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
  • A61B2017/0403—Dowels
• • 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
  • A61B2017/0412—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having anchoring barbs or pins extending outwardly from suture anchor body
• • 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
  • A61B2017/044—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors with a threaded shaft, e.g. screws
• • 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
  • A61B2017/0448—Additional elements on or within the anchor
  • A61B2017/0451—Cams or wedges holding the suture by friction
• • 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
  • A61B2017/0448—Additional elements on or within the anchor
  • A61B2017/0453—Additional elements on or within the anchor threaded elements, e.g. set screws
• • 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
  • A61F2002/0817—Structure of the anchor
  • A61F2002/0823—Modular anchors comprising a plurality of separate parts
  • A61F2002/0835—Modular anchors comprising a plurality of separate parts with deformation of anchor parts, e.g. expansion of dowel by set screw
• • 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
  • A61F2002/0852—Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
• • 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
  • A61F2002/0858—Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
• • 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
  • A61F2002/0864—Fixation of tendon or ligament between anchor elements, e.g. by additional screws in the anchor, anchor crimped around tendon
• • 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

Definitions

• the present invention relates to an anchoring system for fixing a ligament graft in a bone tunnel.
• the short, thick anterior cruciate ligament extends obliquely from the prespineal surface of the upper face of the tibia to the axial face of the outer condyle of the femur and provides anterior rotatory stability of the knee.
• the accidental rupture of the anterior cruciate ligament is one of the most frequently encountered lesions in sports pathology of the knee, often resulting in partial or complete sports disability.
• Reconstruction of anterior cruciate ligament can be achieved by means of a ligament graft introduced into bone tunnels, tibial and femoral, whose articular orifices coincide with the insertion zones of the natural anterior cruciate ligament.
• SUBSTITUTE SHEET (RULE 26) The definitive anchoring of the graft is obtained by incorporation and gradual adhesion of the graft to the walls of the ossicular tunnel.
• This incorporation occurs relatively rapidly (approximately six to eight weeks) if a graft taken from the patellar tendon is used, having at each of its extremities a small bone block coming from the patella and tibia.
• This graft of the bone-tendon-bone type thus comprises a central ligamentary part and two bony parts, the latter allowing a very good fixation in the bone tunnel
• This type of sampling has significant potential disadvantages namely a weakening of the extensor apparatus , residual pain, a risk of fracture of the patella or rupture of the patellar tendon weakened by the levy of which they were the object.
• ligament grafts taken from the tendons of the crow's foot, that is to say the union of the end tendons of the sartorius muscles, internal and semi-tendinous muscles, called the graft of. type DI-DT.
• the graft is then made of a pure tendinous tissue, that is to say without bone blocks at its ends. This in relation to bone graft transplantation, poses a technical problem of graft fixation in the bone tunnel.
• a usual method of attachment is to introduce a so-called interfering screw between the ligamentous graft and the wall of the bone tunnel into which the graft has been introduced beforehand.
• the mechanical resistance to tearing may not exceed 20 daN.
• This sliding causes a gradual loss of the initial tension and may even, after a few hundred cycles, cause the complete removal of the graft out of the bone tunnel.
• Another device to avoid the disadvantages of the interference screws is to pass through the ligament loop a relay strip synthetic fabric itself fixed on a small metal bar (type endo-button). After having traversed the entire bone tunnel along its longitudinal axis by pulling the relay strip and the ligament loop behind it, this bar pivots and applies to the bone cortical bone, thus neutralizing the possible removal of the graft.
• An object of the invention is therefore to propose a device for attaching a ligament graft in a tunnel bone which has a high tensile strength to limit the risk of tearing or sliding of the ligamentous graft in a bone tunnel.
• the patent application WO 2004/045465 represents the closest prior art and relates to a technique for fixing a ligament graft suspended by textile strips screwed into bone tunnels by means of a special screw which has been called TLS screw (Tape Locking Screw).
• Bone quality varies considerably from one individual to another depending on age, sex, mineralization rate, etc.
• the resistance to tearing and especially to sliding of the ribbon depends the quality of the bone in which the screw is implanted.
