JP4879166B2 - Apparatus and method for reconstructing a ligament - Google Patents

Description

  This application is related to the presently pending US application filed Mar. 4, 2004 by Paul Lee et al. For “apparatus and method for reconstructing ligaments” (Attorney Docket No. SCAN-2 CON). Patent application Serial No. 10 / 793,532, which is a continuation-in-part application, in which Paul Lee et al. Relates to “apparatus and method for reconstructing a ligament” (attorney docket SCAN-2). US Patent Application Serial No. 10 / 123,434, filed April 16, 2002, which is entitled “Apparatus and Method for Reconstructing Ligaments” (Attorney Docket Number) For SCAN-2), we claim the benefit of US Provisional Patent Application Serial No. 60 / 326,351, filed October 1, 2001 by Paul Lee et al. These three patent applications are incorporated herein by reference.

  The present invention relates generally to surgical devices and procedures, and more particularly to surgical devices and procedures for reconstructing a ligament.

  A ligament is a piece of fibrous tissue that connects one bone to another.

  Ligaments are often damaged (eg, desorbed or torn or ruptured) as a result of injury and / or accidents. Damaged ligaments can cause instability, prevent proper movement of the joints, and cause pain.

  Various procedures have been developed to repair or replace damaged ligaments. The particular treatment used depends on the particular human body to be recovered and depends on the extent of the injury.

  One ligament that is frequently damaged as a result of injury and / or accident is the anterior cruciate ligament (or ACL). Referring initially to FIGS. 1 and 2, it can be seen that the ACL 5 extends between the top of the tibia 10 and the bottom of the femur 15. Damaged ACLs can cause knee joint instability and can cause great distress and arthritis.

  A number of procedures have been developed to recover damaged ACLs through graft ligament replacement. In general, referring to FIG. 3, these ACL exchange procedures comprise the steps of digging a bone tunnel 20 through the tibia 10 and digging a bone tunnel 25 into the femur 15. In some cases, the femoral tunnel 25 may terminate at the distal surface 30 in the form of a mecha hole. In other cases, the femoral tunnel 25 or an extension of the femoral tunnel 25 may pass completely through the femur 15. Once the tibial tunnel 20 and the femoral tunnel 25 are formed, a transplanted ligament 35 made of a harvested or artificial ligament or tendon is passed through the tibial tunnel 20 and traverses the interior of the knee joint. To the femoral tunnel 25. Next, the distal end portion of the graft ligament 35 is fixed to the femoral tunnel 25, and the supply end portion of the graft ligament 35 is fixed to the tibial tunnel 20.

  Currently, there are a number of different ways to secure a graft ligament within a bone tunnel. One method is to use an interference screw 40 (FIG. 4) to drive the graft ligament against the opposite side wall of the bone tunnel. Another method is to suspend the graft ligament within the bone tunnel using the button 45 and suture 50 (FIG. 5) or using the cross pin 55 (FIG. 6). Yet another method is to pass the graft ligament completely through the bone tunnel and attach the graft ligament to the outside of the bone using screws 60 and washers 65 (FIG. 7) or using staples (not shown). .

  The “golden rule” of ACL recovery is generally considered to be so-called “bone-tendon-bone” fixation. In this procedure, patella tendon implantation is used to replace the natural ACL. Attached to both ends of the harvested tendon are bone grafts, taken from the patient's knee kid (ie, patella tendon) and the patient's tibia (ie, the position where the patella tendon is usually attached to the tibia) Taken from). A graft ligament is a bone tunnel with one bone graft fixed in the femoral tunnel using an interference screw and the other bone implant fixed in the tibial tunnel using another interference screw. Deployed. For many years, this procedure has provided a consistent, powerful and reliable ligament repair procedure. However, this process is considered very invasive and is often painful, typically leaving an annoying wound on the knee and leaving a substantial cavity in the knee kid.

  As a result, alternative procedures have recently been developed that incorporate the use of soft tissue grafts such as hamstrings. However, soft tissue transplants such as hamstrings can be difficult to stabilize within a bone tunnel. More specifically, the use of interference screws that invasively drive the hamstrings against the opposite side wall of the bone tunnel can cause problems such as graft slippage, tendon flexion, tissue necrosis, and tendon cuts. Furthermore, using a suspension cord (eg, shown in FIG. 5) and / or a cross pin (eg, shown in FIG. 6) to suspend the hamstrings in the bone tunnel is not possible. May cause different problem groups, for example, suture tethers and / or cross pins tend to allow the graft ligament to move laterally through the bone tunnel with the so-called “windshield wiper” effect. Yes, this prevents ingrowth between the graft ligament and the host bone and / or causes wear and / or other damage to the graft tissue. In addition, the use of cross pins to secure the hamstrings in the bone tunnel (eg, as shown in FIG. 6) can still cause other problems. For example, difficulty in looping the hamstrings across the cross pin, if the cross pin passes through the body such as the hamstrings, the hamstrings along the length while applying tension when passing The problem is torn.

  As a result of the foregoing, one object of the present invention is to provide an improved device for reconstructing a ligament, such as an allograft, autograft, xenograft, biological Constructed to allow graft ligaments to be made from various soft tissue grafts, such as engineered tissue grafts or synthetic grafts, which are secured in place using transverse fixation pins Is intended.

  Another object of the present invention is to provide an improved method for reconstructing a ligament, which includes, for example, allografts, autografts, xenografts, biotechnological tissue transplants Configured to allow graft ligaments to be made from various soft tissue grafts, such as grafts or synthetic grafts, which are intended to be secured in place using transverse fixation pins Yes.

  These and other objects are addressed by the present invention. The present invention, in one preferred form of the invention, includes the provision and use of a graft ligament support block, the graft ligament support block comprising a body and a graft hole and transverse fixation extending through the body. And both the implantation hole and the transverse fixation pin hole extend substantially perpendicular to the longitudinal axis of the body. In one preferred form of the invention, the present invention further comprises a placement instrument for inserting the graft ligament support block into the bone tunnel, while traversing the host bone while supporting the graft ligament support block within the bone tunnel. A transverse tunnel is formed in the host bone with the tunnel aligned with the transverse fixation pin hole in the graft ligament support block.

  In one preferred method of use, the graft ligament is looped through a graft hole in the graft ligament support block, and the graft ligament support block is attached to an installation instrument. The two free ends of the graft ligament are preferably secured to the proximal end of the installed base under the action of tension, thereby tying the two free ends of the graft ligament. In addition to controlling the two free ends of the graft ligament, this configuration holds the graft ligament support block to the placement instrument. The placement instrument then passes the graft ligament support block through the tibial tunnel and across the interior of the knee joint with the two free ends of the looped graft ligament extending back through the tibial tunnel and into the femoral tunnel. Used to advance to. The transverse tunnel is then formed in the host bone with the transverse tunnel aligned with the transverse fixation pin hole in the graft ligament support block. The graft ligament support block is advanced by pinning the graft ligament support block into the femoral tunnel, i.e., the transverse fixation pin along the transverse tunnel in the host bone and into the transverse fixation pin hole of the graft ligament support block To fix it in place. The two free ends of the looped graft ligament are released from the placement instrument, the placement instrument is removed from the graft ligament support block, and the placement instrument is withdrawn from the surgical site. Eventually, the two free ends of the looped graft ligament are secured to the tibia, thus completing the ACL repair. If desired, tibial attachment can be achieved using a second graft ligament support block.

  According to a further feature of the present invention, an apparatus is provided for use in reconstructing a ligament. The apparatus includes a graft ligament support block for supporting a graft ligament within a bone tunnel, the graft ligament support block extending between a distal end, a proximal end, and the distal end and the proximal end. A body having an existing longitudinal axis, the proximal end of which is tapered to facilitate withdrawal of the ligament support block through a bone tunnel; and the longitudinal direction Extending through the body intersecting the axis and configured to receive a graft ligament; extending through the body intersecting the longitudinal axis; and A transverse fixation pin hole configured to receive a transverse fixation pin.

According to a further feature of the present invention, there is provided a method for securing a graft ligament within a bone tunnel, the method comprising:
(1) Looping the graft ligament through a graft hole in the graft ligament support block, advancing the graft ligament support block into the bone tunnel, withdrawing the graft ligament support block along the bone tunnel, Advancing the graft ligament support block in a looped manner through a graft hole in the graft ligament support block, forming a transverse tunnel in the host bone to align the graft ligament support block with the transverse tunnel in the host bone;
(2) Pinning the graft ligament support block within the bone tunnel by advancing a transverse fixation pin along the transverse tunnel of the host bone to the transverse fixation pin hole of the graft ligament support block Is provided.

According to a further feature of the present invention, there is provided a method for modifying a graft ligament within a bone tunnel, the method comprising:
Removing the graft ligament support block within the bone tunnel by withdrawing the transverse fixation pin from the transverse fixation pin hole in the graft ligament support block and the host bone transverse tunnel;
Withdrawing the graft ligament support block along the bone tunnel;
Advance the graft ligament support block into the bone tunnel such that transverse fixation pin holes in the support block are aligned with the transverse tunnel;
Pinning the graft ligament support block in the bone tunnel by advancing the transverse fixation pin along the transverse tunnel in the host bone and into the transverse fixation pin in the graft ligament support block Is provided.

