FR2980356A1 - Suture for e.g. linking e.g. cruciate ligament of knee with cortical wall of e.g. femur of failing articulation, has side zone penetrating in grommet by upstream opening and forming traction free end in downstream opening - Google Patents

Abstract

The suture has elongated left and right sides zones (2b) adjoining a elongated central zone (2a), where each of the side zones, at a distance from its free end, is equipped with a grommet (22). The grommet is equipped with an upstream opening (220) turned toward the free end, and a downstream opening (221) faces toward the central zone. The side zone is engaged in a sliding motion in the grommet from each other. The side zone penetrates in the grommet by the upstream opening and forms a traction free end (21) in the downstream opening of the grommet.

Description

SUTURE FOR ORTHOPEDIC SURGERY AND METHOD FOR FORMING THE BUCKLES THEREOF. The present invention is in the field of materials used in orthopedic surgery and more particularly relates to a suture for binding a soft tissue, such as ligament or tendon to the cortical wall of one of the bones of a joint. State of the prior art. Prior art known sutures to bind a ligament to a bone. Such sutures are known in particular from patent applications Arthrex, EP 2238944, US 2010/0256677, US 2010/0268273 and BIOMET US 7601 165, US 7,658,751, US2008 / 0312689 and are formed essentially by a braid arranged in several loops and by an anchoring element for example in the form of an anchor plate to which the two loops are secured. According to Arthrex, the anchoring member in the form of a plate comprises two through-holes in which the strands of the loops are engaged. In order to place the suture, a through hole is formed in the bone of the joint. The suture by the loops it forms is engaged in the through bore and the wafer is applied against the bone at the entrance to the bore. The loop or loops formed beyond the piercing receive the ligament to be attached to the bone. Then by pulling on the strands of the loops, the latter are tightened to bring the ligament against the bone. The configuration of the loops is such that it prevents their widening under the effect of the tensile force exerted by the ligament. According to Arthrex, the two loops are interconnected by their ends at a distance from the plate so as to form only one. The disadvantage of this arrangement is that it can cause blocking loops and prohibit their tightening if one of them hangs in a bone or in the ligament. Another disadvantage of this arrangement lies in the fact that the interconnection of the two loops created at their interconnected ends, an extra thickness of small extent that can create under the effect of the tensile force, a zone of aggression likely to hurt the soft tissue.

According to BIOMET the flexible link is provided with a loop in which are engaged the ends of said link to form two adjacent loops. Because of this configuration, the two free strands of tensioning of the suture thus formed are on the side of the loops and for this reason must be engaged in the tunnel drilled into the bone body for the joining of a soft tissue. to this bone body. Such an arrangement may cause difficulties in tensioning the suture due to the interference between the soft tissue, the bone and the free strands as well as the presence of angulation between the tunnel and the direction of the straining efforts. tensioning. In addition, this suture requires additional manipulations to proceed with the cutting of the strands, under arthroscopy. Finally, it persists in the tunnel, useless free strands after their sectioning which unnecessarily increases the volume of implanted material. Presentation of the invention.

The present invention aims to solve the aforementioned drawback by proposing a suture for orthopedic surgery used in particular for binding a ligament to one of the bones of a joint. Thus, the suture in the form of a flexible link made of a biocompatible material consisting of a single strand arranged in loops, in particular for orthopedic surgery that can be used, for example, to bind a soft tissue such as a ligament to one of the bones of a joint, said link having a longiform central zone and two left and right longiform zones, lateral and adjacent to the central zone, is essentially characterized in that each of the right and left lateral zones, at a distance from its free end, is provided with at least one passerby with an upstream orifice turned towards said free end and a downstream orifice turned towards the central zone, and that each lateral zone is engaged in the passage of the other and traverses it from one side to the other, said lateral zone penetrating into said passer-by by the upstream orifice of the latter and forming downstream of said passer a strand free traction.

The suture thus forms two adjacent loops disposed substantially in two parallel planes, each provided in a fraction of its perimeter of a passer or sheath receiving a fraction of the perimeter of the other loop, passers being opposed.

This suture is provided for tensioning between the aforementioned central zone and the opposite zone of the loops and without deforming, that is to say without loops can expand under the effect of tensile forces. This is essentially because the adhesion forces between the loops and the side areas are large enough to prevent any slippage of said areas in the direction of the widening loops. However, they are not sufficient to prohibit the narrowing of the loops under the effect of a traction action exerted by the surgeon on each of the free strands. Another advantage of the arrangement according to the invention lies in the fact that the two loops, opposite the central zone form in combination a cradle in which the soft tissue can be engaged. Such a cradle arrangement, aims to increase the importance of the contact surfaces of the flexible link against the soft tissue and thus reduce the pressures and consequently the risk of deterioration of the soft tissue under the effect of traction forces.

According to another characteristic of the invention, the two loops are formed on the flexible link. Such a configuration aims to simplify the realization of the link. According to another characteristic of the invention, each lateral zone is provided between the first passer and the central zone of a second passer, said second pass having a first orifice facing the downstream orifice of the first passer and a second lead. orifice opposite said central zone. Such a configuration by doubling the number of loops aims to strengthen the strength and rigidity of the binding by increasing the adhesion forces between the loops and the side zones.

