KR102556483B1 - Cannulated oval dilator for cruciate ligament reconstruction of knee - Google Patents

Abstract

The present invention discloses an elliptical reamer for cruciate ligament reconstruction of the knee joint, which is a surgical instrument for cruciate ligament reconstruction of the knee joint, wherein the reamer has an elliptical cross section at an affected part, one side of which is connected to the affected part and has a predetermined length. A bar-shaped connection portion having, a handle portion formed on the other side of the connection portion, a center guide hole through which a main guide pin is inserted through the affected portion, the connection portion, and the inner central axis of the handle portion, and, at the side of the center guide hole It includes a side guide hole for inserting an auxiliary guide pin through the affected part, and is guided by the main guide pin and the auxiliary guide pin so that the long axis of the affected part is aligned with the long axis of the cruciate ligament, and then inserted into the cruciate ligament to form an ellipse It is configured to widen a shaped tunnel.

Description

Elliptical dilator for cruciate ligament reconstruction of knee joint with guide hole {Cannulated oval dilator for cruciate ligament reconstruction of knee}

The present invention discloses an elliptical reamer for knee joint cruciate ligament reconstruction.

The treatment for patients with anterior and posterior cruciate ligament damage is to perform reconstruction surgery, which is performed by creating a bone tunnel in the femur and tibia and inserting a new ligament. In conventional reconstruction, the cross-sectional shape of the tunnel was made circular using a dilator and reamer with a round cross section, but the actual cruciate ligament attachment was attached in an elliptical shape rather than a circular shape, so the results were limited. .

It is known that the actual cruciate ligament has a 'ribbon-like appearance' as the femoral and tibial attachments are elliptical in two strands. To overcome this, a rectangular dilator was recently invented and introduced. This also has a risk of fracture of the femur and tibia due to the square edge, and unlike the circular dilator, the axis due to the long and short axes ( long axis of dilator) was made, and there was a problem that the risk of fracture increased and the shape changed if it did not match the axial direction of the actual cruciate ligament attachment.

Reconstruction using a conventional circular reamer or reamer confirms cruciate ligament rupture below 90° of flexion of the knee joint, and in the case of an anatomical cruciate ligament reconstruction femur, after checking the center point of the actual cruciate ligament, the knee joint is fully flexed to use an offset guide. A guide pin is inserted using a guide pin, and a bone tunnel is secured using a circular reamer or dilator. Then, the tibia also uses an angle guide to insert a guide pin into the central point of the cruciate ligament. At this time, in the case of a rectangular reamer, the usage is different. In general, a rectangular reamer is used after inserting a guide pin in the same way as a circular reamer.

On the other hand, according to previous literatures, cruciate ligament reconstruction using an existing circular tunnel requires about 8% reconstruction (thesis No. 7), which means that the actual cruciate ligament attachment site is elliptical and ribbon-like apprearance (thesis 6, 7), and it is known to be caused by not being able to prevent rotational instability due to the circular tunnel not covering a wide area of attachment (Thesis No. 9).

To this end, various rectangular reamers have been introduced in several papers (papers 1, 2, 3, 4, 5, and 8). According to the preceding documents, the rectangular tunnel is known to show good clinical results compared to the circular tunnel. However, it is known that the rectangular reamer has a higher risk of intraoperative fracture than the circular reamer due to its rectangular shape, and it is difficult to match the long axis of the rectangle with the long axis of the cruciate ligament.

Korean Patent Registration No. 10-1660955 Korean Patent Registration No. 10-2026021

