The present invention relates to a tissue anchor, particularly for use in bone, cartilage and other tissues of a body.
Tissue anchors are widely used in surgery to retain and anchor sutures or other restraining devices. Present designs generally employ asymmetric anchors that are inserted into drilled holes in a bone. In some cases anchors are provided with threads to engage within a threaded hole, or rely on their asymmetric designs for anchorage within the bone or other tissue. Existing designs of tissue anchors are generally bulky, which limits their usefulness in certain bones, e.g. hands and feet.
According to the invention there is provided a tissue anchor comprising a first portion and a second portion, at least one point on the first portion and a resilient device between the first and second portions.
The point on the first portion is sharpened to penetrate the dense tissue when the first and second portions are held in a first configuration relative to one another. Once the point has penetrated the tissue e.g. bone, the resilient device applies a force between the first and second portions in order to move them into a second configuration that is adapted to resist withdrawal from the tissue in the opposite direction of penetration.
Typically, the tissue anchor has a barb pointing in the opposite direction to the main point on the first portion. In preferred embodiments, the first and second portions are mirror image parts with forward facing points and corresponding barbs that extend in a different direction.
In a preferred format, each portion is generally in the form of a hook with a forward pointing end to penetrate the tissue, sloping back to a rearward pointing barb at the trailing end. The or each barb typically extends radially outward further than the points at the leading end.
The resilient device can simply be a resilient wire or piece of sprung plastics material or metal such as sprung steel connecting the two hooks, and in preferred embodiments, the resilient device biases the two portions apart from one another in the absence of any force.
When the device is to be delivered, the two portions are typically forced toward one another against the natural bias of the resilient device before the tissue anchor is delivered into the tissue. In preferred embodiments of the device with the double hook configuration, this forces the tips of the respective hooks on the first and second portions towards one another so that they meet at their leading edge points, and the force applied typically maintains them in this first configuration while the tissue anchor is being delivered. Once the tissue anchor has been delivered to the desired location in the tissue, the force maintaining the device in the first configuration is removed, and in the preferred embodiments, the resilient member then splays apart the points at the leading ends of the first and second portions, and also moves the barbs further apart in order to lodge the tissue anchor securely within the tissue under the force applied by the resilient device.
Optionally, the tissue anchor can be twisted around its axis of insertion, so as to lodge the barbs and points more firmly within the tissue.
In some embodiments, the tissue anchor is forced into the closed configuration for delivery (with the leading edge points of the hooks forced together as described above) by threading a suture through the tissue anchor and threading the suture through a delivery sleeve, and then pulling the suture and the tissue anchor relative to the delivery sleeve so that the sleeve slides along the suture and applies a force to the tissue anchor. This force applied by the delivery sleeve typically moves the first and second portions from their naturally splayed open configuration to their closed configuration with the leading edge points forced together. The pressure applied via the suture and the delivery sleeve typically maintains the tissue anchor in the closed configuration all the way through the delivery process, and one advantage of this is that the tissue anchor can be hammered into place using the delivery sleeve as an anvil.
In some other embodiments the tips of the hooks are pressed together as outlined above by the action of the resilient device, which can be forced into a suitable configuration to achieve this by the confines of the delivery sleeve. For example, some of the resilient devices according to this embodiment can be generally teardrop shaped in the form of a loop with the hooks connected at the narrowed end. In such embodiments, the loop part of the drop is compressed by the confines of the delivery sleeve, so as to push the tips together. This kind of embodiment avoids the need to pull the suture or to apply other external force to it to keep the tips of the hooks together during insertion.
Once the tissue anchor is in the required position, the delivery sleeve can simply be withdrawn from the tissue, leaving the tissue anchor fixed in the correct position, and the suture already trailing out of the required path.
Typically the diameter of the delivery sleeve is less than the diameter of the barbs of the tissue anchor when in the closed configuration. This allows withdrawal of the delivery sleeve without disturbing the tissue anchor, as the rearward facing barbs can bite into solid bone beyond the nominal diameter of the aperture in the tissue made by the delivery sleeve.
If the tissue anchor is to be withdrawn from the tissue, it can be forced into the closed configuration for withdrawal by insertion of a larger diameter recovery sleeve, either over the delivery sleeve or simply over the suture. The diameter of the recovery sleeve is typically wider than the diameter of the splayed barbs in the second configuration, so that during withdrawal of the tissue anchor from the tissue, the rearward facing barbs no longer impede withdrawal of the tissue anchor.
A leading edge of the recovery sleeve can be provided with cutting formations to cut a hole in the tissue and thereby facilitate removal of the sleeve. An internal surface of the recovery sleeve can be provided with an annular groove to accommodate the laterally outermost barbs on the tissue anchor.
