U.S. patent application number 11/121159 was filed with the patent office on 2005-11-24 for method for reconstructing a ligament.
Invention is credited to Chervitz, Alan, Fallin, T. Wade, Justin, Daniel F..
Application Number | 20050261766 11/121159 |
Document ID | / |
Family ID | 26843714 |
Filed Date | 2005-11-24 |
United States Patent
Application |
20050261766 |
Kind Code |
A1 |
Chervitz, Alan ; et
al. |
November 24, 2005 |
Method for reconstructing a ligament
Abstract
A method for reconstructing a ligament. In one form of the
invention, there is disclosed a method for securing a graft
ligament in a bone tunnel, the method comprising the steps of: (1)
forming a first bone tunnel in a bone, and forming a second bone
tunnel in the same bone, the second bone tunnel being transverse
to, and intersecting, the first bone tunnel; (2) positioning a
flexible member in the second transverse bone tunnel so that the
flexible member extends across the first bone tunnel, and
positioning the graft ligament in the first bone tunnel,
independently of the flexible member, so that the graft ligament is
looped over the flexible member; and (3) positioning a crosspin
over the flexible member and in the second transverse bone tunnel
so that the graft ligament is looped over, and may be supported by,
the crosspin.
Inventors: |
Chervitz, Alan; (Palm
Harbor, FL) ; Fallin, T. Wade; (Hyde Park, UT)
; Justin, Daniel F.; (Logan, UT) |
Correspondence
Address: |
Mark J. Pandiscio
Pandiscio & Pandiscio
470 Totten Pond Road
Waltham
MA
02451
US
|
Family ID: |
26843714 |
Appl. No.: |
11/121159 |
Filed: |
May 3, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11121159 |
May 3, 2005 |
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10335550 |
Dec 31, 2002 |
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6886569 |
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10335550 |
Dec 31, 2002 |
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09626506 |
Jul 27, 2000 |
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6499486 |
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60146253 |
Jul 29, 1999 |
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Current U.S.
Class: |
623/13.14 |
Current CPC
Class: |
A61F 2/0805 20130101;
A61B 17/1714 20130101; A61F 2002/0841 20130101; A61F 2002/0882
20130101; A61F 2002/0852 20130101; A61F 2/0811 20130101; A61B
17/1764 20130101 |
Class at
Publication: |
623/013.14 |
International
Class: |
A61B 017/56 |
Claims
What is claimed is:
1. A method for securing a graft ligament in a bone tunnel, said
method comprising the steps of: (1) forming a first bone tunnel in
a bone, and forming a second bone tunnel in the same bone, said
second bone tunnel being transverse to, and intersecting, said
first bone tunnel; (2) positioning a flexible member in said second
transverse bone tunnel so that said flexible member extends across
said first bone tunnel, and positioning said graft ligament in said
first bone tunnel, independently of said flexible member, so that
said graft ligament is looped over said flexible member; and (3)
positioning a crosspin over said flexible member and in said second
transverse bone tunnel so that said graft ligament is looped over,
and may be supported by, said crosspin.
2. A method according to claim 1 wherein said step of positioning
said graft ligament in said first bone tunnel, independently of
said flexible member, comprises the sub-steps of: (i) pulling a
loop of said flexible member out of said first bone tunnel; (b)
pulling a loop of said graft ligament into said first bone tunnel
so that said loop of graft ligament extends past the intersection
of said second transverse bone tunnel with said first bone tunnel;
(c) positioning said loop of said flexible member within said loop
of graft ligament; and (d) pulling said flexible member straight so
as to eliminate said loop of said flexible member.
3. A method according to claim 2 wherein said sub-step of pulling
said loop of said graft ligament into said first bone tunnel
comprises the sub-sub-steps of: (i) attaching said loop of said
graft ligament to a pulling member; and (ii) passing said pulling
member out the far said of said first bone tunnel.
4. A method for securing a graft ligament in a bone tunnel, said
method comprising the steps of: (1) forming a first bone tunnel in
a bone, and forming a second bone tunnel in the same bone, said
second bone tunnel being transverse to, and intersecting, said
first bone tunnel; (2) positioning a flexible member in said second
transverse bone tunnel so that said flexible member extends across
said first bone tunnel; (3) pulling a loop of said flexible member
out of said first bone tunnel; (4) pulling a loop of said graft
ligament into said first bone tunnel so that said loop of graft
ligament extends past the intersection of said second transverse
bone tunnel with said first bone tunnel; (5) positioning said loop
of said flexible member within said loop of graft ligament; (6)
pulling said flexible member straight so as to eliminate said loop
of said flexible member; and (7) positioning a crosspin over said
flexible member and in said second transverse bone tunnel so that
said graft ligament is looped over, and may be supported by, said
crosspin.
