U.S. patent application number 13/276342 was filed with the patent office on 2012-04-19 for apparatus and method for reconstructing a ligament.
This patent application is currently assigned to Tyco Healthcare Group LP. Invention is credited to Mark A. Johanson, Peter F. Marshall, Paul Re.
Application Number | 20120095556 13/276342 |
Document ID | / |
Family ID | 42660969 |
Filed Date | 2012-04-19 |
United States Patent
Application |
20120095556 |
Kind Code |
A1 |
Re; Paul ; et al. |
April 19, 2012 |
APPARATUS AND METHOD FOR RECONSTRUCTING A LIGAMENT
Abstract
A system for use in reconstructing a ligament is provided. The
system includes a graft ligament support block for supporting a
graft ligament in a bone tunnel. The support block includes a body,
a graft hole extending through the body transverse to a
longitudinal axis and configured to receive a graft ligament
therein, and a transverse fixation pin hole extending through the
body transverse to the longitudinal axis and configured to receive
a transverse fixation pin therein. The system further includes a
stepped transverse fixation pin having a first portion at a distal
end, a second portion at a proximal end, and an annular shoulder
configured between the first portion and the second portion. The
first portion, the second portion and the annular shoulder form a
given profile in a cross-section of a given plane perpendicular to
a longitudinal axis of the fixation pin.
Inventors: |
Re; Paul; (Boston, MA)
; Johanson; Mark A.; (Littleton, MA) ; Marshall;
Peter F.; (Bolton, MA) |
Assignee: |
Tyco Healthcare Group LP
|
Family ID: |
42660969 |
Appl. No.: |
13/276342 |
Filed: |
October 19, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12426357 |
Apr 20, 2009 |
8043374 |
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13276342 |
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10829846 |
Apr 22, 2004 |
7520898 |
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12426357 |
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10793532 |
Mar 4, 2004 |
7063724 |
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10829846 |
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10123434 |
Apr 16, 2002 |
6712849 |
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10793532 |
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60326351 |
Oct 1, 2001 |
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Current U.S.
Class: |
623/13.14 |
Current CPC
Class: |
A61F 2002/0829 20130101;
A61F 2002/0882 20130101; A61F 2/0811 20130101; A61B 17/1764
20130101; Y10S 606/908 20130101; A61B 17/1714 20130101; A61B
2090/062 20160201; Y10S 606/916 20130101; A61B 17/1675 20130101;
Y10S 606/91 20130101; A61F 2/0805 20130101; Y10S 606/909 20130101;
Y10S 606/907 20130101; A61F 2002/0852 20130101 |
Class at
Publication: |
623/13.14 |
International
Class: |
A61F 2/08 20060101
A61F002/08 |
Claims
1. A system for use in reconstructing a ligament, said system
comprising: a graft ligament support block for supporting a graft
ligament in a bone tunnel, said graft ligament support block
comprising: a body having a distal end, a proximal end, and a
longitudinal axis extending between said distal end and said
proximal end, a graft hole extending through said body transverse
to said longitudinal axis and configured to receive a graft
ligament therein, and a transverse fixation pin hole extending
through said body transverse to said longitudinal axis and
configured to receive a transverse fixation pin therein; and a
stepped transverse fixation pin having a distal end, a proximal
end, a longitudinal axis extending between said distal end and said
proximal end, a first portion at said distal end, a second portion
at said proximal end, said first portion having a smaller diameter
than second portion, and an annular shoulder configured between
said first portion and said second portion, wherein said first
portion, said second portion and said annular shoulder form a given
profile in a cross-section of a given plane perpendicular to the
longitudinal axis.
2. The system according to claim 1, further comprising: a stepped
transverse tunnel drill having a distal end, a proximal end and a
longitudinal axis extending between said distal end and said
proximal end, said stepped transverse drill corresponding to said
given profile of said stepped transverse fixation pin so as to
provide a stepped transverse tunnel through the bone tunnel
configured to receive said given profile of said stepped transverse
fixation pin.
3. The system according to claim 2, further comprising: a depth
gauge having a distal end and a proximal end, said distal end of
said depth gauge configured for placement through a drill sleeve to
engage a portion of said stepped transverse tunnel corresponding to
said annular shoulder of said stepped fixation pin.
4. The system according to claim 3, wherein said depth gauge
includes markings thereon between said distal end and said proximal
end so as to indicate said transverse fixation pin hole depth
between said portion corresponding to said annular shoulder of the
stepped fixation pin and a bone surface.
5. A system according to claim 4, wherein said markings of said
depth gauge indicate said transverse fixation pin hole depth at
proximal end of said drill sleeve.
6. A system according to claim 5, further comprising a transverse
fixation pin inserter having a proximal end and a distal end, depth
markings disposed thereon between said proximal end and said distal
end, and an engagement surface at said distal end to position said
transverse fixation pin into said transverse fixation pin hole.
7. A system according to claim 6 wherein said depth markings of
said transverse fixation pin inserter indicate depth of said
transverse fixation pin at a proximal end of said drill sleeve.
8. A system according to claim 1, further comprising an
installation tool.
9. A system according to claim 8, wherein the installation tool
includes a holder, said holder including a shaft and a handle
mounted to said shaft.
10. A system according to claim 9, wherein the installation tool
further includes a drill guide adapted to be releasably secured to
the holder.
Description
REFERENCE TO PENDING PRIOR PATENT APPLICATION
[0001] This patent application is a continuation-in-part of pending
prior U.S. patent application Ser. No. 10/793,532, filed Mar. 4,
2004 by Paul Re et al. for APPARATUS AND METHOD FOR RECONSTRUCTING
A LIGAMENT (Attorney's Docket No. SCAN-2 CON), which is in turn a
continuation of U.S. patent application Ser. No. 10/123,434, filed
Apr. 16, 2002 by Paul Re et al. for APPARATUS AND METHOD FOR
RECONSTRUCTING A LIGAMENT (Attorney's Docket No. SCAN-2), which in
turn claims benefit of U.S. Provisional Patent Application Ser. No.
60/326,351, filed Oct. 1, 2001 by Paul Re et al. for APPARATUS AND
METHOD FOR RECONSTRUCTING A LIGAMENT (Attorney's Docket No. SCAN-2
PROV), which three patent applications are hereby incorporated
herein by reference.
FIELD OF THE INVENTION
[0002] This invention relates to surgical apparatus and procedures
in general, and more particularly to surgical apparatus 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 cause instability, impede proper motion of a joint and
cause pain.
[0005] Various procedures have been developed to repair or replace
a damaged ligament. The specific procedure used depends 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 (i.e., the
ACL). Looking first at FIGS. 1 and 2, it will be seen that 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 a damaged
ACL through a graft ligament replacement. In general, and looking
next at FIG. 3, these ACL replacement procedures involve drilling a
bone tunnel 20 up through tibia 10 and drilling a bone tunnel 25 up
into femur 15. In some cases the femoral tunnel 25 may be in the
form of a blind hole and terminate in a distal end surface 30; in
other cases the femoral tunnel 25, or an extension of the femoral
tunnel 25, may pass completely through femur 15. Once tibial tunnel
20 and femoral tunnel 25 have been formed, a graft ligament 35,
consisting of a harvested or artificial ligament or tendon(s), is
passed up through tibial tunnel 20, across the interior of the knee
joint, and up into femoral tunnel 25. Then a distal portion of
graft ligament 35 is secured in femoral tunnel 25 and a proximal
portion of graft ligament 35 is secured in tibial tunnel 20.
[0008] There are currently a number of different ways to secure a
graft ligament in a bone tunnel. One way is to use an interference
screw 40 (FIG. 4) to wedge the graft ligament against an opposing
side wall of the bone tunnel. Another way is to suspend the graft
ligament in the bone tunnel with a button 45 and a suture 50 (FIG.
5) or with a crosspin 55 (FIG. 6). Still another way is to pass the
graft ligament completely through the bone tunnel and affix the
graft ligament to the outside of the bone with a screw 60 and
washer 65 (FIG. 7) or with a staple (not shown).
[0009] The "Gold Standard" of ACL repair is generally considered to
be the so-called "Bone-Tendon-Bone" fixation. In this procedure, a
graft of the patella tendon is used to replace the natural ACL.
Attached to the opposing ends of the harvested tendon are bone
grafts, one taken from the patient's knee cap (i.e., the patella)
and one taken from the patient's tibia (i.e., at the location where
the patella tendon normally attaches to the tibia). The graft
ligament is then deployed in the bone tunnels, with one bone graft
being secured in the femoral tunnel with an interference screw and
the other bone graft being secured in the tibial tunnel with
another interference screw. Over the years, this procedure has
generally yielded a consistent, strong and reliable ligament
repair. However, this procedure is also generally considered to be
highly invasive and, in many cases, quite painful, and typically
leaves unsightly scarring on the knee and a substantial void in the
knee cap.
[0010] As a result, alternative procedures have recently been
developed that incorporate the use of soft tissue grafts such as
the hamstring tendon. However, soft tissue grafts such as the
hamstring can be difficult to stabilize within a bone tunnel. More
particularly, the use of an interference screw to aggressively
wedge the hamstring against an opposing side wall of the bone
tunnel can introduce issues such as graft slippage, tendon winding,
tissue necrosis and tendon cutting. Furthermore, the use of a
suture sling (e.g., such as that shown in FIG. 5) and/or a crosspin
(e.g., such as that shown in FIG. 6) to suspend the hamstring
within the bone tunnel can introduce a different set of issues,
e.g., it has been found that the suture sling and/or crosspin tend
to permit the graft ligament to move laterally within the bone
tunnel, with a so-called "windshield wiper" effect, thereby
impeding ingrowth between the graft ligament and the host bone
and/or causing abrasion and/or other damage to the graft tissue. In
addition, the use of a crosspin (e.g., such as that shown in FIG.
