reattachment site. For example, one end 21 or 22 of the filament may be pulled through the tissue (using a needle or the like) and be used to pull the tissue to the reattachment site at or adjacent to the bone hole, at which point the other end of the filament may be incorporated to tie the tissue to the reattachment site, or the like. Other potential tissues on which this method may be used includes at least a portion of a shoulder labrum, at least a portion of a hip labrum, or the like.


In a further embodiment, the fixation device of the present invention may be used in a method of repair of soft tissue, such as a meniscus, ligament or tendon, or the like, wherein such methods do not require that the device 10 be deployed within a bone hole 51. Instead, the device, as to these methods, would function similar to a button anchor for use in, for example, ACL repair, such as is disclosed in U.S. patent application Ser. No. 12/682,324, now U.S. Published App. No. 2011/0125189, filed Oct. 9, 2008 and assigned to the same assignee as this application, the entirety of which is incorporated by reference herein as if fully set forth herein. The device may also serve as a button anchor for use in, for example, meniscus or cartilage repair, such as is disclosed in U.S. patent application Ser. No. 12/550,069, now U.S. Published App. No. 2009/0312792, filed Aug. 28, 2009, the entirety of which is incorporated by reference herein as if fully set forth herein.


In terms of, for example, a ligament or tendon repair, such as an ACL repair, where a tissue graft is secured within a bone tunnel, the device 10 may, following preparation of the bone tunnel by known means, be passed up through the tunnel, using an inserter such as inserter 30. In this embodiment, at least the distal-most portion of the tunnel (e.g., the lateral side of a femur) may have a diameter which allows the undeployed device, as illustrated in FIG. 1, to pass through the tunnel but not the deployed device, as illustrated in FIG. 2. Once the device exits from the bone tunnel, and is thus positioned on the lateral side of the bone (e.g., femur), the filament ends 21,22, which remain outside the opposite end of the bone tunnel, may be pulled to deploy the anchor. The deployment of the anchor may compress the sleeve 11 in a manner, as in FIG. 2, which inhibits the sleeve from passing back through the tunnel. The filament ends may then be tied or otherwise maneuvered to engage the ACL graft, which may then be placed within the bone tunnel as is known in the art. Thus, the device 10 may act as an anchor against which a graft may be tensioned to complete the repair.


In terms of, for example, the repair of a soft tissue tear such as in a meniscus or cartilage mass, where the tear is to be approximated to promote healing of same, the device 10 may be passed through the tissue mass, through the tear, and through a side surface of the tissue. In this embodiment, the inserter 30 may include, for example, a needle tip or other structure capable of forming a pathway through which the device, in the undeployed configuration as in FIG. 1, may pass. Once the device is positioned outside the side surface of the tissue, the filament ends, which remain in position on the opposite side of the tissue, may be pulled to deploy the sleeve 11. Once the sleeve is deployed, the sleeve is thus too wide to fit back through the pathway. The filament ends may then be tied or otherwise maneuvered to approximate the tear, which is positioned between the sleeve and the filament ends. The filament ends may then form a knot, or otherwise secure to one another, against the opposite side of the tissue. Thus, the device 10 may act as an anchor against which the filament ends may be tensioned to approximate the tear in the soft tissue to complete the repair.


Alternatively, these methods may also be used to secure a bone to hard tissue, such as another bone, as in a syndesmosis repair. In such a method, the filament may, as above, pass through the other bone (e.g., through a bone throughhole) or may pass around the other bone to effect a reattachment of the two bones to one another to promote healing of the injured joint. Thus, upon activation of the device, the filament ends may then engage the other bone and be tied together to secure the two bones together. Such methods of use may be utilized in the repair of bone in the ankle joint or in the acromioclavicular joint.


As illustrated in FIGS. 5 and 6, another embodiment of fixation device 110 includes a sleeve member 111 and a filament 120. The sleeve member 111 includes an interior 115 and an exterior surface 116, both of which extend along a length defined between a first end 113 and a second end 114. The sleeve member 111 may be substantially hollow. The exterior surface also includes at least two openings 112b, 112c positioned along the length of the exterior surface 116, each of which form a passageway through the exterior surface and into the interior 115. As illustrated, in this embodiment, the exterior surface may include four openings (for example, 12a, 12b, 12c, 12d), though any other number of openings in any configuration along the length of the exterior surface may be present.


This embodiment also includes a filament 120 having a length and at least a portion of this length is positioned within the interior 115 of sleeve 111. The filament is slidable within the interior 115. The filament may also pass through at least one of the openings 112 along the exterior surface 116 of the sleeve 111. For example, as in FIG. 5, filament 120 may exit the interior 115 through opening 112a re-enter the interior through opening 112b, exit the interior once again through opening 112c, and re-enter the interior through opening 112d.


Comparing FIG. 5 with the first disclosed embodiment, in FIG. 1, it is apparent that the filament 120 remains inside the interior at the bottom portion (between openings 112b and 112c), while the filament 20 is outside of the interior at the similar bottom portion (between openings 12c and 12d) in FIG. 1. In addition to the aforementioned differences in width of the device upon placement on an inserter, these differing configurations may provide different forces on the sleeve as the filament 20, 120 is tensioned to compress the sleeve. For example, in FIG. 1, as the filament 20 is tensioned, openings 12c and 12d may be pulled towards one another such that the sleeve between these openings may be pinched or crushed to form the W-shape. In FIG. 5, however, the tensioning of filament 120 may provide an upward force at openings 112b and 112c, thereby moving the portion of the sleeve between these openings up towards the first and second ends 113, 114 which may form the W-shape. Thus, these two exemplary embodiments illustrate two different relationships of a sleeve and a filament, either of which may result in a compressed sleeve capable of securing a filament within a bone hole.


The fixation device embodiment illustrated in FIGS. 5 and 6 may be used in similar methods of use as illustrated in FIGS. 3 and 4 and as discussed above.


In further alternative embodiments, which also may be used in similar methods of use as illustrated in FIGS. 3 and 4 and as discussed above, the sleeve and filament may have a relationship which results in the sleeve, upon compressing, attaining a compressed shape other than the W-shape discussed above. For example, as illustrated in FIGS. 7A-C, the sleeve 211 may have a U-shaped starting shape (FIG. 7B), but upon compressing, may attain a clover shape (FIG. 7C). Similar to the embodiments discussed in detail above, the openings 212a-f of this embodiment likewise, upon compression, may move towards one another, e.g., opening 212a and opening 212b are adjacent one another, and even contacting one another, upon compression of sleeve 211. Moreover, in this closer shape, the filament 220 may still have a generally U-shaped arrangement, within the clover shape of sleeve 211, such that the filament 220 may still slide within the sleeve 211.



FIGS. 8-16 illustrate other exemplary shapes which the sleeve may attain upon compressing. As illustrated, the various shapes depend on a variety of factors including but not limited to the number of openings along the length of the sleeve, the location of the openings along the sleeve, the relationship of the filament relative to the sleeve, and the shape of the openings on the sleeve. The pullout strength and capability of being used in the above disclosed methods may be similar to the embodiment disclosed in FIGS. 1-4. It should be noted that in all of the embodiments disclosed in this application, particularly those in FIGS. 7-16, upon compression, the sleeve may not always attain the same shape each and every time. For example, the shape and size of the bone hole may force the sleeve into a different shape, upon compression, than those illustrated herein. Also, in another example, the exact dimensions and locations of the openings through the sleeve may be altered slightly which could result in an alternative shape of the sleeve upon its compression.


For example, in FIGS. 8A-B, the relationship of the sleeve 211′ and filament 220′ is the same as the relationship illustrated in FIG. 7A, except that when the device 210′ is curved into the U-shape of FIG. 8A, the filament 220′ exits outside the sleeve 211′ on the outside of the U-shape, e.g., between openings 212a′ and 212b′. By contrast, the filament 220 illustrated in FIG. 7B, upon exiting the sleeve 211, exits on the inside of the U-shape, e.g., between openings 212a and 212b. While FIGS. 7B and 8A appear to be quite similar, the two different relationships may result in drastic differences once the sleeves are compressed, as illustrated in FIGS. 7C and 8B, which illustrate alternative shapes of compressed sleeves.


