Method and apparatus for preventing migration of sutures through transosseous tunnels

Information

  • Patent Grant
  • 6302886
  • Patent Number
    6,302,886
  • Date Filed
    Tuesday, January 19, 1999
    25 years ago
  • Date Issued
    Tuesday, October 16, 2001
    22 years ago
Abstract
An improved method for attaching soft tissue to bone by passing a suture through an opening in the bone, e.g., a transosseous tunnel, and affixing the soft tissue with the suture. The improvement, for preventing the suture from migrating through the bone at the end of the opening, includes placing a eyelet into an end of the bone opening and passing the suture through the eyelet, as well as through the opening in the bone, in order to affix the soft tissue to the bone with the suture.
Description




BACKGROUND OF THE INVENTION




This invention pertains to surgical systems and, more particularly, methods and apparatus for attaching tissue to bone. The invention has application in, for example, rotator cuff repair.




It is not uncommon for tendons and other soft tissues to tear or to detach from bone. Athletes, for example, often suffer “rotator cuff” tears, in which the supraspinatus tendon separates from the humerus, causing pain and loss of ability to elevate and externally rotate the arm. Complete separation can occur if the shoulder is subjected to gross trauma. Typically, however, the tear begins as a small lesion, especially, in older patients.




To repair a torn rotator cuff, surgeons must reattach the supraspinatus tendon to the humerus. Traditionally, this has been done by boring several holes obliquely through the greater tuberosity, that is, the bony structure on the outer side of the head of the humerus. Sutures are then passed through these holes, or transosseous tunnels, in order to secure the tendon.




Though use of such sutures to anchor the tendon have been referred to as the “gold standard,” it has been shown that the sutures migrate through the bone itself, particularly, along the upper edge of the openings that define the ends of transosseous tunnels on lateral cortex of the greater tuberosity. This is particularly pronounced in older patients, whose bone structures tend to be weaker and, therefore, less resistant to degradation under the force of the sutures. On prior art solution has been to augment the edges of the transosseous tunnels by affixing plate-like pieces; see, Gerber et al, “Mechanical Strength of Repairs of the Rotator Cuff,”


Journal of Bone Joint Surgery


, v. 76, n. 3, p. 371-380 (May 1994). See France et al, “Biomechanical Evaluation of Rotator Cuff Fixation Methods,”


The American Journal of Sports Medicine


. v. 17. n. 2. pp. 176 et seq.




Drawbacks of plate-like augmentation of the greater tuberosity are the difficulties in positioning and affixing the plates. Though endoscopic surgery is generally preferred, use of augmentation plates necessitates that rotator cuff repair be performed by open surgery. Moreover, the plates must be affixed to the bone by surgical glues in order to avoid risk that they will migrate from the site in the event of suture breakage.




An object of this invention is to provide improved surgical systems and, more particularly, methods and apparatus for attaching tissue to bone.




Another object of this invention is to provide improved methods and apparatus for rotator cuff repair.




A related object of the invention is to provide improved methods for reinforcing the edges of transosseous tunnels against force of sutures.




SUMMARY OF THE INVENTION




The above objects are among those met by the invention, which provides in one aspect an improvement on a method for attaching soft tissue to bone by passing a suture through an opening in the bone, e.g., a transosseous tunnel, and affixing the soft tissue with the suture. The improvement, for preventing the suture from migrating through the bone at the end of the opening, includes placing an eyelet into an end of the bone opening and passing the suture through the eyelet, as well as through the opening in the bone, in order to affix the soft tissue with the suture.




In a related aspect, the invention provides a method as described above for use in attaching the spinatus tendon to the humerus bone by placing an eyelet into an end of a transosseous tunnel and passing the suture through the eyelet, as well as through the tunnel, in order to affix the tendon to the humerus.




Further aspects of the invention provide methods as described above, in which the eyelet is screwed, or fit by interference, into the bone opening. In still further related aspects, the bone opening is expanded prior to placement of the eyelet.