Description
REFERENCE TO PENDING PRIOR PATENT APPLICATION
[0001] This patent application claims benefit of pending prior U.S.
Provisional Patent Application Ser. No. 60/146,253, filed Jul. 29,
1999 by Alan Chervitz et al. for METHOD TO DELIVERING AN ACL GRAFT
IN THE KNEE, which patent application is hereby incorporated herein
by reference.
FIELD OF THE INVENTION
[0002] This invention relates to medical devices and procedures in
general, and more particularly to medical devices and procedures
for reconstructing a ligament.
BACKGROUND OF THE INVENTION
[0003] A ligament is a piece of fibrous tissue which connects one
bone to another.
[0004] Ligaments are frequently damaged (e.g., detached or torn or
ruptured, etc.) as the result of injury and/or accident. A damaged
ligament can impede proper motion of a joint and cause significant
pain.
[0005] Various procedures have been developed to repair or replace
a damaged ligament. The specific procedures used depend on the
particular ligament which is to be restored and on the extent of
the damage.
[0006] One ligament which is frequently damaged as the result of
injury and/or accident is the anterior cruciate ligament (ACL).
Looking now at FIG. 1, the ACL 5 extends between the top of the
tibia 10 and the bottom of the femur 15. A damaged ACL can cause
instability of the knee joint and cause substantial pain and
arthritis.
[0007] Numerous procedures have been developed to restore the ACL
through a graft ligament replacement. In general, and looking now
at FIG. 2, these ACL replacement procedures involve drilling a bone
tunnel 20 through tibia 10 and up into femur 15. Then a graft
ligament 25, consisting of a harvested or artificial ligament or
tendon(s), is passed through the tibial portion 30 of tunnel 20
(sometimes referred to as "the tibial tunnel"), across the interior
of the joint, and up into the femoral portion 35 of tunnel 20
(sometimes referred to as "the femoral tunnel"). Then a distal
portion of graft ligament 25 is secured in femoral tunnel 35, and a
proximal portion of graft ligament 25 is secured in tibial tunnel
30.
[0008] There are numerous ways in which graft ligament 25 may be
positioned in tunnel 20 and secured in position.
[0009] One such way is disclosed in U.S. Pat. No. 5,918,604, issued
Jul. 6, 1999 to Whelan for METHOD OF LOADING TENDONS INTO THE KNEE.
According to this patent, the ligament may be towed up tibial
tunnel 30 and femoral tunnel 35 and then secured in femoral tunnel
35 with a crosspin.
[0010] More particularly, and looking now at FIG. 3, the bone
tunnel 20 is formed by drilling through tibia 10 and up into femur
15, whereby to form tibial tunnel 30 and femoral tunnel 35. Then a
transverse bone tunnel 40 is formed in femur 15 so that transverse
bone tunnel 40 intersects femoral tunnel 35. Bone tunnel 20
bifurcates transverse bone tunnel 40 into two tunnel portions, a
first transverse bone tunnel portion 45 and a second transverse
bone tunnel portion 50.
[0011] After transverse bone tunnel 40 has been formed, a flexible
member 55 is used to draw graft ligament 25 up into place.
[0012] More particularly, according to the aforementioned U.S. Pat.
No. 5,918,604, this is done by threading flexible member 55 through
transverse bone tunnel 40. Then a crochet-hook device (not shown in
FIG. 3) is passed up tibial tunnel 30, across the interior of the
knee joint, and up femoral tunnel 35. The crochet-hook device is
used to hook flexible member 55 at the intersection of bone tunnel
20 and transverse bone tunnel 40. Then the crochet-hook device is
used to pull flexible member 55 down femoral tunnel 35, across the
interior of the knee joint, down tibial tunnel 30, and out the
front side of tibia 10. Next, graft ligament 25 is looped over
flexible member 55 (FIG. 3). One or both free ends of flexible
member 55 is/are then pulled away from femur 15, whereby to pull
flexible member 55, and hence the looped graft ligament 25, up
tibial tunnel 30, across the interior of the knee joint, and then
up into femoral tunnel 35 (FIG. 4).
