Patent Grant
8747439
The present invention relates to a new and improved method of securing body tissue by using ultrasonic vibratory energy.
Difficulty has been encountered in securing sutures against movement relative to body tissue. A knot may be tied in a suture to prevent loosening of the suture. However, the knot weakens a portion of the suture and reduces the overall force transmitting capability of the suture. It has been suggested that a suture could be secured using a suture retainer in the manner disclosed in U.S. Pat. Nos. 5,735,875 and 6,010,525.
When a suture retainer is used to maintain a suture in a desired position relative to body tissue, the material of the suture retainer may be pressed against the suture. During pressing of the material of the retainer against the suture, the suture may be heated to promote a flowing of the material of the suture retainer and bonding to the material of the suture retainer to the surface of the suture by heating material of the suture retainer into its transition temperature range.
When the material of the suture retainer is heated into its transition temperature range, the material changes from a solid condition in which it has a fixed form to a soft or viscous condition. When the material of a suture retainer has been heated into the transition temperature range, the material can be molded around an outer side surface of a suture and bonded to the suture without significant deformation of the suture. The transition temperature ranges for various polymers which are suitable for forming suture retainers are disclosed in the aforementioned U.S. Pat. No. 5,735,875.
The present invention provides a new and improved method for use in securing body tissue. If desired, a suture retainer may be used to grip the suture. When a suture retainer is used, ultrasonic vibratory energy is transmitted to the material of the suture retainer to effect a heating of at least some of the material of the suture retainer. Portions of the suture retainer are then bonded to each other and/or to the suture.
It may be desired to retain layers of body tissue in linear apposition with each other. When this is to be done, a suture is used to hold the layers of body tissue in linear apposition after they have been approximated to each other. The suture may be secured relative to the body tissue by a suture retainer or crimp. Alternatively, sections of the suture may be secured together. To secure the suture relative to the body tissue, ultrasonic vibratory energy is applied to either the suture or the suture retainer. The ultrasonic energy may be applied while the suture is being tensioned with a predetermined force and while a predetermined force is being transmitted to the body tissue.
The suture retainer or crimp may have any one of many different constructions. One specific suture retainer constructed in accordance with one of the features of the present invention includes one or more passages through which one or more sections of the suture are inserted. In another embodiment of the invention, the suture retainer has sections which are formed separately from each other. The sections of the suture retainer are connected with the suture and/or each other by transmitting ultrasonic vibratory energy to at least one of the sections of the suture.
If desired, the suture may be wrapped around a portion of the suture retainer. The suture retainer may be provided with one or more recesses into which one or more sections of the suture are moved. The transmission of ultrasonic vibratory energy to the suture retainer is utilized to effect a bonding of portions of the suture retainer with each other and/or with the suture.
The suture retainer may be omitted and sections of the suture bonded to each other. When this is to be done, ultrasonic vibratory energy is transmitted to the sections of the suture. Force is applied against opposite sides of the sections of the suture to increase the extent of the sections of the suture in a direction transverse to the sections of the suture. As the transverse extent of the suture is increased, areas on outer side surfaces of the sections of the suture are increased.
The foregoing and other features of the invention will become more apparent upon a consideration of the following description taken in connection with the accompanying drawings wherein:
A tissue securing system 30 (
The tissue securing system 30 is used in a sterile, operating room environment to secure upper and lower layers 46 and 48 of soft, human body tissue in linear apposition with each other. Thus, the two layers 46 and 48 of human body tissue are approximated and held against movement relative to each other by the suture 32. Although the two layers 46 and 48 of body tissue have been schematically illustrated in
Although the tissue securing system 30 has been illustrated in
If desired, a force distribution member, such as a button, could be utilized between the connector section 42 of the suture 32 and the lower layer 48 of body tissue. The force distribution member would distribute force over a relative large area of the lower layer 48 of body tissue. Similarly, a force distribution member, such as a button, could be utilized between the upper layer 46 of soft tissue and the left and right sections 38 and 40 of the suture 32 and the suture retainer 34.
It is also contemplated that the suture 32 could extend through a suture anchor and/or be connected with body tissue in a manner similar to that disclosed in U.S. Pat. Nos. 5,584,862; 5,549,631; and/or 5,527,343. Of course, the suture 32 could be connected with body tissue in a different manner if desired. For example, the connector section 42 could be eliminated. If this is done, the left section 38 of the suture 32 could be connected with one suture anchor and the right section 40 of the suture could be connected with a second suture anchor.
Although the sections 38 and 40 of the suture 32 could extend straight through the suture retainer 34, in the illustrated embodiment of the invention, the sections 38 and 40 of the suture 32 are wrapped around portions of the suture retainer 34. Thus, the left section 38 of the suture 32 is wrapped around a portion 52 (
In the illustrated embodiment of the invention, the left section 38 of the suture 32 is wrapped for more than a complete turn around the portion 52 of the suture retainer and the right section 40 of the suture is wrapped for more than a complete turn around the portion 54 of the suture retainer. However, if desired, wrapping of the sections 38 and 40 of the suture 32 around the suture retainer 34 could be omitted or each of the sections of the suture could be wrapped for less than one complete turn around a portion of the suture retainer.
When the sections 38 and 40 of the suture 32 are wrapped around the portions 52 and 54 of the suture retainer 34, a plurality of bends are formed in each of the sections of the suture. Thus, bends 58, 60, 62 and 64 are formed in the section 38 of the suture 32 as it is wrapped around the portion 52 of the suture retainer 34. Similarly, bends 66, 68, 70 and 72 are formed in the section 40 of the suture 32 as it is wrapped around the portion 54 of the suture retainer 34. Of course, a greater number of bends would be formed in each of the sections 38 and 40 of the suture 32 if they were wrapped a greater number of times around the suture retainer 34.
Although the suture retainer 34 could have many different constructions and configurations, in the illustrated embodiment of the invention, the suture retainer 34 is integrally formed as one piece and has a spherical configuration. A cylindrical central passage 76 extends axially through the suture retainer 34 between upper and lower (as viewed in
In the illustrated embodiment of the invention, two lengths of the left suture section 38 and two lengths of the right suture section 40 extend through the passage 76 as a result of the wrapping of the sections of the suture around the portions 52 and 54 of the suture retainer 34. However, the two sections 38 and 40 of the suture 32 could extend straight through the passage 76 without being wrapped around the portions 52 and 54 of the suture retainer 34. If this was done, only a single length of the left section 38 of the suture 32 would be disposed in the passage 76 adjacent to a single length of the right section 40 of the suture 32. Of course, if the sections 38 and 40 of the suture 32 were wrapped around the portions 52 and 54 of the suture retainer for a greater number of turns, a greater number of lengths of the sections 38 and 40 of the suture 32 would extend through the passage 76.
In the illustrated embodiment of the suture retainer 34, a pair of grooves or recesses 80 and 82 extend radially inward from a spherical outer side surface 84 of the suture retainer 34. The grooves or recesses 80 and 82 are relatively deep so that the portions 52 and 54 of the suture retainer around which the suture is wrapped are relatively slender. This results in relatively short lengths of the sections 38 and 40 of the suture being disposed in engagement with the outer side surface of the suture retainer 34 adjacent to the upper and lower polar regions of the suture retainer.
In the embodiment of the invention illustrated in
Rather than opening radially outward to the outer side surface 84 of the suture retainer 34, the grooves 80 and 82 could be undercut to enclose the portions of the suture 32 disposed in the grooves. It is contemplated that the grooves could have any one of the groove configurations disclosed in U.S. Pat. No. 6,010,525. The disclosure from the aforementioned U.S. Pat. No. 6,010,525 is incorporated herein in its entirety by this reference thereto. Alternatively, the grooves 80 and 82 could be formed as passages which extend through the suture retainer 34 parallel to and spaced apart from the central passage 76.
It is contemplated that the suture retainer 34 may be formed of many different materials. However, it is contemplated that it will be preferred to form the suture retainer 34 of a biodegradable polymer. One biodegradable polymer which may be utilized is polycaperlactone. Alternatively, the suture retainer 34 could be formed of polyethylene oxide terephthalate or polybutylene terephthalate. The suture retainer 34 could be formed as a polyhydroxyalkanoate if desired. It is also contemplated that other biodegradable or other bioerodible copolymers could be utilized if desired.
Although it is preferred to form the suture retainer 34 of a biodegradable material, the suture retainer could be formed of a material which is not biodegradable. For example, the suture retainer 34 could be formed of an acetyl resin, such as “Delrin”™. Alternatively, the suture retainer 34 could be formed of a para-dimethylamino-benzenediazo sodium sulfonate, such as “Dexon”™. If desired, the suture retainer 34 could be formed of nylon.
The suture 32 may be formed of the same material as the suture retainer 34 or of a different material. The suture 32 may be formed of natural or synthetic materials. The suture 32 may be a monofilament or may be formed of a plurality of interconnected filaments. The suture 32 may be biodegradable or non-biodegradable. It is contemplated that the suture retainer 34 could be utilized in association with force transmitting elements other than a suture. It is believed that it may be preferred to form the suture 32 of the same material as the suture retainer 34.
In accordance with a feature of the present invention, ultrasonic vibratory energy is utilized to cause the suture retainer 34 to grip the suture 32. The ultrasonic vibratory energy is at a frequency above that which can normally be detected by the human ear, that is, above 16 to 20 kilohertz. Although there are a wide range of frequencies which may be utilized, it is believed that it will be desirable to use ultrasonic energy having a frequency of between 20 kilohertz and 70 kilohertz. However, higher frequency vibratory energy could be utilized if desired.
The ultrasonic vibratory energy may be continuously applied, pulsed or modulated in various fashions. Any one of many known transducers may be utilized to change electrical energy into mechanical vibrations having an ultrasonic frequency. The transducers may be piezoelectric, ferroelectric, or magnetostrictive. One commercial source of apparatus which may be utilized to provide ultrasonic vibratory energy is Dukane Corporation, Ultrasonics Division, 2900 Dukane Drive, St. Charles, Ill. Of course, there are other sources of apparatus which can be utilized to provide ultrasonic vibratory energy.
The ultrasonic vibratory energy creates frictional heat at the areas where the suture retainer 34 and suture 32 are disposed in engagement with each other. The frictional heat provided by the ultrasonic vibratory energy is effective to heat the material of the suture retainer 34 into its transition temperature range while the material of the suture 32 remains at a temperature close to or below its transition temperature range. For example, the suture 32 may be formed of a material having a transition temperature range which is above 190 degrees Celsius. The suture retainer 34 may have a transition temperature range which, for the most part, is at a temperature below 190 degrees Celsius.
However, it should be understood that at least a portion or even the entire transition temperature range for the suture 32 could be co-extensive with the transition range for the suture retainer 34. In fact, the transition temperature range of the suture 32 could extend below the transition temperature range of the suture retainer 34. However, it is believed that it may be preferred to have the transition temperature range for the suture 32 above at least a portion of the transition temperature range of the suture retainer 34.
Once the material of the suture retainer 34 has been heated into its transition temperature range by the ultrasonic vibratory energy, the plastic material of the suture retainer 34 loses its rigidity and becomes soft and viscous. The softened material of the suture retainer is moldable and flows, when subjected to pressure, around the suture 32 without significant deformation of the suture. However, the temperature range into which the suture 32 is heated and the pressure applied against the suture may result in some deformation of the suture.
Although it is contemplated that the suture 32 and suture retainer 34 could be made of many different materials, the suture and suture retainer may be formed of a plastic material which is a biopolymer. For example, the suture 32 and/or suture retainer 34 may be formed of polyglycolide which is commercial available under the trademark “Dexon”. Polyglycolide is a crystalline material that melts at about 225° Celsius. However, the suture could be formed of a glycolide-based copolymer which is commercially available under the trademark “Vicryl”.
The suture retainer 34 is also made of a plastic material which may be a biopolymer. For example, the suture retainer 34 may be made of polydellactide. The transition temperature of polydellactide will vary depending upon the specific characteristics of the material. However, a suture retainer 34 formed of polydellactide may have a transition temperature range of about 75° Celsius to about 120° Celsius. Other materials which may be utilized for forming the suture 32 and/or suture retainer 34 are disclosed in U.S. Pat. No. 5,735,875. The disclosure in the aforementioned U.S. Pat. No. 5,735,875 is hereby incorporated herein in its entirety by this reference thereto.
In order to promote bonding of the material of the suture retainer 34 to the suture 32, both the suture and suture retainer may be formed of the same amorphous thermoplastic material. For example, both the suture 32 and suture retainer 34 may be formed of a polyhydroxy-alkanoate. Alternatively, both the suture 32 and suture retainer 34 may be formed of nylon. It is contemplated that the suture 32 and suture retainer 34 could be formed of different amorphous polymers which are similar, that is, have the same or similar chemical properties.
When the ultrasonic vibratory energy is to be applied to the suture retainer 34, a supportive member or anvil 90 (
The horn is vibrated, horizontally as viewed in
To effect a heating of the material of the suture retainer 34, mechanical vibrations are transmitted from the horn 92 through the material of the retainer 34 to a location adjacent to an interface between the suture 32 and the suture retainer 34. The frictional heat created by the ultrasonic vibratory energy transmitted to the suture retainer from the horn 92 is sufficient to heat the material of the suture retainer 34 at locations adjacent to the suture 32, into the transition temperature range of the material of the suture retainer. As this occurs, the passage 76 and grooves 80 and 82 collapse under the influence of the force indicated at 96 and 98 in
The vibration of the horn 92 is then interrupted and the material of the suture retainer 34 begins to cool. The clamping force, indicated by the arrows 96 and 98, is maintained against opposite sides of the suture retainer 34 by the anvil 90 and horn 92 during the time which ultrasonic vibratory energy is transmitted from the horn 92 to the material of the suture retainer 34. After interruption of the transmission of ultrasonic vibratory energy, the clamping force, indicated schematically by the arrows 96 and 98 and applied by the anvil 90 and horn 92, is maintained for a predetermined amount of time sufficient to allow the material of the suture retainer to cool and bond to both itself and the suture 32.
If desired, the force, indicated schematically by the arrows 96 and 98 in
The length of time for which ultrasonic vibratory energy is transmitted to the suture retainer 34 may vary as a function of the amplitude and frequency of the ultrasonic vibratory energy transmitted to the suture retainer. It is contemplated that the frequency of the ultrasonic vibratory energy will be in a range of between 20 kilohertz and 70 kilohertz. It is contemplated that the amplitude of the ultrasonic vibrations may vary within a range of 0.0008 inches to 0.0050 inches depending upon the design of the suture retainer 34 and the material forming the suture retainer.
It is also contemplated that the force, indicated schematically by the arrows 96 and 98, applied against the suture retainer 34 may vary depending upon the construction of the suture retainer 34 and the material forming the suture retainer. For example, a force of approximately 1-15 pounds may be applied against the suture retainer 34 by both the anvil 90 and horn 92. However, the amount of force which is applied will probably be different for different suture retainers and different horns 92.
It is believed that the ultrasonic vibratory energy may be transmitted from the horn 92 to the suture retainer 34 for a period of time which varies between 0.25 seconds and 1.0 second. After the transmission of ultrasonic vibratory energy has been interrupted, the force, indicated by the arrows 96 and 98, may continue to be applied to the suture retainer 34 by the anvil 90 and horn 92 for approximately 1.0 seconds.
The extent to which the suture retainer 34 is compressed by the force 96 and 98 applied against the suture retainer by the anvil 90 and horn 92 has been illustrated schematically in
It should be understood that the foregoing specific operating characteristics, for example, amplitude and frequency of the ultrasonic vibratory energy transmitted from the horn 92 to the suture retainer 34, force applied against the suture retainer by the anvil 90 and horn 92, time for which force and/or ultrasonic vibratory energy is applied, and the distance through which the suture retainer is compressed, have been set forth herein for purposes of clarity of description. It is contemplated that the foregoing specific numerical values will be different for different embodiments of the invention and may vary extensively from the exemplary values set forth.
When the two layers 46 and 48 of body tissue are to be held in position relative to each other by the tissue securing system 30, the suture 32 is positioned relative to the layers of body tissue. The left and right sections 38 and 40 of the suture 32 extend through the two layers 46 and 48 of tissue. Although the sections 38 and 40 of the suture 32 have been illustrated schematically in
In the embodiment of the invention illustrated in
When the suture 32 has been positioned relative to the two layers 46 and 48 of body tissue, the two layers of body tissue are pressed against each other in linear apposition. The suture retainer 34 is then connected with the suture 32. When the suture retainer 34 is to be connected with the suture 32, the left (as viewed in
Similarly, the right section 40 of the suture 32 is inserted through the central passage 76 and wrapped around the portion 54 of the suture retainer 34. The right section 40 of the suture is then inserted through the central passage 76 for a second time. This results in the suture 32 being connected with the suture retainer 34 in the manner illustrated schematically in
The suture retainer 34 is then moved downward (as viewed in
As the suture retainer 34 is moved along the suture 32 toward the upper layer 46 of body tissue, a predetermined tension, indicated by arrows 102 and 104 in
As the suture retainer 34 moves downward (as viewed in
The suture retainer 34 is pressed downward against the body tissue 46 with a predetermined force, indicated schematically by an arrow 106 in
The force, indicated by the arrows 102 and 104, with which the sections 38 and 40 of the suture 32 are tensioned, may vary depending upon the material from which the suture is constructed and the size of the suture. By consulting a chart, a surgeon can select a suture size and strength suitable for a particular use. Thus, a relatively large suture having substantial strength may be selected when body tissue is to be connected with a bone or when portions of a bone are to be interconnected by the suture. On the other hand, a relatively small suture size having a relatively small strength may be selected when delicate body tissue, such as stomach or intestinal tissue, is to be interconnected with the suture. The tension forces 102 and 104 in the sections 38 and 40 are determined as a function of the strength 32 of the suture and the characteristics of the body tissue through which the suture extends.
The suture 34 is pressed against the body tissue with a force which is also a function of the size and strength of the suture 32 and the characteristics of the body tissue 46 and 48. One way in which force with which the suture 32 is tensioned and with which the suture 34 is pressed against body tissue is disclosed in U.S. patent application Ser. No. 09/348,940 filed Jul. 7, 1999 by Peter M. Bonutti et al. and entitled “Method and Apparatus for Securing a Suture”. The disclosure in the aforementioned U.S. patent application Ser. No. 09/348,940 is hereby incorporated herein by this reference thereto.
After the suture retainer 34 has been pressed against the body tissue with a predetermined force and the suture 32 tensioned with a predetermined force to compress the layers 46 and 48 of body tissue, ultrasonic vibratory energy is applied to the suture retainer. To apply the ultrasonic vibratory energy to the suture retainer 34, the anvil 90 (
The specific magnitude of the force 96 and 98 will vary depending upon the composition of the suture retainer 34 and the construction of the suture retainer. In addition, the magnitude of the force 96 and 98 will vary as a function of the desired extent of deformation of the suture retainer 34. When the suture retainer 34 has been heat softened by ultrasonic vibratory energy, the material of the suture retainer is pliable and is plastically deformed by the force applied against the suture retainer by the anvil 90 and horn 92.
In addition to the anvil 90 and horn 92, the apparatus for transmitting ultrasonic vibratory energy to the suture retainer 34 includes a generator (not shown) which changes standard electrical power into electrical energy at the desired ultrasonic frequency. A transducer (not shown) changes the electrical energy into low amplitude mechanical motion or vibration. These vibrations are transmitted to a booster which is used to increase or decrease the amplitude of the vibrations. The vibrations are then transmitted to the horn 92.
The ultrasonic vibratory energy transmitted to the suture retainer 34 from the horn 92 is converted into heat energy. When this occurs, the temperature of the material forming the suture retainer 34 increases. The heat tends to concentrate at a boundary between the suture 32 and the suture retainer 34. Thus, the heat tends to concentrate in the areas where the suture 32 engages the grooves 80 and 82 and the passage 76 (
As the temperature of the suture retainer 34 increases, the material of the suture retainer is heated into the transition temperature range and softens. However, the material of the suture retainer 34 does not melt and become liquid. As the material of the suture retainer 34 softens, the forces 96 and 98 (
As the ultrasonic vibratory energy is effective to heat soften the material of the suture retainer 34, the grooves 80 and 82 close, that is, collapse. As the grooves 80 and 82 close, the central passage 76 also closes. As the grooves 80 and 82 and central passage 76 close, the softened material of the suture retainer 34 moves into engagement with the suture (
The viscous material of the suture retainer 34 engages the suture 32 and bonds to the suture without significant deformation of the suture. The materials of the suture 32 and suture retainer 34 should be chemically compatible so that a molecular bond can be established between the suture retainer and the suture. Like materials, that is materials having chemical properties which are the same or very similar will usually bond together. However, dissimilar materials may bond if their melt temperatures are reasonably close and they are of like molecular structure. Generally speaking, amorphous polymers are readily bonded to each other.
The suture retainer 34 is formed separately from the suture 32. As the material of the suture retainer 34 bonds to the suture 32, the suture retainer 34 becomes fixedly connected to the suture.
If desired, heat may be transmitted directly to the suture retainer 34 during the transmission of ultrasonic vibratory energy to the suture retainer. The heat may be transmitted from a heating element disposed in the anvil 90 and/or the horn 92. Alternatively, a separate member could be utilized to transmit heat to the suture retainer 34.
In the embodiment of the invention illustrated in
In the embodiment of the invention illustrated in
In the embodiment of the invention illustrated in
The suture 112 extends straight through the lower layer 116 and upper layer 114 of body tissue. The two layers of body tissue are disposed in linear apposition with each other and are compressed between the suture anchor 120 and a suture retainer 124. The upper and lower layers 114 and 116 of body tissue are compressed by force applied against the body tissue by the suture retainer 124 and suture anchor 120. By having the layers 114 and 116 of body tissue approximated with each other and by pressing the layers of tissue together, healing of the tissue is promoted.
Although the layers 114 and 116 are layers of soft body tissue, the suture 112, suture anchor 120, and suture retainer 124 could be used with hard body tissue in the manner disclosed in U.S. Pat. No. 5,921,986. Alternatively, the suture 112, suture anchor 120, and suture retainer 124 could be used to connect soft body tissue with hard body tissue.
The suture retainer 124 has a spherical configuration and is formed separately from the suture 112. A cylindrical passage 126 extends axially through the suture retainer 124. Although the suture 112 extends straight through the passage 126 in the suture retainer 124, bends and/or loops could be formed in the suture 112 around the suture retainer 124.
The suture retainer 124 is formed of one piece of spherical polymeric material having a relatively low coefficient of friction. The suture retainer 124 may be formed of many different materials. However, it is believed that it may be preferred to form the suture retainer 124 of a biodegradable polymer such as polycaperlactone or polyhydroxyalkanoate. It is contemplated that other biodegradable or bioerodible polymers could be utilized if desired. It is believed that it may be preferred to form the suture retainer 124 of an amorphous thermoplastic material.
The suture 112 may be a monofilament or may be formed of a plurality of interconnected filaments. The suture 112 may be biodegradable or non-biodegradable. It is believed that it will be preferred to form the suture 112 of the same material as the suture retainer 124. However, the suture 112 could be formed of a material which is different than the material of the suture retainer. The suture 112 may be formed of an amorphous thermoplastic having chemical properties which are the same or similar to the chemical properties of the suture retainer 124. For example, both the suture retainer 124 and the suture 112 may be formed of the same biodegradable polymer, such as polycaperlactone or polyhydroxyalkanoate.
The suture 112 is tensioned with a force which is a function of the size and strength of the suture. In addition, the suture retainer 124 is pressed against the tipper layer 114 of body tissue with a force which is a function of the size and strength of the suture 112. Although the suture retainer 124 is disposed in direct engagement with and is pressed against an outer side surface of the upper layer 114 of body tissue, a force distribution member or button could be positioned between the suture retainer and the upper layer 114 of body tissue.
The suture 112 is tensioned by a force application assembly 130 which is connected with a second our outer end portion 132 of the suture 112. The force application assembly 130 includes a transducer or load cell 134 which provides an output signal indicative of a force, indicated schematically at 136 in
The suture retainer 124 is pressed against the body tissue with a force which is also a function of the strength and size of the suture 112. A force application member 140 is used to apply force against the suture retainer 124. The force application member 140 has a cylindrical opening 142 which extends through the force application member.
The suture 112 extends through the opening 142 in the force application member 140. A slot may be formed in the force application member 140 to enable the suture to be moved into the opening 142. Alternatively, the suture 112 could be inserted through the opening 142 before the end portion of the suture is connected with the force application assembly 130.
