Method and apparatus for repairing a tendon or ligament

Abstract

A method and apparatus for reattaching the opposed ends of a member, such as a tendon, ligament or bone, during preparing and healing of the member using a surgical repair device that can be securely attached to the member and then safely guided through tortuous anatomy for reattachment and repair. The repair device further includes structural means so as to secure opposed ends of the member against separation during healing. Devices for aiding in the positioning of the surgical repair device are provided.

1 . A dilation system comprising:
 a dilation catheter comprising a tube having a lumen, the tube increasing in diameter from a first longitudinal end to a second longitudinal end.   
     
     
         2 . The dilation system of  claim 1  wherein the dilation catheter comprises a plurality of consecutive longitudinal segments, each consecutive longitudinal segment having an outer diameter over a majority of its length greater than an outer diameter of a preceding longitudinal segment. 
     
     
         3 . The dilation system of  claim 1  further comprising:
 a guide member comprising an elongate member for passing through an anatomical passage; 
 wherein the lumen of the dilation catheter is of sufficient size and shape to accept the guide member therethrough so that the dilation catheter may be slid over the guide member. 
 
     
     
         4 . The dilation system of  claim 3  wherein the guide member is longer than the dilation catheter. 
     
     
         5 . The dilation system of  claim 1  wherein the dilation catheter is unitary. 
     
     
         6 . The dilation system of  claim 1  wherein the longitudinal segments of the guide catheter are separable. 
     
     
         7 . The guide system of  claim 6  wherein each longitudinal segment of the dilation catheter has a first longitudinal end and a second longitudinal end, each end adapted to form an interference fit with a longitudinal end of a next consecutive longitudinal segment of the dilation catheter. 
     
     
         8 . The dilation system of  claim 7  wherein the first end of each longitudinal segment other than a first of said longitudinal segments has a necked down portion adapted to fit in an interference fit within the lumen of a next smaller diameter longitudinal segment of the dilation catheter. 
     
     
         9 . The dilation system of  claim 1  wherein the guide member and the dilation catheter are flexible. 
     
     
         10 . The dilation system of  claim 2  wherein each longitudinal segment is longer than an anatomical passage through which the catheter is intended to pass. 
     
     
         11 . The dilation system of  claim 2  wherein each longitudinal segment of the dilation catheter has a first end adjacent the preceding segment and a trailing end adjacent the succeeding segment and wherein each longitudinal segment other than a first segment with a smallest outer diameter includes a first portion adjacent the first longitudinal end that increases in outer diameter gradually from a first diameter substantially equal to the outer diameter at the trailing end of a preceding longitudinal segment to a second diameter larger than the first diameter, and a second portion having a constant outer diameter over its length substantially equal to the second diameter. 
     
     
         12 . The dilation catheter of  claim 1  wherein the catheter is tapered over its entire length. 
     
     
         13 . An apparatus for reattaching a longitudinal anatomical feature to another anatomical feature comprising:
 a first repair device having at least a first filament having a first longitudinal end and a second longitudinal end, a first needle attached to the first end and a second needle attached to the second end;   a catheter comprising a tube having a lumen;   a funnel member having a smaller longitudinal end for placement adjacent an entry to an anatomical passageway and a larger longitudinal end.   
     
     
         14 . The apparatus of  claim 13  wherein the funnel member does not form a complete frustoconical surface and includes a lateral opening in the surface thereof for lateral insertion of the longitudinal anatomical feature. 
     
     
         15 . The apparatus of  claim 13   wherein the catheter has a plurality of consecutive longitudinal segments, each consecutive longitudinal segment having an outer diameter over a majority of its length greater than a diameter of a preceding longitudinal segment.   
     
     
         16 . The apparatus of  claim 15  further comprising:
 an elongate guide member for passing through an anatomical passage; 
 wherein the lumen is of sufficient size and shape to accept the guide member therethrough so that the dilation catheter may be slid over the guide member. 
 
     
     
         17 . The apparatus of  claim 16  wherein the guide member is longer than the dilation catheter. 
     
     
         18 . The apparatus of  claim 15  wherein each longitudinal segment is longer than an anatomical passage that the catheter is intended to traverse. 
     
     
         19 . The apparatus of  claim 13  further comprising a sheath surrounding at least the second needle of the at least one filament. 
     
     
         20 . The apparatus of  claim 19  wherein the sheath further surrounds at least a portion of each of the first and second filaments. 
     
     
         21 . The apparatus of  claim 20  wherein the sheath further comprises a longitudinal strip for tearing the sheath longitudinally. 
     
     
         22 . The apparatus of  claim 19  wherein the sheath is longer than the longitudinal segments of the dilation catheter individually. 
     
     
         23 . The apparatus of  claim 13  wherein the catheter comprises
 a first catheter comprising a hollow tube of relatively constant diameter adapted to accept the first repair device therethrough and having a first end and a second end; and 
 a second catheter comprising a hollow tube adapted to accept the first repair device therein and having a first end adapted to be coupled to the second end of the first catheter and a second, tapered end. 
 
     
     
         24 . The apparatus of  claim 23  wherein the second tapered end of the second catheter is collapsible. 
     
     
         25 . The apparatus of  claim 24  further comprising a second repair device comprising a bone anchor having a distal end for attaching the bone anchor fixedly to bone and a proximal end having at least one filament extending therefrom. 
     
     
         26 . The apparatus of  claim 13  wherein the first and second needles are straight needles. 
     
