Systems and methods for cmc suture suspensionplasty

Abstract

To provide surgical kit systems and methods for using the same for treating thumb arthritis.SOLUTION: A surgical kit system includes a spacer, a strand, a first anchoring mechanism, and a second anchoring mechanism. The spacer is configured to be disposed between the thumb metacarpal and the index metacarpal to prevent impingement between the thumb metacarpal and the index metacarpal. The strand is configured to be anchored to the second and first metacarpals by the first and second anchoring mechanisms to suspend the thumb metacarpal, respectively.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] Priority claim This application claims priority to and benefit of U.S. Provisional Patent Application No. 63 / 267,655, filed February 7, 2022, which is incorporated herein by reference in its entirety. [Background technology]

[0002] The carpometacarpal (CMC) joint forms the base of the thumb and is where the thumb metacarpal, also known as the first metacarpal, attaches to the trapezius bone. Cartilage is found at the base of the bones and acts as a cushion, allowing the bones to glide smoothly over one another. Thumb arthritis, or CMC arthritis, is a common problem that occurs when the cartilage wears away from the ends of the bones at the CMC joint. Without cartilage, the thumb metacarpal and trapezius bones can rub directly against each other, causing severe pain, swelling, and loss of thumb strength.

[0003] Treatment for CMC arthritis can involve removal of the trapezius bone in a procedure called trapezoidectomy, which creates space and prevents bone-to-bone interaction between the thumb metacarpal and the trapezius bone. However, removal of the trapezius bone can cause other problems. First, the thumb metacarpal can collapse onto the navicular bone, a condition known as thumb metacarpal subsidence. To remedy this problem, surgeons can implant natural or synthetic materials in place of the trapezius bone. However, current methods can cause proximal movement of the thumb metacarpal, causing the thumb metacarpal and index metacarpal to rub against each other, a condition known as impingement. Currently, no device or method exists to treat thumb arthritis and prevent both impingement and subsidence. Summary of the Invention [Means for solving the problem]

[0004] The present disclosure provides a novel and innovative surgical kit system and method for using the same for treating thumb arthritis and preventing impingement between the thumb metacarpal and index metacarpal. In some examples, a method for treating and / or preventing thumb arthritis in a patient is provided. The method includes securing a first portion of a strand to the index metacarpal, positioning a spacer along the strand, and securing a second portion of the strand to the thumb metacarpal. The spacer is positioned between the thumb metacarpal and index metacarpal to prevent impingement between the thumb metacarpal and index metacarpal. The method may further include drilling a hole through the thumb metacarpal and passing the second portion of the strand through the hole in the thumb metacarpal before securing the strand to the thumb metacarpal.

[0005] In some examples, a surgical kit system is provided. The surgical kit system includes a spacer, a strand, a first fixation mechanism, and a second fixation mechanism. The spacer is configured to be positioned between an index metacarpal and a thumb metacarpal. The strand includes a first portion and a second portion. The first portion of the strand is configured to be fixed to the index metacarpal by the first fixation mechanism, and the second portion of the strand is configured to be fixed to the thumb metacarpal by the second fixation mechanism.

[0006] Additional features and advantages of the disclosed surgical kit system and method will be described in, and will be apparent from, the following detailed description and drawings. [Brief explanation of the drawings]

[0007] [Figure 1] FIG. 1 is a diagram of an exemplary surgical kit system according to one example of the present disclosure.

[0008] [Figure 2] FIG. 2 is a diagram of an exemplary surgical kit system according to another example of the present disclosure.

[0009] [Figure 3A]FIG. 3A is a diagram of an exemplary surgical kit system according to another example of the present disclosure.

[0010] [Figure 3B] 3B is an enlarged view of a first portion of the strand of the surgical kit system of FIG. 3A, with a second portion of the strand being fed through a hole in the first portion. In FIG. 3B, the spacer of the surgical kit system of FIG. 3A has been omitted for illustrative purposes.

[0011] [Figure 4A] FIG. 4A is a diagram of an exemplary surgical kit system according to another example of the present disclosure. [Figure 4B] FIG. 4B is a diagram of an exemplary surgical kit system according to another example of the present disclosure.

[0012] [Figure 5A] FIG. 5A illustrates an exemplary method according to one example of the present disclosure. [Figure 5B] FIG. 5B illustrates an exemplary method according to one example of the present disclosure. [Figure 5C] FIG. 5C illustrates an exemplary method according to one example of the present disclosure.

[0013] [Figure 6] FIG. 6 illustrates an exemplary method according to another example of the present disclosure.

[0014] [Figure 7A] FIG. 7A illustrates an exemplary method according to another example of the present disclosure. [Figure 7B] FIG. 7B illustrates an exemplary method according to another example of the present disclosure. [Figure 7C] FIG. 7C illustrates an exemplary method according to another example of the present disclosure.

[0015] [Figure 8A] FIG. 8A illustrates an exemplary method according to another example of the present disclosure. [Figure 8B]FIG. 8B illustrates an exemplary method according to another example of the present disclosure.

[0016] [Figure 9] FIG. 9 is a diagram of an exemplary surgical kit system according to another example of the present disclosure.