Forces, indicated schematically at 146 and 148 in
The suture retainer 124 slides downward (as viewed in
After the suture retainer 124 has been moved along the suture 112 to the position illustrated in
While the suture 112 is being pulled straight under the influence of tension in the suture due to the force 136 and while the suture retainer 124 is being pressed against the upper layer 114 of body tissue or against a suitable force distribution member, the suture retainer 124 is heated to grip the suture 112. In accordance with one of the features of the invention, the suture retainer 124 is heated by the application of ultrasonic vibratory energy to the suture retainer. The ultrasonic vibratory energy is converted into heat by the molecules of the suture retainer 124. Thus, the mechanical ultrasonic vibrations applied against the suture retainer 124 cause molecular vibration of the material of the suture retainer and a heating of the suture retainer.
When a portion of the material forming the suture retainer 124 has been heated into its transition temperature range, the application of ultrasonic vibratory energy to the suture retainer 124 is interrupted. Heating the material forming the suture retainer 124 causes the material to lose its rigidity and soften. The material of the suture retainer 124 is not melted and does not become liquid by being heated into its transition temperature range. The softened material of the suture retainer 124 bonds to the suture 112 without significant deformation of the suture.
To apply ultrasonic vibratory energy to the suture retainer 124, a support member or anvil 160 engages one side, that is the left side as viewed in
The anvil 160 and horn 162 are pressed against opposite sides of the suture retainer 124 with predetermined forces, indicated schematically by arrows 164 and 166 in
The mechanical vibrations applied to the suture retainer 124 by the horn 162 are effective to heat a portion of the material of the suture retainer 124 into the transition temperature range. The heat tends to concentrate on the portion of the suture retainer 124 adjacent to the passage 126 and the suture 112. When the material of the suture retainer 124 adjacent to the suture 112 has been heated into its transition temperature range, the application of ultrasonic vibratory energy to the suture retainer 124 is interrupted. The forces 164 and 166 are effective to close or collapse the passage 126 and to press the softened material of the suture retainer 124 against the suture 112.
Although the application of ultrasonic vibratory energy to the suture retainer 124 is interrupted, the anvil 160 and horn 162 continue to apply the forces 164 and 166 against the softened material of the suture retainer. If desired, the forces 164 and 166 may be increased when the application of ultrasonic vibratory energy to the suture retainer 124 by the horn 162 is interrupted. The forces 164 and 166 firmly press the heat-softened material of the suture retainer 124 into the passage 126 to collapse the passage. The heat softened material of the suture retainer 124 is plastically deformed and pressed against the suture 112 by the forces 164 and 166 applied against the suture retainer by the anvil 160 and horn 162.
The forces 164 and 166 are maintained for a sufficient period of time to enable the material of the suture retainer 124 to bond to the suture 112 without significant deformation of the suture. Once this bonding has been achieved, application of the forces 164 and 166 is interrupted and the anvil 160 and horn 162 are withdrawn. The force application member 140 may then be disengaged from the suture retainer and the force application assembly 130 disconnected from the outer end portion 132 of the suture 112.
When the layers 114 and 116 of body tissue are to be interconnected with the suture 112, suture anchor 120 and suture retainer 124, the upper layer 114 is moved into apposition with the lower layer 116 of body tissue. The suture 112 is then connected with the suture anchor 120 and is inserted through the layers 114 and 116 of body tissue with a suitable needle. The outer end portion 132 of the suture 112 is then inserted through the passage 126.
The suture retainer 124 is then moved along the suture 112 into engagement with the upper layer 114 of body tissue. The force application member 140 is utilized to transmit the forces 146 and 148 to the suture retainer 124 to press the suture retainer against the upper layer 114 of body tissue. This results in the two layers 114 and 116 of body tissue being pressed firmly together between the suture retainer 124 and suture anchor 112. The forces 146 and 148 are transmitted to the suture retainer 124 through the force application member 140. The suture 112 is tensioned with a force 136 by the force application assembly 130.
The anvil 160 and horn 162 then compress the suture retainer 124 under the influence of the forces 164 and 166. Ultrasonic vibratory energy is transmitted to the suture retainer. Upon heating and softening of at least a portion of the material of the suture retainer 124, the transmission of ultrasonic energy to the suture retainer is interrupted and a bonding of the material of the suture retainer to the suture 112 occurs. After the suture retainer 124 has firmly gripped the suture 112, the application of the forces 164 and 166 is interrupted.
In the foregoing explanation of the manner in which the layers 114 and 116 of body tissue are secured by the use of the suture 112, suture anchor 120 and suture retainer 124, the suture retainer has been heated by only the application of ultrasonic vibratory energy to the suture retainer. However, it is contemplated that heat energy could be transmitted directly to the suture retainer along with the ultrasonic vibratory energy. If this was to be done, a heating element could be provided in the anvil 160 and/or horn 162. If desired, a separate heating element could engage the suture retainer to transmit the heat to the suture retainer separately from the anvil 160 and horn 162.
It is believed that it probably will be preferred to have the anvil 160 and horn 162 engage the suture retainer 124 at locations spaced from the suture 112 to prevent excessive heating of the material of the suture. If desired, protective collars could be provided around the suture 112 at opposite ends of the passage 126.
In the embodiment of the invention illustrated in
A tissue securing system 174 is used in a sterile, operating room environment and includes a suture 176 and a suture retainer 178. The suture 176 has left and right sections 182 and 184 which extend into human body tissue 186. The body tissue 186 may include a plurality of layers which are approximated in linear apposition with each other in the manner previously described in conjunction with the embodiment of the invention illustrated in
Although the suture 176 has been illustrated in
The suture retainer 178 has a spherical configuration and is formed separately from the suture 176. A pair of parallel passages 190 and 192 extend through the suture retainer 178 at locations offset to opposite sides of a central or polar axis of the suture retainer. A force transmitting member 194 is provided between the suture retainer 178 and the body tissue 186.
The sections 182 and 184 of the suture 176 press against opposite sides of the force transmitting member 194. If desired, the force transmitting member 194 could be provided with grooves or passages to receive the sections 182 and 184 of the suture 176. The force transmitting member 194 could be integrally formed as one piece with the suture retainer 178. Both the force transmitting member 194 and suture retainer 178 are formed separately from the suture 176.
In accordance with a feature of this embodiment of the invention, ultrasonic vibratory energy is applied to the suture retainer 178 by a horn or acoustic tool 200. The horn 200 extends into a cylindrical passage 202 formed in the suture retainer 178. The passage 202 extends parallel to and is disposed midway between the passages 190 and 192 which receive the sections 182 and 184 of the suture 176.
In the embodiment of the invention illustrated in
A pair of force application members or anvils 206 and 208 are pressed against opposite sides of the suture retainer 178 with predetermined forces, indicated schematically by arrows 210 and 212 in
When the tissue securing system 174 is to be utilized to secure the body tissue 186, the suture 176 is positioned relative to the body tissue in the manner illustrated schematically in
After the suture 176 has been positioned relative to the body tissue, the upper (as viewed in
When the suture retainer 178 has been moved along the sections 182 and 184 of the suture 176 into engagement with the force distribution member 194, a predetermined force is applied against suture retainer 178, in the manner similar to that indicated schematically in
While the suture 176 is being tensioned with a predetermined force and while the suture retainer 178 is being pressed against the force distribution member 194 with a predetermined force, the suture retainer 178 is deformed to grip the sections 182 and 184 of the suture 176. This deformation of the suture retainer 178 results in a firm gripping of the sections 182 and 184 of the suture 176 to maintain a desired tension force in the suture and to maintain a desired compression force against the body tissue 186.
To deform the suture retainer 178 to grip the suture 176, the anvils 206 and 208 are pressed against opposite sides of the suture retainer with a predetermined force, as indicated schematically by the arrows 210 and 210 in
Vibration of the horn 200 at ultrasonic frequencies transmits mechanical vibrational energy form the horn 200 to the suture retainer 178. This ultrasonic vibrational energy is converted into heat energy and results in a heating of the suture retainer 178. The heat in the suture retainer tends to be concentrated in the material of the suture retainer at locations adjacent to the passages 190 and 192. When the material of the suture retainer 178 adjacent to the passages 190 and 192 has been heated into a transition temperature range for the material, the material of the suture retainer becomes soft and relatively pliable. However, the material of the suture retainer 178 does not melt and become liquid. The transmission of ultrasonic vibratory energy from the horn 200 to the suture retainer 178 is then interrupted.
The anvils 206 and 208 continue to be pressed against the suture retainer 178 with the forces indicated schematically by the arrows 210 and 212 in
The suture retainer 178 and suture 176 may be formed of many different materials. However, it is believed that it will be preferred to form the suture retainer 178 and the suture 176 of a biodegradable polymer. The biodegradable polymer may advantageously be an amorphous thermoplastic. Bonding of the material of the suture retainer 178 with the material of the suture 176 is promoted by forming the suture retainer and suture of the same material. However, the suture retainer 178 and suture 176 could be formed of different materials having similar chemical properties and which are compatible with each other.
In the embodiment of the invention illustrated in
In the embodiment of the invention illustrated in
A tissue securing system 218 (
A suture 228 includes sections 230 and 232 which are formed separately from the sections 222 and 224 of the suture retainer 220. The suture 228 is positioned relative to human body tissue 234 with the sections 230 and 232 extending away from an outer side surface 236 of the body tissue. The suture 228 may be connected with the body tissue 234 in the same manner as illustrated schematically in
Although the suture 228 has been illustrated schematically in
The left section 222 of the suture retainer 220 has a generally rectangular configuration. The left section 222 of the suture retainer 220 includes a pair of parallel grooves 240 and 242. The grooves 240 and 242 extend inward, that is, toward the left as viewed in
Each of the grooves 240 and 242 has an extent which is slightly less than one-half of the circumferential extent of a cylinder. The radius of the grooves 240 and 242 is the same as the radius of the suture sections 230 and 232. Since the grooves 240 and 242 have side surfaces which are formed as a portion of a cylinder and have an extent which is slightly less than one-half of the diameter of the cylinder, less than half of each of the suture sections 230 and 232 is disposed in a groove 240 and 242.
The right section 224 of the suture retainer 222 has a configuration which is the same as the configuration of the left section 222. Thus, the right section 224 of the suture retainer 220 includes a pair of groves 248 and 250. The grooves 248 and 250 extend inward, that is toward the right, as viewed in
The grooves 248 and 250 are each formed as a portion of a cylinder. However, the grooves 248 and 250 have an extent which is slightly less than one-half the circumferential extent of the cylinder. The grooves 248 and 250 have a radius which is the same as the radius of the suture sections 230 and 232.
In one specific embodiment of the invention, the identical left and right sections 222 and 224 had a rectangular configuration. The major side surfaces 244 and 252 had a length, as measured transversely to the grooves 240, 242, 248 and 250, of approximately 0.236 inches. The major side surfaces 244 and 252 had a width, as measured parallel to the groves 240, 242, 248 and 250, of approximately 0.119 inches. The left and right sections 222 and 224 had a thickness, as measured perpendicular to the major side surfaces 244 and 252, of approximately 0.055 inches. The grooves 240, 242, 248, and 250 had a radius of approximately 0.046 inches. The depths of the grooves 240, 242, 248 and 250 was approximately 0.005 inches less than the radius of the grooves or about 0.041 inches.
It should be understood that the foregoing dimensions for one specific preferred embodiment of the suture retainer 222 have been set forth herein for purposes of clarity of description. It is contemplated that the sections 222 and 224 of the suture retainer 220 will be constructed with dimensions which are substantially different from the specific dimensions which have been set forth herein.
The two sections 222 and 224 of the suture retainer 220 may be formed of many different materials. However, it is believed that it will be preferred to form the sections 222 and 224 of the suture retainer 220 of a biodegradable polymer. The two sections 222 and 224 of the suture retainer 220 may be formed of an amorphous thermoplastic material. The suture 228 and the suture retainer 220 may be formed of any of the materials previously mentioned herein or other materials. The suture 228 and the suture retainer 220 may be formed from the same material or from different materials having the same or similar chemical properties which are compatible with each other.
When the suture 228 and suture retainer 220 are to be used to secure the human body tissue 234, the suture 228 is positioned relative to the body tissue. The suture 228 may be positioned relative to the body tissue in the manner illustrated schematically in
The two sections 222 and 224 of the suture retainer 220 are positioned in engagement with the sections 230 and 232 of the suture 228. The suture retainer 220 is pressed against the body tissue 234 with a predetermined force. This results in the body tissue being pressed between the suture retainer 220 and the portion of the suture connected with the body tissue 234. A force distribution member could be provided between the suture retainer 220 and body tissue 234 if desired.
The left section 222 of the suture retainer 220 is positioned in abutting engagement with the sections 230 and 232 of the suture 228 and with the body tissue 234 in the manner illustrated schematically in
In the specific example for which dimensions have been set forth herein, the major side surface 244 of the left section 222 of the suture retainer 220 is spaced 0.010 inches from the major side surface 252 of the right section 224 of the suture retainer 220. It should be understood that a different spacing could be provided between the major side surfaces 244 and 252 of the suture sections 222 and 224 when the grooves 240 and 242 in the suture section 222 are in engagement with the suture sections 230 and 232 and the grooves 248 and 250 in the right suture section 224 are in engagement with the suture sections 230 and 232.
In order to bond the sections 222 and 224 of the suture retainer 220 to each other and to the sections 230 and 232 of the suture 228, ultrasonic vibratory energy is transmitted to the suture retainer 220. At this time, the suture retainer 228 is pressed against the body tissue 234 with a predetermined force and the sections 230 and 232 of the suture 228 are tensioned with a predetermined force.
To effect the transmission of ultrasonic vibratory energy to the sections 222 and 224 of the suture retainer 220, an anvil 258 is moved into engagement with the left section 222 of the suture retainer 220. A horn or acoustic tool 260 is moved into engagement with the right section 224 of the suture retainer 220. The anvil 258 and horn 260 are pressed against the sections 222 and 224 of the suture retainer 220 with a predetermined force to firmly press the sections of the suture retainer against the sections 230 and 232 of the suture 228.
While the anvil 258 and horn 260 are being pressed against the suture retainer sections 222 and 224 with a predetermined force, ultrasonic vibrations are transmitted from the horn 260 to the suture retainer 220. The ultrasonic vibrations transmitted from the horn 260 to the suture retainer 220 have a frequency in excess of 20 kilohertz. The ultrasonic vibrations transmitted to suture retainer 220 by the horn 260 may have a frequency of between 20 kilohertz and 70 kilohertz. It is believed that it may be preferred to transmit ultrasonic vibrations having a frequency close to or greater than 70 kilohertz to the suture retainer 220 from the horn 260.
The ultrasonic vibrations transmitted to the suture retainer 220 create frictional heat and cause portions of the material of the suture retainer 220 to be heated into the transition temperature range for the material. As the material of the suture retainer 220 is heated into its transition temperature range, the material loses some of its rigidity and softens. The material of the suture retainer 220 does not melt and become liquid. The heat in the suture retainer 220 will tend to be concentrated adjacent to the grooves 240, 242, 248 and 250 and adjacent to the major side surfaces 244 and 252.
As the material of the suture retainer 220 is heated and softened by the ultrasonic vibratory energy, the sections 222 and 224 of the suture retainer 220 are pressed together by force applied against the sections of the suture retainer by the anvil 258 and horn 260. As this occurs, the material of the sections 222 and 224 of the suture retainer 220 is plastically deformed and pressed against the sections 230 and 232 of the suture 228 at the grooves 240, 242, 248 and 250 in the suture retainer. At the same time, at least portions of the major side surfaces 248 and 252 on the sections 222 and 224 of the suture retainer 220 will move into engagement with each other.
When this has occurred, the transmission of ultrasonic energy to the suture retainer 228 is interrupted. However, the force applied against the sections 222 and 224 is maintained. It is believed that it may be desired to increase the force applied against the sections 222 and 224 of the suture retainer 220 by the anvil 258 and horn 260 as the application of ultrasonic vibratory energy to the suture retainer 220 is interrupted.
While the clamping force applied by the anvil 258 and horn 260 is maintained, the left and right sections 222 and 224 of the suture retainer 220 bond to each other. In addition, the left and right sections 222 and 224 of the suture retainer 220 bond to the sections 230 and 232 of the suture 228. This results in the suture 228 being firmly gripped by the sections of the suture retainer 220. The sections 222 and 224 of the suture retainer 220 bond to the suture 228 without significant deformation of the suture.
The left and right sections 222 and 224 of the suture retainer 220 bond to each other at a joint formed between the surfaces 244 and 252 of the sections of the suture retainer. This results in a bonding of the sections 222 and 224 of the suture retainer 220 at locations offset to both sides of the suture 228 and at locations offset to both sides of the suture 230. The material of the sections 222 and 224 of the suture retainer 220 defining the grooves 240, 242, 248 and 250 bond to the outer side surfaces of the sections 230 and 232 of the suture 228.
Although it is preferred to heat the sections 222 and 224 of the suture retainer 220 with ultrasonic vibratory energy in the manner previously explained, it is contemplated that heat energy could be directly transmitted to the suture retainer if desired during the transmission of ultrasonic vibratory energy to the suture retainer. The heat energy could be transmitted to the suture retainer 220 from heating coils in the anvil 258 and/or horn 260. If desired, a separate heat application member could be provided.
The sections 222 and 224 of the suture retainer 220 prevent direct engagement of the anvil 258 and horn 260 with the suture 228. This prevents excessive heating of the suture 228.
In the embodiment of the invention illustrated in
A tissue securing system 268 is used in a sterile, operating room environment and includes a suture retainer 270 and a suture 280. The suture retainer 270 is integrally formed as one piece and has a cylindrical configuration. A pair of cylindrical passages 272 and 274 (
Left and right sections 276 and 278 of a suture 280 extend through the passages 272 and 274. The suture sections 276 and 278 are connected with layers of human body tissue (not shown) in the same manner as has been illustrated schematically in
It is contemplated that the suture retainer 270 and suture 280 could be used in association with hard body tissue, soft body tissue, or hard and soft body tissue. The suture retainer 270 and suture 280 may be used with body tissue in any one of the ways previously described herein. Of course, the suture retainer and suture may be used with body tissue in other known ways if desired.
The suture retainer 270 may be formed of many different materials. However, It is believed that it will be preferred to form the suture retainer 270 of a biodegradable polymer. It is believed that it may be preferred to form both the suture retainer 270 and the suture 280 of the same amorphous thermoplastic material. However, if desired, the suture 280 and suture retainer 270 could be formed of different materials which have the same or similar chemical properties and are compatible with each other. The suture 280 and/or the suture retainer 270 may be formed of either biodegradable or non-biodegradable materials.
In one specific embodiment of the invention, the cylindrical suture retainer 270 had a diameter of 0.119 inches. This particular suture retainer 270 had an axial extent of 0.236 inches. The passages 272 and 274 each had a diameter of 0.046 inches. If desired, the passages 272 and 274 could be formed with an oval configuration with parallel flat surfaces having a length of 0.030 inches extending between semicircular opposite end portions of the ovals.
It should be understood that the foregoing specific dimensions for embodiments of the suture retainer 270 have been set forth herein for purposes of clarity of description. It is contemplated that the suture retainer 270 can and will be formed with dimensions which are different than these specific dimensions. It is also contemplated that the suture retainer 270 will be constructed with a configuration which is different than the specific configuration illustrated herein. For example, the suture retainer 270 could have a prismatic configuration with the passages 272 and 274 extending between one corner portion and a side surface of the prism.
The suture 280 is positioned relative to body tissue in much the same manner as illustrated in
While the body tissue is compressed between the suture 280 and the suture retainer 270, ultrasonic vibratory energy is transmitted to the suture retainer 270. To transmit ultrasonic vibratory energy to the suture retainer 270, an anvil 286 (
The horn 288 is then vibrated at an ultrasonic frequency, that is, at a frequency greater than 20 kilohertz. The horn 280 may be vibrated at a frequency of between 20 and 70 kilohertz. It is believed that it may be preferred to vibrate the horn 288 at a frequency close to or greater than 70 kilohertz. As this occurs, vibratory mechanical energy at ultrasonic frequencies is transmitted from the horn 288 to the suture retainer 270.
The ultrasonic vibratory energy transmitted from the horn 288 to the suture retainer 270 is effective to heat the suture retainer. The heat tends to be concentrated in the portion of the suture retainer 270 adjacent to the sections 276 and 278 of the suture 280.
When the portion of the suture retainer 270 adjacent to the sections 276 and 278 of the suture 280 have been heated to a temperature in the transition temperature range for the material of the suture retainer 270, the application of ultrasonic vibratory energy to the suture retainer 270 by the horn 288 is interrupted. When material of the suture retainer 270 is heated into the transition temperature range, the material of the suture retainer becomes soft and pliable. Although the material of the suture retainer 270 does not melt and become liquid, the material of the suture retainer 270 is softened and loses its rigidity when it is heated into the transition temperature range.
The force applied against the suture retainer 270 is then maintained or increased. The force applied against the suture retainer 270 by the anvil 286 and horn 288 is effective to plastically deform the material of the suture retainer. As the heat softened material of the suture retainer 270 is plastically deformed by the anvil 286 and horn 288, the material of the suture retainer is firmly pressed against the sections 276 and 278 of the suture 280.
As the heated and softened material of the suture retainer 270 cools, the material of the suture retainer bonds to the suture 280. This results in the suture retainer 270 securely gripping the sections 276 and 278 of the suture 280. The suture 280 is not significantly deformed as the suture retainer 270 is heated and bonded to the suture. Therefore, the strength of the suture 280 is not significantly reduced.
In the foregoing description, the suture retainer 270 was heated by the application of ultrasonic vibratory energy to the suture retainer. It is contemplated that heat energy could be transmitted to the suture retainer 270 along with the ultrasonic vibratory energy. This could be accomplished in many different ways. For example, a heating element could be provided in the anvil 286 and/or horn 288. Alternatively, a separate heating element could be moved into contact with the suture retainer 270.
In the embodiment of the invention illustrated in
A tissue securing system 291 is used in a sterile, operating room environment and includes a suture retainer 292 and a suture 302. The suture retainer 292 includes a cylindrical central section 294 which is disposed between left and right side sections 296 and 298. The central section 294 is formed separately from the side sections 296 and 298. The side sections 296 and 298 are formed separately from each other. However, the side sections 296 and 298 could be interconnected if desired. For example, the side sections 296 and 298 could be integrally formed as one piece with a flexible connector section which extends between the side sections. Alternatively, the central section 294 and side sections 296 and 298 could be formed as one piece.
A suture 302 is wrapped around the central section 294. The suture 302 is received in a groove 304 in the central section 294. The groove 304 has a circular configuration and has a central axis which is coincident with a central axis of the cylindrical central section 294.
The groove 304 has an extent which is greater than 360° and extends completely around the central section 294 of the suture retainer 292. The groove 304 is formed as a portion of a helix. Opposite end portions of the groove 304 are disposed in an overlapping relationship on the central portion 294 of the suture retainer 292. The suture 302 is disposed in the groove 304 throughout the extent of its engagement with the central section 294.
Although the groove 304 has been shown as having somewhat more than a single turn in
The suture 302 and suture retainer 292 may be formed of the same material or different materials. Similarly, the central section 294 and side sections 296 and 298 may be formed of the same material or different materials. It is believed that it may be preferred to form the suture 302 and the suture retainer 294 from biodegradable materials. However, the suture 302 and/or the suture retainer 292 could be formed of materials which are not biodegradable. It may also be preferred to form the suture retainer 292 and suture 302 of an amorphous polymeric material. The suture retainer 292 and suture 302 may be formed of any of the materials previously mentioned herein or other materials.
When the suture retainer 292 is to be utilized to secure human body tissue, the suture 302 is positioned relative to the body tissue in the manner illustrated in
The suture 302 is wrapped around the central section 294 of the suture retainer, in the manner illustrated schematically in
As the central section 294 of the suture retainer 292 moves toward the body tissue, a wrap or turn of the suture 302 around the central section of the suture retainer moves along the suture toward the body tissue. The central section 294 of the suture retainer 292 may be moved along a straight path toward the body tissue without rotating while tension is maintained in the suture 302 and the suture slides along the groove 304 in the central section of the suture retainer. Alternatively, the central section 294 of the suture retainer could be rolled along the suture 302 toward the body tissue.
The central section 294 of the suture retainer 292 is moved along the suture 302 until the central section of the suture retainer engages the body tissue in the manner illustrated in
While the suture 302 is tensioned with a predetermined force and a predetermined force is transmitted from the central section 294 of the suture retainer 292 to the body tissue, the side sections 296 and 298 are aligned with the central section 294 of the suture retainer. The side sections 296 and 298 have concave surfaces 310 and 312 which are pressed against the turn in the suture 302 which extends around the central portion 294 of the suture retainer 292. The surfaces 310 and 312 have an arc of curvature which is the same as the arc of curvature of a generally cylindrical outer side surface 314 on the side sections 296 and 298. However, since the suture 302 projects out of the groove 304, the side surfaces 310 and 312 on the side sections 296 and 298 are slightly spaced from the side surface 314 on the central section 294 of the suture retainer 292.
