CA2215943A1 - Surgical anchoring piece for ligaments - Google Patents
Surgical anchoring piece for ligaments Download PDFInfo
- Publication number
- CA2215943A1 CA2215943A1 CA002215943A CA2215943A CA2215943A1 CA 2215943 A1 CA2215943 A1 CA 2215943A1 CA 002215943 A CA002215943 A CA 002215943A CA 2215943 A CA2215943 A CA 2215943A CA 2215943 A1 CA2215943 A1 CA 2215943A1
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- Prior art keywords
- ligament
- milling
- tunnel
- anchor
- attachment means
- Prior art date
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
- A61B2017/0458—Longitudinal through hole, e.g. suture blocked by a distal suture knot
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
- A61F2002/0847—Mode of fixation of anchor to tendon or ligament
- A61F2002/087—Anchor integrated into tendons, e.g. bone blocks, integrated rings
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
- A61F2002/0876—Position of anchor in respect to the bone
- A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Public Health (AREA)
- Surgery (AREA)
- Rheumatology (AREA)
- Molecular Biology (AREA)
- Medical Informatics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Rehabilitation Therapy (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Vascular Medicine (AREA)
- Surgical Instruments (AREA)
- Prostheses (AREA)
Abstract
This invention relates to a surgical anchoring piece (1) for fitting a ligament or the like (8) at the proximal outlet of a tunnel (6, 7) bored in a bone (9). In a preferred embodiment, the anchoring piece (1) is made of an elongate body (2) provided with a milled section (3) perpendicular to the longitudinal axis of the elongate body which is designed for sliding and fastening of a pull wire (5) and a tape (4) for fastening the ligament or the like. The ligament, which is fastened to the anchoring piece (1) by the tape (4) is driven towards the end of the tunnel (6) by pulling on the wire (5); once out of the tunnel (7), the anchoring piece (1) pivots until it lies across the mouth of the tunnel (7) and locks the ligament in position in the tunnel (6).
Description
CA 0221~943 1997-09-19 , EP
SURGICAL ANCHOR FOR LIGAMENTS
The present invention concerns an anchor for attaching ligaments to bones, in ligament reconstruction surgery; it more particularly concerns such an anchor intended for being set in place by arthroscopy.
5 - Anchors for sutures, intended for being pushed through a cannula device, are known in arthroscopic surgery. The anchor with the suture attached thereto is pushed in longitudinal orientation (parallel to the suture) thr~ugh the cannula and, once it emerges from the cannula, 10 the anchor rotates to an angle relative to the suture, and so to seats on the soft tissues.
Such anchors are for examples disclosed in EP-A-0236427 and EP-A-0464480.
It is on the other hand known in orthopaedic surgery, 15 in the ligament reconstruction, to pierce through the joint a t:unnel or blind hole for receiving the ends of the ligament. At its proximal end, this tunnel is continued by a n~rrower or pull tunnel for a passing pin instrument.
When the ligament is inserted, it is attached to a 20 pul:Ling lead which i5 driven within the successive tunnels and pushed up to outside the skin with a passing pin inslrument, which is driven within the tunnels and through the skin; the pulling lead is thereafter used to pull the ligament substantially up to the end of the tunnel.
Once the ligament is inserted, it must be firm:Ly anchored in position.
The conventionnal method includes knotting the pul]ing leads for the ligament at the mouth of the pull tunnel, on a retaining member such as a button, a clip, a 30 screw, etc. This attachment needs thus to surgically acc:ess the bone area where the pull tunnel emerges.
An alternative method is performed entirely under arthroscopic monitoring. In this method, and after the CA 022l~943 l997-09-l9
SURGICAL ANCHOR FOR LIGAMENTS
The present invention concerns an anchor for attaching ligaments to bones, in ligament reconstruction surgery; it more particularly concerns such an anchor intended for being set in place by arthroscopy.
5 - Anchors for sutures, intended for being pushed through a cannula device, are known in arthroscopic surgery. The anchor with the suture attached thereto is pushed in longitudinal orientation (parallel to the suture) thr~ugh the cannula and, once it emerges from the cannula, 10 the anchor rotates to an angle relative to the suture, and so to seats on the soft tissues.