• a soft bone will be much less resistant than a hard bone.
• the healing process of a traumatized bone firstly comprises a phase of bone resorption due to to the work of osteoclasts which necessarily precedes the reconstruction phase secondary to the work of osteoblasts.
• the strength of the initial assembly is significantly altered during the bone resorption phase which could for some time jeopardize the strength of the assembly and could slip the tape relative to decrease the tension in the graft and therefore, the stability of the knee restored during the operation.
• the bone strength is not measurable on a case-by-case basis, such a potential weakening of the assembly would force the surgeon to return to the techniques of protection of the graft (splint, partial discharge) for all cases operated, while the goal
• the essential element of the TLS technique was, by proposing an extremely solid fastening system, to be able to free itself from the protection techniques without risking compromising the quality of the final mechanical result.
• the other possible factors of reduction of the efficiency of the system are related to the quality of the implantation of the screw.
• the third risk factor clearly identified is the insertion depth of the screw.
• the surgeon works blind and must rely on the graduations of placement instruments to assess the depth of introduction of the screw especially to the femur or the thickness of the integuments is much more important than in the tibia.
• experience has shown that there is a significant risk of being wrong in the evaluation of the insertion depth of the screw.
• a screw that is too deep or too shallow will not give the same quality of fastening of the ribbons as if it is at its proper level. This hazard is also a factor in the reduction of mechanical quality, the importance of which is individual and unmeasurable.
• a screw is introduced too shallow, it can cause irritation of the soft tissue where it is derived from the bone and cause at this place a chronic inflammatory reaction for the least embarrassing or painful.
• the aim of the present invention is to propose a system making it possible in all cases to obtain an optimal quality of fixation of the TLS system, ie in all patients regardless of their bone quality while eliminating the risks of mispositioning. of the screw (divergence, excess or lack of depth).
• the present invention makes it possible not only to standardize the quality of the results but also thanks to a simplified technique allows the use of bone tunnels of a single caliber.
• the present invention proposes to improve the effect of a screw or similar locking member by providing to associate therewith a hollow socket comprising an outer wall, an inner wall and two orifices, generally but not necessarily a wider and a narrower .
• the invention provides a hollow socket to be anchored in a bone tunnel for the passage of relay strips or suture characterized in that it has an outer wall, an inner wall and two orifices, said inner wall being adapted to to grip and block said strips by the effect of a locking member introduced into the socket.
• the surgical technique is easily adapted to practice this new device and the invention therefore also relates to the associated method.
• the inner wall of the sleeve corresponds to the negative impression of a tape locking screw.
• a spiral groove whose shape corresponds exactly to the thread of the locking screw. The depth of the groove is calculated so that after tightening the screw in its socket, the entire screw has penetrated into the socket after compacting the ribbons in the grooves of the sleeve according to a predetermined optimum torque in function of the mechanical properties of the material used.
• the outer wall of the sleeve is provided with at least four anti-rotation fins intended to neutralize in the bone the torsional torque induced by the tightening of the screw in its socket.
• the widest orifice, directed outwards, corresponds to the penetration inlet orifice of the screw.
• the bone tunnel to be provided forms with the cortical bone a variable angle on a case-by-case basis of 30 to 60 °.
• the inlet orifice of the screw is inclined by about 30 ° relative to the plane perpendicular to the major axis of the socket.
• the union between this inlet and the outer wall (short side) of the sleeve is a flange intended to abut on the cortical bone thus preventing the penetration of the socket beyond this cortex.
• the conical shape of the socket is already a brake in itself to a possible excess of penetration, this overflow provides additional security and above all allows to place the socket reproducibly from one individual to another regardless of the angulation of the bone tunnel with respect to the cortex.
• the sleeve is not conical but cylindrical on its entire outer surface.
• the inner cavity could be either conical or cylindrical depending on the locking mechanism of the ribbon that is selected.
• Fig. the watch schematically and in perspective a socket according to the invention.
• Fig. Ib and Ic are corresponding horizontal and vertical sections.
• Fig. Id shows the general shape of a socket.
• the figure shows how socket 1 is positioned in a bone tunnel.
