FR2750031A1 - Suture thread bone anchor for torn shoulder tendon or ligament - Google Patents

Abstract

The anchor (2) comprises a groove (7) which is laterally open in which a tapered rigid finger bar (8) is pivotally mounted. The bar comprises a free end (8a) which is pointed. The bar can pivot between a retracted position and an in-use position. In the retracted position, the pointed free end points towards the proximal end (2b) of the anchor and projects slightly from the lateral wall of the anchor body (2c). In the in-use position the bar extends roughly perpendicular to the axis of the anchor.

Description

 The present invention relates to a bone anchoring device for suture and an instrument allowing the positioning of this device.

 The rupture of a tendon or a ligament, in particular at the level of the articulation of the shoulder, involves the anchoring to the bone of a suture thread to allow to join this bone and the tendon or ligament broken.

 A device for this anchoring comprises, from its distal end intended to be engaged in the bone towards its proximal end for mounting on the positioning instrument, a point of substantially conical shape, facilitating its introduction into a hole arranged in the bone, one or more claws or deployable wings, allowing its anchoring in the cancellous bone, a means, such as a transverse hole, for the attachment or the passage of the suture or sutures, and means for its mounting on the instrument allowing its installation.

 An existing anchoring device comprises a claw made of elastic metallic material and a slot arranged opposite this claw. The claw is normally deployed, but can be deformed so as to be engaged in this slot. When mounting the device on the positioning instrument, a wall of the instrument covers the slot and keeps the claw in the latter.

 Another existing anchoring device comprises wings made of non-elastic metallic material, which are deployed, after installation of the device, by a profiled ring engaged in force between them and the body of this device.

 Some existing devices have the disadvantage of requiring the performance of several successive operations for their establishment, namely in particular the drilling of a hole in the bone, and the deployment of claws or anchoring wings after introduction of the device in this hole and removal of the instrument. These different operations are delicate, and can be difficult to perform when the bone site is not very accessible, especially since the suture or sutures are relatively annoying.

 In addition, some existing devices have relatively poor bone holdings, in particular due to the prior drilling of a hole in the bone to receive them and the fact that their implantation depth is not always ideal.

 The present invention aims to remedy all of these drawbacks.

 The device to which it relates comprises, in a manner known per se, a proximal end, intended to be mounted on a positioning instrument, and an opposite distal end; at least one deployable means allowing the anchoring of the device in the cancellous bone; means for hooking or passing the suture (s); and a means for mounting it on the instrument allowing it to be put in place.

 According to the invention, the device comprises a housing, open laterally, in which is pivotally mounted a rigid tapered finger comprising a pointed free end, this finger being able to pivot between a retracted position, in which its free end is turned towards the side of said end. proximal and protrudes slightly beyond the side wall of the device body, and a deployed position, in which this finger extends substantially perpendicular to the axis of the device.

 This finger is placed in the retracted position when the device is put in place. The slight protrusion made by its free end beyond the side wall of the body of the device does not constitute a hindrance to the introduction of the device into the bone.

 When the device is pressed into the bone, the free end of the finger comes to bear against the cancellous bone, and a slight traction exerted on the suture, so as to move the device back, is sufficient to achieve the deployment of that finger.

 The latter has a rigid structure and can have a relatively large length and / or thickness, which allows it to ensure a deep and very solid anchoring of the device.

 Preferably, the walls of the device delimiting the housing longitudinally are shaped to constitute stops limiting the pivoting of the finger in the retracted and deployed positions thereof.

 The device according to the invention is thus particularly simple and easy to produce.

 The end of the instrument on which the device is mounted advantageously has a cross section not greater than that of the body of the device, preferably identical to this one, and the instrument is shaped to allow implantation of the device by impaction. .

 Thus, this end of the instrument does not come beyond the side wall of the body of the device and can be inserted into the bone at the same time as the latter.

The introduction of the device into the bone is therefore immediately carried out to a sufficient depth, which eliminates a subsequent digging operation. Then simply operate the aforementioned traction on the suture to deploy the finger.

 This possibility of sinking the end of the instrument also allows placement by impaction, without prior drilling of a hole, when the bone has a thin cortex, as is the case in the epiphyseal zones. .

 The operation of previously drilling a hole in the bone is therefore eliminated, and the anchoring to the bone of the rigid finger, in an area not previously drilled, is very solid.

 Preferably, the instrument comprises a shoulder situated behind its end receiving the device, this shoulder being positioned in such a way that the device is at an ideal depth of insertion into the bone when the shoulder comes into abutment against cortical.

 This ideal depth of penetration, taking into account the recoil of the device necessary for the deployment of the finger, is thus ensured in all cases, which contributes to perfect solidity of the anchoring obtained.

 Preferably, the instrument according to the invention comprises means making it possible to keep the suture (s) taut, at a slight angle relative to the axis of introduction of the device.

 This or these wires do not interfere with the operation of positioning the anchoring device.