In accordance with a feature of the present invention, ultrasonic vibratory energy is applied to the suture retainer 292. To apply the ultrasonic vibratory energy to the suture retainer 292, a support member or anvil 320 is pressed against the side section 296 of the suture retainer 292. A horn or acoustic tool 322 is pressed against the side section 298 of the suture retainer 292. The anvil 320 and horn 322 are pressed against the opposite side sections 296 and 298 of the suture retainer 292 with a predetermined force.
While the suture retainer 292 is clamped between the anvil 320 and horn 322, mechanical vibrations at an ultrasonic frequency are transmitted from the horn 322 to the suture retainer 292. The ultrasonic vibratory energy is transmitted from the horn 322 to the suture retainer 292 at frequency above 20 kilohertz. The horn 322 may transmit the ultrasonic vibratory energy to the suture retainer 292 at a frequency between 20 kilohertz and 70 kilohertz. It is contemplated that it may be desired to have the ultrasonic vibratory energy transmitted to the suture retainer at a frequency close to or greater than 70 kilohertz. However, it should be understood that the ultrasonic vibratory energy could be transmitted to the suture retainer 292 at any desired frequency above the frequency normally detected by the human ear, that is above approximately 20 kilohertz.
The ultrasonic vibratory energy transmitted to the suture retainer 292 is converted into heat. The heat tends to concentrate at the joints between the side sections 296 and 298 and central section 294 of the suture retainer 292. This results in the material forming the side sections 296 and 298 and the central section 294 of the suture retainer 292 being heated into the transition temperature range of the material forming the suture retainer. The application of the ultrasonic vibratory energy to the suture retainer 292 by the horn 322 is then interrupted.
As the material of the suture retainer 292 is heated into its transition temperature range, the material loses its rigidity and softens. The anvil 320 and horn 322 apply force against the suture retainer 292 to plastically deform the material of the suture retainer. The softened side surfaces 310 and 312 on the side sections 296 and 298 are pressed against and are indented by the suture 302. As this occurs, the softened side surfaces 310 and 312 of the side sections 296 and 298 move into engagement with the softened side surface 314 on the central section 294 of the suture retainer 292.
Although the application of ultrasonic vibratory energy to the suture retainer 292 is interrupted, the anvil 320 and horn 322 continue to be pressed against the side sections 296 and 298 of the suture retainer 292 with a predetermined force. If desired, the force with which the anvil 320 and horn 322 are pressed against the suture retainer 292 can be increased as the transmission of ultrasonic vibratory energy to the suture retainer is interrupted.
As the material of the suture retainer 292 cools, the side sections 296 and 298 are bonded to the central section 294 of the suture retainer 292. In addition, the suture 302 is bonded to the central section 294 and to the side sections 296 and 298 of the suture retainer 292.
The groove 304 in the central section 294 of the suture retainer 292 is deep enough to prevent significant deformation and loss of strength of the suture 302. As the heat softened material of the side sections 296 and 298 of the suture retainer is pressed against the suture 302, the material of the side sections is plastically deformed.
It is contemplated that bonding of the suture 302 with the central section 294 and side sections 296 and 298 of the suture retainer 292 may be promoted by forming the suture and the sections of the suture retainer of the same material. The material may be an amorphous thermoplastic which is biodegradable.
If desired, the groove 304 could be omitted from the central section 294 of the suture retainer 292. Alternatively, the groove 304 could be deepened so that the groove has a depth which is equal to or slightly greater than the diameter of the suture 302. If desired, the groove 304 could be formed with an undercut configuration so that the portion of the suture 302 in the groove 304 is not exposed to the side sections 296 and 298 of the suture retainer 292. If this was done, the suture 302 would be bonded to only the central section 294 of the suture retainer 292 and would not be bonded to the side sections 296 and 298 of the suture retainer.
If the configuration of groove 304 is changed to an undercut configuration, the suture 302 would be completely enclosed by the groove. A groove having this configuration is disclosed in U.S. Pat. No. 6,010,525 which has been and hereby is incorporated herein in its entirety. If the groove 304 has such an undercut configuration, the side sections 296 and 298 could be eliminated. The anvil 320 and horn 322 would then be pressed against opposite sides of the cylindrical outer side surface 314 of the central section 294 in the same manner as is disclosed in
In the foregoing description, it has been assumed that only ultrasonic vibrational energy may be transmitted to the suture retainer 292 to effect a bonding of the suture retainer and the suture 302. However, thermal energy in the form of heat could be directly applied to the suture retainer 292 if desired. This could be accomplished in many different ways. For example, a heating element could be provided in the anvil 320 and/or the horn 322.
In the embodiment of the invention illustrated in
A tissue securing system 328 is used in a sterile, operating room environment and includes a suture 330 and suture retainer 340. The suture 330 (
The central section 338 and side sections 342 and 344 all have rectangular configurations. However, the central and side sections 338, 342 and 344 (
The relatively thin central section 338 and the relatively thick side sections 342 and 344 of the suture retainer 340 are formed of a biodegradable material. The suture 330 is also formed of a biodegradable material. The suture 330 and suture retainer 340 may be formed of the same biodegradable material. It may be preferred to form the suture 330 and suture retainer 340 of an amorphous polymer. If desired, the suture 330 and suture retainer 340 could be formed of different materials which are compatible and have the same or similar chemical properties. The suture 330 and suture retainer 340 may be formed of any of the materials previously mentioned herein or of other known materials.
When the suture 330 and suture retainer 340 are to be used to secure human body tissue, the sections 332 and 334 of the suture 330 are positioned relative to body tissue in a manner similar to that disclosed in
The central section 338 of the suture retainer 340 is pressed against either the body tissue in the manner illustrated schematically in
An apparatus for transmitting ultrasonic vibratory energy to the suture retainer 340 is then moved into engagement with the side sections 342 and 344 of the suture retainer. The apparatus for applying ultrasonic vibratory energy to the suture retainer 340 includes an anvil or support portion 354 and a horn or acoustic tool 356. The anvil 354 and horn 356 are pressed against opposite sides of the suture retainer with a predetermined force. While the suture retainer 340 is clamped between the anvil 354 and horn 356, ultrasonic vibratory energy is transmitted from the horn 356 to the suture retainer 340.
The ultrasonic vibratory energy transmitted from the horn 356 to the suture retainer 340 is effective to heat the material of the suture retainer. The heat tends to be concentrated at the joints between the thick side sections 342 and 344 and the thin central section 338 of the suture retainer 340. In addition, the heat tends to be concentrated at the joint between the sections 332 and 334 of the suture and the central section 338 of the suture retainer. This results in a substantial portion of the material of the thin central section 338 of the suture retainer 340 being heated into its transition temperature range.
As the material of the suture retainer 340 is heated into its transition temperature range, the material of the suture retainer loses its rigidity and becomes soft. However, the material of the suture retainer is not heated enough to melt the material of the suture retainer. Since the central section 338 is relatively thin, the material of the central section becomes very pliable while the side sections 342 and 344 still have some rigidity.
Once a substantial portion of the material of the central section 338 of the suture retainer 340 has been softened by being heated into its transition temperature range, the transmission of ultrasonic vibratory energy from the horn 356 to the suture retainer 340 is interrupted. However, the anvil 354 and horn 356 continue to apply force against opposite sides of the suture retainer 340. The magnitude of the force applied against opposite sides of the suture retainer 340 by the anvil 354 and horn 356 may be increased as the transmission of ultrasonic vibratory energy from the horn 356 to the suture retainer 340 is interrupted. The force applied against opposite sides of the suture retainer 340 by the anvil 354 and horn 356 is effective to plastically deform the heat softened material of the suture retainer 340.
As the suture retainer 340 cools, the side sections 342 and 344 of the suture retainer are bonded to the central section 338 of the suture retainer. In addition, the central section 338 of the suture retainer 340 is bonded to the sections 332 and 334 of the suture 330. This results in the suture 330 being securely gripped by the suture retainer 340. However, there is no significant deformation of the suture 330 so that the strength of the suture 330 is not significantly reduced.
In the foregoing description, the material of the central section 338 of the suture retainer 340 was heated by the transmission of ultrasonic vibratory energy to the suture retainer 340. However, it is contemplated that thermal energy could be applied to the suture retainer 340 along with the ultrasonic vibratory energy. This could be accomplished by providing a heating element in the anvil 354 and/or horn 356. Alternatively, a separate member could be utilized to apply heat directly to the suture retainer 340.
The anvil 354 and horn 356 engage only the suture retainer 340. The anvil 354 and horn 356 are maintained in a spaced apart relationship with the suture 330. This prevents excessive heating and/or deformation of the suture.
In the embodiment of the invention illustrated in
A tissue securing system 359 (
A suture retainer 368 includes a central section 370. A pair of side sections 372 and 374 are disposed on opposite sides of the central section 370. The central section 370 and side sections 374 all have a generally rectangular configuration. However, the central section 370 is thinner than the side sections 372 and 374 (
A pair of grooves 378 and 380 are provided in the central section 370. The grooves 378 and 380 have parallel longitudinal central axes. The grooves 378 and 380 are disposed in opposite sides of the central section 370 and open in opposite directions.
In addition, a groove 384 is formed in the side section 372. The groove 384 extends parallel to and is aligned with the groove 380 in the central section 370. Similarly, a groove 386 is formed in the side section 374. The groove 386 extends parallel to and is aligned with the groove 378 in the central section 370. The section 362 of the suture 360 is received in the grooves 378 and 386 (
The grooves 378 and 386 are aligned with each other and are offset to one side of the grooves 380 and 384. This results in the sections 362 and 364 of the suture 360 being offset from each other (
The central section 370 and side sections 372 and 374 of the suture retainer 368 are formed of a biodegradable material. The suture 360 is also formed of a biodegradable material. The suture 360 and suture retainer 368 may be formed of the same biodegradable material. It may be preferred to form the suture 360 and suture retainer 368 of an amorphous polymer. If desired, the suture 360 and suture retainer 368 could be formed of different materials which are compatible and have the same or similar chemical properties. It is contemplated that the suture 360 and suture retainer 368 could be formed of any of the materials previously mentioned herein or of other materials.
The suture 360 is positioned relative to body tissue in the same manner as is illustrated schematically in
In accordance with one of the features of the present invention, ultrasonic vibratory energy is then transmitted to the suture retainer 368. To transmit ultrasonic vibratory energy to the suture retainer 368, an anvil or support member 390 (
The ultrasonic vibratory energy transmitted from the horn 392 to the suture retainer 368 may have a frequency in a range between 20 kilohertz and 70 kilohertz. It is believed that it will be preferred to transmit ultrasonic vibratory energy having a frequency of approximately 70 kilohertz or more from the horn 392 to the suture retainer 368.
The ultrasonic vibratory energy is effective to heat the suture retainer 368. The heat is concentrated at the joints between the thin central section 370 and thick side sections 372 and 374 of the suture retainer 368. Since the central section 370 is thinner than the side sections 372 and 374, a substantial percentage of the material of the central section 370 is heated into its transition temperature range while a smaller percentage of the material of the side sections 372 and 374 is heated into its transition temperature range.
Heating the material of the suture retainer 368 into the transition temperature range is effective to cause the material of the suture retainer to soften and lose its rigidity. Although the material of the suture retainer 368 softens, the material does not melt and become liquid. The softened material of the suture retainer is pliable and plastically deforms under the influence of the clamping force applied by the anvil 390 and horn 392.
As the material of the suture retainer 368 plastically deforms, a flat major side surface 396 on the central section 370 of the suture retainer 368 and a flat side surface 398 on the side section 372 of the suture retainer move into engagement. At the same time, a flat side surface 402 on the central section 370 of the suture retainer 368 and a flat side surface 404 on the side section 374 of the suture retainer move into engagement. As this occurs, the softened material of the central section 370 of the suture retainer 368 is deformed by force applied to the central section through the sections 362 and 364 of the suture 360.
After material of the suture retainer 368 has been heated into its transition temperature range, the application of ultrasonic vibratory energy to the suture retainer is interrupted. However, the force pressing the anvil 390 and the horn 392 against the suture retainer is maintained. If desired, the magnitude of the force applied against the suture retainer 368 by the anvil 390 and horn 392 may be increased simultaneously with the interruption of the application of ultrasonic vibratory energy to the suture retainer.
As the material of the suture retainer 368 cools, the flat major side surface 396 on the central section 370 bonds to the flat major side surface 398 on the side section 372. In addition, the flat major side surface 402 on the central section 370 bonds to the flat major side surface 404 on the side section 374. The surfaces defining the grooves 378 and 380 in the central section 370 of the suture retainer 368 bond to the sections 362 and 364 of the suture 360. The surfaces defining the grooves 384 and 386 in the side sections 372 and 374 of the suture retainer 368 also bond to the sections 362 and 364 of the suture 360.
In the foregoing description, the suture retainer 368 was heated by the application of ultrasonic vibratory energy to the suture retainer. It is contemplated that the suture retainer 368 could also be heated by the direct application of thermal energy to the suture retainer. If this is to be done, a heating element could be provided in the anvil 390 and/or horn 392. If desired, a separate heating element could be moved into engagement with the suture retainer to transmit heat to the suture retainer.
The anvil 390 and horn 392 engage only the suture retainer 368. The anvil 390 and horn 392 are maintained in a spaced apart relationship with the suture 360. This prevents excessive heating and/or deformation of the suture 360.
In the embodiment of the invention illustrated in
A tissue securing system 408 (
The suture retainer 418 (
When the suture retainer 418 is to be utilized to secure body tissue, the suture sections 412 and 414 are wrapped around the central section 420 of the suture retainer in the manner illustrated schematically in
The central section 420 of the suture retainer is moved into engagement with the body tissue or with a force distribution member in the manner similar to that illustrated in either
While the suture is being tensioned with a predetermined force and while the predetermined force is being transmitted from the central section 420 of the suture retainer 418, the side sections 422 and 424 are moved into juxtaposition with the central section 420 of the suture retainer 418. The side sections 422 and 424 are thicker than the central section 420. Force is also transmitted from the side sections 422 and 424 to the body tissue.
To effect the application of ultrasonic vibratory energy to the suture retainer 418, and anvil or support portion 428 is pressed against the relatively thick side section 422 of the suture retainer 418. At the same time, a horn or acoustic tool 430 is pressed against the relatively thick side section 424 of the suture retainer 418. This results in the suture retainer 418 being clamped between the anvil 428 and horn 430 with a predetermined force. The clamping force presses the suture 410 against the relatively thin central section 420 of the suture retainer.
While maintaining the predetermined clamping force on the suture retainer 418, ultrasonic vibratory energy is transmitted from the horn 430 to the suture retainer. The ultrasonic vibratory energy is transmitted at a frequency of between 20 kilohertz and 70 kilohertz. It is believed that it may be preferred to transmit the ultrasonic vibratory energy at a frequency close to or greater than 70 kilohertz.
The ultrasonic vibratory energy is effective to heat the suture retainer 418. The heat tends to be concentrated at the joints between the thin central section 420 and thick side sections 422 and 424 of the suture retainer 418. Since the central section 420 of the suture retainer 418 is thinner than the side sections 422 and 424 of the suture retainer, a larger percentage of the material of the central section 420 of the suture retainer 418 is heated into its transition temperature range by the ultrasonic vibratory energy before a corresponding percentage of the side sections 422 and 424 is heated into the transition temperature range.
When the material of the suture retainer 418 has been heated into its transition temperature range, the material becomes soft and pliable. The clamping force applied against the side sections 422 and 424 causes the turns in the sections 412 and 414 of the suture 410 to indent and plastically deform the heat softened material of the central section 420 and side sections 422 and 424. As this occurs, the side sections 422 and 424 move into abutting engagement with the central section 410 under the influence of the clamping force applied by the anvil 428 and horn 430.
Once the material of the central section 420 and side sections 422 and 424 adjacent to the turns in the sections 412 and 414 of the suture 410 have been heated into the transition temperature range, the application of ultrasonic vibratory energy to the suture retainer 418 is interrupted. However, the clamping force applied against the suture retainer by the anvil 428 and horn 430 is maintained constant or increased as the application of ultrasonic vibratory energy to the suture retainer is interrupted. As the material of the suture retainer 418 cools, while the suture retainer is clamped between the anvil 428 and horn 430, the side sections 422 and 424 of the suture retainer 418 bond to the central section 420 of the suture retainer. In addition, the side sections 422 and 424 and the central section 420 of the suture retainer 418 bond to the suture 410.
In the embodiments of the invention illustrated in
A tissue securing system 438 is used in a sterile, operating room environment and includes a suture 440 and a suture retainer 448. The suture 440 includes left and right sections 442 and 444. The left and right sections 442 and 444 of the suture 440 are connected with human body tissue in a manner similar to the manner illustrated schematically in
A one-piece suture retainer 448 is formed separately from the suture 440. The suture retainer 448 has a generally H-shaped configuration. The suture retainer 448 includes a rectangular base section 450 and a pair of arm sections 452 and 454. The arm sections 452 and 454 are connected with the base section 450 by a connector section 456. Although only the one side, which may be considered as the top side of the suture retainer 448 is illustrated in
The suture retainer 448 has a pair of recesses 460 and 462 in which the sections 442 and 444 of the suture 440 are received. An entrance 466 to the recess 460 (
The arm section 454 has the same construction as the arm section 452. Thus, the arm section 454 has a nose or detent portion 476 (
The suture 440 and suture retainer 448 are both formed of a biodegradable polymer. It is believed that it may be preferred to form the suture retainer 448 and suture 440 from an amorphous thermoplastic. The suture 440 and suture retainer 448 may be formed of the same material or different materials having similar chemical properties which are compatible. The suture 440 and suture retainer 448 may be formed of any of the materials previously mentioned herein or of other materials.
When the suture 440 and suture retainer 448 are to be utilized to secure human body tissue, the suture 440 is positioned relative to the body tissue, in a manner similar to that illustrated schematically in
While the suture sections 442 and 444 are tensioned, the suture retainer 448 is moved along the suture 440 toward the body tissue. The nose portions 468 and 476 on the arm sections 452 and 454 maintain the suture sections 442 and 444 in the recesses 460 and 462 as the suture retainer 448 is moved along the suture 440 toward the body tissue. The suture retainer 448 is moved into engagement with either the body tissue, in the manner similar to that illustrated in
While a predetermined tension force is applied to the sections 442 and 444 of the suture 440 and while the suture retainer 448 is urged toward the body tissue with a predetermined force, the suture retainer 448 is bonded to the suture 440. This results in a predetermined tension being maintained in the portion of the suture 440 connected with the body tissue and in the transmission of a predetermined force from the suture retainer 448 to the body tissue.
To bond the suture 440 to the suture retainer 448, an anvil or support portion 480 is pressed against the base section 450 of the suture retainer 448. A horn or acoustic tool 482 is pressed against the arm sections 452 and 454 of the suture retainer 448. The arm sections 452 and 454 of the suture retainer 448 have protuberances 486 and 488 which extend toward the horn 482.
The suture retainer 448 is clamped between the anvil 480 and horn 482. The force applied against the arm sections 452 and 454 by the horn 482 resiliently deflects the arm sections toward the base section 450 of the suture retainer 448. This results in the nose portions 468 and 476 on the arm sections 452 and 454 moving into engagement with the base section 450. Protuberances 486 and 488 on the arm sections 452 and 454 enable the horn 482 to deflect the arm sections through a sufficient distance to enable the arm sections to engage the base section 450.
Once the suture retainer 448 has been securely clamped between the anvil 480 and horn 482, ultrasonic vibratory energy is transmitted from the horn 482 to the suture retainer 448. The ultrasonic vibratory energy transmitted from the horn 482 to the suture retainer 448 is at a frequency of between 20 kilohertz and 70 kilohertz. It is believed that it may be preferred to apply ultrasonic vibratory energy at a frequency of approximately 70 kilohertz or more to the suture retainer 448.
The ultrasonic vibratory energy transmitted from the horn 482 to the suture retainer 448 is effective to heat the material of the suture retainer. The heat tends to be concentrated at the joints between the arm sections 452 and 454 and the base section 450. In addition, the heat tends to be concentrated at the joints between the suture sections 442 and 444 and the suture retainer 448.
The material of the suture retainer 448 is heated into a transition temperature range for the material. As the material of the suture retainer 448 is heated into the transition temperature range, the material of the suture retainer softens and becomes pliable. However, the material of the suture retainer 448 does not melt and become a liquid.
The heat softened material of the suture retainer 448 is plastically deformed by the force applied against the suture retainer by the anvil 480 and horn 482. As the material of the suture retainer 448 is plastically deformed, the recesses 460 and 462 are collapsed. The material of the suture retainer 448 is firmly pressed against the suture 440.
Once the material of the suture retainer 448 adjacent to the sections 442 and 444 of the suture and adjacent to the nose portions 468 and 476 on the arm sections has been heated into a transition temperature range and plastically deformed, the application of ultrasonic vibratory energy is interrupted. Heating the material of the suture retainer 448 into its transition temperature range causes the material to lose its rigidity and soften. The heat softened material of the suture retainer 448 can be deformed by the clamping force applied by the anvil 480 and horn 482.
Although the application of ultrasonic vibratory energy to the suture retainer 448 is interrupted, the suture retainer continues to be clamped between the anvil 480 and horn 482. If desired, the clamping force applied against the suture retainer 448 by the anvil 480 and horn 482 could be increased as the application of ultrasonic vibratory energy to the suture retainer is interrupted.
As the material of the suture retainer cools, the arm sections 452 and 454 of the suture retainer are bonded to the base section 450 of the suture retainer. In addition, the arm sections 452 and 454, connector section 456 and base section 450 of the suture retainer 448 are bonded to the sections 442 and 444 of the suture 440. This results in the suture 440 and the suture retainer 448 being securely interconnected.
In the foregoing description, the suture retainer 448 has been heated under the influence of ultrasonic vibratory energy transmitted from the horn 482 to the suture retainer. It is contemplated that the suture retainer 448 could also be heated by the direct application of thermal energy to the suture retainer. For example, a heating element could be provided in the anvil 480 and/or the horn 482 to function as a heat source. Alternatively, a heating element could be moved into contact with the suture retainer 448.
The anvil 480 and horn 482 do not engage the suture 440. The anvil 480 and horn 482 engage only the suture retainer 448. This prevents excessive heating and deformation of the suture 440. There is no significant deformation of the suture 440 so that it maintains its strength.
In the embodiment of the invention illustrated in
A tissue securing system 489 (
A one-piece suture retainer 496 includes main sections 498 and 500. The main sections 498 and 500 of the suture retainer 496 are interconnected by a hinge section 502. The suture retainer 496 is formed separately from the suture 490.
The main sections 498 and 500 and hinge section 502 of the suture retainer 496 are integrally formed as one piece. The suture 490 and suture retainer 496 are both formed of a biodegradable polymer. It is believed that it may be preferred to form the suture 490 and suture retainer 496 from the same amorphous thermoplastic material. However, the suture 490 and suture retainer 496 may be formed of different amorphous thermoplastic materials having similar chemical properties. The suture 490 and suture retainer 496 may be formed from any of the materials previously mentioned herein or other materials.
The main sections 498 and 500 of the suture retainer 496 are initially skewed at an angle of approximately 30° to each other. The main sections 498 and 500 cooperate with the hinge section 502 to define a generally V-shaped recess 506 (
While a predetermined tension is maintained in the suture 490, the suture retainer 496 is moved along the suture into engagement with the body tissue, in a manner generally similar to the manner illustrated in
To effect bonding between the suture retainer 496 and the suture 490, an anvil 512 (
As the anvil 512 and horn 514 are clamped against the suture retainer 496, the main sections 498 and 500 of the suture retainer are deflected from the linear configuration illustrated in
The suture retainer 496 is heated to effect a bonding between the main sections 498 and 500 of the suture retainer and to effect a bonding between the suture 490 and the main sections 498 and 500 and the hinge section 502 of the suture retainer. To effect this bonding, ultrasonic vibratory energy is transmitted from the horn 514 to the suture retainer 496. The ultrasonic vibratory energy transmitted from the horn 514 to the suture retainer 496 has a frequency of between 20 kilohertz and 70 kilohertz. It is believed that it may be preferred to transmit ultrasonic vibratory energy having a frequency of 70 kilohertz or more from the horn 514 to the suture retainer 496.