[0017] [Figure 10A] FIG. 10A is a diagram of an exemplary surgical kit system according to another example of the present disclosure. [Figure 10B] FIG. 10B is a diagram of an exemplary surgical kit system according to another example of the present disclosure. [Figure 10C] FIG. 10C is a diagram of an exemplary surgical kit system according to another example of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0018] The present disclosure is directed to systems and methods for treating thumb arthritis and preventing impingement between the first and second metacarpal bones. The systems and methods according to the present disclosure can also prevent thumb metacarpal subsidence.

[0019] 1 illustrates an exemplary surgical kit system 100 according to one example of the present disclosure. The surgical kit system 100 of the present disclosure may include a spacer 110 and a strand 120. In some examples, the spacer 110 may be configured to provide interposition between the first (thumb) metacarpal bone 10 and the second (index) metacarpal bone 20.

[0020] The strands 120 may be configured to hold the spacer 110 in place and suspend the first metacarpal 10 to prevent the first metacarpal 10 from collapsing onto the navicular 30 after removal of the trapezius. The strands 120 may include a first portion and a second portion. In some examples, the first portion of the strands 120 may be configured to be secured to the second metacarpal 20, while the second portion of the strands 120 may be configured to be secured to the first metacarpal 10.

[0021] The strands 120 may be any suitable length and may be trimmed during a procedure depending on the desired length and desired tension of the strands 120. The tension of the strands 120 may alter thumb movement, such as thumb abduction or how far the thumb can extend from the midline of the fingers. In some examples, the length of the strands 120 may be the same across all surgical kit systems. In other examples, the length of the strands 120 may be tailored to the particular patient for whom the surgical kit system is provided.

[0022] Non-limiting examples of strands 120 can include string, thread, rope, wire, tape, rod, and suture. Strands 110 can be constructed of or include any suitable biocompatible / medical grade material. For example, strands 120 can be made of or include a flexible material, such as a (non-absorbable) suture material. Non-limiting examples of suture material can include nylon, prolene, silk, polyester, or any combination thereof.

[0023] In some examples, strands 120 may be in the form of a tape having a width greater than a thickness. In some examples, the ratio of the width to the thickness of the tape may be in a range of about 2:1 to about 10:1, e.g., about 2:1 to about 4:1, about 4:1 to about 6:1, about 6:1 to about 8:1, or about 8:1 to about 10:1. In other examples, the ratio of the width to the thickness of the tape may have any other suitable range. When strands 120 are in the form of a tape, strands 120 may be less likely to cut through bone (e.g., first / second metacarpal bone), tissue surrounding the bone, and / or spacer 110 than strands 120 in the form of a cord / wire.

[0024] In some examples, the width of strand 120 may be in the range of about 1 mm to about 10 mm, e.g., about 1 mm to about 3 mm, about 3 mm to about 5 mm, about 5 mm to about 7 mm, or about 7 mm to about 10 mm. In some examples, the thickness of strand 120 may be in the range of about 0.1 mm to about 2.0 mm, e.g., about 0.1 mm to about 0.5 mm, about 0.5 mm to about 1.0 mm, about 1.0 mm to about 1.5 mm, or about 1.5 mm to about 2.0 mm. In other examples, strand 120 can have any other suitable width and / or length.

[0025] Strand 120 can have a tensile strength sufficient to withstand forces associated with thumb movement. In some examples, the tensile strength of strand 120 can be in a range of about 10 N to about 880 N, e.g., about 10 N to about 110 N, about 110 N to about 220 N, about 220 N to about 330 N, about 330 N to about 440 N, about 440 N to about 550 N, about 550 N to about 660 N, about 660 N to about 770 N, or about 770 N to about 880 N. In other examples, strand 120 can have any other suitable tensile strength.

[0026] The spacer 110 may be positioned along the strands 120 such that the spacer 110 is positioned between the first and second metacarpal bones. This positioning can provide interposition and cushioning between the two bones and can prevent impingement between the first and second metacarpal bones.

[0027] In some examples, the spacer 110 may be cannulated so that the strands 120 pass through the through-holes 115 of the spacer 110. In other examples, the spacer 110 may be tied to the strands 120. For example, the strands 120 may be wrapped around the outer surface of the spacer 110.

[0028] Non-limiting examples of shapes of spacer 110 include a cylinder, a prism, a cube, a rectangular parallelepiped, a sphere, an ellipsoid, a cone, a torus, an octahedron, and a disk. In other examples, spacer 110 may not have a defined shape or may have any other suitable shape. Spacer 110 may be symmetrical or asymmetrical along its length.

[0029] In some examples, spacer 110 may be made of or include a rigid material, such as a hard plastic, a metal, or any combination thereof. For example, spacer 110 may be made of or include a suitable metal (e.g., cobalt, Notinol (nickel titanium), stainless steel) and / or a suitable plastic (e.g., polyethylene, polyetheretherketone (PEEK), polylactic acid copolymer, polyglycolic acid copolymer).

[0030] In other examples, the spacer 110 may be made of or include a soft material such as a woven fabric. The textile material may include polyester, polytetrafluoroethylene (PTFE), expanded polytetrafluoroethylene (ePTFE), polyethylene terephthalate (PET), or any other suitable biocompatible grade material, or a combination thereof. In some examples, the spacer 110 may be made of or include a biological material. The biological material may include collagen, (allograft) tendon, muscle, fat, skin, or any other suitable joint interposition material, or a combination thereof. In some examples, the spacer 110 may be made of any other suitable implantable material, such as polyurethaneurea, silicone, and pyrocarbon. The spacer 110 may be made of a combination of materials described herein. In some examples, the spacer 110 may be made of (woven) suture.