In yet another example of such differences, FIGS. 9A-C illustrate another alternative embodiment of a relationship of a sleeve 311 and a filament 320 forming an device 310. In this embodiment, openings 312a and 312b are radially offset from one another, and the filament 320 must be twisted around the outside of the sleeve to reach between opening 312a and opening 312b. Upon folding of the sleeve 311 (FIG. 9B), the openings 312a and 312b remain radially offset to one another, and filament 320 twists around sleeve 311 such that it may pass through the openings 312a and 312b. Such a relationship may result in yet another alternative shape of the sleeve upon compressing during deployment of the sleeve. Again, it should be observed, that the filament, upon compression of the sleeve, substantially maintains a U-shape, within and around the sleeve, such that sliding of the filament remains possible.


In some embodiments, as in FIGS. 1-8, the filament, when positioned within the interior of the sleeve, may extend in a generally longitudinal path along the length of the sleeve such that the filament and sleeve are substantially parallel with one another. Using FIG. 7A as an example, filament 220 is generally positioned axially along the length of the sleeve 211 while entering and exiting the interior of the sleeve via openings 212 which are positioned along the length of sleeve 211 and generally in series—one after the other—along the length.


In an alternative example, however, the filament may be generally transverse to the interior of the sleeve, when the filament is positioned within the interior. For example, such a relationship is variously illustrated in FIGS. 9-16. As illustrated clearly in FIGS. 14A-C, for example, the filament may pass through opening 812b, travel transversely through the interior, and out opening 812c. Such a relationship of the filament and sleeve is also shown as to openings 812d and 812e, and 812f and 812g. As shown, however, the filament may still remain substantially parallel to the interior of the sleeve at the ends of the sleeve, e.g., between end 813 and opening 812a and end 814 and opening 812h, such that the filament exits from the interior at the first and second ends. This is similar to other embodiments herein. Such a relationship may provide for better sliding of the filament through the sleeve.


Such embodiments having a generally transverse configuration when the filament passes through the sleeve as FIGS. 9-16 may result in alternative shapes of the sleeve when compressed. As in the other embodiments described above, the shape of the sleeve when compressed will depend on the number of openings along the length of the sleeve, the location of the openings along the sleeve, the relationship of the filament relative to the sleeve, and the shape of the openings on the sleeve.


In yet another alternative, the filament and sleeve may be in a hybrid configuration whereby the filament, along at least a first portion of its length other than at the ends of the sleeve, is substantially parallel to the interior of the sleeve, and along at least one other portion, may be generally transverse to the interior of the sleeve. Such variations are illustrated in FIGS. 13A-C. Thus, in this type of relationship, the filament is again generally parallel to the sleeve at the ends of the sleeve (between end 713 and opening 712a and end 714 and opening 712f). The filament and sleeve are also generally parallel between opening 712c through openings 712d and 712e and on to opening 712f and end 714. The filament is transverse to the sleeve from opening 712b to 712c.


The various embodiments illustrated in the figures provide many examples of the device of the present invention. While the relationship between the filament and sleeve varies from embodiment to embodiment, each of the embodiments have similarities such as, for example: the filament and sleeve are generally parallel to one another at the ends of the sleeve such that the filament exits from the ends of the sleeve; the sleeve and filament can be moved to a U-shape, prior to deployment of the device, and loaded onto an inserter; and with the sleeve compressed, the filament generally maintains a U-shape such that it may remain slidable through the sleeve even when the sleeve is compressed.


These various embodiments result in a smaller device than those presently in public use because the filament only passes through the interior of the sleeve once along its length, remains within the sleeve and exiting through the ends of the sleeve, and, in many embodiments, is outside the sleeve at the location where the inserter tip holds the device, resulting in a generally smaller diameter of the device. The smaller sized device allows for a smaller hole to be prepared in the bone, and a smaller access port to the bone, which results in a smaller surgical site in the patient.


Moreover, in the event the device does pull out from the bone post-surgery, since the device is made entirely of a filament-like material, such as suture, the device would not lacerate adjacent anatomy within the patient, which is a concern if a traditional device pulls out from the bone.


The present invention may also include various kits and systems which include at least one of the device embodiments above. For example, in one embodiment, the present invention may include a system including a device, including a sleeve and filament, and an inserter. The system may be packaged individually, and even sold separately, such that the surgeon may place the device on the inserter. Alternatively, the device may come pre-installed on the inserter, within a single package, such that the surgeon may remove the system from the packaging and immediately use the system and install the device within a bone hole.


In another embodiment, such a system may further include the aforementioned drill guide and drill, which may come pre-packaged as an entire system or which may be sold separately and later combined by the surgeon and used for the above discussed methods of use.


In another embodiment, the present invention may include a kit which includes a plurality of devices, each having a sleeve and filament, and an inserter. The plurality of devices may be any combination of the above devices. For example, the plurality of devices may include more than one of the device disclosed in FIGS. 1-4, wherein the sleeve of each device has a different diameter and/or length than the other sleeves of the other devices. Alternatively, the sleeve of each device may have a different number and/or positioning of openings, such that the appropriate device may be selected which will provide the desired pullout strength or compression properties (which may be dependent on the anatomy in which the device is implanted, the condition of the bone in which the device is implanted, or the like). Alternatively, the plurality of devices may include various devices of the above embodiments, or other similar devices, from which a surgeon may select from based on the specifics of the surgical site, pullout strength required, and the like.


Such kits may further include a plurality of drill bits which may be matched with a device, selected from the plurality of devices, to prepare an appropriately sized bone hole for insertion of the device.


Any other suitable combination is also envisioned for the above systems and kits which may be useful or desirable to a surgeon. For example, the various components of the systems or kits may all be available to a surgeon a la carte, such that a unique system or kit may be created for a particular surgeon dependent on the needs or desires of the particular surgeon.


Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims.