Such anchors are for examples disclosed in EP-A-0236427 and EP-A-0464480.
It is on the other hand known in orthopaedic surgery, 15 in the ligament reconstruction, to pierce through the joint a t:unnel or blind hole for receiving the ends of the ligament. At its proximal end, this tunnel is continued by a n~rrower or pull tunnel for a passing pin instrument.
When the ligament is inserted, it is attached to a 20 pul:Ling lead which i5 driven within the successive tunnels and pushed up to outside the skin with a passing pin inslrument, which is driven within the tunnels and through the skin; the pulling lead is thereafter used to pull the ligament substantially up to the end of the tunnel.
Once the ligament is inserted, it must be firm:Ly anchored in position.
The conventionnal method includes knotting the pul]ing leads for the ligament at the mouth of the pull tunnel, on a retaining member such as a button, a clip, a 30 screw, etc. This attachment needs thus to surgically acc:ess the bone area where the pull tunnel emerges.
An alternative method is performed entirely under arthroscopic monitoring. In this method, and after the CA 022l~943 l997-09-l9
2 EP
tunr;els in the bones have been made, the anchoring member is attached to the ligament, and the assembly is thereafter pulled in the bone tunnels until the anchor completely emerges from the pull tunnel; by pulling in the opposed 5 direction, the anchor thereafter blocks at the end of the push tunnel.
This method is less traumatic since it is not necessary for anchoring, to make an opening at the proximal side. It however requires to feed the anchor through the lo pull tunnel which must thus be larger than for the passing pin instrument of the pulling lead, and it is a concern that the anchor be the narrowest possible, for m;nimi sing the diameter of the pull tunnel.
The anchors to be pushed referred to hereabove are 15 not appropriate for attaching ligaments. Indeed, this would req~Lire enlargment of the bone tunnels for allowing simultaneous passage of the ligament and of the insertion device, which is opposed to the requirements aiming to matc:h as closely as possible the diameter of the ligament 20 and the size of the tunnel for enhancing biological attacl-Lment .
Moreover, the insertion cannula would tend to wound the ligamentary structure during handling for putting in plac:e.
25For this kind of application, pull anchors have t:hus been developped, which can be set in place without cannula inst:rument .
Such an anchor is known for example by EP-A-O 619 982, which discloses a substantially cylindrical 30 anchor, provided with peripheral barbs. When this anchor emerges oustide, at the proximal end of the pull tunnel, the barbs provide the anchoring by seating on the surface of t:he cortical bone.
CA 0221~943 1997-09-19 . . = .
tunr;els in the bones have been made, the anchoring member is attached to the ligament, and the assembly is thereafter pulled in the bone tunnels until the anchor completely emerges from the pull tunnel; by pulling in the opposed 5 direction, the anchor thereafter blocks at the end of the push tunnel.
This method is less traumatic since it is not necessary for anchoring, to make an opening at the proximal side. It however requires to feed the anchor through the lo pull tunnel which must thus be larger than for the passing pin instrument of the pulling lead, and it is a concern that the anchor be the narrowest possible, for m;nimi sing the diameter of the pull tunnel.
The anchors to be pushed referred to hereabove are 15 not appropriate for attaching ligaments. Indeed, this would req~Lire enlargment of the bone tunnels for allowing simultaneous passage of the ligament and of the insertion device, which is opposed to the requirements aiming to matc:h as closely as possible the diameter of the ligament 20 and the size of the tunnel for enhancing biological attacl-Lment .
Moreover, the insertion cannula would tend to wound the ligamentary structure during handling for putting in plac:e.
25For this kind of application, pull anchors have t:hus been developped, which can be set in place without cannula inst:rument .
Such an anchor is known for example by EP-A-O 619 982, which discloses a substantially cylindrical 30 anchor, provided with peripheral barbs. When this anchor emerges oustide, at the proximal end of the pull tunnel, the barbs provide the anchoring by seating on the surface of t:he cortical bone.
CA 0221~943 1997-09-19 . . = .
