U.S. patent application number 09/978216 was filed with the patent office on 2002-02-14 for method for fixing a graft in a bone tunnel.
Invention is credited to Bowman, Steven M., Bruker, Izi, Wenstrom, Richard F. JR., Whittaker, Gregory.
Application Number | 20020019635 09/978216 |
Document ID | / |
Family ID | 24421374 |
Filed Date | 2002-02-14 |
United States Patent
Application |
20020019635 |
Kind Code |
A1 |
Wenstrom, Richard F. JR. ;
et al. |
February 14, 2002 |
Method for fixing a graft in a bone tunnel
Abstract
A method for performing an anterior cruciate ligament repair
procedure wherein a bone plug attached to a section of tendon or
ligament is fixed in a bone tunnel. The method utilizes an adhesive
to secure the bone block in the bone tunnel.
Inventors: |
Wenstrom, Richard F. JR.;
(Norwood, MA) ; Bruker, Izi; (Wayland, MA)
; Bowman, Steven M.; (Sherborn, MA) ; Whittaker,
Gregory; (Stoneham, MA) |
Correspondence
Address: |
AUDLEY A. CIAMPORCERO JR.
JOHNSON & JOHNSON
ONE JOHNSON & JOHNSON PLAZA
NEW BRUNSWICK
NJ
08933-7003
US
|
Family ID: |
24421374 |
Appl. No.: |
09/978216 |
Filed: |
October 15, 2001 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
09978216 |
Oct 15, 2001 |
|
|
|
09604867 |
Jun 28, 2000 |
|
|
|
Current U.S.
Class: |
623/13.12 ;
606/151; 606/88 |
Current CPC
Class: |
A61B 17/1714 20130101;
C08L 35/04 20130101; A61F 2/0805 20130101; A61L 24/06 20130101;
Y10S 606/909 20130101; Y10S 606/916 20130101; A61F 2/0811 20130101;
A61F 2002/0882 20130101; A61B 17/00491 20130101; A61B 17/1764
20130101; A61B 17/0401 20130101; Y10S 606/908 20130101; A61F
2210/0085 20130101; A61F 2002/087 20130101; A61L 24/06
20130101 |
Class at
Publication: |
606/72 ;
606/151 |
International
Class: |
A61B 017/84 |
Claims
We claim:
1. A method of performing a surgical reconstruction of an anterior
cruciate ligament, comprising: providing a bone-tendon graft
comprising at least one bone plug connected to a section of tendon,
the bone plug having an outer surface; drilling a first
substantially longitudinal bone tunnel into a patient's tibia;
drilling a second substantially longitudinal bone tunnel into a
femur, and said second bone tunnel having an inner surface;
inserting the bone plug into the femoral tunnel; and, introducing
an adhesive into the femoral tunnel, wherein the adhesive is in at
least partial contact with the outer surface of the bone plug and
the inner surface of the femoral bone tunnel.
2. The method of claim 1 wherein the bone tendon graft comprises a
section of patellar tendon having a proximal end and a distal end,
a patellar bone plug attached to the distal end of the tendon and a
tibial bone plug attached to the proximal end of the tendon.
3. The method of claim 1 wherein the adhesive is a bone glue.
4. The method of claim 1 wherein the adhesive is a bone cement.
5. The method of claim 3 wherein the glue is bioabsorbable.
6. The method of claim 4 wherein the cement is bioabsorbable.
7. The method of claim 1, wherein a transverse bone tunnel is
drilled into the femur substantially transverse to the femoral
tunnel, wherein the transverse tunnel is in communication with the
femoral tunnel.
8. The method of claim 7 wherein the adhesive is introduced by
injecting through the transverse tunnel into the femoral
tunnel.
9. The method of claim 1, wherein the femoral tunnel is a blind
bore hole, having a distal bottom.
10. The method of claim 9, wherein a suture tunnel substantially in
alignment with the femoral tunnel is drilled through the distal
bottom and out through the femoral bone such that the suture tunnel
is in communication with the femoral tunnel.
11. The method of claim 10, wherein the adhesive is introduced into
the femoral tunnel through the suture tunnel.
12. The method of claim 10, wherein the bone plug has a suture
mounted thereto.
