The present invention relates generally to anterior cruciate ligament (ACL) reconstruction, and specifically to tissue graft fixation with tension adjustment.
In general, anterior cruciate ligament (ACL) reconstruction involves replacing a torn ACL with tissue taken from a patient (autograft) or taken from a tissue donor (allograft). The procedure is usually done arthroscopically and involves making tunnels in the femur and tibia allowing passage of the graft material in order to reconstruct the ACL. During the procedure, there is typically an inherent graft weakness during a period after implantation when allograft and autograft tissues undergo necrosis, revascularization, and cellular proliferation. A graft fixation site for bone-tendon-bone (BTB) ACL reconstructions tends to be a weak link in the fixation construct and it is important to achieve strong fixation. Prior approaches have used interference screws, ENDOBUTTON® type devices, double spiked plates, and so forth, to achieve strong fixation.
What is needed is an apparatus that provides increased fixation strength while providing a way to adjust a tension of a graft at a time of fixation.
The following presents a simplified summary of the innovation in order to provide a basic understanding of some aspects of the invention. This summary is not an extensive overview of the invention. It is intended to neither identify key or critical elements of the invention nor delineate the scope of the invention. Its sole purpose is to present some concepts of the invention in a simplified form as a prelude to the more detailed description that is presented later.
The present invention is directed towards a method and an apparatus for tissue graft fixation with tension adjustment.
In an aspect, the invention features a tissue graft fixation device including a main body part provided with a pair of suture through holes positioned on opposite sides of a spherically radiused screw through hole, the pair of suture through holes sized to receive sutures, the spherically radiused screw through hole sized to receive a radiused head of a securing screw, and two spike parts extending substantially parallel to each other from an underside of the main body, the spike parts spaced apart at a predetermined distance slightly shorter than a diameter of a formed bone tunnel and adapted be stricken into a bone.
In another aspect, the invention features a method including providing a tendon graft comprised of tibial and femoral bone blocks each attached to a respective end of a tendon, each of the bone blocks made of a piece of bone, forming a femur-side bone tunnel in a femur and a tibia-side bone tunnel in a tibia, the tibia-side bone tunnel possessing an opening which opens to outside the tibia, threading sutures through the tibial and femoral bone blocks wherein ends of the threaded sutures are used for navigation and tensioning, providing a fixation device, the fixation device including a main body part provided with a pair of suture through holes positioned on opposites sides of a spherically radiused screw through hole, the pair of suture through holes sized to receive sutures, the spherically radiused screw through hole sized to receive a radiused head of a securing screw, and two spike parts extending substantially parallel to each other from an underside of the main body, the spike parts spaced apart at a predetermined distance slightly shorter than a diameter of a formed bone tunnel and adapted be stricken into a bone, positioning the fixation device approximately over a center of the tibia-side bone tunnel with a guide wire and impactor, the centering enabling the two spikes to engage the walls of the tunnel, using the impactor to fixate the fixation device into an approximate center of the bone, placing the screw over the guide wire, tensioning the graft using the suture ends and a tension gage, and articulating the screw to relieve the tensioned graft.
In another aspect, the invention features an apparatus including a drill guide configured to drill a guide wire into an approximate center of a bone block, the drill guide including a base supporting a drill channel, a bone graft secured to a distal end of the drill channel, wherein a first cannulated portion is placed within a second cannulated portion which centers the first cannulated portion through a center of the drill channel, the first cannulation guiding placement of the guide wire, the second cannulated portion guiding a cannulated drill over the previous placed guide wire to endure concentric location of each drill with respect to the bone block.
Embodiments of the invention may have one or more of the following advantages.
A tissue graft fixation device enables increased fixation strength while providing a manner to adjust a tension of a graft at the time of fixation during anterior cruciate ligament (ACL) reconstruction.
A screw through hole of the tissue graft fixation device is spherically radiused to receive a radiused head of a securing screw, which enables angulation of the securing screw.
These and other features and advantages will be apparent from a reading of the following detailed description and a review of the associated drawings. It is to be understood that both the foregoing general description and the following detailed description are explanatory only and are not restrictive of aspects as claimed.
The invention will be more fully understood by reference to the detailed description, in conjunction with the following figures, wherein:
The subject innovation is now described with reference to the drawings, wherein like reference numerals are used to refer to like elements throughout. In the following description, for purposes of explanation, numerous specific details are set forth in order to provide a thorough understanding of the present invention. It may be evident, however, that the present invention may be practiced without these specific details. In other instances, well-known structures and devices are shown in block diagram form in order to facilitate describing the present invention.