[0031] In some instances, the spacer 110 may be one size fits all. In other instances, the spacer 110 may be custom sized based on the patient's anatomy, such as the size of the first and second metacarpal bones and the space between them. A physician or surgeon can determine the patient's anatomy by any suitable means, such as an x-ray.

[0032] In some examples, the width of the spacer 110 may be in the range of about 1 mm to about 10 mm, e.g., about 1 mm to about 3 mm, about 3 mm to about 5 mm, about 5 mm to about 7 mm, or about 7 mm to about 10 mm. In other examples, the spacer 110 may have any other suitable length.

[0033] In some examples, the surgical kit system 100 can further include one or more fixation mechanisms for securing the strands 120 to bone. The one or more fixation mechanisms can be configured, for example, to secure the strands 120 to bone without tearing or damaging the strands. Non-limiting examples of fixation mechanisms include fasteners (e.g., any fastener capable of securing the strands 120 to bone without cutting or damaging the strands 120), such as screws (e.g., tendon fixation screws), (threaded) suture anchors, buttons, flip buttons, or any other suitable component / device capable of securing the strands 120 to bone. In some examples, the fixation mechanisms can be made from or include a suitable metal, plastic, or combinations thereof. In other examples, the fixation mechanisms can be made from or include any suitable biocompatible / medical-grade material, such as suture material. The fixation mechanisms can be made from a combination of materials described herein.

[0034] In some examples, the one or more fixation mechanisms can include a first fixation mechanism configured to fix a first portion of strand 120 to the second metacarpal bone and a second fixation mechanism configured to fix a second portion of strand 120 to the first metacarpal bone. The first and second fixation mechanisms can be the same or different.

[0035] In some examples, the first fixation mechanism can secure the first portion of the strand 120 to the radial side of the second metacarpal bone 20 or the ulnar side of the second metacarpal bone 20. In other examples, the first fixation mechanism may secure the first portion of the strand 120 to any other suitable portion of the second metacarpal bone 20.

[0036] In some examples, the first metacarpal 10 may include a hole 15 configured to receive the strand. In some examples, the second portion of the strand 120 may be threaded through the hole 15 of the first metacarpal 10, as shown in FIG. 1. In some examples, instead of threading the second portion of the strand 120 through the hole, the second portion of the strand 120 may be suspended below the first metacarpal 10, functioning as a sling below the first metacarpal 10 and secured to the radial side of the first metacarpal 10.

[0037] FIG. 2 illustrates an exemplary surgical kit system 200 according to another example of the present disclosure. The surgical kit system 200 may include a spacer 210 and a strand 220. As shown in FIG. 2 , in some examples, the strand 220 may be secured to the second metacarpal bone 20 by wrapping the strand 220 around the second metacarpal bone 20. Securing the strand 120 in this manner may result in two portions of the strand (a third portion 222 and a fourth portion 224) protruding from the radial side of the second metacarpal bone 20. In some examples, both the third and fourth portions 222, 224 of the strand 120 may be threaded through the spacer 110, as shown in FIG. 2A . In other examples, both the third and fourth portions 222, 224 of the strand 220 may be used to connect the spacer 210 to the strand 220.

[0038] In some examples, the third portion 222 of the strand 220 may be threaded through the foramen 15 of the first metacarpal bone 10, and the fourth portion 224 of the strand 220 may not be threaded through the foramen 15. In other examples, both the third and fourth portions 222, 224 of the strand 220 may or may not be threaded through the foramen 15 of the first metacarpal bone 10.

[0039] In some examples, the third and fourth portions 222, 224 of the strand 220 may be secured to the first metacarpal bone 10, for example, by wrapping the third and fourth portions 222 around the first metacarpal bone 10 or by using one or more securing mechanisms.

[0040] Other configurations / features / characteristics of the surgical kit system 200 of Figure 2 may be similar and / or identical to those described above with respect to the surgical kit system 100 of Figure 1 (e.g., materials, shapes, sizes, functions, etc.), and therefore, redundant descriptions may be omitted.

[0041] FIG. 3 illustrates an exemplary surgical kit system 300 according to another example of the present disclosure. The surgical kit system 300 may include a spacer 310 and a strand 320. As shown in FIGS. 3A and 3B , in some examples, the strand 320 may be secured to the second metacarpal bone 20 by wrapping the strand 320 around the second metacarpal bone 20. In some examples, the strand 320 may include a hole 322 in a first portion 322. A second portion 324 of the strand 320 may be fed through the hole 321, as shown in FIG. 3, thereby allowing the strand 320 to self-tighten.

[0042] In some examples, the second portion 324 of the strand 320 may be threaded through the hole 15 in the spacer 310 and / or the first metacarpal bone 10. In some examples, the strand 120 may include a fixation mechanism that receives the hole 325 in the second portion 324, and the second portion 324 may be fixed to the first metacarpal bone 10 by the fixation mechanism 340.

[0043] Other configurations / features / characteristics of the surgical kit system 300 of Figure 3 may be similar and / or identical to those described above with respect to the surgical kit system 100 of Figure 1 (e.g., materials, shapes, sizes, functions, etc.), and therefore, redundant descriptions may be omitted.

