NONCIRCULAR BROACH AND METHODS OF USE
The disclosure provides apparatus and methods of use pertaining to a surgical broach for creating a noncircular bore in bone. Embodiments include a surgical punch having a handle coupled with a broach shaft. The broach shaft features a cylindrical portion with a boss projecting radially from the cylindrical portion. When the broach shaft is pressed into bone, it creates a circular bone tunnel having a relief groove projecting radially from and in communication with the circular bone tunnel. Thus, when an implant such as a return anchor for a suture is pressed into the resulting noncircular bore, a return path of the suture passes through the relief groove projecting from the bone tunnel, thereby reducing suture traffic through an internal passage of the anchor and relieving the need for an outer sidewall of the anchor to accommodate the return suture path. Other embodiments are disclosed.
1 . An orthopedic surgical punch for creating a noncircular bore within a bone, the punch comprising a broach shaft including:
a cylindrical portion; and
a boss projecting radially from the cylindrical portion, wherein pressing the broach shaft into the bone forms a cylindrical bone tunnel in communication with a relief groove, the cylindrical bone tunnel configured to receive and retain a press-in suture return implant having a sidewall that forms an internal passage with a proximal opening, the relief groove providing a clearance pathway for a return path of a suture exiting the suture return implant through the sidewall of the suture return implant.
2 . The orthopedic surgical punch of claim 1 , further comprising a handle affixed to a proximal end of the broach shaft.
3 . The orthopedic surgical punch of claim 1 , wherein the boss of the broach shaft is rectangular.
4 . The orthopedic surgical punch of claim 1 , wherein the cylindrical portion of the broach shaft tapers to a conical distal end.
5 . The orthopedic surgical punch of claim 1 , wherein the suture return implant comprises a suture returning and locking anchor.
6 . The orthopedic surgical punch of claim 5 , wherein the suture returning and locking anchor comprises a knotless and reversible locking mechanism.
7 . The orthopedic surgical punch of claim 6 , wherein the knotless and reversible locking mechanism comprises a set screw rotationally input into the proximal opening of the suture returning and locking anchor to form an interference fit between the set screw, the suture, and the sidewall of the suture returning and locking anchor.
8 . A method of anchoring a suture to a first bone portion, the suture having opposing first and second ends, the method using:
a first fixation anchor having a sidewall that forms an internal passage having a proximal opening; and
a punch having a broach shaft including a cylindrical portion with a boss projecting radially from the cylindrical portion, the method comprising:
pressing the broach shaft into the first bone portion to form a circular bone tunnel having a relief groove in communication with the circular bone tunnel;
threading the first end of the suture through the first fixation anchor from the proximal opening, down the internal passage, and out through the sidewall of the first fixation anchor; and
pressing the first fixation anchor into the circular bone tunnel such that the first end of the suture passes out of the first bone portion through the relief groove adjacent the sidewall of the first fixation anchor.
9 . The method of claim 8 , further comprising:
affixing the first end of the suture to one or more of a second bone portion, a soft tissue portion, and a second fixation anchor;
pulling upon the second end of the suture to tension the suture between the first and the second ends; and
locking the second end of the suture relative to the first fixation anchor.
10 . The method of claim 9 , wherein the locking the second end of the suture relative to the first fixation anchor comprises knotlessly and reversibly locking the second end of the suture relative to the first fixation anchor.
11 . The method of claim 10 , wherein the locking the second end of the suture relative to the first fixation anchor comprises rotationally inserting a set screw into the proximal end of the first fixation anchor to form an interference fit between the set screw, the second end of the suture, and the sidewall of the first fixation anchor.
12 . The method of claim 8 , wherein the first fixation anchor comprises a suture returning and locking anchor.
13 . The method of claim 8 , wherein the punch further comprises a handle affixed to a proximal end of the broach shaft.
14 . A knotless construct for bone or tissue reinforcement, the knotless construct comprising a returning fixation located at a first bone portion, the returning fixation including:
a noncircular bore formed within the first bone portion, the noncircular bore comprising a bone tunnel having a relief groove extending radially from the bone tunnel;
a first fixation anchor press fit within the bone tunnel, the first fixation anchor having a sidewall forming an internal passage with a proximal opening; and
a suture having first and second opposing ends, the first end threaded through the first fixation anchor from the proximal opening, distally down the internal passage, through the sidewall, and proximally out of the first bone portion through the relief groove adjacent the sidewall of the first fixation anchor.
15 . The knotless construct of claim 14 , wherein the noncircular bore is formed by pressing a broach shaft into the first bone portion, the broach shaft having a cylindrical portion with a boss projecting radially from the cylindrical portion.
16 . The knotless construct of claim 15 , wherein the boss projecting radially from the cylindrical portion of the broach shaft is a rectangular boss.
17 . The knotless construct of claim 14 , wherein the returning fixation comprises a returning and locking fixation and the first fixation anchor is a suture returning and locking anchor.
18 . The knotless construct of claim 17 , further comprising a locking fixation located at one or more of a second bone portion, a soft tissue portion, and a second fixation anchor, wherein the first end of the suture is attached at the locking fixation.
19 . The knotless construct of claim 18 , wherein a tensile force is placed upon the suture between the locking fixation and the returning and locking fixation.
20 . The knotless construct of claim 19 , the returning and locking fixation further comprising a set screw rotationally inserted into the proximal opening of the suture returning and locking anchor to reversibly lock the second end of the suture in relation to the suture returning and locking anchor.