FR2673834A1 - Method for arthroscopic reinsertion of a meniscus on the articular capsule of the knee, clip for reinsertion, and clamp permitting the positioning of such a clip - Google Patents

Method for arthroscopic reinsertion of a meniscus on the articular capsule of the knee, clip for reinsertion, and clamp permitting the positioning of such a clip Download PDF

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Publication number
FR2673834A1
FR2673834A1 FR9102942A FR9102942A FR2673834A1 FR 2673834 A1 FR2673834 A1 FR 2673834A1 FR 9102942 A FR9102942 A FR 9102942A FR 9102942 A FR9102942 A FR 9102942A FR 2673834 A1 FR2673834 A1 FR 2673834A1
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FR
France
Prior art keywords
meniscus
clip
reinsertion
knee
clamp
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
FR9102942A
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French (fr)
Inventor
Missenard Gilles
Durey Alain
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Individual
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Individual
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Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to FR9102942A priority Critical patent/FR2673834A1/en
Publication of FR2673834A1 publication Critical patent/FR2673834A1/en
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00004—(bio)absorbable, (bio)resorbable, resorptive
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B2017/0646—Surgical staples, i.e. penetrating the tissue for insertion into cartillege, e.g. meniscus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B2017/0647—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks
    • 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
    • A61F2/30—Joints
    • A61F2/38—Joints for elbows or knees

Abstract

The present invention relates to a method for reinsertion of a meniscus (3) on the articular capsule of the knee (4), consisting in introducing a clamp into the knee, then, by way of the clamp, a clip which passes through the meniscus to be reinserted and the articular capsule. The present invention also relates to a clip and a clamp which are used in this method. Application to meniscal reinsertion.

Description

Procédé de réinsertion arthroscopique d'un ménisque sur la capsule articulaire du genou, agrafe de reinsertion, et pince permettant la mise en place d'une telle agrafe.Method of arthroscopic reinsertion of a meniscus on the knee joint capsule, reinsertion clip, and clamp allowing the placement of such a clip.

La présente invention concerne un procédé de réinsertion d'un ménisque sur la capsule articulaire du genou. The present invention relates to a method for reinserting a meniscus onto the knee joint capsule.

Elle concerne également une agrafe de réinsertion et ne pince utilisée pour la mise en place d'une ou de plusieurs agrafes. It also relates to a reinsertion staple and a clamp used for the placement of one or more staples.

ta désinsertion méniscale est une lésion fréquente en pathologie sportive. Quand cette lésion touche une grande partie da ménisque, un traitement par exérèse simple consiste à réaliser une ablation totale ou sub-totale du ménisque. On sait que cette ablation est responsable d'une déstabilisation du genou qui aggrave d'éventueLles lésions ligamentaires souvent associées, et qu'elle est génératrice d'arthrose à plus ou moins long terme. your meniscal disinsertion is a frequent lesion in sports pathology. When this lesion affects a large part of the meniscus, treatment by simple excision consists in carrying out a total or sub-total removal of the meniscus. We know that this ablation is responsible for a destabilization of the knee which aggravates possible ligament lesions often associated, and that it generates osteoarthritis in the more or less long term.

