Surgical system and method including looped cell scavenging

Abstract

The present disclosure details surgical systems and methods useful for the treatment of the acromioclavicular (AC) joint. In one embodiment, the disclosed system includes a cerclage that is provided to the coracoid process and includes a loop. In that embodiment, the clavicle is held against the coracoid process using a clavicle fixation assembly that includes a suture passed through the loop in the clavicle.

Description

Background Art

[0001] Sometimes, cerclage is used to maintain the relative position of fractured bone fragments and promote healing. Known cerclage includes cables (i.e., wires) or cloth, etc., and is provided by winding a cable or cloth around the fractured bone. After winding, the cable or cloth is fixed in place relative to the bone with a plug or clip, etc.

Summary of the Invention

Means for Solving the Problems

[0002] The present disclosure details a surgical system and method including a cerclage with a loop. The system and method are useful for treating various displaced, dislocated, transected, and / or fractured bones. The system and method are useful for treating the acromioclavicular (AC) joint. In one embodiment, the disclosed system includes a cerclage provided relative to the coracoid process and including a loop. In that embodiment, the clavicle is held relative to the coracoid process using a clavicle fixation assembly including a suture passed through the loop of the clavicle.

[0003] The cerclage is a separate dedicated assembly provided around a bone such as the coracoid process and can be connected to other assemblies such as a clavicle fixation assembly via the loop. In this way, the assembly connected to the cerclage via the loop can be adjusted independently of the cerclage. Further, in one embodiment, the cerclage can be installed around the coracoid process before the clavicle is positioned using the clavicle fixation assembly. In this way, the clavicle can be positioned by passing or sliding a suture through the loop of the cerclage without the surgeon having to balance the simultaneous installation of the cerclage and the clavicle fixation assembly.

[0004] A system configured for the treatment of an acromioclavicular (AC) joint according to an exemplary aspect of the present disclosure includes, among other things, a cerclage configured to be disposed around the coracoid process. The cerclage includes a loop.

[0005] A method for the treatment of an acromioclavicular (AC) joint according to an exemplary aspect of the present disclosure includes, among other things, providing a cerclage around the coracoid process such that the cerclage includes a loop, and passing a portion of a clavicle fixation assembly through the loop.

[0006] Another method according to an exemplary aspect of the present disclosure includes, among other things, providing a cerclage around a first bone such that the cerclage includes a loop, passing a suture strand through the loop, applying tension to the suture strand, and securing the suture strand to a second bone to maintain the relative positions of the first and second bones.

Brief Description of the Drawings

[0007]

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[0008] The present disclosure details systems and methods useful for treating the acromioclavicular (AC) joint. FIG. 1 is an exemplary view of the shoulder and, in particular, illustrates an AC joint 10 including the coracoid process 12 and the clavicle 14 above the coracoid process 12. In a healthy AC joint, the coracoclavicular ligaments 16, 18 connect the coracoid process 12 to the clavicle 14. The AC joint 10 further includes the acromion 20 that is transverse to the clavicle 14 and, in a healthy AC joint 10, the acromion 20 is connected to the clavicle 14 by the acromioclavicular ligament 22. In FIG. 1, each of the ligaments 16, 18, 22 is completely torn and, therefore, the clavicle 14 is displaced from its predetermined position relative to a healthy AC joint where those ligaments are not torn. While three completely torn ligaments are shown in FIG. 1, the present disclosure is useful for treating AC joints with other defects such as an AC joint having one or more worn, partially torn, or completely torn ligaments. Further, the present disclosure can be used outside the context of the AC joint and, in particular, can be used for treating sternal closure, scapular adhesion (FIG. 9), or fractured or dislocated ribs (FIG. 10).

[0009] Figure 2 illustrates a system 24 configured to treat the AC joint 10. In Figure 2, the system 24 is attached to the AC joint 10 and holds the clavicle 14 in a position substantially similar to the position of a healthy AC joint where the ligaments 16, 18, 22 are not torn.