According to the first aspect of the invention, there is also provided a method of setting an anchor in tissue, the method comprising the steps of:
The method can include the step of penetrating dense tissue with the point of the first portion.
The method can also include urging the first and second portions into the first configuration against the bias of the resilient device prior to inserting the tissue anchor into the tissue. The method can include maintaining the first and second portions in the first configuration during insertion of the tissue anchor into the tissue.
The method can include introducing the tissue anchor into a delivery sleeve, which forces the tissue anchor into the second configuration. The method can include withdrawing the delivery sleeve from the tissue anchor and permitting the tissue anchor to change from the first configuration to the second configuration.
According to a second aspect of the invention, there is provided a method of recovering a tissue anchor disposed in a tissue, the tissue anchor having a first portion and a second portion spaced apart from one another into a second configuration by means of a resilient device, whereby the tissue anchor is secured within the tissue, the recovery method comprising the steps of urging the first and second portions into a first configuration in which the first and second portions are urged against the bias of the resilient device, engaging the tissue anchor within a recovery sleeve and recovering the tissue anchor by withdrawing the recovery sleeve.
The method can include introducing the tissue anchor into a sleeve having a diameter less than the lateral extent of hooks provided on each of the first and second portions and urging the sleeve against a rear face of each hook to thereby urge the first and second portions against the bias of the resilient device.
The method can include accommodating a suture coupled to the tissue anchor in a throughbore of the sleeve. The method can also include sliding the sleeve along the anchored suture and thereby guiding the sleeve through the tissue to the tissue anchor to facilitate removal or adjustment thereof.
The method can also include accommodating the sleeve and the tissue anchor within the recovery sleeve before withdrawing the recovery sleeve and recovering the tissue anchor.
The method can also include retaining the tissue anchor within the bore of the recovery sleeve by providing an annular groove on an internal surface of the recovery sleeve and engaging the laterally outermost portion of the hooks in the groove.
The method can further include cutting through tissue using a leading end of the recovery sleeve to access the tissue anchor prior to its recovery.
An embodiment of the present invention will now be described by way of example, and with reference to the accompanying drawings, in which:—
a and b are side views of a second embodiment of a tissue anchor showing the anchor in its closed configuration for insertion (a) and in the open configuration (b) after withdrawal of the delivery sleeve;
Referring now to the drawings,
Each arm is formed from a stiff wire or steel strip. In the embodiments shown in the drawings, the two arms are made from a single continuous flexible steel strip or wire, but it would be acceptable to form the arms separately, either from a resilient material or a rigid material, and connect them by a resilient device such as a leaf spring, a hinge or some other device.
Referring now to
Each of the hooks 6 has three sides in the embodiments shown. One side extending between the point 6p and the barb 6b is generally arcuate and adopts a slightly concave configuration. The concave configuration assists in the passage of the hook through the tissue, but a straight side would suffice in this embodiment. Another side of the hook 6 connects the hook to the end of the arm 7. The end of the arm 7 is generally resistant to flex, either as a result of the connection of the hook at that point, or by being made of an inherently stiffer material at the end of the arm. The remaining lower side 61 of the hook extends between the barb 6b and the arm 7. The angle made between this lower side 61 of the hook 6 and the arm 7 is generally less than 90°, so that the barb 6b faces away from the leading end at the point 6p, and towards the trailing end at the apex 7x between the arms 7. An angle of 90° in this instance would also suffice, but the acute angle made by the rearward facing lower side 61 of the hook enables the barbs 6b to anchor more effectively within the tissue after insertion, and facilitates loading of the device to push the tips 6p together by loading the delivery sleeve.
In use, the natural position of the tissue anchor 1 is as shown in
Once the suture 9 has been pulled tight through the delivery tube 10, and the points 6p of the leading end of the tissue anchor 1 are closed together as shown in
At that point, the tension applied to the suture 9 relative to the delivery sleeve 10 can be removed, allowing removal of the delivery sleeve 10, and leaving the tissue anchor 1 firmly lodged in the tissue. When the tension is removed from the suture 9 and the distal end 10d is withdrawn from the hooks 6, the natural resilience of the resilient device on the tissue anchor 1 splays the arms 7a, 7b apart from one another, and moves the hooks 6, and thus the barbs 6b further apart as shown in
If the tissue anchor is to be removed, either at completion of treatment, or because of incorrect placement, the delivery sleeve 10 can be reinserted to close the tissue anchor 1 and permit withdrawal, but in preferred embodiments, removal is facilitated by a separate recovery sleeve 12 as shown in
The
Modifications and improvements can be incorporated without departing from the scope of the invention. For example, in some configurations, the hooks 6 can be planar as shown in
Number | Date | Country | Kind |
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0425296.1 | Nov 2004 | GB | national |
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/GB05/04409 | 11/16/2005 | WO | 00 | 10/11/2007 |