quand le ménisque peut etre conserve, le traîte-#nerit consiste à réaliser une restitution anatomique par réinsertion du ménisque sur la capsule articulaire. Cette réinsertion n'est actuellement possible que par un double geste endo et exo-articulaire pour passer à l'aide d'aiguilles des fils de suture de l'intérieur de l'articulation vers l'extérie;r de l'articulation à travers le ménisque puis la capsule articulaire pour solidariser le ménisque sur la capsule
Si la phase endo-articulaire peut être de nos jours pratiquée sous contrôle arthroscopique, la phase exo-acticalaire nécessite un abord chirurgical latéral interne ou externe du genou, ce qui est responsable de nombreuses complications.En effet, le décollement cutané accroît le risque infectieux et il est de plus facteur de cicatrices douloureuses par lésion de l'inervation de la peau. Enfin le passage des aig-uilles de suture en semi-aveugle est un geste dangereux, avec risques de lésions nerveuses dans le compartiment externe dont les rapports avec le nerf sciai#iq#Ie poplité externe sont treks proches, mais aussi dans le compartiment interne au niveau du nerf saphène interne.when the meniscus can be preserved, the # nerit treats consists in carrying out an anatomical restitution by reinsertion of the meniscus on the joint capsule. This reinsertion is currently only possible by a double endo and exo-articular gesture to pass with the help of needles of the sutures from the interior of the joint to the exterior; r of the joint through the meniscus then the joint capsule to secure the meniscus to the capsule
If the endo-articular phase can nowadays be practiced under arthroscopic control, the exoactical phase requires an internal or external lateral surgical approach to the knee, which is responsible for many complications. and it is moreover factor of painful scars by lesion of the skin innervation. Finally the passage of the suture needles in semi-blind is a dangerous gesture, with risks of nerve damage in the external compartment whose relations with the sciai nerve # iq # Ie external poplity are very close, but also in the internal compartment at the level of the long saphenous nerve.

te but de la présente invention est donc d'éviter la phase exo-articulaire en suturant directement le ménisque à la capsule, et ce but est atteint grâce à la mise en place d'une ou de plusieurs agrafes semi-rôsorbables.  The object of the present invention is therefore to avoid the exo-articular phase by suturing the meniscus directly to the capsule, and this object is achieved by the placement of one or more semi-absorbable staples.

La présente invention a pour objet un procédé de rôinsertion d'un ménisque sur la capsule articulaire d'un genou. Selon l'invention, ce procédé consiste à introduire dans le genou, de l'intérieur vers l'extérieur, une pince, à positionner àa' l'aide de l'extrémité de la pince le ménisque à l'endroit exact ou l'on souhaite le réinsérer, à introduire dans le ménisque a-u moins une agrafe munie d'un crochet qui se fixe derrière la capsule articulaire. The present invention relates to a method of reinserting a meniscus on the joint capsule of a knee. According to the invention, this method consists in introducing into the knee, from the inside towards the outside, a forceps, to position with the aid of the end of the forceps the meniscus at the exact place or the one wishes to reinsert it, to introduce into the meniscus at least one clip provided with a hook which is fixed behind the joint capsule.

ta présente invention a également pour objet une agraphe permettant la réinsertion d'un ménisque sur la capsule articulaire du genou. Selon l'invention, elle comporte une tige munie à une extrémité d'un crochet et une butée résorbable située à l'autre extrémité de la tige. Your present invention also relates to a staple allowing the reinsertion of a meniscus on the knee joint capsule. According to the invention, it comprises a rod provided at one end with a hook and a resorbable stop located at the other end of the rod.

La présente invention a également pour objet une pince comportant an canon assurant le guidage des agrafes, 1' extrémité distale du canon comportant deux pointes qui permettent de manoeuvrer le ménisque à réinsérer. The present invention also relates to a clamp comprising a barrel for guiding the staples, the distal end of the barrel comprising two points which make it possible to maneuver the meniscus to be reinserted.

Il est décrit ci-apr~s à titre d'exemple et en référence aux desssins annexés le procédé de l'invention ainsi que l'agrafe et la pince utilisées. It is described below ~ s by way of example and with reference to the accompanying drawings the method of the invention as well as the clip and the clamp used.

- la figure 1 montre une coupe frontale d'un genou;
- la figure 2 montre un ménisque en vue agrandie selon il de la figure 1
- la figure 3 montre l'agrafe mise en place et la pince.- Figure 1 shows a frontal section of a knee;
- Figure 2 shows a meniscus in enlarged view along it of Figure 1
- Figure 3 shows the clip in place and the clamp.

