Fixation system for an implant

Abstract

An implant for being attached to a bone, the implant comprising an implant body (111) comprising attachment means (114). A suture (112) can be attached to the attachment means (114) of the implant body (111), at least two strands (401, 402) of the suture (112) extending from the attachment means (114) through a sleeve (113) comprising a conduit (120) for receiving the suture (112) therethrough (120). The implant body (111) has a volume around the attachment means (114), and the sleeve (113) has a first end (121) configured to receive the volume of the implant body around the attachment means, and a tapered second end (122) opposite the first end (121).

Description

[0001] Fixation system for an implant

[0002] FIELD OF THE INVENTION

[0003] The invention relates to a fixation system for fixation of an implant to a bone. The invention further relates to an implant with the fixation system.

[0004] BACKGROUND OF THE INVENTION

[0005] Implants, such as bone implants, are commonly attached to the bone during implantation. Although direct fixation is possible, for example by means of a screw, this does not allow much flexibility for movement of the implant. Such movement may be necessary to support in its function, e.g. to mimic the function of a body part that the implant replaces. This specifically applies to a transition between two different tissue such as bone tissue and soft tissues including ligaments, muscles, and menisci.

[0006] For example, a meniscus is a relatively mobile element of a knee. During physiological motions of the knee, the meniscus stretches and deforms, following the bias imposed by the anatomy of other structures forming the knee joint. When an implant replaces the meniscus structure, one way to mimic the native behavior is by making the implant of a flexible material. Another way to improve the constrained movability of the implant is by fixing it to the bone using a suture providing degrees of freedom for following the joint kinematics while enabling transduction of joint loads.

[0007] Such a suture may, for example, be looped through an opening in the implant and inserted into a bone tunnel and fixed inside the tunnel. The flexibility properties of the suture may be designed to accommodate the desired freedom of movement for the attached implant. For example, a suture may have a high tensile modulus in the longitudinal direction while allowing deflection in the tangential direction, providing the attached implant a range of motion.

[0008] Substantial tensioning of the suture enables pivoting of the suture protruding from the tunnel around the tunnel ending, and pivoting of the meniscus implant ending fixed to the other end of the protruding suture. This flexibility provides guidance of the meniscus implant over the articular surface and allows for congruent motion of the implant to the imposed physiological kinematics.

[0009] WO 2015 / 057056 discloses that fixation of the meniscus implant to the underlying tibia plateau may occur with sutures or polymer cords through the horns which run further into drill holes provided in the tibia. These cords are responsible to maintain the horns of the implant in a stable position on the tibial plateau while the rest of the implant moves with the movement of the knee joint. While the implant does not biologically integrate into the surrounding tissue, its fixation completely and infinitely relies on the horn attachments to the tibia, i.e. the polymer cords. Although the cords are strong, rubbing against the bone may deteriorate the polymer material and the implant unintentionally may become a loose body in the joint.

[0010] SUMMARY OF THE INVENTION

[0011] It would be advantageous to provide an improved fixation system for an implant, in particular a meniscus implant.

[0012] According to an aspect of the invention, a fixation system is provided comprising a sleeve for a suture for fixation of an implantable device to a bone tunnel, the sleeve comprising a non-resorbable material, the sleeve comprising a conduit in a longitudinal direction of the sleeve, to accommodate a suture, wherein the conduit has an open end on both sides.

[0013] Thus, a sleeve is provided around the fixation suture. The sleeve can be a preassembled, integrated part of the suture or added to the construct as a separate part.

[0014] The sleeve may prevent that the varying tension on the suture is partly transferred to the edges of the bone tunnel into which the suture extends. Also shear stresses occurring between the suture and the edge of the bone tunnel may be reduced. The reduction of these forces and stresses may prevent deterioration of the edge of the bone tunnel. Also the sleeve may prevent deterioration of the suture around the edge of the bone tunnel. The sleeve may protect the suture against abrasive tearing with the bone edge, by increasing the contact surface and better distributing the forces. It also fills the tunnel with extra material, so that the movements of the suture through the tunnel are reduced, also reducing wear.

[0015] At least one end of the sleeve may be tapered. For example, one end of the sleeve may be tapered or both ends. This helps to more easily insert the sleeve into the bone tunnel. The sleeve may be asymmetrical in the longitudinal direction to support in the insertion of the sleeve into the tunnel at the one end, and to shield the connection with the meniscus implant on the other end.