• Fig. 2 shows the screw 9 in place in the doule'lle 1.
• the technique of use of this ligament fixation system is shown schematically from Figure 3 to Figure 7:
• Fig. 3a illustrates the installation of the guide pins
• Fig. 3b illustrates the realization of tunnels 32 from outside to inside.
• Fig. 4a illustrates the preparation of the housing 44 of the socket.
• Fig. 4b describes the final appearance of tunnels 32 and bone boxes 44.
• Fig. 5a illustrates the introduction of the sockets 1 by means of a sleeve holder also sliding on the guide pins 31.
• Fig. 5 b illustrates the appearance of the tunnels after placement of femoral and tibia sockets.
• Fig. 6a shows the passage of the strips 21 in the tunnels 32 and insertion of the graft 61 into the knee by pulling on the strips 21.
• Fig. 6b shows the appearance of the graft 61 after its introduction.
• Fig. 7a illustrates the locking of the graft to the femur.
• Fig. 7b shows the appearance of the graft after complete locking.
• Figs. 8a and 8b respectively illustrate another embodiment of the invention consisting of a cylindrical sleeve to be screwed and a cylindrical sleeve to be driven or wedged in the bone tunnel.
• Figs. 8c and 8d illustrate the same cylindrical bushings but optionally provided with a large head intended to bear on the cortical surface.
• Fig. 9a illustrates in longitudinal section a cylindrical sleeve to be screwed.
• Fig. 9b illustrates the same screw after the introduction of the ribbon locking member.
• Figs. 10a-10c illustrate the case where the ribbon is jammed by a locking member which is not a screw
• Figs. lla-lli illustrate the steps of a method of surgical reconstruction of the anterior cruciate ligament.
• Fig. the watch schematically and in perspective a socket according to the invention having a first orifice 11 and a second orifice 12 narrower and an outer wall 6, and the stop edge 3.
• Fig. Ib and Ic are corresponding horizontal and vertical sections showing four anti-rotation fins 2, the inner wall 6 ', and the inner groove 4'.
• Fig. Id is a longitudinal section showing the flange 3 and the beveled section of the broad part of the cone, with an angle of about 30 ° between the longitudinal axis b of the sleeve and the plane a perpendicular to this axis.
• the figure shows how the sleeve 1 is positioned in a bone tunnel made according to 3 different angulations relative to the cortical bone. In each case the sleeve stops on the cortex, where it forms an acute angle with the bone tunnel.
• FIG. 2 shows the screw 9 in place in the sleeve 1 compacting the ribbon 21 of suspension of the graft in the groove 4 'of the wall 6' of the sleeve 1.
• the technique of use of this ligament fixation system is schematized from FIG. Figure 3 in Figure 7 for a surgical reconstruction of the anterior cruciate ligament at the knee joint.
• Fig. 3a illustrates the establishment of the guide pins 31 for guiding the piercing instruments of the bone tunnels at the ends of the femur 7 and the tibia 8.
• Fig. 3b illustrates the realization of tunnels 32 from outside to inside by means of hollow drills sliding on the guide pins 31.
• the tunnel is hollowed right through in a single gauge according to the measurement of the caliber of the ends of the graft.
• Fig. 4 illustrates more particularly the preparation of the housing 44 of the sleeve 1 by means of a hollow metal instrument 41colluant also on the guide pins 31 and one end 42 comprises a conical member of shape and size strictly identical to the final bushing.
• this conical member is provided with cutting edges preparing the bone grooves which will receive the anti-rotation fins of the sleeve and it is also provided with a cortical stop rim 43 just like the final socket.
• Penetration is done with a hammer.
• sinking the instrument compact the walls of the cylindrical tunnel by creating a conical shaped box whose depth corresponds to the maximum degree of penetration of the instrument that is to say when its cortical stop edge abuts against the entrance to the bone tunnel
• Fig. 4b describes the final appearance of tunnels 32 and bone boxes 44, the guide pins being always present.
• Fig. 5a illustrates the introduction of the sockets 1 by means of a sleeve holder also sliding on the guide pins 31.
• the sockets are driven by hammer until they are blocked in their penetration by their conical shape and by the stop 3 of the cortical stop margin.