According to a further feature of the present invention, there is provided an apparatus for use in reconstructing a ligament, the apparatus comprising a graft ligament support block for supporting the graft ligament within a bone tunnel, the graft ligament The support block includes a body having a distal end, a proximal end, and a longitudinal axis extending between the distal end and the proximal end;
A graft hole extending through the body configured to intersect the longitudinal axis and accommodate a graft ligament, the graft hole being provided along the longitudinal axis The graft hole having a length, wherein the given length is substantially equal to a given cross-sectional dimension of the graft ligament;
A transverse fixation pin hole extending through the body and configured to intersect the longitudinal axis and receive a transverse fixation pin;
Is provided.

According to a further feature of the present invention, there is provided a method for securing a graft ligament within a bone tunnel, the method comprising:
Selecting a graft ligament support block with a graft hole sized to be substantially equal to a given cross-sectional dimension of the graft ligament,
Looping the graft ligament through the graft hole in a graft ligament support block;
Advance the graft ligament support block into the bone tunnel;
Forming a transverse tunnel in the host bone with the transverse tunnel aligned with the transverse fixation pin hole in the graft ligament support block;
Pinning the graft ligament support block within the bone tunnel by advancing a transverse fixation pin along the transverse tunnel of the host bone to the transverse fixation pin hole of the graft ligament support block.

According to another feature of the invention, a method is provided for securing a graft ligament within a bone tunnel, the method comprising:
Forming a transverse tunnel in the host bone,
Selecting a graft ligament support block with a graft hole sized to be substantially equal to a given cross-sectional dimension of the graft ligament,
Looping the graft ligament through the graft hole in a graft ligament support block;
Advancing the graft ligament support block into the bone tunnel such that a transverse fixation pin hole in the graft ligament support block is aligned with the transverse tunnel;
Pinning the graft ligament support block within the bone tunnel by advancing a transverse fixation pin along the transverse tunnel of the host bone to the transverse fixation pin hole of the graft ligament support block.

According to a further feature of the present invention, an apparatus is provided for use in reconstructing a ligament. The device comprises a graft ligament support block for supporting the graft ligament within a bone tunnel, the graft ligament support block comprising:
A body having a distal end, a proximal end, and a longitudinal axis extending between the distal end and the proximal end;
A graft hole extending through the body configured to intersect the longitudinal axis and receive a graft ligament;
A transverse fixation pin hole extending through the body and configured to intersect the longitudinal axis and receive a transverse fixation pin;
A transverse fixation pin having a proximal end and a distal end, wherein the proximal end forms an internal tapped hole to assist in removal of the transverse fixation pin from the bone tunnel; and
Is provided.

According to a further feature of the present invention, there is provided a method for modifying a graft ligament within a bone tunnel, the method comprising:
Engage the removal implement with the internal tap hole in the transverse fixation pin;
With the removal instrument engaged with an internal tap hole in the transverse fixation pin, withdrawing the transverse fixation pin from the bone tunnel and pulling back the graft ligament support block along the bone tunnel;
Placing a graft ligament support block into the bone tunnel;
Pinning the graft ligament support block in the bone tunnel by advancing the transverse fixation pin along the transverse tunnel in the host bone and into the transverse fixation pin in the graft ligament support block Is provided.

According to a further feature of the present invention, there is provided a system for use in reconstructing a ligament, the system comprising a graft ligament support block for supporting a graft ligament within a bone tunnel, wherein the graft The ligament support block
A body having a distal end, a proximal end, and a longitudinal axis extending between the distal end and the proximal end;
A graft hole extending through the body configured to intersect the longitudinal axis and receive a graft ligament;
A distal end, a proximal end, a longitudinal axis extending between the distal end and the proximal end, a first portion provided at the distal end, and provided at the proximal end A second part, wherein the first part is smaller than the second part, and an annular shoulder formed between the first part and the second part; , Wherein the first portion, the second portion and the annular shoulder form a given profile in a given plane cross section perpendicular to the longitudinal axis The stepped fixing pin;
A stepped transverse tunnel drill having a distal end, a proximal end, and a longitudinal axis extending between the distal end and the proximal end, the stepped transverse tunnel drill comprising the transverse transverse drill Corresponding to the given profile of the stepped fixation pin to provide a stepped transverse tunnel through a portion of the bone tunnel configured to align with a path of the fixation pin hole, the transverse fixation pin hole being The transverse tunnel drill extending through the body intersecting the longitudinal axis and configured to receive a transverse fixation pin; and
Is provided.

According to a further feature of the present invention, there is provided a method for securing a graft ligament within a bone tunnel, the method comprising:
Looping the graft ligament through a graft hole in the graft ligament support block;
Advance the graft ligament support block into the bone tunnel;
Using a stepped transverse tunnel drill to form a stepped transverse tunnel in the host bone, the stepped transverse tunnel being aligned with a transverse fixation pin hole in the graft ligament support block;
Pinning the graft ligament support block within the bone tunnel by advancing a stepped transverse fixation pin along the transverse tunnel of the host bone to the transverse fixation pin hole of the graft ligament support block; Prepare.

According to a further feature of the present invention, there is provided a method for securing a graft ligament within a bone tunnel, the method comprising:
Using a stepped crossing tunnel drill to form a stepped crossing tunnel in the host bone,
Looping the graft ligament through a graft hole in the graft ligament support block;
Advancing the graft ligament support block into the bone tunnel such that transverse fixation pin holes in the graft ligament support block are aligned with the stepped transverse tunnel;
Pinning the graft ligament support block within the bone tunnel by advancing a stepped transverse fixation pin along the stepped transverse tunnel of the host bone to the transverse fixation pin hole of the graft ligament support block; A process is provided.

According to a further feature of the present invention, there is provided a system for use in reconstructing a ligament, the system comprising:
A graft ligament support block for supporting the graft ligament within the bone tunnel,
The graft ligament support block is
A body having a distal end, a proximal end, a longitudinal axis extending between the distal end and the proximal end, and at least one element for engagement by an installation tool;
A graft hole extending through the body configured to intersect the longitudinal axis and receive a graft ligament;
A transverse fixation pin hole extending through the body and configured to intersect the longitudinal axis and receive a transverse fixation pin;
An installation tool, the installation tool comprising:
A holder, the holder being
A shaft having a distal end, a proximal end, and a longitudinal axis extending between the distal end and the proximal end, wherein the proximal end of the shaft is the at least one element of the body Said shaft configured to engage with;
A handle attached to the proximal end of the shaft;
The holder comprising:
A drill guide configured to be releasably secured to the holder, the drill guide comprising:
An overhang member comprising a distal end and a base end, wherein the base end of the overhang member is configured to be releasably secured to the holder; and
A drill sleeve movably attached to the distal end of the overhang member, the drill sleeve comprising a drill lumen extending through the sleeve, the drill sleeve having a depth marker. The drill sleeve comprising: the distal end of the overhang member and the depth marker of the drill portion leave configured to indicate an appropriate transverse tunnel depth;
Having the drill guide;
The installation tool comprising:
A transverse tunnel drill having a distal end and a proximal end, wherein the distal end of the transverse tunnel drill is configured to be positioned through the drill sleeve to drill a transverse bone tunnel through the bone tunnel. The transverse tunnel drill has a marker disposed between the proximal end and the distal end, and the depth marker on the transverse tunnel drill and the drill sleeve is the distal end of the transverse tunnel drill. Said transverse tunnel drill configured to display a given depth of the part;
Is provided.

According to a further feature of the present invention, there is provided a method for securing a graft ligament within a bone tunnel, the method comprising:
Looping the graft ligament through a graft hole in the graft ligament support block;
Advance the graft ligament support block into the bone tunnel;
Positioning a drill guide attached to the graft support block, the drill guide comprising an overhanging member and a drill sleeve movably attached to the overhanging member and having a depth marker;
Determine the appropriate transverse tunnel depth using the drill sleeve and the overhang member by moving the drill sleeve in the overhang member toward the bone tunnel and reading the depth marker on the drill sleeve. And
Drilling a transverse tunnel drill to a given depth according to the placed marker to form a transverse tunnel in the host bone to the appropriate transverse tunnel depth, the transverse tunnel supporting the graft ligament Aligned with the transverse fixing pin hole in the block,
Pinning the graft ligament support block within the bone tunnel by advancing a transverse fixation pin along the transverse tunnel of the host bone to the transverse fixation pin hole of the graft ligament support block.

