WO1997020522A1 - Surgical anchorage - Google Patents
Surgical anchorage Download PDFInfo
- Publication number
- WO1997020522A1 WO1997020522A1 PCT/GB1996/002985 GB9602985W WO9720522A1 WO 1997020522 A1 WO1997020522 A1 WO 1997020522A1 GB 9602985 W GB9602985 W GB 9602985W WO 9720522 A1 WO9720522 A1 WO 9720522A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- limbs
- bone tunnel
- length
- loop
- leading
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0417—T-fasteners
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
- A61F2002/0847—Mode of fixation of anchor to tendon or ligament
- A61F2002/0852—Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
- A61F2002/0847—Mode of fixation of anchor to tendon or ligament
- A61F2002/087—Anchor integrated into tendons, e.g. bone blocks, integrated rings
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
- A61F2/0811—Fixation devices for tendons or ligaments
- A61F2002/0876—Position of anchor in respect to the bone
- A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone
Definitions
- This invention relates to a surgical anchorage for a ligament (or tendon) substitute or replacement, which may consist of artificial material such as polyester fabric, or natural material such as autogenous tendon or allogenic ligament or tendon, hereinafter referred to simply as a ligament substitute
- a ligament substitute for a knee is introduced into the joint through bone tunnels or bores through the tibia and femur located to open into the cavity of the knee joint at the anatomical attachment site of the natural ligament, and the ligament substitute is anchored or attached firmly within or at the distal ends of the bone tunnels
- Anchorage or fixation within the bone tunnels may be provided, for instance, by the following methods -
- suture tape or wire attached to the ligament substitute and tied to a screw or a bollard which is placed through the outer cortical surface of the bone and anchored in a drill hole through the bone
- This additional drill hole can substantially weaken the bone
- This method of anchorage requires a separate skin incision to expose the bone In this way it increases the invasive nature of the operation, the remainder of which can be performed by a minimally- invasive or endoscopic technique
- the surgical procedure usually requires an additional incision to gain access to the bone
- An endoscopic or minimally-invasive technique using an "Endobutton” is known This involves making the distal femoral hole in two different diameters, the proximal part being large enough to accommodate the ligament substitute, and the distal part being small enough to take the endobutton on its side, but not large enough to allow it to return down the hole after it has been manipulated to lie transversely across the end of the drill hole.
- the assembly is then attached to a long needle or sharpened guide wire which is introduced and passed into the tibial end of the drill hole, and through the soft tissues of the thigh
- the threads attached to the extremities of the Endobutton are used to manipulate the Endobutton into position on the femoral cortex at the distal end of the drill hole
- the procedure is d ⁇ Bcult as it involves careful planning of the lengths of drill holes and of the tape required to match these lengths It involves pulling the guide sutures on the Endobutton one at a time to manipulate it into position across the mouth of the drill hole This procedure has to be performed either "blind” or by the use of X-rays with image intensification which is expensive and time-consuming
- the object of the present invention is to provide an anchorage device for a ligament
- an anchorage device for a ligament substitute in a bone tunnel comprises leading and trailing limbs in general alignment with each other, and a body part laterally offset from the leading and trailing limbs, the body part providing a loop for attachment of the ligament substitute, and each of the limbs having an eye, for temporary attachment of pulling threads, the overall lateral width of the device being less than the diameter of the bone
- the device to enable the device to be pulled through the bone tunnel by a pulling thread temporarily attached to the leading limb, the overall length of the device between the remote ends of the limbs being greater than the diameter of the bone tunnel, to enable the device to span the distal
- the breadth of the body part in the lengthwise direction of the limbs being less than the diameter of the bone tunnel, to enable the body part to locate in the distal end
- the device is preferably symmetrical about an imaginary line perpendicular to the limbs at the middle of the loop of the body part, so that either limb can be the leading limb or the trailing hmb
- the device may be formed from a single length of small diameter rod or wire (e g of stainless steel), with a mid-portion bent to form a substantially semicircular loop, from the ends of which the leading and trailing limbs extend respectively in opposite directions in substantially
- the mid- portion may be bent almost into a full circle, from the spaced ends of which the end portions of wire are bent away from but in axial alignment with each other, to form the leading and trailing limbs, with curled eyes at their respective remote ends, again, the mid-portton may be coiled to form a full circular loop, from the overlapping ends of which the leading and trailing limbs continue tangentially in opposite directions to curled eyes at their remote ends
- the device may be formed from two (or more) lengths of rod or wire, one length being straight except for curled eyes at the remote ends of the limbs constituted by that length, while the other length is bent into a semicircular loop, the ends of which are welded symmetrically to the straight length, or the other length is bent into a full or an almost full
- the eyes preferably both lie in the same general plane as the body part, loop and limbs, and both preferably extend laterally from the limbs to the same side as the body part and loop, so as to avoid any protrusion liable to snag on the proximal end of the bone tunnel
- a device in accordance with the invention may alternatively be formed in one piece in biocompatible rigid plastics material or ceramic, or by stamping or otherwise cutting out from metal plate (e g , of stainless steel or titanium)