1. Tachibana et al, Femoral tunnel enlargement after anatomic anterior cruciate ligament reconstruction: Bone-patellar tendon-bone/single rectangular tunnel versus hamstring tendon/double tunnels. Journal of Orthopedic Science 23 (2018) 1011e1018 2. Shino et al, Rectangular Tunnel Double-Bundle Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Graft to Mimic Natural Fiber Arrangement. Arthroscopy. 2008 Oct;24(10):1178-83. 3. Shino et al, Anatomically oriented anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft via rectangular socket and tunnel: a snug-fit and impingement-free grafting technique.Arthroscopy. 2005 Nov;21(11):1402. 4. Hiramatsu et al, Contact area between femoral tunnel and interferencescrew in anatomic rectangular tunnel ACL reconstruction:a comparison of outsidein and transportal insideout techniques Knee Surg Sports Traumatol Arthrosc (2018) 26:519-525 5. Takata et al. No difference in the graft shift between a round and a roundedrectangular femoral tunnel for anterior cruciate ligament reconstruction: an experimental study. Archives of Orthopedic and Trauma Surgery (2018) 138:1249-1255 6. Smigielski R, Zdanowicz U, Drwiega M, Ciszek B, Williams A. The anatomy of the anterior cruciate ligament and its relevance to the technique of reconstruction. BoneJoint J 2016;98-B:1020-1026. 7. Smigielski R, Zdanowicz U, Drwiega M, Ciszek B, Ciszkowska-Lyson B, Siebold R. Ribbon like appearance of the midsubstance fibers of the anterior cruciate ligament close to its femoral insertion site: A cadaveric study including111 knees. Knee Surg Sports Traumatol Arthrosc 2015;23:3143-3150. 8. Hayashi et al, Anterior Cruciate Ligament Reconstruction With Bone Patellar Tendon Bone Graft Through a Rectangular Bone Tunnel Made With a Rectangular Retro-dilator: An Operative Technique. Arthrosc Tech. 2017 Jul 17;6(4):e1057-e1062. 9. Grassi et al, What Is the Mid-term Failure Rate of Revision ACL Reconstruction: A Systematic Review. Clin Orthop Relat Res (2017) 475:2484-2499 10. Fink et al, Anterior Cruciate Ligament Reconstruction Using a Ribbon-Like Graft With a C-Shaped Tibial Bone Tunnel. Arthrosc Tech. 2020 Jan 22;9(2):e247-e262.

The present invention is to provide a surgical instrument capable of forming a tunnel shape according to an elliptical shape, which is the original cruciate ligament attachment shape, when tunnel expansion for cruciate ligament reconstruction is performed.

In addition, the present invention is to provide a surgical instrument that is manufactured in an elliptical shape similar to the anatomical shape and can cover more cruciate ligament attachment points even with the same cross-sectional area as a circular reamer in anterior and posterior cruciate ligament reconstruction.

In addition, the present invention intends to provide a surgical instrument capable of reducing the possibility of fracture due to stress-loading of a rectangular vertex by designing a rectangular tunnel (rectangular, rounded rectangular) into an elliptical shape, which is a more anatomical shape.

In addition, the present invention is to provide a surgical instrument that can accurately align the long axis of the dilator and the long axis of the cruciate ligament by inserting an additional pin into the guide hole to bring about excellent results.

In addition, the present invention is intended to provide a surgical instrument capable of further reducing the risk of fracture that may occur during use of a reamer by easily grasping the position of the longest apex of an elliptical dilator through pin insertion in a guide hole.

The present invention for solving the above problems is a reamer, which is a surgical instrument for knee joint cruciate ligament reconstruction, an affected part having an elliptical cross section, one side connected to the affected part and a bar-shaped connection part having a predetermined length , The handle portion formed on the other side of the connection portion, the center guide hole through which the main guide pin is inserted along the inner central axis of the affected portion, the connecting portion and the handle portion, and through the affected portion from the side of the center guide hole It includes a side guide hole for inserting an auxiliary guide pin, and is guided by the main guide pin and the auxiliary guide pin so that the long axis of the affected part is aligned with the long axis of the cruciate ligament, and then inserted into the cruciate ligament to expand an elliptical tunnel. is configured to

In this embodiment, the affected portion may form a head portion protruding from the front end of the central portion, and the side portion of the head portion may form a blade portion.

In addition, the elliptical shape of the affected part may include a structure in which a cross section has a major axis and a minor axis and an outer circumferential surface is a curved surface.

In addition, the elliptical shape of the affected part may include a crescent moon or an eyebrow shape in cross section.