[0044] 4A and 4B show an exemplary surgical kit system 400 according to another example of the present disclosure. The surgical kit system 400 may include a spacer 410 and a first strand 420. The surgical kit system 400 of FIG. 4A is similar to the surgical kit system 400 of FIG. 4B. One difference between the surgical kit system 400 of FIG. 4A and the surgical kit system 400 of FIG. 4B is that the spacer 410 of FIG. 4A may have a rigid body (e.g., hard plastic or metal), while the spacer 410 of FIG. 4B may have a soft body (e.g., woven fabric).

[0045] In some examples, the surgical kit system 400 may include a second strand 430. The second strand 430 may include a first portion 432 and a second portion 434. The first portion 432 of the second strand 430 may be configured to be secured to the second metacarpal bone 20, and the second portion 434 may be configured to be secured to the first metacarpal bone 10.

[0046] In some examples, the second portion 434 of the second strand 430 and / or the second portion 424 of the first strand 420 may be threaded through the foramen 15 of the first metacarpal bone 10. In some examples, the first portion 432 of the second strand 430 may be configured to be secured to the second metacarpal bone 10 at a first location 21 above the second location 22 to which the first portion 422 of the first strand 420 is secured, such that the second metacarpal bone 10, the spacer 410, and the second strand 430 can form a triangular shape (or a substantially triangular shape). The second strand 430 may provide additional support for the suspension of the first metacarpal bone 10.

[0047] In some examples, the angle 435 formed between the spacer 410 and the second strand 430 may be in the range of about 10° to about 80°, such as about 10° to about 30°, about 30° to about 50°, about 50° to about 70°, or about 70° to about 80°. In other examples, the angle 435 may have any other suitable angle.

[0048] Other configurations / features / characteristics of the surgical kit system 400 of Figures 4A and 4B may be similar and / or identical to those (e.g., materials, shapes, sizes, functions, etc.) described above with respect to the surgical kit systems 100, 200, 300 of Figures 1, 2, 3A, and 3B, and therefore, redundant description may be omitted.

[0049] In some examples, components of a surgical kit system according to the present disclosure (e.g., a surgical system described herein) may be packaged together in sterile packaging. In some examples, the surgical kit system may be standardized to fit any patient. In other examples, the surgical kit system may be custom-made according to the patient's anatomy.

[0050] In some examples, a method of treating thumb arthritis using the surgical kit system disclosed herein is provided in accordance with the present disclosure. The method can treat thumb arthritis or CMC arthritis while avoiding both impingement of the first and second metacarpals and subsidence of the thumb onto the navicular bone. The steps presented herein may be performed in any suitable order and combination, and may be modified by or combined with any of the other procedures and features disclosed elsewhere herein.

[0051] In some instances, a method for treating thumb arthritis can include removing the trapezius. Removing the trapezius can stop bone-to-bone interaction between the first metacarpal bone and the trapezius in patients with cartilage deterioration in the CMC joint. The methods disclosed herein can also be performed with the trapezius still in place.

[0052] 5A-5C, the method can include securing a first portion of the strand 120 to the second metacarpal bone 20. The strand 120 can be secured to the second metacarpal bone by any suitable securement mechanism. In some examples, the surgeon can secure the strand 120 to the radial side of the second metacarpal bone 20, thereby allowing the procedure to be performed using only one incision instead of two. In some examples, the surgeon can secure the strand 120 to the ulnar side of the second metacarpal bone 20. The strand 120 can be secured to the lower half of the second metacarpal bone 20, the base of the second metacarpal bone 20, or at location 22, for example. The surgeon can secure the strand 120 to the second metacarpal bone 20 using a securement mechanism described herein. For example, the first portion of the strand 120 can be secured to the second metacarpal bone using a fastener, such as a (tenodesis) screw, button, or suture anchor.

[0053] In some examples, the strands can be secured to the second metacarpal bone 20 by wrapping the strands around the second metacarpal bone 20, as shown in Figure 2. In some examples, the strands 120 can be secured to the second metacarpal bone 20 by wrapping a first portion of the strands around the second metacarpal bone 20 and threading a second portion of the strands through a hole on the first portion of the strands, as shown in Figure 3.

[0054] In some examples, the method may include, for example, drilling a hole in the second metacarpal bone 20 prior to securing the strand 120 to the second metacarpal bone 20. The depth of the hole drilled in the second metacarpal bone 20 may be substantially the same as the length of the fixation mechanism (e.g., the length of the screw or suture anchor). A first portion of the strand 120 may enter the hole on the second metacarpal bone 20 prior to fixation.

[0055] In some examples, a knot may be tied on a first portion of the strand 120 before threading the strand 120 through the hole in the second metacarpal bone 20. For example, with reference to FIGS. 7A-7C , a knot 121 may be formed on the first portion of the strand 120 and inserted into the hole 25 in the second metacarpal bone 20, for example, using a pusher / driver 160. A fixation mechanism 140 (e.g., a tenodesis screw) may then be inserted into the hole 25. In some examples, a first portion of the first portion of the strand 120 may be positioned between the fixation mechanism 140 and the hole 25 in the second metacarpal bone 20. In some examples, the diameter of the hole 25 may be approximately the same as the diameter of the knot 121 tied on the strand 120.

[0056] 8A and 8B, in some examples, fixation mechanism 140 may be cannulated, in which case the second portion of the first portion of strand 120 may be placed within the bore of fixation mechanism 140 after the fixation mechanism 140 is installed in the bone.