- the surgical technique using the device of the invention comprises attaching pulling threads to the eyes of the limbs, attaching a ligament substitute to the loop of the body part, threading the pulling thread attached to the leading limb through the bone tunnel from its proximal end by means of, for example, a needle-like tool of sufficient length until it emerges from the distal end of the bone tunnel and through the muscles, soft tissue and skin beyond, then pulling the device through the bone tunnel by means of the thread attached to the leading limb (possibly assisted by pushing the device by means of, for example, a tubular or semi-tubular introducer fitting on to the trailing limb and furnished with a handle) with the ligament substitute trailing from the loop of the body part and the other pulling thread trailing from the trailing limb, until the device emerges completely beyond the distal end of the bone tunnel
- the device will be initially aligned longitudinally relative to the bone tunnel by initial traction of the leading pulling thread through the bone tunnel, and/or by propulsion of the device by means of the introducer engaged with the trailing limb
- the device can be released, if need be, by pulling on the leading thread until the device is pulled far enough from the distal end of the bone tunnel for pulling on the trailing thread in opposition to pulling on the leading thread to again align the device longitudinally relative to the bone tunnel, whereafter continued pulling of the trailing thread (after releasing the leading thread) retracts the device with the ligament substitute and the leading thread (now trailing) back through the bone tunnel
- the device may be attached to the ligament substitute by looping the latter round the loop of the body part or by means of sutures or threads, and the latter may be remove to release the device from the ligament substitute when biological attachment has occurred, or the sutures or threads may be bioabsorbable
- the ligament substitute may be looped round one end of a link the other end of which is looped round the loop of the body part
- the loop in the body of the device may be incomplete (i.e., formed with a gap), to enable sutures or threads connecting it to a ligament substitute to be released by tilting the device (i.e , until the sutures or threads pass through the gap)
- Figure 2 is an end elevation of the device of Figure 1
- Figure 3 is a side elevation of a link for use with the device of Figures 1 and 2
- Figure 4 is a fragmentary section along a bone tunnel showing the device of Figures 1 and 2 and the link of Figure 3 in use to pull a ligament substitute through a bone tunnel
- FIG. 5 corresponds to Figure 4 but shows the position of the device upon emerging from
- Figure 6 also corresponds to Figure 4 but shows the device in position anchoring the
- FIGs 7 to 1 1 inclusive are side elevations of alternative embodiments of anchorage devices in accordance with the invention, all made with rod or wire
- leading and trailing limbs 15, 16 in general alignment with each other, and a body part 17 having a loop 18 for attachment of the ligament substitute, as by looping the ligament substitute round one end of a link 19 the other end of which is looped round the loop of the body part, and each of the limbs having an eye 20 for temporary attachment of pulling threads.
- the device 12 is symmetrical about an imaginary line perpendicular to the limbs 15, 16 at the middle of the loop 18, so that either limb can be the leading limb or the trailing limb.
- the device 12 shown in Figures 1 to 6 is formed in one piece in biocompatible rigid plastics material or ceramic, or from metal plate such as stainless steel or titanium.
- a pulling thread 23 is attached to the trailing limb 16 for a purpose to be described presently.
- the device is pulled into and through the bone tunnel by threading the pulling thread 21 attached to the leading limb 15 through the bone tunnel from its proximal end (not shown) by means of, for example, a needle-like tool (not shown) of sufficient length until it emerges from the distal end 22 of the bone tunnel and through the muscles, soft tissue and skin beyond (none of which is shown), with the ligament substitute 13 trailing from the link 19 which itself trails from
- the pulling thread 23 attached to the trailing limb 16 trails slackly therefrom.
- Pulling of the device 12 through the bone tunnel 14 may be assisted by pushing the device by means of, for example, a tubular or semi-tubular introducer (not shown) fitting on the trailing limb and furnished with a handle
- the device becomes reorientated spanning the distal end 22 of the bone tunnel 14 with the body part 17 pulled into the bone tunnel to secure it and the ligament substitute 13 in position. If during the operative procedure, the device needs to be released, this can be effected by pulling on the leading thread 21 until the device is pulled far enough from the distal end 22 of the bone tunnel 14 for pulling on the trailing thread 23 in opposition to pulling on the leading thread aligns the device again longitudinally relative to the bone tunnel, whereafter continued pulling of
- the device 12 may be attached to the ligament substitute 13
- the ligament substitute when biological attachment has occurred or the sutures or threads may be bioabsorbable.
- a link or sutures or threads may be used to attach to a ligament substitute any one of the alternative devices shown in Figures 7 to 1 1 made from small diameter rod or wire, or the ligament may be looped directly round the loop 18 of the respective body part 17.
- the device 12 is formed from a single length of rod or wire (e.g of stainless steel) with a mid-portion 17 bent to form a substantially semicircular loop 18 from the ends of which the leading and trailing limbs 15, 16 extend respectively in opposite directions in substantially axial alignment with each other, and the remote ends of the limbs ar curled to form substantially circular eyes 20
- a single length of rod or wire may be bent almost into a full circle forming the body part 17 and loop 18, from the spaced ends of which the end portions of wire are bent away from each other to form the limbs 15, 16, with curled eyes 20 at their respective remote ends, and the bends 27, 28 are shown welded together.
