Method and apparatus for reconstructing a ligament

• US 20060052787A1
• Filed: 08/18/2005
• Published: 03/09/2006
• Est. Priority Date: 08/18/2004
• Status: Active Grant

• Current Assignee: Covidien LP (Medtronic Plc)
• Original Assignee: Covidien LP (Medtronic Plc)
• Inventors: Marshall, Peter F., Re, Paul, Drake, Jesse Scott
• Granted Patent: US 8,470,037 B2
• Time in Patent Office: Days
• US Class Current: 606/191
• CPC Class Codes: A61F 2/0805 Implements for inserting tendons or ligaments
• CPC Class Codes: A61F 2/0811 Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2002/0829 without deformation of anchor parts, e.g. fixation screws on bone surface, extending barbs, cams, butterflies, spring-loaded pins
• CPC Class Codes: A61F 2002/0841 Longitudinal channel for insertion tool running through the whole tendon anchor, e.g. for accommodating bone drill, guidewire
• CPC Class Codes: A61F 2002/0858 Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
• CPC Class Codes: A61F 2002/0882 Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone

Abstract

The present invention comprises the provision and use of a novel retainer which is slidably advanced to a desired fixation position within a bone tunnel, fixed in position within the bone tunnel (preferably by wedging and/or pinning) while applying a lateral force against the graft ligament so as to compressively hold the graft ligament against the sidewall of the bone tunnel, and which then, optionally, has the graft ligament secured thereto with a cap, whereby to secure the graft ligament to the retainer and hence additionally to the host bone. The present invention also comprises the provision and use of a novel retainer which is slidably advanced to a desired fixation position within a bone tunnel so as to apply a lateral force against the graft ligament so as to compressively hold the graft ligament against the sidewall of the bone tunnel, and which is then locked to the host bone as the graft ligament is simultaneously secured to the retainer, whereby to secure the graft ligament to the retainer and hence additionally to the host bone.

Claims

1. A system for reconstructing a ligament by fixing at least one graft ligament strand in a bone tunnel, comprising:

a retainer for disposition in the bone tunnel, wherein the retainer comprises at least one longitudinally-extending groove formed in the outside surface of the retainer, wherein the groove is configured to seat a graft ligament strand therein, and further wherein the at least one longitudinally-extending groove has a floor which is ramped radially outwardly as the floor extends distally-to-proximally, such that non-rotational advancement of the retainer into the bone tunnel will apply a compressive force to hold the graft ligament strand against the sidewall of the bone tunnel, and wherein the retainer comprises a transverse bore extending therethrough; and

a locking pin sized to pass through the transverse bore and into the sidewall of the bone tunnel so as to fix the retainer in place within the bone tunnel.

2. A system according to claim 1 wherein the bone tunnel has a distal end and a proximal end, wherein the distal end of the bone tunnel has a smaller diameter than the proximal end, and further wherein the retainer has a diameter larger than the distal end of the bone tunnel and smaller than the proximal end of the bone tunnel, so that the retainer will be prevented from exiting the distal end of the tunnel.

3. A system according to claim 2 wherein the bone tunnel has a tapered configuration.

4. A system according to claim 2 wherein the bone tunnel has a bore-counterbore configuration.

5. A system according to claim 1 wherein the retainer is tapered along at least a portion of its length so as to have an increasing diameter as it extends distally-to-proximally.

6. A system according to claim 1 wherein the transverse bore extends at an acute angle to the longitudinal axis of the retainer.

7. A system according to claim 1 therein the transverse bore opens on a proximal end surface of the retainer.

8. A system according to claim 1 wherein the transverse bore opens on the floor of the at least one groove.

9. A system according to claim 1 wherein the transverse bore extends at a right angle to the longitudinal axis of the retainer.

10. A system according to claim 1 wherein the retainer has four longitudinally-extending grooves formed in the outside surface of the retainer.

11. A system according to claim 1 wherein the retainer further comprises at least one rib formed on the outside surface of the retainer, wherein the rib extends transverse to the longitudinal axis of the retainer.

12. A system according to claim 11 wherein at least a portion of the rib extends into the at least one groove.

13. A system according to claim 1 wherein the system further comprises a cap removably attached to the retainer for capturing the at least one graft ligament strand to the retainer by compressing the at least one graft ligament strand between the cap and the retainer.