[0057] In some examples, the method may include drilling a hole through the diameter of the second metacarpal bone 20. In some examples, a fixation mechanism may be positioned through the second metacarpal bone 20. The hole may be drilled from the palmar to the dorsal side, the dorsal to the palmar side, the ulnar to the radial side, or the radial to the ulnar side of the second metacarpal bone 20. In some examples, the strand 120 may be secured to the fixation mechanism, and the fixation mechanism and the strand 120 may be forced through the hole in the second metacarpal bone 20. The fixation mechanism can secure the strand 120 to the second metacarpal bone 20 through the hole. In some examples, the strand 120 may be secured to the fixation mechanism, and only the strand 120 may be forced through the hole in the second metacarpal bone 20. In some examples, the method may include positioning a spacer 110 along the strand 120. The spacer 110 may be positioned along the strand 120 before the first portion of the strand 120 is secured to the second metacarpal bone 20 or after the first portion of the strand 120 is secured to the second metacarpal bone 20.

[0058] Spacer 110 may be positioned along strand 120 by any suitable method. For example, referring again to FIG. 1 , in some instances, spacer 110 may be cannulated to allow second portions of strands 120 to pass through holes 115 in spacer 110. In other instances, spacer 110 may be tied to strand 120.

[0059] In some examples, the first metacarpal bone 10 is suspended. The first metacarpal bone may be suspended by any suitable method. For example, referring again to FIGS. 5B and 5C, in some examples, the method may include drilling a hole through the diameter of the first metacarpal bone 10 to create a channel 15 through the bone. In some examples, the hole 15 may be drilled from the ulnar side to the radial side or from the radial side to the ulnar side of the first metacarpal bone 10, as shown in FIGS. 5B and 5C. In other examples, the hole may be drilled from the base of the first metacarpal bone 10 to the radial side, as shown in FIG. 6.

[0060] After the hole 15 is drilled, the method may include threading a second portion of the strand 120 through the channel 15 of the first metacarpal bone 10. The second portion of the strand 120 can be threaded through the channel 15 using any known technique. For example, the strand 120 can be threaded through the channel 15 by inserting a tool 170 having a hook into the channel 15, hooking the strand 120, and pulling the strand 120 back through the channel 15. In some examples, the hole 15 is not drilled in the first metacarpal bone 10, and the strand 120 is suspended below the first metacarpal bone 10, functioning as a sling below the first metacarpal bone 10.

[0061] As shown in FIG. 5C , once strand 120 is threaded through channel 15 or suspended under the first metacarpal bone, the surgeon can pull strand 120 tight to suspend the first metacarpal bone 10. Tensioning strand 120 can be important to ensure proper abduction and mobility of the thumb after the procedure. In some examples, the method can further include adjusting the tension of strand 120 to ensure proper thumb suspension. Adjusting the tension of strand 120 can occur before or during fixation of strand 120 to the first metacarpal bone 10.

[0062] After the second portion of the strand 120 passes through the channel 15 or is suspended below the first metacarpal 10, the second portion of the strand 120 can be secured to the first metacarpal 10 using any suitable securement method described herein. For example, the second portion of the strand 120 can be secured to the radial side of the first metacarpal 10 using a securement mechanism 140. In other examples, the strand 120 can be secured by wrapping the strand 120 around the first metacarpal 10. In some examples, the second portion of the strand 120 can be secured within the channel 15 through which the strand 120 is threaded, as shown in FIG. 5C .

[0063] In some examples, a second hole is drilled in the first metacarpal 10 above or below the channel 15. The depth of the second hole may be substantially the same as the length of the fixation mechanism (e.g., the length of a screw or suture anchor). In some examples, the strand may be secured within the second hole. In some examples, a knot (similar to knot 121 in the first portion) may be tied in the second portion of the strand 120, the knot inserted into the second hole, and the fixation mechanism inserted into the second hole in the first metacarpal 10.

[0064] 4A and 4B, in some examples, the method may include securing a first portion 432 of a second strand 430 to a second metacarpal 20 at a first location 21 above a second location 22 to which a first portion 422 of a first strand 420 is secured, passing a second portion 434 of the second strand 430 through a hole 15 in the first metacarpal 10, and securing the second portion 434 of the second strand 430 to the first metacarpal 10. The second metacarpal 20, the spacer 410, and the second strand 430 may form a triangular shape, as shown in FIGS.

[0065] Returning to FIG. 2 , in some examples, a method of treating thumb arthritis may include wrapping a strand 220 around a second metacarpal 20 such that a third portion 222 and a fourth portion 224 of the strand 220 protrude from the radial side of the second metacarpal 20, positioning a spacer 210 along both portions 222, 224 of the strand 220, and securing both portions 222, 224 of the strand 210 to the first metacarpal 10.

[0066] The spacer 210 can be positioned along the strands by threading both portions 222, 224 of the strands 220 through the cannula bore of the spacer 210. In other examples, one portion of the strands 220 can be positioned along one side of the spacer 210 and the other portion of the strands 220 can be positioned along the other side of the spacer 210, and both portions of the strands 220 can be tied together to hold the spacer 210 in place.

[0067] With the spacer 210 in place, in some instances, one portion 222 of the strand 220 can be threaded through the channel 15 of the first metacarpal bone 10 while the other portion 224 of the strand 220 can be positioned under the base of the first metacarpal bone 10. In other instances, both portions of the strand 220 may pass through a channel in the first metacarpal bone 10. The two portions of the strand 220 can be secured to the first metacarpal bone 10 by wrapping the two portions of the strand together or by using a securing mechanism, as discussed herein.