[0016] The conduit may be wider at one end of the conduit than in a remainder of the conduit. This wider end may be opposite to the tapered end, if the tapered end is provided. The wider end allows to receive a part of the implant in the sleeve to shield the connection between the suture and the meniscus implant. At least part of the sleeve may be radially deformable. For example, at least one of the open ends of the sleeve may be radially deformable. Alternatively, the whole sleeve may be radially deformable. This may help to allow to receive a part of the implant in the sleeve to shield the connection between the suture and the meniscus implant.

[0017] The sleeve may further comprise at least one extension extending from the conduit. Such an extension allows better handling of the sleeve, in particular during implantation thereof. On one side an extension allows to pull the sleeve into the bone tunnel and / or keep it in place, while an extension on the other side of the sleeve allows to pull the sleeve towards and / or over part of the implant body attached to the loop in the suture. By exerting pulling forces to the extensions away from each other, the sleeve can be kept in place while manipulating the sutures and / or the implant body. Extensions may be removed after successful surgical implantation.

[0018] The at least one extension may comprise the suture, wherein at least one strand of the suture is fixed to the sleeve in an attachment zone of the sleeve. This may make it easier to position the sleeve in the correct place, by manipulating the suture. This improves efficient placement of the implant.

[0019] A diameter of the conduit may be configured to enable the conduit to receive a free strand of the suture extending through the conduit adjacent the attachment zone. This facilitates the looping function of the suture for fixation to the implant.

[0020] At least one extension or the suture may extend through the conduit from an inner surface or outer surface of the sleeve to beyond a first end of the conduit. The inner surface is preferred, so that the extension is also surrounded by the sleeve. Advantageously, the free end of the sleeve can receive part of the implant body while the extension / suture loops through the attachment means of the implant body.

[0021] Further, at least one extension or the suture may extend from a second end of the conduit. This extension or suture strand may be used to pull the sleeve into a bone tunnel, for example.

[0022] The attachment zone may comprise the total or a part of the contact surface between the conduit and the suture. This contact surface may be part of the inner surface of the sleeve, and part of the outer surface of the suture. The contact surface may be oriented in the longitudinal direction of the conduit and suture, for example inside the sleeve. Alternatively, the contact surface may be located at the edge of the conduit of the sleeve and may for example be oriented in the transversal direction of the conduit and suture. The attachment zone may be transient and dissolve after implantation, e.g. by means of a bioresorbable glue. The attachment is no longer needed when the implant is in place. The attachment of a separate sleeve and suture at the attachment zone may be established by other techniques including welding and stitching.

[0023] For example, the sleeve is designed so that two strands of the suture just fit side by side in the conduit, but there would be no place for a third strand. This way, the freedom of movement of the sleeve and suture combination is reduced while accommodating both strands.

[0024] The sleeve may comprise the suture, wherein the suture is fixed to the sleeve. When the suture is fixed to the sleeve, it may be easier to handle the sleeve and performance is better ensured. In particular, it is easier and / or safer to pull the sleeve into the bone tunnel rather than having to push it from one side into the tunnel.

[0025] The suture may be fixed to the sleeve inside the conduit. This way, the sleeve protects the suture. Moreover, it is possible to pull the sleeve into the bone tunnel.

[0026] The suture may be fixed to the sleeve in an attachment zone, and the conduit may extend from the attachment zone. This way, the positioning of the sleeve protruding from the bone tunnel may be controlled in detail. For example, by looping the suture to an implant and inserting the free end into the sleeve, it becomes possible to pull a part of the implant towards or into the sleeve by pulling on the free end of the suture. For example, at least 3 millimeters may be provided between at least one end of the sleeve and the attachment zone.

[0027] The attachment zone may extend up to the end of a second end of the sleeve. This way, the sleeve may be pulled into and through a tunnel without folding of the sleeve during insertion in the tunnel.

[0028] The fixation material used to fixate the suture to the sleeve may be configured to disconnect the suture from the sleeve after a while. For example, the fixation material may be slowly solvable. The fixation is not necessary anymore after the implant, suture, and sleeve have been correctly positioned.

[0029] A part of the suture may form the sleeve with the conduit for another part of the suture. This may be advantageous to reduce the number of components needed and to provide the fixation between the sleeve and the suture.

[0030] The suture and the sleeve may be made of a same material. This reduces the likelihood of side effects caused by the material used.