 The tension and the orientation of this or these wires also make it possible to maintain the device on the corresponding end of the instrument.

 According to a preferred embodiment of the invention, in this case, the instrument is in the general form of a screwdriver, that is to say comprises a handle secured to a rod, this rod receiving the device on its free end; the handle is hollow and comprises at least one opening arranged on the side of the rod, putting its internal cavity in communication with the outside; this opening has dimensions such that the suture, as well as the needle or needles possibly connected to the free ends thereof, can be engaged through it.

 The suture and the needle or needles which are connected to it are thus housed in the handle of the instrument and do not in any way interfere with the manipulation of the latter.

 For a good understanding, the invention is again described below with reference to the appended schematic drawing representing, by way of nonlimiting example, a preferred embodiment of the anchoring device and of the instrument which it relates .

Figure 1 is a side view of this device;
Figure 2 is a side view of this device, at an angle of 900 relative to the view according to Figure 1
Figure 3 is a perspective view of the anchoring device while it is mounted on the end of the instrument
Figure 4 is an axial sectional view of this anchoring device and this instrument
FIGS. 5 to 7 are views of the anchoring device and, partially, of the instrument, during three successive steps of placing the anchoring device in a bone, and
FIG. 8 is a view of the anchoring device and of the instrument during a step of fitting the anchoring device following that shown in FIG. 7.

 The figures represent, from different angles, a device 2 allowing the anchoring to a bone 3 of a suture thread 4, the positioning of this device 2 being carried out by means of an instrument 5.

 The device 2 is in particular intended to make it possible to join the bone 3 and a ruptured tendon or ligament (not shown), at the level of any type of joint, and in particular at the level of the shoulder joint.

 The device 2 comprises, from its distal end 2a intended to be engaged in the bone 3 towards its proximal end 2b for mounting on the instrument 5, a tip 6, a housing 7, a finger 8, a transverse hole 9 and a axial hole 10, opening in its end 2b.

 The tip 6 has a substantially conical shape, in order to facilitate the introduction of the device 2 into the bone 3.

 The housing 7 is open laterally. It is delimited longitudinally by walls 15 and laterally by the body 2c of the device 2. A circular stud 16 is located in this housing 7, this stud 16 projecting from the wall of the body 2c laterally delimiting the housing 7.

 The finger 8 is tapered and has a pointed free end 8a. It has a thickness substantially equal to half the diameter of the body 2c, giving it significant rigidity, and a length of the order of two thirds of that of the device 2.

 The finger 8 also includes a bore for its engagement, with the possibility of pivoting, on the stud 16. This pivoting is possible between two extreme positions defined by the coming of the finger 8 in abutment against the walls 15. It is a retracted position, shown in Figures 1,2,5 and 6, in which the pointed free end 8a is turned towards the side of the proximal end 2b and protrudes slightly beyond the side wall of the body 2c, and a deployed position, shown in FIGS. 7 and 8, in which the finger 8 extends substantially perpendicular to the axis of the device 2.

 The transverse hole 9 allows the passage of the suture thread 4, and the axial hole 10 allows the mounting of the device 2 on a lug 17 that includes the corresponding end of the instrument 5.

 FIGS. 3 and 4 show the device 2 while it is engaged, thanks to the hole 10, on the lug 17, and the wire 4 is engaged through the hole 9.

 The instrument 5 is in the form of a screwdriver, that is to say it comprises a handle 20 secured to a rod 21, this rod 21 receiving the device 2 on its free end.

 The handle 20 is hollow, and thus delimits a cavity 22. It comprises, as shown more particularly in FIG. 4, two openings 23 arranged in its end comprising the rod 21. These openings 23 are oriented substantially perpendicular to the longitudinal axis of the instrument 5 and put its cavity 22 in communication with the outside.

 As shown in Figure 4, these openings 23 are such that the two strands of suture 4, as well as the needles 25 connected to the free end thereof, can be engaged through them, in cavity 22.

 The handle 20 also comprises a slot 30 arranged in its wall, transverse to its longitudinal axis, this slot 30 extending over substantially half the circumference of the handle 20. This slot 30 can receive a member 31 having a portion 31a of width slightly greater than that of the slot 30 and a rounded portion 31b, of shape corresponding to that of the internal face of the handle.

 Thanks to its part 31a, the member 31 can be engaged in the slot 30, with wedging. It then allows, as shown in FIG. 4, to wedge the two strands of suture 4 between the end of its part 31b and the side wall of the handle 20.

 The rod 21 includes a shoulder 35 located behind the lug 17, the distance from this shoulder 35 and from this lug 17, therefore from the shoulder 35 and the device 2, being determined precisely, explained below.

 In addition, the instrument 5 comprises an impaction head 40, provided with a part 40a capable of being engaged with wedging, but in a manually removable manner, in the end of the handle 20 opposite the rod 21.