The ultrasonic vibratory energy transmitted from the horn 514 to the suture retainer 496 heats the material of the suture retainer. The heat tends to be concentrated at the joints between the main section 498 and 500 of the suture retainer and at the joints between the suture 490 and the main sections 498 and 500 and the hinge section 502 of the suture retainer. The material of the suture retainer 496 is heated into a transition temperature range for the material.
When the material adjacent to the main sections 498 and 500 of the suture retainer 496 and adjacent to the joint between the suture 490 and the suture retainer 496 has been heated into a transition temperature range, the application of ultrasonic vibratory energy to the suture retainer 496 is interrupted. Although the application of ultrasonic vibratory energy from the horn 514 to the suture retainer 496 is interrupted, the suture retainer continues to be clamped between the anvil 512 and the horn 514. If desired, the force applied against the suture retainer 496 by the anvil 512 and horn 514 could be increased simultaneously with interruption of ultrasonic vibratory energy to the suture retainer 496.
As the material of the suture retainer 496 is heated into its transition temperature range, the material softens and loses its rigidity. Although the material of the suture retainer 496 softens as the material is heated into its transition temperature range, the material does not melt and become liquid. As the material of the suture retainer 496 softens, the force applied against the suture retainer 496 by the anvil 512 and horn 514 plastically deforms the suture retainer from the configuration illustrated in
As the material of the suture retainer 496 cools, a bond is formed between the main sections 498 and 500 of the suture retainer. In addition, the main sections 498 and 500 and the hinge section 502 of the suture retainer 496 are bonded to the suture 490. This results in the suture retainer 496 having a firm grip on the suture 490. The firm grip of the suture retainer 496 on the suture 490 enables a predetermined tension force to be transmitted through the suture 490 to the body tissue and enables a predetermined force to be transmitted from the suture retainer 496 to the body tissue.
The anvil 512 and horn 514 do not engage the suture 490. The anvil 512 and horn 514 engage only the suture retainer 496. This prevents excessive heating and deformation of the suture 490. The suture retainer 496 is bonded to the suture 490 without significant deformation of the suture.
In the embodiment of the invention illustrated in
In the embodiment of the invention illustrated in
A tissue securing system 518 is used in a sterile, operating room environment and includes a suture 520 and a suture retainer 528. The suture 520 (
The suture retainer 528 is formed separately from the suture 520 and encloses a portion of the suture. The suture retainer 528 has a rectangular configuration and includes a base section 530 and an arm section 532. The base and arm sections 530 and 532 of the suture retainer 528 are integrally formed as one piece. The arm section 532 cooperates with the base section 530 to define a generally U-shaped recess 534 in which the suture 520 is received.
The suture retainer 528 may have a configuration which is different than the configuration illustrated in
The suture retainer 528 may be formed of any one of many different materials, including any of the materials previously mentioned herein. It may be preferred to form the suture retainer 528 of a biodegradable material. The suture 520 may be formed of the same biodegradable material as the suture retainer 528. It is believed that it may be preferred to form both the suture 520 and suture retainer 528 of an amorphous polymer, such as polyhydroxyalkanoate. Of course, the suture 520 and suture retainer may be formed of other materials if desired.
When the suture 520 and suture retainer 528 are to be utilized to secure body tissue, the suture 520 is positioned relative to body tissue by engagement with a suture anchor or other device. The suture 520 is then positioned in the recess 534 in the suture retainer 528. The suture 520 may be positioned in the recess 534 by moving the suture through an entrance to the recess. Alternatively, the suture retainer 528 could be moved relative to the suture.
Once the suture 520 has been positioned in the recess 534, a predetermined tension force is applied to the suture 520. The suture retainer 528 is moved along the suture toward the body tissue. The suture retainer is pressed against the body tissue in the manner illustrated schematically in
To interconnect the suture 520 and suture retainer 528, the suture retainer is clamped between a horn and anvil of an ultrasonic energy application apparatus. Ultrasonic energy is then transmitted from the horn to the suture retainer 528 in the manner previously described in conjunction with the embodiments of the invention illustrated in
The clamping force applied against the suture retainer 528 by the horn and anvil deflects the arm section 532 of the suture retainer toward the base section 530 of the suture retainer. The arm section moves into engagement with the base section 530 of the suture retainer 528 and firmly grips the suture 520 under the influence of the clamping force applied by the anvil and horn.
Ultrasonic energy at a frequency of between 20 kilohertz and 70 kilohertz is then applied to the suture retainer 528 by the horn. The ultrasonic vibratory energy heats the material of the suture retainer 528 into its transition temperature range. As the material of the suture retainer 528 is heated into the transition temperature range, the material of the suture retainer softens and loses its rigidity. As this occurs, the softened material of the suture retainer 528 is plastically deformed by the clamping force applied against the suture retainer by the anvil and horn.
The transmission of ultrasonic vibratory energy to the suture retainer 520 is then interrupted. However, the clamping force against the suture retainer is maintained and may even be increased.
As the material of the suture retainer 528 cools, the suture retainer 528 is securely connected to the suture 520. Thus, the arm section 532 is bonded to the base section 530 of the suture retainer. Both the base section 530 and the arm section 532 are bonded to the suture 520. This results in the suture retainer 528 having a firm grip on the suture 520 to maintain the tension in the suture and the transmission of force from the suture retainer to body tissue.
In the embodiment of the invention illustrated in
A suture 540 is connected with body tissue in the manner illustrated schematically in
The suture retainer 542 includes a base section 544 and an arm section 546. The base section 544 and arm section 546 of the suture retainer are integrally formed as one piece. The suture retainer 542 has the same generally rectangular configuration as the suture retainer 528 of
The suture retainer 542 may be formed of a biodegradable polymeric material. It is believed that it may be preferred to form both the suture 540 and the suture retainer 542 from the same biodegradable polymeric material. The suture 540 and suture anchor may be formed from an amorphous thermoset polymer. If desired, the suture retainer 542 and suture 540 could be formed of different polymeric materials which are compatible with each other. The suture 540 and suture retainer 542 could be formed from many different materials, including any of the materials mentioned herein.
The arm section 546 of the suture retainer 542 cooperates with the base section 544 of the suture retainer to define a recess 550 which receives a portion of the suture 540. The arm section 546 has a nose portion 554 which partially blocks an entrance 556 to the recess 550. The nose portion 554 on the arm section 546 is effective to retain the suture 540 in the recess 550.
When the suture 540 and suture retainer 542 are to be utilized to secure body tissue, the suture 540 is positioned relative to the body tissue in a manner similar to that illustrated in
Once the suture 540 has been positioned relative to the body tissue, the suture is tensioned and positioned in the recess 550 in the suture retainer 542. To position the suture 540 in the recess 550, the suture can be moved relative to the recess or the recess can be moved relative to the suture.
As the suture 540 moves into the recess 556, the a cylindrical outer side surface of the suture applies force against a cam surface 558 on the nose portion 554 of the arm section 546. The force applied against the cam surface 558 deflects the arm section 546 outward away from the base section 544 of the suture retainer 542 to open the entrance 556 to the recess 550. This enables the suture 540 to move into the recess 550.
After the suture 540 has moved into the recess 550, the arm section 546 springs back to its initial position, illustrated in
Once the suture 540 has been positioned in the recess 550, the suture 540 is tensioned with a predetermined force and the suture retainer 542 is moved along the suture toward the body tissue. The suture retainer 542 is moved into engagement with the body tissue in the manner illustrated in
The suture retainer 542 and suture 540 are then interconnected to maintain the predetermined tension in the portion of the suture 540 connected with the body tissue and to maintain the transmission of the predetermined force from the suture retainer to the body tissue. To interconnect the suture retainer 542 and suture 540, the suture retainer is clamped between an anvil 562 and a horn 564 of an ultrasonic energy application apparatus. The clamping force applied against the suture retainer 542 by the anvil 562 and horn 564 resiliently deflects the arm section 546 so that the nose portion 554 of the arm section moves into engagement with the base section 544 of the suture retainer. In addition, the arm section 546 is firmly pressed against the suture 540.
While the clamping force is applied to the suture retainer 542 by the anvil 562 and horn 564, ultrasonic vibratory energy is transmitted from the horn to the suture retainer. The ultrasonic vibratory energy has a frequency of between 20 kilohertz and 70 kilohertz. It is believed that it may be preferred to utilize ultrasonic vibratory energy having a frequency of approximately 70 kilohertz or more.
The ultrasonic vibratory energy heats the material of the suture retainer into its transition range. The heat tends to be concentrated at the joint between the arm section 546 and the base section 544 of the suture retainer 542. In addition, the heat is concentrated at the joint between the suture 540 and the suture retainer 542.
Once the material of suture retainer 542 has been softened by being heated into its transition temperature range, the application of ultrasonic vibratory energy to the suture retainer is interrupted. Even though the application of ultrasonic vibratory energy to the suture retainer is interrupted, the clamping force applied against the suture retainer 542 by the anvil 562 and horn 564 is maintained or even increased.
As the material of the suture retainer 542 cools, a secure bond is formed between the arm section 546 and the base section 544 of the suture retainer. In addition, a secure bond is formed between the suture 540 and the base section 544 and arm section 546 of the suture retainer 542.
In the embodiments of the invention illustrated in
In the embodiment of the invention illustrated in
In the illustrated embodiment of the invention, the tissue securing system 574 is located the same distance from the end 578 of the thick layer of tissue as in which the tissue fixation system is located from the end 580 of the thin layer of tissue. This results in the two layers of tissue growing together with a minimum of scarring. In addition, the tissue securing system 574 holds the thick layer 570 and the thin layer 572 of tissue against shifting relative to each other.
If a staple of loop-type suture was used to interconnect the thick layer 570 and thin layer 572 of tissue, a shifting could occur between the two layers of tissue. This shifting could occur inside of the loop formed by the suture or the staple. The shifting can result in extensive scarring and could result in a non-uniform repair of the tissue. The obtaining of a uniform repair of tissue is particularly important when interconnecting a conduit, such as a blood vessel, which has been severed. By using the tissue securing system 574, shifting movement can not occur between the thick layer 570 and thin layer 572 of tissue. This prevents one of the layers from being deflected into the path of flow of material, such as blood, through the conduit in a manner which restricts the conduit and subsequently results in a blockage.
The specific tissue securing system 574 illustrated in
In accordance with a feature of the present invention, the suture retainer 590 is connected with the suture 586 by the application of ultrasonic vibratory energy to the suture retainer 590. The application of ultrasonic vibratory energy to the suture retainer 590 results in a rapid heating of the material of the suture anchor. The very short time which is required to heat the material of the suture retainer 590 by the application of ultrasonic vibratory energy enables the suture retainer to be heated into its transition temperature range and softened without detrimentally affecting the layers 570 and 572 of body tissue.
Although it is contemplated that the amount of heat which is required to heat material of the suture retainer 590 into the transition temperature range by the application of ultrasonic vibratory energy will vary depending upon the construction of the suture retainer 590, an ultrasonic vibratory energy application time of between 0.25 seconds and 1.0 seconds is required to connect any one of the suture retainers of
In the embodiments of the invention illustrated in
Although it is preferred to connect the suture retainers illustrated in
In the embodiments of the invention illustrated in
It is contemplated that the suture retainers illustrated in
It is contemplated that the suture retainers of
An ultrasonic vibratory energy application apparatus 600 includes a pair of members 602 and 604 which are interconnected at a pivot connection 606. An anvil or support member 610 is mounted on one end portion of the member 602. A horn or ultrasonic energy application member 612 is mounted on one end portion of the member 604.
Sections 614 and 616 of a suture retainer are disposed in engagement with the anvil 610 and horn 612. The sections 614 and 616 of the suture retainer may have the same construction as the sections 222 and 224 of the suture retainer 220 of
A generator 630 is connected with a standard electrical power supply (120-240 volts). The generator 630 converts the standard electrical power supply from 50/60 hertz to an ultrasonic frequency, that is a frequency greater than 20 kilohertz. The high frequency electrical energy is conducted through a cable 632 to the member 604.
Suitable electrically insulated conductors in the member 604 conduct the high frequency electrical energy through a transducer (not shown) connected with the horn. The transducer changes the electrical energy into low amplitude mechanical vibrations. These vibrations may be transmitted to a booster to increase or decrease the amplitude of the vibrations. The vibrations are then transmitted to the horn 612 which applies them to the sections 614 and 616 of the suture retainer.
In the embodiment of the invention illustrated in
The ultrasonic energy application apparatus 640 of
Sections 660 and 662 of a suture are disposed between the sections 656 and 658 of the suture retainer. The suture retainer may have a construction similar to the construction of the suture retainer illustrated in
A generator 666 is connected with the handle 642 by a cable 668. The cable 668 connects the generator 666 with a transducer which changes high frequency electrical energy conducted from the generator 666 to low amplitude mechanical vibration. These vibrations are transmitted to a booster. The vibrations are then transmitted to the horn. The horn applies the vibrations to the sections 658 of the suture retainer.
It should be understood that the ultrasonic energy application apparatus of
In the embodiments of the invention illustrated in
A tissue securing system 680 (
The tissue securing system 680 secures upper and lower layers 690 and 692 of soft, human body tissue in linear apposition with each other. Thus, the two layers 690 and 692 of human body tissue are approximated and held against movement relative to each other by a suture 682. Although the two layers 690 and 692 of human body tissue have been schematically illustrated in
Although the tissue securing system 680 has been illustrated in
A force distribution member 694 is disposed between the two sections 684 and 686 of the suture 682. When the suture 682 is tensioned, the force distribution member 694 distributes the force over a relatively large area of the upper layer 690 of body tissue. Although only the force distribution member 694 is illustrated in
In accordance with a feature of this embodiment of the invention, the sections 684 and 686 of the suture 682 are interconnected without using a suture retainer similar to the suture retainers illustrated in
The suture 682 may be formed of many different materials, including the materials previously mentioned herein. The suture 682 may be formed of either a biodegradable or a non-biodegradable material. It is believed that it will be preferred to form the suture 682 of the suture 682 of a biodegradable material. It may be preferred to form the suture 682 of a biodegradable amorphous polymer. For example, the suture 682 could be formed of polyhydroxyalkanoate. Of course, the suture 682 could be formed of other materials if desired.
When the suture 682 is to be connected with the layers 690 and 692 of body tissue, the suture is positioned as illustrated schematically in
Once the layers 690 and 692 have been pressed together with a predetermined force by tensioning the sections 684 and 686 of the suture 682 and pressing the force distribution member 694 against the body tissue, the sections of the suture are interconnected. To interconnect the sections 684 and 686 of the suture 682, the two sections are pulled tight across the force distribution member and disposed in an overlapping relationship. An anvil 700 is positioned on one side of the two sections 684 and 686 of the suture 682. A horn 702 is positioned on the opposite side of the sections 684 and 686 of the suture 682. The anvil 700 and horn 702 are pressed against the opposite sides of the suture 682 with a predetermined force.
The suture sections 684 and 686 are stacked in a side-by-side relationship between the anvil 700 and horn 702. The anvil 700 engages one suture section and the horn 702 engages the other suture section. Thus, the anvil 700 may engage the suture section 684 and the horn 702 my engage the suture section 686.
While the sections 684 and 686 of the suture 682 are clamped between the anvil 700 and horn 702, ultrasonic vibratory energy is transmitted from the horn 702 to the sections 684 and 686 of the suture. At this time, the suture sections are tensioned with a predetermined force. The ultrasonic vibratory energy is at a frequency of between 20 kilohertz and 70 kilohertz. It is believed that it may be preferred to transmit ultrasonic vibratory energy to the sections of the suture 682 at a frequency of 70 kilohertz or more.
The ultrasonic vibratory energy transmitted from the horn 702 to the suture 682 is effective to heat the material of the suture into its transition temperature range. As the material of the suture 682 is heated into its transition temperature range, the material loses its rigidity and softens. However, the material of the suture 682 does not melt and become a liquid as it is heated into the transition temperature range.
The heated and softened material of the sections 684 and 686 of the suture 682 are flattened from the cylindrical configuration of
As the section 684 of the suture 682 is flattened, it is extended sideways in opposite directions along a path which extends perpendicular to a central axis 722 (
The side surfaces 708, 710, 716 and 718 all have a relatively large area. The area of each unit of length as measured along a longitudinal central axes 722 and 724 of the suture sections at the side surfaces 708, 710, 716 and 718, is greater than the corresponding area of a unit of length of the section of the suture having the cylindrical configuration illustrated in
Thus, a one-inch length of a cylindrical portion of the suture 682 has a circumferential area of pi (3.1416) times the diameter of the cylindrical section 684 of the suture 682. A one inch length, as measured along a longitudinal central axis 722 of the suture section 684, of the upper side surface 708 of the layer 706 has an area which is greater than pi (3.1416) times the diameter of the cylindrical portion of the suture 682. Similarly, a unit of length of the upper major side surface 716 of the layer 714 is greater than the area of a unit of length of the cylindrical portion of the suture 682.
When the sections 684 and 686 of the suture 682 have been heated and flattened from the cylindrical configuration of
In the foregoing description, the sections 684 and 686 were heated, under the influence of ultrasonic vibratory energy transmitted from the horn 702, and flattened to have surface areas which are greater than the surface area of a corresponding length of a cylindrical portion of the suture 682. However, it is contemplated that the sections 684 and 686 of the suture 682 could be flattened to a lesser extent. If this was done, the area of one of the major side surfaces, for example the lower major side surface 710 of the layer 706, might not be as great as the area of a corresponding length of a cylindrical portion of the suture 682. Thus, the sections 684 and 686 of the suture 682 may be flattened and extended sideways to a greater or lesser extent. Even a relatively small extent of flattening of the sections 684 and 686 of the suture 682 will result in an increase in the area at which the two sections of the suture are bonded together. This is because the circumferential extent of a bond formed between a pair of cylindrical surfaces disposed in tangential engagement is relatively small. The extent of the bond between the surfaces 710 and 716 is relatively large even though the surfaces have a smaller extent than illustrated in
This application is a continuation of U.S. patent application Ser. No. 10/458,117, filed Jun. 10, 2003 now U.S. Pat. No. 7,429,266, which is a divisional of U.S. patent application Ser. No. 10/076,919, filed Feb. 15, 2002, now U.S. Pat. No. 6,585,750, which is a divisional of U.S. patent application Ser. No. 09/524,397, filed Mar. 13, 2000, now U.S. Pat. No. 6,368,343.