Claims
  • 1. A filamentary fixation system, comprising: a sleeve formed of filamentary material having a longitudinal lumen defined through a length of the sleeve and between a first open end and a second open end, the sleeve defining first and second openings positioned along the length between the first open end and the second open end, the sleeve having a coating adapted to allow for tissue ingrowth; anda filament formed of filamentary material including a first free end and a second free end, the filament extending through the first open end and being disposed inside the sleeve from the first open end to the first opening, at least a portion of the filament being disposed outside the sleeve between the first opening and the second opening, the filament being disposed inside the sleeve from the second opening to the second open end, and the filament extending through the second open end, wherein the filament does not overlap itself within the interior of the sleeve.
  • 2. The system of claim 1, wherein the coating comprises hydroxyapatite powder, tricalcium phosphate, collagen-based additives, platelet-rich plasma, or bioactive glass.
  • 3. The system of claim 2, wherein the coating is positioned on an exterior surface of the sleeve.
  • 4. The system of claim 1, wherein an interior surface of the sleeve defines a hollow volume.
  • 5. The system of claim 4, wherein the sleeve further comprises a longitudinal axis extending through the hollow volume, the first open end and the second open end.
  • 6. The system of claim 1, wherein the sleeve is pliable and is expandable or compressible.
  • 7. The system of claim 6, wherein the filament is adapted to be slidable through the sleeve when the sleeve is expanded and compressed.
  • 8. The system of claim 1, wherein the sleeve further includes a third opening and a fourth opening, and at least a portion of the filament is disposed inside the interior from the first open end to the first opening, outside the sleeve from the first opening to the second opening, inside the sleeve from the second opening to a third opening, outside the sleeve from the third opening to the fourth opening, and inside the sleeve from the fourth opening to the second open end of the sleeve.
  • 9. The system of claim 1, wherein the filament further includes an at least one indicating marker along its length.
  • 10. A filamentary fixation system, comprising: a sleeve formed of filamentary material having a longitudinal lumen defined through a length of the sleeve and between a first open end and a second open end, the sleeve defining first and second openings along the length between the first open end and the second open end, the sleeve having a coating adapted to allow for tissue ingrowth; anda filament including a first free end and a second free end, and a length therebetween, the filament extending through the first open end and being disposed inside the sleeve from the first open end to the first opening, at least a portion of the filament being disposed outside the sleeve between the first opening and the second opening, the filament being disposed inside the sleeve from the second opening to the second open end, and the filament extending through the second open end, wherein the filament does not overlap itself within the sleeve and is adapted to be slidable through the sleeve.
  • 11. The system of claim 10, wherein the filament is formed of filamentary material.
  • 12. The system of claim 10, wherein the sleeve is pliable and is expandable or compressible, and the filament is adapted to be slidable through the sleeve when the sleeve is expanded or compressed.
  • 13. The system of claim 10, wherein the coating comprises hydroxyapatite powder, tricalcium phosphate, collagen-based additives, platelet-rich plasma, or bioactive glass.
  • 14. The system of claim 13, wherein the coating is positioned on an exterior surface of the sleeve.
  • 15. The system of claim 10, wherein the filament further includes at least one indicating marker along its length.
  • 16. A method for securing a filament in a hole in a bone, comprising the steps of: accessing the bone and preparing a bone hole;inserting a fixation device into the bone hole, the device including: a sleeve formed of filamentary material having a longitudinal lumen defined through a length of the sleeve and between a first open end and a second open end, the sleeve defining first and second openings positioned along the length between the first open end and the second open end, the sleeve having a coating adapted to allow for tissue ingrowth; anda filament formed of filamentary material including a first free end and a second free end, the filament extending through the first open end and being disposed inside the interior from the first open end to the first opening, at least a portion of the filament being disposed outside the sleeve between the first opening and the second opening, the filament being disposed inside the sleeve from the second opening to the second open end, and the filament extending through the second open end, wherein the filament does not overlap itself within the interior of the sleeve; and
  • 17. The method of claim 16, wherein the compressing step comprises pulling the first and second free ends of the filament.
  • 18. The method of claim 16, further comprising, after the compressing step, adjusting the filament by pulling on one of the two ends of the filament to slide the filament through the sleeve.
  • 19. The method of claim 16, wherein the compressing step alters the shape of the sleeve from a substantially U-shape to a substantially W-shape.
CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No. 13/303,849, filed on Nov. 23, 2011, now U.S. Pat. No. 9,445,803, the disclosure of which is incorporated herein by reference.

