CN212630970U - Structure of knee joint medial meniscus implant - Google Patents

Abstract

The utility model relates to a structure of knee joint medial meniscus implant, which comprises a medial meniscus body, a first bone block, a second bone block and a ligament connector; the inner meniscus body is C-like, the lower bottom surface is a plane, the first bone block and the second bone block are respectively connected with the anterior horn and the posterior horn of the inner meniscus body, and the ligament connector refers to a tibial ligament of the meniscus connected with the tibia around the inner meniscus; the utility model discloses utilize the ligament connector, can rebuild the anatomical stability of similar natural meniscus more bionically and resume being connected between it and the shin bone and can be fit for all commonly used meniscus transplantation methods.

Description

Structure of knee joint medial meniscus implant

Technical Field

The utility model relates to a transplant operation technical field especially relates to a structure of inboard meniscus graft.

Background

Please refer to fig. 1 and 2, which are schematic views of bones, menisci and ligaments of a knee joint of a human body. As shown in fig. 1, the knee joint is composed of the lower end of the femur 5, the upper end of the tibia 4, and the patella 6, as well as other accessory structures such as the patellar ligament 7. The meniscus, which is located above the tibia 4 between the tibia 4 and the femur 5, is divided into a medial meniscus 20 and a lateral meniscus 10, which are important structures of the knee joint. The meniscus has important functions of conducting and dispersing loads, absorbing shocks, improving the form matching of the femur 5 and the tibia 4, lubricating joints, assisting in maintaining the anterior-posterior direction and the rotational stability of the knee joint, and the like, and bears loads such as pressure, shear force, tension and the like, so meniscus injuries are one of the most common sports injuries.

Meniscal partial and total resections are common treatment for meniscal injuries, especially white and red-white injuries, with up to 2014, and the number of cases treated in the united states and europe reaches over 150 million annually. The results of medium and long-term clinical follow-up confirm that premature and progressive articular cartilage degeneration can occur after total meniscal resection and finally knee osteoarthritis can occur. The development of meniscal suturing and repair techniques has allowed more meniscal tissue to be retained, with the healed meniscal tissue retaining more complete biomechanical function, however, not all meniscal tears may be sutured.

The allogeneic meniscus transplantation can improve the functions of knee joints accompanied by serious injury and meniscus deletion and relieve the symptoms of pain, swelling and the like after the meniscectomy. Current knee medial meniscus implants typically include a medial meniscus body and anterior and posterior angle connecting plugs. Wherein the medial meniscus body is an allogeneic meniscus tissue, the anterior-posterior angle connecting bone bolt is prepared by a allogeneic tibial plateau and is conical, and the anterior-posterior angle connecting bone bolt is fixedly connected between the anterior-posterior angle of the medial meniscus body. However, the implant lacks the tibial ligament structure of the meniscus, and the stability of the meniscus body and the overall stability are not guaranteed.

Therefore, in response to the above deficiencies, it would be desirable to provide a structure for a medial meniscal graft.

SUMMERY OF THE UTILITY MODEL

The to-be-solved technical problem of the utility model is to the defect that the reliability of the inboard meniscus graft of current knee joint rebuilds stability around the meniscus in meniscus transplantation art is not high, provide a bone block structure that adopts the separation of anterior relief angle and have the inboard meniscus graft of people's knee joint allogeneic of ligament connector.

The utility model provides a knee joint medial meniscus implant in a first aspect, which comprises a medial meniscus body, a first bone block, a second bone block and a ligament connector; the inner meniscus body is C-like, the lower bottom surface of the inner meniscus body is a plane, and the first bone block and the second bone block are respectively connected to the anterior angle and the posterior angle of the inner meniscus body; the ligament attachment extends from around the meniscus to the tibial plateau margin.

In the knee joint medial meniscus implant according to the present invention, preferably, the medial meniscus body, the first and second bone pieces, and the ligament connectors are made of human allogeneic tissue.