• Fig. 5b illustrates the appearance of the tunnels after placement of the sockets 1 to the femur and tibia.
• Fig. ⁇ a shows the passage of the strips 21 in the tunnels and introduction of the graft 61 in the knee by pulling on the strips.
• Fig. 6b shows the appearance of the graft 61 after its introduction.
• Fig. 7a illustrates the locking of the graft to the femur by the establishment of the locking screw 9, then, tensioning the graft 61 to the shin and locking by a similar screw 9 '.
• Fig. 7b shows the appearance of the graft after complete locking. It will be understood that the fastening system as illustrated and described above can have considerable advantages:
• the bushing and the screw are made of biocomposite material, that is to say combining a bioabsorbable polymer, for example of the PLA (PbIy Lac ' tic AcTd) type, with an osteogenic substance. inducer, for example, of the TCP (Tri Calcium Phosphate) type.
• PLA PbIy Lac ' tic AcTd
• inducer for example, of the TCP (Tri Calcium Phosphate) type.
• the foreign material thus introduced not only slowly resorbs with time but also does so by stimulating the local proliferation of bone tissue.
• the fasteners (socket and screw) slowly disappear to leave some room for the bone tissue of the recipient host.
• the suspension strips can also be made of absorbable material which after complete absorption of the system would leave a perfectly clean and natural environment. Since the biocomposite material is very hard, there are no more objections to reducing the size of the implants, depending on the situations encountered, since the tightening occurs between two elements of equals. hardness whereas the original TLS system somehow required the use of large diameter screws. It is indeed by crushing and compacting the bone around it that the TLS screw makes it possible to obtain a sufficient tightening effect of the ribbon.
• the present system makes it possible to block textile strips such as they are used in ligamentous surgery but it could also serve as a means of blocking simple suture threads which, having re-tensioned any ligamentous structure, could be very effectively blocked by clamping between a sleeve and a locking screw, thus eliminating the need to make stopping nodes sometimes very difficult to achieve.
• Figs. 8 to 10 illustrate a particularly preferred embodiment of the invention.
• the hollow sleeve is essentially a cylindrical member and no longer a conical member.
• two types of introduction and anchoring of the hollow organ into the bone can be imagined: either a screw-in member as shown in FIG. 8a or an ankle-type hunting member (the same principle as FIG. socket of Figure 1) as shown in Figure 8b.
• the screw member (FIG 8a) therefore comprises a cylindrical body 80 of 20 to 25 mm long for an outside diameter of the cylinder of about 10 mm.
• the outer wall has a wide, relatively sharp thread, resembling the thread of the lag bolts used in the wood, or the broad and deep thread of the spongy bone screws.
• This wide and cutting net 81 provides extremely strong bone anchorage.
• Figure 8b shows a similar cylindrical member but adapted to be driven into the bone tunnel rather than vissé.
• the outer surface- "the cylin 'dre 10 mm could be provided with fine edges perpendicular to the major axis of the
• the hollow body is parallel to one another and the cortical support collar also requires a small milling operation to at least partially bury the head of the ankle.
• the locking of the ribbons inside the socket can be achieved essentially in two ways:
• FIG. 9a shows a cylindrical sleeve 90 to be screwed in longitudinal section.
• FIG. 9b shows the same section after introduction of the locking member 91 of the ribbon 21.
• This locking member is constituted by a screw 91 with a large pitch and foam thread (TLS principle) whose diameter is adjusted to come jamming the tape by clamping against the inner wall of the sleeve and in the internal aliasing.
• This locking screw could have a conical shape like the TLS screw but this device as has already been said is no longer really necessary and a screw of cylindrical section would achieve the same result, possibly more easily.
• the core of the bushing has been hollowed out in the form of a cone and the locking member having the same shape will simply be driven into the conical cavity in order to wedge the ribbon by wedge effect.
• FIG. 10a shows such a sleeve in longitudinal section.
• FIG. 10b illustrates the fastening mechanism of the ribbon 21 after insertion of the locking member 22.