13. The method of claim 12, wherein the adhesive comprises a
frangible capsule having an interior volume containing adhesive
that is placed into the femoral bore hole prior to inserting the
bone plug.
14. The method of claim 1 wherein the adhesive is introduced into
the femoral tunnel prior to inserting the femoral bone plug.
15. The method of claim 2 additionally comprising the step of
fixating the tibial bone plug in the tibial tunnel.
16. The method of claim 1 wherein the bone plug comprises
autologous bone.
17. The method of claim 1 wherein the bone plug comprises an
artificial bone substitute material.
18. The method of claim 1 wherein the tendon comprises an
artificial tendon substitute material.
19. The method of claim 3 wherein the glue comprises 2-octyl
cyanoacrylate.
20. The method of claim 4 wherein the cement comprises
polymethylmethacrylate.
21. A method of fixating a bone plug in a bone tunnel, comprising:
providing a bone plug the bone plug having an outer surface;
drilling bone, said bone tunnel having an inner surface; inserting
the bone plug into the bone tunnel; and, introducing an adhesive
into the bone tunnel, wherein the adhesive is in at least partial
contact with the outer surface of the bone plug and the inner
surface of the bone tunnel.
Description
FIELD OF THE INVENTION
[0001] The field of art to which this invention relates is
orthopedic surgical methods, in particular, surgical procedures for
fixating bone grafts in bone tunnels.
BACKGROUND OF THE INVENTION
[0002] Joint injuries may commonly result in the complete or
partial detachment of ligaments, tendons and soft tissues from
bone. Tissue detachment may occur in may ways, e.g., as the result
of an accident such as a fall, overexertion during a work-related
activity, during the course of an athletic event, or in any one of
many other situations and/or activities. These types of injuries
are generally the result of excess stress or extraordinary forces
being placed upon the tissues.
[0003] In the case of a partial detachment, commonly referred to
under the general term "sprain", the injury frequently heals
without medical intervention, the patent rests, and care is taken
not to expose the injury to undue strenuous activities during the
healing process. If, however, the ligament or tendon is completely
detached from its attachment site on an associated bone or bones,
or if it is severed as the result of a traumatic injury, surgical
intervention may be necessary to restore full function to the
injured joint. A number of conventional surgical procedures exist
for re-attaching such tendons and ligaments to bone.
[0004] One such procedure involves the re-attachment of the
detached tissue using "traditional" attachment devices such as
staples, sutures, and bone screws. Such traditional attachment
devices have also been used to attach tendon or ligament grafts
(often formed from autogenous tissue harvested from elsewhere in
the body) to the desired bone or bones.
[0005] In U.S. Pat. No. 4,950,270, a surgical procedure is
disclosed to replace a damaged anterior cruciate ligament ("ACL")
in a human knee. Initially bone tunnels are formed through the
tibia and femur at the points of normal attachment of the anterior
cruciate ligament. Next, a ligament graft with a bone block on one
of its ends is sized so as to fit within the bone tunnels. Suture
is then attached to the bone block and thereafter passed through
the tibia and femoral bone tunnels. The bone block is then pulled
through the tibia tunnel and up into the femoral tunnel using the
suture. As this is done, the graft ligament extends back out of the
femoral tunnel, across the interior of the knee joint, and then
through the tibial tunnel. The free end of the graft ligament
resides outside the tibia, at the anterior side of the tibia. Next,
a bone screw is inserted between the bone block and the wall of
femoral bone tunnel so as to securely lock the bone block in
position by a tight interference fit. Finally, the free end of the
graft ligament is securely attached to the tibia.
[0006] In U.S. Pat. No. 5,147,362, another ACL reconstruction
procedure is disclosed. Aligned femoral and tibia tunnels are
initially formed in a human knee. A bone block with a graft
ligament attached thereto is passed through the tunnels to a blind
end of the femoral tunnel where the block is fixed in place by an
anchor. The ligament extends out of the tibia tunnel, and the end
is attached to the tibia cortex by staples or the like.
Alternatively, the end of the ligament may be fixed in the tibia
tunnel by an anchor or by an interference screw.
[0007] Various types of ligament and/or suture anchors for
attaching soft tissue to bone are also well known in the art. A
number of these devices are described in detail in U.S. Pat. Nos.
4,898,156; 4,899,743; 4,968,315; 5,356,413; and 5,372,599, which
are incorporated by reference in their entirety.