[0013] Once flexible member 55 and graft ligament 25 have assumed
the position shown in FIG. 4, the graft ligament may be retained in
that position by passing a cannulated crosspin 60 over flexible
member 55 into transverse bone tunnel 40 so that the crosspin
extends under graft ligament 25 and supports the looped graft
ligament within femoral tunnel 35. Then flexible member 55 is
withdrawn from the surgical site.
[0014] Unfortunately, the method taught in U.S. Pat. No. 5,918,604
suffers from a number of drawbacks.
[0015] For one thing, use of this method can result in erosion of
the patient's bone. More particularly, and looking now at FIG. 5,
flexible member 55 must first be drawn down femoral tunnel 35,
across the interior of the knee joint, and then down tibial tunnel
30 in order to pick up graft ligament 25; and then later, flexible
member 55 must be drawn back up tibial tunnel 30, across the
interior of the knee joint, and then back up femoral tunnel 35 in
order to carry graft ligament 25 into position. These actions cause
flexible member 55 to engage the bone which is located at the
intersection of femoral tunnel 35 and transverse bone tunnel 40,
i.e., to engage the bone edges 65 (FIG. 5). This engagement between
flexible member 55 and bone edges 65 can cause bone edges 65 to be
eroded. This erosion can be particularly significant where
substantial forces are required to draw flexible member 55 out of
bone tunnel 20 (e.g., where a metallic flexible member 55 is used);
or when substantial forces are required to draw flexible member 55
and graft ligament 25 up bone tunnel 25 (e.g., where graft ligament
25 makes a tight engagement with the walls of bone tunnel 20).
[0016] For another thing, the method taught in U.S. Pat. No.
5,918,604 can be tedious to practice. More particularly, when
flexible member 55 and ligament graft 25 are in the position shown
in FIG. 5, flexible member 55 will form the angle .theta.; however,
when flexible member 55 and ligament graft 25 are in the position
shown in FIG. 6, flexible member 55 will form a different angle
.theta.. In this respect it will be appreciated that it will be
considerably more difficult to pull graft ligament 25 upwards as
the angle .theta. increases from the position shown in FIG. 5 to
the position shown in FIG. 6.
OBJECTS OF THE INVENTION
[0017] As a result, an object of the present invention is to
provide an improved method for reconstructing a ligament.
[0018] And another object of the present invention is to provide an
improved method for reconstructing a ligament which substantially
avoids the problems associated with the prior art.
SUMMARY OF THE INVENTION
[0019] These and other objects of the present invention are
addressed by a novel method for reconstructing a ligament.
[0020] In one preferred form of the invention, the invention
comprises a method for securing a graft ligament in a bone tunnel,
the method comprising the steps of: (1) forming a first bone tunnel
in a bone, and forming a second bone tunnel in the same bone, the
second bone tunnel being transverse to, and intersecting, the first
bone tunnel; (2) positioning a flexible member in the second
transverse bone tunnel so that the flexible member extends across
the first bone tunnel, and positioning the graft ligament in the
first bone tunnel, independently of the flexible member, so that
the graft ligament is looped over the flexible member; and (3)
positioning a crosspin over the flexible member and in the second
transverse bone tunnel so that the graft ligament is looped over,
and may be supported by, the crosspin.
BRIEF DESCRIPTION OF THE DRAWINGS
[0021] The above and other objects and features of the present
invention will be more fully disclosed or rendered obvious by the
following detailed description of the preferred embodiments of the
invention, which is to be considered together with the accompanying
drawings wherein like numbers refer to like parts, and further
wherein:
[0022] FIG. 1 is a schematic side view of a knee joint, showing an
ACL extending between the top of the tibia and the bottom of the
femur;
[0023] FIG. 2 is a schematic side view of the same knee joint,
except showing portions of an ACL reconstruction;
[0024] FIGS. 3-6 are schematic front views of a knee joint,
illustrating various aspects of a prior art procedure for
positioning a graft ligament in a bone tunnel and securing it in
position; and
[0025] FIGS. 7-14 are schematic front views of a knee joint,
illustrating a novel procedure for positioning a graft ligament in
a bone tunnel and securing it in position.
DETAILED DESCRIPTION OF THE INVENTION
[0026] The present invention comprises a novel method for
reconstructing a ligament.
