Method and apparatus for tying suture to bone

Abstract

A method and apparatus for arthroscopic attachment of a suture to bone by drilling parallel holes in the bone with a cannula and drill guide and passing a suture down one hole through soft bone into the other hole and retrieving the suture through the second hole.

I claim: 
     
       1. Apparatus for attaching a suture to bone under soft tissue comprising in combination: a cannula having an inner bore,   a drill guide telescopically received in the cannula and having at least two generally parallel bores, and   a suture pusher comprising a tool having a straight section telescopically received in one of the bores of the drill guide, a laterally extending handle on one end and on the other end a suture holding section .Iadd.laterally .Iaddend.movable .Iadd.relative to the straight section .Iaddend.in response to manipulation of the handle to push a suture loop through soft bone material between two parallel holes in bone aligned with two of the bores in the drill guide.   
     
     
       2. A suture pusher comprising a strand of resiliently deformable wire having a straight section, a laterally extending handle on one end and on the other end an appertured and naturally curved suture pushing section which in unstressed condition extends laterally from the straight section and a sleeve telescopically surrounding the strand of wire and supporting the naturally curved suture pushing section aligned with the straight section whereby the suture pushing section deforms to said unstressed laterally extending condition responsive to manipulation of the handle to move the wire telescopically from the sleeve. 
     
     
       3. The method of attaching a suture to bone under soft tissue which comprises: inserting a cannula through soft tissue substantially to the bone,   inserting into the cannula a drill guide having at least two generally parallel spaced apart bores,   drilling two non-intersecting holes aligned with the bores of the drill guide into the bone through the hard surface of the bone into softer inner bone material,   inserting through one of the bores and holes a suture pusher having a suture carrying end and pushing the suture carrying end, with a suture loop thereon, through the inner bone material from the one hole to the other hole,   retrieving one strand of the suture loop through the other bone hole and bore,   removing the pusher and the drill guide,   tying a knot in the suture and passing it down the suture through the cannula, and   removing the cannula leaving the suture tied to the bone with the suture encircling a bridge of hard surface bone material between the two holes.   
     
     
       4. The method of claim 3, in which the suture pusher is a strand of a resiliently flexible TiNi alloy having a straight section, a laterally extending handle on one end and on the other end a curved suture pushing section extending laterally from the straight section and resiliently deformable to pass through a bore in a generally straightened condition. 
     
     
       5. The method of claim 4 in which a tube is inserted through the one bore and into the one hole in the bone before inserting the suture pusher so that the tube guides the suture pusher down into the bone before pushing the suture from the one hole to the other hole. .Iadd. 
     
     
       6.  Apparatus for attaching a suture to bone under soft tissue, comprising, in combination: a drill guide having at least two generally parallel bores; and   a suture pusher having a proximal section and a distal section, the distal section including a suture holding section laterally movable relative to the proximal section in response to manipulation of the proximal section to push a suture loop carried by the distal section through soft bone material between two parallel holes in the bone aligned with two of the bores in the drill guide..Iaddend..Iadd.7. The apparatus of claim 6 wherein the suture pusher includes a straight section and is formed of resiliently deformable material, and wherein the distal section has an unstressed condition in which it curves laterally away from the straight section..Iaddend..Iadd.8. A suture pusher comprising:   a strand of resiliently deformable wire having a straight section extending between proximal and distal sections, the distal section including a naturally curved suture carrying section which in an unstressed condition extends laterally from the straight section in a direction;   a sleeve telescopically surrounding the strand of wire and supporting the naturally curved suture pushing section in approximate alignment with the straight section, whereby the suture pushing section deforms to said unstressed laterally extending condition responsive to manipulation of the proximal section to move the wire telescopically from a distal portion of the sleeve; and   means remote from the distal section of the strand for visually indicating the direction in which the distal section will laterally extend when moved from the distal portion of the sleeve..Iaddend..Iadd.9. The method of attaching a suture to bone under soft tissue which comprises:   forming an incision through soft tissue substantially to an underlying bone;   inserting into the incision a drill guide having at least two generally parallel spaced apart bores,   drilling two non-intersecting holes aligned with the bores of the drill guide into the bone through the hard surface of the bone into softer inner bone material,   inserting through one of the holes a suture pusher having a suture carrying end and pushing the suture carrying end, with a suture loop thereon, through the inner bone material from the one hole to the other hole,   retrieving one strand of the suture loop through the other bone hole and bore,   removing from the incision the suture pusher and the drill guide, and   tying a knot in the suture, leaving the suture tied to the bone with the suture encircling a bridge of hard surface bone material between the two   
     
     
        holes..Iaddend..Iadd.10.  The method of attaching a suture to bone under soft tissue which comprises: forming an incision through soft tissue substantially to an underlying bone;   forming a pair of non-intersecting holes in the bone;   inserting a sleeve having at least one bore into the incision,   inserting a suture pusher into the sleeve, the suture pusher having a suture carrying end carrying a suture loop,   with the suture carrying end of the suture pusher disposed within the sleeve and with the sleeve disposed within the incision and substantially longitudinally aligned with a first one of the holes, advancing the suture carrying end out of the bore and into the inner bone material   causing the suture carrying end to push the suture loop from the first hole to a second one of the holes,   retrieving a strand of the suture loop through the second hole,   removing the suture pusher and sleeve from the incision, and   tying a knot in the suture, leaving the suture tied to the bone with the suture encircling a bridge of hard surface bone material between the two holes..Iaddend.