Dans la figure I sont représentés un fémur 1, un tibia 2, deux ménisques 3 dont an présente une désinsertion 3A, deux capsules articulaires 4 et enfin un revêtement cutané 5. In FIG. 1 are shown a femur 1, a tibia 2, two menisci 3, one of which has a disinsertion 3A, two joint capsules 4 and finally a skin covering 5.

ta figure 2 montre bien la désinsertion 3A. your figure 2 clearly shows the 3A disinsertion.

La figure 3 montre l'agrafe 10 et la pince 20. Cette agrafe 10 est composée de deux éléments, le premier élément il étant une tige munie à son extrémité d'un crochet 11A et un deuxième élément constitué par une butée 12 solidaire de la tige. FIG. 3 shows the clip 10 and the clamp 20. This clip 10 is composed of two elements, the first element being a rod provided at its end with a hook 11A and a second element constituted by a stop 12 integral with the rod.

ta tige et son crochet sont réalisés en titane car cette tige doit perforer le ménisque, de dedans en dehors, puis la capsule articulaire. your rod and its hook are made of titanium because this rod must perforate the meniscus, from inside to outside, then the joint capsule.

ta butée 12 est réalisée en une matière résorbable en cinq à six semaines. Cette butée s'appuie sur le ménisque pour le maintenir fixé à la capsule ou est ancrée la tige. your stop 12 is made of absorbable material in five to six weeks. This stop rests on the meniscus to keep it fixed to the capsule where the rod is anchored.

ta pince 20 comporte un canon 21 à travers lequel est projetée l'agraphe 10. L'extrémité distale de cette pince comporte deux pointes 22 qui permettent de repousser et de manoeuvrer le ménisque. Entre ces deux pointes se trouve un chargeur d'agrafes non représenté qui pousse les agrafes les unes après les autres. your forceps 20 comprises a barrel 21 through which is projected the graph 10. The distal end of this forceps comprises two points 22 which make it possible to push back and maneuver the meniscus. Between these two points is a not shown staple loader which pushes the staples one after the other.

Le procédé de l'invention s'effectue de la manière suivante
- dans un premier temps, la pince est amenee en appui sur le ménisque et elle le positionne en le poussant sur la capsule articulaire à l'endroit exact ou l'on veut réinsérer ce ménisque
- dans un second temps, la pince assure alors la poussée de l'agrafe à travers le ménisque puis à travers la capsule articulaire réalisant ainsi la fixation à l'endroit recherché.The process of the invention is carried out as follows
- firstly, the forceps are brought to bear on the meniscus and they position it by pushing it on the joint capsule at the exact place where we want to reinsert this meniscus
- in a second step, the clamp then pushes the clip through the meniscus and then through the joint capsule, thereby fixing it in the desired location.

te procédé se répète chaque fois que l'on veut mettre en place une autre agrafe sur la périphérie du ménisque.  The process is repeated each time we want to put in place another clip on the periphery of the meniscus.

En fin de cicatrisation, la tige restera dans l'épaissear du ménisque et de la capsule, tandis que la butée se sera résorbée ; de ce fait il ne restera rien dans l'articulation qui puisse créer une épine irritative.  At the end of healing, the stem will remain in the thickness of the meniscus and the capsule, while the stop will have been absorbed; therefore there will be nothing left in the joint that could create an irritating thorn.

Claims (5)