- the mid-portion 17 of a single length of rod or wire may be coiled to form a full circular loop 18, from the overlapping ends of which the leading and trailing limbs 15, 16 continue tangentially in opposite directions to curled eyes 20 at their remote ends.
- the devices 12 are each formed from two lengths of rod or wire, one length 29 being straight except for curled eyes 20 at the remote ends of the limbs 15, 16 constituted by that length, while the other length 17 is bent to provide a semicircular loop 18, the ends 30 of which are welded symmetrically to the straight length, as shown in Figure 10, or, as shown in Figure 1 1 , the other length 17 is bent to provide a full (or almost full) circular loop 18 the ends 31 of which are welded symmetrically to the straight length
- the eyes 20 of the wire devices 12 both lie in the same general plane as the body part 17, loop 18 and limbs 15, 16 and both extend laterally from the limbs to the same side as the body part and loop, so as to avoid any protrusion liable to snag on the proximal end of the bone tunnel
Abstract
An anchorage device (12) for a ligament substitute (13) in a bone tunnel (14) has leading and trailing limbs (15, 16) with eyes (20) for temporary attachment of pulling threads (21, 23), and a body part (17) providing a loop (18) for attachment of the ligament substitute, as by a link (19), the overall lateral width (W) of the device (12) being less than the diameter (D) of the bone tunnel (14), to enable the device to be pulled through by the leading pulling thread (21), the overall length (L) of the device being greater than the diameter (D) of the bone tunnel, to enable the device to span the distal end (22) of the bone tunnel, and the breadth (B) of the body part (17) being less than the diameter (D) of the bone tunnel, to enable the body part to locate in the distal end of the bone tunnel when the device spans the distal end of the bone tunnel.
Description
SURGICAL ANCHORAGE
This invention relates to a surgical anchorage for a ligament (or tendon) substitute or replacement, which may consist of artificial material such as polyester fabric, or natural material such as autogenous tendon or allogenic ligament or tendon, hereinafter referred to simply as a ligament substitute A ligament substitute for a knee is introduced into the joint through bone tunnels or bores through the tibia and femur located to open into the cavity of the knee joint at the anatomical attachment site of the natural ligament, and the ligament substitute is anchored or attached firmly within or at the distal ends of the bone tunnels
Anchorage or fixation within the bone tunnels may be provided, for instance, by the following methods -
1 a suture tape or wire attached to the ligament substitute and tied to a screw or a bollard which is placed through the outer cortical surface of the bone and anchored in a drill hole through the bone
2 an "interference screw" which holds the ligament substitute by interference of the
screw threads between the bony wall of the tunnel and the ligament substitute
3 the use of sutures or tape through the ligament substitute and tied through a "button" or over a "toggle" placed across the end of the bone tunnel
With respect to minimally-invasive surgery, disadvantages of the above are the following -
1 Anchorage to a bollard or screw requires drilling through the cortex of the bone at right
angles to the direction of the bone tunnel transmitting the ligament or tendon substitute This additional drill hole can substantially weaken the bone This method of anchorage requires a separate skin incision to expose the bone In this way it increases the invasive nature of the operation, the remainder of which can be performed by a minimally- invasive or endoscopic
technique
2 An interference screw which is positioned alongside a tendon graft or ligament substitute can hold it firmly against the cancellous bone on the side of a bone tunnel This method suffers the disadvantage of possible damage to the ligament substitute It also deforms the area of attachment of the ligament substitute with the danger of creating biomechanical inaccuracy of the constraint which is intended to be created by the ligament substitute Most interference screws are manufactured in metal, which creates artifactual distortion of magnetic resonance (MR) images Since ligaments and soft tissues are best seen by MR imaging, a further disadvantage of interference screw fixation is MR image distortion in the postoperative period This means that the assessment of subsequent injuries becomes difficult after interference screw fixation A further disadvantage of interference screw fixation is the difficulty encountered when an interference screw needs to be removed for purposes of revising the operation, should failure or reinjury occur
3 When a ligament substitute is tied to a button at the external aperture of the drill hole
in bone, the surgical procedure usually requires an additional incision to gain access to the bone
at the distal end of the drill hole
An endoscopic or minimally-invasive technique using an "Endobutton" is known This involves making the distal femoral hole in two different diameters, the proximal part being large enough to accommodate the ligament substitute, and the distal part being small enough to take the endobutton on its side, but not large enough to allow it to return down the hole after it has been manipulated to lie transversely across the end of the drill hole The surgical technique
involves placing threads through holes in the extremities of the bar- shaped Endobutton, which
is tied to the graft by means of a tape or strong sutures through a pair of holes at the middle of
the Endobutton The assembly is then attached to a long needle or sharpened guide wire which
is introduced and passed into the tibial end of the drill hole, and through the soft tissues of the thigh The threads attached to the extremities of the Endobutton are used to manipulate the Endobutton into position on the femoral cortex at the distal end of the drill hole The procedure is dϋBcult as it involves careful planning of the lengths of drill holes and of the tape required to match these lengths It involves pulling the guide sutures on the Endobutton one at a time to manipulate it into position across the mouth of the drill hole This procedure has to be performed either "blind" or by the use of X-rays with image intensification which is expensive and time-consuming
The object of the present invention is to provide an anchorage device for a ligament
substitute in a bone tunnel for use with a minimally-invasive surgical technique without the disadvantages associated with any of the above methods and devices
According to the present invention, an anchorage device for a ligament substitute in a bone tunnel comprises leading and trailing limbs in general alignment with each other, and a body part laterally offset from the leading and trailing limbs, the body part providing a loop for attachment of the ligament substitute, and each of the limbs having an eye, for temporary attachment of pulling threads, the overall lateral width of the device being less than the diameter of the bone