[0010] The system 24 includes a cerclage 26 disposed around the coracoid process 12 and a clavicle fixation assembly 28 configured to hold the clavicle 14 in a fixed position relative to the coracoid process 12. Further, the cerclage 26 includes a loop 30, and a portion of the clavicle fixation assembly 28 is configured to pass through the loop 30. In this embodiment, the clavicle fixation assembly 28 includes at least one suture strand 32 that passes through the loop 30 and a fixation device 34 (such as a PushLock® or SwiveLock® anchor commercially available from Arthrex, Inc.) that is insertable into the clavicle 14 and holds the suture 32, thereby holding the clavicle 14 in a fixed position. The suture 32 may be fixed to the clavicle 14 using a fixation device 34 other than an anchor or by using an entirely different technique. The suture 32 may include a plurality of suture strands. The suture 32 may also include one or more suture strands attached to the acromion 20. In this regard, the term clavicle fixation assembly 28 includes sutures attached to other bones such as the acromion.

[0011] Figure 3 is an enlarged partial view of the system 24 disposed relative to the coracoid process 12. As shown, the cerclage 26 is disposed around the coracoid process 12. The cerclage 26 is tightly clamped against and in direct contact with the outer surface of the coracoid process 12. The cerclage 26 extends entirely around the coracoid process 12. In this embodiment, the cerclage 26 is made of a suture strand 36.

[0012] In one embodiment, the suture 36 forming the cell closure 26 is a high-strength braided suture such as FiberTape® from Arthrex, Inc. The suture 36 may include a multifilament cover formed of a plurality of ultra-high molecular weight polyethylene (UHMWPE) braided fibers and polyester fibers. The cover may surround a core formed of twisted fibers of ultra-high molecular weight polyethylene (UHMWPE). However, other types of sutures are within the scope of the present disclosure.

[0013] In FIG. 3, the suture 32 of the clavicle fixation assembly 28 includes three suture strands 32A - 32C, each of which passes through the loop 30. The suture strands 32A - 32C may be made of the same type of suture as the cell closure 26 or another type of suture. Each of the three suture strands 32A - 32C is tensioned and fixed to either the cell closure 14 or the acromion 20 using a fixing device such as the fixing device 34.

[0014] In the embodiment of FIG. 3, the loop 30, which is a shape generated by a curve that bends around the cross itself, is formed by tying the suture 36 with at least one knot. In this way, both the cell closure 26 and the loop 30 are formed of the suture 36, and the loop 30 is integrally formed with the cell closure 26. The loop 30 may be provided by a separate structure, but this may be attached to the cell closure 26 by being sewn into the cell closure or by using some other attachment technique. In one embodiment, a rigid small hole made of a high-strength rigid polymer is sewn into the suture 36 to provide the loop 30 to the cell closure 26. In another embodiment, a through-hole may be formed in the suture 36 by punching or the like, and the through-hole may provide the loop 30. The small hole or seam may provide the boundary of the through-hole.

[0015] After arranging the cell closure 26 around the coracoid process 12, the cell closure 26 is tightened, the loop 30 is positioned near the upper portion of the coracoid process 12, and the knot 38 is tied to hold the cell closure 26 in place. The knot 38 may include one or more known types of knots, including surgical knots. The suture strands 32A-32C can pass freely through the loop 30 to position the clavicle 14 and / or the acromion 20.

[0016] While the term cell closure is often used to refer to a ring or loop of material that binds fractured bones together, in this embodiment, the cell closure 26 is positioned against the healthy coracoid process 12. The cell closure 26 itself is a ring or loop (which includes the additional loop 30) positioned around the coracoid process 12, which is used to maintain the position of the clavicle 14 and / or the acromion 20 and to treat and / or stabilize it. The use of the term cell closure in the present disclosure does not mean that the bone being cell-closed is fractured.