[0068] 9 illustrates an exemplary surgical kit system 500 according to another example of the present disclosure. The surgical kit system 500 may include a spacer 510 and a strand 520. As shown in FIG. 9 , in some examples, the strand 520 may be secured to the second metacarpal bone 20 by wrapping the strand 520 around the second metacarpal bone 20. When the strand 520 is secured in this manner, two portions of the strand 520 (a third portion 522 and a fourth portion 524) may protrude from the radial side of the second metacarpal bone 20.

[0069] In some examples, the third portion 522 and the fourth portion 524 of the strand 520 may be tied to form a knot that may function as the spacer 510. In some examples, the knot may be an overhand knot, a surgeon's knot, or a square knot. In other examples, the knot may be any other suitable knot.

[0070] In some examples, the third portion 522 of the strand 520 may be threaded through the hole 15 of the first metacarpal bone 10, and the fourth portion 524 of the strand 520 may not be threaded through the hole 15. In other examples, both the third and fourth portions 522, 524 of the strand 220 may or may not be threaded through the hole 15 of the first metacarpal bone 10.

[0071] In some examples, the third and fourth portions 522, 524 of the strand 520 may be secured to the first metacarpal bone 10, for example, by wrapping the third and fourth portions 522 around the first metacarpal bone 10 or by using one or more securing mechanisms. In other examples, the third and fourth portions 522, 524 of the strand 520 may be tied to form another knot to secure the strand 520 to the first metacarpal bone 10.

[0072] Other configurations / features / characteristics of the surgical kit system 500 of Figure 9 may be similar and / or identical to those described above with respect to the surgical kit systems 100, 200, 300 and / or 400 of Figures 1, 2, 3A, 3B, 4A and 4B (e.g., materials, shapes, sizes, functions, etc.), and therefore, redundant description may be omitted.

[0073] In some instances, the surgeon can tie one or more knots (similar to knot 510) in the strands to be positioned between the first and second metacarpal bones in addition to a spacer (e.g., spacers 110, 210, 310, and / or 410 described with respect to FIGS. 1, 2, 3A, 3B, 4A, and 4B). In this case, the knot(s) in the strands can add to the length of the spacer and create extra space between the first and second metacarpal bones 10 and 20. In this way, for example, when using a one-size-fits-all spacer, one or more knots can be used to adjust the distance between the first and second metacarpal bones 10 and 20. For example, if the spacer is too small for a particular patient, the knot(s) can be tied before or after the spacer is positioned on the strands.

[0074] 10A illustrates an exemplary surgical kit system 700 according to another example of the present disclosure. The surgical kit system 700 may include a spacer 710 and a strand 720. The spacer 710 may include a first portion 712 configured to be positioned between the first metacarpal bone 10 and the second metacarpal bone 20, and a second portion 714 configured to be positioned between the first metacarpal bone 10 and the navicular bone 30. In some examples, the spacer 710 may be curved or bent.

[0075] 10B and 10C , in some examples, the strand 720 may be secured to the first metacarpal 10 and / or the second metacarpal 20 via a securing mechanism 740. For example, the securing mechanism 740 may be a flip button, and the strand 720 may be tied to the flip button. The flip button 740 may be configured to be pushed in a first direction through a hole 35 in the bone 30 (the first metacarpal 10 and / or the second metacarpal 20), and upon exiting the hole 35, the flip button 740 may be flipped perpendicular to the first direction (and parallel to the bone).

[0076] In some examples, the strand 720 can have a third portion 722 and a fourth portion 724 that protrude from the flip button 740. In some examples, the spacer 710 can be positioned along the strand 720 by threading both portions 722, 724 of the strand 720 through a cannula bore of the spacer 710. In other examples, one portion 722 of the strand 720 can be positioned along one side of the spacer 710 and the other portion 724 of the strand 720 can be positioned along the other side of the spacer 710, and both portions of the strand 720 can be tied together to hold the spacer 710 in place.

[0077] In some examples, the fixation mechanism 740 may be a button and the strand 720 may be tied to the button. The button may be placed on one side of the bone (the first metacarpal 10 and / or the second metacarpal 20) and the strand 720 may be threaded through a channel in the bone so that the strand 720 protrudes from the other side of the bone opposite the side with the button.

[0078] In some examples, the spacer 710 can be positioned along the strands 720 by threading both portions 722, 724 of the strands 720 through the cannula bore of the spacer 710. In other examples, one portion 722 of the strands 720 can be positioned along one side of the spacer 710 and the other portion 724 of the strands 720 can be positioned along the other side of the spacer 710, and both portions of the strands 720 can be tied together to hold the spacer 710 in place.

[0079] In some examples, once the spacer is positioned along the strands 720, the strands 720 are secured to the first and / or second metacarpal bones 10, 20. The strands 720 may be secured to the first and / or second metacarpal bones 10, 20 through the use of buttons. The strands 720 may be threaded through holes in the first and / or second metacarpal bones 10, 20, and the strands may be tied to buttons that function to secure the strands 720 to the bones.

[0080] Other configurations / features / characteristics of the surgical kit system 700 of FIG. 10A may be similar and / or identical to those (e.g., materials, shapes, sizes, functions, etc.) described above with respect to the surgical kit systems 100, 200, 300 and / or 400 of FIGS. 1, 2, 3A, 3B, 4A and 4B, and therefore, redundant description may be omitted.