In another aspect, the invention provides an apparatus for use in rotator cuff repair for reinforcing a trnsosseous tunnel to prevent migration of a suture through bone at the end of the tunnel. The apparatus comprises an eyelet arranged for placement within the end of the tunnel, or within an expanded hole formed at the end of the tunnel. The eyelet has a channel therethrough for passage of the suture and can include a flanged head to prevent the eyelet from being forced too far into the tunnel.




Related aspects of the invention provide an apparatus as described above in which the eyelet is threaded for screwing into bone on the inside of the wall of the hole or, alternatively, is arranged for interference fit with that inside wall.




Still another aspect of the invention provides an improvement on a method for attaching soft tissue to bone by passing a suture through an opening in the bone and affixing the soft tissue with the suture. The improvement, for reinforcing the bone opening, includes placing an expandable member into an end of the bone opening and inserting an insertion element into a channel that passes through the expandable member. A portion of the insertion element has an outer diameter greater than an inner diameter of at least a portion of the channel in the expandable member, so that insertion of the insertion element into the expandable member causes the expandable member to expand to obtain a pressure fit with the bone opening. The improvement further includes passing the suture through an channel of the insertion element, as well as through the opening in the bone, in order to affix the soft tissue with the suture.




Another aspect of the invention provides a method as described above in which the expandable member is substantially cylindrical and has an axial channel that extends between its proximal and distal ends. According to this embodiment, the insertion element is likewise elongate and has an axial channel extending between its proximal and distal ends.




In yet another aspect, the methods described above are adapted for rotator cuff repair. Accordingly, the step of placing the expandable member into the end of the bone opening comprises placing that member into the end of a transosseous tunnel in the humerus.




Yet another aspect of the invention provides methods as described above in which an emplacement element is used to place an expandable member into the end of the bone opening. In a related aspects, the emplacement element is frangibly attached to the expandable member such that application of force to the insertion element breaks the frangible attachment between those elements after that force has caused the insertion element to expand the expandable member.




Advantages of the invention include the ability to install the reinforcing eyelet via endoscopic surgery, as well as open surgery.




These and other aspects of the invention are evident in the drawings and in the description that follows.











BRIEF DESCRIPTION OF THE DRAWINGS




A more complete understanding of the invention may be attained by reference to the drawings, in which:





FIG. 1A

depicts a partially tom rotator cuff;





FIG. 1B

depicts the rotator cuff of

FIG. 1A

repaired in accord with prior art surgical techniques;





FIG. 2

depicts a surgical rotator cuff repaired according to the invention;





FIGS. 3A-3E

depict an eyelet according to the invention and its use in rotator cuff repair according to the invention; and





FIGS. 4-7

depict further eyelets according to the invention.











DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENT





FIG. 1A

depicts a partially torn rotator cuff. In the illustration, the globular head


10


of humerus


12


rests in the glenoid cavity


14


formed by the scapula


16


. The supraspinatus muscle


18


traverses the scapular spine (not shown) and converges into a tendon


19


(undifferentiated in the illustration), the end of which is normally fully inserted into a facet of the greater tuberosity


22


. A partial tear rotator cuff results when a portion


24


of the tendon


19


detaches from the greater tuberosity


22


, as shown in the illustration





FIG. 1B

illustrates the rotator cuff of

FIG. 1A

repaired in accord with the prior art suturing technique, in which the tendon


19


is resecured to the humerus by a suture


26


passed through a transosseous tunnel


28


bored obliquely through the greater tuberosity


22


. A further understanding of the prior art suturing technique may be attained by reference to Gerber, et al, “Mechanical Strength of Repairs of the Rotator Cuff,”


Journal of Bone and Joint Surgery


, v. 76-B, no. 3 (May 1994), at pp. 371, et seq., the teachings of which are incorporated herein by reference.