According to a further feature of the present invention, there is provided a method for securing a graft ligament within a bone tunnel, the method comprising:
A drill guide is positioned attached to a reamer inserted into the bone tunnel, the drill guide comprising an overhang member and a drill sleeve movably attached to the overhang member and having a depth marker. And
Determine the appropriate transverse tunnel depth using the drill sleeve and the overhang member by moving the drill sleeve in the overhang member toward the bone tunnel and reading the depth marker on the drill sleeve. And
Forming a transverse tunnel in the host bone to the appropriate transverse tunnel depth by drilling the transverse tunnel drill to a given depth according to the placed marker;
Removing the reamer from the bone tunnel;
Looping the graft ligament through the graft hole in the graft ligament support block;
Advancing the graft ligament support block into the bone tunnel such that transverse fixation pin holes in the graft ligament support block are aligned with the transverse tunnel;
Pinning the graft ligament support block within the bone tunnel by advancing a transverse fixation pin along the transverse tunnel of the host bone to the transverse fixation pin hole of the graft ligament support block.

According to a further feature of the present invention, there is provided a system for use in reconstructing a ligament, the system comprising:
A graft ligament support block for supporting the graft ligament within the bone tunnel,
The graft ligament support block is
A body having a distal end, a proximal end, a longitudinal axis extending between the distal end and the proximal end, and at least one element for engagement by an installation tool;
A graft hole extending through the body configured to intersect the longitudinal axis and receive a graft ligament;
A transverse fixation pin hole extending through the body and configured to intersect the longitudinal axis and receive a transverse fixation pin;
An installation tool, the installation tool comprising:
A holder, the holder being
A shaft having a distal end, a proximal end, and a longitudinal axis extending between the distal end and the proximal end, wherein the proximal end of the shaft is the at least one element of the body Said shaft configured to engage with;
A handle attached to the proximal end of the shaft;
The holder comprising:
A drill guide configured to be releasably secured to the holder, the drill guide comprising:
An overhang member comprising a distal end and a base end, wherein the base end of the overhang member is configured to be releasably secured to the holder; and
A drill sleeve movably attached to the distal end of the overhang member, the drill sleeve comprising a drill lumen extending through the sleeve; and
The drill guide comprising:
Having the installation tool;
A transverse tunnel drill having a distal end and a proximal end, wherein the distal end of the transverse tunnel drill is configured to be positioned through the drill sleeve to drill a transverse bone tunnel through the bone tunnel. The transverse tunnel drill having a stop element configured to engage the drill sleeve to limit excavation to a predetermined depth;
Is provided.

According to a further feature of the present invention, there is provided a system for use in reconstructing a ligament, the system comprising:
A graft ligament support block for supporting the graft ligament within the bone tunnel,
The graft ligament support block is
A body having a distal end, a proximal end, and a longitudinal axis extending between the distal end and the proximal end;
A graft hole extending through the body configured to intersect the longitudinal axis and receive a graft ligament;
A distal end, a proximal end, a longitudinal axis extending between the distal end and the proximal end, a first portion provided at the distal end, and provided at the proximal end A second part, wherein the first part is smaller than the second part, and an annular shoulder formed between the first part and the second part; Wherein the first portion, the second portion and the annular shoulder have a given profile in a cross section of a given plane perpendicular to the longitudinal axis. Forming the stepped transverse fixing pin; and
A stepped transverse tunnel drill having a distal end, a proximal end, and a longitudinal axis extending between the distal end and the proximal end, wherein the stepped transverse tunnel drill includes the stepped transverse tunnel drill. The bridging cross drill corresponds to the given profile of the stepped transverse fixation pin to provide a stepped transverse tunnel through the bone tunnel configured to receive the given profile of the stepped transverse fixation pin The stepped cross tunnel drill,
A depth gauge having a distal end and a proximal end, wherein the distal end of the depth gauge engages a portion of the stepped transverse tunnel corresponding to the annular shoulder of the stepped securing pin. Configured to be positioned through a drill sleeve, the depth gauge indicating the depth of the transverse fixation pin hole between the portion corresponding to the annular shoulder of the stepped fixation pin and the bone surface The depth gauge having a label between the distal end and the proximal end; and
Is provided.

According to a further feature of the present invention, there is provided a method for securing a graft ligament within a bone tunnel, the method comprising:
Looping the graft ligament through a graft hole in the graft ligament support block;
Advance the graft ligament support block into the bone tunnel;
Determine the appropriate transverse tunnel depth by reading the position of the first set of depth markers of the drill sleeve relative to the overhang member;
With the transverse tunnel aligned with the transverse fixation pin hole in the graft ligament support block, a transverse tunnel drill having a second set of depth markers to drill the transverse tunnel to the appropriate transverse tunnel depth Use to form a transverse tunnel in the host bone,
Pin the graft ligament support block within the bone tunnel by selecting the transverse fixation pin based on the appropriate transverse tunnel depth determined by the first set of depth markers on the drill sleeve and selected Each step includes advancing a transverse fixation pin along a transverse tunnel in the host bone to a transverse fixation pin hole in the graft ligament support block.

According to a further feature of the present invention, there is provided a method for securing a graft ligament within a bone tunnel, the method comprising:
Determining the appropriate transverse tunnel depth by reading the position of the first set of depth markers on the drill sleeve relative to the overhang member;
Forming a transverse tunnel in the host bone using a transverse tunnel drill having a second set of depth markers to excavate the transverse tunnel to the appropriate transverse tunnel depth;
Looping the graft ligament through a graft hole in the graft ligament support block;
Advancing the graft ligament support block into the bone tunnel such that a transverse fixation pin hole in the graft ligament support block is aligned with the transverse tunnel;
Pinning the graft ligament support block within the bone tunnel by selecting a transverse fixation pin based on an appropriate transverse tunnel depth determined by a first set of depth markers on the drill sleeve, Are advanced along the transverse tunnel in the host bone to the transverse fixation pin hole in the graft ligament support block.

According to a further feature of the present invention, there is provided a method for securing a graft ligament within a bone tunnel, the method comprising:
Looping the graft ligament through a graft hole in the graft ligament support block;
Advance the graft ligament support block into the bone tunnel;
A transverse tunnel is formed in the host bone to a predetermined depth using the transverse tunnel drill having a stop element at a predetermined distance from a distal end of the transverse tunnel drill, wherein the stop element is configured so that the cross tunnel is a graft ligament. Configured to engage a drill sleeve to limit excavation to the predetermined depth in alignment with a transverse fixation pin hole in the support block;
Pinning the graft ligament support block within the bone tunnel by advancing a transverse fixation pin along the transverse tunnel within the host bone to the transverse fixation pin within the graft ligament support block; Prepare.

According to a further feature of the present invention, there is provided a method for securing a graft ligament within a bone tunnel, the method comprising:
A transverse tunnel is formed in the host bone to a predetermined depth using the transverse tunnel drill having a stop element at a predetermined distance from a distal end of the transverse tunnel drill, the stop element being at the predetermined depth Is configured to engage with the drill sleeve to limit drilling of
Looping the graft ligament through a graft hole in the graft ligament support block;
Advancing the graft ligament support block into the bone tunnel such that transverse fixation pin holes in the graft ligament support block are aligned with the transverse tunnel;
Pinning the graft ligament support block within the bone tunnel by advancing a transverse fixation pin along the transverse tunnel within the host bone to the transverse fixation pin within the graft ligament support block; Prepare.

According to a further feature of the present invention, there is provided an apparatus for use in reconstructing a ligament, the apparatus comprising a graft ligament support block for supporting a graft ligament within a bone tunnel, wherein the graft The ligament support block
A body having a distal end, a proximal end, and a longitudinal axis extending between the distal and proximal ends, the proximal end of the ligament support block through a bone tunnel The body formed with a taper to facilitate drawing;
A graft hole extending through the body intersecting the longitudinal axis and configured to receive a graft ligament;
An area configured to drill a transverse fixation pin hole that intersects the longitudinal axis through the body when a transverse hole is drilled through the bone tunnel;
Is provided.

  The above and other objects and features of the invention will be more fully disclosed and will become apparent from the following detailed description of preferred embodiments of the invention with reference to the accompanying drawings. In the accompanying drawings, like numerals indicate like components.

  Referring to FIG. 8, a graft ligament support block 100 comprising a preferred form of the present invention is shown. The graft ligament support block 100 includes a body 105, a graft hole 110, and a transverse fixation pin hole 115 extending through the body 105. At this time, both the transplant hole 110 and the transverse fixing pin hole 115 preferably extend substantially perpendicular to the longitudinal axis 120 of the body 105. In one preferred form of the invention, the implantation hole 110 and the transverse fixation pin hole 115 extend across the diameter of the body 105, and the implantation hole 110 and the transverse fixation pin hole 115 extend substantially parallel to each other. Yes. Preferably, the implantation hole 110 is positioned closer to the proximal end 125 of the body 105 than the transverse fixation pin hole 115, and the transverse fixation pin hole 115 is closer to the distal end 130 of the body 105 than the implantation hole 110. Are arranged. In one preferred form of the invention, the distal end of the body 105 has a circular cross section. The distal end can also have an elliptical cross section or a polygonal cross section (eg, square, rectangular, triangular, etc.). In one preferred offensive, the distal end of the body 105 is sized slightly smaller than the diameter of the bone tunnel to provide a close interface between the body 105 and the bone tunnel wall. In one preferred form of the invention, the distal end 130 of the body 105 is tapered to facilitate advancement of the graft ligament support block 100 through the bone tunnel. In a preferred form of the invention, the proximal end of the body 105 is looped through the graft hole 110 to provide more room for the graft ligament extending distally therefrom, such as at 135. As shown, it is a plastic image. The body 105 also includes a pair of recesses 140 for attaching the body 105 to a suitable installation tool, as will be described in further detail below.