6) to secure a hamstring within the bone tunnel can introduce still
other issues, e.g., difficulties in looping the hamstring over the
crosspin, or tearing of the hamstring along its length during
tensioning if and where the crosspin passes through the body of the
hamstring, etc.
SUMMARY OF THE INVENTION
[0011] As a result, one object of the present invention is to
provide improved apparatus for reconstructing a ligament, wherein
the apparatus is adapted to permit the graft ligament to be
fashioned out of various soft tissue grafts, e.g., allografts,
autografts, xenografts, bioengineered tissue grafts or synthetic
grafts, and further wherein the graft is intended to be secured in
place using a transverse fixation pin.
[0012] Another object of the present invention is to provide an
improved method for reconstructing a ligament, wherein the method
is adapted to permit the graft ligament to be fashioned out of
various soft tissue grafts, e.g., allografts, autografts,
xenografts, bioengineered tissue grafts or synthetic grafts, and
further wherein the graft is intended to be secured in place using
a transverse fixation pin.
[0013] These and other objects are addressed by the present
invention which comprises, in one preferred form of the invention,
the provision and use of a graft ligament support block which
comprises a body, and a graft hole and a transverse fixation pin
hole extending through the body, with both the graft hole and the
transverse fixation pin hole preferably extending substantially
perpendicular to the longitudinal axis of the body. In one
preferred form of the invention, the invention also comprises an
installation tool for inserting the graft ligament support block
into the bone tunnel and, while supporting the graft ligament
support block in the bone tunnel, forming a transverse tunnel in
the host bone, with the transverse tunnel in the host bone being
aligned with the transverse fixation pin hole in the graft ligament
support block.
[0014] In one preferred method of use, a graft ligament is looped
through the graft hole in the graft ligament support block, and the
graft ligament support block is mounted to the installation tool.
The two free ends of the graft ligament are then preferably secured
to a proximal portion of the installation tool under tension,
whereby to tie down the two free ends of the graft ligament. In
addition to controlling the two free ends of the graft ligament,
this arrangement will also help hold the graft ligament support
block to the installation tool. Then the installation tool is used
to advance the graft ligament support block through the tibial
tunnel, across the interior of the knee joint, and up into the
femoral tunnel, with the two free ends of the looped graft ligament
extending back out through the tibial tunnel. Next, a transverse
tunnel is formed in the host bone, with the transverse tunnel being
aligned with the transverse fixation pin hole in the graft ligament
support block. Then the graft ligament support block is secured in
place by pinning the graft ligament support block within the
femoral tunnel, i.e., by advancing a transverse fixation pin along
the transverse tunnel in the host bone and into the transverse
fixation pin hole in the graft ligament support block. Then the two
free ends of the looped graft ligament are released from the
installation tool, the installation tool is detached from the graft
ligament support block, and the installation tool is withdrawn from
the surgical site. Finally, the two free ends of the looped graft
ligament are secured to the tibia, thus completing the ACL repair.
If desired, the tibial attachment can be effected using a second
graft ligament support block.
[0015] In accordance with a further feature of the invention, there
is provided apparatus for use in reconstructing a ligament, the
apparatus comprising:
[0016] a graft ligament support block for supporting a graft
ligament in a bone tunnel, the graft ligament support block
comprising: [0017] a body having a distal end, a proximal end, and
a longitudinal axis extending between the distal end and the
proximal end, the proximal end being tapered so as to facilitate
withdrawal of the graft ligament support block through a bone
tunnel; [0018] a graft hole extending through the body transverse
to the longitudinal axis and configured to receive a graft ligament
therein; and [0019] a transverse fixation pin hole extending
through the body transverse to the longitudinal axis and configured
to receive a transverse fixation pin therein.
[0020] In accordance with a still further feature of the invention,
there is provided a method for securing a graft ligament in a bone
tunnel, comprising the steps of:
[0021] (1) looping a graft ligament through a graft hole in a graft
ligament support block, advancing the graft ligament support block
into the bone tunnel, withdrawing the graft ligament support block
back down the bone tunnel, advancing a graft ligament support block
into the bone tunnel, with a graft ligament being looped through a
graft hole in the graft ligament support block, and forming a
transverse tunnel in the host bone, with a transverse fixation pin
hole in the graft ligament support block being aligned with the
transverse tunnel in the host bone; and
[0022] (2) pinning the graft ligament support block within the bone
tunnel by advancing a transverse fixation pin along the transverse
tunnel in the host bone and into the transverse fixation pin hole
in the graft ligament support block.
[0023] In accordance with a further feature of the invention, there
is provided a method for revising a graft ligament in a bone
tunnel, the method comprising the steps of:
[0024] unpinning a graft ligament support block within a bone
tunnel by withdrawing a transverse fixation pin from a transverse
fixation pin hole in the graft ligament support block and from a
transverse tunnel a host bone;
[0025] withdrawing the graft ligament support block back down the
bone tunnel;
[0026] advancing a graft ligament support block into the bone
tunnel so that a transverse fixation pin hole in the support block
is aligned with the transverse tunnel; and
[0027] pinning the graft ligament support block within 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.
[0028] In accordance with a further feature of the invention, there
is provided apparatus for use in reconstructing a ligament, the
apparatus comprising:
[0029] a graft ligament support block for supporting a graft
ligament in a bone tunnel, the graft ligament support block
comprising: [0030] a body having a distal end, a proximal end, and
a longitudinal axis extending between the distal end and the
proximal end; [0031] a graft hole extending through the body
transverse to the longitudinal axis and configured to receive a
graft ligament therein, the graft hole having a given length along
the longitudinal axis, the given length being substantially equal
to a given cross-sectional dimension of the graft ligament; and
[0032] a transverse fixation pin hole extending through the body
transverse to the longitudinal axis and configured to receive a
transverse fixation pin therein.
[0033] In accordance with a still further feature of the invention,
there is provided a method for securing a graft ligament in a bone
tunnel, comprising the steps of:
[0034] selecting a graft ligament support block with a graft hole
sized substantially equal to a given cross-sectional dimension of a
graft ligament;
[0035] looping the graft ligament through the graft hole in a graft
ligament support block;
[0036] advancing the graft ligament support block into the bone
tunnel;
[0037] forming a transverse tunnel in the host bone, with a
transverse tunnel being aligned with a transverse fixation pin hole
in the graft ligament support block; and
[0038] pinning the graft ligament support block within the bone
tunnel by advancing a transverse fixation pin along the transverse
tunnel in the host bone and into the transverse fixation pin hole
in the graft ligament support block.
[0039] In accordance with another feature of the invention, there
is provided a method for securing a graft ligament in a bone
tunnel, the method comprising the steps of:
[0040] forming a transverse tunnel in the host bone;
[0041] selecting a graft ligament support block with a graft hole
sized substantially equal to a given cross-sectional dimension of a
graft ligament;
[0042] looping the graft ligament through the graft hole in the
graft ligament support block;
[0043] advancing the graft ligament support block into the bone
tunnel so that a transverse fixation pin hole in the graft ligament
support block is aligned with the transverse tunnel; and
[0044] pinning the graft ligament support block within the bone
tunnel by advancing a transverse fixation pin along the transverse
tunnel in the host bone and into the transverse fixation pin hole
in the graft ligament support block.
[0045] In accordance with a further feature of the invention, there
is provided apparatus for use in reconstructing a ligament, the
apparatus comprising:
[0046] a graft ligament support block for supporting a graft
ligament in a bone tunnel, the graft ligament support block
comprising: [0047] a body having a distal end, a proximal end, and
a longitudinal axis extending between the distal end and the
proximal end; [0048] a graft hole extending through the body
transverse to the longitudinal axis and configured to receive a
graft ligament therein; and [0049] a transverse fixation pin hole
extending through the body transverse to the longitudinal axis and
configured to receive a transverse fixation pin therein; and
[0050] a transverse fixation pin having a proximal end and a distal
end, and the proximal end forming an internal tapped hole therein
so as to aid removal of the transverse fixation pin from the bone
tunnel.
[0051] In accordance with a still further feature of the invention,
there is provided a method for revising a graft ligament in a bone
tunnel, comprising the steps of:
[0052] engaging an internal tapped hole in a transverse fixation
pin with a removal tool;
[0053] withdrawing the transverse fixation pin from the bone tunnel
with removal tool engaged with the internal tapped hole, and
withdrawing a graft ligament support block back down the bone
tunnel;
[0054] positioning a graft ligament support block into the bone
tunnel;
[0055] pinning the graft ligament support block within the bone
tunnel by advancing a transverse fixation pin along a transverse
tunnel in the host bone and into the transverse fixation pin hole
in the graft ligament support block.