[0081] Without further elaboration, it is believed that one skilled in the art can use the preceding description to make full use of the claimed invention. The examples and embodiments disclosed herein should be construed as merely illustrative and in no way limit the scope of the present disclosure. It will be apparent to those skilled in the art that changes can be made to the details of the above-described examples without departing from the basic principles described. In other words, various modifications and improvements of the examples specifically disclosed in the above description are within the scope of the appended claims. For example, any suitable combination of features of the various examples described is contemplated.

[0082] (Embodiment) Various aspects of the subject matter described herein are set forth in the following numbered embodiments.

[0083] Embodiment 1: A method of treating thumb arthritis, comprising: securing a first portion of a strand to an index metacarpal; positioning a spacer along the strand; and securing a second portion of the strand to the thumb metacarpal, wherein the spacer is positioned between the thumb metacarpal and the index metacarpal to prevent impingement between the thumb metacarpal and the index metacarpal.

[0084] Embodiment 2. The method of embodiment 1, further comprising drilling a hole in the thumb metacarpal bone and threading a second portion of the strand through the hole in the thumb metacarpal bone.

[0085] Embodiment 3. The method of any one of embodiments 1-2, wherein the fixing of the first portion of the strand and / or the second portion of the strand is performed using one or more fixing mechanisms.

[0086] Embodiment 4: The method of any one of embodiments 1-3, further comprising tying at least one knot in the strand, wherein the at least one knot is positioned between the thumb metacarpal and the index metacarpal.

[0087] Embodiment 5. The method of any one of embodiments 1 to 4, further comprising tying a knot in a first portion of the strand, inserting the knot into a hole in the index metacarpal bone, and inserting a fixation mechanism into the hole in the index metacarpal bone.

[0088] Embodiment 6: The method of any one of embodiments 1 to 5, further comprising: fixing a first portion of the second strand to the index metacarpal at a first location above the second location at which the first portion of the strand is fixed; and fixing a second portion of the second strand to the thumb metacarpal, wherein the index metacarpal, the spacer, and the second strand form a triangular shape.

[0089] Embodiment 7. The method of any one of embodiments 1 to 6, wherein the spacer comprises at least one of a plastic material, a metal material, a woven suture, a fabric, and a biological material.

[0090]

[0022] Embodiment 8. The method of any one of embodiments 1-7, wherein the strand comprises a tape having a width greater than its thickness.

[0091] Embodiment 9. The method of any one of embodiments 1 to 8, wherein the spacer comprises a knot.

[0092] Embodiment 10: The method of any one of embodiments 1 to 9, wherein the knot comprises at least one of an overhand knot, a surgeon's knot, and a square knot.

[0093] Embodiment 11: A surgical kit system for treating thumb arthritis, the surgical kit comprising: a spacer configured to be positioned between the thumb metacarpal and the index metacarpal; a strand having a first portion configured to be secured to the index metacarpal and a second portion configured to be secured to the thumb metacarpal; a first fixation mechanism configured to secure the first portion of the strand to the index metacarpal; and a second fixation mechanism configured to secure the second portion of the strand to the thumb metacarpal.

[0094] Embodiment 12: A surgical kit as described in embodiment 11, wherein the first fixing mechanism and / or the second fixing mechanism comprises a suture anchor.

[0095] Embodiment 13: A surgical kit system as described in embodiment 12, wherein the first fixing mechanism and / or the second fixing mechanism is a flip button.

[0096] Embodiment 14: A surgical kit system according to any one of embodiments 11 to 13, wherein the strand comprises a suture material.

[0097] Embodiment 15: A surgical kit system according to any one of embodiments 11 to 14, wherein the strand comprises a tape having a width greater than its thickness.

[0098] Embodiment 16: A surgical kit system described in any one of embodiments 11 to 15, wherein the spacer comprises at least one of a plastic material, a metal material, a woven suture, a woven fabric, and a biological material.

[0099] Embodiment 17: A surgical kit system according to any one of embodiments 11 to 16, wherein the spacer is cannulated. A surgical kit according to claim 11.

[0100] Embodiment 18: A surgical kit system described in any one of embodiments 11 to 17, further comprising a second strand having a first portion configured to be fixed to the index metacarpal bone and a second portion configured to be fixed to the thumb metacarpal bone, wherein the first portion of the second strand is configured to be fixed to the index metacarpal bone at a first position above the second position at which the first portion of the strand is fixed, so that the index metacarpal bone, spacer, and second strand form a triangular shape.

[0101] Embodiment 19: A surgical kit system described in any one of embodiments 11 to 18, wherein the spacer includes a knot.

[0102] Embodiment 20: A surgical kit system described in embodiments 11 to 19, wherein the shape of the spacer is one of a cylinder, a cube, a rectangular parallelepiped, a sphere, an ellipsoid, a cone, a torus, and an octahedron.

[0103] As used herein, "about," "approximately," and "substantially" are understood to refer to numbers within a numerical range, such as, for example, a range of -10% to +10% of the referenced number, preferably -5% to +5% of the referenced number, more preferably -1% to +1% of the referenced number, and most preferably -0.1% to +0.1% of the referenced number. Furthermore, these numerical ranges should be interpreted as providing support for claims directed to any number or subset of numbers within that range. For example, a disclosure of 1 to 10 should be interpreted as supporting ranges of 1 to 8, 3 to 7, 1 to 9, 3.6 to 4.6, 3.5 to 9.9, etc.