In addition, the center guide hole and the side guide hole, may be formed in a direction parallel to each other.

In addition, the affected part may have a shape that is bent to one side toward the distal end.

The reamer of the present invention has an elliptical shape that is most similar to an ellipse, which is the shape of the actual cruciate ligament attachment, when compared to a circular tunnel, which is still the most used surgical method, so that a ribbon-like appearance cruciate ligament can be made after surgery. Compared to circular surgery, biomechanical properties and clinical results are very good.

In addition, even if the reamer of the present invention has a circular cross-sectional area, its shape (elliptical shape) makes it possible to cover a wider area where the cruciate ligament is attached, and it is possible to use a larger reamer, so that a thicker graft tendon can be obtained. Better surgical results can be expected.

In addition, since the reamer of the present invention has two guide holes, compared to a reamer having one guide hole, the long axis of the ellipse and the long axis of the cruciate ligament attachment can be easily matched, and the reamer of the present invention can be found in a rectangular reamer. It reduces the risk of fracture due to stress loading of the square apex. In addition, the possibility of fracture of the femur and tibia can be predicted through the insertion of a guide pin.

In addition, the reamer of the present invention consists of two guide holes, a central guide hole on the central axis and a side guide hole on the side, so that direct guidance is possible during surgery through the side guide holes. No guide is required, making the operation much faster, easier and more economical.

In addition, the reamer of the present invention can be performed with the same surgical method as the existing circular surgical method, so the surgical difficulty is not different from that of the existing surgical method.

1 is a view showing an elliptical reamer according to this embodiment;
Figure 2 is a view showing the affected part of the elliptical reamer of Figure 1;
Fig. 3 is a front view of the affected part of the elliptical reamer of Fig. 1;

The technical problems achieved by the present invention and its practice will be clarified by the preferred embodiments described below. Hereinafter, preferred embodiments of the present invention will be described in detail with reference to the accompanying drawings.

It should be understood that the differences in the present embodiment, which will be described later, are not mutually exclusive. That is, without departing from the spirit and scope of the present invention, specific shapes, structures, and characteristics described may be implemented in relation to one embodiment in another embodiment, and the location of individual components within each disclosed embodiment. Alternatively, it should be understood that the arrangement may be changed, and similar reference numerals in the drawings indicate the same or similar functions across several aspects, and the shape, such as length, area and thickness, may be exaggerated for convenience.

FIG. 1 is a view showing an elliptical reamer according to this embodiment, FIG. 2 is a view showing the affected part of the elliptical reamer of FIG. 1, and FIG. 3 is a view showing the front of the affected part of the elliptical reamer of FIG. 1.

The reamer according to the present embodiment includes an affected part (A), a connection part (B) and a handle part (C). Here, the affected part (A) is a straight bar shape, and the cross section is an elliptical shape. The affected part means 'the affected part insertion part'. The connection part (B) is a straight bar shape having a predetermined length and connects the affected part (A) and the handle part (C). Therefore, the connecting portion (B) has an affected portion (A) formed on one side, and a handle portion (C) is formed on the other side. The handle part (C) is a part that allows the operator (operator) to manually operate, and is formed on the other side of the connection part (B).

Since the cross section of the affected portion (A) of the reamer of this embodiment forms an elliptical shape, the long axis of the reamer has a greater width than that of the connecting portion (B). Such an elliptical affected part (A) overcomes the circular tunnel, which is a limitation of circular reamers or dilators, and forms a tunnel that approximates the actual anatomical attachment shape. In addition, the oval-shaped affected part (A) can overcome a fracture caused by stress loading at the vertex that occurs in a rectangular reamer.

In addition, the reamer of this embodiment has a center guide hole 10 into which a main guide pin (not shown) can be inserted along the interior central axis of the affected part (A), the connecting part (B) and the handle part (C). is formed In addition, the reamer of the present embodiment is a side guide hole (20) into which an auxiliary guide pin (not shown) can be inserted along the affected part (A) in the side region of the affected part (A) spaced apart from the center guide hole (10). , Side guide hole) is formed. The side guide hole 20 is formed while penetrating the affected part (A) in the long axis of the affected part (A).