[0008] One known method for anchoring bone blocks in bone tunnels
is through "cross-pinning" technique, in which a pin, screw or rod
is driven into the bone transversely to the bone tunnel so as to
intersect the bone block and thereby cross-pin the bone block in
the bone tunnel. In order to provide for proper cross-pinning of
the bone block in the bone tunnel, a drill guide is generally used.
The drill guide serves to ensure that the transverse passage is
positioned in the bone so that it will intersect the appropriate
tunnel section and the bone block.
[0009] U.S. Pat. No. 5,431,651, discloses a cross-pin screw made
from a broadabsorbable material which is absorbed by the body over
time, thereby eliminating any need for the cross-pin screw to be
removed in a subsequent surgical procedure.
[0010] Although the soft tissue attachment procedures of the prior
art have proven to be beneficial, there is a continuing need in
this art for novel, improved surgical procedures, particularly in
the area of anterior cruciate ligament reconstruction.
SUMMARY OF THE INVENTION
[0011] Accordingly it is an object of the present invention, to
provide a method for fixing a bone block in a bone tunnel such that
the bone block is retained in the tunnel by a bone cement or bone
glue, thereby eliminating the need for a cross-pin or screw or
other mechanical fastening device to secure the bone block.
[0012] It is a further object of the present invention to provide a
novel method of graft fixation in an anterior cruciate ligament
reconstruction procedure using a bone cement or bone glue.
[0013] Therefore, a novel method of performing a surgical
reconstruction of an anterior cruciate ligament is disclosed. The
method consists of providing a bone-tendon graft comprising at
least one bone plug connected to a section of tendon. The bone plug
has an outer surface. Next, a substantially longitudinal bone
tunnel is drilled into a patient's tibia, and a substantially
longitudinal bone tunnel is drilled into the patient's femur. The
femoral bone tunnel and the tibial bone tunnel are drilled so as to
be in substantial alignment. Each bone tunnel has an inner surface.
The bone plug is then inserted into the femoral tunnel such that
the tendon extends from the femoral plug, out of the femoral bone
tunnel, and into the tibial bone tunnel. And, a bone glue or cement
is introduced into the femoral tunnel such that the glue or cement
is in at least partial contact with the outer surface of the bone
plug and the inner surface of the femoral bone tunnel, thereby
securing the bone plug in the femoral tunnel.
[0014] Yet another aspect of the present invention is the
above-described method wherein the bone glue or cement is inserted
into the femoral bone tunnel prior to inserting the bone plug.
[0015] Still yet another aspect of the present invention is a
method of securing a bone plug in a bone tunnel. A bone tunnel is
drilled into a bone. A bone plug is provided. A glue or cement is
introduced into the bone tunnel to secure the bone plug in the bone
tunnel.
[0016] These and other advantages of the present invention will
become more apparent from the following description and
accompanying drawings.
BRIEF DESCRIPTION OF DRAWINGS
[0017] FIG. 1 illustrates a human knee prior to harvesting a
bone-tendon-bone graft; the outline of the graft on the patella,
patellar tendon, and tibia is shown by phantom lines.
[0018] FIG. 2 illustrates a bone-tendon-bone graft after
harvesting; the bone plug that is inserted into the femur has a
suture mounted thereto.
[0019] FIG. 3A illustrates a knee after a pilot drill was used to
drill a series of pilot holes into the tibia and femur of a knee
joint, including the suture tunnel, and after a conventional
concentric bone drill was placed over the pilot drill to drill out
the tibial and femoral bone tunnels; the pilot drill is shown in
place in the knee, the concentric drill is not shown.
[0020] FIG. 3B illustrates the knee joint of FIG. 3A after the
tibial and femoral bone tunnels have been drilled out, and
illustrates a drill guide being mounted to the knee; also
illustrated is a cannula and a trocar drill used for drilling a
transverse glue tunnel.
[0021] FIG. 3C illustrates a transverse glue tunnel being drilled
into the femur in communication with the femoral bone tunnel.
[0022] FIG. 3D illustrates the knee after the transverse glue
tunnel has been drilled and the drill has been removed.
[0023] FIG. 3E illustrates a removable clamp on the drill guide
which is disengaged prior to removing the drill guide from the knee
in order to allow the cannula to remain in place in the glue
tunnel.