According to yet another characteristic of the invention, each lateral zone is slidably engaged successively in the two loops of the other lateral zone and passes right through them to form downstream of these two loops a free traction strand. Such an arrangement provides a better tensile strength and a lower elongation by increasing the contact surfaces between the loops and strands and consequently, by increasing the importance of the adhesion forces between them. Such an arrangement allows the system to be tensioned from the outside, which facilitates fixation and reduces the amount of implanted material in the patient by avoiding leaving unnecessary strands unnecessary within the bone piercing. According to another characteristic of the invention, the suture comprises an anchoring member in a bone body. According to another characteristic of the invention, the anchoring member is carried by the central zone of the flexible link. According to yet another characteristic of the invention, the flexible link is formed of a tubular braid and each passer consists of a fraction of the length of this tubular braid, the upstream and downstream orifices of each passer being each formed by a radial drilling practiced in the braid. Such a provision is still intended to simplify the realization of the flexible link. Brief description of figures and drawings. Other advantages, aims and features of the invention will become apparent on reading the description of a preferred embodiment, given by way of non-limiting example, with reference to the appended drawings in which: FIG. 1 is a plan view of a first embodiment of a flexible link constituting the suture according to the invention; FIG. 2 is a plan view of a suture made with a link according to the first form of FIG. 3 is a plan view of a second embodiment of a flexible link, FIG. 4 is a plan view of a first embodiment of a suture made with a flexible link according to FIG. Fig. 5 is a plan view of a second embodiment of a suture made with a flexible tie according to the second embodiment; Fig. 6 is a plan view of a second embodiment of a suture made with a flexible tie according to the second embodiment; a third embodiment of a suture made with a flexible link according to the second embodiment; - Fig. 7 is a plan view of a third embodiment of a flexible link; - Fig. 8 is a plan view of a suture made with a flexible link according to the third embodiment, - Figures 9 to 11 are plan views of sutures equipped with anchoring members according to various embodiments. - Figure 12 is a suture having two anchors. Best embodiment of the invention. As shown, the suture is intended for the fixation of a soft tissue such as a ligament or tendon to the bone of a defective joint in order to restore the functions of the latter. More particularly, without being limiting, the suture is used for the reconstruction of cruciate ligaments of the knee and allows the attachment of an appropriate graft to one of the bones, tibia or femur of this joint.

This suture is essentially formed by a flexible link 2 of biocompatible material, having a central zone 2a longiformes and two longiform lateral zones 2b adjacent to the central zone. According to the invention, each central right and left central zone, at a distance from its free end, is provided with at least one passer 22 having an upstream orifice 220 facing said free end and a downstream orifice 221 turned towards the central zone 2a. Such a loop is shown in FIG. 1. FIG. 2 shows a suture formed with a flexible link according to FIG. 1. It can be seen that each lateral zone 2b is slidably engaged in the loop 22 of the other zone 2b. and crosses it through to penetrate through the upstream orifice 220. It can also be seen that this side zone forms downstream of the passer, a free traction strand 21. Each passer 22 therefore receives a fraction of the length of the link flexible and therefore sees its external diameter increased by expansion. According to an alternative embodiment of the flexible link (FIG. 3), each lateral zone 2b is provided between the first passer 22 and the central zone 2 a with a second passer 23. As can be seen in this figure, this second passerby 23 has a first orifice 230 opposite the downstream orifice 221 of the first passer 22 and a second orifice 231 opposite the central zone 2a. According to a first embodiment (FIG. 4) of a suture made with the flexible link 2 according to FIG. 3, each lateral zone 2b is successively engaged in the two loops 22, 23 of the other lateral zone and passes through them. partly to form downstream of these two loops 22, 23 a free traction strand 21. More specifically, each lateral zone 2b first passes through the first pass 22 of the other zone by engaging in it through the orifice upstream 220 and then through the second pass 23 of this other zone by engaging in the first port 230. Such an embodiment provides greater strength for less elongation. According to a second embodiment (FIG. 5) of a suture made with the flexible link object of FIG. 4, each lateral zone 2b is first slidably engaged in the first passer 22 of the other lateral zone and the crosses completely through the upstream orifice 220 to the downstream orifice 221, and 10 is then slidably engaged in the second passage 23 that it comprises and traverses it through from the first orifice 230 to the second orifice 231 and forms beyond the latter, a free strand 21 traction. Such an arrangement is still intended to increase the resistance and decrease the elongation of the suture. Alternatively, according to the embodiment object of FIG. 6, each lateral zone 2b is first slidably engaged in the first pass 22 of the other lateral zone 2b and traverses it through from the upstream orifice 220 to the downstream orifice 221 and then is engaged in sliding in its own second pass 23 and passes right through it from the second orifice 231 to the first orifice 230 and forms beyond the latter, the free traction strand 21. According to this embodiment, the free tensioning strands 21 develop opposite the central zone 2a and consequently the tensioning of the suture is effected by traction on the opposite side to the central zone 2a. . Such an embodiment of the suture makes it possible to bring and bind a bone to a soft tissue or a second bone when the operative way does not allow access to the bearing surface of the suture and therefore to proceed to the tensioning. According to the various embodiments as described, the flexible link 2 is formed of a tubular braid and each passer 22, 23 is constituted by a fraction of the length of this tubular braid. According to this embodiment, each upstream orifice 220 or downstream 221 of each passer 22 and each first and second orifices 230, 231 of each second pass 23 is formed by a radial bore formed in the tubular braid. In Figure 7 is shown in plan a third embodiment of a suture link 2 according to the invention. Note in this figure that the two loops 22, 23 that includes each side zone 2b are arranged laterally adjacent to one another. The first pass 22 of each lateral zone 2b, or internal pass, comprises an upstream orifice 220 facing the free end of the lateral zone 2b and a downstream orifice 221 turned towards the central zone 2a. The second external passing or passing of each lateral zone 2b has a first orifice 230 facing the free end of the lateral zone 2b and a second orifice 231 turned towards the central zone 2a. Alternatively passers 22, 23 are shifted partially or totally. FIG. 8 shows a suture made with the flexible link according to FIG. 7. It may be noted that one of the lateral zones 2b is slidably engaged in the first guide 22 of the other lateral zone 2b and traverses it from one side to the other. part from the upstream orifice 220 to the downstream orifice 221 and is then slidably engaged in its own first pass 22 and passes right through it from the downstream orifice 221 to the upstream orifice 220. It can also be seen that the Another lateral zone 2b is slidably engaged in the second loop 23 of the other lateral zone 2b and passes right through it from the first orifice 230 to the second orifice 231 and is then slidably engaged in its own second pass 23. and crosses it completely through the second orifice 231 to the first orifice 230. In this configuration, the two free traction strands 21 develop opposite the central zone 2a, the tensioning of the sutu re performed by pulling the opposite side to said central zone. In addition, such an arrangement with respect to that object of FIG. 6 has the advantage of reduced bulk. The suture in the various embodiments as described forms two adjacent loops 20 parallel traction and holding and two strands free traction 21 allowing traction on the latter, the tightening of the two loops 20. As can be seen the two loops 20 are respectively formed in two substantially parallel geometric planes. The median zone 2a of the flexible link 2 may be provided to be anchored in the cortical zone of one of the bones of a joint to be restored while the two loops 20, opposite the central zone 2a, are provided to receive the soft tissue to attach to the bone of the joint.