[0031] The sleeve may comprise a cushioning construct or material. This may further reduce the stain caused by the suture.

[0032] The wall of the conduit may be smooth enough to allow the suture to slide along the wall of the conduit under exertion of a force. If the suture can slide inside the sleeve without any object sliding over the bone surface, the wear and tear of bone and / or suture can be reduced.

[0033] The sleeve may be press-fit into a tunnel in a patient’s bone. This improves the fixation of the suture to the bone and thereby improves the fixation of the implant to the bone.

[0034] The sleeve and the suture may be constructed with the sleeve as an integral part of the suture, e.g. by means of braiding or weaving techniques. These techniques allow for defining the attachment zone while deformation of the sleeve upon fixation of the implant remains.

[0035] According to another aspect of the invention, an implant is provided for being attached to a bone, the implant comprising: an implant body comprising attachment means for a suture; a suture for being attached to the attachment means of the implant body, at least two ends of the suture extending from the attachment means when the suture is attached to the attachment means; and a sleeve comprising a conduit for receiving the suture therethrough.

[0036] The attachment means may comprise a through hole.

[0037] The implant body may have a volume around the attachment means, and the sleeve may have an end at which the conduit is wider than in a remainder of the conduit, said end configured to receive the volume of the implant body around the attachment means. The attachment of the implant and the suture limits displacement of the implant relative to the suture in the longitudinal direction of the suture.

[0038] The person skilled in the art will understand that the features described above may be combined in any way deemed useful. Moreover, modifications and variations described in respect of the system may likewise be applied to the method and to the computer program product, and modifications and variations described in respect of the method may likewise be applied to the system and to the computer program product.

[0039] BRIEF DESCRIPTION OF THE DRAWINGS

[0040] In the following, aspects of the invention will be elucidated by means of examples, with reference to the drawings. The drawings are diagrammatic and may not be drawn to scale. Throughout the drawings, similar items may be marked with the same reference numerals.

[0041] Fig. 1 A shows a sketch of a frontal view of a knee joint.

[0042] Fig. 1 B shows a sketch of a lateral view of a knee joint.

[0043] Fig. 2A shows a tibia with a tibia plateau. Fig. 2B shows a detail of tunnel trajectory.

[0044] Fig. 2C shows a detail of tunnel trajectory.

[0045] Fig. 3A shows a tibia with a tunnel.

[0046] Fig. 3B shows an example implant in a bone tunnel.

[0047] Fig. 4 shows an example implant body with suture and sleeve.

[0048] Fig. 5 shows an example implant with suture and sleeve in a bone tunnel.

[0049] Fig. 6 shows an example of a suture with strands extending through a sleeve.

[0050] Fig. 7 shows a suture and sleeve in the context of a bone.

[0051] Fig. 8 shows an example of a sleeve with an attached suture.

[0052] Fig. 9 shows an example of a sleeve with an attached suture in the context of an implant.

[0053] Fig. 10 shows an example of a sleeve with attached suture and implant in the context of a bone tunnel.

[0054] Fig. 11 shows an example of a sleeve.

[0055] DETAILED DESCRIPTION OF EMBODIMENTS

[0056] Certain exemplary embodiments will be described in greater detail, with reference to the accompanying drawings.

[0057] The matters disclosed in the description, such as detailed construction and elements, are provided to assist in a comprehensive understanding of the exemplary embodiments. Accordingly, it is apparent that the exemplary embodiments can be carried out without those specifically defined matters. Also, well-known operations or structures are not described in detail, since they would obscure the description with unnecessary detail.

[0058] Fig. 1 A shows a sketch of a frontal view of a knee joint. Fig. 1 B shows a sketch of a lateral view of a knee joint. The knee joint is where the femur 101 meets the tibia 103. A patella 102 is provided anterior of the joint. The meniscus implant 111 may be provided in the place of the lateral meniscus or medial meniscus. Tunnels may be created in the bone. For example, the tunnels may extend from positions close to the natural meniscus horns, all through the bone up to the anterior cortex of the tibia. This way, the suture may be pulled through the hole, and fixed at the far end of the tunnel, away from the prosthesis and out of the knee. Two separate sutures may be provided, one for each tunnel, to attach the meniscus implant at its fixation positions to the bone. In the illustrated example, an anterior tunnel 115 and a posterior tunnel 116 are indicated. However, the above configuration is only provided as an example. The prosthesis may have different arrangements of the implant and of the bone tunnels. Moreover, other kinds of implants may benefit from the techniques disclosed herein, such as a sleeve around a fixation suture. Another example of an implant that may benefit from the sleeve is a cruciate ligament replacement implant.

