Methods and apparatus for delivering and positioning sheet-like materials in surgery
An implant delivery system for delivering a sheet-like implant is disclosed. The implant delivery system includes a distal guidewire port for receiving the proximal end of guidewire after the guidewire distal end has been affixed to a first point on bone or other tissue. The implant delivery system is tracked over the guidewire to a selected position defined by the guidewire attachment. The device includes an implant spreader assembly disposed proximate the distal end of a delivery shaft. The implant spreader assembly includes a first arm and a second arm. The arms are coupled to the delivery shaft such that the first arm and second arm are moveable between a closed position and an open position. When pivoting to the open position the distal end of each arm travels in a generally transverse direction to spread a sheet-like implant.
1. A method for delivering an implant to repair a tendon, the method comprising:
attaching a first marker proximate a lateral edge of a desired implant attachment site of a tendon;
attaching a second marker proximate the lateral edge of the implant attachment site and displaced longitudinally from the first marker to define a line therebetween parallel to the lateral edge of the implant attachment site;
identifying a point within the implant attachment site and displaced laterally from the line defined by the first marker and the second marker;
advancing an implant repair system to the implant attachment site, the implant repair system including:
a delivery shaft; and
an implant mounted on the delivery shaft in a compact configuration;
unfurling the implant to an unfurled configuration;
positioning the implant adjacent the implant attachment site;
wherein an edge of the implant is parallel to the line defined by the first marker and the second marker;
detaching the delivery shaft from the implant in vivo;
removing the delivery shaft from the implant attachment site; and
thereafter affixing the implant to the implant attachment site.
2. The method of claim 1 , wherein the implant repair system further comprises an implant spreader coupled between a distal end of the delivery shaft and the implant.
3. The method of claim 2 , wherein the implant spreader is configured and adapted to unfurl the implant from the compact configuration to the unfurled configuration.
4. The method of claim 3 , wherein the implant spreader includes a plurality of arms having a first parallel state and having a second diverging state.
5. The method of claim 4 , wherein in the unfurled configuration, the implant is positioned between the implant attachment site and the plurality of arms of the implant spreader.
6. The method of claim 1 , wherein the point is displaced laterally from the line by one-half a width of the implant.
7. The method of claim 1 , wherein identifying a point within the implant attachment site includes placing a tip of a K-wire at the implant attachment site.
8. The method of claim 7 , wherein positioning the implant adjacent the implant attachment site includes advancing the delivery shaft until a portion thereof is proximate the K-wire.
9. The method of claim 1 , wherein identifying a point within the implant attachment site includes placing a screw into the implant attachment site.
10. The method of claim 9 , wherein the screw includes a wire attached thereto.
11. The method of claim 9 , wherein positioning the implant adjacent the implant attachment site includes advancing the delivery shaft until a portion thereof is proximate the screw.
12. The method of claim 1 , wherein the affixing step comprises securing the implant to underlying tissue using a plurality of staples.
13. The method of claim 1 , wherein the tendon is a supraspinatus tendon.
14. The method of claim 1 , wherein the first marker includes a plurality of flexible arms located at a distal end thereof.
15. The method of claim 14 , wherein the second marker includes a plurality of flexible arms located at a distal end thereof.
16. The method of claim 1 , further comprising rotating the implant about the point prior to affixing the implant to the implant attachment site.
17. A method of attaching a sheet-like implant over a tendon treatment site comprising in sequence:
advancing an implant delivery system to the tendon treatment site, the implant delivery system including:
a delivery shaft; and
a sheet-like implant mounted on the delivery shaft in a compact configuration;
deploying the sheet-like implant from the delivery shaft at the tendon treatment site;
positioning the sheet-like implant in an unfurled configuration over a tendon at the tendon treatment site;
detaching the delivery shaft from the implant with the sheet-like implant positioned in the unfurled configuration over the tendon at the tendon treatment site;
removing the delivery shaft from the tendon treatment site; and
applying one or more staples to affix the implant to the tendon after removing the delivery shaft from the tendon treatment site.
18. The method of claim 17 , wherein the implant delivery system further comprises an implant spreader coupled between a distal end of the delivery shaft and the sheet-like implant.
19. The method of claim 18 , wherein the implant spreader includes a plurality of deployable arms.
20. The method of claim 19 , wherein in the sheet-like implant is positioned between the tendon and the plurality of arms of the implant spreader when the sheet-like implant is positioned over the tendon at the tendon treatment site.