US Referenced Citations (771)
Number Name Date Kind
749624 McCullough Jan 1904 A
1308798 Masland Jul 1919 A
1624530 Caruso Apr 1927 A
2073903 O'Neil Mar 1937 A
2250434 Dugaw Jul 1941 A
2267925 Johnston Dec 1941 A
2382019 Miller Aug 1945 A
2461947 Weber Feb 1949 A
2494229 Collison Jan 1950 A
2515365 Zublin Jul 1950 A
2547571 Ettinger Apr 1951 A
2773672 Holmes et al. Dec 1956 A
2808632 Cline Oct 1957 A
2833284 Springer May 1958 A
3384085 Hall May 1968 A
3407889 Hjalsten et al. Oct 1968 A
3461875 Hall Aug 1969 A
3554192 Isberner Jan 1971 A
3580256 Wilkinson et al. May 1971 A
3608095 Barry Sep 1971 A
3659597 Wolfers May 1972 A
3750671 Hedrick Aug 1973 A
3810456 Karman May 1974 A
3845772 Smith Nov 1974 A
3867932 Huene Feb 1975 A
3892232 Neufeld Jul 1975 A
3976079 Samuels et al. Aug 1976 A
3981051 Brumlik Sep 1976 A
4212569 Andersson et al. Jul 1980 A
4265231 Scheller, Jr. et al. May 1981 A
4328839 Lyons et al. May 1982 A
4483562 Schoolman Nov 1984 A
4489446 Reed Dec 1984 A
4541423 Barber Sep 1985 A
4594033 Peetz et al. Jun 1986 A
4605347 Jodock et al. Aug 1986 A
4608972 Small Sep 1986 A
4611515 Marbourg, Jr. Sep 1986 A
4635738 Schillinger et al. Jan 1987 A
4646738 Trott Mar 1987 A
4706659 Matthews et al. Nov 1987 A
4728231 Kunimori et al. Mar 1988 A
4741330 Hayhurst May 1988 A
4748872 Brown Jun 1988 A
4751922 DiPietropolo Jun 1988 A
4781182 Purnell et al. Nov 1988 A
4823780 Odensten et al. Apr 1989 A
4842451 Dugger Jun 1989 A
4863471 Mansat Sep 1989 A
4872451 Moore et al. Oct 1989 A
4946462 Watanabe Aug 1990 A
5002546 Romano Mar 1991 A
5007911 Baker Apr 1991 A
5021059 Kensey et al. Jun 1991 A
5030219 Matsen, III et al. Jul 1991 A
5037422 Hayhurst et al. Aug 1991 A
5037423 Kenna Aug 1991 A
5061277 Carpentier et al. Oct 1991 A
5064431 Gilbertson Nov 1991 A
5122134 Borzone et al. Jun 1992 A
5123914 Cope Jun 1992 A
5133720 Greenberg Jul 1992 A
5139520 Rosenberg Aug 1992 A
5141520 Goble et al. Aug 1992 A
5163940 Bourque Nov 1992 A
5165494 Barr Nov 1992 A
5186268 Clegg Feb 1993 A
5190548 Davis Mar 1993 A
5203595 Borzone et al. Apr 1993 A
5203787 Noblitt et al. Apr 1993 A
RE34293 Goble et al. Jun 1993 E
5234435 Seagrave, Jr. Aug 1993 A
5259846 Granger et al. Nov 1993 A
5269785 Bonutti Dec 1993 A
5269809 Hayhurst et al. Dec 1993 A
5273380 Musacchia Dec 1993 A
5300077 Howell Apr 1994 A
5314429 Goble May 1994 A
5320115 Kenna Jun 1994 A
5320626 Schmieding Jun 1994 A
5324308 Pierce Jun 1994 A
5330468 Burkhart Jul 1994 A
5342376 Ruff Aug 1994 A
5350383 Schmieding et al. Sep 1994 A
RE34762 Goble et al. Oct 1994 E
5374269 Rosenberg Dec 1994 A
5380334 Torrie et al. Jan 1995 A
5385567 Goble Jan 1995 A
5391170 McGuire et al. Feb 1995 A
5391171 Schmieding Feb 1995 A
RE34871 McGuire et al. Mar 1995 E
5395188 Bailey et al. Mar 1995 A
5403317 Bonutti Apr 1995 A
5403348 Bonutti Apr 1995 A
5405359 Pierce Apr 1995 A
5409494 Morgan Apr 1995 A
5417691 Hayhurst May 1995 A
5423824 Akerfeldt et al. Jun 1995 A
5423860 Lizardi et al. Jun 1995 A
5437630 Daniel et al. Aug 1995 A
5437675 Wilson Aug 1995 A
5437677 Shearer et al. Aug 1995 A
5441502 Bartlett Aug 1995 A
5443482 Stone et al. Aug 1995 A
5458604 Schmieding Oct 1995 A
5464407 McGuire Nov 1995 A
5464425 Skiba Nov 1995 A
5464426 Bonutti Nov 1995 A
5466243 Schmieding et al. Nov 1995 A
5472452 Trott Dec 1995 A
5486197 Le et al. Jan 1996 A
5488761 Leone Feb 1996 A
5496348 Bonutti Mar 1996 A
5505736 Reimels et al. Apr 1996 A
5520693 McGuire et al. May 1996 A
5520700 Beyar et al. May 1996 A
5522846 Bonutti Jun 1996 A
5527316 Stone et al. Jun 1996 A
5527343 Bonutti Jun 1996 A
5529580 Kusunoki et al. Jun 1996 A
5531759 Kensey et al. Jul 1996 A
5534012 Bonutti Jul 1996 A
5540703 Barker, Jr. et al. Jul 1996 A
5545178 Kensey Aug 1996 A
5548862 Curtis Aug 1996 A
5569269 Hart et al. Oct 1996 A
5569306 Thal Oct 1996 A
5570706 Howell Nov 1996 A
5571111 Aboczky Nov 1996 A
5573542 Stevens Nov 1996 A
5575819 Amis Nov 1996 A
5584617 Houser Dec 1996 A
5584695 Lal Sachdeva et al. Dec 1996 A
5584835 Greenfield Dec 1996 A
5601550 Esser Feb 1997 A
5601557 Hayhurst Feb 1997 A
5601561 Terry et al. Feb 1997 A
5618314 Harwin et al. Apr 1997 A
5645545 Bryant Jul 1997 A
5645589 Li Jul 1997 A
5647874 Hayhurst Jul 1997 A
5649963 McDevitt Jul 1997 A
5658289 Boucher et al. Aug 1997 A
5658313 Thal Aug 1997 A
5662658 Wenstrom, Jr. Sep 1997 A
5664914 Taniguchi Sep 1997 A
5665110 Chervitz et al. Sep 1997 A
5665111 Ray et al. Sep 1997 A
5665112 Thal Sep 1997 A
5667509 Westin Sep 1997 A
5671695 Schroeder Sep 1997 A
5674279 Wright et al. Oct 1997 A
5681315 Szabo Oct 1997 A
5681320 McGuire Oct 1997 A
5681352 Clancy, III et al. Oct 1997 A
5683401 Schmieding et al. Nov 1997 A
5683418 Luscombe et al. Nov 1997 A
5683419 Thal Nov 1997 A
5690676 DiPoto et al. Nov 1997 A
5690677 Schmieding et al. Nov 1997 A
5695513 Johnson et al. Dec 1997 A
5699657 Paulson Dec 1997 A
5702397 Goble et al. Dec 1997 A
5707374 Schmidt Jan 1998 A
5709708 Thal Jan 1998 A
5713905 Goble et al. Feb 1998 A
5716397 Myers Feb 1998 A
5718717 Bonutti Feb 1998 A
5720765 Thal Feb 1998 A
5725530 Popken Mar 1998 A
5725541 Anspach, III et al. Mar 1998 A
5725557 Gatturna et al. Mar 1998 A
5728136 Thal Mar 1998 A
5732606 Chiang Mar 1998 A
5733306 Bonutti Mar 1998 A
5733307 Dinsdale Mar 1998 A
5749899 Bardin et al. May 1998 A
5755724 Yoon May 1998 A
5755731 Grinberg May 1998 A
5759185 Grinberg Jun 1998 A
5766221 Benderev et al. Jun 1998 A
5782862 Bonutti Jul 1998 A
5782864 Lizardi Jul 1998 A
5782866 Wenstrom, Jr. Jul 1998 A
5788699 Bobst et al. Aug 1998 A
5797918 McGuire et al. Aug 1998 A
5810825 Huebner Sep 1998 A
5814056 Prosst et al. Sep 1998 A
5820464 Parlato Oct 1998 A
5836953 Yoon Nov 1998 A
5851208 Trott Dec 1998 A
5885294 Pedlick et al. Mar 1999 A
5888034 Greenberg Mar 1999 A
5891168 Thal Apr 1999 A
5895179 Gschwend et al. Apr 1999 A
5897574 Bonutti Apr 1999 A
5906626 Carrillo May 1999 A
5908423 Kashuba et al. Jun 1999 A
5921986 Bonutti Jul 1999 A
5928244 Tovey et al. Jul 1999 A
5941139 Vodehnal Aug 1999 A
5941883 Sklar Aug 1999 A
5947659 Mays Sep 1999 A
5948002 Bonutti Sep 1999 A
5951559 Burkhart Sep 1999 A
5954747 Clark Sep 1999 A
