Surgical method and apparatus

• US 5,234,435 A
• Filed: 03/08/1991
• Issued: 08/10/1993
• Est. Priority Date: 03/08/1991
• Status: Expired due to Fees

• Current Assignee: Richard A. Seagrave Jr
• Original Assignee: Richard A. Seagrave Jr
• Inventors: Seagrave, Richard A. Jr.
• Primary Examiner(s): Hafer, Robert A.
• Assistant Examiner(s): RIMELL, SAMUEL G
• Application Number:
  US07/665,953
• Time in Patent Office: 886 Days
• Field of Search: 606/80, 606/86, 606/87, 606/88, 606/96, 606/99, 606/103, 606/104, 623/13
• US Class Current: 606/103
• 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: 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 2002/0858 Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
• CPC Class Codes: A61F 2002/087 Anchor integrated into tendons, e.g. bone blocks, integrated rings
• 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

Arthroscopic knee surgery is performed without a thigh incision by cutting a plug-receiving bore in the tibia, cutting a bore through the femur with a cannulated drill bit which is inserted through the tibial bore at an acute angle, and passing a wire in a proximal direction through the cannulated bit until it punctures and exits the thigh. The wire has a bend which is kept straight while it is in the cannulated bit but, upon exiting the bit, the wire'"'"'s resilience restores the bend to direct the puncturing tip of the wire anteriorly toward the surface of the thigh. During the procedure, the proximal and distal ends of the wire are available to facilitate the movement of elements including a replacement graft to and from the site via the tibial bore.

Claims

1. A method of performing anterior cruciate reconstructive surgery on a patient having a thigh and a knee joint which connects a femur to a tibia, said method including the following steps:

(a) cutting a tibial bore through the tibia;

(b) cutting a femoral bore through the femur;

(c) inserting a wire through the tibial bore and then through the femoral bore,

(d) forcing the wire beyond the femur and through the thigh until the wire has an exposed proximal portion which is accessible above the thigh,

(e) connecting a replacement ligament to the wire distally of the tibia,

(f) pulling the proximal portion of the wire to pull the replacement ligament first through the tibia and then into the femur, and

(g) fixing the replacement ligament to the tibia and to the femur.

2. A method according to claim 1 in which the femoral bore is cut through the femur with a drill bit which (i) extends through the tibial bore, (ii) has a smaller diameter than the tibial bore, and (iii) is oriented at an acute angle to the tibial bore.

3. A method according to claim 1 in which the following steps are performed prior to step (c):

inserting a cannulated guide tube first through the tibial bore and then through the femoral bore, said cannulated guide tube having a bore,

said step of inserting a wire being performed by passing the wire through the bore of the cannulated guide tube.

4. A method according to claim 3 in which the cannulated guide tube is a cannulated drill bit which is rotated to cut the femoral bore.

5. A method according to claim 3 wherein the cannulated drill bit has an obturator which prevents material from entering the drill bit bore during drilling, said method including the step of removing the obturator from the drill bit bore before the wire is passed through it.

6. A method according to claim 1 wherein the wire is resilient and has a leading end portion with a bend therein when the wire is in a relaxed state;

said step of inserting the wire through the femur being performed in a guide tube which keeps the bend straight until it exits the guide tube, said wire upon exiting the guide tube resuming its shape including said bend to affect the direction it punctures the thigh and to reduce the distance it travels before it exits the thigh.

7. A method according to claim 1 including the performance of an isometry test between step (d) and (e), said isometry test being performed by attaching a stop to the wire, pulling the exposed portion of the wire until the stop engages the femur, and conducting an isometry test by moving the tibia relative to the femur through a range of motion while observing the distance the tibia moves relative to the wire.

8. A method according to claim 1 including the cutting of a recess in the femur between steps (d) and (e) by

placing a cutting tool on the wire;

and,

cutting said recess by rotating said cutting tool while advancing it into the femur.

9. A method according to claim 8 in which s cannulated guide sleeve with an external guide surface is placed on the wire, said cutting tool being cannulated and being guided on said wire by said guide sleeve during said cutting step.

10. A method according to claim 8 in which the wire is attached to the cutting tool and the exposed proximal portion of the wire is pulled to pull the cutting tool into the femur.

11. A method according to claim 10 in which the step of fixing the replacement ligament includes the following steps:

placing a cannulated fixation screw on said wire, and guiding said screw on said wire while rotating said screw to screw it into said femur.