3 EP
This anchor is however difficult to use; indeed, the barbs must be short to avoid wedging thereof in the bone tunnel, so that the pull tunnel must be closely adjusted.
When not, the short barbs would extend loosely inside, and 5 could not seat on the cortical bone at the mouth of the tunnel.
So, the anchor moves with high friction within the pull tunnel, and it is difficult for the surgeon to determine exactly whether the anchor has or not emerged 10 from the tunnel. To ascertain this fact, the surgeon indeed pulls in the opposite direction (side of the ligament), and the barbs would then tend to wedge the anchor within the bone, already inside the tunnel, so that the right setting of the anchor can actually only be ascertained by accurate 15 measuring and marking of the graft provided with the anchor, relative to the length of the bone tunnel, or still by radioscopic monitoring, all these handling being technically critical, and time consuming.
Another drawback of this anchor is yet that the bone 20 surface on which the barbs seat is generally not flat, nor perpendicular to the longitll~;n~1 axis of the anchor, in whi~h case the support results from only two barbs.
One also know (patent US-A-5306301) an anchor in the for]~ of an elongated plate, pierced by four holes 25 substantially aligned in the longitudinal direction of the plate (EndoButton~ from Acufex Microsurgical Inc.). The two medial holes are used for attaching the ligament, and the two external holes are used for attaching pulling leads.
This anchor is inserted longit~ n~1 ly in the pull 30 tunnel, through the pulling leads, until it emerges at its proximal end. Once emerged from the tunnel, a pulling on the posterior pulling lead make it rotate about an axis perpendicular to its longitudinal axis, and it is driven bac]~ by a pull on the ligament side, so as to make it seat CA 022lCi943 l997-09-l9 . . .
,.
This anchor is however difficult to use; indeed, the barbs must be short to avoid wedging thereof in the bone tunnel, so that the pull tunnel must be closely adjusted.
When not, the short barbs would extend loosely inside, and 5 could not seat on the cortical bone at the mouth of the tunnel.
So, the anchor moves with high friction within the pull tunnel, and it is difficult for the surgeon to determine exactly whether the anchor has or not emerged 10 from the tunnel. To ascertain this fact, the surgeon indeed pulls in the opposite direction (side of the ligament), and the barbs would then tend to wedge the anchor within the bone, already inside the tunnel, so that the right setting of the anchor can actually only be ascertained by accurate 15 measuring and marking of the graft provided with the anchor, relative to the length of the bone tunnel, or still by radioscopic monitoring, all these handling being technically critical, and time consuming.
Another drawback of this anchor is yet that the bone 20 surface on which the barbs seat is generally not flat, nor perpendicular to the longitll~;n~1 axis of the anchor, in whi~h case the support results from only two barbs.
One also know (patent US-A-5306301) an anchor in the for]~ of an elongated plate, pierced by four holes 25 substantially aligned in the longitudinal direction of the plate (EndoButton~ from Acufex Microsurgical Inc.). The two medial holes are used for attaching the ligament, and the two external holes are used for attaching pulling leads.
This anchor is inserted longit~ n~1 ly in the pull 30 tunnel, through the pulling leads, until it emerges at its proximal end. Once emerged from the tunnel, a pulling on the posterior pulling lead make it rotate about an axis perpendicular to its longitudinal axis, and it is driven bac]~ by a pull on the ligament side, so as to make it seat CA 022lCi943 l997-09-l9 . . .
,.
4 EP
on the rim of the tunnel, with its longitudinal i~xis substantially perpendicular to the axis of the tunnel.
According to the invention, one proposes to provide an anchor of this kind, easier to make and to handle, and
on the rim of the tunnel, with its longitudinal i~xis substantially perpendicular to the axis of the tunnel.
According to the invention, one proposes to provide an anchor of this kind, easier to make and to handle, and
5 before all of lower size, so that it can be driven through a ni~rrower pull tunnel, with less weakening of the bone" or allows to use it for smaller, or less strong bones.