[0024] FIG. 4 illustrates the knee with the drill guide removed,
and also illustrates a trocar cannula inserted into the glue
tunnel; the distal tip of the cannula extends into the femoral bone
tunnel.
[0025] FIG. 5 illustrates the graft being emplaced in the femoral
and tibial tunnels by pulling on the suture attached to the femoral
bone plug.
[0026] FIG. 6 illustrates the tibial and femoral bone plugs in
place in the bone tunnel; and, bone glue being introduced into the
cannula in the femoral bone tunnel through the transverse glue hole
to secure the femoral bone plug by using a hypodermic needle to
inject the glue into the cannula.
[0027] FIG. 7 illustrates a bolus of glue in the femoral tunnel
between the top of the femoral plug and the distal end of the
femoral tunnel injected via the needle of the syringe placed in the
cannula.
[0028] FIG. 8 illustrates a bolus of glue on top of the femoral
plug in the femoral bone tunnel prior to setting the femoral plug
in place; the cannula has been removed.
[0029] FIG. 9 is a partial cross-sectional view illustrating the
graft after the femoral plug has been pulled into place, and the
glue has been spread about the femoral plug and femoral tunnel.
[0030] FIG. 10 illustrates an alternate embodiment of the present
invention, wherein the adhesive is introduced into the femoral bone
tunnel through the distal suture hole in the femur in communication
with the femoral bone tunnel, to secure the femoral bone plug.
[0031] FIGS. 11A-B illustrate another embodiment of the present
invention wherein the bone glue is contained in a frangible capsule
which is introduced in the femoral bone hole prior to emplacing the
femoral bone plug, and the capsule is crushed when the femoral plug
is pulled into place, thereby allowing the glue to exit the capsule
and make contact with the bone plug and the interior surface of the
femoral bone tunnel.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0032] The terms "bone cement" and "bone glue" are used
interchangeably herein when describing the surgical procedures of
the present invention. The term "tendon" as used herein is defined
to include both tendons and ligaments. The bone-tendon-bone ACL
reconstruction surgical procedures of the present invention are
initiated by first providing a bone-tendon-bone graft. Also,
depending upon the particular circumstances surrounding an
individual patient and the particular injury, a bone-tendon graft
could also be used having a single bone plug. As seen in FIG. 1,
knee joint 10 consisting of a tibia 20, femur 40, and a patella 60
having patella tendon 80 is illustrated. An autologous
bone-tendon-bone graft 100 useful in the procedure of the present
invention is illustrated in FIGS. 1 and 2. The graft 100 is
harvested in a conventional manner. The graft 100 is seen to have
tendon section 110 having proximal end 112 and distal end 114. The
femoral bone plug 120 is seen to be cut out from the patella 60.
The bone plug 120 is seen to have outer surface 125, proximal end
130 connected to the distal end 114 of tendon section 110 and
distal end 135. The tibia bone plug 140 is seen to be cut from
tibia 20, and is seen to have distal end 145 connected to the
proximal end 112 of tendon 110. The bone plug 140 is also seen to
have outer surface 150 and distal end 155. Suture 160 is seen to be
inserted through tunnel 165.
[0033] After the bone-tendon-bone graft 100 has been harvested, as
seen in FIG. 2, it is maintained in a moist condition prior to
implantation in a conventional manner. Next, the patient's knee is
prepared to receive the graft 100 by drilling tunnels into the
femur and tibia as seen in FIG. 3A. A substantially longitudinal
bone tunnel 200 is drilled into the tibia 20 in a conventional
manner using conventional surgical equipment. The bone tunnel 200
is seen to have longitudinal passage 205 and longitudinal axis 206.
