Transosseous guide and method
Instruments and methods for surgical transosseous attachment to a bone include a guide able to guide the formation of intersecting bone tunnels and a passer able to pass a member through the bone tunnels.
1. A method for placing a member transosseously through first and second transverse, intersecting bone tunnels, the method comprising:
inserting a first tunnel member into a bone along a first insertion axis, the first tunnel member having a proximal end, a distal end, and a first longitudinal passage;
inserting a second tunnel member into the bone along a second insertion axis, the second insertion axis intersecting the first insertion axis, the second tunnel member having a proximal end, a distal end, and a second longitudinal passage;
inserting a passer through the first and second tunnel members in one continuous motion until the passer extends through the first longitudinal passage, the second longitudinal passage, out of the proximal end of the first tunnel member, and out of the proximal end of the second tunnel member;
engaging a flexible member with the passer; and
withdrawing the passer to pass the flexible member through the first and second tunnel members.
2. The method of claim 1 further comprising:
forming a first bone tunnel to receive the first tunnel member;
inserting the first tunnel member into the first bone tunnel; and
punching the second tunnel member into the bone to form a second bone tunnel and inserting the second tunnel member into the bone along the second insertion axis after the first tunnel member has been inserted into the first bone tunnel.
3. The method of claim 1 wherein inserting the passer through the first and second tunnel members comprises inserting the passer so that it extends between the proximal end of the first longitudinal passage, the distal end of the first longitudinal passage, the distal end of the second longitudinal passage, and the proximal end of the second longitudinal passage by advancing the passer into the proximal end of the first tunnel member, along the first longitudinal passage, through a distal opening in the first tunnel member, through a side opening in the second tunnel member, along the second longitudinal passage, and out a proximal end of the second tunnel member in one continuous motion.
4. The method of claim 3 , wherein the passer further comprises:
a wire forming a loop in a first plane, the loop being bent so that a portion of the loop forms a curved profile in a second plane perpendicular to the first plane; and
an outer tube moveable relative to the wire between a first position in which the outer tube encloses a portion of a length of the wire and a second position in which the outer tube encloses less of the length of the wire.
5. The method of claim 4 further comprising:
inserting the wire into the first tunnel member while the outer tube is positioned in the first position and subsequently moving the outer tube to the second position;
passing the loop from the distal opening in the first tunnel member through the side opening in the second tunnel member and out the proximal end of the second tunnel member;
engaging the flexible member with the loop of the passer prior to the withdrawing step;
after the withdrawing step, passing the first flexible member through soft tissue adjacent to the bone; and
securing the soft tissue to the bone.
6. The method of claim 5 wherein the step of securing the soft tissue to the bone comprises inserting a knotless anchor into a first bone tunnel and securing the first flexible member with the knotless anchor.
7. The method of claim 6 , wherein the flexible member comprises a suture.
8. The method of claim 3 , wherein the second tunnel member causes the flexible to member to define a curved profile in the second tunnel member as the flexible member travels toward the first tunnel member during the step of advancing the passer.
9. The method of claim 1 , wherein the step of engaging the flexible member with the passer is performed outside the bone and outside each of the first and second tunnel members.
10. The method of claim 1 , wherein the step of inserting the second tunnel member comprises inserting a distal end of the second tunnel member into the first tunnel member.