The solution according to the invention comprises providing a surgical anchor for attaching a ligament or the o like, at the proximal mouth of a tunnel pierced in a bone, made of an elongated body provided with passage means perpendicular to the longitudinal axis of the elongated body, for attaching on one hand pulling means, and on the other hand attachment means for a ligament or the l:Lke, 15 said anchor being provided for pivoting perpendicularly to its longitudinal axis at the mouth of the tunnel, to lay in blocking position substantially perpendicularly to the c~xis of lhe tunnel, characterized in that 20 - the passage means for the pull means is made of a single milling perpendicular to the longitudinal ax:is of the elongated body, and - the passage means for the attachment means for the ligament or the like is made of a single mil]ing perpendicular to the longitll~;n~l axis of the elongated body.
According to another feature of the invention, the millillg for the ligament attachment means is a milling with a narrow and elongated section, with a long side parallel 30 to the longitudinal axis of the elongated body, provided for receiving a flat, ribbon like ligament attachment means~
CA 022l~943 l997-09-l9 ~'' ' "
EP
According to another feature of the invention, the milling for the pulling means and the milling for attaching the ligament are a single common milling.
According to another feature of the invention, the 5 attachment means for the ligament or the like, driven in the milling of the elongated body, is attached thereto while being retained by a reinforced tickness at its end, which can not pass within the milling.
According to another feature of the invention, the 10 attachment means for the ligament or the like is attached to the elongated body while being inserted within said milling like a lead in a needle.
According to another feature of the invention, the two filaments of the attachment means are whipped near the 15 surface of the elongated body.
According to another feature of the invention, the two filaments of the attachment means are knotted near the surface of the elongated body.
According to another feature of the invention, the 20 elongated body has a substantially cylindrical section.
Other aspects, characteristics and advantages of the invention will appear from the detailed description which folLow, and the annexed drawings, in which:
Figure 1 is a side view, partially broken away, oi- an 25 anchor according to the invention, Figure 2 is a perspective view of the anchor of the invention, provided with pulling means and means for attaching a ligament or the like, Figure 3 is a cross-sectional view of the anchor 30 according to the invention, with another attachment of the attachment means for the ligament or the like, Figure 4 is a view of the anchor being driven through the tunnel pierced in a bone.
CA 0221~943 1997-09-19 .
~,
The solution according to the invention comprises providing a surgical anchor for attaching a ligament or the o like, at the proximal mouth of a tunnel pierced in a bone, made of an elongated body provided with passage means perpendicular to the longitudinal axis of the elongated body, for attaching on one hand pulling means, and on the other hand attachment means for a ligament or the l:Lke, 15 said anchor being provided for pivoting perpendicularly to its longitudinal axis at the mouth of the tunnel, to lay in blocking position substantially perpendicularly to the c~xis of lhe tunnel, characterized in that 20 - the passage means for the pull means is made of a single milling perpendicular to the longitudinal ax:is of the elongated body, and - the passage means for the attachment means for the ligament or the like is made of a single mil]ing perpendicular to the longitll~;n~l axis of the elongated body.
According to another feature of the invention, the millillg for the ligament attachment means is a milling with a narrow and elongated section, with a long side parallel 30 to the longitudinal axis of the elongated body, provided for receiving a flat, ribbon like ligament attachment means~
CA 022l~943 l997-09-l9 ~'' ' "
EP
According to another feature of the invention, the milling for the pulling means and the milling for attaching the ligament are a single common milling.
According to another feature of the invention, the 5 attachment means for the ligament or the like, driven in the milling of the elongated body, is attached thereto while being retained by a reinforced tickness at its end, which can not pass within the milling.
According to another feature of the invention, the 10 attachment means for the ligament or the like is attached to the elongated body while being inserted within said milling like a lead in a needle.
According to another feature of the invention, the two filaments of the attachment means are whipped near the 15 surface of the elongated body.
According to another feature of the invention, the two filaments of the attachment means are knotted near the surface of the elongated body.
According to another feature of the invention, the 20 elongated body has a substantially cylindrical section.
Other aspects, characteristics and advantages of the invention will appear from the detailed description which folLow, and the annexed drawings, in which:
Figure 1 is a side view, partially broken away, oi- an 25 anchor according to the invention, Figure 2 is a perspective view of the anchor of the invention, provided with pulling means and means for attaching a ligament or the like, Figure 3 is a cross-sectional view of the anchor 30 according to the invention, with another attachment of the attachment means for the ligament or the like, Figure 4 is a view of the anchor being driven through the tunnel pierced in a bone.