Though

FIG. 1B

shows use of only a single transosseous tunnel and suture, multiple tunnels and sutures are typically used, as discussed in the aforementioned prior art reference. Each suture can be looped superiorly (i.e., over the greater tuberosity), passed through the tendon and tied to itself Alternatively, pairs of adjacent sutures can be tied together between the exit holes on the lateral cortex.





FIG. 2

illustrates a modified suturing technique according to the invention. The modification comprises use of a bone “eyelet” to reinforce the opening


30


at the end of transosseous tunnel


28


on the lateral cortex of the greater tuberosity


22


. This prevents migration of the suture


26


through the upper edoe of the opening


30


. Such migration has been discovered to result from repeated loading of the suture during use of the shoulder.




The eyelet


32


comprises a cylinder, or other such solid geometric shape (e.g., parallelapiped), suitable to be embedded into the humerus


12


and, particularly, the greater tuberosity


22


, as shown. The eyelet


32


includes a cannula


34


, which is aligned with the transosseous tunnel


28


, through which suture


26


passes. The eyelet


32


also preferably includes a head


36


that protrudes above the bone surface. This head


36


is flanged to prevent the eyelet


32


from being driven too far into the opening


30


and, more particularly, to prevent the head from being driven below the bone surface on emplacement or as a result of forces exerted by the suture


26


.




The eyelet


32


is threaded into transosseous tunnel


28


or is held by interference fit, surgical epoxy or, simply, by the force exerted by suture


26


. In instances where the eyelet


32


requires it, the end


30


of the tunnel


28


can be enlarged to facilitate embedding the eyelet in the bone.




The eyelet


32


is comprised of a biocompatible material, i.e., a material that is chemically and biologically inert, such as, an implant grade high density polyethylene, low density polyethylene (PE 6010 and PE 2030) and polypropylene (13R9A and 23M2: all made by Rexene, Dallas, Tex.). The eyelet


32


may also be comprised of a metal, such as, surgical implant grade stainless steel.




In one preferred embodiment, an eyelet


40


according to the invention is constructed in a manner similar to the bone anchor of the type described in copending, commonly assigned U.S. application patent application Ser. No. 08/163,130, filed Dec. 6, 1993, the teachings of which are incorporated herein by reference. Such an eyelet is illustrated in

FIGS. 3A-3E

.




Referring to

FIG. 3A

, the eyelet


40


generally comprises an elongated insertion element


42


and an approximately cylindrical expandable member


44


. In its unexpended state, the expandable member


44


can be placed into a bone hole


45


, i.e., the end


30


of the transosseous tunnel


28


or an enlarged opening drilled into the bone at the end


30


of the tunnel


28


. The expandable member


44


includes an axial channel


46


, running end to end, for receiving the insertion element and for permitting passage of a transosseous suture.




As shown in the drawing, the outer diameter of at least a portion of the insertion element


42


is greater than the inner diameter of at least a portion of the axial channel


46


of the expandable member


44


. Accordingly, when the insertion element


42


is inserted into the axial channel


46


, the wider portion of the insertion element


42


exerts on the walls of the expandable member


44


a force orthogonal to the channel


46


. This outward force causes the expandable member


44


to expand against the walls of bone hole


45


, fixing the insertion element


42


within the expandable member


44


and fixing the expandable member


44


in a pressure fit firmily within the opening


45


.




The expandable member


44


includes an outer surface for secured engagement with an inner surface of the tansosseous tunnel. That outer surface can be smooth or can be provided with a plurality of ridges


48


, as shown. In particular, a preferred configuration includes a plurality of annular ridges for engaging irregularities in the bone opening wall as the expandable member


44


deforms and conforms to the bone opening wall during and after expansion.




The expandable member


44


also includes a flanged head


49


disposed at the end to prevent the member


44


from being driven too far into the transosseous tunnel on emplacement or as a result of forces exerted by the transosseous suture. The head


49


preferably has a rounded outer surface to better distribute loads placed on it by the suture.