| Number | Name | Date | Kind |
|---|---|---|---|
| 157343 | Molesworth | Dec 1874 | A |
| 319296 | Molesworth | Jun 1885 | A |
| 668878 | Jensen | Feb 1901 | A |
| 668879 | Miller | Feb 1901 | A |
| 673783 | Peters | May 1901 | A |
| 702789 | Gibson | Jun 1902 | A |
| 832201 | Kistler | Oct 1906 | A |
| 862712 | Collins | Aug 1907 | A |
| 1213005 | Pillsbury | Jan 1917 | A |
| 1433031 | Pegaitaz | Oct 1922 | A |
| 1725670 | Novack | Aug 1929 | A |
| 1863057 | Innes | Jun 1932 | A |
| 1870942 | Beatty | Aug 1932 | A |
| 2121193 | Hanicke | Dec 1932 | A |
| 1909967 | Jones | May 1933 | A |
| 1959615 | Derrah | May 1934 | A |
| 2187852 | Friddle | Aug 1936 | A |
| 2178840 | Lorenian | Nov 1936 | A |
| 2199025 | Conn | Apr 1940 | A |
| 2235419 | Callahan | Mar 1941 | A |
| 2248054 | Becker | Jul 1941 | A |
| 2270188 | Longfellow | Jan 1942 | A |
| 2433815 | Nicephore et al. | Dec 1947 | A |
| 2518276 | Braward | Aug 1950 | A |
| 2526662 | Hipps et al. | Oct 1950 | A |
| 2557669 | Lloyd | Jun 1951 | A |
| 2566499 | Richter | Sep 1951 | A |
| 2589720 | McMath | Mar 1952 | A |
| 2621145 | Sano | Dec 1952 | A |
| 2621653 | Briggs | Dec 1952 | A |
| 2642874 | Keeling | Jun 1953 | A |
| 2687719 | Hoyt | Aug 1954 | A |
| 2701559 | Cooper | Feb 1955 | A |
| 2724326 | Long | Nov 1955 | A |
| 2725053 | Bambara | Nov 1955 | A |
| 2830587 | Everett | Apr 1958 | A |
| 2854983 | Baskin | Oct 1958 | A |
| 2936760 | Gants | May 1960 | A |
| 2955530 | Nilo | Oct 1960 | A |
| 3039468 | Price | Jun 1962 | A |
| 3048522 | Velley | Aug 1962 | A |
| 3081773 | Boyd | Mar 1963 | A |
| 3108357 | Liebig | Oct 1963 | A |
| 3108595 | Overment | Oct 1963 | A |
| 3367809 | Soloff | May 1964 | A |
| 3229006 | Nohl | Jan 1966 | A |
| 3253594 | Matthews et al. | May 1966 | A |
| 3347234 | Voss | Oct 1967 | A |
| 3391690 | Armao | Jul 1968 | A |
| 3397699 | Kohl | Aug 1968 | A |
| 3417745 | Sheldon | Dec 1968 | A |
| 3459175 | Miller | Aug 1969 | A |
| 3469003 | Hardy | Sep 1969 | A |
| 3477429 | Sampson | Nov 1969 | A |
| 3495586 | Regenbogen | Feb 1970 | A |
| 3513848 | Winston et al. | May 1970 | A |
| 3514791 | Sparks | Jun 1970 | A |
| 3517128 | Hines | Jun 1970 | A |
| 3554192 | Isberner | Jan 1971 | A |
| 3557794 | Patten | Jan 1971 | A |
| 3577991 | Wilkinson | May 1971 | A |
| 3593709 | Halloran | Jul 1971 | A |
| 3596292 | Erb et al. | Aug 1971 | A |
| 3608539 | Miller | Sep 1971 | A |
| 3613497 | Heldermann | Oct 1971 | A |
| 3620218 | Schmitt | Nov 1971 | A |
| 3624747 | McKnight et al. | Nov 1971 | A |
| 3625220 | Engelsher | Dec 1971 | A |
| 3626949 | Shute | Dec 1971 | A |
| 3635223 | Klieman | Jan 1972 | A |
| 3648705 | Lary | Mar 1972 | A |
| 3656476 | Swinney | Apr 1972 | A |
| 3657056 | Winston et al. | Apr 1972 | A |
| 3670732 | Robinson | Jun 1972 | A |
| 3678980 | Gutshall | Jul 1972 | A |
| 3698017 | Scales et al. | Oct 1972 | A |
| 3709218 | Halloran | Jan 1973 | A |
| 3711347 | Wagner et al. | Jan 1973 | A |
| 3716051 | Fischer | Feb 1973 | A |
| 3721244 | Elmaleh | Mar 1973 | A |
| 3739773 | Schmitt et al. | Jun 1973 | A |
| 3750652 | Sherwin | Aug 1973 | A |
| 3769980 | Karman | Nov 1973 | A |
| 3774244 | Walker | Nov 1973 | A |
| 3774596 | Cook | Nov 1973 | A |
| 3779239 | Fischer et al. | Dec 1973 | A |
| 3788318 | Kim et al. | Jan 1974 | A |
| 3789852 | Kim et al. | Feb 1974 | A |
| 3800788 | White | Apr 1974 | A |
| 3802438 | Wolvek | Apr 1974 | A |
| 3804089 | Bridgman | Apr 1974 | A |
| 3807393 | McDonald | Apr 1974 | A |
| 3807394 | Attenborough | Apr 1974 | A |
| 3809075 | Matles | May 1974 | A |
| 3811449 | Gravlee et al. | May 1974 | A |
| 3812855 | Banko | May 1974 | A |
| 3825010 | McDonald | Jul 1974 | A |
| 3833003 | Taricco | Sep 1974 | A |
| 3835849 | McGuire | Sep 1974 | A |
| 3841304 | Jones | Oct 1974 | A |
| 3842824 | Neufeld | Oct 1974 | A |
| 3845772 | Smith | Nov 1974 | A |
| 3850172 | Cazalis | Nov 1974 | A |
| 3850720 | Collins | Nov 1974 | A |
| 3852830 | Marmor | Dec 1974 | A |
| 3857396 | Hardwick | Dec 1974 | A |
| 3863639 | Kleaveland | Feb 1975 | A |
| 3867932 | Huene | Feb 1975 | A |
| 3869731 | Waugh et al. | Mar 1975 | A |
| 3874264 | Polos | Apr 1975 | A |
| 3875652 | Arnold | Apr 1975 | A |
| 3875946 | Duncan | Apr 1975 | A |
| 3882852 | Sinnreich | May 1975 | A |
| 3889686 | Duturbure | Jun 1975 | A |
| 3894530 | Dardik et al. | Jul 1975 | A |
| 3898992 | Balamuth | Aug 1975 | A |
| 3903549 | Deyerle | Sep 1975 | A |
| 3911923 | Yoon | Oct 1975 | A |
| 3915171 | Shermeta | Oct 1975 | A |
| 3918442 | Nikolaev et al. | Nov 1975 | A |
| 3920022 | Pastor | Nov 1975 | A |
| 3939835 | Bridgman | Feb 1976 | A |
| 3945375 | Banko | Mar 1976 | A |
| 3960143 | Terada | Jun 1976 | A |
| 3961632 | Moossun | Jun 1976 | A |
| 3967625 | Yoon | Jul 1976 | A |
| 3968800 | Vilasi | Jul 1976 | A |
| 3970089 | Saice | Jul 1976 | A |
| 3973277 | Semple et al. | Aug 1976 | A |
| 3976079 | Samuels et al. | Aug 1976 | A |
| 3989049 | Yoon | Nov 1976 | A |
| 3991426 | Flom et al. | Nov 1976 | A |
| 3994287 | Turp et al. | Nov 1976 | A |
| 4000525 | Klawitter et al. | Jan 1977 | A |
| 4022216 | Stevens | May 1977 | A |
| 4023559 | Gaskell | May 1977 | A |
| 4040413 | Ohshiro | Aug 1977 | A |
| 4053953 | Flom et al. | Oct 1977 | A |
| 4055862 | Farling | Nov 1977 | A |
| 4064566 | Fletcher et al. | Dec 1977 | A |
| 4077412 | Moossun | Mar 1978 | A |
| 4081866 | Upshaw et al. | Apr 1978 | A |
| 4083369 | Sinnreich | Apr 1978 | A |
| 4085466 | Goodfellow et al. | Apr 1978 | A |
| 4085743 | Yoon | Apr 1978 | A |
| 4089071 | Kalnberz et al. | May 1978 | A |
| 4092113 | Hardy | May 1978 | A |
| 4103680 | Yoon | Aug 1978 | A |
| 4122605 | Hirabayashi et al. | Oct 1978 | A |
| 4142517 | Contreras Guerrero de Stavropoulos et al. | Mar 1979 | A |
| 4148307 | Utsugi | Apr 1979 | A |
| 4156574 | Boden | May 1979 | A |
| 4164794 | Spector et al. | Aug 1979 | A |
| 4169470 | Ender et al. | Oct 1979 | A |
| 4171544 | Hench et al. | Oct 1979 | A |
| 4177814 | Knepshield et al. | Dec 1979 | A |
| 4183102 | Guiset | Jan 1980 | A |
| 4186448 | Brekke | Feb 1980 | A |
| 4191747 | Scheicher | Mar 1980 | A |
| 4198981 | Sinnreich | Apr 1980 | A |
| 4199864 | Ashman | Apr 1980 | A |
| 4200939 | Oser | May 1980 | A |
| 4203444 | Bonnell et al. | May 1980 | A |
| 4209012 | Smucker | Jun 1980 | A |
| 4209861 | Walker et al. | Jul 1980 | A |
| 4210148 | Stivala | Jul 1980 | A |
| 4210580 | Amrani | Jul 1980 | A |
| 4213209 | Insall et al. | Jul 1980 | A |
| 4213816 | Morris | Jul 1980 | A |
| 4224696 | Murray et al. | Sep 1980 | A |
| 4224929 | Furihata | Sep 1980 | A |
| 4228802 | Trott | Oct 1980 | A |
| 4230119 | Blum | Oct 1980 | A |
| 4235233 | Mouwen | Nov 1980 | A |
| 4235238 | Ogiu et al. | Nov 1980 | A |
| 4240433 | Bordow | Dec 1980 | A |
| 4243048 | Griffin | Jan 1981 | A |
| 4244370 | Furlow et al. | Jan 1981 | A |
| 4257411 | Cho | Mar 1981 | A |
| 4263900 | Nicholson | Apr 1981 | A |
| 4265231 | Scheller, Jr. et al. | May 1981 | A |
| 4265848 | Rusch | May 1981 | A |
| 4274414 | Johnson et al. | Jun 1981 | A |
| 4281649 | Derweduwen | Aug 1981 | A |
| 4295464 | Shihata | Oct 1981 | A |
| 4298002 | Ronel et al. | Nov 1981 | A |
| 4298992 | Burstein et al. | Nov 1981 | A |
| 4298998 | Naficy | Nov 1981 | A |
| 4299224 | Noiles | Nov 1981 | A |
| 4299227 | Lincoff | Nov 1981 | A |
| 4304178 | Haberle | Dec 1981 | A |
| 4309488 | Heide et al. | Jan 1982 | A |
| 4311145 | Esty et al. | Jan 1982 | A |
| 4312353 | Shahbabian | Jan 1982 | A |
| 4320762 | Bentov | Mar 1982 | A |
| 4344193 | Kenny | Aug 1982 | A |
| 4349029 | Mott | Sep 1982 | A |
| 4349921 | Kuntz | Sep 1982 | A |
| 4351069 | Ballintyn et al. | Sep 1982 | A |
| 4352883 | Lim | Oct 1982 | A |
| 4357940 | Muller | Nov 1982 | A |
| 4364381 | Sher et al. | Dec 1982 | A |
| 4365356 | Broemer et al. | Dec 1982 | A |
| 4369768 | Vukovic | Jan 1983 | A |
| 4373217 | Draenert | Feb 1983 | A |
| 4373709 | Whitt | Feb 1983 | A |
| 4374523 | Yoon | Feb 1983 | A |
| 4385404 | Sully et al. | May 1983 | A |
| 4388921 | Sutter et al. | Jun 1983 | A |
| 4391909 | Lim | Jul 1983 | A |
| 4395798 | McVey | Aug 1983 | A |
| 4400833 | Kurland | Aug 1983 | A |
| 4407273 | Ouchi | Oct 1983 | A |
| 4409974 | Freedland | Oct 1983 | A |
| 4414166 | Charlson et al. | Nov 1983 | A |
| 4421112 | Mains et al. | Dec 1983 | A |
| 4430760 | Smestad | Feb 1984 | A |
| 4434797 | Silander | Mar 1984 | A |
| 4437191 | van der Zel et al. | Mar 1984 | A |
| 4437362 | Hurst | Mar 1984 | A |
| 4442655 | Stroetmann | Apr 1984 | A |
| 4444180 | Schneider et al. | Apr 1984 | A |
| 4445509 | Auth | May 1984 | A |
| 4447227 | Kotsanis | May 1984 | A |
| 4448194 | DiGiovanni et al. | May 1984 | A |
| 4450591 | Rappaport | May 1984 | A |
| 4453421 | Umano | Jun 1984 | A |
| 4453539 | Raftopoulos et al. | Jun 1984 | A |
| 4456005 | Lichty | Jun 1984 | A |
| 4457302 | Caspari et al. | Jul 1984 | A |
| 4461281 | Carson | Jul 1984 | A |
| 4466429 | Loscher et al. | Aug 1984 | A |
| 4466888 | Verkaart | Aug 1984 | A |
| 4472840 | Jefferies | Sep 1984 | A |
| 4474177 | Whiteside | Oct 1984 | A |
| 4484579 | Meno et al. | Nov 1984 | A |
| 4485096 | Bell | Nov 1984 | A |
| 4487203 | Androphy | Dec 1984 | A |
| 4493317 | Klaue | Jan 1985 | A |
| 4495664 | Bianquaert | Jan 1985 | A |
| 4501031 | McDaniel et al. | Feb 1985 | A |
| 4501266 | McDaniel | Feb 1985 | A |
| 4501269 | Bagby | Feb 1985 | A |
| 4502159 | Woodroof et al. | Mar 1985 | A |
| 4502161 | Wall | Mar 1985 | A |
| 4504268 | Herlitze | Mar 1985 | A |
| 4505274 | Speelman | Mar 1985 | A |
| 4506681 | Mundell | Mar 1985 | A |
| 4509518 | McGarry et al. | Apr 1985 | A |
| 4514125 | Stol | Apr 1985 | A |
| 4516276 | Mittelmeier et al. | May 1985 | A |
| 4526173 | Sheehan | Jul 1985 | A |
| 4535757 | Webster, Jr. | Aug 1985 | A |
| 4535772 | Sheehan | Aug 1985 | A |
| 4540404 | Wolvek | Sep 1985 | A |
| 4541423 | Barber | Sep 1985 | A |
| 4543375 | Doebler et al. | Sep 1985 | A |
| 4545374 | Jacobson | Oct 1985 | A |
| 4545375 | Cline | Oct 1985 | A |
| 4547327 | Bruins et al. | Oct 1985 | A |
| 4551135 | Gorman et al. | Nov 1985 | A |
| 4553272 | Mears | Nov 1985 | A |
| 4554686 | Baker | Nov 1985 | A |
| 4555242 | Saudagar | Nov 1985 | A |
| 4556059 | Adamson, Jr. | Dec 1985 | A |
| 4556350 | Bernhardt et al. | Dec 1985 | A |
| 4556391 | Tardivel et al. | Dec 1985 | A |
| 4562598 | Kranz | Jan 1986 | A |
| 4565192 | Shapiro | Jan 1986 | A |
| 4566138 | Lewis et al. | Jan 1986 | A |
| 4572186 | Gould et al. | Feb 1986 | A |
| 4573448 | Kambin | Mar 1986 | A |
| 4574794 | Cooke et al. | Mar 1986 | A |
| 4575371 | Nordqvist et al. | Mar 1986 | A |
| 4584722 | Levy et al. | Apr 1986 | A |
| 4585000 | Hershenson | Apr 1986 | A |
| 4589414 | Yoshida et al. | May 1986 | A |
| 4589686 | McGrew | May 1986 | A |
| 4589868 | Dretler | May 1986 | A |
| 4590928 | Hunt et al. | May 1986 | A |
| 4597379 | Kihn et al. | Jul 1986 | A |
| 4599085 | Riess et al. | Jul 1986 | A |
| 4601893 | Cardinal | Jul 1986 | A |
| 4603694 | Wheeler | Aug 1986 | A |
| 4606335 | Wedeen | Aug 1986 | A |
| 4608052 | Van Kampen et al. | Aug 1986 | A |
| 4608965 | Anspach, Jr. et al. | Sep 1986 | A |
| 4610662 | Weikl et al. | Sep 1986 | A |
| 4611593 | Fogarty et al. | Sep 1986 | A |
| 4615717 | Neubauer et al. | Oct 1986 | A |
| 4619391 | Sharkany et al. | Oct 1986 | A |
| 4621640 | Mulhollan et al. | Nov 1986 | A |
| 4623553 | Ries et al. | Nov 1986 | A |
| 4624254 | McGarry et al. | Nov 1986 | A |
| 4630609 | Chin | Dec 1986 | A |
| 4632101 | Freedland | Dec 1986 | A |
| 4641648 | Shapiro | Feb 1987 | A |
| 4642117 | Nguyen et al. | Feb 1987 | A |
| 4642120 | Nevo et al. | Feb 1987 | A |
| 4645503 | Lin et al. | Feb 1987 | A |
| 4646736 | Auth | Mar 1987 | A |
| 4646738 | Trott | Mar 1987 | A |
| 4649918 | Pegg et al. | Mar 1987 | A |
| 4651717 | Jakubczak | Mar 1987 | A |
| 4651752 | Fuerst | Mar 1987 | A |
| 4654464 | Mittelmeier et al. | Mar 1987 | A |
| 4657460 | Bien | Apr 1987 | A |
| 4657548 | Nichols | Apr 1987 | A |
| 4659268 | Del Mundo et al. | Apr 1987 | A |
| 4662063 | Collins et al. | May 1987 | A |
| 4662068 | Polonsky | May 1987 | A |
| 4662372 | Sharkany et al. | May 1987 | A |
| 4662887 | Turner et al. | May 1987 | A |
| 4669473 | Richards et al. | Jun 1987 | A |
| 4678470 | Nashef et al. | Jul 1987 | A |
| 4681106 | Kensey et al. | Jul 1987 | A |
| 4681107 | Kees, Jr. | Jul 1987 | A |
| 4682598 | Beraha | Jul 1987 | A |
| 4685458 | Leckrone | Aug 1987 | A |
| 4685460 | Thornton | Aug 1987 | A |
| 4691741 | Affa et al. | Sep 1987 | A |
| 4696667 | Masch | Sep 1987 | A |
| 4705040 | Mueller et al. | Nov 1987 | A |
| 4706659 | Matthews et al. | Nov 1987 | A |
| 4706670 | Andersen et al. | Nov 1987 | A |
| 4708139 | Dunbar, IV | Nov 1987 | A |
| 4711233 | Brown | Dec 1987 | A |
| 4712542 | Daniel et al. | Dec 1987 | A |
| 4713076 | Draenert | Dec 1987 | A |
| 4713077 | Small | Dec 1987 | A |
| 4714074 | Rey et al. | Dec 1987 | A |
| 4716893 | Fischer et al. | Jan 1988 | A |
| 4716901 | Jackson et al. | Jan 1988 | A |
| 4718909 | Brown | Jan 1988 | A |
| 4718916 | Morscher | Jan 1988 | A |
| 4719908 | Averill et al. | Jan 1988 | A |
| 4721096 | Naughton et al. | Jan 1988 | A |
| 4721103 | Freedland | Jan 1988 | A |
| 4721104 | Kaufman et al. | Jan 1988 | A |
| 4722331 | Fox | Feb 1988 | A |
| 4722948 | Sanderson | Feb 1988 | A |
| 4724584 | Kasai | Feb 1988 | A |
| 4738255 | Goble et al. | Apr 1988 | A |
| 4739751 | Sapega et al. | Apr 1988 | A |
| 4741330 | Hayhurst | May 1988 | A |
| 4743229 | Chu | May 1988 | A |
| 4743259 | Bolander et al. | May 1988 | A |
| 4744364 | Kensey | May 1988 | A |
| 4747405 | Leckrone | May 1988 | A |
| 4749585 | Greco et al. | Jun 1988 | A |
| 4750488 | Wuchinich et al. | Jun 1988 | A |
| 4750492 | Jacobs | Jun 1988 | A |
| 4751922 | DiPietropolo | Jun 1988 | A |
| 4755184 | Silverberg | Jul 1988 | A |
| 4759350 | Dunn et al. | Jul 1988 | A |
| 4768507 | Fischell et al. | Sep 1988 | A |
| 4772286 | Goble et al. | Sep 1988 | A |
| 4776328 | Frey et al. | Oct 1988 | A |
| 4776738 | Winston | Oct 1988 | A |
| 4776851 | Bruchman et al. | Oct 1988 | A |
| 4779611 | Grooters et al. | Oct 1988 | A |
| 4781182 | Purnell et al. | Nov 1988 | A |
| 4781681 | Sharrow et al. | Nov 1988 | A |
| 4781922 | Bone | Nov 1988 | A |
| 4784133 | Mackin | Nov 1988 | A |
| 4789663 | Wallace et al. | Dec 1988 | A |
| 4790303 | Steffee | Dec 1988 | A |
| 4790819 | Li et al. | Dec 1988 | A |
| 4792336 | Hlavacek et al. | Dec 1988 | A |
| 4793359 | Sharrow | Dec 1988 | A |
| 4794854 | Swaim | Jan 1989 | A |
| 4795467 | Piez et al. | Jan 1989 | A |
| 4796629 | Grayzel | Jan 1989 | A |
| 4798205 | Bonomo et al. | Jan 1989 | A |
| 4798213 | Doppelt | Jan 1989 | A |
| 4800901 | Rosenberg | Jan 1989 | A |
| 4801299 | Brendel et al. | Jan 1989 | A |
| 4802479 | Haber et al. | Feb 1989 | A |
| 4817591 | Klaue | Apr 1989 | A |
| 4817602 | Beraha | Apr 1989 | A |
| 4822224 | Carl et al. | Apr 1989 | A |
| 4823794 | Pierce | Apr 1989 | A |
| 4825857 | Kenna | May 1989 | A |
| 4828563 | Muller-Lierheim | May 1989 | A |
| 4832025 | Coates | May 1989 | A |
| 4832026 | Jones | May 1989 | A |
| 4832683 | Idemoto et al. | May 1989 | A |
| 4834752 | Van Kampen | May 1989 | A |
| 4834757 | Brantigan | May 1989 | A |
| 4841960 | Garner | Jun 1989 | A |
| 4842517 | Kawahara et al. | Jun 1989 | A |
| 4843112 | Gerhart | Jun 1989 | A |
| 4844064 | Thimsen et al. | Jul 1989 | A |
| 4846791 | Hattler et al. | Jul 1989 | A |
| 4846812 | Walker et al. | Jul 1989 | A |
| 4846835 | Grande | Jul 1989 | A |
| 4857045 | Rydell | Aug 1989 | A |
| 4861334 | Nawaz | Aug 1989 | A |
| 4862874 | Kellner | Sep 1989 | A |
| 4862882 | Venturi et al. | Sep 1989 | A |
| 4862974 | Warren et al. | Sep 1989 | A |
| 4863472 | Tormala et al. | Sep 1989 | A |
| 4867157 | McGurk-Burleson et al. | Sep 1989 | A |
| 4869242 | Galluzzo | Sep 1989 | A |
| 4870957 | Goble et al. | Oct 1989 | A |
| 4875468 | Krauter et al. | Oct 1989 | A |
| 4877020 | Vich | Oct 1989 | A |
| 4880429 | Stone | Nov 1989 | A |
| 4883048 | Purnell et al. | Nov 1989 | A |
| 4883666 | Sabel et al. | Nov 1989 | A |
| 4888022 | Huebsch | Dec 1989 | A |
| 4890612 | Kensey | Jan 1990 | A |
| 4892552 | Ainsworth et al. | Jan 1990 | A |
| 4895148 | Bays et al. | Jan 1990 | A |
| 4898156 | Gatturna et al. | Feb 1990 | A |
| 4899729 | Gill et al. | Feb 1990 | A |
| 4899743 | Nicholson et al. | Feb 1990 | A |
| 4899744 | Fujitsuka et al. | Feb 1990 | A |
| 4901721 | Hakki | Feb 1990 | A |
| 4902296 | Bolander et al. | Feb 1990 | A |
| 4904259 | Itay | Feb 1990 | A |
| 4904261 | Dove et al. | Feb 1990 | A |
| 4909789 | Taguchi et al. | Mar 1990 | A |
| 4911721 | Andergaten 3 et al. | Mar 1990 | A |
| 4919667 | Richmond | Apr 1990 | A |
| 4921478 | Solano et al. | May 1990 | A |
| 4921479 | Grayzel | May 1990 | A |
| 4922897 | Sapega et al. | May 1990 | A |
| 4923464 | DiPisa, Jr. | May 1990 | A |
| 4924865 | Bays et al. | May 1990 | A |
| 4924866 | Yoon | May 1990 | A |
| 4927412 | Menasche | May 1990 | A |
| 4927421 | Goble et al. | May 1990 | A |
| 4932956 | Reddy et al. | Jun 1990 | A |
| 4932959 | Horzewski et al. | Jun 1990 | A |
| 4932960 | Green et al. | Jun 1990 | A |
| 4932973 | Gendler | Jun 1990 | A |
| 4935023 | Whiteside et al. | Jun 1990 | A |
| 4935026 | McFadden | Jun 1990 | A |
| 4935028 | Drews | Jun 1990 | A |
| 4936848 | Bagby | Jun 1990 | A |
| 4936852 | Kent et al. | Jun 1990 | A |
| 4944760 | Kenna | Jul 1990 | A |
| 4945625 | Winston | Aug 1990 | A |
| 4945896 | Gade | Aug 1990 | A |
| 4946468 | Li | Aug 1990 | A |
| 4950296 | McIntyre | Aug 1990 | A |
| 4950298 | Gustilo et al. | Aug 1990 | A |
| 4952213 | Bowman et al. | Aug 1990 | A |
| 4954126 | Wallsten | Sep 1990 | A |
| 4955910 | Bolesky | Sep 1990 | A |
| 4957498 | Caspari et al. | Sep 1990 | A |
| 4961740 | Ray et al. | Oct 1990 | A |