CA 0221~943 1997-09-19 .
~,
6 EP
Referring to the drawing, the anchor 1 comprises a generally cylindrical, elongated body 2 with a through milling 3 the longit~ n~ l axis A-AI of which is substantially perpendicular to the longitudinal axis :B-B' 5 of the cylindrical body 2.
As it can be seen from the drawing, the milling has the form of a slit 3, and has an elongated cross section along the longitudinal direction B-B' of the cylindrical body 2.
The milling 3 is provided for insertion of an attachment means 4 for a ligament or the like, as well ,~s a pulling lead 5.
The pulling lead 5 is used only during the operat.ion, for allowing the surgeon to pull the anchor within the 15 insertion tunnel 6 for the ligament or the like, then wit:hin the narrower pull tunnel continuing the later, w].lile drawing the ligament 8 substantially up to the end of the insertion tunnel 6. The insertion and pull tunnels are pie:rced through the bone 9 to which the ligament must: be 20 attached.
Once the anchor is set in place, the lead 5 is wit].ldrawn, most conveniently by pulling one filament the:reof.
The ligament attachment means is used not only for 25 pul:Ling the ligament substantially up to the end of the insertion tunnel 6, during the operation, but is also used for anchoring the ligament to the bone, and it must thus be sized accordingly.
The milling with an elongated section according to 30 the lnvention presents a passage of a relatively large section for a narrow slit; in conjunction with flat, ribbon like attachment means 4, it allows to give it a section sufi-icient for supporting the stress to which it will be CA 0221~943 1997-09-19 . ~
. .
Referring to the drawing, the anchor 1 comprises a generally cylindrical, elongated body 2 with a through milling 3 the longit~ n~ l axis A-AI of which is substantially perpendicular to the longitudinal axis :B-B' 5 of the cylindrical body 2.
As it can be seen from the drawing, the milling has the form of a slit 3, and has an elongated cross section along the longitudinal direction B-B' of the cylindrical body 2.
The milling 3 is provided for insertion of an attachment means 4 for a ligament or the like, as well ,~s a pulling lead 5.
The pulling lead 5 is used only during the operat.ion, for allowing the surgeon to pull the anchor within the 15 insertion tunnel 6 for the ligament or the like, then wit:hin the narrower pull tunnel continuing the later, w].lile drawing the ligament 8 substantially up to the end of the insertion tunnel 6. The insertion and pull tunnels are pie:rced through the bone 9 to which the ligament must: be 20 attached.
Once the anchor is set in place, the lead 5 is wit].ldrawn, most conveniently by pulling one filament the:reof.
The ligament attachment means is used not only for 25 pul:Ling the ligament substantially up to the end of the insertion tunnel 6, during the operation, but is also used for anchoring the ligament to the bone, and it must thus be sized accordingly.
The milling with an elongated section according to 30 the lnvention presents a passage of a relatively large section for a narrow slit; in conjunction with flat, ribbon like attachment means 4, it allows to give it a section sufi-icient for supporting the stress to which it will be CA 0221~943 1997-09-19 . ~
. .
7 EP
subjected, and this for a short diameter of the cylindrical body 2.
At Figure 2, the attachment ribbon 4 and the pulling lead 5 are represented as threaded through the milling 3 5 like a lead in the eye of a needle, which constitutes the simplest and the most reliable means for attaching the attachment ribbon 4 and the pulling lead 5 to the cylindrical body 2. The two filaments of the ribbon 4 are on the other hand whipped together, as shown by the dotted o line 11.
In the alternative of figure 3, the pulling ribbon is represented with an extra tickness 10 at its free end, opposed to the ligament, so as to prevent the thre/ded ribbon to get out the milling. This is however a less 15 prefered embodiment, since less reliable.
A single milling 3, which is used both for the pulling lead and for the attachment ribbon, and which con,titutes a prefered embodiment of the invention, has bee~ shown in the drawings. The invention is obviously not 20 limited to this embodiment, and two individual millings may also be provided for, or yet one milling for the attachment ribbon and one hole for the pulling lead; this leads however to no particilar advantages.