  If desired, the graft ligament support block 100 may include a suture hole 145 for receiving a tow suture, as will be described in more detail below.

  In addition, if desired, the proximal end of the graft hole 110 is shown at 150 to provide a less traumatic receiving surface for the graft ligament looped through the graft hole 110. A taper may be formed and / or tapered as indicated at 155 so that introduction of the transverse fixation pin hole 115 facilitates introduction of the transverse fixation pin into the transverse fixation pin hole 115. May be.

  The body 105 may be formed from a polymer, a bioabsorbable or bioreconfigurable material, an allograft bone, a metal, a ceramic, a coral, a fiber composite, a composite comprising at least one of the foregoing. By forming the body 105 from a relatively strong material, the graft ligament can be brought into close contact with the periphery of the body 105 when the body 105 is relatively small or one or more of the holes 110, 115 and / or 145. Even when placed, it can be held under the action of tension.

  Referring now to FIGS. 9-15, an installation tool 200 that can be used in conjunction with the graft ligament support block 100 is shown. The installation tool 200 includes a holder 205 and an associated drill guide 210.

  The holder 205 includes a shaft 215 having a pair of fingers 220 at its distal end and a handle 225 at its proximal end. The finger 220 is paired with the graft ligament support block 100 by selectively fitting the installation instrument 200 into a recess 140 (FIG. 8) formed at the proximal end of the graft ligament support block 100. It makes it possible to hold the block releasably. See FIGS. 9-12 and FIG. In essence, the finger 220 and the recess 140 have a male / female connection, and the male and female members may be reversed if desired (i.e., the male, It is also possible to use a female part in the holder 205) or an alternative type of connection means (eg a gripper). Preferably, one or more suture posts 227 are formed at the proximal end of the shaft 215 adjacent to the handle 225. The suture post 227 allows the two free ends of the graft ligament to be secured to the placement instrument, as will be described in further detail below. The handle 225 allows the installation tool 200 to be conveniently grasped by the user. The handle 225 includes a post hole 230. The post hole 230 allows the drill guide 210 to be releasably secured to the holder 205, as will be described in further detail below.

  The drill guide 210 includes an overhang member 235 that includes a threaded bore 240 (FIG. 14) formed at its distal end 245 and a slot 250 (FIG. 9) and post formed at its proximal end 260. 255. The end of the post 255 is threaded, for example as shown at 265.

  The threaded bore 240 (FIG. 14) at the end 245 of the overhang member is sized to receive the drill sleeve 270. The drill sleeve 270 has a threaded portion 275 along its length and ends at the proximal head portion 280. The head portion 280 can be used to move the drill sleeve 270 relative to the distal end 245 of the overhang member 235 by manually rotating the drill sleeve 270 within the threaded bore 240 of the overhang member. A lumen 285 extends through the drill sleeve 270.

  Slot 250 and post 255 allow releasable member 235 to be releasably attached to holder 205. More specifically, the overhanging member 235 fits into the holder 205 by fitting the holder shaft 215 into the overhanging member slot 250 (FIGS. 13 and 14) and tightening the nut 290 to the threaded end 265 of the post 255. Can be attached.

  As described below, the graft ligament support block 100 and the placement instrument 200 are intended for use in conjunction with a transverse fixation pin. One preferred transverse fixation pin 300 is shown in FIG. The transverse fixation pin 300 generally comprises a solid shaft 305 that terminates in a tapered end 310 and a ribbed (or protruding or threaded) section 315. A non-circular socket 320 is formed at the proximal end of the transverse fixation pin 300, with which the transverse fixation pin 300 can be engaged by a driver.

  The following describes the ACL reconstruction achieved in accordance with the present invention.

  First, the surgical site is prepared for the graft ligament, such as by removing damaged ACL. Next, the guide wire 400 (FIG. 17) is drilled through the tibial bone 10 and into the knee joint. Preferably, the guidewire 400 is stopped at a position that does not reach the bottom of the femur 15 (FIG. 18). A cannulated tibia drill 500 (FIG. 19) is then supported on the guidewire 400 and drilled through the tibia 10 to the interior of the knee joint (FIG. 20). The cannulated tibial drill 500 is then withdrawn down the guide wire (FIG. 21), leaving the tibial tunnel 20.

  Next, the guide wire 400 is drilled an appropriate distance into the femur 15. If desired, the guidewire 400 may be drilled over the entire path through the femur 15 for reasons described below (FIG. 22). A cannulated femoral drill 600 (e.g., an akon drill) is then supported by guidewire 400 (FIG. 22) and passed through the femoral tunnel 20 across the interior of the knee joint. The bone 15 is excavated and stopped within the femur 15 (FIG. 23). The cannulated femoral drill 600 is withdrawn back through the guidewire, leaving the femoral tunnel 25 (FIG. 24).

  Next, the graft ligament 35 is attached to the graft ligament support block 100 by screwing one end of the graft ligament through the graft hole 110, and the graft ligament support block 100 then seats the finger 220 in the recess 140. By attaching it, it attaches to the terminal part of the shaft 215. The two free ends of the graft ligament 35 are pinned, for example, by passing the suture 70 through the two free ends of the graft ligament 35 and securing (eg, wrapping) the suture to suture the post 227. It is preferably stretched. This configuration assists in controlling the two free ends of the graft ligament 35 and helps retain the graft ligament support block 100 in the holder 205. Next, the installation instrument 200 pushes the graft ligament support block 100 and thus pushes the graft ligament 35 through the tibial tunnel 20 (FIG. 25) and across the interior of the knee joint to the femoral tunnel (FIG. 26). .

  If desired, all of the forces required to propel the graft ligament support block 100 and graft ligament 35 through the tibia tunnel 20 and across the interior of the knee joint into the femoral tunnel 25 may cause the placement instrument 200 to move distally. Can be supplied by pressing on. As an alternative, if the guidewire 400 is fully drilled through the femur 15 (eg, as shown in FIG. 22), as well as the proximal end of the guidewire 400 is a suture eyelet (eg, With the suture ostium 405 shown in FIGS. 23 and 24), the suture can be used to assist in pulling the graft ligament support block 100 and graft ligament 35 into place. More particularly, the suture 700 (FIG. 25) may be looped through the suture hole 145 in the graft ligament support block 100 and through the suture eyelet 405 of the guidewire 400 and extends from the apex of the femur 15. By pulling distally with wire 400, suture 700 can be used to assist in pulling and lifting graft ligament support block 100 and graft ligament 35 into place (FIG. 26). Such a configuration reduces the amount of force that needs to be distributed by the installation tool 200 to push the graft ligament support block 100 and graft ligament 35 into place.

  Once the graft ligament support block 100 and graft ligament 35 have been pushed into place (FIG. 26), the drill sleeve 270 is advanced into tight engagement with the femur 15 (FIG. 27). This action stabilizes the installation tool 200 relative to the femur 15. A transverse tunnel drill (FIG. 28) then drills the transverse tunnel 75 through the transverse portion of the femur 15 through the transverse fixation pin hole 115 in the graft ligament support block 100 and into the intermediate portion of the femur 15. used. In this regard, due to the fact that the orientation of the graft ligament support block 100 and the placement instrument 200 (and thereby the drill sleeve 270) is adjusted by the engagement of the fingers 220 within the recess 140, the graft ligament support block. It will be appreciated that the transverse tunnel drill 800 is directed accurately and consistently through the transverse fixation pin hole 115 in 100 (FIG. 28).

  Once the transverse tunnel drill 800 has been used to excavate the transverse tunnel 75, the transverse tunnel drill 800 is removed (FIG. 29). The drill sleeve 70 is loosened and the overhanging member 210 is removed from the holder 205 (FIG. 30). The transverse fixation pin 300 attached to the driver 325 is advanced to the transverse tunnel 75, traverses the transverse fixation pin hole 115 in the graft ligament support block 100 (FIG. 31), and the graft ligament support block 100 in the femoral tunnel 25. (And thereby the graft ligament 35) is fixed. Depending on whether the section 315 of the transverse fixation pin 300 is ribbed or protuberant or threaded, the transverse fixation pin can be rotated by tapping the driver's proximal end with a mallet or rotating the driver. And / or both can be advanced by the driver 325. Next, the driver 325 is removed (FIG. 32). The two free ends of the graft ligament 35 are then detached from the handle's suture post 227 and the holder 205 is pulled apart (FIG. 33). In this regard, the graft ligament support block 100 is held in position within the femoral tunnel 25 when the holder 205 is retracted due to the presence of the transverse fixation pin 300 in the transverse tunnel 75 and transverse fixation pin hole 115. Is recognized. Eventually, the two free ends of the graft ligament 35 will be secured to the tibia 10 thereby completing the ACL reconstruction procedure.