Bone tunnel 200 is additionally seen to have first opening 210 and
second opening 220, both openings which are in communication with
passage 205. In addition, tibial bone tunnel 200 is seen to have
interior surface 225. The femoral bone tunnel 250 is also drilled
into the femur using conventional surgical equipment and
techniques. The femoral tunnel 250 is seen to have opening 260,
longitudinal passage 255 and longitudinal axis 256. The femoral
bone tunnel 250 is also seen to have distal end 270 and inner
surface 265. Longitudinal axis 256 is seen to be in substantial
alignment with longitudinal axis 206. Next, the suture tunnel 280
is drilled into the femur such that the suture tunnel 280 is
substantially in longitudinal alignment with the longitudinal axis
256 of the femoral bore hole 250. Suture tunnel 280 is seen to have
interior passage 286. In addition, tunnel 280 is seen to have first
opening 282 and second opening 284 such that the inner passage of
tunnel 280 is in communication with the inner passage 255 of
femoral bore hole 250 through opening 282 and also in communication
with the exterior of the femur 40 through opening 284. The glue
tunnel 300 is seen to be substantially transverse to longitudinal
axis 256 of femoral tunnel 250 in a preferred embodiment, but may,
if desired, be angulated. Glue tunnel 300 is seen to have interior
passage 305 in communication with passage 255 through first opening
307, and in communication with the exterior of femur 40 through
second opening 308.
[0034] The tunnels 200, 250, and 280 are drilled in a conventional
manner using conventional surgical orthopedic drilling equipment.
Initially, the surgeon aligns the tibia and femur into the desired
position for the procedure. Next, the distal end 355 of pilot pin
drill 350 is placed against the outer surface of the tibia and a
pilot bone hole is drilled through the tibia and femur by rotating
drill 350 with a conventional surgical drill apparatus, until the
end 355 exits the femur from opening 284 thus creating tunnel 280,
and the pilot bone hole precursors for tunnels 200 and 250. Tunnels
200 and 250 are further formed by drilling with a conventional
concentric surgical drill 370 (not shown) having drilling end 375
and inner passage 372, which is mounted over pilot pin drill 350 in
a conventional manner. After the drilling of tunnels 200, 250 and
280 has been successfully completed, the pilot pin drill 350 and
concentric drill 370 are withdrawn from the tunnels.
[0035] Next, the transverse glue tunnel 300 is drilled into the
femur. Specifically, as seen in FIGS. 3B-E, the conventional
L-shaped drill guide 400 is used to locate and align the transverse
tunnel 300. Drill guide 400 is seen to have first and second legs
410 and 430. At the end 412 of leg 410 is located the base receiver
415. Extending up from base receiver 415 is the locating leg 420
having proximal end 422, and distal end 424. If desired, although
optional, drills and other instruments can be inserted through base
receiver 415 into and through locating leg 420 by providing
appropriate openings and passageways. Leg 430 is seen to have end
432 and drill receiver 435 mounted thereto, having first opening
436, second opening 437 and internal passageway 439 in
communication with both openings. Locating leg 420 is seen to be
mounted in tibial bone hole 200.
[0036] Then, cannula 450 having drill 390 with distal drilling end
395 located therein, is inserted into and through opening 432 of
drill guide 400, and the drill 390 is rotated by a conventional
surgical drill to drill out glue tunnel 300 and place cannula 450
in tunnel 280. Cannula 450 is seen to have internal passage 452,
proximal end opening 454 in communication with passage 452 and
distal end opening 456 in communication with passage 452. After the
tunnel 300 is completely formed, drill 390 is removed and guide 400
is removed by removing retention bracket 490 secured by screw 492
and pulling out leg 420 from passage 200, leaving cannula 450 in
glue tunnel 280. Although not preferred, the method of the present
invention can be performed without the use of cannula 450. Also, if
desired, cannula 450 may be placed into the tunnel 280 subsequent
to drilling.
[0037] Referring now to FIGS. 4-9, after the bone tunnels 200 and
250, the suture tunnel 280, and glue tunnel 300 have been drilled,
the longitudinal axes 206 and 256, respectively, of the bone tunnel
200 and bone tunnel 250 are placed in alignment by the surgeon.
Next, the conventional suture 160 mounted to the femoral bone plug
120 is threaded through the interior passages of 205 and 255 of the
tibial tunnel 200 and the femoral tunnel 250, respectively, and is
further threaded through and out of the suture tunnel 280. Next,
the surgeon pulls the suture 160 such that the femoral plug passes
into passage 255 of the femoral tunnel 250 and the tibia plug
passes into passage 205 of the tibia tunnel 200.