[0056] In accordance with a further feature of the invention, there
is provided a system for use in reconstructing a ligament, the
system comprising:
[0057] a graft ligament support block for supporting a graft
ligament in a bone tunnel, the graft ligament support block
comprising: [0058] a body having a distal end, a proximal end, and
a longitudinal axis extending between the distal end and the
proximal end; [0059] a graft hole extending through the body
transverse to the longitudinal axis and configured to receive a
graft ligament therein;
[0060] a stepped fixation pin having a distal end, a proximal end,
a longitudinal axis extending between the distal end and the
proximal end, a first portion at the distal end, a second portion
at the proximal end, the first portion having a smaller diameter
than second portion, and an annular shoulder configured between the
first portion and the second portion, wherein the first portion,
the second portion and the annular shoulder form a given profile in
a cross-section of a given plane perpendicular to the longitudinal
axis; and
[0061] 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 drill
corresponding to the given profile of the stepped fixation pin so
as to provide a stepped transverse tunnel through a portion of the
bone tunnel configured to align with a pathway of the transverse
fixation pin hole, wherein the transverse fixation pin hole extends
through the body transverse to the longitudinal axis and is
configured to receive a transverse fixation pin therein.
[0062] In accordance with a further feature of the invention, there
is provided a method for securing a graft ligament in a bone
tunnel, comprising the steps of:
[0063] looping a graft ligament through a graft hole in a graft
ligament support block;
[0064] advancing the graft ligament support block into the bone
tunnel;
[0065] forming a stepped transverse tunnel in the host bone with a
stepped transverse tunnel drill, with the stepped transverse tunnel
being aligned with a transverse fixation pin hole in the graft
ligament support block; and
[0066] pinning the graft ligament support block within the bone
tunnel by advancing a stepped transverse fixation pin along the
transverse tunnel in the host bone and into the transverse fixation
pin hole in the graft ligament support block.
[0067] In accordance with a still further feature of the invention,
there is provided a method for securing a graft ligament in a bone
tunnel, the method comprising the steps of:
[0068] forming a stepped transverse tunnel in the host bone with a
stepped transverse tunnel drill;
[0069] looping a graft ligament through a graft hole in a graft
ligament support block;
[0070] advancing the graft ligament support block into the bone
tunnel so that a transverse fixation pin hole in the graft ligament
support block is aligned with the stepped transverse tunnel;
and
[0071] pinning the graft ligament support block within the bone
tunnel by advancing a stepped transverse fixation pin along the
stepped transverse tunnel in the host bone and into the transverse
fixation pin hole in the graft ligament support block.
[0072] In accordance with a further feature of the invention, there
is provided a system for use in reconstructing a ligament, the
system comprising:
[0073] a graft ligament support block for supporting a graft
ligament in a bone tunnel, the graft ligament support block
comprising: [0074] 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; [0075] a graft hole extending through the body transverse to
the longitudinal axis and configured to receive a graft ligament
therein; and [0076] a transverse fixation pin hole extending
through the body transverse to the longitudinal axis and configured
to receive a transverse fixation pin therein;
[0077] an installation tool comprising: [0078] a holder, the holder
comprising: [0079] a shaft having a distal end, a proximal end, and
a longitudinal axis extending between the distal end and the
proximal end, the proximal end of the shaft configured to engage
the at least one element of the body; [0080] a handle mounted to
the proximal end of the shaft; [0081] a drill guide adapted to be
releasably secured to the holder, the drill guide comprising:
[0082] an outrigger comprising a distal end and a proximal end, the
proximal end of the outrigger configured to be releasably secured
to the holder; and [0083] a drill sleeve moveably attached to the
distal end of the outrigger, the drill sleeve comprising a drilling
lumen extending therethrough, and the drill sleeve having depth
markers thereon, wherein the distal end of the outrigger and the
depth markers on the drill sleeve are configured so as to indicate
a proper transverse tunnel depth; and
[0084] a transverse tunnel drill having a distal end and a proximal
end, the distal end of the transverse tunnel drill configured for
placement through the drill sleeve so as to drill a transverse bone
tunnel through the bone tunnel, the transverse tunnel drill having
markers disposed thereon between the proximal end and the distal
end thereof, wherein the depth markers on the transverse tunnel
drill and the drill sleeve are configured so as to indicate a given
depth of the distal end of the transverse tunnel drill.
[0085] In accordance with a further feature of the invention, there
is provided a method for securing a graft ligament in a bone
tunnel, comprising the steps of:
[0086] looping a graft ligament through a graft hole in a graft
ligament support block;
[0087] advancing the graft ligament support block into the bone
tunnel;
[0088] positioning a drill guide in attachment to the graft support
block, the drill guide comprising an outrigger and a drill sleeve
movably attached to the outrigger, and the drill sleeve having
depth markers thereon;
[0089] determining a proper transverse tunnel depth with the drill
sleeve and the outrigger by moving the drill sleeve within the
outrigger toward the bone tunnel and reading the depth markers on
the drill sleeve;
[0090] forming a transverse tunnel in the host bone to a proper
transverse tunnel depth by drilling a transverse tunnel drill to a
given depth according to markers disposed on thereon, with the
transverse tunnel being aligned with a transverse fixation pin hole
in the graft ligament support block; and
[0091] pinning the graft ligament support block within the bone
tunnel by advancing a transverse fixation pin along the transverse
tunnel in the host bone and into the transverse fixation pin hole
in the graft ligament support block.
[0092] In accordance with a still further feature of the invention,
there is provided a method for securing a graft ligament in a bone
tunnel, the method comprising the steps of:
[0093] positioning a drill guide in attachment to a reamer inserted
into the bone tunnel, the drill guide comprising an outrigger and a
drill sleeve movably attached to the outrigger, and the drill
sleeve having depth markers thereon;
[0094] determining a proper transverse tunnel depth with the drill
sleeve and the outrigger by moving the drill sleeve within the
outrigger toward the bone tunnel and reading the depth markers on
the drill sleeve;
[0095] forming a transverse tunnel in the host bone to a proper
transverse tunnel depth by drilling a transverse tunnel drill to a
given depth according to markers disposed thereon;
[0096] removing the reamer from the bone tunnel;
[0097] looping a graft ligament through a graft hole in a graft
ligament support block;
[0098] advancing the graft ligament support block into the bone
tunnel so that a transverse fixation pin hole in the graft ligament
support block is aligned with the transverse tunnel; and
[0099] pinning the graft ligament support block within the bone
tunnel by advancing a transverse fixation pin along the transverse
tunnel in the host bone and into the transverse fixation pin hole
in the graft ligament support block.
[0100] In accordance with a further feature of the invention, there
is provided a system for use in reconstructing a ligament, the
system comprising:
[0101] a graft ligament support block for supporting a graft
ligament in a bone tunnel, the graft ligament support block
comprising: [0102] 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; [0103] a graft hole extending through the body transverse to
the longitudinal axis and configured to receive a graft ligament
therein; and [0104] a transverse fixation pin hole extending
through the body transverse to the longitudinal axis and configured
to receive a transverse fixation pin therein;
[0105] an installation tool comprising: [0106] a holder, the holder
comprising: [0107] a shaft having a distal end, a proximal end, and
longitudinal axis extending between the distal end and the proximal
end, the proximal end of the shaft configured to engage the at
least one element of the body; [0108] a handle mounted to the
proximal end of the shaft; [0109] a drill guide adapted to be
releasably secured to the holder, the drill guide comprising:
[0110] an outrigger comprising a distal end and a proximal end, the
proximal end of the outrigger configured to be releasably secured
to the holder; and [0111] a drill sleeve moveably attached to the
distal end of the outrigger, and the drill sleeve comprising a
drilling lumen extending therethrough; and
[0112] a transverse tunnel drill having a distal end and a proximal
end, the distal end of the transverse tunnel drill configured for
placement through the drill sleeve so as to drill a transverse bone
tunnel through the bone tunnel, the transverse tunnel drill having
a stop element configured to engage the drill sleeve so as to limit
drilling to a predetermined depth.
[0113] In accordance with a further feature of the invention, there
is provided a system for use in reconstructing a ligament, the
system comprising:
[0114] a graft ligament support block for supporting a graft
ligament in a bone tunnel, the graft ligament support block
comprising: [0115] a body having a distal end, a proximal end, and
a longitudinal axis extending between the distal end and the
proximal end; and [0116] a graft hole extending through the body
transverse to the longitudinal axis and configured to receive a
graft ligament therein;
[0117] a stepped transverse fixation pin having a distal end, a
proximal end, a longitudinal axis extending between the distal end
and the proximal end, a first portion at the distal end, a second
portion at the proximal end, the first portion having a smaller
diameter than second portion, and an annular shoulder configured
between the first portion and the second portion, wherein the first
portion, the second portion and the annular shoulder form a given
profile in a cross-section of a given plane perpendicular to the
longitudinal axis;
[0118] 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 drill
corresponding to the given profile of the stepped transverse
fixation pin so as to provide a stepped transverse tunnel through
the bone tunnel configured to receive the given profile of the
stepped transverse fixation pin; and
[0119] a depth gauge having a distal end and a proximal end, the
distal end of the depth gauge configured for placement through a
drill sleeve to engage a portion of the stepped transverse tunnel
corresponding to the annular shoulder of the stepped fixation pin,
and the depth gauge having markings thereon between the distal end
and the proximal end so as to indicate the transverse fixation pin
hole depth between the portion corresponding to the annular
shoulder of the stepped fixation pin and a bone surface.
[0120] In accordance with a still further feature of the invention,
there is provided a method for securing a graft ligament in a bone
tunnel, comprising the steps of:
[0121] looping a graft ligament through a graft hole in a graft
ligament support block;
[0122] advancing the graft ligament support block into the bone
tunnel;
[0123] determining a proper transverse tunnel depth by reading a
position of a first set of depth markers on a drill sleeve relative
to an outrigger;
[0124] forming a transverse tunnel in the host bone using a
transverse tunnel drill having a second set of depth markers
thereon so as to drill the transverse tunnel to the proper
transverse tunnel depth, with a transverse tunnel being aligned
with a transverse fixation pin hole in the graft ligament support
block; and
[0125] pinning the graft ligament support block within the bone
tunnel by selecting a transverse fixation pin based on the proper
transverse tunnel depth determined by the first set of depth
markers on the drill sleeve and advancing the selected transverse
fixation pin along the transverse tunnel in the host bone and into
the transverse fixation pin hole in the graft ligament support
block.