14. A system according to claim 13 wherein the distal end of the retainer has a stepped configuration so as to form a tortuous path for the at least one graft ligament strand.

15. A system according to claim 13 wherein the cap is attached to the proximal end of the retainer with a post and hole arrangement.

16. A system according to claim 15 wherein the cap comprises the post, and the retainer comprises the hole.

17. A system according to claim 16 wherein the post is threaded and the hole is threaded.

18. A system according to claim 16 wherein the post is ribbed.

19. A system according to claim 15 wherein the hole of the cap'"'"'s post and hole arrangement is the transverse bore extending through the retainer, and the post of the cap'"'"'s post and hole arrangement is the locking pin.

20. A system according to claim 19 wherein the post is threaded and the hole is threaded.

21. A system according to claim 19 wherein the cap is slidably mounted on the post.

22. A system according to claim 21 wherein the post comprises a head for holding the cap against the retainer.

23. A system according to claim 22 wherein the cap comprises a recess for seating the head of the post.

24. A system according to claim 13 wherein the cap comprises at least one longitudinally-extending projection extending distally away from the cap.

25. A system according to claim 24 wherein the retainer comprises at least one recess for receiving the at least one longitudinally-extending projection of the cap when the cap is mounted to the retainer.

26. A system according to claim 13 wherein the cap comprises at least one opening for passing the at least one graft ligament strand therethrough.

27. A system according to claim 1 further comprising an inserter for deploying the retainer in the bone tunnel, the inserter being adapted for selective attachment to the retainer.

28. A system according to claim 27 wherein the inserter is attached to the proximal end of the retainer with a finger and recess arrangement.

29. A system according to claim 27 wherein the retainer comprises a lumen, the inserter comprises a lumen, and wherein the system further comprises a stylus for selective insertion through the inserter lumen and the retainer lumen.

30. A system according to claim 1 further comprising a dilator for dilating the at least one graft ligament strand and the wall of the bone tunnel before disposition of the retainer in the bone tunnel.

88. A system according to claim 19 wherein the post is ribbed and the hole has a mating geometry so as to form a one-way ratchet mechanism.

31. A method for reconstructing a ligament by fixing at least one graft ligament strand in a bone tunnel, comprising:

positioning the at least one graft ligament strand in the bone tunnel;

providing a retainer in the bone tunnel, wherein the retainer comprises at least one longitudinally-extending groove formed in the outside surface of the retainer, wherein the groove is configured to seat a graft ligament strand therein, and further wherein the at least one longitudinally-extending groove has a floor which is ramped radially outwardly as the floor extends distally-to-proximally, such that non-rotational advancement of the retainer into the bone tunnel will apply a compressive force to hold the graft ligament strand against the sidewall of the bone tunnel, and wherein the retainer comprises a transverse bore extending therethrough;

positioning the retainer in the bone tunnel so that the at least one graft ligament strand resides in a longitudinally-extending groove so that the retainer is wedged into place; and

passing a locking pin through the transverse bore and into the sidewall of the bone tunnel so as to pin the retainer to the host bone.

32. A method according to claim 31 wherein the method further comprises securing a locking cap against the proximal end surface of the retainer to hold the at least one graft ligament strand to the retainer.

33. A method according to claim 32 wherein the locking cap is secured to the proximal end surface of the retainer with the locking pin.

34. A system for reconstructing a ligament by fixing at least one graft ligament strand in a bone tunnel, comprising:

a retainer for disposition in the bone tunnel; and

a cap removably attached to the retainer for capturing the at least one graft ligament strand to the retainer by compressing the at least one graft ligament strand between the cap and the retainer.

35. A system according to claim 34 wherein the bone tunnel has a distal end and a proximal end, wherein the distal end of the bone tunnel has a smaller diameter than the proximal end, and further wherein the retainer has a diameter larger than the distal end of the bone tunnel and smaller than the proximal end of the bone tunnel, so that the retainer will be prevented from exiting the distal end of the tunnel.