In the knee joint medial meniscus graft according to the present invention, preferably, the medial meniscus body has two ends respectively having anterior and posterior angles, the first and second bone pieces are made of tibial bone tissue parts connected by the anterior and posterior angles, and the ligament connecting body is made of a meniscus tibial ligament having a bony connection with the medial meniscus and the tibia.

In a knee medial meniscus graft according to the invention, preferably the first and second bone pieces are square, cylindrical or rectangular and consist of cartilage, subchondral bone and bone.

In the medial knee meniscal graft according to the present invention, preferably, in Key-Hole bone bridge fixation, a rectangular bone groove is formed in the intercondylar crest of the medial side of the tibial plateau, and the first bone block and the second bone block are trimmed to be rectangular and inserted into the bone groove for fixation.

In the medial meniscus of knee joint according to the present invention, preferably, in the bone pin fixation, the top of the tibia is provided with a cut surface on which two cylindrical bone paths are drilled, and the first bone block and the second bone block are trimmed into a cylindrical shape and inserted into the two bone paths for fixation.

In the medial meniscus implant of the knee joint according to the present invention, preferably, in the bone-free fixation, the anterior angle and the posterior angle are drawn with the braided wire, and both ends of the braided wire are embedded in the tibia and fixed.

In the knee joint medial meniscus graft according to the present invention, preferably, the anterior-posterior diameter of the medial meniscus body ranges from 20mm to 70mm, and the left-right diameter of the medial meniscus body ranges from 20mm to 50 mm; the first and second bone pieces have a width of 5mm to 20mm, a length of 5mm to 35mm, and a thickness of 5mm to 30 mm.

In the medial meniscus graft of the knee according to the invention, preferably, the anterior and posterior inner and outer margins are free margin and synovial margin, respectively, the free margin thickness being between 1 and 2mm and the synovial margin thickness being between 4 and 20 mm.

Implement the utility model discloses a inboard meniscus graft of people's knee joint has following beneficial effect: the utility model adopts the mode that the front and rear angles are provided with the bone blocks which are separated from each other, and can carry out necessary adjustment on the fixed positions of the front and rear angles of the meniscus according to the variation of the meniscus; the first bone block and the second bone block are separated in a way that the implant can be suitable for all three current surgical methods for transplanting the medial meniscus, and each surgical method can achieve reconstruction and fixation of the anatomical position of the meniscus more easily and can be better suitable for personalized difference of the position and the size of the meniscus of different patients; and the utility model discloses utilize the ligament connector of being connected naturally with inboard meniscus body to be connected the meniscus of transplanting with patient's shin bone upper portion fixedly, can reach the fixed effect of the connected mode between natural meniscus and the shin bone.

Drawings

FIG. 1 is a left side view of a knee joint of the present invention;

FIG. 2 is a right side view of the knee joint of the present invention;

FIG. 3 is a schematic view of a knee joint medial-lateral meniscus graft according to a preferred embodiment of the present invention;

fig. 4 is a schematic illustration of implantation of a medial meniscus graft of a knee joint according to a preferred embodiment of the present invention;

FIG. 5 is a schematic illustration of a medial meniscal implant in a knee joint according to a preferred embodiment of the present invention, which may be adapted for use in a bone groove fixation implantation procedure;

fig. 6 is a schematic view of a preferred embodiment of the present invention of a method of implantation of a medial knee meniscal graft suitable for use in the anterior and posterior horn braid fixation of a boneless meniscal body.

In the figure: 1. a medial meniscus body; 11. a hook angle; 12. a relief angle; 13. a free edge; 14. a slip film edge; 21. a first bone piece; 22. a second bone piece; 3. a ligament attachment; 4. a tibia; 41. cutting into noodles; 42. the bone tract; 43. a bone groove; 44. weaving wires; 5. the femur; 6. a patella; 7. the patellar ligament.

Detailed Description

In order to make the objects, technical solutions and advantages of the embodiments of the present invention clearer, the technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the accompanying drawings in the embodiments of the present invention, and it is obvious that the described embodiments are some, but not all embodiments of the present invention. Based on the embodiments in the present invention, all other embodiments obtained by a person skilled in the art without creative efforts belong to the protection scope of the present invention.