[0126] In accordance with a further feature of the invention, there
is provided a method for securing a graft ligament in a bone
tunnel, comprising the steps of:
[0127] looping a graft ligament through a graft hole in a graft
ligament support block;
[0128] advancing the graft ligament support block into the bone
tunnel;
[0129] determining a proper transverse tunnel depth by reading a
position of a first set of depth markers on a drill sleeve relative
to an outrigger;
[0130] forming a transverse tunnel in the host bone using a
transverse tunnel drill having a second set of depth markers
thereon so as to drill the transverse tunnel to the proper
transverse tunnel depth, with the transverse tunnel being aligned
with a transverse fixation pin hole in the graft ligament support
block; and
[0131] pinning the graft ligament support block within the bone
tunnel by selecting a transverse fixation pin based on the proper
transverse tunnel depth determined by the first set of depth
markers on the drill sleeve and advancing the selected transverse
fixation pin along the transverse tunnel in the host bone and into
the transverse fixation pin hole in the graft ligament support
block.
[0132] In accordance with a further feature of the invention, there
is provided a method for securing a graft ligament in a bone
tunnel, comprising the steps of:
[0133] looping a graft ligament through a graft hole in a graft
ligament support block;
[0134] advancing the graft ligament support block into the bone
tunnel;
[0135] forming a transverse tunnel in the host bone to a
predetermined depth using a transverse tunnel drill having a stop
element at a predetermined distance from a distal end of the
transverse tunnel drill, the stop element configured to engage a
drill sleeve so as to limit drilling to the predetermined depth,
with said transverse tunnel being aligned with a transverse
fixation pin hole in the graft ligament support block; and
[0136] pinning the graft ligament support block within the bone
tunnel by advancing a transverse fixation pin along the transverse
tunnel in the host bone and into the transverse fixation pin hole
in the graft ligament support block.
[0137] In accordance with a still further feature of the invention,
there is provided a method for securing a graft ligament in a bone
tunnel, the method comprising the steps of:
[0138] forming a transverse tunnel in the host bone to a
predetermined depth using a transverse tunnel drill having a stop
element at a predetermined distance from a distal end of the
transverse tunnel drill, the stop element configured to engage a
drill sleeve so as to limit drilling to the predetermined
depth;
[0139] looping a graft ligament through a graft hole in a graft
ligament support block;
[0140] advancing the graft ligament support block into the bone
tunnel so that a transverse fixation pin hole in the graft ligament
support block is aligned with the transverse tunnel; and
[0141] pinning the graft ligament support block within the bone
tunnel by advancing a transverse fixation pin along the transverse
tunnel in the host bone and into the transverse fixation pin hole
in the graft ligament support block.
[0142] In accordance with a further feature of the invention, there
is provided apparatus for use in reconstructing a ligament, the
apparatus comprising:
[0143] a graft ligament support block for supporting a graft
ligament in a bone tunnel, the graft ligament support block
comprising: [0144] a body having a distal end, a proximal end, and
a longitudinal axis extending between the distal end and the
proximal end, the proximal end being tapered so as to facilitate
withdrawal of the graft ligament support block through the bone
tunnel; [0145] a graft hole extending through the body transverse
to the longitudinal axis and configured to receive a graft ligament
therein; and [0146] a region configured for drilling a transverse
fixation pin hole through the body transverse to the longitudinal
axis as a transverse hole is drilled through the bone tunnel.
BRIEF DESCRIPTION OF THE DRAWINGS
[0147] These 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:
[0148] FIG. 1 is a schematic view of a knee joint, as viewed from
the anterior side;
[0149] FIG. 2 is a schematic view of a knee joint, as viewed from
the posterior side;
[0150] FIG. 3 is a schematic view of a generic ACL
reconstruction;
[0151] FIG. 4 is a schematic view of an ACL reconstruction effected
using an interference screw;
[0152] FIG. 5 is a schematic view of an ACL reconstruction effected
using a suture sling;
[0153] FIG. 6 is a schematic view of an ACL reconstruction effected
using a crosspin;
[0154] FIG. 7 is a schematic view of an ACL reconstruction effected
using a screw and washer;
[0155] FIG. 8 is a schematic view of a graft ligament support block
formed in accordance with the present invention;
[0156] FIG. 9 is a partially exploded view showing the graft
ligament support block of FIG. 8 and an installation tool for
deploying the same;
[0157] FIGS. 10-12 are various views showing the graft ligament
support block of FIG. 8 mounted to the distal end of the
installation tool shown in FIG. 9;
[0158] FIG. 13 is a partial perspective view showing details of the
proximal end of the installation tool shown in FIG. 9;
[0159] FIG. 14 is a side view, partially in section, showing
further details of the construction of the installation tool shown
in FIG. 9;
[0160] FIG. 15 is a side sectional view of the installation tool's
drill sleeve;
[0161] FIG. 16 is a perspective view of a transverse fixation pin
which may be used in conjunction with the graft ligament support
block of FIG. 8 and the installation tool of FIG. 9;
[0162] FIGS. 17-33 are a series of schematic views showing an ACL
reconstruction being effected in accordance with the present
invention;
[0163] FIG. 34 is a schematic view showing another form of graft
ligament support block formed in accordance with the present
invention;
[0164] FIG. 35 is an enlarged side view showing an alternative
construction for a portion of the installation tool;
[0165] FIG. 36 is a sectional view taken along line 36-36 of FIG.
35;
[0166] FIG. 37 is a schematic view showing a reamer drill guide
formed in accordance with the present invention;
[0167] FIG. 38 is a schematic view showing the reamer element of
the reamer drill guide shown in FIG. 37;
[0168] FIGS. 39-44 are a series of schematic views showing an ACL
reconstruction being effected in accordance with the present
invention;
[0169] FIGS. 45, 46A and 46B are schematic views of graft ligament
support blocks, with each one showing a tapered distal edge
configuration;
[0170] FIG. 47 is a schematic view of a transverse fixation pin
having an internal tapped hole formed at its proximal end;
[0171] FIG. 48 is a schematic view of a retraction tool having a
threaded projection configured to engage the internal tapped hole
of the transverse fixation pin shown in FIG. 47;
[0172] FIG. 49 is a schematic view showing a stepped transverse
tunnel drill having a narrow cutting portion and a wide cutting
portion;
[0173] FIG. 50 is a schematic view of an ACL reconstruction
procedure effected using the stepped transverse tunnel drill shown
in FIG. 49;
[0174] FIGS. 51A, 51B and 52 are schematic views of a system for
use in reconstructing a ligament, the system including a stepped
transverse tunnel drill with depth markers thereon and a drill
sleeve with depth markers thereon;
[0175] FIGS. 53 and 54 are schematic views of a transverse tunnel
drill having a stop element configured thereon; and
[0176] FIGS. 55 and 56 are schematic views of a system for use in
reconstructing a ligament, the system including a transverse pin
inserter depth gauge configured to determine the placement depth of
a transverse pin inserted into the transverse tunnel.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0177] Looking next at FIG. 8, there is shown a graft ligament
support block 100 which comprises one preferred form of the
invention. Graft ligament support block 100 comprises a body 105,
and a graft hole 110 and a transverse fixation pin hole 115
extending through body 105, with both graft hole 110 and transverse
fixation pin hole 115 preferably extending substantially
perpendicular to the longitudinal axis 120 of body 105. In one
preferred form of the invention, graft hole 110 and transverse
fixation pin hole 115 extend diametrically across body 105, with
graft hole 110 and transverse fixation pin hole 115 extending
substantially parallel to one another. Preferably graft hole 110
resides closer to the proximal end 125 of body 105 than transverse
fixation pin hole 115, and transverse fixation pin hole 115 resides
closer to the distal end 130 of body 105 than graft hole 110. In
one preferred form of the invention, the distal end of body 105 has
a circular cross-section, although it may also have an oval
cross-section or a polygonal cross-section (e.g., square or
rectangular or triangular, etc.). In one preferred construction,
the distal end of body 105 has a cross-section sized just slightly
smaller than the diameter of the bone tunnel, so as to provide a
close interface between body 105 and the walls of the bone tunnel.
In one preferred form of the invention, the distal end 130 of body
105 is tapered so as to facilitate advancement of graft ligament
support block 100 through a bone tunnel. And in a preferred form of
the invention, the proximal end of body 105 is sculpted away, e.g.
such as shown at 135, so as to provide more room for a graft
ligament looped through graft hole 110 and extending distally
therefrom. Body 105 also includes a pair of recesses 140 for
mounting body 105 to an appropriate installation tool, as will
hereinafter be discussed in further detail.
[0178] If desired, graft ligament support block 100 may also
include suture hole 145 for receiving a tow suture, as will
hereinafter be discussed in further detail.
[0179] Additionally, if desired, the proximal end of graft hole 110
may be tapered as shown at 150 so as to provide a less traumatic
bearing surface for a graft ligament looped through graft hole 110,
and/or the entrance of transverse fixation pin hole 115 may be
tapered as shown at 155 so as to facilitate entry of a transverse
fixation pin into transverse fixation pin hole 115.