  In the embodiment described above, the transverse fixing pin hole 115 (FIG. 8) is formed in the body 105 in advance. Such a configuration is generally advantageous. This is because after the graft ligament support block 100 is placed in the femoral tunnel, it is not necessary to drill through the body 105 before the transverse fixation pin 300 is passed through the body 105. In addition, by pre-forming the transverse fixation pin hole 115 in the body 105, the transverse fixation pin hole 115 is given a desired shape. For example, it allows the entrance to the cross pin hole 115 to be tapered, as shown at 155 in FIG. However, it should be understood that the transverse fixation pin hole 115 may not be pre-formed in the body 105 if desired. As an alternative, the transverse fixation pin hole 115 may be formed in a natural position during surgery, for example by drilling across the body 105 when forming the transverse tunnel 75 with the transverse tunnel drill 800. Of course, if the transverse fixing pin hole 115 is to be formed in a natural position, the body 105 needs to be formed from a digable material. In addition, when the transverse fixing pin hole 115 is to be formed in a natural position, the body 105 is preferably formed from a relatively strong material. This is because any misplacement of the transverse fixing pin hole 115 (that is, an offset from the center) is sufficiently allowed by the body 105.

  In addition, in the embodiment described above, the outer surface of the body 105 is proximate to the graft hole 110 to assist in mating with the graft ligament in the femoral tunnel 25, as shown at 135 in FIG. To be molded. In FIG. 8, plasticity is achieved to produce a substantially flat surface at 135. However, if desired, the plastic forming can also be accomplished to provide alternative shapes such as surface grooves. Thus, for example, in FIG. 34, the body 105 is shown with a pair of surface grooves 165 that communicate with the implant hole 110 and extend proximally from the implant hole. The surface groove 165 is sized to provide a recess for a seating portion of the graft ligament as the graft ligament extends proximally from the graft hole 110.

  Also, in the above-described embodiment, the body 105 is shown as having a relatively smooth outer surface (see, for example, FIG. 8). However, if desired, the body 105 can have spikes or ribs formed on its sidewalls to stabilize the body 105 within the bone tunnel.

  Further, in the disclosed embodiment, the drill sleeve 270 is movable to the overhang member 235 via a threaded connection (ie, the threaded portion 275 outside the drill sleeve 270 and the threaded bore 240 of the overhang member 235). It is connected to the. This configuration provides a simple and cost effective way to movably secure the drill sleeve 270 to the overhang member 235. However, other types of configurations can be used if desired. For example, referring to FIGS. 35 and 36, the drill sleeve 270 has a smooth, ribbed or rounded (eg, humped) exterior 275A that slides through an unthreaded bore 240A in the overhang member 235. Can have. The locking pin 235A can be selectively advanced into engagement with the drill sleeve 270 (through the threaded bore 235B), thereby selectively locking the drill sleeve to the overhang member. Still other possible configurations for selectively locking the drill sleeve 270 to the overhang member 235 will be apparent to those skilled in the art of drilling and drill sleeves.

  Also, in the disclosed embodiment, the drill guide 210 is shown as being releasably secured to the holder 205 via a post 255 and a clamping nut 290 (see, eg, FIG. 14). However, it can be appreciated that other types of connections (eg, a “quick” release mechanism) can also be used to releasably secure the drill guide 210 to the holder 205.

  It is also possible to form a transverse tunnel 75 before the graft ligament support block 100 and the graft ligament 35 are placed in the femoral tunnel 25. More particularly, a reamer drill guide 200A (FIG. 37) can be used in one possible configuration. The reamer drill guide 200A is substantially the same as the installation tool 200 described above except for those described below. More specifically, the reamer drill guide 200A includes a reamer 205A and a drill guide 210. The reamer 205A has a cylindrical element 220A (FIGS. 37 and 38) at its end that penetrates the transverse hole 220B, and omits the suture post 227 that is preferably provided on the holder 205, except for the ceiling. The holder 205 is substantially the same. The reamer 205A has (i) a cylindrical element 220A having a diameter approximately equal to the diameter of the femoral tunnel 25, and (ii) a lumen within the drill sleeve 270 when the drill guide 210 is attached to the reamer 205A. 285 is configured to align with transverse hole 220B of reamer 205A.

  The graft ligament support block 100, holder 205, and reamer drill guide 200A can be used to achieve ACL reconstruction as follows.

  Initially, a surgical site is prepared for the graft ligament, such as by removing the damaged ACL. Next, a guidewire 400 (FIG. 17) is drilled through the tibia 10 across the interior of the knee joint. Preferably, the guidewire 400 is stopped where it does not engage the bottom of the femur 15 (FIG. 18). The cannulated tibial drill 500 (FIG. 19) is then withdrawn downward along the guide wire (FIG. 21), leaving the tibial tunnel 20.

  The guide wire 400 is then excavated a suitable distance into the femur 15. A cannulated femoral drill 600 (e.g., an akon drill of the type shown in FIG. 22) is then supported on the guidewire 400, passed through the tibial tunnel 20, traversed the interior of the knee joint, and then the femoral Drilled into the bone 15 and stopped within the femur 15. Next, the cannulated femoral drill 600 is withdrawn downward along the guide wire, leaving the femoral tunnel 25, and finally the guide wire 400 is withdrawn (see FIG. 39).

  The reamer drill guide 200A is then pushed so that its cylindrical element 220A is advanced through the tibial tunnel 20 across the interior of the knee and up into the femoral tunnel 25. In this regard, it is understood that when the reamer drill guide 200A is advanced through the tibial tunnel 20 and the femoral tunnel 25, its cylindrical element 220A expands both the bone tunnels and clears the debris inside. Should be.

  Once the reamer drill guide 200A has been pushed into place, the drill sleeve 270 is advanced into tight engagement with the femur 15. This action stabilizes the reamer drill guide 200A with respect to the femur 15. Next, the transverse tunnel drill 800 (FIG. 40) is used to drill the transverse tunnel 75 through the transverse portion of the femur 15 and through the transverse hole 220B of the cylindrical element 220A to the middle portion of the femur 15. In this regard, due to the fact that the relative arrangement of the cylindrical element 220A and the drill sleeve 270 is adjusted by the predefined engagement of the drill guide 210 with the reamer 205A, the transverse tunnel drill 800 has the cylindrical element 220A ( It will be understood that it is accurately and consistently oriented through the transverse hole 220B in FIG.

  Once the transverse tunnel drill 800 has been used to excavate the transverse tunnel 75, the transverse tunnel drill 800 is removed. Next, the drill sleeve 270 is loosened, and the reamer drill guide 200A is pulled out from the surgical site (FIG. 41).

  Next, the graft ligament 35 is attached to the graft ligament support block 100 by screwing one end of the graft ligament through the graft hole 110, and then the graft ligament support block 100 has a finger in the recess 140. By seating 220, it is attached to the distal end of shaft 215. The two free ends of the graft ligament 35 are passed through the two free ends of the graft ligament 35 and the suture 70 is then secured to the suture post 227 (eg, wrapping). ) And is preferably kept taut. This configuration assists in controlling the two free ends of the graft ligament 35 and allows the graft ligament support block 100 to be held in the holder 205. Next, the holder 205 is used to push the graft ligament support block 100, thus pushing the graft ligament 35, through the tibial tunnel 20 and across the interior of the knee joint and into the femoral tunnel 25 (FIG. 42). . When the graft ligament support block is advanced through the tibial tunnel 25 or after it has been advanced through the tibial tunnel 25 by an appropriate distance, it aligns the transverse fixation pin hole 115 with the transverse tunnel 75. The handle 225 is rotated as necessary to rotate as necessary. Such alignment can be facilitated by providing an alignment marker (eg, alignment marker 225A shown in FIG. 43) on the handle 225.

  The transverse fixation pin 300 attached to the driver is advanced into the transverse tunnel 75 and traverses the transverse fixation pin hole 115 in the graft ligament support block 100 (FIG. 44), thereby causing the graft ligament support block into the femoral tunnel 25. 100 (and thereby the graft ligament 35) is fixed. Next, the driver 325 is removed. The two free ends of the graft ligament 35 are then detached from the handle suture post 227 and the holder 205 is withdrawn. In this regard, the graft ligament support block 100 is held in place within the femoral tunnel 25 when the holder 205 is withdrawn due to the presence of the transverse fixation pin 300 and transverse fixation pin hole 115 in the transverse tunnel 75. The Eventually, the two free ends of the graft ligament 35 are secured to the tibia 10 thereby completing the ACL reconstruction procedure.