The insertion element


42


is a substantially elongated shape with an outer surface having one or more projections


50


for engagement with the inner surface of the axial channel


46


of expandable member


44


. The projections


50


include portions with outer diameters that are greater than the inner diameter of the channel


46


, as shown, so that they expand the expandable member


44


upon insertion.




The insertion element


42


includes a channel


52


running the length of the element, from end to end. The channel is sized to permit passage of a suture


26


of the type used for transosseous suture repair of the rotator cuff.




The eyelet


40


is embedded in the transosseous tunnel


28




45


using an emplacement device of the type disclosed in aforementioned U.S. application patent application Ser. No. 08/163,130. The device includes a cylindrical holding member


54


that holds the expandable member during emplacement via a frangible junction


55


. The holding member also retains the insertion element


42


in alignment with the end of the expandable member


44


, as shown. The emplacement device further includes a plunger


56


that exerts force on the insertion element


42


forcing it into the frangibly-retained expandable member


44


and causing the holding member to break-away from the expandable member


44


, once insertion is complete.




A further understanding of the construction and operation of a bone anchor upon which the eyelet


40


is based may be attached by reference to aforementioned U.S. application patent application Ser. No. 08/163,130, the teachings of which are incorporated herein by reference.




A surgical technique according to the invention proceeds in accord with conventional surgical techniques for suture rotator cuff repair. Once the transosseous tunnel


28


is drilled, however, the eyelet


40


is installed in order to reinforce the bone hole


45


and, particularly, the opening


30


at the end of transosseous tunnel


28


on the lateral cortex of the greater tuberosity


22


. Particularly, as shown in

FIG. 3A

, the eyelet


40


is positioned in the end of the bone hole


45


. As shown in

FIG. 3B

, the plunger


56


is used to force the insertion element


42


into the expandable member


44


, thereby fixing the insertion element


42


within the expandable member


44


and fixing the expandable member


44


in a pressure fit firmly within the opening


45


. As shown in

FIG. 3C

, once the insertion element


42


is fully inserted, the continued force of the plunger


56


causes the holding member


54


to detach from the expandable member


44


at the frangible junction


55


. Once the eyelet is installed, the suture rotator cuff repair surgery is completed in the normal course, with the transosseous suture


26


being passed through the eyelet


40


and, particularly, channels


46


and


52


, as shown in FIG.


4


D. The completed repair, using eyelet


40


, is shown in FIG.


3


E.




Eyelets other than that shown in

FIGS. 3A-3E

may also be used to practice the invention. These are shown, for example, in

FIGS. 4-7

.




Referring to

FIGS. 4A-4C

, there is shown a threaded two-part eyelet


58


having an insertion member


60


and an expandable member


62


. The eyelet is used in the manner described above, however, the insertion member


60


is screwed (rather then pushed) into the expander member


62


after the latter has been placed in the bone hole. As shown in

FIGS. 4B and 4C

, as the insertion element advances into the expander member, caming surfaces


63


on the insertion element


60


force wings


64


on the expander member


62


into walls of the bone hole. The expanded wings act as anchors, preventing the assembled unit (as shown in

FIG. 4C

) from moving within the hole. The expander element includes a flanged head region that prevents the assembly from being driving further into the bone hole by the force of the suture (not shown). As above, both the insertion member


60


and expander element


62


are cannulated in order to permit the suture to pass therethrough.





FIGS. 5A-5D

show one-piece eyelets


70


according to the invention. Referring to

FIGS. 5A and 5C

, each eyelet


70


includes a head


72


to prevent the eyelet from being driven too far into the bone hole. The eyelet


70


also includes a cannula


74


to permit passage of a suture. On the exterior surface of the body of the eyelet are one or more annular wings that anchor the eyelet within the bone hole. An embodiment with multiple such wings


76


is shown, in cross-section, in

FIG. 5A and

, in side view, in FIG.