That is, the reamer of this embodiment has two guide holes, a center guide hole 10 penetrating along the central axis and an auxiliary guide hole 20 penetrating the side of the affected part A, and has a two cannulated guide hole shape as a whole. make up The center guide hole 10 and the auxiliary guide hole 20 are formed in parallel directions while being spaced apart at a predetermined interval.

The size of the reamer having the two cannulated guide holes can be measured and guessed through the auxiliary guide pin inserted into the side guide hole 20, so that fractures can be prevented in advance.

In addition, since the reamer of this embodiment can specify the direction according to the position of the auxiliary guide pin inserted into the side guide hole 20 with the main guide pin inserted into the center guide hole 10 as the central axis, It can be aligned so that the long axis and the long axis of the cruciate ligament exactly coincide.

In addition, since the reamer of this embodiment is fixed to the femur and tibia at two points of the center guide hole 10 position and the side guide hole 20 position, rotational instability does not appear because it does not rotate independently.

In addition, the auxiliary guide hole 20 is auxiliaryly formed on the side of the center guide hole 10 formed on the existing central axis, so that there is no significant difference from the existing circular tunnel surgery method, so anyone can easily adapt to the surgery. instrument is not required.

In addition, since the reamer can accurately determine the position of the head part 30 at the tip of the reamer according to the positions of the center guide hole 10 and the auxiliary guide hole 20, there is an advantage in preventing fractures.

In addition, the reamer of this embodiment forms a sharp blade portion 31 on the side of the head portion 30 at the tip. The blade part 31 is formed in the long axis direction around the head part 30 so that the reamer can be easily inserted between the femur and the tibia, so that surgery can be performed easily. This is because the reamer of this embodiment has two cannulated guide holes, so that the long axis of the reamer and the long axis of the cruciate ligament can be precisely aligned and the position of the head of the central axis can be accurately identified. Because it guides you not to. In addition, the blade portion 31 forms a concave curved surface shape. This shape allows the reamer to expand the tunnel up to the cruciate ligament attachment site, while minimizing damage to the femur or tibia at the attachment site.

On the other hand, although not shown, the affected part A of the reamer may be bent to one side while having a predetermined inclination towards the end. In addition, in the description of the present invention, the ellipse includes not only a square elliptical shape but also a curved structure having a long axis and a short axis in cross section, and includes, for example, a structure having a crescent moon shape and an eyebrow shape in cross section.

Hereinafter, an example of surgery using the elliptical reamer of the present invention will be schematically described.

1. Anterior Cruciate Ligament Reconstruction

First, an arthroscopic camera is inserted through the insertion port, and the attachment site and location of the cruciate ligament are confirmed. In the case of the femoral tunnel, the main guide pin is inserted with the knee joint fully flexed through a commonly used 6-7 mm offset guide at the central point of the cruciate ligament attachment site.

Then, the main guide pin is inserted into the central guide hole of the elliptical reamer of the present invention and inserted into the joint, aligning the long axis of the multi-circular reamer with the long axis of the cruciate ligament attachment, and then inserting into the side guide hole. Insert the auxiliary guide pin so that it can slide. At this time, the direction of the long axis can be adjusted in a desired direction, and the possibility of fracture of the femur can be confirmed according to the position of the side guide hole.

After inserting two guide pins, an elliptical reamer is inserted step by step to enlarge the femoral tunnel. The length of the tunnel is enlarged to be at least 20mm, and the far cortex bone is finished with a reamer corresponding to each instrument (suspensory fixation or bioscrew fixation) used.

For the formation of the tibial tunnel, the main guide pin is aimed at the center of the origin of the cruciate ligament using a general tibial drill guide from the upper part of the pes anserinus attachment point with the insertion point 3 to 5 cm inside the tibial tuberosity. insert

Afterwards, the main guide pin is inserted into the center guide hole of the elliptical reamer and attached to the tibia, and then additional guide pins are inserted into the side guide hole to align with the long axis of the tibia attachment. Expand into an oval shape.