| 4961741 | Hayhurst | Oct 1990 | A |
| 4961954 | Goldberg et al. | Oct 1990 | A |
| 4963151 | Ducheyne et al. | Oct 1990 | A |
| 4963489 | Naughton et al. | Oct 1990 | A |
| 4964862 | Arms | Oct 1990 | A |
| 4964865 | Burkhead et al. | Oct 1990 | A |
| 4966583 | Debbas | Oct 1990 | A |
| 4968298 | Michelson | Nov 1990 | A |
| 4968315 | Gatturna | Nov 1990 | A |
| 4969888 | Scholten et al. | Nov 1990 | A |
| 4969892 | Burton et al. | Nov 1990 | A |
| 4969895 | McLeod et al. | Nov 1990 | A |
| 4979949 | Matsen, III et al. | Dec 1990 | A |
| 4979957 | Hodorek | Dec 1990 | A |
| 4983179 | Sjostrom | Jan 1991 | A |
| 4984563 | Renaud | Jan 1991 | A |
| 4984564 | Yuen | Jan 1991 | A |
| 4985038 | Lyell | Jan 1991 | A |
| 4990161 | Kampner | Feb 1991 | A |
| 4994047 | Walker et al. | Feb 1991 | A |
| 4994067 | Summers | Feb 1991 | A |
| 4994071 | MacGregor | Feb 1991 | A |
| 4995868 | Brazier | Feb 1991 | A |
| 4997445 | Hodorek | Mar 1991 | A |
| 4998539 | Delsanti | Mar 1991 | A |
| 5002550 | Li | Mar 1991 | A |
| 5002557 | Hasson | Mar 1991 | A |
| 5002563 | Pyka et al. | Mar 1991 | A |
| 5007912 | Albrektsson et al. | Apr 1991 | A |
| 5009652 | Morgan et al. | Apr 1991 | A |
| 5009662 | Wallace et al. | Apr 1991 | A |
| 5009663 | Broome | Apr 1991 | A |
| 5009664 | Sievers | Apr 1991 | A |
| 5013316 | Goble et al. | May 1991 | A |
| 5015247 | Michelson | May 1991 | A |
| 5015255 | Kuslich | May 1991 | A |
| 5019090 | Pinchuk | May 1991 | A |
| 5019104 | Whiteside et al. | May 1991 | A |
| 5021056 | Hofmann et al. | Jun 1991 | A |
| 5021059 | Kensey et al. | Jun 1991 | A |
| 5026373 | Ray et al. | Jun 1991 | A |
| 5032132 | Matsen, III et al. | Jul 1991 | A |
| 5035699 | Coates | Jul 1991 | A |
| 5035713 | Friis | Jul 1991 | A |
| 5037404 | Gold et al. | Aug 1991 | A |
| 5037422 | Hayhurst et al. | Aug 1991 | A |
| 5037423 | Kenna | Aug 1991 | A |
| 5041093 | Chu | Aug 1991 | A |
| 5041114 | Chapman et al. | Aug 1991 | A |
| 5041125 | Montano, Jr. | Aug 1991 | A |
| 5041129 | Hayhurst et al. | Aug 1991 | A |
| 5042976 | Ishitsu et al. | Aug 1991 | A |
| 5046513 | Gatturna et al. | Sep 1991 | A |
| 5047055 | Bao et al. | Sep 1991 | A |
| 5051049 | Wills | Sep 1991 | A |
| 5053009 | Herzberg | Oct 1991 | A |
| 5053039 | Hofmann et al. | Oct 1991 | A |
| 5053046 | Janese | Oct 1991 | A |
| 5053047 | Yoon | Oct 1991 | A |
| 5059193 | Kuslich | Oct 1991 | A |
| 5059206 | Winters | Oct 1991 | A |
| 5060678 | Bauman et al. | Oct 1991 | A |
| 5061274 | Kensey | Oct 1991 | A |
| 5061281 | Mares et al. | Oct 1991 | A |
| 5061286 | Lyle | Oct 1991 | A |
| 5062843 | Mahony, III | Nov 1991 | A |
| 5069674 | Fearnot et al. | Dec 1991 | A |
| 5071411 | Hillstead | Dec 1991 | A |
| 5073373 | O'Leary et al. | Dec 1991 | A |
| 5078731 | Hayhurst | Jan 1992 | A |
| 5078744 | Chvapil | Jan 1992 | A |
| 5078745 | Rhenter et al. | Jan 1992 | A |
| 5082670 | Gage et al. | Jan 1992 | A |
| 5084050 | Draenert | Jan 1992 | A |
| 5084051 | Tormala et al. | Jan 1992 | A |
| 5085660 | Lin | Feb 1992 | A |
| 5085661 | Moss | Feb 1992 | A |
| 5092348 | Dubrul et al. | Mar 1992 | A |
| 5098433 | Freedland | Mar 1992 | A |
| 5098434 | Serbousek | Mar 1992 | A |
| 5098436 | Ferrante et al. | Mar 1992 | A |
| 5098437 | Kashuba et al. | Mar 1992 | A |
| 5099859 | Bell | Mar 1992 | A |
| 5100405 | McLaren | Mar 1992 | A |
| 5100409 | Coates et al. | Mar 1992 | A |
| 5100417 | Cerier et al. | Mar 1992 | A |
| 5100689 | Goldberg et al. | Mar 1992 | A |
| 5101720 | Bianchi | Apr 1992 | A |
| 5102417 | Palmaz | Apr 1992 | A |
| 5102421 | Anspach, Jr. | Apr 1992 | A |
| 5104383 | Shichman | Apr 1992 | A |
| 5108399 | Eitenmuller et al. | Apr 1992 | A |
| 5108433 | May et al. | Apr 1992 | A |
| 5108441 | McDowell | Apr 1992 | A |
| 5111987 | Moeinzadeh et al. | May 1992 | A |
| 5116374 | Stone | May 1992 | A |
| 5120175 | Arbegast et al. | Jun 1992 | A |
| 5122122 | Allgood | Jun 1992 | A |
| 5122144 | Bert et al. | Jun 1992 | A |
| 5123520 | Schmid et al. | Jun 1992 | A |
| 5123906 | Kelman | Jun 1992 | A |
| 5123914 | Cope | Jun 1992 | A |
| 5123941 | Lauren et al. | Jun 1992 | A |
| 5133732 | Wiktor | Jul 1992 | A |
| RE34021 | Mueller | Aug 1992 | E |
| 5139520 | Rosenberg | Aug 1992 | A |
| 5141520 | Goble et al. | Aug 1992 | A |
| 5143062 | Peckham | Sep 1992 | A |
| 5143093 | Sahota | Sep 1992 | A |
| 5147362 | Goble | Sep 1992 | A |
| 5152744 | Krause et al. | Oct 1992 | A |
| 5152765 | Ross et al. | Oct 1992 | A |
| 5152778 | Bales, Jr. et al. | Oct 1992 | A |
| 5154717 | Matsen, III et al. | Oct 1992 | A |
| 5154720 | Trott et al. | Oct 1992 | A |
| 5156613 | Sawyer | Oct 1992 | A |
| 5156616 | Meadows et al. | Oct 1992 | A |
| 5158553 | Berry et al. | Oct 1992 | A |
| 5158566 | Pianetti | Oct 1992 | A |
| 5158571 | Picha | Oct 1992 | A |
| 5158934 | Ammann et al. | Oct 1992 | A |
| 5159921 | Hoover | Nov 1992 | A |
| 5162506 | Hadden | Nov 1992 | A |
| 5163949 | Bonutti | Nov 1992 | A |
| 5163960 | Bonutti | Nov 1992 | A |
| 5170800 | Smith et al. | Dec 1992 | A |
| 5171243 | Kashuba et al. | Dec 1992 | A |
| 5171244 | Caspari et al. | Dec 1992 | A |
| 5171251 | Bregen et al. | Dec 1992 | A |
| 5171276 | Caspari et al. | Dec 1992 | A |
| 5174300 | Bales et al. | Dec 1992 | A |
| 5176682 | Chow | Jan 1993 | A |
| 5176684 | Ferrante et al. | Jan 1993 | A |
| 5176702 | Bales et al. | Jan 1993 | A |
| 5178622 | Lehner, II | Jan 1993 | A |
| 5179964 | Cook | Jan 1993 | A |
| 5180388 | DiCarlo | Jan 1993 | A |
| 5183053 | Yeh et al. | Feb 1993 | A |
| 5183464 | Dubrul et al. | Feb 1993 | A |
| 5186178 | Yeh et al. | Feb 1993 | A |
| 5192287 | Fournier et al. | Mar 1993 | A |
| 5192326 | Bao et al. | Mar 1993 | A |
| 5192327 | Brantigan | Mar 1993 | A |
| 5195507 | Bilweis | Mar 1993 | A |
| 5195970 | Gahara | Mar 1993 | A |
| 5197166 | Meier et al. | Mar 1993 | A |
| 5197488 | Kovacevic | Mar 1993 | A |
| 5197955 | Stephens et al. | Mar 1993 | A |
| 5197968 | Clement | Mar 1993 | A |
| 5197971 | Bonutti | Mar 1993 | A |
| 5197987 | Koch et al. | Mar 1993 | A |
| 5201768 | Caspari et al. | Apr 1993 | A |
| 5203784 | Ross et al. | Apr 1993 | A |
| 5203787 | Noblitt et al. | Apr 1993 | A |
| 5204106 | Schepers et al. | Apr 1993 | A |
| 5207692 | Kraus et al. | May 1993 | A |
| 5208950 | Merritt | May 1993 | A |
| 5209776 | Bass et al. | May 1993 | A |
| 5211647 | Schmieding | May 1993 | A |
| 5217463 | Mikhail | Jun 1993 | A |
| 5217486 | Rice et al. | Jun 1993 | A |
| 5217493 | Raad et al. | Jun 1993 | A |
| 5219359 | McQuilkin et al. | Jun 1993 | A |
| 5224946 | Hayhurst et al. | Jul 1993 | A |
| 5226426 | Yoon | Jul 1993 | A |
| 5226899 | Lee et al. | Jul 1993 | A |
| 5226915 | Bertin | Jul 1993 | A |
| 5228459 | Caspari et al. | Jul 1993 | A |
| 5234006 | Eaton et al. | Aug 1993 | A |
| 5234425 | Fogarty et al. | Aug 1993 | A |
| 5234433 | Bert et al. | Aug 1993 | A |
| 5236432 | Matsen, III et al. | Aug 1993 | A |
| 5236438 | Wilk | Aug 1993 | A |
| 5236445 | Hayhurst et al. | Aug 1993 | A |
| 5242902 | Murphy et al. | Sep 1993 | A |
| 5244946 | Guest et al. | Sep 1993 | A |
| 5246441 | Ross et al. | Sep 1993 | A |
| 5250026 | Ehrlich et al. | Oct 1993 | A |
| 5250055 | Moore et al. | Oct 1993 | A |
| 5250070 | Parodi | Oct 1993 | A |
| 5254091 | Aliahmad et al. | Oct 1993 | A |
| 5254113 | Wilk | Oct 1993 | A |
| 5258004 | Bales et al. | Nov 1993 | A |
| 5258007 | Spetzler et al. | Nov 1993 | A |
| 5258015 | Li et al. | Nov 1993 | A |
| 5258016 | DiPoto et al. | Nov 1993 | A |
| 5258031 | Salib et al. | Nov 1993 | A |
| 5258032 | Bertin | Nov 1993 | A |
| 5261914 | Warren | Nov 1993 | A |
| 5263498 | Caspari et al. | Nov 1993 | A |
| 5263987 | Shah | Nov 1993 | A |
| 5266325 | Kuzma et al. | Nov 1993 | A |
| 5269783 | Sander | Dec 1993 | A |
| 5269785 | Bonutti | Dec 1993 | A |
| 5269809 | Hayhurst et al. | Dec 1993 | A |
| 5273524 | Fox et al. | Dec 1993 | A |
| 5275166 | Vaitekunas et al. | Jan 1994 | A |
| 5281235 | Haber et al. | Jan 1994 | A |
| 5282803 | Lackey | Feb 1994 | A |
| 5282832 | Toso et al. | Feb 1994 | A |
| 5282861 | Kaplan | Feb 1994 | A |
| 5284655 | Bogdansky et al. | Feb 1994 | A |
| 5285655 | Sung-Il et al. | Feb 1994 | A |
| 5290249 | Foster et al. | Mar 1994 | A |
| 5290281 | Tschakaloff | Mar 1994 | A |
| 5298254 | Prewett et al. | Mar 1994 | A |
| 5304119 | Balaban et al. | Apr 1994 | A |
| 5304181 | Caspari et al. | Apr 1994 | A |
| 5306280 | Bregen et al. | Apr 1994 | A |
| 5306301 | Graf et al. | Apr 1994 | A |
| 5312438 | Johnson | May 1994 | A |
| 5315741 | Dubberke | May 1994 | A |
| 5318588 | Horzewski et al. | Jun 1994 | A |
| 5320611 | Bonutti | Jun 1994 | A |
| 5322505 | Krause et al. | Jun 1994 | A |
| 5324308 | Pierce | Jun 1994 | A |
| 5326361 | Hollister | Jul 1994 | A |
| 5328480 | Melker et al. | Jul 1994 | A |
| 5329846 | Bonutti | Jul 1994 | A |
| 5329924 | Bonutti | Jul 1994 | A |
| 5330468 | Burkhart | Jul 1994 | A |
| 5330476 | Hiot et al. | Jul 1994 | A |
| 5330486 | Wilk | Jul 1994 | A |
| 5330497 | Freitas et al. | Jul 1994 | A |
| 5331975 | Bonutti | Jul 1994 | A |
| 5334146 | Ozasa | Aug 1994 | A |
| 5336231 | Adair | Aug 1994 | A |
| 5336240 | Metzler et al. | Aug 1994 | A |
| 5339799 | Kami et al. | Aug 1994 | A |
| 5345927 | Bonutti | Sep 1994 | A |
| 5349956 | Bonutti | Sep 1994 | A |
| 5352229 | Goble et al. | Oct 1994 | A |
| 5354298 | Lee et al. | Oct 1994 | A |
| 5354302 | Ko | Oct 1994 | A |
| 5356413 | Martins et al. | Oct 1994 | A |
| 5360450 | Giannini | Nov 1994 | A |
| 5366480 | Corriveau et al. | Nov 1994 | A |
| 5370646 | Reese et al. | Dec 1994 | A |
| 5370660 | Weinstein et al. | Dec 1994 | A |
| 5370662 | Stone et al. | Dec 1994 | A |
| 5372146 | Branch | Dec 1994 | A |
| 5374235 | Ahrens | Dec 1994 | A |
| 5376101 | Green et al. | Dec 1994 | A |
| 5376126 | Lin | Dec 1994 | A |
| 5379759 | Sewell, Jr. | Jan 1995 | A |
| 5382254 | McGarry et al. | Jan 1995 | A |
| 5383883 | Wilk et al. | Jan 1995 | A |
| 5383905 | Golds et al. | Jan 1995 | A |
| 5383937 | Mikhail | Jan 1995 | A |
| RE34866 | Kensey et al. | Feb 1995 | E |
| 5390683 | Pisharodi | Feb 1995 | A |
| 5391171 | Schmieding | Feb 1995 | A |
| 5391173 | Wilk | Feb 1995 | A |
| RE34871 | McGuire et al. | Mar 1995 | E |
| 5395308 | Fox et al. | Mar 1995 | A |
| 5395376 | Caspari et al. | Mar 1995 | A |
| 5400805 | Warren | Mar 1995 | A |
| 5403312 | Yates et al. | Apr 1995 | A |
| 5403317 | Bonutti | Apr 1995 | A |
| 5403348 | Bonutti | Apr 1995 | A |
| 5405359 | Pierce | Apr 1995 | A |
| 5411523 | Goble | May 1995 | A |
| 5413585 | Pagedas | May 1995 | A |
| 5415663 | Luckman et al. | May 1995 | A |
| 5417691 | Hayhurst | May 1995 | A |
| 5417700 | Egan | May 1995 | A |
| 5417701 | Holmes | May 1995 | A |
| 5417712 | Whittaker et al. | May 1995 | A |
| 5423796 | Shikhman et al. | Jun 1995 | A |
| 5423819 | Small et al. | Jun 1995 | A |
| 5423860 | Lizardi et al. | Jun 1995 | A |
| 5425733 | Schmieding | Jun 1995 | A |
| 5431670 | Holmes | Jul 1995 | A |
| 5439470 | Li | Aug 1995 | A |
| 5441502 | Bartlett | Aug 1995 | A |
| 5441538 | Bonutti | Aug 1995 | A |
| 5443482 | Stone et al. | Aug 1995 | A |
| 5443512 | Parr et al. | Aug 1995 | A |
| 5445615 | Yoon | Aug 1995 | A |
| 5449372 | Schmaltz et al. | Sep 1995 | A |
| 5449382 | Dayton | Sep 1995 | A |
| 5451235 | Lock | Sep 1995 | A |
| 5454365 | Bonutti | Oct 1995 | A |
| 5456722 | McLeod et al. | Oct 1995 | A |
| 5458653 | Davidson | Oct 1995 | A |
| 5462549 | Glock | Oct 1995 | A |
| 5462561 | Voda | Oct 1995 | A |
| 5464424 | O'Donnell, Jr. | Nov 1995 | A |
| 5464425 | Skiba | Nov 1995 | A |
| 5464426 | Bonutti | Nov 1995 | A |
| 5464427 | Curtis et al. | Nov 1995 | A |
| 5470337 | Moss | Nov 1995 | A |
| 5472444 | Huebner et al. | Dec 1995 | A |
| 5474554 | Ku | Dec 1995 | A |
| 5474559 | Bertin et al. | Dec 1995 | A |
| 5478351 | Meade et al. | Dec 1995 | A |
| 5478353 | Yoon | Dec 1995 | A |
| 5480403 | Lee et al. | Jan 1996 | A |
| 5484437 | Michelson | Jan 1996 | A |
| 5486197 | Le et al. | Jan 1996 | A |
| 5487844 | Fujita | Jan 1996 | A |
| 5488958 | Topel et al. | Feb 1996 | A |
| 5492697 | Boyan et al. | Feb 1996 | A |
| 5496292 | Burnham | Mar 1996 | A |
| 5496335 | Thomason et al. | Mar 1996 | A |
| 5496348 | Bonutti | Mar 1996 | A |
| 5500000 | Feagin et al. | Mar 1996 | A |
| 5501700 | Hirata | Mar 1996 | A |
| 5504977 | Weppner | Apr 1996 | A |
| 5505735 | Li | Apr 1996 | A |
| 5507754 | Green et al. | Apr 1996 | A |
| 5514091 | Yoon | May 1996 | A |
| 5514153 | Bonutti | May 1996 | A |
| 5520700 | Beyar et al. | May 1996 | A |
| 5522844 | Johnson | Jun 1996 | A |
| 5522845 | Wenstrom, Jr. | Jun 1996 | A |
| 5522846 | Bonutti | Jun 1996 | A |
| 5527341 | Gogolewski et al. | Jun 1996 | A |
| 5527342 | Pietrzak et al. | Jun 1996 | A |
| 5527343 | Bonutti | Jun 1996 | A |
| 5529075 | Clark | Jun 1996 | A |
| 5531759 | Kensey et al. | Jul 1996 | A |
| 5534012 | Bonutti | Jul 1996 | A |
| 5534028 | Bao et al. | Jul 1996 | A |
| 5540718 | Bartlett | Jul 1996 | A |
| 5542423 | Bonutti | Aug 1996 | A |
| 5542947 | Treacy | Aug 1996 | A |
| 5545178 | Kensey et al. | Aug 1996 | A |
| 5545180 | Le et al. | Aug 1996 | A |
| 5545206 | Carson | Aug 1996 | A |
| 5545222 | Bonutti | Aug 1996 | A |
| 5549630 | Bonutti | Aug 1996 | A |
| 5549631 | Bonutti | Aug 1996 | A |
| 5549689 | Epstein et al. | Aug 1996 | A |
| 5550172 | Regula et al. | Aug 1996 | A |
| 5556402 | Xu | Sep 1996 | A |
| 5562668 | Johnson | Oct 1996 | A |
| 5562684 | Kammerer | Oct 1996 | A |
| 5562688 | Riza | Oct 1996 | A |
| 5569252 | Justin et al. | Oct 1996 | A |
| 5569259 | Ferrante et al. | Oct 1996 | A |
| 5569305 | Bonutti | Oct 1996 | A |
| 5569306 | Thal | Oct 1996 | A |
| 5571139 | Jenkins, Jr. | Nov 1996 | A |
| 5571196 | Stein | Nov 1996 | A |
| 5573517 | Bonutti et al. | Nov 1996 | A |
| 5573538 | Laboureau | Nov 1996 | A |
| 5573542 | Stevens | Nov 1996 | A |
| 5575801 | Habermeyer et al. | Nov 1996 | A |
| 5577517 | Bonutti | Nov 1996 | A |
| 5584835 | Greenfield | Dec 1996 | A |
| 5584860 | Goble et al. | Dec 1996 | A |
| 5584862 | Bonutti | Dec 1996 | A |
| 5591206 | Moufarrege | Jan 1997 | A |
| 5593422 | Muijs Van de Moer et al. | Jan 1997 | A |
| 5593425 | Bonutti et al. | Jan 1997 | A |
| 5593625 | Riebel et al. | Jan 1997 | A |
| 5601557 | Hayhurst | Feb 1997 | A |
| 5601558 | Torrie et al. | Feb 1997 | A |
| 5601565 | Huebner | Feb 1997 | A |
| 5601595 | Smith | Feb 1997 | A |
| 5607427 | Tschakaloff | Mar 1997 | A |
| 5609595 | Pennig | Mar 1997 | A |
| 5609635 | Michelson | Mar 1997 | A |
| 5618314 | Harwin et al. | Apr 1997 | A |
| 5620448 | Puddu | Apr 1997 | A |
| 5620461 | Muijs Van De Moer et al. | Apr 1997 | A |
| 5624462 | Bonutti | Apr 1997 | A |
| 5624463 | Stone et al. | Apr 1997 | A |
| 5626612 | Bartlett | May 1997 | A |
| 5626614 | Hart | May 1997 | A |
| 5626718 | Philippe et al. | May 1997 | A |
| 5628751 | Sander et al. | May 1997 | A |
| 5630824 | Hart | May 1997 | A |
| 5634926 | Jobe | Jun 1997 | A |
| 5643274 | Sander et al. | Jul 1997 | A |
| 5643293 | Kogasaka et al. | Jul 1997 | A |
| 5643295 | Yoon | Jul 1997 | A |
| 5643320 | Lower et al. | Jul 1997 | A |
| 5643321 | McDevitt | Jul 1997 | A |
| 5644002 | Cooper et al. | Jul 1997 | A |
| 5645553 | Kolesa et al. | Jul 1997 | A |
| 5645588 | Graf et al. | Jul 1997 | A |
| 5645597 | Krapiva | Jul 1997 | A |
| 5645599 | Samani | Jul 1997 | A |
| 5649955 | Hashimoto et al. | Jul 1997 | A |
| 5649963 | McDevitt | Jul 1997 | A |
| 5651377 | O'Donnell, Jr. | Jul 1997 | A |
| 5658313 | Thal | Aug 1997 | A |
| 5660225 | Saffran | Aug 1997 | A |
| 5662658 | Wenstrom, Jr. | Sep 1997 | A |
| 5662710 | Bonutti | Sep 1997 | A |
| 5665089 | Dall et al. | Sep 1997 | A |
| 5665109 | Yoon | Sep 1997 | A |
| 5665112 | Thal | Sep 1997 | A |
| 5667513 | Torrie et al. | Sep 1997 | A |
| 5667520 | Bonutti | Sep 1997 | A |
| 5669909 | Zdeblick et al. | Sep 1997 | A |
| 5669917 | Sauer et al. | Sep 1997 | A |
| 5674240 | Bonut | Oct 1997 | A |
| 5681310 | Yuan et al. | Oct 1997 | A |
| 5681333 | Burkhart et al. | Oct 1997 | A |
| 5681351 | Jamiolkowski et al. | Oct 1997 | A |
| 5681352 | Clancy, III et al. | Oct 1997 | A |
| 5682886 | Delp et al. | Nov 1997 | A |
| 5683401 | Schmieding et al. | Nov 1997 | A |
| 5683418 | Luscombe et al. | Nov 1997 | A |
| 5683469 | Johnson et al. | Nov 1997 | A |
| 5685820 | Riek et al. | Nov 1997 | A |
| 5685826 | Bonutti | Nov 1997 | A |
| 5688283 | Knapp | Nov 1997 | A |
| 5690654 | Ovil | Nov 1997 | A |
| 5690655 | Hart et al. | Nov 1997 | A |
| 5690674 | Diaz | Nov 1997 | A |
| 5690676 | DiPoto et al. | Nov 1997 | A |
| 5693055 | Zahiri et al. | Dec 1997 | A |
| 5694951 | Bonutti | Dec 1997 | A |
| 5697950 | Fucci et al. | Dec 1997 | A |
| 5702397 | Gonle et al. | Dec 1997 | A |
| 5702462 | Oberlander | Dec 1997 | A |
| 5707390 | Bonutti | Jan 1998 | A |
| 5707395 | Li | Jan 1998 | A |
| 5713897 | Goble et al. | Feb 1998 | A |
| 5713903 | Sander et al. | Feb 1998 | A |
| 5713921 | Bonutti | Feb 1998 | A |
| 5715836 | Kliegis et al. | Feb 1998 | A |
| 5716325 | Bonutti | Feb 1998 | A |
| 5718717 | Bonutti | Feb 1998 | A |
| 5720747 | Burke | Feb 1998 | A |
| 5720753 | Sander et al. | Feb 1998 | A |
| 5722978 | Jenkins, Jr. | Mar 1998 | A |
| 5723016 | Minns et al. | Mar 1998 | A |
| 5725529 | Nicholson et al. | Mar 1998 | A |
| 5725541 | Anspach, III et al. | Mar 1998 | A |
| 5725556 | Moser et al. | Mar 1998 | A |
| 5725557 | Gatturna et al. | Mar 1998 | A |
| 5725582 | Bevan et al. | Mar 1998 | A |
| 5730747 | Ek et al. | Mar 1998 | A |
| 5733306 | Bonutti | Mar 1998 | A |
| 5735875 | Bonutti et al. | Apr 1998 | A |
| 5735877 | Pagedas | Apr 1998 | A |
| 5735899 | Schwartz et al. | Apr 1998 | A |
| 5741268 | Schutz | Apr 1998 | A |
| 5741282 | Anspach, III et al. | Apr 1998 | A |
| 5752952 | Adamson | May 1998 | A |
| 5752974 | Rhee et al. | May 1998 | A |