36. A system according to claim 35 wherein the bone tunnel has a tapered configuration.

37. A system according to claim 35 wherein the bone tunnel has a bore-counterbore configuration.

38. A system according to claim 34 wherein the retainer is tapered along at least a portion of its length so as to have an increasing diameter as it extends distally-to-proximally.

39. A system according to claim 34 wherein the retainer comprises a transverse bore, and further wherein the system further comprises a locking pin sized to pass through the transverse bore and into the sidewall of the bone tunnel so as to fix the retainer in place within the bone tunnel.

40. A system according to claim 39 wherein the transverse bore extends at an acute angle to the longitudinal axis of the retainer.

41. A system according to claim 40 therein the transverse bore opens on a proximal end surface of the retainer.

42. A system according to claim 39 wherein the transverse bore extends at a right angle to the longitudinal axis of the retainer.

43. A system according to claim 34 wherein the retainer further comprises at least one longitudinally-extending groove formed in the outside surface of the retainer, wherein the groove is configured to seat a graft ligament strand therein.

44. A system according to claim 43 wherein the retainer further comprises a transverse bore extending therethrough, and further wherein the transverse bore opens on the floor of the at least one groove.

45. A system according to claim 43 wherein the at least one longitudinally-extending groove has a floor which is ramped relative to the longitudinal axis of the retainer.

46. A system according to claim 45 wherein the floor is ramped radially outwardly as the floor extends distally-to-proximally.

47. A system according to claim 43 wherein the retainer has four longitudinally-extending grooves formed in the outside surface of the retainer.

48. A system according to claim 34 wherein the retainer further comprises at least one rib formed on the outside surface of the retainer, wherein the rib extends transverse to the longitudinal axis of the retainer.

49. A system according to claim 34 wherein the retainer further comprises at least one longitudinally-extending groove formed in the outside surface of the retainer, wherein the groove is configured to seat a graft ligament strand therein, and wherein the retainer further comprises at least one rib formed on the outside surface of the retainer, wherein the rib extends transverse to the longitudinal axis of the retainer, and further wherein at least a portion of the rib extends into the at least one groove.

50. A system according to claim 34 wherein the distal end of the retainer has a stepped configuration so as to form a tortuous path for the at least one graft ligament strand.

51. A system according to claim 34 wherein the cap is attached to the proximal end of the retainer with a post and hole arrangement.

52. A system according to claim 51 wherein the cap comprises the post, and the retainer comprises the hole.

53. A system according to claim 52 wherein the post is threaded and the hole is threaded.

54. A system according to claim 52 wherein the post is ribbed.

55. A system according to claim 51 wherein the hole opens on a proximal end surface of the retainer and extends transversely through the retainer, and further wherein the post is sized to extend out of the retainer and into the sidewall of the bone tunnel when the cap is in contact with the proximal end of the retainer.

56. A system according to claim 55 wherein the post is threaded and the hole is threaded.

57. A system according to claim 55 wherein the cap is slidably mounted on the post.

58. A system according to claim 57 wherein the post comprises a head for holding the cap against the retainer.

59. A system according to claim 58 wherein the cap comprises a recess for seating the head of the post.

60. A system according to claim 34 wherein the cap comprises at least one longitudinally-extending projection extending distally away from the cap.

61. A system according to claim 60 wherein the retainer comprises at least one recess for receiving the at least one longitudinally-extending projection of the cap when the cap is mounted to the retainer.

62. A system according to claim 34 wherein the cap comprises at least one opening for passing the at least one graft ligament strand therethrough.

63. A system according to claim 34 further comprising an inserter for deploying the retainer in the bone tunnel, the inserter being adapted for selective attachment to the retainer.

64. A system according to claim 63 wherein the inserter is attached to the proximal end of the retainer with a finger and recess arrangement.

65. A system according to claim 63 wherein the retainer comprises a lumen, the inserter comprises a lumen, and wherein the system further comprises a stylus for selective insertion through the inserter lumen and the retainer lumen.

66. A system according to claim 34 further comprising a dilator for dilating the at least one graft ligament strand and the wall of the bone tunnel before disposition of the retainer in the bone tunnel.