[0180] Body 105 may be formed out of a polymer, a bioabsorbable or
bioremodelable material, allograft bone, a metal, a ceramic, coral,
a fiber composite, a composite including at least one of the
foregoing, etc. By forming body 105 out of a relatively strong
material, the graft ligament can be held under tension even where
body 105 is relatively small, or where one or more of the holes
110, 115 and/or 145 is located fairly close to the periphery of
body 105.
[0181] Looking next at FIGS. 9-15, there is shown an installation
tool 200 which may be used in conjunction with graft ligament
support block 100. Installation tool 200 generally comprises a
holder 205 and an associated drill guide 210.
[0182] Holder 205 comprises a shaft 215 having a pair of fingers
220 at its distal end and a handle 225 at its proximal end. Fingers
220 allow installation tool 200 to mate with, and releasably hold,
graft ligament support block 100 by selectively fitting into the
recesses 140 (FIG. 8) formed on the proximal end of graft ligament
support block 100. See FIGS. 9-12 and 14. In essence, fingers 220
and recesses 140 comprise a male/female connection; if desired, the
locations of the male and female members may be reversed (i.e.,
with the male portion on support block 100 and the female portion
on holder 205); or an alternative type of connection (e.g., a
grasper) may be used. Preferably one or more suture posts 227 are
formed on the proximal end of shaft 215 adjacent to handle 225.
Suture posts 227 allow the two free ends of a graft ligament to be
secured to the installation tool, as will hereinafter be discussed
in further detail. Handle 225 allows installation tool 200 to be
conveniently grasped by a user. Handle 225 includes a post hole
230. Post hole 230 allows drill guide 210 to be releasably secured
to holder 205, as will hereinafter be discussed in further
detail.
[0183] Drill guide 210 comprises an outrigger 235 having a threaded
bore 240 (FIG. 14) formed in its distal end 245, and a slot 250
(FIG. 9) and post 255 at its proximal end 260. The end of post 255
is threaded, e.g., as shown at 265.
[0184] The threaded bore 240 (FIG. 14) in the outrigger's distal
end 245 is sized to receive a drill sleeve 270 therein. Drill
sleeve 270 has threads 275 along its length and terminates in a
proximal head 280. Head 280 can be used to manually rotate drill
sleeve 270 within the outrigger's threaded bore 240, whereby to
move drill sleeve 270 relative to the distal end 245 of outrigger
235. A lumen 285 extends through drill sleeve 270.
[0185] Slot 250 and post 255 permit outrigger 235 to be releasably
mounted to holder 205. More particularly, outrigger 235 may be
mounted to holder 205 by fitting the holder's shaft 215 in the
outrigger's slot 250 (FIGS. 13 and 14), fitting the outrigger's
post 255 in the holder's post hole 230, and then tightening nut 290
onto the threaded end 265 of post 255.
[0186] As will hereinafter be described, graft ligament support
block 100 and installation tool 200 are intended to be used in
conjunction with a transverse fixation pin. One preferred
transverse fixation pin 300 is shown in FIG. 16. Transverse
fixation pin 300 generally comprises a solid shaft 305 terminating
in a tapered distal end 310, and a ribbed (or barbed or threaded)
section 315. A non-circular socket 320 is formed in the proximal
end of transverse fixation pin 300, whereby transverse fixation pin
300 may be engaged by a driver.
[0187] An ACL reconstruction effected in accordance with the
present invention will now be described.
[0188] First, the surgical site is prepared for the graft ligament,
e.g., by clearing away the damaged ACL, etc.
[0189] Then a guidewire 400 (FIG. 17) is drilled up through tibia
10 and into the interior of the knee joint. Preferably guidewire
400 is stopped short of engaging the bottom of femur 15 (FIG. 18).
Then a cannulated tibial drill 500 (FIG. 19) is loaded onto
guidewire 400 and drilled up through tibia 10 and into the interior
of the knee joint (FIG. 20). Then cannulated tibial drill 500 is
withdrawn back down the guidewire (FIG. 21), leaving a tibial
tunnel 20.
[0190] Next, guidewire 400 is drilled an appropriate distance into
the interior of femur 15. If desired, guidewire 400 may be drilled
all the way through femur 15 (FIG. 22), for reasons which will
hereinafter be described. Then a cannulated femoral drill 600
(e.g., an acorn drill) is loaded onto guidewire 400 (FIG. 22),
passed through tibial tunnel 20, across the interior of the knee
joint, and then drilled up into femur 15, stopping within the
interior of femur 15 (FIG. 23). Then cannulated femoral drill 600
is withdrawn back down the guidewire, leaving a femoral tunnel 25
(FIG. 24).
[0191] Next, a graft ligament 35 is mounted to graft ligament
support block 100 by threading one end of the graft ligament
through graft hole 110, and then graft ligament support block 100
is mounted to the distal end of shaft 215, i.e., by seating fingers
220 in recesses 140. The two free ends of graft ligament 35 are
preferably held taut, e.g., by passing sutures 70 through the two
free ends of graft ligament 35 and then securing those sutures
(e.g., by winding) to suture posts 227. This arrangement will help
control the two free ends of graft ligament 35 and will help hold
graft ligament support block 100 to holder 205. Then installation
tool 200 is used to push graft ligament support block 100, and
hence graft ligament 35, up through tibial tunnel 20 (FIG. 25),
across the interior of the knee joint, and up into femoral tunnel
25 (FIG. 26).
[0192] If desired, all of the force required to advance graft
ligament support block 100 and graft ligament 35 through tibial
tunnel 20, across the interior of the knee joint, and up into
femoral tunnel 25 may be supplied by pushing distally on
installation tool 200. Alternatively, if guidewire 400 has been
drilled completely through femur 15 (e.g., such as is shown in FIG.
22), and if the proximal end of guidewire 400 includes a suture
eyelet (e.g., such as the suture eyelet 405 shown in FIGS. 23 and
24), a suture may be used to help tow graft ligament support block
100 and graft ligament 35 up into position. More particularly, a
suture 700 (FIG. 25) may be looped through the suture hole 145 in
graft ligament support block 100 and through suture eyelet 405 on
guidewire 400; then, by pulling distally on the portion of
guidewire 400 extending out of the top end of femur 15, suture 700
can be used to help tow graft ligament support block 100 and graft
ligament 35 up into position (FIG. 26). Such an arrangement will
help reduce the amount of force which needs to be delivered by
installation tool 200 to push graft ligament support block 100 and
graft ligament 35 up into position.
[0193] Once graft ligament support block 100 and graft ligament 35
have been advanced into position (FIG. 26), drill sleeve 270 is
advanced into tight engagement with femur 15 (FIG. 27). This action
will help stabilize installation tool 200 relative to femur 15.
Then a transverse tunnel drill 800 (FIG. 28) is used to drill a
transverse tunnel 75 through the lateral portion of femur 15,
through transverse fixation pin hole 115 in graft ligament support
block 100, and into the medial portion of femur 15. In this respect
it will be appreciated that transverse tunnel drill 800 will be
accurately and consistently directed through transverse fixation
pin hole 115 in graft ligament support block 100 (FIG. 28) due to
the fact that the orientation of graft ligament support block 100
and installation tool 200 (and hence drill sleeve 270) is regulated
by the engagement of fingers 220 in recesses 140.
[0194] Once transverse tunnel drill 800 has been used to drill
transverse tunnel 75, transverse tunnel drill 800 is removed (FIG.
29). Then drill sleeve 270 is loosened and outrigger 210 dismounted
from holder 205 (FIG. 30). Then transverse fixation pin 300,
mounted on a driver 325, is advanced into transverse tunnel 75 and
across transverse fixation pin hole 115 in graft ligament support
block 100 (FIG. 31), whereby to secure graft ligament support block
100 (and hence graft ligament 35) in femoral tunnel 25. Depending
on whether section 315 of transverse fixation pin 300 is ribbed or
barbed or threaded, the transverse fixation pin may be advanced by
driver 325 by tapping on the proximal end of the driver with a
mallet or by rotating the driver and/or both. The driver 325 is
then removed (FIG. 32). Next, the two free ends of graft ligament
35 are detached from the handle's suture posts 227, and holder 205
is withdrawn (FIG. 33). In this respect it will be appreciated that
graft ligament support block 100 will be held in position in
femoral tunnel 25 when holder 205 is withdrawn due to the presence
of transverse fixation pin 300 in transverse tunnel 75 and
transverse fixation pin hole 115. Finally, the two free ends of
graft ligament 35 are secured to tibia 10, thereby completing the
ACL reconstruction procedure.
[0195] In the embodiment disclosed above, transverse fixation pin
hole 115 (FIG. 8) is pre-formed in body 105. Such a construction is
generally advantageous, since it eliminates the need to drill
through body 105 after graft ligament support block 100 has been
positioned in the femoral tunnel and before transverse fixation pin
300 has been passed through body 105. In addition, by pre-forming
transverse fixation pin hole 115 in body 105, transverse fixation
pin hole 115 can be given a desired geometry, e.g., it permits the
entrance to crosspin hole 115 to be tapered, such as is shown at
155 in FIG. 8, whereby to help center transverse fixation pin 300
in transverse fixation pin hole 115. However, it should also be
appreciated that, if desired, transverse fixation pin hole 115 may
not be pre-formed in body 105. Instead, transverse fixation pin
hole 115 may be formed in situ, at the time of surgery, e.g., by
drilling across body 105 when forming transverse tunnel 75 with
transverse tunnel drill 800. Where transverse fixation pin hole 115
is to be formed in situ, it is of course necessary for body 105 to
be formed out of a drillable material. In addition, where
transverse fixation pin hole 115 is to be formed in situ, it is
preferred that body 105 be formed out of a relatively strong
material, since then any misplacement (i.e., any off-center
placement) of transverse fixation pin hole 115 will be well
tolerated by body 105.