[0059] Fig. 2A shows a tibia 103 with a tibia plateau 205. Two example trajectories for a tunnel are illustrated: trajectory 202 and trajectory 203. Fig. 2B shows a detail of tunnel trajectory 203. Since the tunnel 203 is inclined with respect to the tibia plateau 205, and the forces on the implant pull the suture towards the sharp edge 206 of the end of the tunnel 203 at the tibia surface 205, the edge 206 may suffer from wear and tear. Fig. 2C shows a detail of tunnel trajectory 202. Although the tunnel 202 is not much inclined with respect to the tibia plateau 205, the forces on the implant still pull the suture towards the edge 207 of the end of the tunnel 202 at the tibia surface 205, so that the edge 206 may still suffer from wear and tear.

[0060] Fig. 3A and Fig. 3B show again the tibia 103 with the tunnel 202 extending through the tibia 103 from the tibia plateau 205 to the side of the tibia 103. Fig. 3B additionally shows the edge 207 of the tunnel 202 to which the suture 112 is drawn by the implant 111. In addition, a sleeve 113 is provided inside the tunnel 202, to reduce strain caused by the bone and in particular the edge 207. The sleeve 113 defines a conduit 120 through the sleeve 113 in longitudinal direction of the sleeve 113. The suture 112 extends through the conduit 120 of the sleeve 113.

[0061] Fig. 4 shows an implant 111 with attachment means 114 in form of a through hole. Alternatively, the attachment means 114 could be implemented by a hook or a ring (not visualized). The suture 112 is looped through the attachment means 114. Both strands 401 and 402 of the suture 112 are inserted into a sleeve 113. In the illustrated example, the sleeve 113 also covers a part of the implant 111 up to the attachment means 114.

[0062] Fig. 5 shows the implant 111 with suture 112 and sleeve 113 in a bone tunnel 202.

[0063] Fig. 6 shows another example of a suture 112 with strands 401 , 402 extending through a sleeve 613. The implant has been omitted from the illustration for clarity. Different from the other examples, the sleeve 613 has extensions 614, for example in form of pulling wires. By pulling the extensions 614, the sleeve 613 can be positioned inside the bone tunnel in the longitudinal direction. After positioning the extensions 614 may be cut away or otherwise disposed of. Alternatively, the extensions 614 are made of a biocompatible material that dissolves in the body over time. The extensions 614 may be attached to the sleeve 613 in any suitable way, by knitting or by molding, for example. Alternatively, the sleeve 613 and its extensions 614 can be made of one piece, e.g. by molding or 3D printing. Fig. 7 shows the suture 112 and sleeve 613 in the context of a bone 103.

[0064] Fig. 8 shows another example of a sleeve 113 that can be positioned by means of strands on both sides of the sleeve 113. Both strands 401 , 402 of the looped suture 111 extend through the conduit of the sleeve 113, as in the other examples. One of the strands 402 is attached to the sleeve 113 in an attachment zone 801. The other strand 401 is free. Fig. 9 shows the sleeve 113 with attached suture 111 in the context of an implant 111 , the suture 111 looping through the attachment means 114 of the implant 111 . A zone 802 of the sleeve 113 close to the loop of the suture 111 is not part of the attachment zone, and can therefore engage with part of the implant more easily, when pulling on the free strand 401 in the direction of the arrows. Fig. 10 shows the sleeve with attached suture 111 in the context of the implant 111 and the bone tunnel 202. The bone tunnel end 207 is protected by the sleeve 113. Moreover, the implant 111 is engaged with the sleeve 113 in that the sleeve 113 receives a part of the implant 111 around the attachment means 114. Because one strand 402 of the suture is attached to the sleeve 113 in the attachment zone 801 , pulling this strand 402 pulls the sleeve 113 into the bone tunnel 202. Moreover, pulling the free strand 401 pulls the horn implant 111 towards the sleeve 113, and optionally into the optional free end 802 of the sleeve 113.

[0065] In certain embodiments, the sleeve 113 and the suture 112 may form a single piece, joined together at the attachment zone 801. This may be implemented in effect as two separate sutures, for example by one suture strand extending from one end 1001 of the sleeve 113 and one suture strand extending from the inside wall of the sleeve 113, a bit away from the other end 1002 of the sleeve.