[0104] Throughout this specification, a reference to "various aspects," "some aspects," "some examples," "other examples," "some instances," or "one aspect" means that a particular feature, structure, or characteristic described in connection with that aspect is included in at least one example. Thus, the appearances of the phrases "in various aspects," "in some aspects," "certain embodiments," "some examples," "other examples," "certain other embodiments," "some instances," or "in one aspect" in places throughout this specification do not necessarily all refer to the same aspect. Furthermore, a particular feature, structure, or characteristic illustrated or described in connection with one example can be combined, in whole or in part, with a feature, structure, or characteristic of one or more other aspects, including, but not limited to, that feature, structure, or characteristic.

[0105] When terms such as "above," "upper," "below," "below," and "next" are used to describe a positional relationship between two components, one or more components may be positioned between the two components unless the terms "immediately" or "directly" are used. Similarly, as used herein, the terms "mountable," "mounted," "connectable," "connected," or any similar term may include directly or indirectly mountable, directly or indirectly attached, directly or indirectly connectable, and directly or indirectly connected.

[0106] It should be understood that at least some of the figures and descriptions herein have been simplified to show elements relevant for a clear understanding of the present disclosure, and have excluded other elements for clarity. However, one skilled in the art will recognize that these and other elements may be desirable. However, because such elements are well known in the art and because they do not facilitate a better understanding of the present disclosure, descriptions of such elements are not provided herein.

[0107] The terms used herein are intended to describe particular embodiments only and are not intended to limit the disclosure. As used herein, the singular forms "a," "an," and "the" are intended to include the plural forms as well, unless otherwise specified. It will be further understood that the terms "comprises" and / or "comprising," when used herein, specify the presence of stated features, integers, steps, operations, elements, and / or components, but do not exclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and / or groups thereof. As used herein, the terms "at least one of X or Y" or "at least one of X and Y" should be interpreted as X, Y, or X and Y.

[0108] Additionally, in describing components of the systems of the present disclosure, there may be terms used such as first, second, third, and fourth, which may be used to distinguish one component from another, but do not imply or suggest the substance, order, sequence, or number of the components.

[0109] It should be understood that various changes and modifications to the examples described herein will be apparent to those skilled in the art. Such changes and modifications can be made without departing from the spirit and scope of the present subject matter and without diminishing its intended advantages. It is therefore intended that such changes and modifications be covered by the appended claims.

Claims

1. A surgical kit system for treating thumb arthritis, comprising: a spacer configured to be positioned between the thumb metacarpal and the index finger metacarpal; a strand having a first portion configured to be coupled to the index metacarpal and a second portion configured to be coupled to the thumb metacarpal; A surgical kit system comprising:

2. A surgical kit system as described in claim 1, further comprising one or more fixation mechanisms configured to fix the strand to either or both of the index finger metacarpal and the thumb metacarpal.

3. A surgical kit system as described in claim 2, wherein the one or more fixing mechanisms include a first fixing mechanism and a second fixing mechanism.

4. A surgical kit system as described in claim 2, wherein the one or more fixation mechanisms include screws or suture anchors.

5. The surgical kit system of claim 2, wherein the one or more fixing mechanisms include a button or a flip button.

6. A surgical kit system as described in claim 1, wherein the strands comprise suture material.

7. A surgical kit system as described in claim 1, wherein the strand comprises a tape having a width greater than its thickness.

8. The surgical kit system of claim 1, wherein the spacer comprises at least one of a plastic material, a metal material, a woven suture, a fabric, and a biologic material.

9. A surgical kit system as described in claim 1, wherein the spacer is cannulated.

10. A surgical kit system as described in claim 1, wherein the spacer includes a knot.

11. A surgical kit system as described in claim 1, wherein the spacer comprises a woven material.

12. The surgical kit system of claim 11, wherein the woven material comprises polyester, polytetrafluoroethylene (PTFE), expanded polytetrafluoroethylene (ePTFE), polyethylene terephthalate (PET) or other biocompatible grade material.

13. The surgical kit system of claim 1, wherein the spacer comprises a biological material.

14. A surgical kit system as described in claim 13, wherein the biological material comprises collagen, (allograft) tendon, muscle, fat, skin, interarticular material or any combination thereof.

15. The surgical kit system of claim 1, wherein the spacer comprises polyurethaneurea, silicone or pyrocarbon.

16. The surgical kit system of claim 1, wherein the shape of the spacer is one of a cylinder, a cube, a rectangular prism, a sphere, an ellipsoid, a cone, a torus, and an octahedron.

17. A surgical kit system as described in claim 1, further comprising a second strand having a first portion configured to be coupled to the index finger metacarpal bone and a second portion configured to be coupled to the thumb metacarpal bone.

18. A surgical kit system as described in claim 17, wherein the first portion of the second strand is configured to be attached to the index metacarpal at a first position above a second position at which the first portion of the strand is attached, so that the index metacarpal, the spacer, and the second strand form a triangular shape.

19. A surgical kit system as described in claim 1, wherein the spacer is curved or bent.

20. A surgical kit system as described in claim 1, wherein the spacer includes a first portion configured to be positioned between the first metacarpal bone and the second metacarpal bone, and a second portion configured to be positioned between the first metacarpal bone and the navicular bone.

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