Knotless soft tissue attachment
Devices and methods to attach soft tissue to bone include, for example, forming a transosseous bone tunnel, and forming a suture construct securing soft tissue to the bone wherein the suture construct extends from the soft tissue to the first opening, through the first opening, through the bone tunnel, through the second opening, and outside of the bone tunnel to the soft tissue.
1. A method of attaching a soft tissue to bone, the method comprising:
forming a bone tunnel through the bone, the bone tunnel having at least first and second spaced apart openings at a surface of the bone;
inserting a knotless suture anchor into a portion of the bone tunnel such that the knotless suture anchor is fully contained within the bone tunnel, the knotless suture anchor having a proximal end, a distal end and a longitudinal axis extending from the proximal end to the distal end;
engaging the knotless suture anchor with a suture having a first end and a second end and a mid-portion in between the first and second ends, to form a suture construct securing the soft tissue to the bone wherein the suture construct extends from the knotless suture anchor to the soft tissue and from the soft tissue to the knotless suture anchor, the suture construct passing only once through each of the first opening and the second opening; and
moving a locking mechanism within the knotless suture anchor to lock the first end and the second end to the knotless suture anchor, and wherein the suture is not routed through the locking member.
2. The method of claim 1 wherein engaging the knotless suture anchor with the suture comprises engaging the knotless suture anchor with the suture to form a loop of suture with first and second suture ends secured by the knotless suture anchor.
3. The method of claim 1 wherein engaging the knotless suture anchor with the suture comprises engaging the knotless suture anchor with a plurality of discrete sutures.
4. The method of claim 1 further comprising:
passing the suture through the soft tissue prior to engaging the knotless suture anchor with the suture to form the suture construct.
5. The method of claim 4 wherein the suture is positioned with a first suture portion on a first side of the soft tissue and a second suture portion on a second side of the soft tissue, the first suture portion extending from the soft tissue to the knotless suture anchor along a first path through the bone tunnel and the second suture portion extending from the soft tissue to the knotless suture anchor along a second path outside of the bone.
6. The method of claim 5 wherein at least one of the first and second suture portions extends through a portion of the knotless suture anchor and at least one of the first and second suture portions extends along a portion of the outside of the knotless suture anchor.
7. The method of claim 1 wherein moving the locking mechanism locks both the first and second suture ends relative to the knotless suture anchor.
8. The method of claim 1 wherein the knotless suture anchor includes a longitudinal passage extending into an anchor body from the proximal end, and wherein moving the locking mechanism further comprises:
advancing the locking mechanism in the longitudinal passage.
9. The method of claim 8 wherein the locking mechanism is dimensioned and configured to urge at least one of the first and second suture portions toward an inner wall of the longitudinal passage.
10. The method of claim 1 further comprising:
after engaging the knotless suture anchor, tensioning the suture.
11. The method of claim 10 further comprising:
after tensioning the suture, provisionally securing the suture with the knotless suture anchor such that tension on the suture is temporarily maintained; and
evaluating the suture construct.
12. The method of claim 11 further comprising:
after evaluating the suture construct, adjusting the suture.
13. The method of claim 1 wherein forming the bone tunnel through the bone comprises forming a bone tunnel through a proximal humeral bone adjacent to a rotator cuff.
14. The method of claim 1 wherein the bone tunnel is formed through the bone as a single continuous path from a first opening on a surface of the bone to a second opening on a surface of the bone.
15. The method of claim 1 wherein the bone tunnel is formed through the bone by first and second intersecting bores into the bone.
16. The method of claim 1 wherein the suture extends from the soft tissue to the first opening, through the first opening to the knotless suture anchor, and the suture extends from the soft tissue outside of the bone tunnel to the second opening, through the second opening to the knotless suture anchor.
17. The method of claim 1 , wherein:
moving the locking mechanism within the knotless suture anchor to lock the first end and the second end to the knotless suture anchor comprises:
locking the first end closer to the proximal end than the distal end; and
locking the second end closer to the distal end than the proximal end; and
after moving the locking mechanism, the mid-portion extends outside the knotless suture anchor from the proximal end to the distal end.
18. A method of making a transosseous repair of a rotator cuff adjacent a shoulder joint, the method comprising:
forming a bone tunnel through a humeral bone, the bone tunnel having at least first and second spaced apart openings at a surface of the humeral bone;
forming a suture construct securing a portion of the rotator cuff to the humeral bone, without tying any knots,
wherein:
the suture construct comprises a knotless suture anchor residing entirely within the bone tunnel, the knotless suture anchor having a one-piece anchor body;
the suture construct extends from the knotless suture anchor to the rotator cuff and from the rotator cuff to the knotless suture anchor, the suture construct passing only once through each of the first opening and the second opening; and
forming the suture construct further comprises moving a locking mechanism in the knotless suture anchor to secure the suture such that when the suture is secured, the suture has not been passed through the locking mechanism.
19. A method of attaching a soft tissue to a bone, the method comprising:
forming a bone tunnel through the bone, the bone tunnel having at least first and second spaced apart openings at a surface of the bone;
engaging a knotless suture anchor with a suture to form a suture construct securing the soft tissue to the bone by passing the suture through at least one pair of apertures on a longitudinal side of the anchor, the suture construct extending from the knotless suture anchor to the soft tissue and from the soft tissue to the knotless suture anchor, the suture construct passing only once through each of the first opening and the second opening; and
with the suture anchor residing entirely within the bone tunnel, longitudinally translating a locking member within the knotless suture anchor, to lock the suture relative to the knotless suture anchor, and wherein the suture is not routed through the locking member.
20. The method of claim 19 wherein the knotless suture anchor has a longitudinal passageway into which the locking member is translated longitudinally.