Fig. 3 is a schematic view of a medial meniscus graft of a knee joint according to a preferred embodiment of the present invention. As shown in fig. 3, the knee joint medial meniscus graft includes a medial meniscus body 1, a first bone piece 21, a second bone piece 22 and a ligament connector 3. Wherein the medial meniscus body 1 is C-shaped and the lower bottom surface is a plane. The two ends of the medial meniscus body 1 are an anterior horn 11 and a posterior horn 12 respectively, and the first bone block 21 and the second bone block 22 are made of tibial bone tissue parts connected with the anterior horn 11 and the posterior horn 12 respectively. The ligament connecting body 3 is wrapped on the outer side of the medial meniscus body 1 and extends downwards.

Please refer to fig. 4, which is a schematic diagram of the implantation of the medial meniscus graft of the knee joint according to the preferred embodiment of the present invention. A tangent plane 41 is formed in a tibia 4 of a patient to be implanted with a meniscus, two bone channels 42 penetrating the tangent plane 41 are formed in the front corner and the rear corner of the tibia 4 located on the inner side of the meniscus, the lower bottom surface of an inner side meniscus body 1 is attached to the surface 41 of an inner side tibial plateau during implantation, a first bone block 21 and a second bone block 22 are inserted into the two bone channels 42 in the tibia 4 respectively, and a ligament connecting body 3 is connected to the outer lower edge of the inner side meniscus body 1 and the outer upper edge of the inner side plateau of the tibia 4 of the patient.

The utility model has the advantages that on one hand, the fixing position of the anterior and posterior corners can be fully adjusted according to the variation of the meniscus by adopting the fixing mode of the first bone block 21 and the second bone block 22 with the separated anterior and posterior corners, so that the anatomical reconstruction of the meniscus can be more easily achieved, and the utility model is more suitable for the personalized difference of the positions and the sizes of the menisci of different patients; the utility model discloses first bone piece 21 and second bone piece 22 part and present square, cylindrical or rectangle, can make the utility model discloses the graft is fit for the fixing of preceding, the relief angle of meniscus body in the operation of all three kinds of inboard meniscus transplantation operations commonly used. On the other hand, the utility model discloses do benefit to and fix the graft on patient's shin bone 4 upper portions through ligament connector 3 of being connected naturally with inboard meniscus body 1, enable the graft more effectively by fixed, reach the anatomical stability of graft and rebuild.

Preferably, the lower bottom surface of the medial meniscus body 1 of the present invention is treated to be planar, to better conform to the tangent plane 41, improving the stability of the graft. The meniscal graft inside the knee joint of the utility model can adopt different sizes and specifications. The anterior-posterior diameter of the medial meniscus body 1 preferably ranges from but not limited to 20mm to 70mm, and the left-right diameter preferably ranges from but not limited to 20mm to 50 mm. That is to say, the minimum 20mm of footpath all around of inboard meniscus body 1 is 70mm at the maximum, and the minimum 20mm of footpath all around is 50mm at the maximum, and half moon plate size that can the adaptation masses realizes the accurate transplantation of one-to-one formula, and the guarantee meniscus has good suitability. The inner and outer edges of the front and rear angles 11 and 12 are a free edge 13 and a slip film edge 14, respectively, the thickness of the free edge 13 being from 1 to 2mm, and the thickness of the slip film edge 14 being from 4 to 20 mm. The thickness gradually increases from the thinnest to the thickest.

Referring to fig. 3 and 4, the first bone piece 21 and the second bone piece 22 are composed of cartilage, subchondral bone, and bone. When bone bolt fixing is performed, a cut surface 41 is formed at the top of the tibia 4, two cylindrical bone paths 42 are drilled on the cut surface 41, and the first bone block 21 and the second bone block 22 are trimmed into a square shape or a cylindrical shape and are respectively inserted into the two bone paths 42 for fixing. Two bone blocks are trimmed into cylindrical bone plugs with the same diameter and inserted into two cylindrical bone paths 42, so that the implant structure is more stable.