[0066] Fig. 11 shows an example of a sleeve 113 as described herein. Some optional elements are shown as well, such as extensions 614, which may optionally be the same as the suture strands 401 , 402. However, in one example, the extension on the side of the implant is the suture strand 401 , whereas the extension on the opposite side, away from the implant, is an additional extension in addition to the suture strand 402. Further illustrated are the optional widening at the first end 121 near the implant body and optional tapering at the second end 122 away from the implant body to receive the implant at one side and ease insertion in the bone tunnel at the other side.

[0067] Certain embodiments comprise an element part of a fixation system for fixation of a knee meniscus implant in the knee, the fixation system comprising a flexible fixation between the meniscus implant and the bone, in particular a fixation tape, or suture, with a high tensile modulus in the longitudinal direction while allowing deflection in the tangential direction. The deflection of the fixation suture adds to freedom of motion of the meniscus implant within the knee and supports the natural motion along the articular surfaces, enabling its function to redistribute compressive loads between the femur and tibia bones forming the knee, and, to add to distribution of the synovial fluid within the compartment considered supportive in the bearing function of the meniscus and contributing to the healthy biologic state of the articular surfaces.

[0068] The fixation sutures of the fixation system may interconnect a meniscus implant and the bone, e.g. the tibia bone, by tunneling of the fixation sutures through tunnels in the bone and fixation of the suture to the bone at a second location at a distance from the tunnel opening near the fixation point of the meniscus implant, e.g. the suture is kept in position by means of an interference screw in the cortex of the tibia. Typically, the fixation suture is looped through an opening in the meniscus prosthesis and two ends pass through the tunnel. Substantial tensioning of the fixation suture enables pivoting of the fixation suture protruding from the tunnel around the tunnel ending. Combined with pivoting of the meniscus implant ending (horn) around the other end of the protruding fixation suture, the actual end of the fixation suture, also provides guidance of the meniscus implant over the articular surface when the implant ending is not exactly aligned with the tunnel ending. These translations improve functioning of the meniscus implant and are inevitably related to wear of the fixation system at the transitional zone from free motion of the suture ending to full enclosure of the fixation suture within the tunnel.

[0069] In a surgical action creating the tunnel in the bone, an edge is formed at the ending of the tunnel. The edge of the tunnel can be more circular shaped in case the tunnel is orthogonal to the surface of the bone and more elliptical in case the tunnel is formed at an angle to the surface. As such, the angle of the tunnel can be adjusted to either create a more sharp edge on the one side of the tunnel ending and a more gradual edge on the other side of the tunnel ending. Depending on the load direction of a fixation suture protruding from the tunnel, the contacting edge of the tunnel ending with the fixation suture differs. Wear of the fixation system can be influenced by creating a tunnel orientation with less sharp angles with respect to the load directions.

[0070] The interaction between the fixation suture and the bone may also establish wear of the bone. Higher stresses are typically associated with higher wear rates of the materials, e.g. the materials of the fixation suture and biological tissues, e.g. bone and cartilage. A lower tangentiality of the tunnel generally results in a sharper angle, i.e. in case the bone surface is a flat surface, and the bone volume present to transduce the stresses exerted by the fixation suture is lower compared to the opposing side of the tunnel. In case of a certain load exerted by the fixation suture, the combined increased stress due to the smaller contact area and the lower bone volume may result in increased wear when that certain load is exerted in the direction at the relatively sharp angle. This wear may result in widening of the tunnel opening, which may in turn cause displacement of the fixation suture relative to the initial tunnel ending. This affects the fixation and the range of motion of the meniscus implant within the knee compartment, potentially resulting in undesirable contact of the meniscus implant and / or the associated fixation system with the articular surfaces of the joint, limiting the functionality and increasing the wear. As such, this type of wear and translation should be prevented.