For convenience, the single milling will preferably 25 be made symetrically in the middle of the body, so that the anchor be perfectly symetrical, and does not present a forward and a rearward ends.
At figure 4, the anchor is shown during inserlion within the pull tunnel 7 pierced in a bone 9, following the 30 insertion tunnel 6 for the ligament or the like.
In a known manner, the tunnels are pierced in the bone after an opening has been made in the soft tissues at the distal end, and the pull lead 5 is inserted within the tunnels 6, 7 with the aid of a passing pin instrument that CA 022l~943 l997-09-l9 ! . _, .'
subjected, and this for a short diameter of the cylindrical body 2.
At Figure 2, the attachment ribbon 4 and the pulling lead 5 are represented as threaded through the milling 3 5 like a lead in the eye of a needle, which constitutes the simplest and the most reliable means for attaching the attachment ribbon 4 and the pulling lead 5 to the cylindrical body 2. The two filaments of the ribbon 4 are on the other hand whipped together, as shown by the dotted o line 11.
In the alternative of figure 3, the pulling ribbon is represented with an extra tickness 10 at its free end, opposed to the ligament, so as to prevent the thre/ded ribbon to get out the milling. This is however a less 15 prefered embodiment, since less reliable.
A single milling 3, which is used both for the pulling lead and for the attachment ribbon, and which con,titutes a prefered embodiment of the invention, has bee~ shown in the drawings. The invention is obviously not 20 limited to this embodiment, and two individual millings may also be provided for, or yet one milling for the attachment ribbon and one hole for the pulling lead; this leads however to no particilar advantages.
For convenience, the single milling will preferably 25 be made symetrically in the middle of the body, so that the anchor be perfectly symetrical, and does not present a forward and a rearward ends.
At figure 4, the anchor is shown during inserlion within the pull tunnel 7 pierced in a bone 9, following the 30 insertion tunnel 6 for the ligament or the like.
In a known manner, the tunnels are pierced in the bone after an opening has been made in the soft tissues at the distal end, and the pull lead 5 is inserted within the tunnels 6, 7 with the aid of a passing pin instrument that CA 022l~943 l997-09-l9 ! . _, .'
8 EP
the surgeon makes to emerge outside, proximally, by piercing the skin; once the lead is outside, the surgeon can take it directly in hand, and pull the anchor and the ligament within the tunnels.
As seen in figure 4, the pulling lead lays down longitll~in~lly relative to the cylindrical body, while both filaments of the ribbon distord (twist) to lay down also longitudinally relative to the cylindrical body 2.
When the anchor emerges from the tunnel 7, it tends o to erect (to rotate perpendicularly to its longitudinal axis), inter alia due to the asymetrical attachment of the ribbon 4. Thus, it does not remain aligned with the axis of the tunnel and, when the surgeon pull in the opposite direction, on the side of the ligament, the rounded end of 15 the anchor contacts the bone wall at the mouth of the tunnel. By a continued pulling on the ligament side -optionaly in conjunction with short pulls on the pull lead side, the surgeon drive the anchor in seating positlon, transversaly to the axis of the pull tunnel.
At figure 2, a whipping of the two filaments of the attachment ribbon 4, near the cylindrical body 2, is shown a dotted line 11. The purpose of this whipping is to force the ribbon to lay as showrt in figure 4, with its edges 4', 4" substantially perpendicular to the longitll~;n~l axis of 25 the body 2, while thus preventing the ribbon to lay down longitll~i n~ 1 ly like the pull lead 5, which would reduce the tendancy of the body to erect.
This whipping can however be replaced by a mere knotting of the two filaments, which provides the same 30 effect, with however the drawback to be more bulky than the whipping, what then requires a larger pull tunnel.
According to the invention, an improved surgical anchor has been provided, which allows anchoring a ligament by arthroscopy, and thus with the less traumatism, by . , CA 0221~943 1997-09-19 .. .