 In practice, the device 2 is mounted on the instrument 5 by engagement of its hole 10 on the lug 17. The needles 25 and the two strands of the suture 4 are then engaged through the openings 23, then through the cavity 22 until it can be grasped on the side of the handle 20 opposite the rod 21, the member 31 and the impaction head 40 then not being put in place. A traction is exerted on the strands of the wire 4, relative to the instrument 5, so as to put these strands in tension, then the member 31 is put in place to maintain these strands in tension.

 The parts of the strands located beyond the member 31 and then the needles 25 are then engaged in the cavity 22. The impaction head 40 is then put in place.

 The anchoring device 2 is thus held on the instrument 5 by the tension of these strands, and the assembly can be packaged in sterile packaging, so as to be ready for use.

 During the implantation of the device 2, the instrument 5 allows, thanks to the rod 21, to present the device 2 opposite the implantation site, even when this site is relatively inaccessible.

 The device 2 is placed in the cancellous bone 3a, through a thin cortex 3b, by impaction on the head 40, without prior drilling of a hole through the cortex 3b.

 The tip 6 promotes the introduction of the device 2, and the slight projection made by the end 8a of the finger 8 beyond the side wall of the body 2c does not constitute a hindrance to the introduction of the device 2 into the bone .

 This introduction occurs until the shoulder 35 comes into abutment against the cortex 3b. This shoulder 35 is positioned in such a way that the device 2 is at an ideal depth of insertion into the bone.

 A slight traction is then exerted on the strands of the wire 4 so as to make the device 2 move back.

The free end 8a of finger 8 comes to bear against the cancellous bone, which makes it possible, during this retraction, to deploy finger 8 in the position shown in FIG. 7. Thanks to its rigid structure and its relatively large length and thickness, this finger 8 provides a very solid anchoring of the device 2.

 The member 31 can then be removed so as to free the sliding of the strands of the wire 4 relative to the instrument 5, and allow, as shown in FIGS. 7 and 8, the withdrawal of this instrument 5.

Claims (8)

 1 - Bone anchoring device for suture, comprising a proximal end (2b), intended to be mounted on an instrument (5) for positioning, and an opposite distal end (2a); at least one deployable means (8) allowing the anchoring of the device in the cancellous bone (3a); means (9) for hooking or passing the suture (s) (4); and a means (10) for mounting it on the instrument (5) allowing its positioning, device (2) characterized in that it comprises a housing (7), open laterally, in which a rigid finger is pivotally mounted tapered (8) comprising a pointed free end (8a), this finger (8) being able to pivot between a retracted position, in which its free end (8a) is turned towards the side of said proximal end (2b) and projects slightly beyond the side wall of the body (2c) of the device (2), and a deployed position, in which this finger (8) extends substantially perpendicular to the axis of the device (2).  2 - Device according to claim 1, characterized in that the walls (15) delimiting the housing longitudinally (7) are shaped to constitute stops limiting the pivoting of the finger (8) in the retracted and deployed positions thereof.  3 - Instrument allowing the installation of the device (2) according to claim 1 or claim 2, characterized in that its end on which the device (2) is mounted has a cross section not greater than that of the body (2c) of the device (2), and in that it is shaped to allow the implantation of the device (2) by impaction.  4 - Instrument according to claim 3, characterized in that it comprises a shoulder (35) located behind its end receiving the device (2), this shoulder (35) being positioned such that the device (2) is found at an ideal depth of insertion into the bone (3) when the shoulder (35) abuts against the cortex (3b).  5 - Instrument according to claim 3 or claim 4, characterized in that it comprises means (22,23,31) for maintaining the suture or sutures (4) stretched, at a small angle relative to the 'axis of introduction of the device (2).  6 - Instrument according to one of claims 3 to 5, characterized in that it is in the general form of a screwdriver, that is to say that it comprises a handle (20) secured to a rod (21), this rod (21) receiving the device (2) on its free end; the handle (20) is hollow and comprises at least one opening (23) arranged on the side of the rod (21), putting its internal cavity (22) in communication with the outside; this opening (23) has dimensions such that the suture (4), as well as the needle or needles (25) possibly connected to the free ends thereof, can be engaged through it.  7 - Instrument according to claims 5 and 6, characterized in that the means for maintaining the suture or sutures (4) stretched consist of the opening (s) (23), by a slot (30) arranged in the wall the handle (20), transverse to the longitudinal axis thereof, and by a member (31) having a part (31a) of width slightly greater than that of the slot (30) and a rounded part (3lob), of shape corresponding to that of the internal face of the handle (20), the member 31 being able to be engaged in the slot (30) with wedging, thanks to its part (3 la), and being shaped to, in this position, wedge the two strands of the suture (4) between the end of its part (3lob) and the side wall of the handle (20).  8 - Instrument according to claim 6 or claim 7, characterized in that it comprises an impaction head (40) provided with a part (40a) capable of being engaged with wedging, but in a manually removable manner, in the cavity (22), on the side of the handle (20) opposite the rod (21).