5961538 Pedlick Oct 1999 A
5968078 Grotz Oct 1999 A
5970697 Jacobs et al. Oct 1999 A
5980539 Kontos Nov 1999 A
5980558 Wiley Nov 1999 A
5980559 Bonutti Nov 1999 A
5989252 Fumex Nov 1999 A
5993451 Burkhart Nov 1999 A
5997541 Schenk Dec 1999 A
6007566 Wenstrom, Jr. Dec 1999 A
6007567 Bonutti Dec 1999 A
6010515 Swain et al. Jan 2000 A
6010525 Bonutti et al. Jan 2000 A
6019767 Howell Feb 2000 A
6024758 Thal Feb 2000 A
6030406 Davis et al. Feb 2000 A
6045574 Thal Apr 2000 A
6053922 Krause et al. Apr 2000 A
6068642 Johnson et al. May 2000 A
6077292 Bonutti Jun 2000 A
6083244 Lubbers et al. Jul 2000 A
6083522 Chu et al. Jul 2000 A
6120511 Chan Sep 2000 A
6143017 Thal Nov 2000 A
6146385 Torrie et al. Nov 2000 A
6152949 Bonutti Nov 2000 A
6156039 Thal Dec 2000 A
6156056 Kearns et al. Dec 2000 A
6159234 Bonutti et al. Dec 2000 A
6183461 Matsuura et al. Feb 2001 B1
6187011 Torrie Feb 2001 B1
6189422 Stihl Feb 2001 B1
6210415 Bester Apr 2001 B1
6224608 Ciccolella et al. May 2001 B1
6245081 Bowman et al. Jun 2001 B1
6254604 Howell Jul 2001 B1
6258093 Edwards et al. Jul 2001 B1
6270501 Freiberg et al. Aug 2001 B1
6296659 Foerster Oct 2001 B1
6306138 Clark et al. Oct 2001 B1
6306159 Schwartz et al. Oct 2001 B1
6312438 Adams Nov 2001 B1
6343482 Endo et al. Feb 2002 B1
6352538 McGuire et al. Mar 2002 B2
6358253 Torrie et al. Mar 2002 B1
6364886 Sklar Apr 2002 B1
6383188 Kuslich et al. May 2002 B2
6402781 Langberg Jun 2002 B1
6416517 Harder et al. Jul 2002 B2
6419678 Asfora Jul 2002 B1
6419684 Heisler et al. Jul 2002 B1
6431801 Vasudeva et al. Aug 2002 B2
6436100 Berger Aug 2002 B1
6436124 Anderson et al. Aug 2002 B1
6440138 Reiley et al. Aug 2002 B1
6440141 Philippon Aug 2002 B1
6447518 Krause et al. Sep 2002 B1
6464713 Bonutti Oct 2002 B2
6474425 Truax et al. Nov 2002 B1
6475230 Bonutti Nov 2002 B1
6478800 Fraser et al. Nov 2002 B1
6485504 Johnson et al. Nov 2002 B1
6494272 Eppink et al. Dec 2002 B1
6500195 Bonutti Dec 2002 B2
RE37963 Thal Jan 2003 E
6508830 Steiner Jan 2003 B2
6511498 Fumex Jan 2003 B1
6517578 Hein Feb 2003 B2
6544281 ElAttrache et al. Apr 2003 B2
6558386 Cragg May 2003 B1
6558390 Cragg May 2003 B2
6569187 Bonutti et al. May 2003 B1
6572635 Bonutti Jun 2003 B1
6575979 Cragg Jun 2003 B1
6599310 Leung et al. Jul 2003 B2
6610080 Morgan Aug 2003 B2
6635073 Bonutti Oct 2003 B2
6638279 Bonutti Oct 2003 B2
6638283 Thal Oct 2003 B2
6641597 Burkhart et al. Nov 2003 B2
6652450 Neisz Nov 2003 B2
6660023 McDevitt et al. Dec 2003 B2
6712822 Re et al. Mar 2004 B2
6716234 Grafton et al. Apr 2004 B2
6730092 Songer May 2004 B2
6740090 Cragg et al. May 2004 B1
6746451 Middleton et al. Jun 2004 B2
6773450 Leung et al. Aug 2004 B2
6780188 Clark et al. Aug 2004 B2
6783533 Green et al. Aug 2004 B2
6790210 Cragg et al. Sep 2004 B1
6805697 Helm et al. Oct 2004 B1
6824552 Robison et al. Nov 2004 B2
6830570 Frey et al. Dec 2004 B1
6848152 Genova et al. Feb 2005 B2
6863672 Reiley et al. Mar 2005 B2
6874978 Gongola Apr 2005 B2
6878150 McGuire et al. Apr 2005 B1
6887259 Lizardi May 2005 B2
6893445 Revie et al. May 2005 B1
6899716 Cragg May 2005 B2
6921403 Cragg et al. Jul 2005 B2
6923811 Carl et al. Aug 2005 B1
6923814 Hildebrand et al. Aug 2005 B1
6936052 Gellman et al. Aug 2005 B2
6955683 Bonutti Oct 2005 B2
6960214 Burkinshaw Nov 2005 B2
6984241 Lubbers et al. Jan 2006 B2
6991636 Rose Jan 2006 B2
6994719 Grafton Feb 2006 B2
6994725 Goble Feb 2006 B1
6995683 Smithson et al. Feb 2006 B2
7008431 Simonson Mar 2006 B2
7018144 Sasagawa et al. Mar 2006 B2
7025770 McGuire et al. Apr 2006 B2
7029479 Tallarida et al. Apr 2006 B2
7029490 Grafton et al. Apr 2006 B2
7041107 Pohjonen et al. May 2006 B2
7048754 Martin et al. May 2006 B2
7056331 Kaplan et al. Jun 2006 B2
7060073 Frey et al. Jun 2006 B2
7067132 Grabstein et al. Jun 2006 B2
7077863 Schmieding et al. Jul 2006 B2
7087058 Cragg Aug 2006 B2
7087073 Bonutti Aug 2006 B2
7204839 Dreyfuss et al. Apr 2007 B2
7217279 Reese May 2007 B2
7217290 Bonutti May 2007 B2
7225512 Genova et al. Jun 2007 B2
7235091 Thornes Jun 2007 B2
7241297 Shaolian et al. Jul 2007 B2
7258692 Thelen et al. Aug 2007 B2
7261016 Miller Aug 2007 B2
7285124 Foerster Oct 2007 B2
7309338 Cragg Dec 2007 B2
7326215 Myers et al. Feb 2008 B2
7331263 Erickson et al. Feb 2008 B2
7371253 Leung et al. May 2008 B2
7381213 Lizardi Jun 2008 B2
7488322 Brunnett et al. Feb 2009 B2
7488329 Thelen et al. Feb 2009 B2
7494490 Justin Feb 2009 B2
7500977 Assell et al. Mar 2009 B2
7503920 Siegal Mar 2009 B2
7520898 Re et al. Apr 2009 B2
7563266 Camino et al. Jul 2009 B2
7578836 Justin et al. Aug 2009 B2
7585300 Cha Sep 2009 B2
7601155 Petersen Oct 2009 B2
7601165 Stone Oct 2009 B2
7604636 Walters et al. Oct 2009 B1
7608098 Stone et al. Oct 2009 B1
7611521 Lubbers et al. Nov 2009 B2
7621912 Harms et al. Nov 2009 B2
7621940 Harms et al. Nov 2009 B2
7624487 Trull et al. Dec 2009 B2
7651509 Bojarski et al. Jan 2010 B2
7651515 Mack et al. Jan 2010 B2
7658751 Stone et al. Feb 2010 B2
7666189 Gerber et al. Feb 2010 B2
7678134 Schmieding et al. Mar 2010 B2
7749250 Stone et al. Jul 2010 B2
7776049 Curran et al. Aug 2010 B1
7803173 Burkhart et al. Sep 2010 B2
7857829 Kaplan et al. Dec 2010 B2
7857830 Stone et al. Dec 2010 B2
7875057 Cook et al. Jan 2011 B2
7875058 Holmes, Jr. Jan 2011 B2
7879037 Brunnett et al. Feb 2011 B2
7892235 Ellis Feb 2011 B2
7892256 Grafton et al. Feb 2011 B2
7901431 Shumas Mar 2011 B2
7905903 Stone et al. Mar 2011 B2
7905904 Stone Mar 2011 B2
7909547 Jordan et al. Mar 2011 B2
7909851 Stone et al. Mar 2011 B2
7913365 Genova et al. Mar 2011 B2
7914539 Stone et al. Mar 2011 B2
7918874 Siegal Apr 2011 B2
7959650 Kaiser et al. Jun 2011 B2
7963967 Woods Jun 2011 B1
7981117 Newton et al. Jul 2011 B2
7981140 Burkhart Jul 2011 B2
7993369 Dreyfuss Aug 2011 B2
7996967 Genova et al. Aug 2011 B2
7996968 Genova et al. Aug 2011 B2
8002733 Kraft et al. Aug 2011 B2
8011072 Genova et al. Sep 2011 B2
8015678 Genova et al. Sep 2011 B2
8020263 Genova et al. Sep 2011 B2
8028387 Genova et al. Oct 2011 B2
8028388 Genova et al. Oct 2011 B2
8032996 Trull et al. Oct 2011 B2
8043253 Kraft et al. Oct 2011 B2
8057500 Mitusina Nov 2011 B2