[0017] Here, an exemplary method of providing the cell closure 26 against the coracoid process 12, including forming the loop 30, will be described. The surgeon may perform some or all of the method. One or more steps of the method may be performed by the manufacturer or a surgical assistant. The method may be performed partially or fully during arthroscopic surgery.

[0018] Referring to FIG. 4, a suture 36 used for cell closure 26 is provided and is disposed relative to a pull-through suture 40. The pull-through suture 40 includes a first end loop 42 and a second end loop 44 on the opposite side of the first end loop. A main section 46 connects the first and second end loops 42, 44. The pull-through suture 40 may be provided by a suture strand such as a monofilament suture, and in one embodiment, is a suture thinner than the suture 36. The first and second end loops 42, 44 may be provided by tying and / or sewing them to the main section 46. The use of the pull-through suture 40 will be described below. The pull-through suture 40 does not form part of the installed cell closure 26, but instead is used only during the process of installing the cell closure 26.

[0019] In FIG. 4, the suture 36 is folded so as to present a folded end 48 and first and second free ends 50, 52. The suture 36 is tied in a cow hitch knot 53 around the main section 46 of the pull-through suture 40 in this embodiment. However, while the cow hitch knot is mentioned, other types of knots such as other types of hitch knots may be used. The cow hitch knot 53 is arranged such that the suture 36 presents a pull-through loop 54 adjacent to the main section 46. Since this step may be performed preoperatively or before winding the suture 36 around the uvula protrusion 12, tying the cow hitch knot 53 to the pull-through suture 40 is sometimes referred to as preloading the pull-through suture 40 into the pull-through loop 54.

[0020] Next, suture 36 is tied to provide loop 30. As shown, suture 36 presents two lengths between the folded end 48 and the first and second free ends 50, 52. As represented in FIG. 5, the lengths are held together and simultaneously (in one) tied to the first stopper knot 56. Another type of knot may be used. The first stopper knot 56 is loosely held so as to present an opening 58 provided by the two lengths of suture 36, which will ultimately form the opening of loop 30. In this regard, loop 30 is provided by the two loop lengths of suture 36, which provides a secure connection point to the clavicle fixation assembly 28.

[0021] Next, as represented in FIG. 6, another knot is tied adjacent to the first stopper knot 56. In FIG. 6, the second stopper knot 60 is tied. The second stopper knot 60 is fully tightened adjacent to the first stopper knot 56, holding the opening 58 in place, and as a result, the opening 58, and then loop 30, is prevented from closing. Therefore, additional sutures, such as the suture of the clavicle fixation assembly 28, can pass through loop 30.

[0022] As described above, one or more steps of the method may be performed prior to surgery. In a particular embodiment, the steps represented by FIGS. 4 - 6 may be performed preoperatively by a surgical assistant or the manufacturer.

[0023] When the structures of FIGS. 4-6 are formed, the first and second free ends 50, 52 pass around the coracoid process 12 during surgery, as generally shown in FIG. 7. Next, the first and second free ends 50, 52 are inserted into one of the first end loop 42 or the second end loop 44. In FIG. 7, both the first and second free ends 50, 52 are inserted into the second end loop 44. Next, as shown in FIG. 8, the surgeon applies force to the first end loop 42, pulls the second end loop 44 through the pull-through loop 54, and then pulls the first and second free ends 50, 52. The first and second free ends 50, 52 are then further pulled in the same direction to tighten the cell closure 26 around the coracoid process 12. Then the knot 38 is tied as needed and the excess is trimmed.

[0024] With the cell closure 26 in place, the clavicle fixation assembly 28 may then be installed by passing the suture 32 through the loop 30, applying tension to the suture 32 to provide the desired position of the clavicle 14 and / or acromion, and securing at least one suture 32 in place relative to the clavicle 14 and / or acromion 20, among other things. Although exemplary methods have been described, the present disclosure extends to variations of the methods described above.