tunnel, to enable the device to be pulled through the bone tunnel by a pulling thread temporarily attached to the leading limb, the overall length of the device between the remote ends of the limbs being greater than the diameter of the bone tunnel, to enable the device to span the distal
end of the bone tunnel, and the breadth of the body part in the lengthwise direction of the limbs being less than the diameter of the bone tunnel, to enable the body part to locate in the distal end
of the bone tunnel when the device spans the distal end of the bone tunnel
The device is preferably symmetrical about an imaginary line perpendicular to the limbs at the middle of the loop of the body part, so that either limb can be the leading limb or the trailing
hmb
The device may be formed from a single length of small diameter rod or wire (e g of stainless steel), with a mid-portion bent to form a substantially semicircular loop, from the ends of which the leading and trailing limbs extend respectively in opposite directions in substantially
axial alignment with each other, and the remote ends of the limbs are curled to form substantially circular eyes, alternatively, the mid- portion may be bent almost into a full circle, from the spaced ends of which the end portions of wire are bent away from but in axial alignment with each other, to form the leading and trailing limbs, with curled eyes at their respective remote ends, again, the mid-portton may be coiled to form a full circular loop, from the overlapping ends of which the leading and trailing limbs continue tangentially in opposite directions to curled eyes at their remote ends
Alternatively, the device may be formed from two (or more) lengths of rod or wire, one length being straight except for curled eyes at the remote ends of the limbs constituted by that length, while the other length is bent into a semicircular loop, the ends of which are welded symmetrically to the straight length, or the other length is bent into a full or an almost full
circular loop, the ends of which are welded symmetrically to the straight length, or, again, the other length may be bent into a full circle, the mating ends of which are welded to each other and
to the middle of the straight length
The eyes preferably both lie in the same general plane as the body part, loop and limbs, and both preferably extend laterally from the limbs to the same side as the body part and loop, so as to avoid any protrusion liable to snag on the proximal end of the bone tunnel
A device in accordance with the invention may alternatively be formed in one piece in biocompatible rigid plastics material or ceramic, or by stamping or otherwise cutting out from metal plate (e g , of stainless steel or titanium)
The surgical technique using the device of the invention comprises attaching pulling threads to the eyes of the limbs, attaching a ligament substitute to the loop of the body part, threading the pulling thread attached to the leading limb through the bone tunnel from its proximal end by means of, for example, a needle-like tool of sufficient length until it emerges from the distal end of the bone tunnel and through the muscles, soft tissue and skin beyond, then pulling the device through the bone tunnel by means of the thread attached to the leading limb (possibly assisted by pushing the device by means of, for example, a tubular or semi-tubular introducer fitting on to the trailing limb and furnished with a handle) with the ligament substitute trailing from the loop of the body part and the other pulling thread trailing from the trailing limb, until the device emerges completely beyond the distal end of the bone tunnel, then by pulling on the ligament substitute in the opposite direction to the leading pulling thread, which is released, the device becomes reorientated spanning the distal end of the bone tunnel, and further slight pulling on the ligament substitute pulls the body part into the bone tunnel to secure it and the ligament substitute in position
It will be appreciated that the device will be initially aligned longitudinally relative to the bone tunnel by initial traction of the leading pulling thread through the bone tunnel, and/or by propulsion of the device by means of the introducer engaged with the trailing limb
During the operative procedure the device can be released, if need be, by pulling on the leading thread until the device is pulled far enough from the distal end of the bone tunnel for pulling on the trailing thread in opposition to pulling on the leading thread to again align the device longitudinally relative to the bone tunnel, whereafter continued pulling of the trailing thread (after releasing the leading thread) retracts the device with the ligament substitute and the leading thread (now trailing) back through the bone tunnel
The device may be attached to the ligament substitute by looping the latter round the loop
of the body part or by means of sutures or threads, and the latter may be remove to release the device from the ligament substitute when biological attachment has occurred, or the sutures or threads may be bioabsorbable Again, the ligament substitute may be looped round one end of a link the other end of which is looped round the loop of the body part
The loop in the body of the device may be incomplete (i.e., formed with a gap), to enable sutures or threads connecting it to a ligament substitute to be released by tilting the device (i.e , until the sutures or threads pass through the gap)
Embodiments of the invention will now be described, by way of example only, with reference to the accompanying diagrammatic drawings, all of which are approximately four times normal size and in which - Figure 1 is a side elevation of a preferred form of anchorage device in accordance with the invention;
Figure 2 is an end elevation of the device of Figure 1,
Figure 3 is a side elevation of a link for use with the device of Figures 1 and 2, Figure 4 is a fragmentary section along a bone tunnel showing the device of Figures 1 and 2 and the link of Figure 3 in use to pull a ligament substitute through a bone tunnel,
Figure 5 corresponds to Figure 4 but shows the position of the device upon emerging from
the bone tunnel;
Figure 6 also corresponds to Figure 4 but shows the device in position anchoring the
ligament substitute, and Figures 7 to 1 1 inclusive are side elevations of alternative embodiments of anchorage devices in accordance with the invention, all made with rod or wire
In Figures 1 to 6, an anchorage device 12 for a ligament substitute 13 in a bone tunnel 14
comprises leading and trailing limbs 15, 16 in general alignment with each other, and a body part
17 having a loop 18 for attachment of the ligament substitute, as by looping the ligament substitute round one end of a link 19 the other end of which is looped round the loop of the body part, and each of the limbs having an eye 20 for temporary attachment of pulling threads.