8070750 Wenstrom, Jr. et al. Dec 2011 B2
8083770 Ruff et al. Dec 2011 B2
8088130 Kaiser et al. Jan 2012 B2
8100940 Leung et al. Jan 2012 B2
8109700 Jordan et al. Feb 2012 B2
8114088 Miller Feb 2012 B2
8118834 Goraltchouk et al. Feb 2012 B1
8118836 Denham et al. Feb 2012 B2
8123750 Norton et al. Feb 2012 B2
8128640 Harris et al. Mar 2012 B2
8128658 Kaiser et al. Mar 2012 B2
8128669 Bonutti Mar 2012 B2
8133231 Martinek et al. Mar 2012 B2
8137382 Denham et al. Mar 2012 B2
8147514 Bonutti Apr 2012 B2
8162997 Struhl Apr 2012 B2
8172846 Brunnett et al. May 2012 B2
8216273 Goraltchouk et al. Jul 2012 B1
8231654 Kaiser et al. Jul 2012 B2
8231674 Albertorio et al. Jul 2012 B2
8241305 Stone Aug 2012 B2
8246652 Ruff Aug 2012 B2
8267959 Fallman Sep 2012 B2
8273106 Stone et al. Sep 2012 B2
8292921 Stone et al. Oct 2012 B2
8298262 Stone et al. Oct 2012 B2
8303604 Stone et al. Nov 2012 B2
8312942 Ho et al. Nov 2012 B2
8317825 Stone Nov 2012 B2
8337525 Stone et al. Dec 2012 B2
8343187 Lamson et al. Jan 2013 B2
8361113 Stone et al. Jan 2013 B2
8366713 Long et al. Feb 2013 B2
8394129 Morgenstern Lopez et al. Mar 2013 B2
8398678 Baker et al. Mar 2013 B2
8409253 Stone et al. Apr 2013 B2
8439976 Albertorio et al. May 2013 B2
8460338 Goraltchouk et al. Jun 2013 B2
8460379 Albertorio et al. Jun 2013 B2
8469998 Sojka et al. Jun 2013 B2
8512340 Easley et al. Aug 2013 B2
8518087 Lopez et al. Aug 2013 B2
8556911 Mehta et al. Oct 2013 B2
8562645 Stone et al. Oct 2013 B2
8591578 Albertorio et al. Nov 2013 B2
8597333 Morgenstern Lopez et al. Dec 2013 B2
8623051 Bojarski et al. Jan 2014 B2
8663324 Schmieding et al. Mar 2014 B2
8801800 Bagga et al. Aug 2014 B2
8814905 Sengun et al. Aug 2014 B2
8821543 Hernandez et al. Sep 2014 B2
8821544 Sengun et al. Sep 2014 B2
8821545 Sengun Sep 2014 B2
8936620 Kaiser et al. Jan 2015 B2
9072530 Mehta et al. Jul 2015 B2
9370350 Norton Jun 2016 B2
20010027320 Sasso Oct 2001 A1
20020019635 Wenstrom et al. Feb 2002 A1
20020052649 Greenhalgh May 2002 A1
20020087166 Brock et al. Jul 2002 A1
20020183758 Middleton et al. Dec 2002 A1
20020188301 Dallara et al. Dec 2002 A1
20030032961 Pelo et al. Feb 2003 A1
20030176919 Schmieding Sep 2003 A1
20030195565 Bonutti Oct 2003 A1
20030220646 Thelen et al. Nov 2003 A1
20030233098 Markworth Dec 2003 A1
20040010264 Acker et al. Jan 2004 A1
20040010287 Bonutti Jan 2004 A1
20040030346 Frey et al. Feb 2004 A1
20040049194 Harvie et al. Mar 2004 A1
20040060409 Leung et al. Apr 2004 A1
20040073227 Dreyfuss et al. Apr 2004 A1
20040073306 Eichhorn et al. Apr 2004 A1
20040092933 Shaolian et al. May 2004 A1
20040149093 Tang Aug 2004 A1
20040193168 Long et al. Sep 2004 A1
20040193217 Lubbers et al. Sep 2004 A1
20040208717 Greenhalgh Oct 2004 A1
20040220593 Greenhalgh Nov 2004 A1
20040260300 Gorensek et al. Dec 2004 A1
20040267277 Zannis et al. Dec 2004 A1
20040267317 Higgins et al. Dec 2004 A1
20050015153 Goble et al. Jan 2005 A1
20050033362 Grafton Feb 2005 A1
20050038427 Perriello et al. Feb 2005 A1
20050049681 Greenhalgh Mar 2005 A1
20050070906 Clark et al. Mar 2005 A1
20050080400 Corcoran et al. Apr 2005 A1
20050137600 Jacobs et al. Jun 2005 A1
20050137601 Assell et al. Jun 2005 A1
20050143741 Timmermans et al. Jun 2005 A1
20050147478 Greenberg Jul 2005 A1
20050171569 Girard Aug 2005 A1
20050177168 Brunnett et al. Aug 2005 A1
20050187537 Loeb et al. Aug 2005 A1
20050203527 Carrison et al. Sep 2005 A1
20050228399 Kubo et al. Oct 2005 A1
20050251159 Ewers Nov 2005 A1
20050251208 Elmer Nov 2005 A1
20050261604 Stephens et al. Nov 2005 A1
20050283156 Schmieding et al. Dec 2005 A1
20050288710 Fallin et al. Dec 2005 A1
20060001518 Hayashi et al. Jan 2006 A1
20060004369 Patel et al. Jan 2006 A1
20060004410 Nobis Jan 2006 A1
20060015108 Bonutti Jan 2006 A1
20060015110 Pepper Jan 2006 A1
20060030884 Yeung Feb 2006 A1
20060074434 Wenstrom et al. Apr 2006 A1
20060079904 Thal Apr 2006 A1
20060100631 Sullivan et al. May 2006 A1
20060155329 Grafton et al. Jul 2006 A1
20060178748 Dinger et al. Aug 2006 A1
20060189993 Stone Aug 2006 A1
20060190042 Stone et al. Aug 2006 A1
20060212055 Karabey et al. Sep 2006 A1
20060241675 Johnson Oct 2006 A1
20060247641 Re et al. Nov 2006 A1
20060247642 Stone et al. Nov 2006 A1
20060282085 Stone et al. Dec 2006 A1
20060293689 Miller et al. Dec 2006 A1
20070010843 Green Jan 2007 A1
20070010857 Sugimoto et al. Jan 2007 A1
20070032800 Ortiz Feb 2007 A1
20070093840 Pacelli et al. Apr 2007 A1
20070167950 Tauro Jul 2007 A1
20070185532 Stone Aug 2007 A1
20070191853 Stone Aug 2007 A1
20070213734 Bleich et al. Sep 2007 A1
20070213735 Saadat et al. Sep 2007 A1
20070225721 Thelen et al. Sep 2007 A1
20070233151 Chudik Oct 2007 A1
20070255317 Fanton et al. Nov 2007 A1
20070260259 Fanton et al. Nov 2007 A1
20070276392 Beyar et al. Nov 2007 A1
20070288023 Pellegrino et al. Dec 2007 A1
20070288031 Dreyfuss et al. Dec 2007 A1
20070293879 Baker Dec 2007 A1
20080004659 Burkhart et al. Jan 2008 A1
20080009904 Bourque et al. Jan 2008 A1
20080027446 Stone Jan 2008 A1
20080027457 Dienst et al. Jan 2008 A1
20080046009 Albertorio et al. Feb 2008 A1
20080058816 Philippon et al. Mar 2008 A1
20080065080 Assell et al. Mar 2008 A1
20080065092 Assell et al. Mar 2008 A1
20080065114 Stone Mar 2008 A1
20080071282 Assell et al. Mar 2008 A1
20080082127 Stone et al. Apr 2008 A1
20080082128 Stone Apr 2008 A1
20080103528 Zirps May 2008 A1
20080109037 Steiner et al. May 2008 A1
20080114364 Goldin et al. May 2008 A1
20080114399 Bonutti May 2008 A1
20080132932 Hoeppner et al. Jun 2008 A1
20080140078 Nelson et al. Jun 2008 A1
20080140092 Stone Jun 2008 A1
20080140093 Stone et al. Jun 2008 A1
20080140116 Bonutti Jun 2008 A1
20080140123 Ferree Jun 2008 A1
20080147063 Cauldwell et al. Jun 2008 A1
20080147064 Cauldwell et al. Jun 2008 A1
20080147071 Serra et al. Jun 2008 A1
20080154275 Assell et al. Jun 2008 A1
20080161814 McAllister et al. Jul 2008 A1
20080167660 Moreau et al. Jul 2008 A1
20080188854 Moser Aug 2008 A1
20080188935 Saylor et al. Aug 2008 A1
20080243163 Masseglia et al. Oct 2008 A1
20080249481 Crainich et al. Oct 2008 A1
20080255613 Kaiser et al. Oct 2008 A1