REVENDICATIONS 1. Dispositif de réinsertion d'un ménisque (3) sur la capsule articulaire (4) du genou, cette réinsertion s'effectuant sous contrôle arthroscopique, caractérisé en ce qu'il comprend au moins une agrafe munie d'un crochet fixé derrière la capsule articulaire du genou, et une pince permettant de positionner, à l'aide de son extrémité, le ménisque à l'endroit exact où l'on souhaite le réinsérer, puis d'introduire à chaque endroit une pince à travers le ménisque et la capsule articulaire. 1. Device for reinserting a meniscus (3) onto the articular capsule (4) of the knee, this reinsertion being carried out under arthroscopic control, characterized in that it comprises at least one clip provided with a hook fixed behind the knee joint capsule, and a clamp making it possible to position, using its end, the meniscus at the exact location where it is desired to reinsert it, then to introduce a clamp at each location through the meniscus and the joint capsule. 2. Dispositif selon la revendication 1, caractérisé en ce que chaque agrafe comporte une tige (11) munie à une extrémité d'un crochet (liA), et une butée résorbable (12) située à l'autre extrémité de la tige (11).  2. Device according to claim 1, characterized in that each clip comprises a rod (11) provided at one end with a hook (liA), and an absorbable stop (12) located at the other end of the rod (11 ). 3. Dispositif selon la revendication 2, caractérisée en ce que la tige (11) et le crochet (liA) de chaque agrafe sont réalisés en titane. 3. Device according to claim 2, characterized in that the rod (11) and the hook (liA) of each clip are made of titanium. 4. Dispositif selon l'une des revendications 1 à 3 caractérisé en ce que la pince comporte un canon (21) assurant le guidage des agrafes. 4. Device according to one of claims 1 to 3 characterized in that the clamp comprises a barrel (21) ensuring the guidance of the staples. 5. Dispositif selon la revendication 4, caractérisée en ce que l'extrémité distale du canon de la pince comporte deux pointes (22) qui permettent de manoeuvrer le ménisque à réinsérer.  5. Device according to claim 4, characterized in that the distal end of the barrel of the forceps comprises two points (22) which allow to maneuver the meniscus to be reinserted.
FR9102942A 1991-03-12 1991-03-12 Method for arthroscopic reinsertion of a meniscus on the articular capsule of the knee, clip for reinsertion, and clamp permitting the positioning of such a clip Withdrawn FR2673834A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
FR9102942A FR2673834A1 (en) 1991-03-12 1991-03-12 Method for arthroscopic reinsertion of a meniscus on the articular capsule of the knee, clip for reinsertion, and clamp permitting the positioning of such a clip

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FR9102942A FR2673834A1 (en) 1991-03-12 1991-03-12 Method for arthroscopic reinsertion of a meniscus on the articular capsule of the knee, clip for reinsertion, and clamp permitting the positioning of such a clip

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FR9102942A Withdrawn FR2673834A1 (en) 1991-03-12 1991-03-12 Method for arthroscopic reinsertion of a meniscus on the articular capsule of the knee, clip for reinsertion, and clamp permitting the positioning of such a clip

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0770354A1 (en) * 1995-10-20 1997-05-02 United States Surgical Corporation Meniscal fastener applying apparatus

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1985003857A1 (en) * 1984-02-28 1985-09-12 Saul Nethtali Schreiber Surgical fasteners and method
FR2573647A1 (en) * 1984-11-28 1986-05-30 Catier Philippe Device for repairing a meniscus by endoscopy alone
US4635637A (en) * 1984-03-29 1987-01-13 Schreiber Saul N Surgical suture
US4696300A (en) * 1985-04-11 1987-09-29 Dennison Manufacturing Company Fastener for joining materials
EP0390613A1 (en) * 1989-03-31 1990-10-03 United States Surgical Corporation Absorbable surgical fastener with bone penetrating elements

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1985003857A1 (en) * 1984-02-28 1985-09-12 Saul Nethtali Schreiber Surgical fasteners and method
US4635637A (en) * 1984-03-29 1987-01-13 Schreiber Saul N Surgical suture
FR2573647A1 (en) * 1984-11-28 1986-05-30 Catier Philippe Device for repairing a meniscus by endoscopy alone
US4696300A (en) * 1985-04-11 1987-09-29 Dennison Manufacturing Company Fastener for joining materials
EP0390613A1 (en) * 1989-03-31 1990-10-03 United States Surgical Corporation Absorbable surgical fastener with bone penetrating elements

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0770354A1 (en) * 1995-10-20 1997-05-02 United States Surgical Corporation Meniscal fastener applying apparatus
EP1319369A1 (en) * 1995-10-20 2003-06-18 United States Surgical Corporation Meniscal fastener applying device

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