The overall lateral width W of the device 12 less than the diameter D of the bone tunnel 14, to enable the device to be pulled through the bone tunnel by a pulling thread 21 temporarily attached to the leading limb 15 (see Figure 4), the overall length L of the device between the remote ends of the limbs is greater than the diameter of the bone tunnel to enable the device to span the distal end 22 of the bone tunnel (see Figure 6), and the breadth B of the body part 17 in the lengthwise direction of the limbs is less than the diameter of the bone tunnel, to enable the body part to locate in the distal end of the bone tunnel when the device spans the distal end of the bone tunnel.
The device 12 is symmetrical about an imaginary line perpendicular to the limbs 15, 16 at the middle of the loop 18, so that either limb can be the leading limb or the trailing limb.
The device 12 shown in Figures 1 to 6 is formed in one piece in biocompatible rigid plastics material or ceramic, or from metal plate such as stainless steel or titanium.
Before the device 12 is pulled into the bone tunnel 14, a pulling thread 23 is attached to the trailing limb 16 for a purpose to be described presently.
The device is pulled into and through the bone tunnel by threading the pulling thread 21 attached to the leading limb 15 through the bone tunnel from its proximal end (not shown) by means of, for example, a needle-like tool (not shown) of sufficient length until it emerges from the distal end 22 of the bone tunnel and through the muscles, soft tissue and skin beyond (none of which is shown), with the ligament substitute 13 trailing from the link 19 which itself trails from
the loop 18 of the body part 17 of the anchorage device 12. The pulling thread 23 attached to the trailing limb 16 trails slackly therefrom.
Pulling of the device 12 through the bone tunnel 14 may be assisted by pushing the device by means of, for example, a tubular or semi-tubular introducer (not shown) fitting on the trailing limb and furnished with a handle
Without such assistance, and as indicated in Figure 4, the pull on the leading pulling thread
21 (which pull is indicated by the arrow 24) and the drag on the ligament substitute 13 (which drag is indicated by the broken arrows 25) imposes a moment on the device 12 such that the end of the trailing limb 16 rides along the wall of the bone tunnel 14 until, as the device emerges from the distal end 22 of the bone tunnel, the device rotates farther under the influence of that moment and brings the end of the trailing limb on to the bone surface adjacent the distal end of the bone tunnel, as shown in Figure 5. Then, by pulling on the ligament substitute 13 in the opposite direction to the leading pulling thread 21, which is released, (and which pull on the ligament substitute is indicated by the arrows 26 in Figure 6) the device becomes reorientated spanning the distal end 22 of the bone tunnel 14 with the body part 17 pulled into the bone tunnel to secure it and the ligament substitute 13 in position. If during the operative procedure, the device needs to be released, this can be effected by pulling on the leading thread 21 until the device is pulled far enough from the distal end 22 of the bone tunnel 14 for pulling on the trailing thread 23 in opposition to pulling on the leading thread aligns the device again longitudinally relative to the bone tunnel, whereafter continued pulling of
the trailing thread (after releasing the leading thread) retracts the device with the ligament substitute and the leading thread (now trailing) back through the bone tunnel
Alternatively to the link 19, the device 12 may be attached to the ligament substitute 13
by means of sutures or threads (not shown), and the latter may be cut to release the device from
the ligament substitute when biological attachment has occurred, or the sutures or threads may
be bioabsorbable.
A link or sutures or threads may be used to attach to a ligament substitute any one of the alternative devices shown in Figures 7 to 1 1 made from small diameter rod or wire, or the ligament may be looped directly round the loop 18 of the respective body part 17.
