Percutaneous delivery device and method for tendon-ligament-muscle repair
Embodiments include systems, methods and devices for the percutaneous delivery of therapeutic agents to tendons, ligaments and muscle. Certain embodiments include a device comprising a needle-catheter based delivery system with adjustable characteristics to allow a clinician to control the angle and depth of needle and/or catheter deployment to a desired location. System embodiments may include a controller unit where a clinician can adjust the axial position depth and location of needles and/or catheters.
1. A device for percutaneous use comprising:
a tubular system having at least two hollow tubes, the tubular system comprising:
an outer tube having a first proximal end, a first hollow shaft, and a first distal end; and
an innermost tube, the innermost tube having a second proximal end, a second hollow shaft, and a second distal end, the innermost tube being housed coaxially within the first hollow shaft of the outer tube, the innermost tube configured to advance within the first hollow shaft of the outer tube, and wherein the second distal end of the innermost tube exits the first distal end of the outer tube, wherein the innermost tube comprises a plurality of projections at the second distal end, the plurality of projections aligned to engage ligament, tendon, or muscle fiber bundles and configured to guide the second distal end of the innermost tube along the axial direction of the ligament, tendon, or muscle fiber bundles, without flexing toward the innermost tube, as the innermost tube is advanced in the axial direction into the ligament, tendon, or muscle fiber bundles; and
a controller apparatus operatively coupled to the tubular system, the controller apparatus configured to adjust an angle of deployment of the tubular system in a coronal plane, and further to adjust an angle of deployment of the innermost tube in a sagittal plane independently from the outer tube, the controller apparatus further configured to adjust a length of deployment of at least one of the tubes of the tubular system.
2. The device of claim 1 , wherein the second distal end of the innermost tube comprises a pre-formed curvature having a shallowest angle when fully retracted, and a steepest angle when fully extended from the first distal end.
3. The device of claim 1 , wherein the first distal end of the outer tube is angled in a preformed direction that guides the innermost tube as the second distal end exits the first distal end at the preformed angle of the first distal end.
4. The device of claim 1 wherein:
the tubular system further comprises an inner tube having a third proximal end, a third hollow shaft, and a third distal end, the inner tube housing the innermost tube in the third hollow shaft.
5. The device of claim 4 , wherein the third distal end of the inner tube comprises a pre-formed curvature having a shallowest angle when fully retracted, and a steepest angle when fully extended from the first distal end.
6. The device of claim 1 , wherein the innermost tube further comprises a rotation mechanism near the second distal end that allows the plurality of projections to freely rotate perpendicular to a longitudinal axis of the innermost tube.
7. The device of claim 1 , wherein the plurality of projections at the second distal end of the innermost tube comprise a size and geometry that interacts with the fiber bundles to allow the innermost tube to self-navigate in the direction of the bundles, wherein the size and geometries are selected from a group comprising sharp, rounded, pointed, smooth, wing-shaped, tines, square, rectangular, half-circular, and triangular.
8. The device of claim 1 , wherein the plurality of projections comprise grooves, ridges, or perturbations that further interact with smaller fiber bundles of tissue to aid in self-guidance of the innermost tube.
9. The device of claim 1 wherein the controller apparatus comprises one or more components to control the deployment length and the deployment angles of the innermost tube.
10. The device of claim 1 wherein the controller apparatus comprises one or more knobs or dials providing for adjustment of the deployment length and the deployment angles of the tubular system.
11. The device of claim 1 , wherein the controller apparatus comprises a visual display providing deployment length and deployment angle adjustment feedback.
12. The device of claim 1 , wherein the innermost tube is formed in a substantially helical spiral shape.
13. The device of claim 1 wherein the outer tube comprises a needle tip having at least one of the following tip types, Quincke, Touhy, beveled, Whitacre, and pencil point.
14. The device of claim 1 wherein at least one of the first, second, or third distal tips are echogenic.
15. The device of claim 1 wherein the at least one of the at least two tubes of the tubular system are visible using fluoroscopy.
16. The device of claim 1 wherein the innermost tube is comprised of at least one of a memory metal, steel, a carbon steel, a surgical steel, or a polymer plastic.
17. The device of claim 16 wherein the innermost tube is comprised of memory metal, and the memory metal comprises at least one of copper-zinc-aluminum-nickel, copper-aluminum-nickel, or nickel-titanium.
18. The device of claim 16 wherein the innermost tube is comprised of polymer plastic, and the polymer plastic comprises at least one of silicone rubber, nylon, polyurethane, polyethylene terephthalate latex or thermoplastic elastomers.
19. A method for percutaneous treatment of the proximal region of an anterior cruciate ligament (ACL) comprising:
providing a device for percutaneous use comprising:
a tubular system having at least two hollow tubes, the tubular system comprising:
an outer tube having a first proximal end, a first hollow shaft, and a first distal end; and
an innermost tube, the innermost tube having a second proximal end, a second hollow shaft, and a second distal end, the innermost tube being housed coaxially within the first hollow shaft of the outer tube, the innermost tube configured to advance within the first hollow shaft of the outer tube, and wherein the second distal end of the innermost tube exits the first distal end of the outer tube, wherein the innermost tube comprises a plurality of projections at the second distal end, the plurality of projections aligned to engage ligament, tendon, or muscle fiber bundles and configured to guide the second distal end of the innermost tube along the axial direction of the ligament, tendon, or muscle fiber bundles; and
a controller apparatus operatively coupled to the tubular system, the controller apparatus configured to adjust an angle of deployment of the tubular system in a coronal plane, and further to adjust an angle of deployment of the innermost tube in a sagittal plane independently from the outer tube, the controller apparatus further configured to adjust a length of deployment of at least one of the tubes of the tubular system;
determining an angle of the ACL preoperatively;
aligning the outer tube with the determined angle of the ACL in at least one plane;
deploying the outer tube into the ACL substantially aligned with the determined angle of the ACL;
deploying the innermost tube from the outer tube; and
positioning the innermost tube to a proximal region of the ACL, the positioning step comprising;
adjusting an angle of the innermost tube along a second plane perpendicular to the at least one plane;
engaging a ligament, tendon, or muscle fiber bundle with at least one of the plurality of projections from the innermost tube;
guiding the innermost tube along the ligament, tendon, or muscle fiber bundle with at least one of the plurality of projections from the innermost tube; and
deploying therapeutic agents through the innermost tube to the proximal region of the ACL.
20. The method of claim 19 wherein the outer tube is aligned by the controller apparatus to the determined angle of the ACL in the coronal plane of the ACL.
21. The method of claim 20 wherein the innermost tube is aligned by the controller apparatus to a selected angle in the sagittal plane of the ACL.