As shown in fig. 5, when performing Key-Hole bone bridge fixation, a rectangular bone slot 43 is opened at the medial intercondylar crest of the tibia 4 platform, and the first bone block 21 and the second bone block 22 are trimmed to be rectangular and inserted into the bone slot 42 for fixation.

As shown in fig. 6, when the bone-free block fixation is performed, the braided wires 44 are pulled in the anterior horn 11 and the posterior horn 12, the two ends of the braided wires 44 are embedded in the tibia 4 for fixation, the braided wires 44 are braided and sutured in an 8 shape, and the braided wires 44 can be fixed on the tibia 4 to complete the fixation of the meniscus graft.

Preferably, the ligament link 3 may restore the stability of the medial meniscal body 1 to a normal state after surgery.

In some embodiments of the present invention, the medial meniscus implant of the knee joint may be made of tissue engineering materials, including natural and synthetic biomaterials, such as polyvinyl alcohol-hydrogel (PVA-H), gelatin sponge, collagen, alginate, polyglycolic acid (PGA), polylactic acid (PLA), fibrin gel, etc. For example, in one embodiment of the present invention, the medial meniscal body 1, the first bone peg 21 and the second bone peg 22 may each be a 3D printed polylactic acid-polycaprolactone copolymer P (LLA-CL) scaffold material. The ligament attachment 3 may be formed of any biomaterial known to those skilled in the art and applicable to biomimetic ligaments. The knee joint medial meniscus implant can further perform in vitro cell culture on the tissue engineering scaffold material to obtain a corresponding bionic tissue.

In the preferred embodiment of the present invention, the medial meniscus graft of the knee joint is made of allogeneic tissue, i.e. the medial meniscus body 1, the first and second bone pieces 21, 22, and the ligament connectors 3 are all made of allogeneic tissue. More preferably, the above-mentioned respective portions are taken from the same individual. Wherein, the medial meniscus body 1 is made of allogeneic medial meniscus, the first bone piece 21 and the second bone piece 22 are taken from the tibia part naturally connected with the medial meniscus, and the first bone piece 21 and the second bone piece 22 which are taken down are still naturally connected with the medial meniscus body 1. Ligament connectors 3 are taken from the tibial ligament of the meniscus to which the medial meniscus is naturally attached. In the existing transplantation operation, only the meniscus body and the anterior-posterior corner connecting bone block are usually taken down for transplantation, and for a patient with the cut-off meniscus edge, an operator can suture and fix the meniscus graft on the joint capsule, and the normal position and function of the meniscus cannot be reconstructed if the meniscus is not connected. The reason why the tibial ligament of the meniscus is not removed is because the producer and the doctor of the meniscal graft assume in advance that the outer edge of the meniscal body of the patient after the meniscal is removed still has a body of 2-32mm, so that the ligament connecting body 3 for connecting the outer edge and the tibia exists, and the ligament connecting body 3 is not needed. However, it is the case that most patients with total meniscal resection have both the periphery of the meniscal body 1 and the ligament connectors 3 removed. And the utility model discloses take off meniscus shin bone ligament as ligament connector 3, can make the body of meniscus graft can more effectively be transplanted fixedly under this condition, reach the reconstruction of anatomical stability and dissection normal architecture. Moreover, run into the outer fringe of meniscus body and the patient that ligament connector 3 exists, can with the utility model discloses a ligament connector excision uses patient's self ligament connector. Therefore, the utility model can be suitable for the needs of all patients.