20080262544 Burkhart Oct 2008 A1
20080275431 Stone et al. Nov 2008 A1
20080275453 Lafosse et al. Nov 2008 A1
20080306483 Iannarone Dec 2008 A1
20080312689 Denham Dec 2008 A1
20080319478 Foerster et al. Dec 2008 A1
20090012526 Fletcher Jan 2009 A1
20090018654 Schmieding et al. Jan 2009 A1
20090024130 Lombardo Jan 2009 A1
20090054928 Denham et al. Feb 2009 A1
20090062854 Kaiser et al. Mar 2009 A1
20090076514 Haines Mar 2009 A1
20090082805 Kaiser et al. Mar 2009 A1
20090099554 Forster et al. Apr 2009 A1
20090105775 Mitchell et al. Apr 2009 A1
20090112270 Lunn et al. Apr 2009 A1
20090112770 Schmidt et al. Apr 2009 A1
20090131940 Brunnett et al. May 2009 A1
20090138015 Conner et al. May 2009 A1
20090138042 Thal May 2009 A1
20090143784 Petersen et al. Jun 2009 A1
20090143819 D'Agostino Jun 2009 A1
20090149858 Fanelli et al. Jun 2009 A1
20090157081 Homan et al. Jun 2009 A1
20090157124 Ferragamo et al. Jun 2009 A1
20090160112 Ostrovsky Jun 2009 A1
20090171359 Sterrett Jul 2009 A1
20090192468 Stone Jul 2009 A1
20090194446 Miller et al. Aug 2009 A1
20090198258 Workman Aug 2009 A1
20090210047 Amplatz Aug 2009 A1
20090216238 Stark Aug 2009 A1
20090216243 Re Aug 2009 A1
20090221922 Lec et al. Sep 2009 A1
20090222013 Graf et al. Sep 2009 A1
20090234386 Dean et al. Sep 2009 A1
20090234451 Manderson Sep 2009 A1
20090240104 Ogdahl et al. Sep 2009 A1
20090240335 Arcenio Sep 2009 A1
20090248029 Paulos Oct 2009 A1
20090265002 Re et al. Oct 2009 A1
20090306671 McCormack et al. Dec 2009 A1
20090306711 Stone Dec 2009 A1
20090312763 McCormack et al. Dec 2009 A1
20090312776 Kaiser et al. Dec 2009 A1
20090312792 Fallin et al. Dec 2009 A1
20090312793 Huxel et al. Dec 2009 A1
20090318961 Stone et al. Dec 2009 A1
20090326538 Sennett et al. Dec 2009 A1
20100023056 Johansson Jan 2010 A1
20100049196 Re Feb 2010 A1
20100049202 Re Feb 2010 A1
20100049203 Re Feb 2010 A1
20100057045 Albritton, IV et al. Mar 2010 A1
20100076440 Pamichev et al. Mar 2010 A1
20100082033 Germain Apr 2010 A1
20100087857 Stone et al. Apr 2010 A1
20100121332 Crainich et al. May 2010 A1
20100121333 Crainich et al. May 2010 A1
20100137679 Lashinski Jun 2010 A1
20100145341 Ranck et al. Jun 2010 A1
20100145384 Stone et al. Jun 2010 A1
20100152739 Sidebotham et al. Jun 2010 A1
20100160962 Dreyfuss et al. Jun 2010 A1
20100185238 Cauldwell et al. Jul 2010 A1
20100185283 Baird et al. Jul 2010 A1
20100191241 McCormack et al. Jul 2010 A1
20100211075 Stone Aug 2010 A1
20100222881 Prewett Sep 2010 A1
20100234947 Ben Rubi Sep 2010 A1
20100241121 Logan et al. Sep 2010 A1
20100249786 Schmieding et al. Sep 2010 A1
20100262146 Tulkis Oct 2010 A1
20100262184 Dreyfuss Oct 2010 A1
20100268275 Stone et al. Oct 2010 A1
20100286694 Rio et al. Nov 2010 A1
20100292713 Cohn et al. Nov 2010 A1
20100292731 Gittings et al. Nov 2010 A1
20100292732 Hirotsuka Nov 2010 A1
20100292792 Stone et al. Nov 2010 A1
20100298878 Leung et al. Nov 2010 A1
20100298879 Leung et al. Nov 2010 A1
20100305709 Metzger et al. Dec 2010 A1
20100318122 Leung et al. Dec 2010 A1
20110009902 Leung et al. Jan 2011 A1
20110015674 Howard et al. Jan 2011 A1
20110015675 Howard et al. Jan 2011 A1
20110022083 DiMatteo et al. Jan 2011 A1
20110022084 Sengun et al. Jan 2011 A1
20110046625 Boileau et al. Feb 2011 A1
20110054526 Stone et al. Mar 2011 A1
20110087247 Fung et al. Apr 2011 A1
20110087280 Albertorio Apr 2011 A1
20110087284 Stone et al. Apr 2011 A1
20110093010 Genova et al. Apr 2011 A1
20110098727 Kaiser Apr 2011 A1
20110106089 Brunnett et al. May 2011 A1
20110106153 Stone et al. May 2011 A1
20110125189 Stoll, Jr. et al. May 2011 A1
20110152927 Deng et al. Jun 2011 A1
20110160767 Stone et al. Jun 2011 A1
20110160768 Stone et al. Jun 2011 A1
20110184516 Baird et al. Jul 2011 A1
20110208194 Steiner et al. Aug 2011 A1
20110208239 Stone et al. Aug 2011 A1
20110208240 Stone et al. Aug 2011 A1
20110213416 Kaiser Sep 2011 A1
20110213417 Foerster et al. Sep 2011 A1
20110218538 Sherman et al. Sep 2011 A1
20110218625 Berelsman et al. Sep 2011 A1
20110224799 Stone Sep 2011 A1
20110264138 Avelar et al. Oct 2011 A1
20110264140 Lizardi et al. Oct 2011 A1
20110264141 Denham et al. Oct 2011 A1
20110270278 Overes et al. Nov 2011 A1
20110270293 Malla et al. Nov 2011 A1
20110270306 Denham et al. Nov 2011 A1
20110276090 Berndt et al. Nov 2011 A1
20110295279 Stone et al. Dec 2011 A1
20110301708 Stone et al. Dec 2011 A1
20110319896 Papenfuss et al. Dec 2011 A1
20120004672 Giap et al. Jan 2012 A1
20120041485 Kaiser et al. Feb 2012 A1
20120041486 Stone et al. Feb 2012 A1
20120046693 Denham et al. Feb 2012 A1
20120053629 Reiser et al. Mar 2012 A1
20120053630 Denham et al. Mar 2012 A1
20120053641 Meridew Mar 2012 A1
20120059417 Norton et al. Mar 2012 A1
20120059418 Denham Mar 2012 A1
20120071976 May et al. Mar 2012 A1
20120089193 Stone et al. Apr 2012 A1
20120095470 Kaiser et al. Apr 2012 A1
20120095556 Re et al. Apr 2012 A1
20120109142 Dayan May 2012 A1
20120109156 Overes et al. May 2012 A1
20120109194 Miller et al. May 2012 A1
20120116452 Stone et al. May 2012 A1
20120123474 Zajac et al. May 2012 A1
20120136388 Odermatt et al. May 2012 A1
20120150203 Brady et al. Jun 2012 A1
20120150297 Denham et al. Jun 2012 A1
20120150301 Gamache et al. Jun 2012 A1
20120160050 Nishio et al. Jun 2012 A1
20120165866 Kaiser et al. Jun 2012 A1
20120165867 Denham et al. Jun 2012 A1
20120165938 Denham et al. Jun 2012 A1
20120172986 Stone et al. Jul 2012 A1
20120179254 Saliman Jul 2012 A1
20120180291 Oren et al. Jul 2012 A1
20120197271 Astorino Aug 2012 A1
20120203231 Long et al. Aug 2012 A1
20120203288 Lange et al. Aug 2012 A1
20120209325 Gagliano et al. Aug 2012 A1
20120239085 Schlotterback et al. Sep 2012 A1
20120239086 Reznik et al. Sep 2012 A1
20120245585 Kaiser et al. Sep 2012 A1
20120253355 Murray et al. Oct 2012 A1
20120265205 Steiner et al. Oct 2012 A1
20120290002 Astorino Nov 2012 A1
20120290004 Lombardo et al. Nov 2012 A1
20120290006 Collins et al. Nov 2012 A1
20120296345 Wack et al. Nov 2012 A1
20120296427 Conner et al. Nov 2012 A1
20120303046 Stone et al. Nov 2012 A1
20130012962 Stone Jan 2013 A1
20130018416 Lombardo et al. Jan 2013 A1