[0196] Additionally, in the embodiment disclosed above, the outer
surface of body 105 is sculpted away proximal to graft hole 110,
such as is shown at 135 in FIG. 8, so as to help accommodate the
graft ligament in femoral tunnel 25. In FIG. 8, sculpting is
effected so as to produce a substantially planar surface at 135.
However, if desired, sculpting can be effected so as to provide
alternative geometries, e.g., a surface groove, etc. Thus, for
example, in FIG. 34 body 105 is shown with a pair of surface
grooves 165 communicating with, and extending proximally from,
graft hole 110. Surface grooves 165 are sized so as to provide a
recess for seating portions of the graft ligament as the graft
ligament extends proximally from graft hole 110.
[0197] Also, in the embodiment disclosed above, body 105 is shown
(see, for example, FIG. 8) as having a relatively smooth outer
surface. However, if desired, body 105 may have spikes or ribs,
etc. formed on a side wall thereof so as to help stabilize body 105
within the bone tunnel.
[0198] Furthermore, in the embodiment disclosed above, drill sleeve
270 is movably connected to outrigger 235 via a screw connection
(i.e., screw threads 275 on the exterior of drill sleeve 270 and
threaded bore 240 in outrigger 235). This arrangement provides a
simple and cost-effective way to movably secure drill sleeve 270 to
outrigger 235. However, if desired, other types of arrangements
could also be used. For example, and looking now at FIGS. 35 and
36, drill sleeve 270 could have a smooth or ribbed or roughed (e.g.
knurled) exterior 275A that slides through a non-threaded bore 240A
in outrigger 235, with a locking pin 235A being selectively
advanceable (through a threaded bore 235B) into engagement with
drill sleeve 270, whereby to selectively lock the drill sleeve to
the outrigger. Still other possible arrangements for selectively
locking drill sleeve 270 to outrigger 235 will be apparent to those
skilled in the art of drilling and drill sleeves.
[0199] Also, in the embodiment disclosed above, drill guide 210 is
shown (see, for example, FIG. 14) as being releasably secured to
holder 205 via a post 255 and tightening nut 290. However, it
should be appreciated that other types of connections (e.g., a
"quick release" clamping mechanism) may also be used to releasably
secure drill guide 210 to holder 205.
[0200] It is also possible to form transverse tunnel 75 before
graft ligament support block 100 and graft ligament 35 are
positioned in femoral tunnel 25. More particularly, in one possible
arrangement, a reamer drill guide 200A (FIG. 37) may be used.
Reamer drill guide 200A is substantially identical to the
installation tool 200 described above, except as will hereinafter
be described. More particularly, reamer drill guide 200A comprises
a reamer 205A and the drill guide 210. Reamer 205A is substantially
identical to the holder 205 described above, except that it has a
cylindrical element 220A (FIGS. 37 and 38) at its distal end having
a transverse hole 220B extending therethrough, and it omits the
suture posts 227 which are preferably provided on holder 205.
Reamer 205A is configured so that (i) its cylindrical element 220A
has a diameter approximately equal to the diameter of femoral
tunnel 25, and (ii) when drill guide 210 is attached to reamer
205A, the lumen 285 in drill sleeve 270 will be aligned with
transverse hole 220B in reamer 205A.
[0201] Graft ligament support block 100, holder 205 and reamer
drill guide 200A may be used to effect an ACL reconstruction as
follows.
[0202] First, the surgical site is prepared for the graft ligament,
e.g., by clearing away the damaged ACL, etc. Then a guidewire 400
(FIG. 17) is drilled up through tibia 10, across the interior of
the knee joint. Preferably guidewire 400 is stopped short of
engaging the bottom of femur 15 (FIG. 18). Then a cannulated tibial
drill 500 (FIG. 19) is loaded onto guidewire 400 and drilled up
through tibia 10 and into the interior of the knee joint (FIG. 20).
Then cannulated tibial drill 500 is withdrawn back down the
guidewire (FIG. 21), leaving a tibial tunnel 20.
[0203] Next, guidewire 400 is drilled an appropriate distance into
the interior of femur 15. Then a cannulated femoral drill 600
(e.g., an acorn drill of the type shown in FIG. 22) is loaded onto
guidewire 400, passed through tibial tunnel 20, across the interior
of the knee joint, and then drilled up into femur 15, stopping
within the interior of femur 15. Then cannulated femoral drill 600
is withdrawn back down the guidewire, leaving a femoral tunnel 25,
and then guidewire 400 is withdrawn (see FIG. 39).
[0204] Next, reamer drill guide 200A is advanced so that its
cylindrical element 220A is advanced through tibial tunnel 20,
across the interior of the knee, and up into femoral tunnel 25. In
this respect it should be appreciated that as reamer drill guide
200A is advanced through tibial tunnel 20 and femoral tunnel 25,
its cylindrical element 220A will ream both bone tunnels, clearing
out any intervening debris.
[0205] Once reamer drill guide 200A has been advanced into
position, drill sleeve 270 is advanced into tight engagement with
femur 15. This action will help stabilize reamer drill guide 200A
relative to femur 15. Then a transverse tunnel drill 800 (FIG. 40)
is used to drill a transverse tunnel 75 through the lateral portion
of femur 15, through transverse hole 2208 in cylindrical element
220A, and into the medial portion of femur 15. In this respect it
will be appreciated that transverse tunnel drill 800 will be
accurately and consistently directed through transverse hole 220B
in cylindrical element 220A (FIG. 40) due to the fact that the
relative orientation of cylindrical element 220A and drill sleeve
270 is regulated by the pre-defined engagement of drill guide 210
with reamer 205A.
[0206] Once transverse tunnel drill 800 has been used to drill
transverse tunnel 75, transverse tunnel drill 800 is removed. Then
drill sleeve 270 is loosened and reamer drill guide 200A is
withdrawn from the surgical site (FIG. 41).
[0207] Next, a graft ligament 35 is mounted to graft ligament
support block 100 by threading one end of the graft ligament
through graft hole 110, and then graft ligament support block 100
is mounted to the distal end of shaft 215, i.e., by seating fingers
220 in recesses 140. The two free ends of graft ligament 35 are
preferably held taut, e.g., by passing sutures 70 through the two
free ends of graft ligament 35 and then securing these sutures
(e.g., by winding) to suture posts 227. This arrangement will help
control the two free ends of graft ligament 35 and will help hold
graft ligament support block 100 to holder 205. Then holder 205 is
used to push graft ligament support block 100, and hence graft
ligament 35, up through tibial tunnel 20, across the interior of
the knee joint, and up into femoral tunnel 25 (FIG. 42). As graft
ligament support block is advanced in femoral tunnel 25, or after
it has been advanced an appropriate distance into femoral tunnel
25, it is rotated as necessary, by turning handle 225 as necessary,
so as to align the transverse fixation pin hole 115 with transverse
tunnel 75. Such alignment may be facilitated by providing an
alignment marker (e.g., such as the alignment marker 225A shown in
FIG. 43) on handle 225.
[0208] Then transverse fixation pin 300, mounted on a driver 325,
is advanced into transverse tunnel 75 and across transverse
fixation pin hole 115 in graft ligament support block 100 (FIG.
44), whereby to secure graft ligament support block 100 (and hence
graft ligament 35) in femoral tunnel 25. Then driver 325 is
removed. Next, the two free ends of graft ligament 35 are detached
from the handle's suture posts 227, and holder 205 is withdrawn. In
this respect it will be appreciated that graft ligament support
block 100 will be held in position in femoral tunnel 25 when holder
205 is withdrawn due to the presence of transverse fixation pin 300
in transverse tunnel 75 and transverse fixation pin hole 115.
Finally, the two free ends of graft ligament 35 then secured to
tibia 10, thereby completing the ACL reconstruction procedure.
[0209] Looking next at FIGS. 45 and 46, there is shown a modified
graft ligament support block 1500 which comprises one preferred
form of the invention. Graft ligament support block 1500 comprises
a body 1505, and a graft hole 1510 and a transverse fixation pin
hole 1515 extending through body 1505, with both graft hole 1510
and transverse fixation pin hole 1515 preferably extending
substantially perpendicular to the longitudinal axis 1520 of body
1505. In one preferred form of the invention, graft hole 1510 and
transverse fixation pin hole 1515 extend diametrically across body
1505, with graft hole 1510 and transverse fixation pin hole 1515
extending substantially parallel to one another. Preferably graft
hole 1510 resides closer to the proximal end 1525 of body 1505 than
transverse fixation pin hole 1515, and transverse fixation pin hole
1515 resides closer to the distal end 1530 of body 1505 than graft
hole 1510. In one preferred form of the invention, the distal end
of body 1505 has a circular cross-section, although it may also
have an oval cross-section or a polygonal cross-section (e.g.,
square or rectangular or triangular, etc.). In one preferred
construction, the distal end of body 1505 has a cross-section sized
just slightly smaller than the diameter of the bone tunnel, so as
to provide a close interface between body 1505 and the walls of the
bone tunnel. In one preferred form of the invention, the distal end
1530 of body 1505 is tapered so as to facilitate advancement of
graft ligament support block 100 through a bone tunnel. And in a
preferred form of the invention, the proximal end of body 1505 is
sculpted away, e.g. such as shown at 1535, so as to provide more
room for a graft ligament looped through graft hole 1510 and
extending distally therefrom. Body 1505 also includes one or more
recesses (not shown, but preferably similar to or analogous to the
recesses 140 provided in body (105)) for mounting body 1505 to an
appropriate installation tool.
