DOUBLE BUNDLE ACL REPAIR

• US 20110137416A1
• Filed: 02/14/2011
• Published: 06/09/2011
• Est. Priority Date: 03/31/2009
• Status: Active Grant

• Current Assignee: IMDS LLC, Thomas H. Myers
• Original Assignee: Medicinelodge, Inc (Nelso Antolotti), Thomas H. Myers
• Inventors: Myers, Thomas
• Granted Patent: US 8,579,975 B2
• Time in Patent Office: Days
• US Class Current: 623/13.14
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1714 for applying tendons or ligaments implements for applying tendons or ligaments A61F2/0805
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/0419 H-fasteners
• CPC Class Codes: A61B 2017/044 with a threaded shaft, e.g. screws
• 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 2002/0852 Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
• 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
• CPC Class Codes: A61F 2002/0888 Anchor in or on a blind hole or on the bone surface without formation of a tunnel
• CPC Class Codes: A61F 2230/001 Figure-8-shaped, e.g. hourglass-shaped
• CPC Class Codes: A61F 2230/0013 Horseshoe-shaped, e.g. crescent-shaped, C-shaped, U-shaped
• CPC Class Codes: A61F 2230/0082 parallelepipedal
• CPC Class Codes: A61F 2240/008 : Means for testing implantable prostheses

Abstract

A system for single tunnel, double bundle anterior cruciate ligament reconstruction includes implant constructs and instruments. The implant constructs provide a combination of cortical fixation and bone tunnel aperture fixation. The implant constructs separate a graft into distinct bundles. The instruments are used to prepare shaped bone tunnels to receive the implant constructs and graft bundles. Methods for reconstructing the antero-medial and postero-lateral bundles of the anterior cruciate ligament may rely on single femoral and tibial tunnels and a single strand of graft.

Claims

1. A system for securing a graft in a bone tunnel, wherein the graft comprises a plurality of separate bundles between opposite first and second parts of the graft, the system comprising:

an implant, wherein the implant comprises a length extending between opposite first and second ends of the implant, a hole in the first end of the implant, a groove across the second end of the implant, and an aperture extending through the implant, wherein the hole is aligned with the length, wherein the aperture is transverse to the length;

a button; and

a loop, wherein the loop connects the implant to the button.

2. The system of claim 1, wherein the implant comprises polyetheretherketone.

3. The system of claim 1, wherein an opening extends through the button, wherein the loop passes through the aperture in the implant and the opening in the button.

4. The system of claim 1, wherein the loop comprises a braid.

5. The system of claim 1, wherein the loop comprises a splice.

6. The system of claim 1, wherein, when the system secures the graft in the bone tunnel, the implant is positioned between the graft bundles proximate a first end of the bone tunnel, the button bears against an extracortical bone surface proximate a second end of the bone tunnel opposite the first end of the bone tunnel, and the loop encircles portions of the implant, the button, and the graft.

7. The system of claim 1, wherein the graft comprises a doubled-over strand, wherein a selected one of the first and second parts of the graft comprises a middle portion of the strand.

8. A system for securing a graft in a bone tunnel, wherein the graft comprises a plurality of separate bundles between opposite first and second parts of the graft, the system comprising:

first fixation means for suspending the first part of the graft in the bone tunnel;

first body means for separating the graft bundles proximate a first end of the bone tunnel, and for urging the graft bundles against a side wall of the bone tunnel at the first end of the bone tunnel; and

first connection means for securing the fixation means to the body means.

9. The system of claim 8, wherein the first fixation means suspends the first part of the graft from an extracortical bone surface proximate a second end of the bone tunnel, wherein the second end of the bone tunnel is opposite the first end of the bone tunnel.

10. The system of claim 9, wherein the bone tunnel comprises a length extending between the first and second ends of the bone tunnel, and a cross section transverse to the length, wherein the cross section is larger in width than in height;

wherein the first body means urges the graft bundles against the side wall of the bone tunnel across the width of the cross section.

11. The system of claim 8, wherein the first connection means comprises a suture.

12. The system of claim 8, wherein the first connection means comprises a braid.

13. The system of claim 8, wherein the first connection means comprises a splice.

14. The system of claim 8, comprising:

second fixation means for suspending the second part of the graft in a second bone tunnel;

second body means for separating the graft bundles proximate a first end of the second bone tunnel, and for urging the graft bundles against a side wall of the second bone tunnel at the first end of the second bone tunnel; and

second connection means for securing the second fixation means to the second body means.

15. The system of claim 8, wherein the graft comprises a doubled-over strand, wherein a selected one of the first and second parts of the graft comprises a middle portion of the strand.