20130023928 Dreyfuss Jan 2013 A1
20130023929 Sullivan et al. Jan 2013 A1
20130023930 Stone et al. Jan 2013 A1
20130035698 Stone et al. Feb 2013 A1
20130046341 Stone et al. Feb 2013 A1
20130053897 Brown et al. Feb 2013 A1
20130072989 Overes et al. Mar 2013 A1
20130085568 Smith et al. Apr 2013 A1
20130096611 Sullivan Apr 2013 A1
20130096612 Zajac et al. Apr 2013 A1
20130110165 Burkhart et al. May 2013 A1
20130116730 Denham et al. May 2013 A1
20130131722 Marchand et al. May 2013 A1
20130158596 Miller et al. Jun 2013 A1
20130158601 Stone et al. Jun 2013 A1
20130165972 Sullivan Jun 2013 A1
20130190818 Norton Jul 2013 A1
20130190819 Norton Jul 2013 A1
20130237997 Arai et al. Sep 2013 A1
20130238025 Howard et al. Sep 2013 A1
20130245700 Choinski Sep 2013 A1
20130268000 Harner et al. Oct 2013 A1
20130296931 Sengun Nov 2013 A1
20130317544 Ferguson et al. Nov 2013 A1
20130325063 Norton et al. Dec 2013 A1
20130345749 Sullivan et al. Dec 2013 A1
20140039503 Pilgeram Feb 2014 A1
20140135835 Stone et al. May 2014 A1
20140163679 Re et al. Jun 2014 A1
20140188163 Sengun Jul 2014 A1
20140277121 Pilgeram et al. Sep 2014 A1
Foreign Referenced Citations (45)
Number Date Country
2713309 Feb 2011 CA
3131496 Feb 1983 DE
8903079 May 1989 DE
4231101 Mar 1994 DE
4243715 Jul 1994 DE
19503504 Mar 1996 DE
153831 Sep 1985 EP
253526 Jan 1988 EP
0440371 Aug 1991 EP
0611551 Aug 1994 EP
1155776 Nov 2001 EP
1174584 Jan 2002 EP
1369089 Dec 2003 EP
1398455 Mar 2004 EP
2277457 Jan 2011 EP
2286742 Feb 2011 EP
2544607 Jan 2013 EP
2548519 Jan 2013 EP
2596755 May 2013 EP
2662030 Nov 2013 EP
2662032 Nov 2013 EP
1166884 Nov 1958 FR
2606996 May 1988 FR
2676638 Nov 1992 FR
2093353 Sep 1982 GB
95011631 May 1995 WO
9628100 Sep 1996 WO
9704908 Feb 1997 WO
9722301 Jun 1997 WO
0024327 May 2000 WO
0044291 Aug 2000 WO
0128457 Apr 2001 WO
0160268 Aug 2001 WO
03007861 Jan 2003 WO
03086221 Oct 2003 WO
03092514 Nov 2003 WO
2004092531 Oct 2004 WO
2007010389 Jan 2007 WO
2008128075 Oct 2008 WO
2009105880 Sep 2009 WO
2011112371 Sep 2011 WO
2012134999 Oct 2012 WO
2012158583 Nov 2012 WO
2013006820 Jan 2013 WO
2014107729 Jul 2014 WO
Non-Patent Literature Citations (48)
Entry
ConMed: Linvatec: Shoulder Restoration System Y-Knot 1.3mm All Suture Anchor, © 2011 Linvatec Corporation, a subsidiary of ConMed Corporation—CBR 3057 (4 pages).
Biomet Sports Medicine: Micromax Flex Suture Anchor, (2008).
International Search Report PCT/US2010/042264, dated Sep. 30, 2010.
European Search Report, EP 10173568, dated Nov. 30, 2010.
Chen et al., Journal of Orthopaedic Research, pp. 1432-1438, Nov. 2009.
Chen et al., Poster No. 538, 54th Annual Meeting of the Orthopaedic Research Society, San Francisco, CA Mar. 2008.
HHS Tube, Fort Wayne Metals Research Products Corp., 2009.
Cole et al., American Journal of Sports Medicine, vol. XX, No. X, 2011.
Medtronic, The VISAO High-Speed Otologic Drill Catalog, 2007.
U.S. Appl. No. 13/303,849, filed Nov. 23, 2011.
U.S. Appl. No. 13/368,730, filed Feb. 8, 2012.
Burkinshaw, U.S. Appl. No. 60/418,545, filed Oct. 15, 2002.
U.S. Appl. No. 13/588,586, filed Aug. 17, 2012.
U.S. Appl. No. 13/588,592, filed Aug. 17, 2012.
U.S. Appl. No. 13/783,804, filed Mar. 4, 2013.
U.S. Appl. No. 61/679,336, filed Aug. 3, 2012.
Perthes, German Surgery Periodical, vol. 85, Commermorative Publication, pp. 2-18, 1906.
Perthes, Ober Operationen bel habitueller Schulterluxaton, X, pp. 199-227, 85.
Sugaya et al., Journal of Bone and Joint Surgery, vol. 85-A, No. 5, pp. 878-884, May 2003.
Insall et al., The Journal of Bone and Joint Surgery, vol. 49B, No. 2, pp. 211-228, May 1967.
Chen et al., European Cells and Materials, vol. 16, Supp. 4, p. 7, 2008.
U.S. Appl. No. 13/085,882, filed Apr. 13, 2011.
Extended European Search Report for Application No. EP 12164104 dated Jul. 11, 2012.
International Search Report and Written Opinion for Application No. PCT/US2012/024303 dated May 24, 2012.
Canadian Office Action for Application No. 2773849 dated Aug. 5, 2013.
Canadian Office Action for Application No. 2,812,775 dated Aug. 23, 2013.
U.S. Appl. No. 13/792,982, filed Mar. 11, 2013.
U.S. Appl. No. 13/799,773, filed Mar. 13, 2013.
U.S. Appl. No. 13/182,851, filed Jul. 14, 2011.
U.S. Appl. No. 13/070,692, filed Mar. 24, 2011.
U.S. Appl. No. 12/682,324, filed Sep. 7, 2010.
Stamboulis, et al., “Mechanical properties of biodegradable polymer sutures coated with bioactive glass”, Journal of Materials Science: Materials in Medicine, vol. 13, 2002, pp. 843-848.
Bretca, et al., “Bioactivity of degradable polymer sutures coated with bioactive glass”, Journal of Materials Science: Materials in Medicine, vol. 15, 2004, pp. 893-899.
Boccaccini, et al., “Composite Surgical Sutures with Bioactive Glass Coating”, J Biomed Mater Res Part B: Appl Biomater 67B, pp. 618-626, 2003.
Canadian Office Action for Application No. 2768020 dated Jan. 21, 2014.
Australian Examination Report for Application No. 2013202699 dated Feb. 21, 2014.
Partial European Search Report for Application No. EP14151822 dated May 16, 2014.
Canadian Office Action for Application No. 2,811,838 dated May 22, 2014.
Extended European Search Report for Application No. EP14159656 dated Jun. 6, 2014.
International Search Report and Written Opinion for Application No. PCT/US2014/021231 dated Jun. 25, 2014.
Extended European Search Report for Application No. EP14157129 dated Oct. 9, 2014.
Partial International Search Report for Application No. PCT/US2014/069087 dated Mar. 12, 2015.
Canadian Office Action for Application No. 2811838 dated Feb. 24, 2015.
International Search Report and Written Opinion for Application No. PCT/US2014/069087 dated Jun. 17, 2015.
Partial European Search Report for Application No. 13162591 dated Aug. 14, 2015.
European Search Report for Application No. 13178933.1 dated Sep. 25, 2015.
Extended European Search Report for Application No. EP14157877 dated Jul. 4, 2016.
Partial European Search Report for Appln No. EP12193507 dated Jun. 30, 2017.
Related Publications (1)
Number Date Country
20160354079 A1 Dec 2016 US
Continuations (1)
Number Date Country
Parent 13303849 Nov 2011 US
Child 15243183 US