     
         27 . A method of retrieving through an anatomical passage a first stump of a longitudinal anatomical feature for reattachment to another anatomical feature, the method comprising:
 providing a first repair device having a first longitudinal end and a second longitudinal end, the first repair device including at least one filament having a first longitudinal end defining the first longitudinal end of the first repair device and a second longitudinal end defining the second longitudinal end of the first repair device, a first needle attached to the first end of the at least one filament;   retrieving the first stump through a first opening in a patient;   stitching the at least one filament to the first stump using the first needle;   passing a catheter having a first longitudinal end and a second longitudinal end through the anatomical passage between the first opening and a second opening;   inserting at least the second longitudinal end of the at least one filament of the first repair device into the catheter from the first opening; and   pulling the catheter, the first repair device, and the first stump attached to the first repair device from the second opening.   
     
     
         28 . The method of  claim 27  further comprising a second needle attached to the second end of the at least one filament wherein the inserting comprises inserting both the first and second longitudinal ends of the at least one filament into the catheter. 
     
     
         29 . The method of  claim 27  wherein the inserting comprises passing the at least one filament through the catheter to a point where the second longitudinal end of the first filament extends from the second longitudinal end of the catheter and an end of the stump is adjacent the first longitudinal end of the catheter. 
     
     
         30 . The method of  claim 29  wherein the passing comprises inserting at least a portion of the at least one needle into a rod and pushing the filament, needle and tube through the catheter from the first opening to the second opening. 
     
     
         31 . The method of  claim 30  wherein the rod is a tube having a lumen and wherein the inserting comprises inserting the at least one needle into the lumen in the tube. 
     
     
         32 . The method of  claim 29  wherein the passing comprises:
 inserting a tube through the catheter and extending from both ends of the catheter; 
 subsequently lodging at least a portion of the at least one needle into the tube from the first opening; and 
 pulling the tube through the catheter from the second opening, whereby the needle and filament are pulled through the catheter from the first opening to the second opening. 
 
     
     
         33 . The method of  claim 29  wherein the pulling comprises pulling the repair device, first stump, and catheter simultaneously as a unit. 
     
     
         34 . The method of  claim 33  wherein the passing comprises:
 passing an elongate guide member between the first opening and the second opening; 
 passing the catheter over the guide member between the first opening and the second opening; and 
 subsequently removing the guide member. 
 
     
     
         35 . The method of  claim 34  wherein the catheter comprises a dilation catheter comprising a tube having a lumen, the tube having a plurality of consecutive longitudinal segments, each consecutive longitudinal segment having an outer diameter over a majority of its length greater than an outer diameter of a preceding longitudinal segment, and wherein the passing comprises:
 dilating the anatomical passage by passing the catheter through the anatomical passage starting with a smallest one of the longitudinal segments until a certain one of the longitudinal segments of the catheter dilates the anatomical passage a desired amount. 
 
     
     
         36 . The method of  claim 35  wherein each longitudinal segment is longer than the anatomical passage the catheter is intended to traverse and wherein the passing comprises positioning the certain one of the longitudinal segments so that it entirely occupies the anatomical passage between the first opening and the second opening. 
     
     
         37 . The method of  claim 36  wherein the passing further comprises removing the longitudinal segments other than the certain one of the longitudinal segments from the catheter after the positioning. 
     
     
         38 . The method of  claim 37  wherein the removing comprises cutting the catheter. 
     
     
         39 . The method of  claim 35  wherein the pulling comprises:
 pulling the repair device, catheter, and first stump simultaneously as a unit through the anatomical passage. 
 
     
     
         40 . The method of  claim 39  wherein the pulling further comprises:
 pulling the unit through the anatomical passage until the stump is adjacent an entry to the anatomical passage; 
 positioning a funnel member having a smaller longitudinal end and a larger longitudinal end with the smaller longitudinal end adjacent the entry to the anatomical passage; 
 placing the first stump in the funnel member; and 
 pulling the unit to cause the stump to slide through the funnel member into the anatomical passage. 
 
     
     
         41 . The method of  claim 37  further comprising:
 attaching a bone anchor to a bone; 
 removing the first repair device from the catheter; and 
 attaching the first repair device to the bone anchor. 
 
     
     
         42 . The method of  claim 41  wherein the attaching the first repair device to the bone anchor comprises attaching the at least one filament to the bone anchor. 
     
     
         43 . The method of  claim 41  wherein the bone anchor comprises an eyelet and the attaching the first repair device to the bone anchor comprises threading the at least one filament of the first repair device through the eyelet of the bone anchor. 
     
     
         44 . The method of  claim 27  further comprising:
 removing the first repair device from the catheter; and 
 attaching the first repair device to a second stump of the longitudinal anatomical feature. 
 
     
     
         45 . The method of  claim 44  wherein the first repair device further comprising a second needle attached to the second end of each of the at least one filament, and wherein the attaching the first repair device to the second stump of the longitudinal anatomical feature comprises stitching the at least one filament to the second stump. 
     
     
         46 . The method of  claim 27  further comprising:
 providing a second repair device having a first longitudinal end and a second longitudinal end, the second repair device including at least one filament having a first longitudinal end and a second longitudinal end, a first needle attached to the first end of the at least one filament of the second repair device; 
 attaching the second repair device to a second stump of the longitudinal anatomical feature using the first needle of the at least one filament of the second repair device; 
 pulling the first stump and the second stump toward each other so that the ends of the first and second stumps abut; 
 stitching the first repair device to the second stump; and 
 stitching the second repair device to the first stump. 
 
     
     
         47 . The method of  claim 27  further comprising:
 providing a bone anchor comprising at least one filament having a first longitudinal end attached to the bone anchor and a second longitudinal end bearing a needle; 
 attaching the bone anchor to a bone; 
 passing the at least one filament of the bone anchor through a second stump of the longitudinal anatomical feature; 
 pulling the first stump toward the second stump so that the ends of the first and second stumps abut; 
 stitching the first repair device to the second stump; and 
 stitching the at least one filament of the bone anchor to the first stump using the needle of the bone anchor.