[0025] As described above, the present disclosure can be used outside the context of the AC joint. FIGS. 9 and 10 illustrate two such embodiments. FIGS. 9 and 10 illustrate a system 124 similar to the system 24, with like parts having a "1" added to the head of the reference numeral. The system 124 is used for bones adjacent to the thoracic vertebrae.

[0026] Referring to FIG. 9, the cell closure 126 is provided with respect to the scapula 162. The cell closure 126 is provided through a hole 164 that may be opened within the scapula 162 and is wound around the inner edge 166 of the scapula 162. The cell closure 126 is arranged such that the loop 130 projects inside the inner edge 166. The cell closure 126 is formed and positioned using techniques similar to those described above and shown with respect to FIGS. 4 - 8. A fixation assembly 128 including a plurality of suture strands 132A, 132B, 132C is used to apply tension to the scapula 162 and hold the scapula 162 against the ribs 168A, 168B, 168C, thereby providing scapular adhesion.

[0027] In another embodiment, the system 124 may be used to treat rib slippage or fracture. Referring to FIG. 10, the system 124 includes a cell closure 126 provided around a rib 168D in either a slipped or fractured state. The cell closure 126 is formed and positioned using techniques similar to those described above and shown with respect to FIGS. 4 - 8, and the cell closure 126 is arranged around the rib 168D such that the loop 130 projects from the rib 168D in a direction (here, upward) towards other healthy ribs 168B, 168C to which the fixation assembly 128 will be attached. In this embodiment, the fixation assembly 128 includes two suture strands 132A, 132B that pass through the loop 130 and are attached to one of each of the ribs 168B, 168C. Before being attached to the ribs 168B, 168C, the suture strands 132A, 132B are tensioned to position the rib 168D in a desired position to promote healing.

[0028] Of course, directional terms such as upper, inner, outer, etc. are used herein in accordance with their accepted meanings in the art. These terms should not be considered to be limiting in any other way.

[0029] Although the different embodiments have the specific components shown in the explanatory drawings, the embodiments of the present disclosure are not limited to those specific combinations. It is possible to use some of the components or features from one of those embodiments in combination with the features or components of another of those embodiments. In addition, the various figures accompanying the present disclosure are not necessarily drawn to scale, and some features may be exaggerated or minimized to show certain details of a particular component or arrangement.

[0030] Those skilled in the art will understand that the above embodiments are illustrative and non-limiting. That is, modifications to the present disclosure will fall within the scope of the claims. As a result, the following claims should be considered to determine the true scope and content thereof.

Claims

1. A system configured for the treatment of the acromioclavicular (AC) joint, a cerclage configured to be disposed around the coracoid process, the cerclage including a loop, the cerclage being provided by a first suture strand, the cerclage; and a clavicle fixation assembly configured to hold the clavicle against the coracoid process, a portion of the clavicle fixation assembly being configured to pass through the loop, the clavicle fixation assembly including a second suture strand, the second suture strand being configured to pass through the loop and attach to the clavicle, the clavicle fixation assembly; and A system comprising.

2. The system of claim 1, wherein the loop is also provided by the first suture strand.

3. The first suture strand is folded and includes a folded end and first and second free ends opposite the folded end, The system of claim 2, wherein the loop is adjacent to the folded end.

4. A pull-through loop is also provided adjacent to the folded end, The first and second free ends are configured to be pulled through the pull-through loop so as to tighten the cerclage against the outer surface of the coracoid process by continuously pulling the first and second free ends.

5. A pull-through suture is pre-loaded into the pull-through loop, The pull-through suture includes a first end loop and a second end loop opposite the first end loop, One of the first and second end loops is configured to receive the first and second free ends, The system according to claim 4, wherein the other of the first and second end loops is configured such that a user can apply a force and pull the first and second free ends through the pull-through loop. **Claim 6** The system according to claim 1, wherein the loop is provided by a separate structure attached to the first suture strand. **Claim 7** The system according to claim 6, wherein the separate structure is a rigid eyelet. **Claim 8** The system according to claim 6, wherein the separate structure is sewn into the first suture strand.

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