5


B. An embodiment with a single such wing


76


is shown, in cross-section in

FIG. 5C and

, in side view, in FIG.


5


D. The wings


76


are flexed or compressed inwardly on insertion of the eyelet


70


into the bone hole. Once inserted in the bone hole, the resiliency of the wings forces them back to the expanded state whence they anchor the eyelet


70


.





FIG. 6

shows another one-piece eyelet


80


according to the invention. The eyelet


80


includes head


82


, body


84


and cannula


85


. The head


82


is flanged to prevent the eyelet


80


from being pushed too far into the bone hole


86


by suture


88


. The cannula


85


permits passage of the suture


88


through the eyelet. Unlike eyelet


70


described above, eyelet


80


does not include wings at its distal end. Rather eyelet


80


is held by simple interference fit with the curved walls of hole


86


, as shown.





FIG. 7

shows yet another one-piece eyelet


90


constructed like eyelet


80


, except for inclusion of spiral threads


92


on the body of the eyelet. These threads permit eyelet


90


to be screwed into bone hole


94


, as shown.




The eyelets shown in

FIGS. 4-7

are comprised of a biocompatible materials such as implant grade high density polyethylene, low density polyethylene (PE 6010 and PE 2030) and polypropylene (13R9A and 23M2: all made by Rexene, Dallas, Tex.). The eyelets may also be comprised of a metal, such as, surgical implant grade stainless steel.




Described above are methods and apparatus meeting the objects set forth above. Those skilled in the art will appreciate that the illustrated embodiments are shown and described by way of example only, and that other methods and apparatus incorporating modifications therein fall within the scope of the invention. For example, in addition to rotator cuff repair, the invention can be beneficially applied in connection with other soft tissue-to-bone attachments utilizing transosseous tunnels, such as (by way of nonlimiting example) distal biceps tendon repair, scapho-lunate ligament repair and dorsal capsulodesis, DRUJ arthroplasty, reconstruction RCL/UCL of the thumb, reconstruction RCL/UCL of the fingers, repair of central siip for Boutonniere deformity of the hand, repair of terminal tendon for Mailet deformity of the hand, repair of avulsed or lacerated FDP/FDS, repair of ATF/CF ligaments to correct lateral ligamentous instability of the ankle/foot, achilles tendon repair following tear, bifurcate ligament repair to correct avultion of anterior lateral calcaneous.



Claims
  • 1. A device for reinforcing a transosseous tunnel to prevent migration of a suture through bone at the end thereof, comprising an eyelet arranged for placement within any of (i) a bone hole forming the end of the tunnel, and (ii) an expansion of the bone hole forming the end of the tunnel, said eyelet having a channel extending therethrough and a suture extending through the channel, passing through both ends of the transosseous tunnel and forming a loop thereby.
  • 2. A device for use in rotator cuff repair for reinforcing a transosseous tunnel to prevent migration of a suture through a humerus bone at the end of the tunnel, the device comprising an eyelet arranged for placement within any of (i) a bone hole forming the end of the tunnel, and (ii) an expansion of the bone hole forming the end of the tunnel, said eyelet having a channel extending therethrough and a suture extending through the channel, passing through both ends of the transosseous tunnel and forming a loop thereby.
  • 3. A device according to any one of claims 1 and 2, wherein the body of the eyelet is threaded for screwing into bone wall on any of (i) an inside of the bone hole forming the end of the tunnel, and (ii) an expansion of the bone hole forming the end of the tunnel.
  • 4. A device according to any one of claims 1 and 2, wherein the body of the eyelet is arranged for interference fit with the bone wall on any of (i) an inside of the bone hole forming the end of the tunnel, and (ii) an expansion of the bone hole forming the end of the tunnel.
  • 5. A device according to any one of claims 1 and 2, wherein the eyelet includes a flanged head portion.
  • 6. A device for reinforcing a transosseous tunnel to prevent migration of a suture through bone at the end thereof, comprising an eyelet arranged for placement within any of (i) a bone hole forming the end of the tunnel, and (ii) an expansion of the bone hole forming the end of the tunnel, said eyelet having a channel extending therethrough for passage of a suture and;A. an expandable member having a channel extending therethrough; and B. an insertion element including a channel extending therethrough, at least a portion of the insertion element including an outer diameter greater than an inner diameter of the channel at least a portion of the expandable member for expansion thereof upon engagement therewith, whereby, fully inserting the insertion element into the expandable member causes the expandable member to expand to obtain a pressure fit with the bone opening.
  • 7. A device for use in rotator cuff repair for reinforcing a transosseous tunnel to prevent migration of a suture through humerus bone at the end of the tunnel, the device comprising an eyelet arranged for placement within any of (i) a bone hole forming the end of the tunnel, and (ii) an expansion of the bone hole forming the end of the tunnel, said eyelet having a channel extending therethrough for passage of a suture and;A. an expandable member having a channel extending therethrough; and B. an insertion element including a channel extending therethrough, at least a portion of the insertion element including an outer diameter greater than an inner diameter of the channel at least a portion of the expandable member for expansion thereof upon engagement therewith, whereby, fully inserting the insertion element into the expandable member causes the expandable member to expand to obtain a pressure fit with the bone opening.
  • 8. The device according to any of claims 6 and 7, wherein the expandable member includes a flanged head that protrudes above a surface of the bone.
Parent Case Info