  45 and 46, there is shown a modified graft ligament support block 1500 comprising one preferred form of the invention. The graft ligament support block 1500 includes a body 1505, a graft hole 1510, and a transverse fixation pin hole 1515 extending through the body 1505, where both the graft hole 1510 and the transverse fixation pin hole 1515 are the length of the body 1505. Preferably, the directional axis 1520 is substantially perpendicular. In one preferred form of the invention, the graft hole 1510 and the transverse fixation pin hole 1515 extend diametrically across the body 1505 with the substantially parallel to each other. Preferably, the graft hole 1510 is positioned closer to the proximal end 1525 of the body 1505 than the transverse fixation pin hole 1515, and the transverse fixation pin hole 1515 is closer to the distal end 1530 of the body 1505 than the graft hole 1510. Arranged. In one preferred form of the invention, the distal end of the body 1505 has a circular cross section. It may have an elliptical cross section or a polygonal cross section (eg square, rectangular or triangular). In one preferred configuration, the distal end of the body 1505 has a cross section that is slightly smaller in size than the diameter of the bone tunnel so as to provide a close interface between the body 1505 and the bone tunnel wall. In one preferred form of the invention, the distal end 1530 of the body 1505 is tapered to facilitate advancement of the graft ligament support block 100 through the bone tunnel. In a preferred form of the invention, the proximal end of the body 1505 forms a loop through the graft hole 1510 and provides more extra space for the graft ligament extending distally therefrom, for example, , 1535, is plasticized. The body 1505 further comprises one or more recesses (not shown, but preferably similar to or similar to the recesses 140 provided in the body (105)) for attaching the body 1505 to a suitable installation tool. ing.

  If desired, the graft ligament support block 1500 further includes a suture hole 1545 for receiving a tow suture, as will be described in further detail below.

  In addition, if desired, the proximal end of the graft hole 1510 can be shown at 1550 to provide a less traumatic bearing surface for the graft ligament looped through the graft hole 1510. And / or may be tapered as shown at 1555 to facilitate introduction into the transverse fixation pin hole 1515.

  The body 1505 can be formed from a composite comprising a polymer, a bioabsorbable or bioreconfigurable material, an allograft bone, a metal, a ceramic, a coral, a fiber composite, at least one of the foregoing. . By molding the body 1505 from a relatively strong material, the graft ligament can be in close proximity to the periphery of the body 1505 even when the body 1505 is relatively small or one of the holes 1510, 1515 and / or 1545. In the case of being arranged in a state of being held, it can be held under the action of tension.

  With further reference to FIGS. 45, 46A and 46B, a tapered portion 1560 provided at the proximal end 1525 of the body 1505 is shown. The tapered portion 1560 facilitates withdrawal of the implantation block 1505 from the bone tunnel, for example, where manipulation is required for the same modification. This is advantageous in this respect because other designs with square corners tend to restrain in the bone tunnel when the body is pulled proximally out of the bone tunnel.

  Referring now to FIGS. 46A and 46B, a body 1505 is shown having a graft hole 1510 with a length X (FIG. 46A) that is substantially equal to the width of the graft ligament. The graft hole 1510 provides an opening that is shorter than the length Y of the graft hole 110 in the body 105 (FIG. 46B), increasing contact between the tunnel wall and the graft ligament.

  In a preferred embodiment of the present invention, a method is provided for securing a graft ligament within a bone tunnel. The method includes a first step of selecting a graft ligament support block with a graft hole of a size substantially equal to a given width of the graft ligament. The method includes looping the graft ligament through the graft hole in the graft ligament support block. The method comprises the further step of advancing the graft ligament support block into the bone tunnel. The method comprises forming a transverse tunnel in the host bone with the transverse tunnel aligned with a transverse fixation pin hole in the graft ligament support block. The final step of the method is to pin the graft ligament support block into the bone tunnel by pushing the transverse fixation pin along the transverse tunnel in the host bone and into the transverse fixation pin hole in the graft ligament support block. The process of carrying out is provided.

  In another preferred embodiment of the present invention, a method is provided for securing a graft ligament within a bone tunnel. The method includes forming a transverse tunnel in the host bone. The method includes selecting a graft ligament support block having a graft hole sized substantially equal to a given width of the graft ligament. The method also includes looping the graft ligament through the graft hole in the graft ligament support block. The graft ligament support block is advanced into the bone tunnel such that the transverse fixation pin holes in the graft ligament support block are aligned with the transverse tunnel. The final step is to pin the graft ligament support block in the bone tunnel by pushing the transverse fixation pin along the transverse tunnel in the host bone into the transverse fixation pin hole in the graft ligament support block. I have.

  Referring now to FIGS. 47 and 48, in a preferred embodiment of the present invention, a removable transverse fixation pin 1600 (configured for use in a manner similar to the transverse fixation pin 300 (FIG. 30) described above. FIG. 47) is shown. The removable transverse fixation pin 1600 (FIG. 47) generally comprises a solid shaft 1605 that terminates in a tapered end 1610 and a ribbed (protruded or threaded) section 1615. A socket 1620 is formed at the proximal end of the removable transverse fixation pin 1600 so that the transverse fixation pin 1600 can be engaged by a driver. The socket 1620 can be configured to accommodate a rotary screwdriver (eg, a hex screwdriver) or a mallet screwdriver. Socket 1620 further includes an internal tap hole 1625 formed therein. Inner tap hole 1625 is configured to engage extraction device 1630 (FIG. 48) to assist in the removal of removable fixation pin 1600 from the transverse bone tunnel.

  The extraction instrument 1630 generally includes a shaft 1635 having a handle 1640 at one end and a threaded protrusion 1645 at the other end. The threaded protrusion 1645 is configured to be screwed into an internal tap hole 1625 formed in the removable fixing pin 1600. When the threaded protrusion 1645 is securely fitted into the internal tap hole 1625, the removable transverse fixation pin 1600 can be withdrawn from the bone tunnel by applying an appropriate force to the handle 1640.

  In a preferred embodiment of the present invention, a method is provided for modifying a graft ligament within a bone tunnel. The method comprises the step of engaging the removal tool with the internal tap hole of the transverse fixation pin. The method further comprises withdrawing the transverse fixation pin from the bone tunnel using a removal instrument engaged with the internal tap hole. The method comprises the further step of repositioning the graft ligament support block within the bone tunnel. The method comprises the final step of pinning the graft ligament support block within the bone tunnel by pushing the transverse fixation pin along the transverse tunnel in the host bone and into the transverse pin hole in the graft ligament support block. ing.

  Referring now to FIG. 49, in accordance with a preferred embodiment of the present invention, a narrow cutting portion 1710 along the first length of its distal end and a second end in the proximal direction of the narrow cutting portion 1710. Shown is a stepped transverse tunnel drill 1700 having a shaft 1705 with a wide cutting portion 1715 along the length and a discontinuous portion 1720 formed at the junction of the narrow cutting portion 1710 and the wide cutting portion 1715. ing.

  Referring now to FIG. 50, a stepped transverse tunnel drill 1700 is stepped across the lateral portion of the femur 15 through a portion of the bone tunnel 25 and into the middle portion of the femur 15 as described above. Used to excavate tunnel 1725 (FIG. 50). Transverse tunnel 1725 includes a narrow portion 1730 and a wide portion 1735 that correspond to the narrow cut portion 1710 and wide cut portion 1715 of stepped cross tunnel drill 1700, respectively. A stepped portion (not shown) in the transverse tunnel 1725 provides an annular shoulder for stopping the advancement of the transverse tunnel pin (not shown). .

  In a preferred embodiment of the present invention (not shown), a stepped locking pin having a profile of a portion of a stepped transverse tunnel drill 1700 is provided. The stepped fixation pin is preferably configured with an annular shoulder formed between a narrow portion at its distal end and a wide portion at its proximal end. The annular shoulder is positioned so that the narrow portion of the stepped fixation pin in the narrow portion 1730 of the transverse tunnel 1725 and the wide portion of the stepped fixation pin in the wide portion 1735 of the break tunnel 1725 are positioned. Enables the stepped fixation pin to be seated at a predetermined position within a known distance within 1725.

  In a preferred embodiment of the present invention, a method is provided for securing a graft ligament within a bone tunnel. The method includes looping the graft ligament through a graft hole in a graft ligament support block (not shown). The method further comprises advancing the graft ligament support block into the bone tunnel 25. The method uses a stepped transverse tunnel drill 1700 (FIG. 49) in the host bone 15 with a stepped transverse tunnel 1725 (FIG. 50) aligned with a transverse fixation pin hole (not shown) in the graft ligament support block. A step of forming a stepped crossing tunnel 1725 (FIG. 50) is also provided. The method pushes a stepped transverse fixation pin (not shown) along a transverse tunnel 1725 in the host bone 15 into a transverse fixation pin hole (not shown) of a graft ligament support block (not shown). To provide a final step of pinning the graft ligament support block within the bone tunnel 25.

  In the preferred embodiment of the present invention, the placement instrument is used to advance the graft ligament support block into the bone tunnel prior to the step of forming the stepped transverse tunnel 1725 in the host bone 15 (FIG. 50). . Preferably, the installation tool is used with a stepped transverse tunnel drill to form a stepped transverse tunnel in the host bone.

  In another preferred embodiment of the present invention, the tow suture is used to advance the graft ligament support block into the bone tunnel prior to the step of forming a stepped transverse tunnel 1725 in the host bone 15 (FIG. 50). used.