[0210] If desired, graft ligament support block 1500 may also
include suture hole 1545 for receiving a tow suture, as will
hereinafter be discussed in further detail.
[0211] Additionally, if desired, the proximal end of graft hole
1510 may be tapered as shown at 1550 so as to provide a less
traumatic bearing surface for a graft ligament looped through graft
hole 1510, and/or the entrance of transverse fixation pin hole 1515
may be tapered as shown at 1555 so as to facilitate entry of a
transverse fixation pin into transverse fixation pin hole 1515.
[0212] Body 1505 may be formed out of a polymer, a bioabsorbable or
bioremodelable material, allograft bone, a metal, a ceramic, coral,
a fiber composite, a composite including at least one of the
foregoing, etc. By forming body 1505 out of a relatively strong
material, the graft ligament can be held under tension even where
body 1505 is relatively small, or where one or more of the holes
1510, 1515 and/or 1545 is located fairly close to the periphery of
body 1505.
[0213] Still looking at FIGS. 45, 46A and 46B, there is shown a
tapered portion 1560 at the proximal end 1525 of body 1505. Tapered
portion 1560 facilitates retraction of graft block 1505 out of a
bone tunnel if the same is needed, e.g., for an interoperative
revision. This is beneficial in that other designs with squared
corners tend to bind in the bone tunnel if the body is retracted
proximally out of a bone tunnel.
[0214] Referring now to FIGS. 46A and 46B, there is shown body 1505
having a graft hole 1510 with a length X (FIG. 46A), which is
substantially equal to the width of a graft ligament. Graft hole
1510 provides an opening which is shorter than length Y of graft
hole 110 of body 105 (FIG. 46B), which in turn provides increased
contact of the graft with the tunnel wall.
[0215] In a preferred embodiment of the invention, there is
provided a method for securing a graft ligament in a bone tunnel.
The method comprises a first step of selecting a graft ligament
support block with a graft hole sized substantially equal to a
given width of a graft ligament. The method comprises a step of
looping the graft ligament through the graft hole in the graft
ligament support block. The method comprises a further step of
advancing the graft ligament support block into the bone tunnel.
The method comprises a step of a transverse tunnel in the host
bone, with a transverse tunnel being aligned with a transverse
fixation pin hole in the graft ligament support block. The final
step of the method comprises pinning the graft ligament support
block within the bone tunnel by advancing a transverse fixation pin
along the transverse tunnel in the host bone and into the
transverse fixation pin hole in the graft ligament support
block.
[0216] In another preferred embodiment of the present invention,
there is provided a method for securing a graft ligament in a bone
tunnel. The method comprises the step of forming a transverse
tunnel in the host bone. The method comprises the step of selecting
a graft ligament support block with a graft hole sized
substantially equal to a given width of a graft ligament. The
method also comprises the step of 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 so
that a transverse fixation pin hole in the graft ligament support
block is aligned with the transverse tunnel. The final step
comprises pinning the graft ligament support block within the bone
tunnel by advancing a transverse fixation pin along the transverse
tunnel in the host bone and into the transverse fixation pin hole
in the graft ligament support block.
[0217] Looking now at FIGS. 47 and 48, in a preferred embodiment of
the present invention, there is shown a removable transverse
fixation pin 1600 (FIG. 47) which is configured to be used in a
similar fashion as transverse fixation pin 300 (FIG. 16) described
hereinabove. Removable fixation pin 1600 (FIG. 47) generally
comprises a solid shaft 1605 terminating in a tapered distal end
1610, and a ribbed (or barbed or threaded) section 1615. A socket
1620 is formed in the proximal end of removable transverse fixation
pin 1600, whereby transverse fixation pin 1600 may be engaged by a
driver. Socket 1620 may be adapted to receive a rotational-type
driver (e.g., a hex driver) or a mallet-type driver. Socket 1620
further includes an internal tapped hole 1625 formed therein.
Internal tapped hole 1625 is configured to engage a retraction tool
1630 (FIG. 48) so as to aid in the removal of removable fixation
pin 1600 from a transverse bone tunnel.
[0218] Retraction tool 1630 generally comprises a shaft 1635 having
a handle 1640 at one end and a threaded projection 1645 at the
other end. Threaded projection 1645 is configured for threadable
engagement with internal tapped hole 1625 formed in removable
fixation pin 1600. When threaded projection 1645 is securely mated
with internal tapped hole 1625, removable transverse fixation pin
1600 may be withdrawn from a bone tunnel by applying appropriate
forces on handle 1640.
[0219] In a preferred embodiment of the present invention, there is
provided a method for revising a graft ligament in a bone tunnel.
The method comprises of engaging an internal tapped hole in a
transverse fixation pin with a removal tool. The method also
comprises the step of withdrawing the transverse fixation pin from
the bone tunnel with the removal tool engaged with the internal
tapped hole. The method comprises a further step of repositioning
the graft ligament support block into the bone tunnel. The method
comprises a final step of pinning the graft ligament support block
within the bone tunnel by advancing a transverse fixation pin along
a transverse tunnel in the host bone and into the transverse
fixation pin hole in the graft ligament support block.
[0220] Referring now to FIG. 49, and in a preferred embodiment of
the present invention, there is shown a stepped transverse tunnel
drill 1700 having a shaft 1705 with a narrow cutting portion 1710
along a first length of the distal end thereof, a wide cutting
portion 1715 along a second length proximally of the narrow cutting
portion 1710, and a discontinuous portion 1720 formed at the
junction of narrow cutting portion 1710 and wide cutting portion
1715.
[0221] Looking now at FIG. 50, stepped transverse tunnel drill 1700
is used so as to drill a stepped transverse tunnel 1725 (FIG. 50)
through the lateral portion of femur 15, through a portion of bone
tunnel 25, and into the medial portion of femur 15 as described
herein. Transverse tunnel 1725 includes a narrow portion 1730 and a
wide portion 1735 corresponding to narrow cutting portion 1710 and
wide cutting portion 1715 of stepped transverse tunnel drill 1700,
respectively. A stepped portion (not shown) within transverse
tunnel 1725 provides an annular shoulder to stop the advancement of
a transverse tunnel pin (not shown).
[0222] In a preferred embodiment of the present invention (not
shown), there is provided a stepped fixation pin having a profile
of a portion of stepped transverse tunnel drill 1700. 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 allows the
stepped fixation pin to be positionably seated at a known distance
within transverse tunnel 1725 so as to position the narrow portion
of the stepped fixation pin within narrow portion 1730 of
transverse tunnel 1725 and the wide portion of the stepped fixation
pin within wide portion 1735 of transverse tunnel 1725.
[0223] In a preferred embodiment of the present invention, a method
is provided for securing a graft ligament in a bone tunnel. The
method comprises looping a 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 bone
tunnel 25. The method also comprises a step of forming stepped
transverse tunnel 1725 (FIG. 50) in host bone 15 with stepped
transverse tunnel drill 1700 (FIG. 49), with the stepped transverse
tunnel 1725 (FIG. 50) being aligned with a transverse fixation pin
hole (not shown) in the graft ligament support block. The method
comprises a final step of pinning the graft ligament support block
within bone tunnel 25 by advancing a stepped transverse fixation
pin (not shown) along transverse tunnel 1725 in host bone 15 and
into the transverse fixation pin hole (not shown) in the graft
ligament support block (not shown).
[0224] In a preferred embodiment of the present invention, an
installation tool is used to advance the graft ligament support
block into the bone tunnel prior to the step of forming stepped
transverse tunnel 1725 in host bone 15 (FIG. 50). Preferably, the
installation tool is used together with the stepped transverse
tunnel drill to form the stepped transverse tunnel in the host
bone.
[0225] In another preferred embodiment to the present invention, a
tow suture is used to advance the graft ligament support block into
the bone tunnel prior to the step of forming stepped transverse
tunnel 1725 in host bone 15 (FIG. 50).
[0226] In a preferred embodiment of the present invention, there is
provided another method for securing a graft ligament in a bone
tunnel. This method comprises a first step of forming a stepped
transverse tunnel 1725 (FIG. 50) in host bone 15 with stepped
transverse tunnel drill 1700 (FIG. 49). The method comprises a
subsequent step of looping a graft ligament through a graft hole in
a graft ligament support block. This is followed by the step of
advancing the graft ligament support block into bone tunnel 25 so
that a transverse fixation pin hole in the graft ligament support
block (not shown) is aligned with the stepped transverse tunnel
1725. The method comprises a final the step of pinning the graft
ligament support block within bone tunnel 25 by advancing a stepped
transverse fixation pin (not shown) along the stepped transverse
tunnel 1725 in host bone 15 and into the transverse fixation pin
hole (not shown) in the graft ligament support block (not
shown).
[0227] In a preferred embodiment of the present invention (not
shown), an installation tool is used to advance the graft ligament
support block into the bone tunnel subsequent to the steps of
forming the stepped transverse tunnel and looping the graft
ligament through the graft hole.
[0228] Referring now to FIGS. 51A, 51B and 52, and in a preferred
embodiment of the present invention, there is shown a calibrated
graft ligament reconstruction system 1740 (FIG. 52) which generally
includes a holder 1745 and an associated drill guide 1750.