| 5755809 | Cohen et al. | May 1998 | A |
| 5762458 | Wang et al. | Jun 1998 | A |
| 5763416 | Bonadio et al. | Jun 1998 | A |
| 5766221 | Benderev et al. | Jun 1998 | A |
| 5766251 | Koshino | Jun 1998 | A |
| 5769854 | Bastian et al. | Jun 1998 | A |
| 5769894 | Ferragamo | Jun 1998 | A |
| 5772672 | Toy et al. | Jun 1998 | A |
| 5776151 | Chan | Jul 1998 | A |
| 5779706 | Tschakaloff | Jul 1998 | A |
| 5779719 | Klein et al. | Jul 1998 | A |
| 5779728 | Lunsford et al. | Jul 1998 | A |
| 5782862 | Bonutti | Jul 1998 | A |
| 5782925 | Collazo et al. | Jul 1998 | A |
| 5785713 | Jobe | Jul 1998 | A |
| 5792096 | Rentmeester et al. | Aug 1998 | A |
| 5797931 | Bito et al. | Aug 1998 | A |
| 5797963 | McDevitt | Aug 1998 | A |
| 5800537 | Bell | Sep 1998 | A |
| 5800544 | Demopulos et al. | Sep 1998 | A |
| 5806518 | Mittelstadt | Sep 1998 | A |
| 5807403 | Beyar et al. | Sep 1998 | A |
| 5810827 | Haines et al. | Sep 1998 | A |
| 5810849 | Kontos | Sep 1998 | A |
| 5810853 | Yoon | Sep 1998 | A |
| 5810884 | Kim | Sep 1998 | A |
| 5814071 | McDevitt et al. | Sep 1998 | A |
| 5814072 | Bonutti | Sep 1998 | A |
| 5814073 | Bonutti | Sep 1998 | A |
| 5817107 | Schaller | Oct 1998 | A |
| 5823994 | Sharkey et al. | Oct 1998 | A |
| 5824009 | Fukuda et al. | Oct 1998 | A |
| 5827318 | Bonutti | Oct 1998 | A |
| 5830125 | Scribner et al. | Nov 1998 | A |
| 5836897 | Sakurai et al. | Nov 1998 | A |
| 5836948 | Zucherman et al. | Nov 1998 | A |
| 5839899 | Robinson | Nov 1998 | A |
| 5843178 | Vanney et al. | Dec 1998 | A |
| 5845645 | Bonutti | Dec 1998 | A |
| 5851185 | Berns | Dec 1998 | A |
| 5860997 | Bonutti | Jan 1999 | A |
| 5865834 | McGuire | Feb 1999 | A |
| 5866634 | Tokushige | Feb 1999 | A |
| 5868749 | Reed | Feb 1999 | A |
| 5871018 | Delp et al. | Feb 1999 | A |
| 5873891 | Sohn | Feb 1999 | A |
| 5874235 | Chan | Feb 1999 | A |
| 5879372 | Bartlett | Mar 1999 | A |
| 5888196 | Bonutti | Mar 1999 | A |
| 5888219 | Bonutti | Mar 1999 | A |
| 5891166 | Schervinsky | Apr 1999 | A |
| 5891168 | Thal | Apr 1999 | A |
| 5893880 | Egan et al. | Apr 1999 | A |
| 5895426 | Scarborough et al. | Apr 1999 | A |
| 5897559 | Masini | Apr 1999 | A |
| 5897574 | Bonutti | Apr 1999 | A |
| 5899911 | Carter | May 1999 | A |
| 5899921 | Caspari et al. | May 1999 | A |
| 5902321 | Caspari et al. | May 1999 | A |
| 5906579 | Vander Salm et al. | May 1999 | A |
| 5906616 | Pavlov et al. | May 1999 | A |
| 5906625 | Bito et al. | May 1999 | A |
| 5908429 | Yoon | Jun 1999 | A |
| 5911721 | Nicholson et al. | Jun 1999 | A |
| 5916221 | Hodorek et al. | Jun 1999 | A |
| 5918604 | Whelan | Jul 1999 | A |
| 5919193 | Slavitt | Jul 1999 | A |
| 5919194 | Anderson | Jul 1999 | A |
| 5919208 | Valenti | Jul 1999 | A |
| 5919215 | Wiklund et al. | Jul 1999 | A |
| 5921986 | Bonutti | Jul 1999 | A |
| 5925064 | Meyers et al. | Jul 1999 | A |
| 5928244 | Tovey et al. | Jul 1999 | A |
| 5928267 | Bonutti et al. | Jul 1999 | A |
| 5931838 | Vito | Aug 1999 | A |
| 5931869 | Boucher et al. | Aug 1999 | A |
| 5935094 | Zupkas | Aug 1999 | A |
| 5935131 | Bonutti | Aug 1999 | A |
| 5940942 | Fong | Aug 1999 | A |
| 5941900 | Bonutti | Aug 1999 | A |
| 5941901 | Egan | Aug 1999 | A |
| 5945002 | Leukes et al. | Aug 1999 | A |
| 5947982 | Duran | Sep 1999 | A |
| 5948000 | Larsen et al. | Sep 1999 | A |
| 5948001 | Larsen | Sep 1999 | A |
| 5948002 | Bonutti | Sep 1999 | A |
| 5951590 | Goldfarb | Sep 1999 | A |
| 5954739 | Bonutti | Sep 1999 | A |
| 5957953 | DiPoto et al. | Sep 1999 | A |
| 5961499 | Bonutti | Oct 1999 | A |
| 5961521 | Roger | Oct 1999 | A |
| 5961538 | Pedlick et al. | Oct 1999 | A |
| 5961554 | Janson et al. | Oct 1999 | A |
| 5964765 | Fenton, Jr. et al. | Oct 1999 | A |
| 5964769 | Wagner et al. | Oct 1999 | A |
| 5968044 | Nicholson et al. | Oct 1999 | A |
| 5968046 | Castleman | Oct 1999 | A |
| 5968047 | Reed | Oct 1999 | A |
| 5980520 | Vancaillie | Nov 1999 | A |
| 5980558 | Wiley | Nov 1999 | A |
| 5980559 | Bonutti | Nov 1999 | A |
| 5984929 | Bashiri et al. | Nov 1999 | A |
| 5984967 | Zdeblick et al. | Nov 1999 | A |
| 5989282 | Bonutti | Nov 1999 | A |
| 5989289 | Coates et al. | Nov 1999 | A |
| 5993458 | Vaitekunas et al. | Nov 1999 | A |
| 5993477 | Vaitekunas et al. | Nov 1999 | A |
| 6007537 | Burkinshaw et al. | Dec 1999 | A |
| 6007567 | Bonutti | Dec 1999 | A |
| 6007580 | Lehto et al. | Dec 1999 | A |
| 6008433 | Stone | Dec 1999 | A |
| 6010525 | Bonutti | Jan 2000 | A |
| 6010526 | Sandstrom et al. | Jan 2000 | A |
| 6013853 | Athanasiou et al. | Jan 2000 | A |
| 6017305 | Bonutti | Jan 2000 | A |
| 6017321 | Boone | Jan 2000 | A |
| 6024746 | Katz | Feb 2000 | A |
| 6033410 | McLean et al. | Mar 2000 | A |
| 6033429 | Magovern | Mar 2000 | A |
| 6033430 | Bonutti | Mar 2000 | A |
| 6042596 | Bonutti | Mar 2000 | A |
| 6045551 | Bonutti | Apr 2000 | A |
| 6056751 | Fenton, Jr. | May 2000 | A |
| 6056754 | Haines et al. | May 2000 | A |
| 6056772 | Bonutti | May 2000 | A |
| 6056773 | Bonutti | May 2000 | A |
| 6059797 | Mears | May 2000 | A |
| 6059817 | Bonutti et al. | May 2000 | A |
| 6059827 | Fenton, Jr. | May 2000 | A |
| 6059831 | Braslow et al. | May 2000 | A |
| 6063095 | Wang et al. | May 2000 | A |
| 6066151 | Miyawaki et al. | May 2000 | A |
| 6066160 | Colvin et al. | May 2000 | A |
| 6066166 | Bischoff et al. | May 2000 | A |
| 6066175 | Henderson et al. | May 2000 | A |
| 6068637 | Popov et al. | May 2000 | A |
| 6068648 | Cole et al. | May 2000 | A |
| 6074409 | Goldfarb | Jun 2000 | A |
| 6077277 | Mollenauer et al. | Jun 2000 | A |
| 6077292 | Bonutti | Jun 2000 | A |
| 6080161 | Eaves, III et al. | Jun 2000 | A |
| 6083244 | Lubbers et al. | Jul 2000 | A |
| 6083522 | Chu et al. | Jul 2000 | A |
| 6086593 | Bonutti | Jul 2000 | A |
| 6086608 | Ek et al. | Jul 2000 | A |
| 6099531 | Bonutti | Aug 2000 | A |
| 6099537 | Sugai et al. | Aug 2000 | A |
| 6099547 | Gellman et al. | Aug 2000 | A |
| 6099550 | Yoon | Aug 2000 | A |
| 6099552 | Adams | Aug 2000 | A |
| 6102850 | Wang et al. | Aug 2000 | A |
| 6102928 | Bonutti | Aug 2000 | A |
| 6102950 | Vaccaro | Aug 2000 | A |
| 6102955 | Mendes et al. | Aug 2000 | A |
| 6106529 | Techiera | Aug 2000 | A |
| 6106545 | Egan | Aug 2000 | A |
| 6110188 | Narciso, Jr. | Aug 2000 | A |
| 6110207 | Eichhorn et al. | Aug 2000 | A |
| 6117160 | Bonutti | Sep 2000 | A |
| 6120536 | Ding et al. | Sep 2000 | A |
| 6123710 | Pinczewski et al. | Sep 2000 | A |
| 6125574 | Ganaja et al. | Oct 2000 | A |
| 6126677 | Ganaja et al. | Oct 2000 | A |
| 6132468 | Mansmann | Oct 2000 | A |
| 6132472 | Bonutti | Oct 2000 | A |
| 6139320 | Hahn | Oct 2000 | A |
| RE36974 | Bonutti | Nov 2000 | E |
| 6146385 | Torrie et al. | Nov 2000 | A |
| 6149669 | Li | Nov 2000 | A |
| 6152949 | Bonutti | Nov 2000 | A |
| 6155756 | Mericle et al. | Dec 2000 | A |
| 6156070 | Incavo et al. | Dec 2000 | A |
| 6159224 | Yoon | Dec 2000 | A |
| 6159234 | Bonutti et al. | Dec 2000 | A |
| 6171236 | Bonutti | Jan 2001 | B1 |
| 6171299 | Bonutti | Jan 2001 | B1 |
| 6171307 | Orlich | Jan 2001 | B1 |
| 6171340 | McDowell | Jan 2001 | B1 |
| 6174313 | Bonutti | Jan 2001 | B1 |
| 6174314 | Waddell | Jan 2001 | B1 |
| 6174324 | Egan et al. | Jan 2001 | B1 |
| 6179840 | Bowman | Jan 2001 | B1 |
| 6179850 | Goradia | Jan 2001 | B1 |
| 6187008 | Hamman | Feb 2001 | B1 |
| 6187023 | Bonutti | Feb 2001 | B1 |
| 6190400 | Van De Moer et al. | Feb 2001 | B1 |
| 6190401 | Green et al. | Feb 2001 | B1 |
| 6193754 | Seedhom | Feb 2001 | B1 |
| 6200322 | Branch et al. | Mar 2001 | B1 |
| 6200329 | Fung et al. | Mar 2001 | B1 |
| 6203565 | Bonutti et al. | Mar 2001 | B1 |
| 6214051 | Badorf et al. | Apr 2001 | B1 |
| 6217591 | Egan et al. | Apr 2001 | B1 |
| 6217617 | Bonutti | Apr 2001 | B1 |
| 6224593 | Ryan et al. | May 2001 | B1 |
| 6224630 | Bao et al. | May 2001 | B1 |
| 6228086 | Wahl et al. | May 2001 | B1 |
| 6231592 | Bonutti et al. | May 2001 | B1 |
| 6235057 | Roger et al. | May 2001 | B1 |
| 6238395 | Bonutti | May 2001 | B1 |
| 6241749 | Rayhanabad | Jun 2001 | B1 |
| 6241771 | Gresser et al. | Jun 2001 | B1 |
| 6258091 | Sevrain et al. | Jul 2001 | B1 |
| 6264675 | Brotz | Jul 2001 | B1 |
| 6267761 | Ryan | Jul 2001 | B1 |
| 6273717 | Hahn et al. | Aug 2001 | B1 |
| 6277136 | Bonutti | Aug 2001 | B1 |
| 6280474 | Cassidy et al. | Aug 2001 | B1 |
| 6286746 | Egan et al. | Sep 2001 | B1 |
| 6287325 | Bonutti | Sep 2001 | B1 |
| 6293961 | Schwartz et al. | Sep 2001 | B2 |
| 6296646 | Williamson | Oct 2001 | B1 |
| 6306159 | Schwartz et al. | Oct 2001 | B1 |
| 6309405 | Bonutti | Oct 2001 | B1 |
| 6312448 | Bonutti | Nov 2001 | B1 |
| 6319252 | McDevitt et al. | Nov 2001 | B1 |
| 6319271 | Schwartz et al. | Nov 2001 | B1 |
| 6338730 | Bonutti | Jan 2002 | B1 |
| 6340365 | Dittrich et al. | Jan 2002 | B2 |
| 6342075 | MacArthur | Jan 2002 | B1 |
| 6348056 | Bates et al. | Feb 2002 | B1 |
| 6358266 | Bonutti | Mar 2002 | B1 |
| 6358271 | Egan et al. | Mar 2002 | B1 |
| 6361565 | Bonutti | Mar 2002 | B1 |
| 6364897 | Bonutti | Apr 2002 | B1 |
| 6368325 | McKinley et al. | Apr 2002 | B1 |
| 6368326 | Dakin et al. | Apr 2002 | B1 |
| 6368343 | Bonutti | Apr 2002 | B1 |
| 6371957 | Amrein et al. | Apr 2002 | B1 |
| 6409742 | Fulton, III | Jun 2002 | B1 |
| 6409743 | Fenton, Jr. | Jun 2002 | B1 |
| 6419704 | Ferree | Jul 2002 | B1 |
| 6423063 | Bonutti | Jul 2002 | B1 |
| 6423088 | Fenton, Jr. | Jul 2002 | B1 |
| 6425919 | Lambrecht | Jul 2002 | B1 |
| 6428562 | Bonutti | Aug 2002 | B2 |
| 6432115 | Mollenauer et al. | Aug 2002 | B1 |
| 6447516 | Bonutti | Sep 2002 | B1 |
| 6450985 | Schoelling et al. | Sep 2002 | B1 |
| 6451042 | Bonutti | Sep 2002 | B1 |
| 6461360 | Adam | Oct 2002 | B1 |
| 6464713 | Bonutti | Oct 2002 | B2 |
| 6468289 | Bonutti | Oct 2002 | B1 |
| 6468293 | Bonutti | Oct 2002 | B2 |
| 6471715 | Weiss | Oct 2002 | B1 |
| 6471724 | Zdeblick et al. | Oct 2002 | B2 |
| 6475230 | Bonutti | Nov 2002 | B1 |
| 6482209 | Engh et al. | Nov 2002 | B1 |
| 6488196 | Fenton | Dec 2002 | B1 |
| 6500179 | Masini | Dec 2002 | B1 |
| 6500195 | Bonutti | Dec 2002 | B2 |
| 6503259 | Huxel et al. | Jan 2003 | B2 |
| 6503267 | Bonutti et al. | Jan 2003 | B2 |
| 6503277 | Bonutti | Jan 2003 | B2 |
| 6527774 | Lieberman | Mar 2003 | B2 |
| 6530933 | Yeung et al. | Mar 2003 | B1 |
| 6535764 | Imran et al. | Mar 2003 | B2 |
| 6540786 | Chibrac et al. | Apr 2003 | B2 |
| 6543455 | Bonutti | Apr 2003 | B2 |
| 6544267 | Cole et al. | Apr 2003 | B1 |
| 6545390 | Hahn et al. | Apr 2003 | B1 |
| 6547792 | Tsuji et al. | Apr 2003 | B1 |
| 6551304 | Whalen et al. | Apr 2003 | B1 |
| 6554852 | Oberlander | Apr 2003 | B1 |
| 6557426 | Reinemann et al. | May 2003 | B2 |
| 6558390 | Cragg | May 2003 | B2 |
| 6562043 | Chan | May 2003 | B1 |
| 6568313 | Fukui et al. | May 2003 | B2 |
| 6569167 | Bobechko et al. | May 2003 | B1 |
| 6569187 | Bonutti et al. | May 2003 | B1 |
| 6572635 | Bonutti | Jun 2003 | B1 |
| 6575980 | Robie et al. | Jun 2003 | B1 |
| 6575982 | Bonutti | Jun 2003 | B1 |
| D477776 | Pontaoe | Jul 2003 | S |
| 6585750 | Bonutti | Jul 2003 | B2 |
| 6585764 | Wright et al. | Jul 2003 | B2 |
| 6589248 | Hughes | Jul 2003 | B1 |
| 6589281 | Hyde, Jr. | Jul 2003 | B2 |
| 6592531 | Bonutti | Jul 2003 | B2 |
| 6592609 | Bonutti | Jul 2003 | B1 |
| 6594517 | Nevo | Jul 2003 | B1 |
| 6605090 | Trieu | Aug 2003 | B1 |
| 6607534 | Bonutti | Aug 2003 | B2 |
| 6610080 | Morgan | Aug 2003 | B2 |
| 6616696 | Merchant | Sep 2003 | B1 |
| 6618910 | Pontaoe | Sep 2003 | B1 |
| 6620181 | Bonutti | Sep 2003 | B1 |
| 6623486 | Weaver | Sep 2003 | B1 |
| 6623487 | Goshert | Sep 2003 | B1 |
| 6626944 | Taylor | Sep 2003 | B1 |
| 6630000 | Bonutti | Oct 2003 | B1 |
| 6632245 | Kim | Oct 2003 | B2 |
| 6635073 | Bonutti | Oct 2003 | B2 |
| 6638279 | Bonutti | Oct 2003 | B2 |
| 6638309 | Bonutti | Oct 2003 | B2 |
| 6641592 | Sauer et al. | Nov 2003 | B1 |
| 6645227 | Fallin et al. | Nov 2003 | B2 |
| 6652532 | Bonutti | Nov 2003 | B2 |
| 6652587 | Felt et al. | Nov 2003 | B2 |
| 6666877 | Morgan et al. | Dec 2003 | B2 |
| 6669705 | Westhaver et al. | Dec 2003 | B2 |
| 6679888 | Green et al. | Jan 2004 | B2 |
| 6685750 | Plos et al. | Feb 2004 | B1 |
| 6699240 | Francischelli | Mar 2004 | B2 |
| 6702821 | Bonutti | Mar 2004 | B2 |
| 6702856 | Bonutti | Mar 2004 | B2 |
| 6705179 | Mohtasham | Mar 2004 | B1 |
| 6709457 | Otte | Mar 2004 | B1 |
| 6719765 | Bonutti | Apr 2004 | B2 |
| 6719797 | Ferree | Apr 2004 | B1 |
| 6719803 | Bonutti | Apr 2004 | B2 |
| 6722552 | Fenton | Apr 2004 | B2 |
| 6723102 | Johnson et al. | Apr 2004 | B2 |
| 6733506 | McDevitt et al. | May 2004 | B1 |
| 6733531 | Trieu | May 2004 | B1 |
| 6736853 | Bonutti | May 2004 | B2 |
| 6755865 | Tarabishy | Jun 2004 | B2 |
| 6764514 | Li et al. | Jul 2004 | B1 |
| 6770078 | Bonutti | Aug 2004 | B2 |
| 6776938 | Bonutti | Aug 2004 | B2 |
| 6780198 | Gregoire et al. | Aug 2004 | B1 |
| 6786989 | Torriani et al. | Sep 2004 | B2 |
| 6796003 | Marvel | Sep 2004 | B1 |
| 6818010 | Eichhorn et al. | Nov 2004 | B2 |
| 6823871 | Schmieding | Nov 2004 | B2 |
| 6827723 | Carson | Dec 2004 | B2 |
| 6835198 | Bonutti | Dec 2004 | B2 |
| 6860885 | Bonutti | Mar 2005 | B2 |
| 6860904 | Bonutti | Mar 2005 | B2 |
| 6878167 | Ferree | Apr 2005 | B2 |
| 6890334 | Brace et al. | May 2005 | B2 |
| 6893434 | Fenton et al. | May 2005 | B2 |
| 6899722 | Bonutti | May 2005 | B2 |
| 6905517 | Bonutti | Jun 2005 | B2 |
| 6908466 | Bonutti et al. | Jun 2005 | B1 |
| 6913666 | Aeschlimann et al. | Jul 2005 | B1 |
| 6921264 | Mayer et al. | Jul 2005 | B2 |
| 6923824 | Morgan et al. | Aug 2005 | B2 |
| 6932835 | Bonutti | Aug 2005 | B2 |
| 6942684 | Bonutti | Sep 2005 | B2 |
| 6944111 | Nakamura et al. | Sep 2005 | B2 |
| 6955540 | Mayer et al. | Oct 2005 | B2 |
| 6955683 | Bonutti | Oct 2005 | B2 |
| 6958077 | Suddaby | Oct 2005 | B2 |
| 6981983 | Rosenblatt et al. | Jan 2006 | B1 |
| 6989029 | Bonutti | Jan 2006 | B2 |
| 6990982 | Bonutti | Jan 2006 | B1 |
| 6997940 | Bonutti | Feb 2006 | B2 |
| 7001385 | Bonutti | Feb 2006 | B2 |
| 7001411 | Dean | Feb 2006 | B1 |
| 7004959 | Bonutti | Feb 2006 | B2 |
| 7008226 | Mayer et al. | Mar 2006 | B2 |
| 7018380 | Cole | Mar 2006 | B2 |
| 7033379 | Peterson | Apr 2006 | B2 |
| 7048741 | Swanson | May 2006 | B2 |
| 7048755 | Bonutti | May 2006 | B2 |
| 7066960 | Dickman | Jun 2006 | B1 |
| 7070557 | Bonutti | Jul 2006 | B2 |
| 7087073 | Bonutti | Aug 2006 | B2 |
| 7090111 | Egan et al. | Aug 2006 | B2 |
| 7094251 | Bonutti | Aug 2006 | B2 |
| 7104996 | Bonutti | Sep 2006 | B2 |
| 7114500 | Bonutti | Oct 2006 | B2 |
| 7128753 | Bonutti et al. | Oct 2006 | B1 |
| 7128763 | Blatt | Oct 2006 | B1 |
| 7134437 | Bonutti | Nov 2006 | B2 |
| 7147652 | Bonutti et al. | Dec 2006 | B2 |
| 7153312 | Torrie et al. | Dec 2006 | B1 |
| 7160405 | Aeschlimann et al. | Jan 2007 | B2 |
| 7179259 | Gibbs | Feb 2007 | B1 |
| 7192448 | Ferree | Mar 2007 | B2 |
| 7208013 | Bonutti | Apr 2007 | B1 |
| 7217273 | Bonutti | May 2007 | B2 |
| 7217279 | Reese | May 2007 | B2 |
| 7217290 | Bonutti | May 2007 | B2 |
| 7241297 | Shaolian et al. | Jul 2007 | B2 |
| 7250051 | Francischelli | Jul 2007 | B2 |
| 7252685 | Bindseil et al. | Aug 2007 | B2 |
| 7273497 | Ferree | Sep 2007 | B2 |
| 7311719 | Bonutti | Dec 2007 | B2 |
| 7329263 | Bonutti | Feb 2008 | B2 |
| 7335205 | Aeschlimann | Feb 2008 | B2 |
| 7371240 | Pinczewski et al. | May 2008 | B2 |
| 7429266 | Bonutti | Sep 2008 | B2 |
| 7445634 | Trieu | Nov 2008 | B2 |
| 7462200 | Bonutti | Dec 2008 | B2 |
| 7481825 | Bonutti | Jan 2009 | B2 |
| 7481831 | Bonutti | Jan 2009 | B2 |
| 7510895 | Raterman | Mar 2009 | B2 |
| 7610557 | McLennan et al. | Oct 2009 | B2 |
| 7615054 | Bonutti | Nov 2009 | B1 |
| 7635390 | Bonutti | Dec 2009 | B1 |
| 7708740 | Bonutti | May 2010 | B1 |
| 7708741 | Bonutti | May 2010 | B1 |
| 7727283 | Bonutti | Jun 2010 | B2 |
| 7749229 | Bonutti | Jul 2010 | B1 |
| 7780670 | Bonutti | Aug 2010 | B2 |
| 7806896 | Bonutti | Oct 2010 | B1 |
| 7806897 | Bonutti | Oct 2010 | B1 |
| 7828852 | Bonutti | Nov 2010 | B2 |
| 7837736 | Bonutti | Nov 2010 | B2 |
| 7854750 | Bonutti | Dec 2010 | B2 |
| 7879072 | Bonutti | Feb 2011 | B2 |
| 7891691 | Bearey | Feb 2011 | B2 |
| 7892236 | Bonutti | Feb 2011 | B1 |
| 7892261 | Bonutti | Feb 2011 | B2 |
| 7896880 | Bonutti | Mar 2011 | B2 |
| 7931690 | Bonutti | Apr 2011 | B1 |
| 7959635 | Bonutti | Jun 2011 | B1 |
| 7967820 | Bonutti | Jun 2011 | B2 |
| 8092462 | Pinczewski et al. | Jan 2012 | B2 |
| 8128669 | Bonutti | Mar 2012 | B2 |
| 8133229 | Bonutti | Mar 2012 | B1 |
| 8140982 | Hamilton, II et al. | Mar 2012 | B2 |
| 8147514 | Bonutti | Apr 2012 | B2 |
| 8162977 | Bonutti et al. | Apr 2012 | B2 |
| 8425522 | Bonutti | Apr 2013 | B2 |
| 8486066 | Bonutti | Jul 2013 | B2 |
| 20010002440 | Bonutti | May 2001 | A1 |
| 20010009250 | Herman et al. | Jul 2001 | A1 |
| 20010023371 | Bonutti | Sep 2001 | A1 |
| 20010041916 | Bonutti | Nov 2001 | A1 |
| 20020016593 | Hearn et al. | Feb 2002 | A1 |
| 20020016633 | Lin et al. | Feb 2002 | A1 |
| 20020019649 | Sikora | Feb 2002 | A1 |
| 20020026244 | Trieu | Feb 2002 | A1 |
| 20020029055 | Bonutti | Mar 2002 | A1 |
| 20020029083 | Zucherman et al. | Mar 2002 | A1 |
| 20020029084 | Paul et al. | Mar 2002 | A1 |
| 20020040246 | Bonutti | Apr 2002 | A1 |
| 20020045902 | Bonutti | Apr 2002 | A1 |
| 20020062153 | Paul et al. | May 2002 | A1 |
| 20020095160 | Bonutti | Jul 2002 | A1 |
| 20020103495 | Cole | Aug 2002 | A1 |
| 20020123750 | Eisermann et al. | Sep 2002 | A1 |
| 20020138150 | Leclercq | Sep 2002 | A1 |
| 20020183762 | Anderson et al. | Dec 2002 | A1 |
| 20020188301 | Dallara et al. | Dec 2002 | A1 |
| 20030009147 | Bonutti | Jan 2003 | A1 |
| 20030023260 | Bonutti | Jan 2003 | A1 |
| 20030032975 | Bonutti | Feb 2003 | A1 |
| 20030039196 | Nakamura et al. | Feb 2003 | A1 |