[0071] The wear may be reduced by reducing the stress levels for the suture at the bone edge by increasing the contact area of the fixation system, or by increasing the contact area of the bone. To provide in this wear reduction, a cushioning part enclosing the load bearing fixation suture may be added at the end of the tunnel, shielding the fixation system, the end of the meniscus prosthesis, and the tissues at the tunnel ending. This cushioning part may be implemented as a ‘sleeve’. Such a sleeve may have properties that allow for substantial adaptation, deformation, of the part to the contacting surfaces. Also, it may allow for free movement of the weight bearing fixation suture upon loading of the meniscus implant while the sleeve remains in place. A connection between the sleeve and one or two ends of the looped fixation suture may be present to prevent the sleeve part to dislocate from the tunnel ending. The interconnection between the fixation suture and the sleeve also facilitates insertion of the sleeve into the tunnel opening without warping.

[0072] The sleeve may be wider at the meniscus implant ending to shield the implant-fixation suture (‘implant horn’) connection from wear inducing contact, and smaller at the tunnel ending to facilitate partial insertion into the tunnel in the combined configuration with the fixation suture. In certain alternative embodiments, the sleeve may be made of a flexible material or deformable construct so that it widens as a part of the implant is pulled into the conduit of the sleeve. T o this end, in certain embodiments at least part of the sleeve, including e.g. one of the open ends of the sleeve, may be radially deformable. Deformability may be achieved by a flexible material such as a polymer or a textile.

[0073] The outside diameter of the sleeve with the suture strands therein may be made to correspond with the intended diameter of the bone tunnel, so that the sleeve with the fixation suture is press-fit in the tunnel to provide a gradual distribution of load exerted on the bone. The sleeve can be introduced in the tunnel by means of pulling wires protruding from the distal end of the tunnel. The pulling wires may be removed after the sleeve is correctly positioned. In a similar manner, the sleeve may be pulled in the tunnel by tensioning the fixation suture when the sleeve is interconnected with the suture.

[0074] A radial marking on the outer surface of the sleeve may be provided to evaluate the position of the sleeve in the tunnel.

[0075] The sleeve supports translation of the fixation suture ending, e.g. the pivoting around the tunnel ending. As such, compressive loads exerted by the fixation suture on the surrounding bone are distributed while relative motion of the fixation suture within the sleeve remains unrestricted, also allowing for ‘rolling’ of the fixation suture within the sleeve during pivoting.

[0076] The sleeve may be made of woven or non-woven threads. Alternatively, the sleeve may be molded from a flexible material. The sleeve may be made of the same material as the suture. In certain embodiments, the material of the sleeve also has a similar structure as the suture. The sleeve may be made of a flexible material so that it adapts itself to the sutures inside the conduit and the bone tunnel around the sleeve.

[0077] Application of a sleeve extends the lifetime of the fixation system since wear becomes less direction dependent.

[0078] A method of preparing an implant surgery is defined, comprising the following steps: looping a suture through an implant, and providing a sleeve as set forth surrounding at least part of each of two strands of the suture. A method of implant surgery is defined, comprising looping a suture through a hole of an implant body, and providing a sleeve as set forth around at least part of each of two strands of the suture, and providing the sleeved strands in a bone tunnel.

[0079] The examples and embodiments described herein serve to illustrate rather than limit the invention. The person skilled in the art will be able to design alternative embodiments without departing from the spirit and scope of the present disclosure, as defined by the appended claims and their equivalents. Reference signs placed in parentheses in the claims shall not be interpreted to limit the scope of the claims. Items described as separate entities in the claims or the description may be implemented as a single hardware or software item combining the features of the items described.

[0080] Certain aspects are defined in the following clauses.

[0081] 1 . A fixation system for an implant, the fixation system comprising a sleeve for a suture for fixation of an implantable device to a bone, the sleeve (113) comprising a non-resorbable compatible material, the sleeve (113) having a conduit (120) in a longitudinal direction of the sleeve (113), to accommodate a suture (112), wherein the conduit (120) has an open end on both sides (121 , 122).

[0082] 2. The sleeve of clause 1, wherein at least one of the open ends is a tapered end (122).

[0083] 3. The sleeve of any preceding clause, wherein the conduit of the sleeve is wider at one of the open ends (121) than in a remainder of the conduit.

[0084] 4. The sleeve of any preceding clause, wherein at least one of the open ends of the sleeve is radially deformable.

[0085] 5. The sleeve of any preceding clause, further comprising at least one extension (614) extending from the conduit (120).

[0086] 6. The sleeve of any preceding clause, wherein the suture (112) is movable with respect to the sleeve.

[0087] 7. The sleeve of clause 5, wherein the at least one extension (614) comprises the suture, wherein at least one strand (402) of the suture (112) is fixed to the sleeve (113) in an attachment zone (801) of the sleeve (113).