In Figure 7 the device 12 is formed from a single length of rod or wire (e.g of stainless steel) with a mid-portion 17 bent to form a substantially semicircular loop 18 from the ends of which the leading and trailing limbs 15, 16 extend respectively in opposite directions in substantially axial alignment with each other, and the remote ends of the limbs ar curled to form substantially circular eyes 20
Altematively, and as shown in Figure 8, a single length of rod or wire, may be bent almost into a full circle forming the body part 17 and loop 18, from the spaced ends of which the end portions of wire are bent away from each other to form the limbs 15, 16, with curled eyes 20 at their respective remote ends, and the bends 27, 28 are shown welded together.
Again, and as shown in Figure 9, the mid-portion 17 of a single length of rod or wire may be coiled to form a full circular loop 18, from the overlapping ends of which the leading and trailing limbs 15, 16 continue tangentially in opposite directions to curled eyes 20 at their remote ends.
In Figures 10 and 11 the devices 12 are each formed from two lengths of rod or wire, one length 29 being straight except for curled eyes 20 at the remote ends of the limbs 15, 16 constituted by that length, while the other length 17 is bent to provide a semicircular loop 18, the ends 30 of which are welded symmetrically to the straight length, as shown in Figure 10, or, as shown in Figure 1 1 , the other length 17 is bent to provide a full (or almost full) circular loop 18 the ends 31 of which are welded symmetrically to the straight length
The eyes 20 of the wire devices 12 both lie in the same general plane as the body part 17,
loop 18 and limbs 15, 16 and both extend laterally from the limbs to the same side as the body part and loop, so as to avoid any protrusion liable to snag on the proximal end of the bone tunnel
Claims
1. An anchorage device for a ligament substitute in a bone tunnel comprising leading and trailing limbs in general alignment with each other, and a body part laterally offset from the leading and trailing limbs; the body part providing a loop for attachment of the ligament substitute; and each of the limbs having an eye, for temporary attachment of pulling threads; the overall lateral width of the device being less than the diameter of the bone tunnel, to enable the device to be pulled through the bone tunnel by a pulling thread temporarily attached to the leading limb; the overall length of the device between the remote ends of the limbs being greater than the diameter of the bone tunnel, to enable the device to span the distal end of the bone tunnel; and the breadth of the body part in the lengthwise direction of the limbs being less than the diameter of the bone tunnel, to enable the body part to locate in the distal end of the bone tunnel when the device spans the distal end of the bone tunnel.
2. A device as in Claim 1, the device being symmetrical about an imaginary line perpendicular to the limbs at the middle of the loop of the body part, so that either limb can be the leading limb or the trailing limb. 3 A device as in Claim 1 or Claim 2, the device being formed from a single length of
small diameter rod or wire with a mid-portion bent to form a substantially semicircular loop, from the ends of which the leading and trailing limbs extend respectively in opposite directions in substantially axial alignment with each other, and the remote ends of the limbs are curled to form substantially circular eyes. 4. A device as in Claim 1 or Claim 2, the device being formed from a single length of small diameter rod or wire with a mid-portion bent almost into a full circle, from the spaced ends of which the end portions of wire are bent away from but in axial alignment with each other, to
form the leading and trailing limbs, with curled eyes at their respective remote ends. 5 A device as in Claim 1 or Claim 2, the device being formed from a single length of small diameter rod or wire with a mid-portion coiled to form a full circular loop, from the overlapping ends of which the leading and trailing limbs continue tangentially in opposite directions to curled eyes at their remote ends
6 A device as in Claim 1 or Claim 2, the device being formed from two lengths of rod or wire, one length being straight except for curled eyes at the remote ends of the limbs constituted by that length , while the other length is bent into a semicircular loop, the ends of which are welded symmetrically to the straight length
7 A device as in Claim 1 or Claim 2, the device being formed from two lengths of rod or wire, one length being straight except for curled eyes at the remote ends of the limbs constituted by that length while the other length is bent into a full or an almost full circular loop, the ends of which are welded symmetrically to the straight length
8 A device as in Claim 7, wherein the mating ends of the full circle are welded to each other as well as to the middle of the straight length.
9 A device as in any one of Claims 3 to 8, the device being formed from stainless steel rod or wire.
10 A device as in any one of Claims 3 to 9 wherein the eyes both lie in the same general plane as the body part, loop and limbs, and both extend laterally from the limbs to the same side as the body part and loop, so as to avoid any protrusion liable to snag on the proximal end of the bone tunnel.