,....
g EP
reducing substantially the diameter of the pull tunneL to be pierced in the bone, and providing a safe blocking of the anchor, with no recourse to radioscopy or the like.
So, according to the invention, a diameter of the 5 body 2 of the order of 2,5 mm or even 2 mm is easily reached, to be compared with a transverse ~;men.sion of about 4 mm for the Endobutton~ plate, or a diameter of about 5 mm for the anchor according to EP-A-O 619 982.
By "milling" it is meant in the present description a lo through perforation of the body of the anchor, which ca:n be made by a mill, but also by any other means, for example a Laser.
the surgeon makes to emerge outside, proximally, by piercing the skin; once the lead is outside, the surgeon can take it directly in hand, and pull the anchor and the ligament within the tunnels.
As seen in figure 4, the pulling lead lays down longitll~in~lly relative to the cylindrical body, while both filaments of the ribbon distord (twist) to lay down also longitudinally relative to the cylindrical body 2.
When the anchor emerges from the tunnel 7, it tends o to erect (to rotate perpendicularly to its longitudinal axis), inter alia due to the asymetrical attachment of the ribbon 4. Thus, it does not remain aligned with the axis of the tunnel and, when the surgeon pull in the opposite direction, on the side of the ligament, the rounded end of 15 the anchor contacts the bone wall at the mouth of the tunnel. By a continued pulling on the ligament side -optionaly in conjunction with short pulls on the pull lead side, the surgeon drive the anchor in seating positlon, transversaly to the axis of the pull tunnel.
At figure 2, a whipping of the two filaments of the attachment ribbon 4, near the cylindrical body 2, is shown a dotted line 11. The purpose of this whipping is to force the ribbon to lay as showrt in figure 4, with its edges 4', 4" substantially perpendicular to the longitll~;n~l axis of 25 the body 2, while thus preventing the ribbon to lay down longitll~i n~ 1 ly like the pull lead 5, which would reduce the tendancy of the body to erect.
This whipping can however be replaced by a mere knotting of the two filaments, which provides the same 30 effect, with however the drawback to be more bulky than the whipping, what then requires a larger pull tunnel.
According to the invention, an improved surgical anchor has been provided, which allows anchoring a ligament by arthroscopy, and thus with the less traumatism, by . , CA 0221~943 1997-09-19 .. .
,....
g EP
reducing substantially the diameter of the pull tunneL to be pierced in the bone, and providing a safe blocking of the anchor, with no recourse to radioscopy or the like.
So, according to the invention, a diameter of the 5 body 2 of the order of 2,5 mm or even 2 mm is easily reached, to be compared with a transverse ~;men.sion of about 4 mm for the Endobutton~ plate, or a diameter of about 5 mm for the anchor according to EP-A-O 619 982.
By "milling" it is meant in the present description a lo through perforation of the body of the anchor, which ca:n be made by a mill, but also by any other means, for example a Laser.
Claims (8)
1. Surgical anchor (1) for attaching a ligament or the like, at the proximal mouth of a tunnel pierced in a bone, made of - an elongated substantially cylindrical body (2) provided with a first passage perpendicular to the longitudinal axis (B-B') of the elongated body, for attaching on one hand pulling means (5), and with a second passage perpendicular to the longitudinal axis of the elongated body, for attaching on the other hand attachment means (4) for a ligament or the like, - pulling means and attachment means for a ligament, inserted respectively in said respective passage, characterized in that - the milling for the ligament attachment means is provided in the median portion of the elongated body, and - the ligament attachment means is attached asymetrically to the cylindrical body, - the anchor being intended for attaching a ligament by pivoting accross the tunnel, at the mounth thereof.
2. Anchor according to claim 1, characterized in that the milling for the ligament attachment means is a milling (3) with a narrow and elongated section, with a long side parallel to the longitudinal axis (B-B') of the elongated body (2), provided for receiving a flat, ribbon like ligament attachment means (4).
3. Anchor according to claim 1 or 2, characterized in that the milling for the pulling means and the milling for attaching the ligament are a single common milling (3).
4. Anchor according to anyone of claims 1 to 3, characterized in that the attachment means (4) for the ligement or the like, threaded in the milling (3) of the elongated body (2), is attached thereto while being retained by a reinforced tickness (10) at its end, which can not pass within the milling.