The utility model discloses still correspondingly provide a preparation method of inboard meniscus graft of knee joint, including following step:

(1) the knee medial meniscus implant was made by taking the allogeneic medial meniscus and the complete structure of the tibial ligament of the meniscus and the portion of the osteochondral block of the tibia at the anterior and posterior horn stops of the medial meniscus. Wherein the medial meniscus is C-shaped and the inferior basal surface is a natural plane; the tibial portion is cut into a first bone block 21 and a second bone block 22 naturally connected to the anterior and posterior angles, respectively, of the lower bottom surface of the medial meniscal body (1). The tibial ligament of the meniscus, which is naturally attached to the medial meniscus, constitutes the ligament attachment. The utility model discloses an inboard meniscus, shin bone cartilage and meniscus shin bone ligament that the graft was used need to be taken from the healthy donor of 18 ~ 44 years old within the dead 12 hours to the guarantee is transplanted used meniscus physiology structure and is good, guarantees good after-transplanting effect.

(2) And (4) sterilizing and carrying out safety detection on the meniscus graft at the inner side of the knee joint to obtain a final finished product. The medial meniscal body removed from a healthy donor should be white or yellowish, healthy with a shiny tear-free surface, and the bone mass should be red or yellowish. The implant is sterilized by 25kGy rays, so that the health of the inner meniscus body 1 to be implanted is ensured to be free from loss, and pathogenic microorganisms possibly carried by the implant or polluted by the implant are killed, so that disease transmission to a patient is avoided. The inner meniscus body 1 and the ligament connector 3 are subjected to quality control of detection of cytotoxicity, genetic toxicity, allergenicity, heat source and hemolysis according to the requirements of passive implants of class III medical instruments before transplantation, so that the meniscus used for transplantation has extremely high safety, and adverse reactions of patients are avoided.

The following introduces the transplantation process of the medial meniscal graft of the knee joint of the present invention, including the following steps:

under the guidance of an anterior cruciate ligament locator, taking the front and rear angle dead points of the original meniscus as reference points, and drilling two bone paths 42 by using a guide pin and a hollow drill;

II, pushing the medial meniscus body 1, the first bone block 21 and the second bone block 22 into a joint cavity between the tibia 4 and the femur 5, respectively drawing and leading out the first bone block 21 and the second bone block 22 from the upper corresponding bone channels 42 of the anterior horn and the posterior horn through PDS wires, and tensioning the sutures to enable the bone blocks to be embedded into the bone channels 42 of the anterior horn and the posterior horn; in the case of the implant method for fixing the anterior and posterior meniscal using the anterior and posterior horn woven fabric, the first bone piece 21 and the second bone piece 22 are cut, the anterior and posterior horn woven fabric is sutured in the form of "8", and the anterior and posterior horn are fixed by a suture. If Key-Hole bone slot fixation is used, first bone piece 21 and second bone piece 22 are inserted end-to-end into bone slot 43. Thus, the graft of the present invention is suitable for all current mainstream meniscal grafting procedures.

And III, embedding and fixing the first bone block 21 and the second bone block 22 in the anterior and posterior angles, or carrying out 8-shaped weaving and sewing after cutting the bone blocks in the anterior and posterior angles, then pulling and fixing the weaving lines on the tibia, or embedding and fixing the first bone block 21 and the second bone block 22 in the anterior and posterior angles in an end-to-end bone groove 43. The graft is then sutured to the rim of the medial meniscus body 1 in the presence of the 2mm to 32mm outer rim of the medial meniscus body 1 and ligament connectors 3. At this point the graft itself may be cleaned of ligament connectors.

In most cases, the outer edge of the medial meniscal body 1 of the patient is cut away, either completely or partially, leaving the ligament connector 3 of the graft fixed to the outer edge of the tibia where the ligament connector had been originally inserted. For patients without a ligament connector portion, reconstruction suturing of the lost ligament connector is performed with ligament connector 3, depending on the location of the patient's incomplete ligament connector, so that ligament connector 3 is restored between medial meniscus body 1 and tibia 4.