[0027] More particularly, and looking now at FIG. 7, the bone
tunnel 20 is formed by drilling through tibia 10 and up into femur
15, whereby to form tibial tunnel 30 and femoral tunnel 35. Then
the transverse bone tunnel 40 is formed in femur 15 so that
transverse bone tunnel 40 intersects femoral tunnel 35. Bone tunnel
20 bifurcates transverse bone tunnel 40 into two tunnel portions, a
first transverse bone tunnel portion 45 and a second transverse
bone tunnel portion 50.
[0028] After transverse bone tunnel 40 has been formed, a flexible
member 55 is passed across transverse bone tunnel 40. This may be
done by attaching a distal end 70 of flexible member 55 to the
proximal end 75 of a transverse drill pin 80, and then drawing
flexible member 55 through transverse bone tunnel 40 in the manner
shown in FIGS. 7 and 8.
[0029] Next, a crochet-hook member 85 (FIG. 9) is passed up tibial
tunnel 30, across the interior of the knee joint, and then up
femoral tunnel 35 so as to hook flexible member 55 and draw it down
femoral tunnel 35, across the interior of the knee joint, down
tibial tunnel 30 and then out the bottom of tibial tunnel 30. See
FIG. 9.
[0030] The end of flexible member 55 extending out of tibial tunnel
30, shown generally at 90, is set aside for future use. See FIG.
10.
[0031] Next, and still looking now at FIG. 10, a second drill pin
95 is passed up tibial tunnel 30, across the interior of the knee
joint, up femoral tunnel 35, and then drilled out the top of femur
15. Then graft ligament 25 is looped through a loop 100 of flexible
material, and loop 100 is connected to the proximal end 105 of
second drill pin 95. Then drill pin 95 is passed through the top of
femur 15 so as to draw graft ligament 25 up tibial tunnel 30,
across the interior of the knee joint, and up femoral tunnel 35.
Second drill pin 95 may then be removed, with loop 100 holding
graft ligament 25 in position within femoral tunnel 35 and tibial
tunnel 30. See FIG. 11.
[0032] After graft ligament 25 has been positioned in the manner
shown in FIG. 11, the end of flexible member 55 that extends out of
tibial tunnel 30, shown generally at 90, is placed between the
graft ligament strands. See FIG. 11. Then one or both of the free
ends of flexible member 55 is/are pulled away from femur 15, in the
manner shown in FIG. 12, whereby to pull flexible member 55 up
tibial tunnel 30, across the interior of the knee joint, and up
femoral tunnel 35 so as to achieve the position shown in FIGS. 12
and 13. In this respect it should be appreciated that while
flexible member 55 is being drawn up tibial tunnel 30, across the
interior of the knee joint, and up femoral tunnel 35, graft
ligament 25 is being supported within bone tunnel 20 by loop 100.
As a result, flexible member 55 may be drawn readily upward, with
minimal erosion of bone edges 65 (FIGS. 12 and 13).
[0033] Looking next at FIG. 14, flexible member 55 is then used as
a guide to pass a crosspin 60 through transverse bone tunnel 40
and, in the process, beneath looped graft ligament 25, whereby to
support graft ligament 25 within bone tunnel 20. Loop 100 may
thereafter be removed from graft ligament 25, and flexible member
55 removed from transverse bone tunnel 40. The proximal end of the
graft ligament may thereafter be secured to tibia 10 in ways well
known in the art so as to complete the ligament repair
procedure.
ADVANTAGES OF THE INVENTION
[0034] Numerous advantages are achieved by using the present
invention.
[0035] For one thing, since graft ligament 25 is pulled into bone
tunnel 20 by the loop 100 moving along the line of bone tunnel 20,
optimal force can be applied to lifting the graft ligament into
position without damaging tunnel edges 65.
[0036] In addition, since flexible member 55 is used solely as a
guide for crosspin 60, and is not used to lift graft ligament 25
within bone tunnel 20, flexible member 55 does not need to be
strong enough to lift the graft ligament up the bone tunnel. As a
result, flexible member 55 can be formed out of a wider range of
materials and can have a smaller diameter, which in turn permits
the cannulation in crosspin 60 to be smaller, which in turn permits
the construction of a stronger crosspin.
[0037] Still other advantages of the present invention will be
apparent to those skilled in the art.
[0038] Modifications
[0039] It is to be understood that the present invention is by no
means limited to the particular constructions and method steps
disclosed above and/or shown in the drawings, but also comprises
any modifications or equivalents within the scope of the
claims.
* * * * *