| 20030040758 | Wang et al. | Feb 2003 | A1 |
| 20030065361 | Dreyfuss | Apr 2003 | A1 |
| 20030105474 | Bonutti | Jun 2003 | A1 |
| 20030118518 | Hahn et al. | Jun 2003 | A1 |
| 20030158582 | Bonutti et al. | Aug 2003 | A1 |
| 20030167072 | Oberlander | Sep 2003 | A1 |
| 20030181800 | Bonutti | Sep 2003 | A1 |
| 20030195530 | Thill | Oct 2003 | A1 |
| 20030195565 | Bonutti | Oct 2003 | A1 |
| 20030204204 | Bonutti | Oct 2003 | A1 |
| 20030216742 | Wetzler et al. | Nov 2003 | A1 |
| 20030225438 | Bonutti et al. | Dec 2003 | A1 |
| 20030229361 | Jackson | Dec 2003 | A1 |
| 20040010287 | Bonutti | Jan 2004 | A1 |
| 20040030341 | Aeschlimann et al. | Feb 2004 | A1 |
| 20040034357 | Beane et al. | Feb 2004 | A1 |
| 20040097794 | Bonutti | May 2004 | A1 |
| 20040097939 | Bonutti | May 2004 | A1 |
| 20040098016 | Bonutti | May 2004 | A1 |
| 20040098050 | Foerster et al. | May 2004 | A1 |
| 20040127930 | Bonutti | Jul 2004 | A1 |
| 20040138689 | Bonutti | Jul 2004 | A1 |
| 20040138690 | Bonutti | Jul 2004 | A1 |
| 20040138703 | Alleyne | Jul 2004 | A1 |
| 20040143285 | Bonutti | Jul 2004 | A1 |
| 20040143334 | Ferree | Jul 2004 | A1 |
| 20040167548 | Bonutti | Aug 2004 | A1 |
| 20040172033 | Bonutti | Sep 2004 | A1 |
| 20040193181 | Bonutti | Sep 2004 | A1 |
| 20040220616 | Bonutti | Nov 2004 | A1 |
| 20040225325 | Bonutti | Nov 2004 | A1 |
| 20040230223 | Bonutti | Nov 2004 | A1 |
| 20040236374 | Bonutti et al. | Nov 2004 | A1 |
| 20040254582 | Bonutti | Dec 2004 | A1 |
| 20050033366 | Cole | Feb 2005 | A1 |
| 20050038514 | Helm et al. | Feb 2005 | A1 |
| 20050043796 | Grant et al. | Feb 2005 | A1 |
| 20050071012 | Serhan et al. | Mar 2005 | A1 |
| 20050090827 | Gedebou | Apr 2005 | A1 |
| 20050096699 | Wixey et al. | May 2005 | A1 |
| 20050113928 | Cragg et al. | May 2005 | A1 |
| 20050126680 | Aeschlimann et al. | Jun 2005 | A1 |
| 20050143826 | Zucherman et al. | Jun 2005 | A1 |
| 20050149024 | Ferrante et al. | Jul 2005 | A1 |
| 20050149029 | Bonutti | Jul 2005 | A1 |
| 20050203521 | Bonutti | Sep 2005 | A1 |
| 20050216059 | Bonutti | Sep 2005 | A1 |
| 20050216087 | Zucherman et al. | Sep 2005 | A1 |
| 20050222620 | Bonutti | Oct 2005 | A1 |
| 20050240190 | Gall et al. | Oct 2005 | A1 |
| 20050240227 | Bonutti | Oct 2005 | A1 |
| 20050246021 | Ringeisen et al. | Nov 2005 | A1 |
| 20050261684 | Shaolian et al. | Nov 2005 | A1 |
| 20050267481 | Carl et al. | Dec 2005 | A1 |
| 20050267534 | Bonutti | Dec 2005 | A1 |
| 20060009855 | Goble et al. | Jan 2006 | A1 |
| 20060015101 | Warburton et al. | Jan 2006 | A1 |
| 20060015108 | Bonutti | Jan 2006 | A1 |
| 20060024357 | Carpenter et al. | Feb 2006 | A1 |
| 20060026244 | Watson | Feb 2006 | A1 |
| 20060064095 | Senn et al. | Mar 2006 | A1 |
| 20060089646 | Bonutti | Apr 2006 | A1 |
| 20060122600 | Cole | Jun 2006 | A1 |
| 20060122704 | Vresilovic et al. | Jun 2006 | A1 |
| 20060142799 | Bonutti | Jun 2006 | A1 |
| 20060167495 | Bonutti | Jul 2006 | A1 |
| 20060200199 | Bonutti | Sep 2006 | A1 |
| 20060212073 | Bonutti | Sep 2006 | A1 |
| 20060217765 | Bonutti | Sep 2006 | A1 |
| 20060229623 | Bonutti | Oct 2006 | A1 |
| 20060235470 | Bonutti | Oct 2006 | A1 |
| 20060241695 | Bonutti | Oct 2006 | A1 |
| 20060265009 | Bonutti | Nov 2006 | A1 |
| 20060265011 | Bonutti | Nov 2006 | A1 |
| 20070032825 | Bonutti et al. | Feb 2007 | A1 |
| 20070088362 | Bonutti et al. | Apr 2007 | A1 |
| 20070102005 | Bonutti | May 2007 | A1 |
| 20070118129 | Fraser | May 2007 | A1 |
| 20070198555 | Friedman et al. | Aug 2007 | A1 |
| 20070208378 | Bonutti et al. | Sep 2007 | A1 |
| 20070265561 | Yeung | Nov 2007 | A1 |
| 20070270833 | Bonutti | Nov 2007 | A1 |
| 20080021474 | Bonutti | Jan 2008 | A1 |
| 20080039845 | Bonutti | Feb 2008 | A1 |
| 20080039873 | Bonutti | Feb 2008 | A1 |
| 20080046090 | Paul et al. | Feb 2008 | A1 |
| 20080047567 | Bonutti | Feb 2008 | A1 |
| 20080051799 | Bonutti | Feb 2008 | A1 |
| 20080058822 | Bonutti | Mar 2008 | A1 |
| 20080065140 | Bonutti | Mar 2008 | A1 |
| 20080097448 | Binder et al. | Apr 2008 | A1 |
| 20080103519 | Bonutti | May 2008 | A1 |
| 20080108897 | Bonutti et al. | May 2008 | A1 |
| 20080108916 | Bonutti | May 2008 | A1 |
| 20080114399 | Bonutti | May 2008 | A1 |
| 20080132950 | Lange | Jun 2008 | A1 |
| 20080140116 | Bonutti | Jun 2008 | A1 |
| 20080140117 | Bonutti | Jun 2008 | A1 |
| 20080195145 | Bonutti | Aug 2008 | A1 |
| 20080269753 | Cannestra | Oct 2008 | A1 |
| 20080269808 | Gall et al. | Oct 2008 | A1 |
| 20090024161 | Bonutti | Jan 2009 | A1 |
| 20090093684 | Schorer | Apr 2009 | A1 |
| 20090138014 | Bonutti | May 2009 | A1 |
| 20090194969 | Bearey | Aug 2009 | A1 |
| 20100211120 | Bonutti | Aug 2010 | A1 |
| 20100312350 | Bonutti | Dec 2010 | A1 |
| 20110060375 | Bonutti | Mar 2011 | A1 |
| 20110295253 | Bonutti et al. | Dec 2011 | A1 |
| 20120010623 | Bonutti | Jan 2012 | A1 |
| 20120165841 | Bonutti | Jun 2012 | A1 |
| 20120191140 | Bonutti | Jul 2012 | A1 |
| 20120215226 | Bonutti | Aug 2012 | A1 |
| 20120215233 | Bonutti et al. | Aug 2012 | A1 |
| 20120221017 | Bonutti | Aug 2012 | A1 |
| 20130144389 | Bonutti | Jun 2013 | A1 |
| 20130197542 | Bonutti | Aug 2013 | A1 |
| 20130197543 | Bonutti | Aug 2013 | A1 |
| 20130204272 | Bonutti | Aug 2013 | A1 |
| 20130226185 | Bonutti | Aug 2013 | A1 |
| 20130226311 | Bonutti | Aug 2013 | A1 |
| Number | Date | Country |
|---|---|---|
| 2641580 | Aug 2007 | CA |
| 2680827 | Sep 2008 | CA |
| 2698057 | Mar 2009 | CA |
| 1903016 | Oct 1964 | DE |
| 1903316 | Oct 1964 | DE |
| 1903016 | Aug 1970 | DE |
| 3517204 | Nov 1986 | DE |
| 3722538 | Jan 1989 | DE |
| 9002844 | Jan 1991 | DE |
| 784454 | May 1996 | EP |
| 773004 | May 1997 | EP |
| 1614525 | Jan 2006 | EP |
| 1988837 | Aug 2007 | EP |
| 2134294 | Dec 2009 | EP |
| 2717368 | Mar 1994 | FR |
| 2696338 | Apr 1994 | FR |
| 2728779 | Jan 1995 | FR |
| 2736257 | Jul 1995 | FR |
| 2750031 | Jun 1996 | FR |
| 2771621 | Nov 1997 | FR |
| 2785171 | Oct 1998 | FR |
| 2093701 | Sep 1982 | GB |
| 2306110 | Apr 1997 | GB |
| 8-140982 | Jun 1996 | JP |
| 8140982 | Jun 1996 | JP |
| 184396 | Jul 1966 | SU |
| 9112779 | Sep 1991 | WO |
| 9323094 | Nov 1993 | WO |
| W09408642 | Apr 1994 | WO |
| 9516398 | Jun 1995 | WO |
| WO 9531941 | Nov 1995 | WO |
| W09614802 | May 1996 | WO |
| W09712779 | Apr 1997 | WO |
| 9749347 | Dec 1997 | WO |
| WO 9749347 | Dec 1997 | WO |
| W09811838 | Mar 1998 | WO |
| W09826720 | Jun 1998 | WO |
| W002053011 | Jul 2002 | WO |
| 2007092869 | Aug 2007 | WO |
| 20071092869 | Aug 2007 | WO |
| 2008116203 | Sep 2008 | WO |
| 2009029908 | Mar 2009 | WO |
| W02010099222 | Feb 2010 | WO |
| Entry |
|---|
| Branson Technolog TL 4, Article entitled “Textured Surface Technology” Branson Ultrasonics Corp., Copyright 1992. |
| Article entitled “Problem Solving Report Question No. 1014984.066”, Ultrasonic Welding, Copyright 1999 NERAC Inc., Dec. 15, 1999. |
| Brochure entitled “Guide to Ultrasonic Plastic Assembly”, Dukane Corporation, Ultrasonic Division, Publication date unknown. |
| Author: Unknown/Oxford University Press, Title: “AskOxford:projection“, Item Title: ”Compact Oxford English Dictionary: projection”, Date: Unknown—Retrieved Mar. 30, 2009, Pages/Volume/Issue: http://www.askoxford.com/concise—oed/projection?view=uk, Publisher: Oxford University Press, City/Country: UK. |
| Author: Unknown/Oxford University Press, Title: “AskOxford:slit”, Item Title: “Compact Oxford English Dictionary: slit”, Date: Unknown—Retrieved Mar. 30, 2009, Pages/Volume/Issue: http://www.askoxford.com/concise—oed/slit?view=uk, Publisher: Oxford University Press, City/Country: UK. |
| Arthrex, Protect your graft, Am J Sports Med, vol. 22, No. 4, Jul.-Aug 1994. |
| Barrett et al, T-Fix endoscopic meniscal repair: technique and approach to different types of tears, Apr-95, Arthroscopy vol. 11 No. 2 p. 245-51. |
| Cope, Suture Anchor for Visceral Drainage, AJR, vol. 148 p. 160-162, Jan. 1986. |
| Gabriel, Arthroscopic Fixation Devices, Wiley Enc. Of Biomed Eng., 2006. |
| Innovasive, We've got you covered, Am J Sports Med, vol. 26, No. 1, Jan-Feb. 1998. |
| 510k—TranSet Fracture Fixation System, 2004-02-24, k033717. |
| 510k—Linvatec Biomaterials modification of Duet and impact Suture Anchor, 2004-11-19, k042966. |
| 510k, arthrex pushlock, 2005-06-29, K051219. |
| 510k, mitek micro anchor, 1996-11-06, K962511. |
| 510k, Multitak Suture System, 1997-01-10, K964324. |
| 510k, Modified Mitek 3.5mm Absorbable Suture Anchor System, 1997-06-09, K970896. |
| 510K, Summary for Arthrex Inc.'s Bio-Interference Screw, 1997-07-09, K971358. |
| 510k, Surgicraft Bone Tie, 1998-09-25, K982719. |
| Karlsson et al, Repair of Bankart lesions with a suture anchor in recurrent dislocation of the shoulder, Scand. j. of Med & Science in Sports, 1995, 5:170-174. |
| Madjar et al, Minimally Invasive Pervaginam Procedures, for the Treatment of Female Stress Incontinence . . . , Artificial Organs, 22 (10) 879-885, 1998. |
| Nowak et al, Comparative Study of Fixation Techniques in the Open Bankart Operation Using Either a Cannulated Screw or Suture-Anchors, Acta Orthopcedica Belgica, vol. 64—2—1998. |
| Packer et al, Repair of Acute Scapho-Lunate Dissociation Facilitated by the “Tag. ” Suture Anchor, Journal of Hand Surgery (British and European Volume, 1994) 19B: 5: 563-564. |
| Richmond, Modificatio of the Bankart reconstruction with a suture anchor, Am J Sports Med, vol. 19, No. 4, p. 343-346, 1991. |
| Shea et al, Technical Note: Arthroscopic Rotator Cuff Repair Using a Transhumeral Approach to Fixation, Arthroscopy: The Journal of Arthroscopic and Related Surgery, vol. 14, No. 1 (Jan.-Feb.), 1998: pp. 118-122. |
| Tfix, Acufex just tied the knot . . . , Am. J. Sports Med., vol. 22, No. 3, May-Jun 1994. |
| Wong et al, Case Report: Proper Insertion Angle Is Essential to Prevent Intra-Articular Protrusion of a Knotless Suture Anchor in Shoulder Rotator Cuff Repair, Arthroscopy: The Journal of Arthroscopic and Related Surgery, vol. 26, No. 2 (Feb.), 2010: pp. 286-290. |
| Cobb et al, Late Correction of Malunited Intercondylar Humeral Fractures Intra-Articular Osteotomy and Tricortical Bone Grafting, J BoneJointSurg [Br] 1994; 76-B:622-6. |
| Fellinger, et al, Radial avulsion of the triangular fibrocartilage complex in acute wrist trauma: a new technique for arthroscopic repair, Jun-97, Arthroscopy vol. 13 No. 3 p. 370-374. |
| Hecker et al , Pull-out strength of suture anchors for rotator cuff and Bankart lesion repairs, Nov-Dec ,1993, The American Journal of Sports Medicine, vol. 21 No. 6 p. 874-879. |
| Hernigou et al , Proximal Tibial Osteotomy for Osteoarthritis with Varus Deformity a Ten to Thirteen-Year Follow-Up Study, J Bone Joint Surg, vol. 69-A, No. 3. Mar. 1987, p. 332-354. |
| Ibarra et al, Glenoid Replacement in Total Shoulder Arthroplasty, The Orthopedic Clinics of Northamerica: Total Shoulder Arthroplasty, vol. 29 No. 3, Jul. 1998 p. 403-413. |
| Mosca et al, Calcaneal Lengthening for Valgus Deformity of the Hindfoot: Results in Children Who Had Severe, Symptomatic flatfoot and Skewfoot, J Bone Joint Surg 1195- p. 499-512, 1995. |
| Murphycet al, Radial Opening Wedge Osteotomy in Madelung's Deformity, J. Hand Surg, vol. 21 A No.6 Nov. 1996, p. 1035-44. |
| Biomet, Stanmore Modular Hip, J. Bone Joint Surg., vol. 76-B : No. Two, Mar. 1994. |
| Intl Prelim Rep on Patentability and Written Opinion for PCT/US10/25263 dated 2011-08-30. |
| European Search Report dated Sep. 10, 2012 for EP08732724.3 (046). |
| Copending U.S. Appl. No. 11/932,907—RCE Response Sep. 15, 2011. |
| Copending U.S. Appl. 11/258,795 Non-Final Office Action mailed Apr. 26, 2011. |
| Copending U.S. Appl. No. 11/689,670, RCE Response Sep. 19, 2011. |
| European Search Report dated Sep. 10, 2012 for EP08732724.3. |
| Copending U.S. Appl. No. 10/614,352, Final Office Action Jul. 12, 2010. |
| Copending U.S. Appl. No. 11/932,602 Final Response to Office Action Jun. 6, 2011. |
| Copending U.S. Appl. No. 11/671,556 Response filed Aug. 23, 2010. |
| Co-pending U.S. Appl. No. 11438537, Supplemental Final Rejection mailed Sep. 25, 2009. |
| IPR—International Publication WO/2008/116203, published Sep. 22, 2009, for PCT/US08/57948. |
| ISR—International Search Report WO/2008/116203, published Dec. 24, 2008 for PCT/US08/57948. |
| IPER—Internation Preliminary Report on Patentability, WO/2008/116203, published Sep. 22, 2009 for PCT/US08/57948. |
| Written Opinion WO/2008/116203 dated Oct. 23, 2008, for PCT/US08/57948. |
| IPR—International Publication W02009/029908, published May 3, 2009 for PCT/US08/74941. |
| ISR—International Search Report, W02009/029908, published May 3, 2009 for PCT/US08/74941. |
| IPER—Internation Preliminary Report on Patentability, W02009/029908, published Mar. 2, 2010 for PCT1US08/74941. |
| Written Opinion W02009/029908 dated Feb. 28, 2010 for PCT/US08/74941. |
| International Search Report PCT/US2010/025263 completed Apr. 13, 2010. |
| Written Opinion for PCT/US2010/025263 completed Apr. 13, 2010. |
| The Search for the Holy Grail: A Centrury of Anterior Cruciate Ligament Reconstruction, R. John Naranja, American Journal of Orthopedics, Nov. 1997. |
| Femoral Bone Plug Recession in Endoscope Anterior Cruciate Ligament Reconstruction, David E. Taylor, Arthroscopy: The Journal of Arthroscopic and Related Surgery, Aug. 1996. |
| Meniscus Replacement with Bone Anchors: A Surgical Technique, Arthroscopy: The Journal of Arthroscopic and Related Surgery, 1994. |
| Problem Solving Report Question No. 1014984.066, Ultrasonic Welding, (c) 1999. |
| Guide to Ultrasound Plastic Assembly, Ultrasonic Division Publication, (c) 1995. |
| Branson, Polymers: Characteristics and Compatibility for Ultrasonic Assembly, Applied Technologies Group, Publication unknown date unknown. |
| Enabling Local Drug Delivery-Implant Device Combination Therapies, Surmodics, Inc., (c) 2003. |
| Stent Based Delivery of Sirolimus Reduces Neointimal Formation in a Porcine Coronary Model, Takeshi Suzuki, American Heart Association, Inc. (c) 2001. |
| Why Tie a Knot When You Can Use Y-Knot?, Innovasive Devices Inc., (c) 1998. |
| Ask Oxford, compact Oxford English dictionary: projection, Mar. 30, 2009. |
| Ask Oxford, compact Oxford English dictionary: slit, Mar. 30, 2009. |
| Textured Surface Technology, Branson Technolog, Branson Ultrasonics Copr., (c) 1992. |
| IPR—International Publication W0/2007/092869, published Aug. 16, 2007 for PCT1US20071061730. |
| ISR—International Search Report W0/2007/092869, published Dec. 13, 2007 for PCT/US2007/061730. |
| Intl Prelim Report on Patentability, WO/2007/092869, published Aug. 12, 2008 for PCT/US2007/061730. |
| Written Opinion WO/2007/092869 dated Aug. 7, 2008 for PCT/US2007/061730. |
| Petition for Inter Partes Review of U.S. Patent No. 5,980,559, IPR 2013-00603, Filing Date Sep. 24, 2013. |
| Declaration of David Kaplan, PH.D. Regarding U.S. Patent No. 5,980,559, IPR 2013-00603, Sep. 24, 2013. |
| Petition for Inter Partes Reviews Of U.S. Patent No. 7,087,073, IPR 2013-00604, filing Date Sep. 24, 2013. |
| Declaration of Wayne J. Sebastianelli, MD Regarding U.S. Patent No. 7,087,073, Sep. 24, 2013, IPR 2013-00604. |
| Petition for Inter Partes Review of U.S. Patent No. 6,500,195, IPR 2013-00624, Filing Date Oct. 2, 2013. |
| Declaration of Dr. Philip Hardy in Support of Petition for Inter Partes Review of U.S. Patent No. 6,500,195, IPR 2013-00624, Sep. 25, 2013. |
| Petition for Inter Partes Review of U.S. Patent No. 5,527,343, IPR 2013-00628, Filing Date Sep. 26, 2013, Sept 25, 2013. |
| Declaration of Dr. Philip Hardy in Support of Petition for Inter Partes Review of U.S. Patent No. 5,527,343, IPR 2013-00628, Sep. 25, 2013. |
| Corrected Petition for Inter Partes Review of U.S. Patent No. 5,921,986, IPR 2013-00631, Filing Date Sep. 27, 2013. |
| Expert Declaration of Steve E. Jordan, MD, for Inter Partes Review of U.S.Patent No. 5,921,986, IPR 2013-00631, Sep. 24, 2013. |
| Corrected Petition for Inter Partes Review of U.S. Patent No. 8,147,514, IPR 2013-00632, Filing Date Sep. 27, 2013. |
| Declaration of Steve Jordan for USP 8,147,514, from IPR 2013-00632, dated Sep. 23, 2013 (exhibit 1009). |
| Corrected Petition for Inter Partes Review of U.S. Appl. No. 8,147,514, IPR 2013-00633, Filing Date Sep. 27, 2013. |
| Declaration of Steve Jordan for USP 8,147,514, from IPR 2013-00633, dated Sep. 23, 2013 (exhibit 1006). |
| Flory, Principles of Polymer Chemistry, 1953, selected pages. |
| Grizzi, Hydrolytic degradation of devices based on poly(Dl-lactic acid) size-dependence, Biomaterials, 1995, vol. 16, No. 4, p. 305-11. |
| Gopferich, Mechanisms of polymer degradation and erosion, Biomaterials, 1996, vol. 17, No. 2, p. 103-114. |
| Gao et el, Swelling of Hydroxypropyl Methylcellulose Matrix Tablets . . . , J. of Pharmaceutical Sciences, vol. 85, No. 7, Jul. 1996, p. 732-740. |
| Linvatec, Impact Suture Anchor brochure, 2004. |
| Seitz et al, Repair of the Tibiofibular Syndesmosis with a Flexible Implant, J. Of Orthopaedic Trauma, vol. 5, No. 1, p. 78-82, 1991. |
| Translation of FR2696338 with translator's certificate dated Sep. 17, 2013. |
| Translation of DE9002844.9 with translator's certificate dated Sep. 26, 2013. |
| Declaration of Steve Jordan for USP 5921986, from IPR 2013-00632, dated Sep. 24, 2013. |
| Declaration of Steve Jordan for USP 5921986, from IPR 2013-00633, dated Sep. 24, 2013. |
| Declaration of Dr. Steve E. Jordan for USP 8,147,514, from IPR 2013-00631, dated Sep. 23, 2013. |
| Number | Date | Country | |
|---|---|---|---|
| 20060241695 A1 | Oct 2006 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 10076919 | Feb 2002 | US |
| Child | 10458117 | US | |
| Parent | 09524397 | Mar 2000 | US |
| Child | 10076919 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 10458117 | Jun 2003 | US |
| Child | 11456221 | US |