Afterwards, the tendon graft passes through the femoral tunnel through the tibial tunnel, and the femur can be fixed according to the operator's choice because both suspensory fixation and bone fixation are possible. Additionally, the tibia was reinforced with a cortical screw using a spiked washer, and secondary tendon graft fixation was performed.

2. Posterior Cruciate Ligament Reconstruction

First, an arthroscopic camera is inserted through the insertion port, and the attachment site and location of the cruciate ligament are confirmed. In the case of the femoral tunnel, check the posterior cruciate ligament attached to the femoral condyle, insert the main guide pin into the center of the cruciate ligament, and then insert an elliptical reamer into the center guide hole so that the main guide pin is inserted.

Then, after aligning the elliptical reamer on the long axis of the posterior cruciate ligament, insert the auxiliary guide pin into the side guide hole so that it can slide and expand the hole. At this time, the direction of the long axis can be adjusted in a desired direction, and the possibility of fracture of the femur can be confirmed according to the position of the side guide hole.

After inserting two guide pins, an elliptical reamer is inserted step by step to establish a femoral tunnel. The length of the tunnel is enlarged to be at least 20mm, and the far cortex bone is finished with a reamer corresponding to each instrument (suspensory fixation or bioscrew fixation) used.

For the formation of the tibial tunnel, the posterior part of the knee joint is dissected, the posterior cruciate ligament attachment site is checked, and the main guide pin is inserted 1.5 cm below the joint surface. Then, a tibial tunnel is secured using an oval reamer at the top of the pes anserinus attachment 3 to 5 cm inside the tibial tuberosity. At this time, an auxiliary guide pin is additionally inserted into the side guide hole to secure the tunnel by aligning with the long axis of the posterior cruciate ligament.

After passing through the tendon graft, both suspensory fixation and bone fixation are possible for the femur, so it can be fixed according to the surgeon's choice. Additionally, the tibia was reinforced with a cortical screw using a spiked washer, and secondary tendon graft fixation was performed.

Although exemplary embodiments of the present invention have been shown and described as described above, various modifications and other embodiments may be made by those skilled in the art. All of these modifications and other embodiments are to be considered and included in the appended claims without departing from the true spirit and scope of the present invention.

A: Affected area
B: Connection
C: handle part
10: Center guide hole
20: side guide hole
30: head part
31: blade part

Claims (6)

As a reamer, a surgical instrument for knee joint cruciate ligament reconstruction,
A cross section having an elliptical curvature and forming a head portion protruding from the tip of the central portion, the side portion of the head portion forming a blade portion, the affected portion;
a bar-shaped connection part having one side connected to the affected part and having a predetermined length; and,
a handle portion formed on the other side of the connection portion;
A center guide hole formed through the affected part, along the inner central axis of the connection part and the handle part;
a main guide pin inserted into the center guide hole;
a side guide hole formed through the affected part at one side of a position eccentric about the center guide hole; and
Including; an auxiliary guide pin inserted into the side guide hole and slideable;
When the affected part is inserted into the cruciate ligament while being guided by the main guide pin and the auxiliary guide pin,
The main guide pin inserted into the center guide hole guides the affected part to be inserted into the center of the cruciate ligament, and is guided by the auxiliary guide pin inserted into the side guide hole to confirm while rotating the main guide pin around the central axis. After the long axis of the air and the long axis of the cruciate ligament are aligned so that they coincide, the reamer and the cruciate ligament are inserted in a fixed state by the main guide pin and the auxiliary guide pin to expand an elliptical tunnel inside the cruciate ligament An elliptical reamer for knee joint cruciate ligament reconstruction, configured to do so. delete According to claim 1,
The elliptical shape of the affected part includes a crescent moon or eyebrow shape in which the outer circumferential surface is curved while having a long axis and a short axis in cross section. delete According to claim 1,
The center guide hole and the side guide hole are formed in parallel directions, an elliptical reamer for knee joint cruciate ligament reconstruction. According to claim 1,
The affected part has a shape that is bent to one side toward the distal end, an elliptical reamer for knee joint cruciate ligament reconstruction.

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