[0038] The surgeon is careful to locate the distal end 135 of the
femoral bone plug 120 immediately below the opening 307. At this
time, the tibial bone plug 150 is either partially or completely
located in bone tunnel 200. Next, the surgeon injects a bone glue
or bone cement into the cannula 450 using a conventional syringe
500 such that a bolus of the bone cement or bone glue 550 flows
through the interior passage of cannula 450, through the interior
of glue tunnel 300, and finally into the interior of bone tunnel
250 as seen in FIGS. 6, 7 and 8. Syringe 500 is seen to have barrel
510 for receiving glue 550 plunger 520 and hollow needle 530. The
surgeon then removes the trocar 450 and syringe 500 from the glue
tunnel 300, next the surgeon pulls on the ends of suture 160
thereby pulling the bone plug 120 into position in the femoral bone
tunnel 250 such that the distal end 135 or the bone plug 125 abuts
the distal end 270 of the bone tunnel 250. At the same time the
glue 550 is spread in and about the inner surface 265 of the bone
tunnel 250 and the outer surface 125 of the plug 120 thereby
securing the bone plug in place upon the curing of bone glue or
bone cement 550. The suture 160 may then be removed from the
femoral bone plug 120, or the ends external to the femur may be
cut. The tibial bone plug 140 can then be secured in the bone
tunnel 200 in a conventional manner using, for example, bone screws
or pins. Or, if desired, an additional transverse glue hole can
also be drilled into the tibia in communication with tibial tunnel
200, and bone glue or bone cement 550 may be similarly delivered by
the surgeon into the bone tunnel 200 through the tibial glue
tunnel. Although not preferred, the surgeon may inject a bolus of
bone glue 550 into femoral bone tunnel 250 prior to locating the
femoral bone plug 120 in tunnel 250.
[0039] FIG. 10 illustrates and alternate embodiment of an ACL
reconstruction method of the present invention. As seen in FIG. 10,
the method steps are similar to that of the previously described
preferred method, except that the glue tunnel 300 is not drilled
and utilized. Instead, the glue 550 is injected via syringe 500
through the suture tunnel 280 into the femoral bone tunnel 250 when
the bone plug 120 is partially engaged in the bone tunnel 250, or
prior to inserting the bone plug 120 into femoral bone tunnel
250.
[0040] Yet another embodiment of the ACL reconstruction method of
the present invention is illustrated in FIGS. 11A-B. In FIGS.
11A-B, the method steps are similar to that of the method steps of
the preferred embodiment of the present invention. However, rather
than drilling a transverse bone tunnel or injecting bone glue or
cement through the suture tunnel, a frangible capsule 600
containing bone glue or bone cement 550 is inserted into the
femoral tunnel 250 prior to introducing the plug 120 into the
tunnel 250. Then the surgeon pulls the suture threads 60 upwardly
such that the distal end of the bone plug engages the frangible
capsule 600 thereby breaking open the shell 610 of capsule 600 and
causing glue 550 contained in the interior 620 of capsule 600 to be
spread about the inner surface 265 of the bone tunnel 250 and the
outer surface 125 of the plug 120.
[0041] The methods of the present invention preferably will utilize
bone plugs and tendons and ligaments harvested from autologous
tissue in the patient's knee or other areas of the body as
illustrated in FIGS. 1 and 2 using conventional surgical
techniques. However, if desired, artificial bone plugs and tendons
may be utilized. The bone plugs may consist of conventional bone
substitute materials including polylactic acid and polyglycolic
acid as well as bioceramics such as tricalcium phosphate, calcium
phosphate, tetracalcium phosphate and hydroxyapatite, and any
copolymers, mixtures or blends thereof, and the like and
equivalents thereof. The artificial tendons or ligaments can
consist of conventional tendon replacement materials including
carbon fibers, polyethylene terephthalate, polytetrafluoroethylene
(PTFE), polypropylene, as well as biodegradable polymers including
polylactic acid, polyglycolic acid, polydioxanone, polycarbonate,
polycaprolactone, and copolymers thereof, and the like, and
combinations thereof and equivalents thereof.
[0042] The amount of glue or cement used to secure the bone plugs
in the bone tunnels in the method of the present invention will be
sufficient to effectively maintain the bone plugs in place after
curing and setting. The amount that is used will depend upon
several factors including the characteristics and nature of the
bone plug, the nature and characteristics of the bone cement or
glue, the size and length of the bone tunnels, the nature and
characteristics of the bone glue or cement and the individual
characteristics of the patient.
