This application claims priority of German Patent Application No. 10 2004 053 464.0 filed on Nov. 3, 2004.
The invention relates to a pin for fixing an implant subjected to tensile load, in particular a tendon implant, said pin having a rod-shaped body, a force exerted by the implant being able to be input onto a cross section of the pin, on one side, and being able to be output on an opposite side to an anchoring site.
Pins of this kind are used to fix an implant fitted in an opening in a bone. To do this, the implant is first pushed into the opening, in most cases a bore that has been formed from the outside. The pin is then driven in transversely thereto, thus passing transversely through the bore and through the implant pushed into the latter, as a result of which said implant is fixed in position. Since the pin extends transversely with respect to the longitudinal extent of the implant, the expression “cross pin” has become established.
A common application is in fixing an implant serving as a replacement for the cruciate ligaments of the knee.
For replacing the cruciate ligament, an operating technique has been developed in which the implant or graft, in most cases a tendon from the patient, is formed into a loop, and the pin is driven transversely through it in the area of the loop. It is also known for two loose ends of tendon sections to be sewn together. When moving the knee a strong tension acts on the tendon implant which is transferred to the pin.
The tendon loops round the rod-shaped body of the pin in a cross-sectional plane. The result of this is that the tensile load exerted by the tendon is input into the rod-shaped body on one side of its cross section and can be output on the opposite side to anchoring sites which are axially spaced apart from the input side. This anchoring site is the inner wall, geometrically speaking a surface line of the wall, of a bore in which the pin is received.
Such pins usually have a circular cross section so that the force output site lies along a surface line of the rod-shaped body lying opposite the loop or cross-section side around which the loop is guided. Additionally, the force input side is located in the central section of the pin, the force output sides are located at the opposite end sections of the pin resting in the bone.
In the event of loading, this has the effect that the force input by the tendon implant is output to the anchoring site in a more or less limited area on the end sections of the pin.
A study has established that this geometry can cause the pin to fracture.
In order to remedy this situation, it was attempted to introduce a second identical pin, with a likewise circular cross section, directly below the first pin in the direction of the force input.
A further study has now shown that even the placement of a second adjacent pin is unable to exclude the possibility of fracturing. On the contrary, if the first pin fractures under strong tensile loading, then the second pin also fractures thereafter. There is, as it were, a kind of domino effect.
It is therefore an object of the present invention is to remedy this situation and make available a pin of the aforementioned type for fixing an implant subjected to tensile load, which pin is able to withstand high tensile loads without fracturing.
According to the invention, this object is achieved by the fact that the cross section has a longer dimension, in the direction of the force input from the tendon implant, than it has transverse to the longitudinal direction.
It was found that greater safety against fracturing can be achieved by means of a deviation from a round geometry and by arranging the pin in such a way that the longer cross-sectional dimension extends in the direction of the force input from the tendon implant.
A further advantage was found to be that the tendon engages around the implant about a relatively large circumference angle and across a large circumference surface area, resulting in planar contact of the tendon implant in the bore, which promotes incorporation of the tendon. The tendon is also more strongly compressed than by a round pin, resulting in better fixing.
In a further embodiment of the invention, the cross section of the pin is oval.
It was found that particularly favorable resistance to fracturing can be achieved with this geometry and that the tendon implant can bear intimately on the pin within a large area, thus promoting incorporation, which in the end also contributes to the resistance to fracturing, since a tendon firmly fused to the area surrounding the bone can divert some of the load via these growth points.
In a further embodiment, the cross section is configured as a flat oval.
Not only is this easy to obtain from the manufacturing point of view, this geometry corresponds approximately to the contour curve of two pins of circular cross section lying next to one another. This means that there does not have to be any more space than in the aforementioned operating techniques with two adjoining pins. However, a much greater resistance to fracturing is achieved.
This does not mean, however, that a pin with an oval cross section now necessarily has to have the size of an orbit of two conventional pins of circular cross section. It can be enough that the longer vertical axis of the cross-sectional profile corresponds to the diameter of a conventional pin.
The important thing is that there is a longer dimension in the direction of the force input, it being possible to use not only oval shapes curved concavely outward, but also bone shapes or other geometries.
It will be appreciated that the aforementioned features and those still to be discussed below can be used not only in the respectively cited combination, but also in other combinations, or singly, without departing from the scope of the present invention.
The invention is described and explained in more detail below using a number of illustrative embodiments and with reference to the attached drawings, in which:
A pin 10 shown in the
It will be seen from the view in
At its opposite ends, the flat oval 22 is delimited by two semicircles 24 and 25 which are connected via two mutually parallel side flanks 26 and 28.
The figure also shows how a tendon implant 30 is placed around the pin 20, specifically in the form of a loop 31.
The pin 20 is oriented in such a way that its long axis 32 is directed upward, that is to say in the direction of the force input by the tendon implant. The short axis 34 extends transverse thereto and also transverse to the longitudinal axis of the pin 20.
The pins have, for example, a length of ca. 40 mm and a diameter of approximately 4.5 mm.
They can be made from absorbable materials, from plastic material or from metal, in particular titanium or a titanium alloy.
For this purpose, a through-bore 38 has been formed in the tibia 36 and continues as a blind bore 42 in the femur 40.
A transverse bore 44 is also formed in the femur 40 to allow the pin 20 to be driven in, specifically in such a way that it extends through the loop 32 of the tendon implant 30, which was previously inserted into the blind bore 42.
The operating technique and the necessary auxiliary instruments for forming the bores 38, 42 and for correctly forming the transverse bore 44 and for fitting and securing the implant and the pin are described in particular in US 2003/0065391 A1 and in U.S. Pat. No. 5,601,562, express reference being made to the content of these documents.
If a pin of oval cross section is to be fitted, a drill is first used to form the transverse bore 44 with a round cross section, and a dilator with approximately the same contour as the pin 20 is then driven in. The dilator is in this case slightly smaller than the pin 20 to ensure that a press fit is obtained when the pin 20 is introduced. The oval pin is in each case introduced as shown in
As can be seen from
In the embodiment of
Number | Date | Country | Kind |
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10 2004 053 464.0 | Nov 2004 | DE | national |