1 1 A device as in Claim 1 or Claim 2, the device being formed in one piece in a
biocompatible rigid plastics material or ceramic
12 A device as in Claim 1 or Claim 2, the device being stamped or otherwise cut out
from metal plate. 13 A device as in Claim 12, wherein the metal is stainless steel
14 A device as in Claim 12, wherein the metal is titanium
15 A device as in any one of Claims 4 or Claims 1 1 to 14, wherein the loop in the body of the device is incomplete, to enable sutures or threads connecting it to a ligament substitute to be released by tilting the device.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU10366/97A AU1036697A (en) | 1995-12-05 | 1996-12-04 | Surgical anchorage |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
GBGB9524861.3A GB9524861D0 (en) | 1995-12-05 | 1995-12-05 | Surgical anchorage |
GB9524861.3 | 1995-12-05 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1997020522A1 true WO1997020522A1 (en) | 1997-06-12 |
Family
ID=10784946
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/GB1996/002985 WO1997020522A1 (en) | 1995-12-05 | 1996-12-04 | Surgical anchorage |
Country Status (3)
Country | Link |
---|---|
AU (1) | AU1036697A (en) |
GB (1) | GB9524861D0 (en) |
WO (1) | WO1997020522A1 (en) |
Cited By (23)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1998033455A1 (en) * | 1997-02-05 | 1998-08-06 | Smith & Nephew, Inc. | Graft attachment device and method of attachment |
FR2774582A1 (en) * | 1998-02-06 | 1999-08-13 | Hugues Charles | Ligament anchor for orthopaedic surgery |
WO2000064378A1 (en) * | 1999-04-22 | 2000-11-02 | Hugues Charles | Device for anchoring a ligament on a bone structure |
EP1072234A3 (en) * | 1999-07-29 | 2001-09-26 | Andrea Castiglioni | Device for the femoral fixation of tendons for the reconstruction of the anterior cruciate ligament of the knee |
EP1598018A1 (en) * | 2004-05-20 | 2005-11-23 | Olympus Corporation | Treatment system for living tissues |
EP2095776A3 (en) * | 2001-02-12 | 2009-11-25 | ArthroCare Corporation | Devices for attaching connective tissues to bone using a knotless suture anchoring device |
EP2191791A3 (en) * | 2001-05-16 | 2012-08-22 | Smith & Nephew, Inc. | Endobutton continuous loop for bone-tendon-bone |
EP2676613A3 (en) * | 2012-06-22 | 2014-01-08 | Peter Michael Sutherland Walker | Improved graft fixation device |
US8721683B2 (en) | 2011-09-29 | 2014-05-13 | Smith & Nephew, Inc. | Attachment device to attach tissue graft |
US8834523B2 (en) | 2011-09-29 | 2014-09-16 | Smith & Nephew, Inc. | Attachment device to attach tissue graft |
US8845687B2 (en) | 1996-08-19 | 2014-09-30 | Bonutti Skeletal Innovations Llc | Anchor for securing a suture |
US8845699B2 (en) | 1999-08-09 | 2014-09-30 | Bonutti Skeletal Innovations Llc | Method of securing tissue |
US9023083B2 (en) | 2012-01-27 | 2015-05-05 | Arthrocare Corporation | Method for soft tissue repair with free floating suture locking member |
US9034014B2 (en) | 2012-01-27 | 2015-05-19 | Arthrocare Corporation | Free floating wedge suture anchor for soft tissue repair |
US9198649B2 (en) | 2012-01-27 | 2015-12-01 | Arthrocare Corporation | Rotating locking member suture anchor and method for soft tissue repair |
US9226742B2 (en) | 2012-01-27 | 2016-01-05 | Arthrocare Corporation | Restricted wedge suture anchor and method for soft tissue repair |
US9364210B2 (en) | 2012-01-27 | 2016-06-14 | Arthrocare Corporation | Biased wedge suture anchor and method for soft tissue repair |
US9636101B2 (en) | 2011-09-01 | 2017-05-02 | Arthrocare Corporation | Bone anchor having an integrated stress isolator |
CN106667622A (en) * | 2017-02-06 | 2017-05-17 | 北京万洁天元医疗器械有限公司 | Adjustable lantern ring steel plate for fixing soft tissue or ligament graft |
US9855028B2 (en) | 2012-04-06 | 2018-01-02 | Arthrocare Corporation | Multi-suture knotless anchor for attaching tissue to bone and related method |
US10426595B2 (en) | 2014-10-22 | 2019-10-01 | Xiros Limited | Elongate guide element for an implant |
US10653409B2 (en) | 2015-12-04 | 2020-05-19 | Crossroads Extremity Systems, Llc | Devices and methods for anchoring tissue |
WO2022246129A1 (en) * | 2021-05-20 | 2022-11-24 | Invicta Medical, Inc. | Techniques for placing implantable electrodes to treat sleep apnea, and associated systems |
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FR2696338A1 (en) * | 1992-10-07 | 1994-04-08 | Perrin Max | Artificial ligament for use in knee joint and other body areas - comprises elongate thread with attachment portion formed at one end and separate transverse cylindrical fastening head attached to other end |
US5306301A (en) * | 1993-02-11 | 1994-04-26 | American Cyanamid Company | Graft attachment device and method of using same |
