TRANSOSSEOUS ATTACHMENT INSTRUMENTS
Techniques and instruments for surgical transosseous attachment to a bone include a guide able to guide the formation of intersecting bone tunnels and a retriever able to retrieve a suture through the bone tunnels.
1 . An instrument for placing a suture transosseously through first and second transverse, intersecting bone tunnels, The instrument comprising:
an elongated first indexing member defining an indexing member axis and having an end defining a suture support insertable into the first bone tunnel;
a guide having an indexing portion and a guiding portion, the indexing portion having an indexing portion axis and being engageable with the indexing member to constrain the indexing portion axis to a predetermined angle relative to the indexing member axis, the guiding portion defining a guide axis transverse to the indexing portion axis; and
a suture retriever engageable with the guide portion for constrained motion along the guide axis, the suture retriever having a bone penetrating end operable to be advanced into solid bone to form a second bone tunnel coaxial with the guide axis and intersecting the first bone tunnel, the suture retriever having a suture receiving portion operable to receive a suture.
2 . The instrument of claim 1 wherein the indexing portion comprises a passageway through the guide, the indexing portion being operable to axially receive the indexing member in coaxial relationship.
3 . The instrument of claim 1 wherein the indexing portion comprises an open slot having a slot wall parallel to the indexing portion axis, the indexing member defining a sidewall parallel to the indexing member axis, the indexing portion being responsive to motion transverse to the indexing portion axis to engage the slot wall with the indexing member sidewall and align the indexing member axis with the indexing portion axis.
4 . The instrument of claim 1 wherein the guide comprises an elongated member having a proximal end and a distal end, the indexing portion comprising an indexing passageway through the elongate member and the guide portion comprising a guide passageway through the elongate member transverse to the indexing passageway.
5 . The instrument of claim 4 wherein the elongated member defines a longitudinal shaft axis and both the guide passageway and the indexing passageway are transverse to the longitudinal shaft axis.
6 . The instrument of claim 4 wherein the elongated member defines a longitudinal shaft axis, the guide passageway being coaxial with the shaft axis and the indexing passageway being transverse to the longitudinal shaft axis.
7 . The instrument of claim 4 wherein the elongated member has a proximally facing face nearer the proximal end and a distally facing face nearer the distal end, the guide passageway having a proximal opening in the proximal face and a distal opening in the distal face.
8 . The instrument of claim 4 wherein the elongated member defines a side wall and the indexing passageway has an opening in the side wall.
9 . The instrument of claim 1 wherein the suture retriever comprises a proximal end and a distal end and wherein the suture receiving portion comprises a slot nearer the distal end.
10 . The instrument of claim 1 wherein the suture retriever comprises a proximal end and a distal end and wherein the suture receiving portion comprises a plurality of slots nearer the distal end.
11 . The instrument of claim 1 wherein the suture retriever comprises an elongated shaft defining a suture retriever axis extending from a proximal end to a distal end, the bone penetrating end being nearer the distal end, the bone penetrating end having a width defined in a first width direction transverse to the suture retriever shaft and the suture retriever shaft having a reduced width portion adjacent to and proximal to the bone penetrating end having a width in the first width direction less than the width of the bone penetrating portion.
12 . An instrument for placing a suture transosseously through first and second transverse, intersecting bone tunnels, the instrument comprising:
a guide having an indexing member and a guiding portion, the indexing member comprising a probe fixed to the guide, the probe being hollow and having a suture supporting portion, the guide further comprising a suture passer with an end movable within the probe between a first retracted position and a second extended position in which the suture passer displaces the suture distally from the probe, the guiding portion defining a guide axis transverse to the indexing portion axis; and
a suture retriever engageable with the guide portion for constrained motion along the guide axis, the suture retriever having a bone penetrating end operable to be advanced into solid bone to form a second bone tunnel coaxial with the guide axis and intersecting the first bone tunnel, the suture retriever having a suture receiving portion operable to receive a suture.
13 . The instrument of claim 12 wherein the distal end of the probe defines a probe tip axis and the suture retriever comprises an elongated shaft defining a suture retriever axis extending from a proximal end to a distal end and having a transverse aperture through the suture retrieving shaft, the suture retriever being mounted to the guide for translation between a first, distal retriever position in which the probe tip axis intersects the transverse aperture and a second, proximal retriever position in which the transverse aperture is displaced proximally from the probe tip axis.
14 . The instrument of claim 13 wherein the bone penetrating end is nearer the distal end, the bone penetrating end having a width defined in a first width direction transverse to the suture retriever axis and the suture retriever shaft having a reduced width portion adjacent to and proximal to the bone penetrating end having a width in the first width direction less than the width of the bone penetrating portion.
15 . The instrument of claim 13 wherein the suture retriever further comprises a retriever sleeve, the retriever shaft being mounted coaxially within the retriever sleeve for relative axial translation between a first sleeve position in which the transverse aperture is relatively open and able to receive a portion of a suture and a second sleeve position in which the sleeve at least partially covers the transverse aperture to grip a portion of a suture.
16 . The instrument of claim 15 wherein the suture retriever further comprises a handle fixed to the proximal end of the shaft, the handle having a stop engageable with the proximal end of the sleeve, the handle being responsive to a first amount of axial translation to translate the shaft within the sleeve between the first and second sleeve positions and responsive to a second amount of axial translation to translate the shaft and sleeve together relative to the guide between the first and second retriever positions.
17 . An instrument for placing a suture transosseously through first and second transverse, intersecting bone tunnels, The instrument comprising:
a guide having a proximal end and a distal end, an indexing portion formed nearer the distal end and being indexable to a first bone tunnel, the guide defining a guide path from nearer the proximal end to nearer the distal end, in predetermined relationship to the indexing portion; and
a tunnel forming instrument engageable with the guide in constrained guiding relationship along the guide path, the tunnel forming instrument having a distal end configured to penetrate bone and a suture retrieving portion having a feature able to receive a suture from the first tunnel for retrieval through the transverse, intersecting second tunnel.
18 . The instrument of claim 17 wherein the indexing portion comprises a probe engageable with the first bone tunnel.
19 . The instrument of claim 18 wherein the probe comprises a shaft and a ball tip.
20 . The instrument of claim 19 wherein the guide path passes near but not through the ball tip.