To sum up, the utility model provides an effective, safe inboard meniscus graft of knee joint can realize the reliable and effective transplantation of the serious disappearance of knee joint meniscus, makes its structure and function obtain recovering and rebuilding. Meanwhile, the operation is simple and convenient, and the device is suitable for clinical popularization and application in sports medicine and orthopedics. The utility model discloses compare in prior art, its graft has anatomical feature more, can be fit for the operation technique of transplanting the usefulness of present all mainstream meniscus and use, in addition fixed convenient simultaneously, because there is the constitution of ligament connector 3, increased fixed stability, guaranteed the rebuilding of normal connection between meniscus and the shin bone of the patient that meniscus edge and meniscus shin bone ligament were amputated. In addition, the graft of the utility model accords with all standards of passive implants of three medical instruments of the State food and drug administration headquarter in the aspects of cytotoxicity, genetic toxicity, allergenicity, heat source and hemolysis, and has safe and effective guarantee.

Finally, it should be noted that: the above embodiments are only used to illustrate the technical solution of the present invention, and not to limit it; although the present invention has been described in detail with reference to the foregoing embodiments, it should be understood by those skilled in the art that: the technical solutions described in the foregoing embodiments may still be modified, or some technical features may be equivalently replaced; such modifications and substitutions do not depart from the spirit and scope of the present invention in its corresponding aspects.

Claims (9)

1. A knee medial meniscus graft, characterized by: comprises a medial meniscus body (1), a first bone block (21), a second bone block (22) and a ligament connecting body (3); the inner side meniscus body (1) is C-like, the lower bottom surface is a plane, and the first bone block (21) and the second bone block (22) are respectively connected with the anterior angle (11) and the posterior angle (12) of the inner side meniscus body (1); the ligament connecting body (3) is connected to the outer lower edge of the inner meniscus body (1) and the outer upper edge of the inner platform of the tibia (4).

2. A knee medial meniscus graft according to claim 1, characterised in that the medial meniscus body (1), the first (21) and second (22) bone pieces, the ligament connectors (3) are made of human allogeneic tissue.

3. A knee joint medial meniscus graft according to claim 2, characterised in that the medial meniscus body (1) is made of a human allogeneic medial meniscus, the first (21) and second (22) bone pieces are made of tibial bone tissue parts connected to the anterior and posterior horn of the medial meniscus respectively, and the ligament connecting body is made of a tibial ligament forming a ligamentous connection with the medial meniscus and the tibia.

4. A knee medial meniscus graft according to any one of claims 1 to 3, characterised in that the first (21) and second (22) bone pieces are each composed of cartilage, subchondral bone and bone.

5. The medial knee meniscal implant of claim 4, wherein said first (21) and second (22) bone pieces are square or rectangular for fixation in a Key-Hole bridge fixation procedure inserted into a rectangular bone groove (43) formed in the medial intercondylar crest of the tibial plateau (4).

6. The meniscal implant of claim 4 in which said first (21) and second (22) bone pieces are of a square or cylindrical shape and are intended to be inserted in bone pegs into two cylindrical bone tunnels (42) drilled in a cut (41) made in the top of the tibia (4) for fixation.

7. The knee joint medial meniscus graft according to claim 4, characterised in that the anterior horn (11) and the posterior horn (12) of the medial meniscus body (1) are internally pulled with braided wires (44) in a no bone fixation for fixation in the tibia (4) by both ends of the braided wires (44).

8. The knee joint medial meniscus graft according to any one of claims 1 to 3, characterised in that the anterior-posterior diameter of the medial meniscus body (1) ranges from 20mm to 70mm, and the left-right diameter of the medial meniscus body (1) ranges from 20mm to 50 mm; the first bone piece (21) and the second bone piece (22) have a width of 5mm to 20mm, the first bone piece (21) and the second bone piece (22) have a length of 5mm to 35mm, and the first bone piece (21) and the second bone piece (22) have a thickness of 5mm to 30 mm.

9. The meniscal graft of any one of claims 1 to 3 in which the anterior (11) and posterior (12) medial and lateral margins are a free margin (13) and a synovial margin (14), respectively, the thickness of the free margin (13) being between 1 and 2mm and the thickness of the synovial margin (14) being between 4 and 20 mm.

Images