The suture as described may receive at least one anchoring member 1 of biocompatible material provided to support or be plugged into a bone body. The anchoring member 1 is integral with the central zone 2a of the flexible link 2, allows the anchoring of the suture in the cortical zone of one of the bones of the joint. The two traction loops 20 formed by the flexible link 2 make it possible to maintain and adjust the tension of a suitable graft, this graft being engaged in and supported by the cradle formed by the two loops 20 opposite the zone. Central 2a. In Figure 9 is shown a first embodiment of such a suture. According to this embodiment, the anchoring member 1 is formed by a plate having two through-holes 10, formed at a small distance from each other in which the central zone 2a of the flexible link 2 is engaged as well as the traction strands 21. The wafer 1 has a bearing surface 11, which may be flat, designed to abut against the cortical zone of the bone of the articulation and a dorsal face 12 opposite to the preceding one. The loops 20 of the suture are formed facing the bearing face 11 of the wafer 1, while the free traction strands 21 extend opposite the dorsal face 12 of the wafer 1. The through holes 10 of the plate are made in the latter at a short distance from each other and from the bearing face 11 to the dorsal face 12. The axis of each of these holes is perpendicular to these two faces. The flexible link 2, more precisely the central zone 2a of the latter is engaged in the two holes 10 and short on the dorsal face 12 of the wafer, a through hole 10 to the other. The downstream orifice 221 of each passer 22, is disposed against the bearing face 11 of the wafer 1 around the mouth of the through bore 10. Such an arrangement prevents the loops 22 from tightening the loops 20. driven into the through holes 10 of the wafer. Another effect of this characteristic is to avoid the widening of the loops under the effect of the tensile force exerted at their end by the ligament or the tendon. In the embodiment object of FIG. 9, each lateral zone 2b of the flexible link comprises only one passer 22, but alternatively may be used a flexible link provided with two loops 22, 23. In this case, the second orifice 231 of each passer 23 will be disposed against the bearing face 11 of the wafer 1. In Figure 10 is shown a suture comprising an anchoring member 1 in the form of a screw. It is noted that this screw comprises a threaded body and a head having a diametrical through bore in which is engaged the central zone 2a of the flexible link. FIG. 11 shows a suture comprising an anchoring member in the form of a nail. It can be seen that the body of this nail is provided with a diametrical through bore in which is engaged the central zone 2a of the flexible link 2.

According to another embodiment (FIG. 12), the suture comprises two anchoring members 1, the first of which is secured to the central zone 2a and the second of the two loops formed 20. More precisely, this second anchoring member is integral with the area of each loop, opposite the central zone 2a.

It goes without saying that the present invention may receive any arrangements and variants of the field of technical equivalents without departing from the scope of this patent.