GB2288739A (en) * | 1994-04-27 | 1995-11-01 | Corin Medical Ltd | Surgical anchor |
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1995
- 1995-12-05 GB GBGB9524861.3A patent/GB9524861D0/en active Pending
-
1996
- 1996-12-04 WO PCT/GB1996/002985 patent/WO1997020522A1/en active Application Filing
- 1996-12-04 AU AU10366/97A patent/AU1036697A/en not_active Abandoned
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Publication number | Priority date | Publication date | Assignee | Title |
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FR2696338A1 (en) * | 1992-10-07 | 1994-04-08 | Perrin Max | Artificial ligament for use in knee joint and other body areas - comprises elongate thread with attachment portion formed at one end and separate transverse cylindrical fastening head attached to other end |
US5306301A (en) * | 1993-02-11 | 1994-04-26 | American Cyanamid Company | Graft attachment device and method of using same |
GB2288739A (en) * | 1994-04-27 | 1995-11-01 | Corin Medical Ltd | Surgical anchor |
Cited By (27)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8845687B2 (en) | 1996-08-19 | 2014-09-30 | Bonutti Skeletal Innovations Llc | Anchor for securing a suture |
WO1998033455A1 (en) * | 1997-02-05 | 1998-08-06 | Smith & Nephew, Inc. | Graft attachment device and method of attachment |
FR2774582A1 (en) * | 1998-02-06 | 1999-08-13 | Hugues Charles | Ligament anchor for orthopaedic surgery |
WO2000064378A1 (en) * | 1999-04-22 | 2000-11-02 | Hugues Charles | Device for anchoring a ligament on a bone structure |
EP1072234A3 (en) * | 1999-07-29 | 2001-09-26 | Andrea Castiglioni | Device for the femoral fixation of tendons for the reconstruction of the anterior cruciate ligament of the knee |
US6440134B1 (en) | 1999-07-29 | 2002-08-27 | Giovanni Zaccherotti | Device for the femoral fixation of the semitendinosus and gracilis tendons for the reconstruction of the anterior cruciate ligament of the knee |
US8845699B2 (en) | 1999-08-09 | 2014-09-30 | Bonutti Skeletal Innovations Llc | Method of securing tissue |
EP2095776A3 (en) * | 2001-02-12 | 2009-11-25 | ArthroCare Corporation | Devices for attaching connective tissues to bone using a knotless suture anchoring device |
EP2191791A3 (en) * | 2001-05-16 | 2012-08-22 | Smith & Nephew, Inc. | Endobutton continuous loop for bone-tendon-bone |
EP1598018A1 (en) * | 2004-05-20 | 2005-11-23 | Olympus Corporation | Treatment system for living tissues |
US9636101B2 (en) | 2011-09-01 | 2017-05-02 | Arthrocare Corporation | Bone anchor having an integrated stress isolator |
US8721683B2 (en) | 2011-09-29 | 2014-05-13 | Smith & Nephew, Inc. | Attachment device to attach tissue graft |
US8834523B2 (en) | 2011-09-29 | 2014-09-16 | Smith & Nephew, Inc. | Attachment device to attach tissue graft |
US9517125B2 (en) | 2011-09-29 | 2016-12-13 | Smith & Nephew, Inc. | Attachment device to attach tissue graft |
US9023083B2 (en) | 2012-01-27 | 2015-05-05 | Arthrocare Corporation | Method for soft tissue repair with free floating suture locking member |
US9034014B2 (en) | 2012-01-27 | 2015-05-19 | Arthrocare Corporation | Free floating wedge suture anchor for soft tissue repair |
US9198649B2 (en) | 2012-01-27 | 2015-12-01 | Arthrocare Corporation | Rotating locking member suture anchor and method for soft tissue repair |
US9226742B2 (en) | 2012-01-27 | 2016-01-05 | Arthrocare Corporation | Restricted wedge suture anchor and method for soft tissue repair |
US9364210B2 (en) | 2012-01-27 | 2016-06-14 | Arthrocare Corporation | Biased wedge suture anchor and method for soft tissue repair |
US9855028B2 (en) | 2012-04-06 | 2018-01-02 | Arthrocare Corporation | Multi-suture knotless anchor for attaching tissue to bone and related method |
US9186241B2 (en) | 2012-06-22 | 2015-11-17 | Peter Michael Sutherland Walker | Graft fixation device |
EP2676613A3 (en) * | 2012-06-22 | 2014-01-08 | Peter Michael Sutherland Walker | Improved graft fixation device |
US10426595B2 (en) | 2014-10-22 | 2019-10-01 | Xiros Limited | Elongate guide element for an implant |
US10653409B2 (en) | 2015-12-04 | 2020-05-19 | Crossroads Extremity Systems, Llc | Devices and methods for anchoring tissue |
US11806005B2 (en) | 2015-12-04 | 2023-11-07 | Crossroads Extremity Systems, Llc | Devices and methods for anchoring tissue |
CN106667622A (en) * | 2017-02-06 | 2017-05-17 | 北京万洁天元医疗器械有限公司 | Adjustable lantern ring steel plate for fixing soft tissue or ligament graft |
WO2022246129A1 (en) * | 2021-05-20 | 2022-11-24 | Invicta Medical, Inc. | Techniques for placing implantable electrodes to treat sleep apnea, and associated systems |
Also Published As
Publication number | Publication date |
---|---|
GB9524861D0 (en) | 1996-02-07 |
AU1036697A (en) | 1997-06-27 |
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