In the description below, the term “or” is intended to mean an inclusive “or” rather than an exclusive “or.” That is, unless specified otherwise, or clear from context, “X employs A or B” is intended to mean any of the natural inclusive permutations. That is, if X employs A, X employs B, or X employs both A and B, then “X employs A or B” is satisfied under any of the foregoing instances. Moreover, articles “a” and “an” as used in the subject specification and annexed drawings should generally be construed to mean “one or more” unless specified otherwise or clear from context to be directed to a singular form.
Some embodiments may be described using the expression “one embodiment” or “an embodiment” along with their derivatives. These terms mean that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. The appearances of the phrase “in one embodiment” in various places in the specification are not necessarily all referring to the same embodiment.
Some embodiments may be described using the expression “coupled” and “connected” along with their derivatives. These terms are not necessarily intended as synonyms for each other. For example, some embodiments may be described using the terms “connected” and/or “coupled” to indicate that two or more elements are in direct physical or electrical contact with each other. The term “coupled,” however, may also mean that two or more elements are not in direct contact with each other, but yet still co-operate or interact with each other.
The present disclosure will be used with reference to an anterior cruciate ligament (ACL) reconstruction, but it will be understood that the technology and methods of the present invention may have other applications for reconstruction of other parts of body. In addition, the present disclosure is used with reference to placement in a tibia, but it will be understood that the technology and methods of the present invention may used for femoral placement.
As fully described below, the tissue graft fixation device of the present invention is used in a ligament reconstruction operation to fix a tendon graft having a bone plug that can be inserted into a bone tunnel formed in a bone. In other words, the tissue graft fixation device of the present invention is used to fix a bone plug attached to at least one end of a tendon graft inside a bone tunnel formed at a portion where the tendon graft is to be transplanted and other end of the tendon graft is fixed. The tissue graft fixation device of the present invention is a tensile force-adjustable fixing tool.
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The tissue graft fixation device 10 may be constructed from stainless steel, titanium, tungsten, a polymeric material and so forth.
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The two spike parts 35, 40 located on the underside of the main body part 15 are spaced at a predetermined interval shorter than a diameter of a formed bone tunnel. It is preferable that the interval between the spike parts 35, 40 is shorter than a diameter of an open portion of a bone tunnel to such an extent that the tissue graft fixation device 10 can be stricken into a bone, such as a tibia, while breaking a periphery of the open portion of the bone tunnel. It is more preferable that the interval between the spike parts 35, 40 is 0.5 mm (0.020 in.) shorter than the diameter of the bone tunnel. For example, if a diameter of a bone tunnel is 10 mm (0.394 in.), the interval between spike parts 35, 50 is preferred to be 9.5 mm (0.374 in.). In another example, if a diameter of a bone tunnel is 13 mm (0.512 in.), the interval between spike parts 35, 50 is preferred to be 12.5 mm (0.492 in.).
Each of the spike parts 35, 40 includes a main spike portion 45, 50, respectively, and a tapered tip portion 55, 60 respectively. In embodiments, the tapered tip portions 55, 60 are multifaceted. In one example, the tapered tip portions include faces 56, 57, 58, 61, 62, respectively, as shown in
Referring again to
It is preferable that each of the tapered tip portions 55, 60 are positioned at approximately a forty-five (45) degree angle inwardly from each of the main spike portions 45, 50.
A method for tibial fixation of a BTB ACL reconstruction using the tissue graft fixation device will now be described.
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The drill guide 130 includes a base 137 supporting a drill channel 140. The BTB graft 135 is secured to a distal end 145 of the drill channel. A first cannulated portion 147 is placed within a second cannulated portion 150, which centers the first cannulated portion 147 through a center of the drill channel 140 and thus into a center of the bone block 155, resulting in a centered hole in the bone block.
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While this invention has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the spirit and scope of the present application as defined by the appended claims. Such variations are intended to be covered by the scope of this present application. As such, the foregoing description of embodiments of the present application is not intended to be limiting. Rather, any limitations to the invention are presented in the following claims.
This application claims priority to U.S.Provisional Application No. 61/993,336, filed May 15, 2014, the entire contents of which is hereby incorporated by reference.
Filing Document | Filing Date | Country | Kind |
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PCT/US2015/031055 | 5/15/2015 | WO | 00 |
Number | Date | Country | |
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61993336 | May 2014 | US |