This application is a continuation of U.S. application Ser. No. 08/689,443, filed Aug. 9, 1996, now U.S. Pat. No. 5,860, 978 which is a continuation-in-part of U.S. application Ser. No. 08/163,130, filed Dec. 6, 1993, now U.S. Pat. No. 5,725,529 which is a continuation-in-part of U.S. application Ser. No. 07/765,445, filed Sep. 25, 1991, and issued as U.S. Pat. No. 5,268,001, which is a continuation-in-part of U.S. patent application Ser. No. 07/588,055, filed Sep. 24, 1990, now U.S. Pat. No. 5,088,147. The entire contents of these applications are incorporated herein by reference.

US Referenced Citations (62)
Number Name Date Kind
RE. 34293 Goble et al. Jun 1993
2381050 Hardinge Aug 1945
3036482 Kenworthy et al. May 1962
3566739 Lebar Mar 1971
3708883 Flander Jan 1973
3842824 Neufeld Oct 1974
3953896 Treace May 1976
3973277 Semple et al. Aug 1976
4013071 Rosenberg Mar 1977
4091806 Aginsky May 1978
4149277 Bokros Apr 1979
4408938 Maguire Oct 1983
4492226 Belykh et al. Jan 1985
4506670 Crossley Mar 1985
4590928 Hunt et al. May 1986
4632100 Somers et al. Dec 1986
4716893 Fischer et al. Jan 1988
4738255 Goble Apr 1988
4741330 Hayhurst May 1988
4744793 Parr May 1988
4778468 Hunt et al. Oct 1988
4828562 Kenna May 1989
4870957 Goble Oct 1989
4871289 Choiniere Oct 1989
4873976 Schreiber Oct 1989
4894063 Nashef Jan 1990
4940467 Tronzo Jul 1990
4944742 Clemow et al. Jul 1990
5013316 Goble et al. May 1991
5037422 Hayhurst et al. Aug 1991
5046513 Gatturna et al. Sep 1991
5108431 Mansat et al. Apr 1992
5116337 Johnson May 1992
5141373 Kendall Aug 1992
5141520 Goble et al. Aug 1992
5152763 Johnson Oct 1992
5176682 Chow Jan 1993
5207679 Li May 1993
5209753 Biedermann et al. May 1993
5224946 Hayhurst et al. Jul 1993
5236445 Hayhurst et al. Aug 1993
5248231 Denham et al. Sep 1993
5258015 Li et al. Nov 1993
5268001 Nicholson et al. Dec 1993
5324308 Pierce Jun 1994
5326205 Anspach, Jr. et al. Jul 1994
5354298 Lee et al. Oct 1994
5411523 Goble May 1995
5417712 Whittaker May 1995
5458601 Young, Jr. et al. Oct 1995
5464427 Curtis et al. Nov 1995
5472452 Trott Dec 1995
5480403 Lee et al. Jan 1996
5486197 Le et al. Jan 1996
5489210 Hanosh Feb 1996
5496326 Johnson Mar 1996
5501683 Trott Mar 1996
5501695 Anspach et al. Mar 1996
5522845 Wenstrom, Jr. Jun 1996