  In a preferred embodiment of the present invention, another method for securing a graft ligament within a bone tunnel is provided. The method includes a first step of forming a stepped transverse tunnel drill 1725 (FIG. 50) in the host bone 15 using a stepped transverse tunnel drill 1700 (FIG. 49). The method comprises a subsequent step of looping the graft ligament through the graft hole in the graft ligament support block. Following this step, the step of advancing the graft ligament support block into the bone tunnel 25 is performed such that the transverse fixation pin holes in the graft ligament support block (not shown) are aligned with the stepped transverse tunnel 1725. . The method moves a stepped transverse fixation pin (not shown) along a stepped transverse tunnel 1725 in the host bone into a transverse fixation pin hole (not shown) in a graft ligament support block (not shown). Providing the final step of pinning the graft ligament support block within the bone tunnel 25 by advancing.

  In a preferred embodiment of the present invention (not shown), following the steps of forming a stepped transverse tunnel and looping the graft ligament through the graft hole, an installation tool is provided to advance the graft ligament support block into the bone tunnel. used.

  Referring now to FIGS. 51A, 51B and 52, a calibrated graft ligament reconstruction system 1740 (FIG. 52) comprising a holder 1745 as a whole and a drill guide 1750 associated therewith in accordance with a preferred embodiment of the present invention. It is shown.

  The drill guide 1750 has a configuration similar to the drill guide 210 described above. Preferably, the drill guide 1750 comprises an overhang member 1755 having a smooth bore 1760 formed at its distal end 1765 and sized to receive a drill sleeve 1770 therein. A first set of depth markers 1775 disposed on the drill sleeve 1770 is configured to display the distance from the distal tip 1780 of the drill sleeve 1770 to a preselected portion within the femur 15. . Preferably, the depth marker 1775 is read at a position relative to the proximal opening 1785 of the smooth bore 1760.

  51B and 52, there is shown a stepped cross drill 1700 having a second set of depth markers 1790, according to a preferred embodiment of the present invention. Depth marker 1790 is configured to display the distance to a preselected position in femur 15. Preferably, the depth marker 1790 is read at a position relative to the proximal opening 1795 (FIG. 52) of the drill sleeve 1770.

  In a preferred embodiment of the present invention, a method for securing a graft ligament within a bone tunnel is disclosed. The method includes a first step of looping the graft ligament through the graft hole in the graft ligament support block. The method includes the following steps of advancing the graft ligament support block into the bone tunnel. Following this step, a step of placing a drill guide attached to the graft ligament support block is performed. At this time, the drill guide has an overhang member and a drill sleeve movably attached to the overhang member, and the drill sleeve has a depth marker. The method uses a drill sleeve and an overhang member to determine an appropriate transverse tunnel depth by moving the drill sleeve within the overhang member toward the bone tunnel and reading a depth marker on the drill sleeve. Is further provided. With this method, with the transverse tunnel aligned with the transverse fixation pin hole in the graft ligament support block, the appropriate transverse tunnel depth is drilled with a transverse tunnel drill to a given depth according to the placed marker. A step of forming a transverse tunnel in the host bone is also provided. The method includes the final step of pinning the graft ligament support block in the bone tunnel by advancing the transverse fixation pin along the transverse tunnel in the host bone and into the transverse fixation pin hole in the graft ligament support block. I have.

  In another preferred embodiment of the present invention, a method for securing a graft ligament to a bone tunnel is disclosed. The method includes an initial step of positioning a drill guide attached to the graft ligament support block. At this time, the drill guide has an overhang member and a drill sleeve movably attached to the overhang member, and the drill sleeve has a depth marker. The method uses the drill sleeve and the overhang member to determine the appropriate transverse tunnel depth by moving the drill sleeve within the overhang member toward the bone tunnel and reading the depth marker on the drill sleeve. The process is further provided. The method comprises forming a transverse tunnel in the host bone to the appropriate transverse tunnel depth by drilling with a transverse tunnel drill to a given depth according to the placed marker. The method invokes the step of looping the graft ligament through the graft hole in the graft ligament support block. The method comprises advancing the graft ligament support block into the bone tunnel such that a transverse fixation pin hole in the graft ligament support block is aligned with the transverse tunnel. The method includes the final step of pinning the graft ligament support block in the bone tunnel by advancing the transverse fixation pin along the transverse tunnel in the host bone and into the transverse fixation pin hole in the graft ligament support block. I have.

  53 and 54, there is shown a depth limited transverse tunnel drill 1800 with a stop element 1805 disposed in accordance with a preferred embodiment of the present invention. The drill 1800 can have any one of a number of tips known in the orthopedic field, such as a standard fluted tip, a trocar tip, a spade tip, and the like. Stop element 1805 is located at a position along the length of the depth that limits transverse tunnel drill 1800 to limit the depth of penetration of distal tip 1810 of transverse tunnel drill 1800 into femur 15. (FIG. 54). Stop element 1805 restricts the distal penetration of transverse tunnel drill 1800 by engaging bulge member 1755 at distal end 1765 adjacent proximal opening 1785 and allows only distal end 1815 to pass.

  In a preferred embodiment of the present invention, the stop element 1805 is adjustably or fixedly positioned along a portion that limits the depth of the transverse tunnel drill 1800 and further penetrates the femur 15 of the transverse tunnel drill 1800. A locking device is further provided to selectively determine the depth of the.

  Referring now to FIGS. 55 and 56, there is shown a depth gauge 1900 formed with a series of depth gauge indicators 1905, according to a preferred embodiment of the present invention. The depth gauge 1900 is configured to engage a transverse fixation pin 1910 at its distal end 1915 for insertion into the femur 15 and proper placement (FIG. 56). The depth gauge indicator 1905 of the depth gauge 1900 indicates the location of the distal end 1915 and thus indicates the proximal end of the depth gauge within the femur 15. Preferably, the depth gauge indicator 1905 is read at a position relative to the proximal opening 1795 of the drill sleeve 1775 through which the insert 1900 passes.

  Referring to FIG. 52, a method for securing a graft ligament in a bone tunnel according to a preferred embodiment of the present invention is disclosed. The method includes a first step of forming a graft ligament loop through a graft hole in a graft ligament support block. This step is followed by advancing the graft ligament support block into the bone tunnel. The method comprises the further step of determining the appropriate transverse tunnel depth by reading the position of the depth marker 1775 on the drill sleeve 1770 relative to the overhang member 1755. The method forms a transverse tunnel in the host bone using a transverse tunnel drill 1770 having a depth marker 1790 to drill the transverse tunnel to the appropriate transverse tunnel depth, and within the graft ligament support block A subsequent step in which the transverse fixation pin holes are aligned. The method selects a transverse fixation pin based on the appropriate transverse tunnel depth determined by a depth marker 1775 on the drill sleeve 1770 and implants the selected transverse fixation pin along the transverse tunnel in the host bone. A final step of pinning the graft ligament support block within the bone tunnel by advancing into the transverse fixation pin hole of the ligament support block is provided.

  With further reference to FIG. 52, a method for securing a graft ligament in a bone tunnel according to a preferred embodiment of the present invention is disclosed. The method includes an initial step of determining an appropriate transverse tunnel depth by reading the position of the depth marker 1775 on the drill sleeve 1770 relative to the overhang member 1755. The method includes the further step of forming a transverse tunnel in the host bone using a transverse tunnel drill 1700 having a depth marker 1790 to drill the transverse tunnel to the appropriate transverse tunnel depth. . The method comprises a subsequent emperor looping the graft ligament through the graft hole in the graft ligament support block. This step is followed by advancing the graft ligament support block into the bone tunnel such that the transverse fixation pin hole in the graft ligament support block is aligned with the transverse tunnel. The method selects a transverse fixation pin based on an appropriate transverse tunnel depth determined by a depth marker 1775 on the drill sleeve 1770, and places the transverse fixation pin along the transverse tunnel in the host bone to a graft ligament support block. A final step of pinning the graft ligament support block within the bone tunnel by advancing into the transverse fixation pin hole.

  53 and 54, a method for securing a graft ligament in a bone tunnel according to a preferred embodiment of the present invention is disclosed. The method includes an initial step of looping the graft ligament through the graft hole in the graft ligament support block. The method comprises the following steps of advancing the graft ligament support block into the bone tunnel. The method includes another step of forming a transverse tunnel in the host bone 15 to a predetermined depth using a transverse tunnel drill 1800 having a stop element 1805 at a predetermined distance from its distal end. The stop element 1805 engages with the drill sleeve or end 1765 of the overhanging member 1755 to limit excavation to a predetermined depth with the transverse tunnel aligned with the transverse fixation pin hole in the graft ligament support block. Configured to match. The method comprises the final step of pinning the graft ligament support block within the bone tunnel by advancing the transverse fixation pin along the transverse tunnel in the host bone to the transverse fixation pin hole in the graft ligament support block.

  With further reference to FIGS. 53 and 54, a method for securing a graft ligament within a bone tunnel according to a preferred embodiment of the present invention is disclosed. The method includes another step of forming a transverse tunnel in the host bone 15 to a predetermined depth using a transverse tunnel drill 1800 having a stop element 1805 at a predetermined distance from its distal end. The stop element 1805 is configured to engage the drill sleeve or distal end 1765 of the overhang member 1755 to limit excavation to a predetermined depth. The method comprises the following steps of looping the graft ligament through the graft hole in the graft ligament support block. The method comprises the further step of advancing the graft ligament support block into the bone tunnel such that the transverse fixation pin hole in the graft ligament support block is aligned with the transverse tunnel. The method comprises the final step of pinning the graft ligament support block within the bone tunnel by advancing the transverse fixation pin along the transverse tunnel in the host bone to the transverse fixation pin hole in the graft ligament support block.