[0043] The term "adhesive" is used collectively herein to include
bone glues and bone cements. The bone glues which can be used in
the practice of the present invention include conventional
biocompatible bone glues including 2-octyl cyanoacrylate and the
like and equivalent thereof. The bone cements which can be used in
the practice of the present invention include conventional
biocompatible bone cements such as polymethylmethacrylate and the
like. The bone glues and bone cements may be absorbable or
nonabsorbable.
[0044] The frangible capsules 600 useful in the practice of the
embodiment of the method of the present invention will typically
have a hollow body having a shell 610 and interior 620. The
interior 620 of the shell 610 will be filled with bone cement or
bone glue 550. The shell will typically be made out of
biocompatible material which is frangible and will break or rupture
when squeezed or compressed. Examples of such shell materials
include gelatin, and conventional bioabsorbable and bioresorbable
polymeric materials, and the like.
[0045] The following example is representative of the principles
and practice of the present invention although not limited
thereto.
EXAMPLE
[0046] A patient was anesthetized in accordance with conventional
anesthesiology procedures. The patient's knee joint was prepared
for an ACL reconstruction in a conventional manner. Incisions were
made into the knee exposing the lower part of the femur, the upper
part of the tibia, the tibial tendon and the patellar tendon. A
bone-plug-tendon-bone-plug bone graft was harvested from the
patellar bone, the tibial tendon and the tibia. Then, a
conventional pilot pin wire drill was utilized to drill a bone
tunnel through the tibia into and out of the femur thereby creating
the suture tunnel and precursor tibial and femoral bone tunnels.
Next, a conventional concentric drill was placed over the
drill/guide wire and the drill was operated in a conventional
manner to create the tibial tunnel and the femoral bone tunnel. The
drills were then removed. Then, a conventional drill guide was
mounted on the patient's tibia and femur. Next, a transverse glue
tunnel was drilled into the femur utilizing the drill guide and a
conventional trocar drill and cannula, the tunnel intersecting the
femoral bone tunnel such that the interior passage of the femoral
bone tunnel was in communication with the transverse glue tunnel.
After removing the drill, the cannula was left in place in the glue
tunnel. Next, the surgeon prepared the bone tendon, bone graft by
drilling a transverse hole through the femoral plug and inserting a
length of conventional Ethibond.RTM. surgical suture therethrough.
Next, the surgical suture was threaded through the tibial tunnel,
the femoral tunnel and through and out of the suture tunnel so that
both ends of the suture were exterior to the femur. Next, the
surgeon proceeded to pull the bone-tendon-bone graft through the
tibial tunnel and further into the femoral tunnel such that the
distal end face of the femoral bone plug was located just proximal
to the opening into the glue tunnel. Next, the surgeon mounted a
the needle of conventional syringe containing about 40 cc of
2-octyl cyanoacrylate bone glue into the trocar cannula, and a
bolus of the bone cement was injected through the cannula into the
femoral bone tunnel, and the cannula was removed. Next, the surgeon
continued to pull on the ends of the suture such that the distal
face of the bone plug was in contact with the distal end of the
femoral tunnel, effectively spreading the bolus of bone glue about
the interior surfaces of the femoral bone tunnel and also over the
exterior surfaces of the femoral bone plug such that the bone plug
was effectively bonded to the interior surfaces of the bone tunnel
by the bone glue. After waiting a sufficient period of time for the
bone glue to cure, the surgeon cut off the ends of the suture, and
the incisions were then approximated in a conventional manner
utilizing conventional surgical sutures. Next, the surgeon secured
the tibial plug to the tibial bone hole in a conventional manner
utilizing a conventional bone screw. The patient's knee was then
immobilized, and the ACL reconstruction was completed.
[0047] The advantages of the improved ACL reconstruction methods of
the present invention are numerous. It is now possible to perform
an ACL reconstruction without having to use mechanical fasteners to
maintain a femoral bone plug in place. In addition, the length of
the surgical procedure can be reduced since it not necessary to
drill additional bone tunnels to receive mechanical fasteners such
as screws and pins.
[0048] Although this invention has been shown and described with
respect to detailed embodiments thereof, it will be understood by
those skilled in the art that various changes in form and detail
may be made without departing from the spirit and scope of the
claimed invention.
* * * * *