67. An inserter for inserting a retainer into a bone tunnel, the inserter comprising:

a shaft;

an element on the distal end of the shaft for engaging a counterpart element on the retainer, whereby to releasably hold the retainer to the shaft; and

an opening formed in the shaft, wherein the opening extends transverse to the longitudinal axis of the shaft, with the opening being aligned with a transverse opening formed in the retainer when the retainer is releasably held to the shaft.

68. A dilator for simultaneously (i) dilating a graft ligament strand extending through a bone tunnel and (ii) dilating the sidewall of the bone tunnel, the dilator comprising:

a shaft sized to dilate the sidewall of the bone tunnel when the dilator is inserted into the bone tunnel; and

at least one longitudinally-extending groove formed in the side wall of the dilator, wherein the at least one longitudinally-extending groove is configured to seat a graft ligament strand therein, and further wherein the at least one longitudinally-extending groove is sized to dilate the graft ligament strand when the graft ligament strand is seated in the at least one longitudinally-extending groove and the dilator is inserted into the bone tunnel.

69. A method for reconstructing a ligament by fixing at least one graft ligament strand in a bone tunnel, comprising:

positioning a retainer in the bone tunnel; and

attaching a cap to the retainer so as to capture the at least one graft ligament strand to the retainer by compressing the at least one graft ligament strand between the cap and the retainer.

70. A method according to claim 69 wherein the bone tunnel has a distal end and a proximal end, wherein the distal end of the bone tunnel has a smaller diameter than the proximal end, and further wherein the retainer has a diameter larger than the distal end of the bone tunnel and smaller than the proximal end of the bone tunnel, so that the retainer will be prevented from exiting the distal end of the tunnel.

71. A method according to claim 69 wherein the retainer is tapered along at least a portion of its length so as to have an increasing diameter as it extends distally-to-proximally.

72. A method according to claim 69 wherein the retainer comprises a transverse bore, wherein the system further comprises a locking pin sized to pass through the transverse bore and into the sidewall of the bone tunnel so as to fix the retainer in place within the bone tunnel, and further wherein the locking pin is passed through the transverse bore and into the sidewall of the bone tunnel before the cap is attached to the retainer.

73. A method according to claim 72 wherein the transverse bore extends at an acute angle to the longitudinal axis of the retainer.

74. A method according to claim 73 therein the transverse bore opens on the proximal end of the retainer.

75. A method according to claim 69 wherein the retainer further comprises at least one longitudinally-extending groove formed in the outside surface of the retainer, wherein the groove is configured to seat a graft ligament strand therein, and further wherein the at least one graft ligament strand is positioned in the at least one longitudinally-extending groove as the retainer is positioned in the bone tunnel.

76. A method according to claim 75 wherein the at least one longitudinally-extending groove has a floor which is ramped relative to the longitudinal axis of the retainer.

77. A method according to claim 75 wherein the floor is ramped radially outwardly as the floor extends distally-to-proximally.

78. A method according to claim 75 wherein the retainer has four longitudinally-extending grooves formed in the outside surface of the retainer.

79. A method according to claim 69 wherein the retainer further comprises at least one longitudinally-extending groove formed in the outside surface of the retainer, wherein the groove is configured to seat a graft ligament strand therein, and wherein the retainer further comprises at least one rib formed on the outside surface of the retainer, wherein the rib extends transverse to the longitudinal axis of the retainer, and further wherein at least a portion of the rib extends into the at least one groove.

80. A method according to claim 69 wherein the cap is attached to the proximal end of the retainer with a post and hole arrangement.

81. A method according to claim 80 wherein the cap comprises the post, and the retainer comprises the hole.

82. A method according to claim 81 wherein the post is threaded and the hole is threaded.

83. A method according to claim 82 wherein the hole opens on the proximal end of the retainer and extends transversely through the retainer, and further wherein the post is sized to extend out of the retainer and into the sidewall of the bone tunnel when the cap is in contact with the proximal end of the retainer.

84. A method according to claim 83 wherein the cap is slidably mounted on the post.

85. A method according to claim 84 wherein the post comprises a head for holding the cap against the retainer.

86. A method according to claim 69 wherein the cap comprises at least one longitudinally-extending projection extending distally away from the cap.

87. A method according to claim 86 wherein the retainer comprises at least one recess for receiving the at least one longitudinally-extending projection of the cap when the cap is mounted to the retainer.