• FIG. 10c constitutes a variant of this device in which the inner wall 23 of the sleeve and the outer wall 24 of the 22 'blocking has been provided with fine indentations 25 so as to avoid the risk of accidental release of the system.
• An additional advantage of the present system is that once the tibial tunnel is made entirely at the graft size, it can to penetrate the knee by the tunnel itself from outside to inside as is done in classical techniques (and no longer through the arthroscopic opening). This makes it possible to preserve the remains of the broken anterior cruciate ligament which, it seems, could significantly favor the revascularization of the graft and its incorporation into the bone tissue. It can indeed be considered that it is from these residual tissues that the vascularization of the graft begins, which is essential for its incorporation and survival.
• cylindrical sockets allows the use of standard 10 mm gauge sockets which correspond to the maximum observable size for anterior cruciate ligament grafts.
• the drilling instrumentation of the tunnel would therefore comprise hollow two-segment drill bits, a first segment of variable caliber depending on the graft size (from 6 to 10 mm) and the second segment, of constant diameter, of 10 mm corresponding to the socket housing.
• Such a standardization would be more difficult in the case of a conical socket because the recess The taper of the stump must always be substantially greater than the diameter of the tunnel accommodating the graft.
• the invention also relates to a technical nnuvpllp surgical reconstruction of the anterior cruciate ligament using for example a sleeve and a locking member to be screwed.
• the method according to the invention is summarized and schematized in the following manner with reference to FIGS. 11 a-i:
• a single tendon of the crow's feet is removed.
• the tendon is wound four to five times on itself to obtain a short closed loop with four or five strands.
• Two transfixing stitches are placed at both ends of the loop to neutralize the slipping of the strands together.
• a surgical textile strip is passed freely through each end of the loop, thereby allowing suspension and fixation of the ligament loop.
• the loop thus made is placed on a traction table by means of the strips and a prestressing of 50 kg is applied to the system for 15 to 20 minutes before introducing it into the knee.
• This prestressing deforms the graft somewhat and thus neutralizes any phenomenon of parasitic elongation that may occur during the postoperative period, which would lead to relaxation in the graft and at least partial reappearance of joint laxity.
• the graft is calibrated to know the tunnel drilling diameter.
• Preparation of bone tunnels (Fig.llb-d): Placement of guide pins in the femur and tibia under arthroscopic control using conventional instruments (sights, etc.) (Fig. 11b)
• the end of each of the pins corresponds to the intra-articular anchoring zone chosen by the surgeon for docking the graft.
• Fig. Ile Drilling of the bone tunnels from outside to inside to the femur and then to the tibia according to the size of the graft (Fig. Ile).
• the instrumentation has a series of two-segment hollow wicks: the distal segment is variable (from 6 to 10 mm) and corresponds to the measured size of the graft.
• the proximal segment is constant and corresponds to the caliber of the socket (10mm). The use of this special wick thus allows to realize in a single passage the housing of the ligament and that of the socket. Digging is also done from outside to inside.
• Fig. Hd schematically shows the appearance of the tunnels after drilling.
• Implantation and fixation of the graft (Fig. Lle-i): a pull wire is introduced into each of the tunnels from the outside to the inside of the knee and then recovered by the anterior arthroscopic anterior approach. This pulling wire makes it possible to draw the strips into the knee, then through each of the tunnels and collect them at the external orifice of each of the tunnels. This method allows to introduce the graft by the endoscopic approach by simply pulling on the strips as shown in Figure 6a and 6b.
• An alternative is to introduce a single pull wire into the femoral tunnel first from out into the inside and then retrieve this wire through the tibial tunnel from inside to out (Fig.
• This thread then makes it possible to attract the strips suspending the femoral pole of the graft through the tibial tunnel and then the knee and then through the femoral tunnel (Fig. llf).
• This method thus makes it possible to introduce the graft through the tibial tunnel ⁇ nmmp in most traditional ligamentoplasty methods.
• it may be advantageous in that it avoids excessively generous debridement of the entrance to the tibial tunnel, which could have a negative effect on the subsequent revascularization of the graft.
• Figure Hi shows the final appearance after locking the femur and tibia by the locking screw and section strips.

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