[0088] 8. The sleeve of clause 7, wherein a diameter of the conduit (120) is configured to enable the conduit (120) to receive a free strand (401) of the suture extending through the conduit adjacent the attachment zone (801).

[0089] 9. The sleeve of any one of clauses 5, 7, and 8, wherein the extension (614) extends through the conduit from an inner surface of the sleeve (113) to beyond a first end (121) of the conduit (120).

[0090] 10. The sleeve of clause 8 or 9, wherein the at least one extension (614) further extends from a second end (122) of the conduit.

[0091] 11. The sleeve of any one of clauses 7 to 10, wherein the attachment zone (801) is bioresorbable.

[0092] 12. The sleeve of any preceding clause, wherein the suture and the sleeve are made of a same material.

[0093] 13. The sleeve of any preceding clause, wherein the sleeve comprises a cushion material or wherein two strands of the suture just fit side by side in the conduit.

[0094] 14. An implant for being attached to a bone, the implant comprising: an implant body (111) comprising attachment means (114); a suture (112) for being attached to the attachment means (114) of the implant body (111), at least two strands (401 , 402) of the suture (112) extending from the attachment means (114) when the suture (112) is attached to the attachment means (114); and a sleeve (113) comprising a conduit (120) for receiving the suture (112) therethrough (120). 15. The implant of clause 14, wherein the implant body (111) has a volume around the attachment means (114), and the sleeve (113) has a first end (121) configured to receive the volume of the implant body around the attachment means, and a tapered second end (122) opposite the first end (121).

Claims

CLAIMS:1 . A fixation system for an implant, the fixation system comprising: a suture; a sleeve for the suture for fixation of an implantable device to a bone, the sleeve (113) comprising a non-resorbable compatible material, the sleeve (113) having a conduit (120) in a longitudinal direction of the sleeve (113), to accommodate the suture (112), wherein the conduit (120) has an open end on both sides (121 , 122); and at least one extension (614) extending from the conduit (120), wherein the at least one extension (614) comprises the suture, wherein at least one strand (402) of the suture (112) is fixed to the sleeve (113) in an attachment zone (801) of the sleeve (113).

2. The sleeve of claim 1 , wherein at least one of the open ends is a tapered end (122).

3. The sleeve of any preceding claim, wherein the conduit of the sleeve is wider at one of the open ends (121) than in a remainder of the conduit.

4. The sleeve of any preceding claim, wherein at least one of the open ends of the sleeve is radially deformable.

5. The sleeve of any preceding claim, wherein the suture (112) is movable with respect to the sleeve.

6. The sleeve of claim 1 , wherein a diameter of the conduit (120) is configured to enable the conduit (120) to receive a free strand (401) of the suture extending through the conduit adjacent the attachment zone (801).

7. The sleeve of any preceding claim, wherein the extension (614) extends through the conduit from an inner surface of the sleeve (113) to beyond a first end (121) of the conduit (120).

8. The sleeve of claim 6 or 7, wherein the at least one extension (614) further extends from a second end (122) of the conduit.

9. The sleeve of any preceding claim, wherein the attachment zone (801) is bioresorbable.

10. The sleeve of any preceding claim, wherein the suture and the sleeve are made of a same material.

11. The sleeve of any preceding claim, wherein the sleeve comprises a cushion material or wherein two strands of the suture just fit side by side in the conduit.

12. An implant for being attached to a bone, the implant comprising: an implant body (111) comprising attachment means (114); a suture (112) for being attached to the attachment means (114) of the implant body (111), at least two strands (401 , 402) of the suture (112) extending from the attachment means (114) when the suture (112) is attached to the attachment means (114); a sleeve (113) comprising a non-resorbable compatible material, the sleeve (113) having a conduit (120) in a longitudinal direction of the sleeve (113), to accommodate the suture (112), wherein the conduit (120) has an open end on both sides (121 , 122); and at least one extension (614) extending from the conduit (120), wherein the at least one extension (614) comprises the suture, wherein at least one strand (402) of the suture (112) is fixed to the sleeve (113) in an attachment zone (801) of the sleeve (113).

13. The implant of claim 12, wherein the implant body (111) has a volume around the attachment means (114), and the sleeve (113) has a first end (121) configured to receive the volume of the implant body around the attachment means, and a tapered second end (122) opposite the first end (121).

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