[0229] Drill guide 1750 has a similar configuration to drill guide
210 described hereinabove. Preferably, drill guide 1750 comprises
an outrigger 1755 having a smooth bore 1760 formed in its distal
end 1765 and sized to receive a drill sleeve 1770 therein. A first
set of depth markers 1775 disposed on drill sleeve 1770 are
configured to indicate the distance from a distal tip 1780 of the
drill sleeve 1770 to a preselected portion within femur 15.
Preferably, depth markers 1775 are read relative to a proximal
opening 1785 of smooth bore 1760.
[0230] Referring now to FIGS. 51B and 52, and in a preferred
embodiment of the present invention, there is shown stepped
transverse drill 1700 having a second set of depth markers 1790
thereon. Depth markers 1790 are configured to indicate the distance
to the preselected portion within femur 15. Preferably, depth
markers 1790 are read relative to a proximal opening 1795 (FIG. 52)
of drill sleeve 1770.
[0231] In a preferred embodiment of the present invention, a method
is disclosed for securing a graft ligament in a bone tunnel. The
method comprises a first step of looping a graft ligament through a
graft hole in a graft ligament support block. The method comprises
a subsequent step of advancing the graft ligament support block
into the bone tunnel. This step is followed by the step of
positioning a drill guide in attachment to the graft support block,
the drill guide comprising an outrigger and a drill sleeve moveably
attached to the outrigger, and the drill sleeve having depth
markers thereon. The method further comprises a step of determining
a proper transverse tunnel depth with the drill sleeve and the
outrigger by moving the drill sleeve within the outrigger toward
the bone tunnel and reading the depth markers on the drill sleeve.
The method comprises the step of forming a transverse tunnel in the
host bone to a proper transverse tunnel depth by drilling a
transverse tunnel drill to a given depth according to markers
disposed on thereon, with the transverse tunnel being aligned with
a transverse fixation pin hole in the graft ligament support block.
The method comprises a final step of pinning the graft ligament
support block within the bone tunnel by advancing a transverse
fixation pin along the transverse tunnel in the host bone and into
the transverse fixation pin hole in the graft ligament support
block.
[0232] In another preferred embodiment of the present invention, a
method is disclosed for securing a graft ligament in a bone tunnel.
The method comprises a first step of positioning a drill guide in
attachment to a bone tunnel guide inserted into the bone tunnel,
the drill guide comprising an outrigger and a drill sleeve moveably
attached to the outrigger, and the drill sleeve having depth
markers thereon. The method comprises a subsequent step of
determining a proper transverse tunnel depth with the drill sleeve
and the outrigger by moving the drill sleeve within the outrigger
toward the bone tunnel and reading the depth markers on the drill
sleeve. The method comprises the step of forming a transverse
tunnel in the host bone to a proper transverse tunnel depth by
drilling a transverse tunnel drill to a given depth according to
markers disposed thereon. The method calls for the step of looping
a graft ligament through a graft hole in a graft ligament support
block. The method comprises the step of advancing the graft
ligament support block into the bone tunnel so that a transverse
fixation pin hole in the graft ligament support block is aligned
with the transverse tunnel. The method comprises a final step of
pinning the graft ligament support block within the bone tunnel by
advancing a transverse fixation pin along the transverse tunnel in
the host bone and into the transverse fixation pin hole in the
graft ligament support block.
[0233] Looking at FIGS. 53 and 54, and in a preferred embodiment of
the present invention, there is shown a depth limiting transverse
tunnel drill 1800 having a stop element 1805 disposed thereon.
Drill 1800 may have anyone of the many tips known in the orthopedic
art, e.g., a standard fluted tip, a trocar tip, and a spade tip,
etc. Stop element 1805 is placed at a position along the length of
depth limiting transverse tunnel drill 1800 so as to limit the
depth of penetration of a distal tip 1810 of transverse tunnel
drill 1800 into femur 15 (FIG. 54). Stop element 1805 limits the
distal penetration of transverse tunnel drill 1800 by engaging
outrigger 1755 at distal end 1765 adjacent to proximal opening
1785, which allow only a distal portion 1815 to pass
therethrough.
[0234] In a preferred embodiment of the present invention, stop
element 1805 is adjustably or fixedly positioned along a portion of
depth limiting transverse tunnel drill 1800 and further comprises a
locking device so as to selectively determine the depth of
penetration of transverse tunnel drill 1800 into femur 15.
[0235] Referring now to FIGS. 55 and 56, and in a preferred
embodiment of the present invention, there is shown a depth gauge
1900 with a series of depth gauge markings 1905 configured thereon.
Depth gauge 1900 is configured to engage a transverse fixation pin
1910 at a distal end 1915 thereof for insertion and proper
placement into femur 15 (FIG. 56). Depth gauge markings 1905 of
depth gauge 1900 indicate the position of distal end 1915, and
hence the proximal end of the depth gauge, within femur 15.
Preferably, depth gauge markings 1905 are read relative to proximal
opening 1795 of drill sleeve 1775, which inserter 1900 passes
therethrough.
[0236] Referring to FIG. 52, and in a preferred embodiment of the
present invention, a method is disclosed for securing a graft
ligament in a bone tunnel. The method comprises a first step of
looping a graft ligament through a graft hole in a graft ligament
support block. This step is followed by the step of advancing the
graft ligament support block into the bone tunnel. The method
comprises a further step of determining a proper transverse tunnel
depth by reading a position of depth markers 1775 on drill sleeve
1770 relative to outrigger 1755. The method comprises a subsequent
step of forming a transverse tunnel in the host bone using
transverse tunnel drill 1770 having depth markers 1790 thereon so
as to drill the transverse tunnel to the proper transverse tunnel
depth, transverse is aligned a transverse fixation pin hole in the
graft ligament support block. The method comprises a final step of
pinning the graft ligament support block within the bone tunnel by
selecting a transverse fixation pin based on the proper transverse
tunnel depth determined by depth markers 1775 on drill sleeve 1770
and advancing the selected transverse fixation pin along the
transverse tunnel in the host bone and into the transverse fixation
pin hole in the graft ligament support block.
[0237] Referring still to FIG. 52, and in a preferred embodiment of
the present invention, a method is disclosed for securing a graft
ligament in a bone tunnel. The method comprises a first step of
determining a proper transverse tunnel depth by reading a position
of depth markers 1775 on drill sleeve 1770 relative to outrigger
1755. The method comprises a further step of forming a transverse
tunnel in the host bone using transverse tunnel drill 1700 having
depth markers 1790 thereon so as to drill the transverse tunnel to
the proper transverse tunnel depth. The method comprises a
subsequent step of looping a graft ligament through a graft hole in
a graft ligament support block. This step is followed by the step
of advancing the graft ligament support block into the bone tunnel
so that a transverse fixation pin hole in the graft ligament
support block is aligned with the transverse tunnel. The method
comprises a final step of pinning the graft ligament support block
within the bone tunnel by selecting a transverse fixation pin based
on the proper transverse tunnel depth determined by depth markers
1775 on drill sleeve 1770 and advancing a transverse fixation pin
along the transverse tunnel in the host bone and into the
transverse fixation pin hole in the graft ligament support
block.
[0238] Referring now to FIGS. 53 and 54, and in a preferred
embodiment of the present invention, a method is disclosed for
securing a graft ligament in a bone tunnel. The method comprises a
first step of looping a graft ligament through a graft hole in a
graft ligament support block. The method comprises a subsequent
step of advancing the graft ligament support block into the bone
tunnel. The method comprises another step of forming a transverse
tunnel in host bone 15 to a predetermined depth using transverse
tunnel drill 1800 having stop element 1805 at a predetermined
distance from the distal end thereof, and stop element 1805 is
configured to engage drill sleeve 1265 or distal end 1765 of
outrigger 1755 so as to limit drilling to the predetermined depth,
with said transverse tunnel being aligned with a transverse
fixation pin hole in the graft ligament support block. The method
comprises a final step of pinning the graft ligament support block
within the bone tunnel by advancing a transverse fixation pin along
the transverse tunnel in the host bone and into the transverse
fixation pin hole in the graft ligament support block.
[0239] Referring still to FIGS. 53 and 54, and in a preferred
embodiment of the present invention, a method is disclosed for
securing a graft ligament in a bone tunnel. The method comprises a
first step of forming a transverse tunnel in host bone 15 to a
predetermined depth using transverse tunnel drill 1800 having stop
element 1805 at a predetermined distance from the distal end
thereof, and stop element 1805 configured to engage a drill sleeve
or distal end 1765 of outrigger 1755 so as to limit drilling to the
predetermined depth. The method comprises a subsequent step of
looping a graft ligament through a graft hole in a graft ligament
support block. The method comprises a further step of advancing the
graft ligament support block into the bone tunnel so that a
transverse fixation pin hole in the graft ligament support block is
aligned with the transverse tunnel. The method comprises a final
step of pinning the graft ligament support block within the bone
tunnel by advancing a transverse fixation pin along the transverse
tunnel in the host bone and into the transverse fixation pin hole
in the graft ligament support block.
[0240] 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 for
supporting a graft ligament in a bone tunnel. The modified graft
ligament support block comprises a region configured therein for
drilling a transverse fixation pin hole through the body transverse
to the longitudinal axis as a crosspin hole is drilled through the
bone tunnel. Preferably, the modified graft ligament support block
further comprises a tapered proximal end so as to facilitate
withdrawal of the graft ligament support block through the bone
tunnel.
[0241] In the preceding discussion, the present invention has been
discussed on the context of an ACL reconstruction. However, it
should also be appreciated that the present invention may also be
used in connection with the other types of ligament reconstructions
and/or other types of anatomical reconstructions.
* * * * *