# US 2013/0158596 A1 · Methods and systems for attaching tissue to bone

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- Number: US 2013/0158596 A1
- Document ID: US20130158596A1
- Status: Published application
- Kind: A1
- Application number: 13/328,656
- Filed: 2011-12-16
- Published: 2013-06-20
- Earliest claimed: 2011-12-16
- Assignees: DePuy Mitek, LLC
- Inventors: Gerome O. Miller; Kevin B. McKenney; Gregory R. Whittaker
- Web page: https://patentgrep.com/patent/US20130158596A1

## CPC

- A61B 17/17: Guides {or aligning means} for drills {, mills, pins or wires}
- A61B 17/0401: {Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors (A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811)}
- A61B 17/0483: {Hand-held instruments for holding sutures (A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30)}
- A61B 17/0485: {Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet}
- A61B 17/34: Trocars; Puncturing needles
- A61B 2017/0409: {Instruments for applying suture anchors}
- A61B 2017/0414: {having a suture-receiving opening, e.g. lateral opening}
- A61B 2017/044: {with a threaded shaft, e.g. screws}
- A61B 2017/0445: {cannulated, e.g. with a longitudinal through-hole for passage of an instrument}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

A system and method for attaching tissue to bone are provided. In one embodiment, a system for attaching tissue to bone includes a suture, suture anchor, inserter tool, drill, and drill guide having an outer guide and an inner guide. A method for attaching tissue to bone includes attaching a suture to tissue, nesting the suture in a notch on the distal end of the outer guide, passing the suture through a lumen formed in the outer guide, and inserting an inner guide in a lumen formed in the outer guide. The drill guide protects the suture from rotational movement of the drill and allows a user to maintain alignment between the drill guide and the drilled hole. As a result, a suture anchor can be more easily positioned within the drilled hole.

## Claims

### Claim 1

A system for attaching soft tissue to bone, comprising:
a suture having proximal and distal ends;
a suture anchor having at least one aperture for receiving a suture;
an outer drill guide having a lumen formed therein and extending from a proximal end to a distal end thereof; and
an inner drill guide having an inner lumen formed therein and extending from a proximal end to a distal end thereof, the inner drill guide being configured to be removably and replaceably positioned within the lumen of the outer drill guide;
wherein when the inner drill guide is inserted into the lumen of the outer drill guide, the inner and outer drill guides are configured to retain at least a portion of the suture therebetween such that the suture is able to slide relative to the inner and outer drill guides.

### Claim 2 (depends on 1)

The system of claim 1, wherein the distal end of the outer drill guide includes at least one slot formed in a side wall thereof and extending proximally from the distal end.

### Claim 3 (depends on 1)

The system of claim 1, further comprising a drill tool configured to be removably and replaceably positioned within the inner lumen of the inner drill guide, and a distal end of the drill tool having a bone cutting tip disposed thereon.

### Claim 4 (depends on 2)

The system of claim 2, wherein the outer guide further includes at least one viewing window positioned adjacent to the at least one slot.

### Claim 5 (depends on 1)

The system of claim 1, wherein the distal end of the outer guide has a plurality of surface features for engaging bone.

### Claim 6 (depends on 1)

The system of claim 1, further comprising a threading tool configured to thread terminal ends of the suture through the lumen formed in the suture anchor.

### Claim 7 (depends on 1)

The system of claim 1, further comprising a cannula having a central lumen configured to receive the outer guide therein.

### Claim 8 (depends on 1)

The system of claim 1, wherein when the inner drill guide is inserted into the lumen of the outer drill guide, the distal end of the inner drill guide terminates distal to the distal end of the outer drill guide.

### Claim 9 (depends on 1)

The system of claim 1, wherein at least one bone engaging feature is disposed on an outer surface of the suture anchor.

### Claim 10 (depends on 8)

The system of claim 8, wherein a proximal end of the inner guide is configured to mate with the proximal end of the handle disposed on the outer guide.

### Claim 11

A method of attaching soft tissue to bone, comprising:
passing a suture through tissue at a desired location within a patient's body such that the suture extends through the tissue and the that first and second terminal ends of the suture are positioned outside of the patient's body;
positioning an outer guide within the patient such that a distal end of the outer guide is located adjacent to bone at a location that will receive a suture anchor and such that a portion of the suture extends through a central lumen of the outer guide;
attaching the suture to a suture anchor while terminal ends of the suture remain positioned outside of the patient's body;
inserting an inner guide through the central lumen of the outer guide such that a portion of the suture is positioned between an outer wall of the inner guide and an inner wall of the outer guide;
inserting a bone drill through a central lumen in the inner guide and forming a hole at a desired location in the bone and subsequently removing the bone drill and the inner guide; and
while maintaining the outer guide in position surrounding the hole and in contact with bone, passing the suture anchor through the outer guide and implanting the suture anchor within the hole.

### Claim 12 (depends on 11)

The method of claim 11, wherein when the outer guide is positioned within the patient, a portion of the suture adjacent to the distal end of the outer guide is slidably nested in a notch that extends proximally from the distal end of the outer guide.

### Claim 13 (depends on 11)

The method of claim 11, wherein when the inner guide is inserted into the outer guide, the distal end of the inner guide terminates proximal to the distal end of the outer guide.

### Claim 14 (depends on 11)

The method of claim 11, further comprising tensioning the suture to draw the tissue into a desired position with respect to the bone.

### Claim 15 (depends on 11)

The method of claim 11, further comprising trimming the suture adjacent to a proximal end of the suture anchor.

### Claim 16 (depends on 11)

The method of claim 11, wherein attaching the suture to the suture anchor is accomplished by passing the suture from a position outside of the suture anchor, through an opening at a distal end of the suture anchor, and up through a central lumen within the suture anchor.

### Claim 17 (depends on 11)

The method of claim 11, wherein attaching the suture to the suture anchor is performed prior to inserting the bone drill through the central lumen in the inner guide.

### Claim 18 (depends on 11)

The method of claim 11, wherein positioning an outer guide within the patient includes passing the suture through the central lumen of the outer guide until the terminal ends of the suture are positioned outside of the outer guide.

### Claim 19 (depends on 11)

The method of claim 11, wherein when the suture anchor is passed through the outer guide, a longitudinal axis of the suture anchor is substantially aligned with a longitudinal axis of the hole.

### Claim 20 (depends on 11)

The method of claim 11, wherein positioning the outer guide within the patient includes positioning the outer guide through a cannula inserted in the patient.

### Claim 21 (depends on 11)

The method of claim 11, wherein when the inner guide is inserted into the outer guide, the distal end of the inner guide terminates distal to the distal end of the outer guide.