5. Anchor according to anyone of claims 1 to 3, characterized in that the attachment means (4) for the ligament or the like is attached to the elongated body (2) while being threaded within said milling (3) like a lead in a needle.
6. Anchor according to claim 5, characterized in that the two filaments of the attachment means (4) are whipped (11) near the surface of the elongated body.
7. Anchor according to claim 5, characterized in that the two filaments of the attachment means (4) are knotted near the surface of the elongated body (2).
8. Anchor according to anyone of the preceding claims, characterized in that the elongated body (2) has a substantially circular section.
Priority Applications (4)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| EP95912098A EP0814730A1 (en) | 1995-03-21 | 1995-03-21 | Surgical anchoring piece for ligaments |
| CA002215943A CA2215943A1 (en) | 1995-03-21 | 1995-03-21 | Surgical anchoring piece for ligaments |
| PCT/BE1995/000025 WO1996029029A1 (en) | 1995-03-21 | 1995-03-21 | Surgical anchoring piece for ligaments |
| AU19431/95A AU1943195A (en) | 1995-03-21 | 1995-03-21 | Surgical anchoring piece for ligaments |
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CA002215943A CA2215943A1 (en) | 1995-03-21 | 1995-03-21 | Surgical anchoring piece for ligaments |
| PCT/BE1995/000025 WO1996029029A1 (en) | 1995-03-21 | 1995-03-21 | Surgical anchoring piece for ligaments |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2215943A1 true CA2215943A1 (en) | 1996-09-26 |
Family
ID=25662963
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002215943A Abandoned CA2215943A1 (en) | 1995-03-21 | 1995-03-21 | Surgical anchoring piece for ligaments |
Country Status (4)
| Country | Link |
|---|---|
| EP (1) | EP0814730A1 (en) |
| AU (1) | AU1943195A (en) |
| CA (1) | CA2215943A1 (en) |
| WO (1) | WO1996029029A1 (en) |
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| US3541591A (en) * | 1968-04-26 | 1970-11-17 | Henry J Hoegerman | Method and apparatus for closing wounds |
| US4823794A (en) * | 1982-07-12 | 1989-04-25 | Pierce William S | Surgical pledget |
| US4773910A (en) * | 1987-08-17 | 1988-09-27 | Johnson & Johnson Consumer Products, Inc. | Permanent ligament prosthesis |
| EP0492172A1 (en) * | 1990-12-24 | 1992-07-01 | American Cyanamid Company | Molded or extruded buttressing pledget |
| DE4127550A1 (en) * | 1991-08-20 | 1993-02-25 | Telos Herstellung Und Vertrieb | Implantable surgical connecting plate - is used for attaching strap to bone and has two parallel slots to hold strap to plate |
| FR2696338B1 (en) * | 1992-10-07 | 1997-10-17 | Max Perrin | ARTIFICIAL LIGAMENT AND ITS PRESENTATION MODE. |
| US5306301A (en) * | 1993-02-11 | 1994-04-26 | American Cyanamid Company | Graft attachment device and method of using same |
-
1995
- 1995-03-21 CA CA002215943A patent/CA2215943A1/en not_active Abandoned
- 1995-03-21 EP EP95912098A patent/EP0814730A1/en not_active Withdrawn
- 1995-03-21 AU AU19431/95A patent/AU1943195A/en not_active Abandoned
- 1995-03-21 WO PCT/BE1995/000025 patent/WO1996029029A1/en not_active Application Discontinuation
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US9517062B2 (en) | 2014-12-03 | 2016-12-13 | Smith & Nephew, Inc. | Closed loop suture for anchoring tissue grafts |
| US10925716B2 (en) | 2015-02-25 | 2021-02-23 | Smith & Nephew, Inc. | Closed loop suture for anchoring tissue grafts |
Also Published As
| Publication number | Publication date |
|---|---|
| AU1943195A (en) | 1996-10-08 |
| EP0814730A1 (en) | 1998-01-07 |
| WO1996029029A1 (en) | 1996-09-26 |
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