5540703 Barker, Jr. et al. Jul 1996
5545180 Le et al. Aug 1996
5571104 Li Nov 1996
Foreign Referenced Citations (22)
Number Date Country
31 46634 Jun 1983 DE
34 06961 Sep 1985 DE
85 20206 Jun 1986 DE
0 058 744 Sep 1982 EP
0 124 489 Nov 1984 EP
0 232 049 Aug 1987 EP
0 241 240 Oct 1987 EP
0 260 970 Mar 1988 EP
0 270 704 Jun 1988 EP
0 251 583 Jul 1988 EP
0 340 159 Nov 1989 EP
0 409 364 Jan 1991 EP
0 574 707 Dec 1993 EP
2.054.731 May 1971 FR
2 346 591 Oct 1977 FR
2 622 430 May 1989 FR
2 084 468 Apr 1982 GB
8901767 Mar 1989 WO
9204874 Apr 1992 WO
9210149 Jun 1992 WO
9515726 Jun 1995 WO
8809157 Dec 1998 WO
Non-Patent Literature Citations (7)
Entry
Abrams, Jeffrey S. “Arthroscopic Assisted Rotator Cuff Repairs.” Arthroscopic Surgery of the Shoulder. 13th Annual San Diego Meeting, 6/95, pp. 151-154 & 164.
Bigliani, Louis U., Ticker, Jonathan B., flatow, Evan L., Soslowsky, Louis J. and Mow, Van C. “The Relationship of Acromial Architecture to Rotator Cuff Disease.” Clinics in Sports Medicine. 10 No. 4(1991) pp. 823-838.
* Craft, et al. “Fixation Strength of Rotator Cuff Repairs With Suture Anchors and the Transosseous Suture Technique.” Journal of Shoulder and Elbow Surgery. 5, No. 1(1996), pp. 32-40.
* Ellman, Harvard, Hanker, Gregory and Bayer, Michael. “Repair of the Rotator Cuff.” The Journal of Bone and Joint Surgery. 68-A No. 8 (1986) pp. 1136-1144.
* France, E. Paul, Paulos, Lonnie E., Harner, Chris D. and Straight, Chris B. Biomechanical Evaluation of Rotator Cuff Fixation Methods. The American Journal of Sports Medicine. 17 No. 2(1989) pp. 176-181.
* Gerber, Christian, Schneeberger, Alberto G., Beck, Martin and Schlegel, Urs. “Mechanical Strength of Repairs of the Rotator Cuff.” The Journal of Bone and Joint Surgery. 76-B No. 3(1994) pp. 371-380.
* Reed, Stephen C., Glossop, N. and Ogilvie-Harris, Darrell J. “Full-Thickness Rotator Cuff Tears—A Biomechanical Comparison of Suture Versus Bone Anchor Techniques.” The American Journal of Sports Medicine. 24 No. 1(1996) pp. 46-481.
Continuations (1)
Number Date Country
Parent 08/689443 Aug 1996 US
Child 09/234022 US
Continuation in Parts (3)
Number Date Country
Parent 08/163130 Dec 1993 US
Child 08/689443 US
Parent 07/765445 Sep 1991 US
Child 08/163130 US
Parent 07/588055 Sep 1990 US
Child 07/765445 US