16. A method of securing a graft in a bone tunnel, the method comprising the steps of:

providing the graft, wherein the graft comprises a plurality of separate bundles between opposite first and second parts of the graft;

forming the bone tunnel, wherein the bone tunnel comprises a length, a width, and a height, wherein the length extends between opposite first and second ends of the bone tunnel, wherein the width and height are measured perpendicular to the length, wherein the width is greater than the height;

inserting the first part of the graft into the first end of the bone tunnel;

separating the graft bundles across the width of the bone tunnel so that each bundle is pressed against a side wall of the bone tunnel; and

securing the first part of the graft to an extracortical bone surface at the second end of the bone tunnel.

17. The method of claim 16, wherein separating the graft bundles comprises positioning a plug between the bundles so that the first part of the graft is at least partially in a groove across a first end of the plug.

18. The method of claim 17, comprising inserting the plug into the first end of the bone tunnel between the graft bundles to press the graft bundles against the side wall of the bone tunnel.

19. The method of claim 17, wherein securing the first part of the graft to the extracortical bone surface comprises threading a filament through an opening through a button, supporting the button on the extracortical bone surface, threading the filament through a transverse aperture through the plug, and splicing the filament to form a loop.

20. The method of claim 16, wherein forming the bone tunnel comprises:

positioning the first end of the bone tunnel coincident with an attachment area of a natural cruciate ligament of a knee joint, wherein the attachment area comprises first and second portions, wherein a first functional bundle of the natural cruciate ligament attaches to the first portion of the attachment area, wherein a second functional bundle of the natural cruciate ligament attaches to the second portion of the attachment area;

orienting the height of the bone tunnel along a border between the first and second portions; and

orienting the width of the bone tunnel across the first and second portions.

21. The method of claim 16, wherein providing the graft comprises:

providing a strand; and

doubling over the strand so that a selected one of the first and second parts of the graft comprises a middle portion of the strand.

22. A method of securing a graft in a first bone tunnel, the method comprising the steps of:

providing the graft, wherein the graft comprises a plurality of separate bundles between opposite first and second parts of the graft;

forming the first bone tunnel, wherein the first bone tunnel comprises a length extending between opposite first and second ends of the first bone tunnel;

inserting the first part of the graft into the first end of the first bone tunnel;

pressing the graft bundles outwardly against the first bone tunnel; and

securing the first part of the graft to an extracortical surface at the second end of the first bone tunnel.

23. The method of claim 22, comprising:

forming a second bone tunnel in an adjacent bone, wherein the second bone tunnel comprises a length extending between opposite first and second ends of the second bone tunnel, wherein the first ends of the first and second bone tunnels open into an intra-articular space of a joint;

inserting the second part of the graft into the first end of the second bone tunnel;

pressing the graft bundles outwardly against the second bone tunnel; and

securing the second part of the graft to an extracortical surface at the second end of the second bone tunnel.

24. The method of claim 23, wherein forming the first bone tunnel comprises:

positioning the first end of the first bone tunnel coincident with a first attachment area of a natural cruciate ligament of a knee joint, wherein the first attachment area comprises first and second portions, wherein a first functional bundle of the natural cruciate ligament attaches to the first portion of the first attachment area, wherein a second functional bundle of the natural cruciate ligament attaches to the second portion of the second attachment area;

orienting the height of the first bone tunnel along a border between the first and second portions; and

dividing the width of the first bone tunnel between the first and second portions;

wherein forming the second bone tunnel comprises;

positioning the first end of the second bone tunnel coincident with a second attachment area of the natural cruciate ligament, wherein the second attachment area comprises third and fourth portions, wherein the first functional bundle attaches to the third portion of the second attachment area, wherein the second functional bundle attaches to the fourth portion of the second attachment area;

orienting the height of the second bone tunnel along a border between the third and fourth portions; and

dividing the width of the second bone tunnel between the third and fourth portions.

25. The method of claim 22, wherein pressing the graft bundles outwardly against the first bone tunnel comprises:

positioning a plug between the graft bundles so that the first part of the graft rests in a groove across a first end of the plug; and

inserting the plug into the first end of the bone tunnel to press the graft bundles outwardly against the side wall of the bone tunnel.

26. The method of claim 25, wherein securing the first part of the graft to the extracortical bone surface comprises threading a filament through an opening through a button, supporting the button on the extracortical bone surface, threading the filament through a transverse aperture through the plug, and splicing the filament to form a loop.

27. The method of claim 22, wherein providing the graft comprises:

providing a strand; and

doubling over the strand so that a selected one of the first and second parts of the graft comprises a middle portion of the strand.