  In a preferred embodiment of the present invention (not shown), a modified graft ligament support block similar to support block 1500 (FIG. 45) and support block 100 (FIG. 8) is provided to support the graft ligament within the bone tunnel. The The modified graft ligament support block includes an area configured therein for drilling a transverse fixation pin hole through the body that intersects the longitudinal axis when the cross pin hole is drilled through the bone tunnel. Preferably, the modified graft ligament support block further comprises a proximal end tapered to facilitate withdrawal of the graft ligament support block through the bone tunnel.

  In the foregoing description, the present invention has been described in terms of ACL reconstruction. However, it is to be understood that the present invention can also be used in connection with other types of ligament reconstruction and / or other types of anatomical reconstruction.

FIG. 1 is a schematic view of a knee joint when viewed from the front side. FIG. 2 is a schematic view of the knee joint when viewed from the rear side. FIG. 3 is a schematic diagram of a comprehensive ACL reconstruction. FIG. 4 is a schematic diagram of an ACL reconstruction achieved using an interference screw. FIG. 5 is a schematic diagram of an ACL reconstruction achieved using a suture sling. FIG. 6 is a schematic diagram of the ACL reconstruction achieved using crossing pins. FIG. 7 is a schematic diagram of the ACL reconstruction achieved using screws and washers. FIG. 8 is a schematic view of a graft ligament support block formed in accordance with the present invention. FIG. 9 is a partially exploded view showing the graft ligament support block of FIG. 8 and an installation tool for deploying the block. 10 shows the graft ligament support block of FIG. 8 attached to the distal end of the installation instrument shown in FIG. 11 shows the graft ligament support block of FIG. 8 attached to the distal end of the installation instrument shown in FIG. 12 shows the graft ligament support block of FIG. 8 attached to the distal end of the placement instrument shown in FIG. FIG. 13 is a partial perspective view showing a detailed configuration of a proximal end portion of the installation tool shown in FIG. 9. 14 is a partial cross-sectional side view showing a detailed configuration of the configuration of the installation instrument shown in FIG. 9. FIG. 15 is a side sectional view of the drill sleeve of the installation tool. 16 is a perspective view of a transverse fixation pin that can be used in connection with the graft ligament support block of FIG. 8 and the installation instrument of FIG. FIG. 17 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 18 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 19 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 20 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 21 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 22 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 23 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 24 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 25 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 26 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 27 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 28 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 29 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 30 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 31 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 32 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 33 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 34 is a schematic diagram illustrating another form of graft ligament support block formed in accordance with the present invention. FIG. 35 is an enlarged side view showing an alternative configuration for a portion of the installation tool. 36 is a cross-sectional view taken along line 36-36 of FIG. FIG. 37 is a schematic diagram showing a reamer drill guide formed in accordance with the present invention. FIG. 38 is a schematic view showing a reamer element of the reamer drill guide shown in FIG. FIG. 39 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 40 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 41 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 42 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 43 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 44 is one of a series of schematic diagrams illustrating the ACL reconstruction achieved in accordance with the present invention. FIG. 45 is a schematic view of a graft ligament support block showing a distal edge configuration in which each of the blocks is tapered. FIG. 46A is a schematic illustration of a graft ligament support block showing a distal edge configuration in which each of the blocks is tapered. FIG. 46B is a schematic view of a graft ligament support block showing a distal edge configuration in which each of the blocks is tapered. FIG. 47 is a schematic view of a transverse fixation pin, which has an internal tapered hole formed in its proximal end. 48 is a schematic view of a withdrawal device having a threaded projection configured to engage an internal tapered hole of the transverse fixation pin of FIG. 47. FIG. FIG. 49 is a schematic diagram showing a stepped transverse tunnel drill having a narrow cut and a wide cut. FIG. 50 is a schematic diagram of the ACL reconstruction procedure achieved using the stepped crossing tunnel drill shown in FIG. FIG. 51A is a schematic diagram of a system for use in reconstructing a ligament, the system comprising a stepped transverse tunnel drill with a depth marker formed thereon and a drill sleeve with a depth marker formed thereon And. FIG. 51B is a schematic diagram of a system for use in reconstructing a ligament, the system comprising a stepped transverse tunnel drill with a depth marker formed therein and a drill sleeve with a depth marker formed therein. And. FIG. 52 is a schematic diagram of a system for use in reconstructing a ligament comprising a stepped transverse tunnel drill with a depth marker formed therein and a drill sleeve with a depth marker formed therein. And. FIG. 53 is a schematic view of a transverse tunnel drill with stop elements formed on the drill. FIG. 54 is a schematic view of a transverse tunnel drill with stop elements formed on the drill. FIG. 55 is a schematic diagram of a system for use in reconstructing a ligament, the system configured to determine the placement depth of a transverse pin inserted into a transverse tunnel An insertion depth gauge is provided. FIG. 56 is a schematic diagram of a system for use in reconstructing a ligament, the system configured to determine the placement depth of a transverse pin inserted into a transverse tunnel An insertion depth gauge is provided.

Claims (21)

An apparatus for use in reconstructing a ligament,
The device comprises a graft ligament support block for supporting the graft ligament within a bone tunnel;
The graft ligament support block is
A body having a distal end, a proximal end, and a longitudinal axis extending between the distal and proximal ends, the proximal end of the ligament support block through a bone tunnel It said body tapering is formed to facilitate withdrawal,
A graft hole extending through the body intersecting the longitudinal axis and configured to receive a graft ligament;
A transverse fixation pin hole extending through the body intersecting the longitudinal axis and configured to receive a transverse fixation pin;
Equipped with a,
The taper is formed such that the width thereof becomes narrower from the distal end side toward the proximal end side when viewed from the axial direction of the transplant hole or the transverse fixing pin hole at the proximal end portion . The apparatus of claim 1, wherein the transplant hole is provided closer to the proximal end of the body than the transverse fixation pin hole. 2. The at least a portion of the graft hole opening is tapered to provide a less traumatic bearing surface for a graft ligament looped through the graft hole. Equipment.   The apparatus of claim 1, wherein the opening of the transverse fixation pin hole is tapered to facilitate introduction of a transverse fixation pin into the transverse fixation pin hole.   The apparatus of claim 1, wherein at least a portion of the body between the graft hole and the transverse fixation pin hole has a substantially cylindrical cross section.   The apparatus of claim 1, wherein the distal end of the body is tapered to facilitate advancement of the graft ligament support block through the bone tunnel.   The proximal portion of the body is looped through the graft hole and is plasticized to provide more space for the graft ligament extending proximally from the graft hole. The apparatus of claim 1.   The apparatus of claim 7, wherein the proximal end of the body is plasticized to form at least one substantially flat surface.   8. The device of claim 7, wherein the proximal end of the body is plasticized to form at least one surface groove extending between the graft hole and the proximal end of the body.   The body is a material selected from the group consisting of polymers, bioabsorbable materials, bioreconfigurable materials, allograft bones, metals, ceramics, corals, fiber composites, composites including at least one of the foregoing The device of claim 1, formed from:   The apparatus of claim 1, wherein the body further comprises at least one element for engagement by an installation tool. The apparatus of claim 11, wherein the at least one element comprises an opening formed in the proximal end of the body and configured to be engaged by a finger formed on an installation tool.   The at least one element comprises a finger extending proximally from the proximal end of the body and configured to engage an opening formed on the installation tool. The device described in 1.   The apparatus of claim 1, wherein the body further comprises a suture hole extending through the body intersecting the longitudinal axis and configured to receive a tow suture.   The apparatus of claim 14, wherein the suture hole is positioned closer to the distal end of the body than the transverse fixation pin hole. Further comprising an installation tool, the installation tool having a holder;
The holder is
A shaft having a distal end, a proximal end, and a longitudinal axis extending between the distal end and the proximal end, wherein the proximal end of the shaft engages within the opening The shaft comprising at least one finger of
A handle attached to the proximal end of the shaft;
The apparatus of claim 1, comprising:   The apparatus of claim 16, further comprising at least one suture post formed on the proximal end of the shaft.   The apparatus of claim 16, wherein the installation tool further comprises a drill guide configured to be releasably secured to the holder. The drill guide is
An overhang member comprising a distal end and a base end, wherein the base end of the overhang member is configured to be releasably secured to the holder; and
A drill sleeve movably attached to the distal end of the overhang member,
The drill sleeve comprises a drill lumen extending through the sleeve; and
The apparatus of claim 18, comprising:   The installation instrument is configured such that the drill lumen of the drill guide is aligned with the transverse fixation pin hole in the body when the graft ligament support block is attached to the distal end of the shaft. The apparatus of claim 19.   The apparatus of claim 16, wherein the proximal end of the holder comprises an alignment marker for visually indicating an on-axis arrangement of the distal end of the shaft.

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