12. A method according to claim 11 wherein a cannulated guide sleeve is placed on said wire, said cannulated guide sleeve having an external surface which guides and supports the fixation screw on the wire.

30. A method according to claim 2 wherein the wire is provided with an enlargement which is unable to pass through the femoral bore formed during step (b);

and, between steps (d) and (e), the wire is moved in a proximal direction until said enlargement engages against a distal surface of the femur, moving the knee joint through a range of motion while observing changes in the position of the wire relative to the tibia to determine the suitability of the location of the femoral bore, and,

after observing said changes and before step (f), cutting the femur to enlarge said femoral bore.

13. A surgical method for positioning an element at a surgical site in the body of a patient, said method involving the use of a guide wire and a cannulated guide tube with inlet and outlet ends, said method including the following steps:

creating a hole in the patient'"'"'s body,

inserting the outlet end of the cannulated guide tube in the patient'"'"'s body.

moving the guide wire in an insertion direction through the guide tube and then beyond its outlet end until the guide wire punctures tissue and exits the patient'"'"'s body,

removing the guide tube from the patient'"'"'s body, connecting an element to the guide wire, and pulling the guide wire in said insertion direction to move the element to the surgical site.

14. A method according to claim 13 in which the guide wire has two ends which both are outside the patient'"'"'s body when the element is at the surgical site, whereby the element can be withdrawn from the surgical site in a direction which is opposite to the insertion direction.

15. A method according to claim 13 in which the wire has a resilient leading end portion with a bend therein when the wire is in a relaxed state,

said guide tube having a shape which keeps the bend straight until it exits the guide tube, said wire upon exiting the guide tube resuming its shape including said bend to affect the direction it travels.

16. A method according to claim 13 wherein the step of connecting an element to the guide wire is performed by connecting a replacement ligament to the guide wire.

17. A method according to claim 13 wherein the cannulated guide tube is a drill bit with cutting means at its outlet end, said method including the step of rotating said guide tube to cut a bore in a bone before moving said guide wire through the guide tube.

18. A method according to claim 17 wherein the cannulated drill bit has an obturator which prevents material from entering the bore during cutting of the bore, said method including the step of removing the obturator from the bore before the wire is passed through the bore.

19. A method according to claim 17 wherein the stop of connecting an element to the guide wire is performed by connecting, to the guide wire, a stop member having dimensions which prevent it from passing through said bore in the bone.

20. A method according to claim 13 including the step of placing a cannulated fixation screw on the guide wire, and moving the fixation screw along the guide wire to the surgical site.

21. A method according to claim 13 wherein the step of connecting an element to the guide wire is performed by connecting, to the guide wire, a rotary bone-cutting tool.

22. A method according to claim 13 wherein the step of connecting an element to the guide wire is performed by connecting, to the guide wire, a flexible radiopaque element which is conformable to bone surfaces at the surgical site.

23. A method of performing anterior cruciate ligament reconstructive surgery on a patient whose body has a thigh and a knee joint which connects a femur to a tibia, said method including the following steps:

forming bores in the tibia and femur;

attaching a replacement ligament to a midportion of a wire which has proximal and distal portions extending in opposite directions from said midportion;

said wire in a proximal direction to carrying a replacement ligament to a position where it extends from the tibia to the femur, to an operative position where, simultaneously, (a) said midportion thereof is in said bores, (b) said proximal portion is exposed and extends out from the patient'"'"'s body, and (c) said distal portion is exposed and extends out from the patient'"'"'s body.

24. A method according to claim 23, also including the step of connecting a cutting tool to said wire, and rotating said cutting tool to cut a graft-receiving recess in a distal surface of the femur.

25. A method according to claim 23, also including the step of attaching a flexible radiopaque body to the wire, and moving the wire in a proximal direction to carry said radiopaque body into the recess, said radiopaque body being conformable to the shape of the recess to permit radiological evaluation of the shape of the recess.

26. A method of performing anterior cruciate ligament reconstructive surgery on a patient whose body has a thigh and a knee joint which connects a femur to a tibia, said method including the following steps:

forming bores in the tibia and femur, inserting a wire through said bores;

said wire having an operative position where, simultaneously, (a) a midportion thereof extends through said bores, (b) an exposed proximal portion thereof extends out from the patient'"'"'s body, and (3) an exposed distal portion thereof extends out from the patient'"'"'s body;

said midportion lying between the proximal portion and the distal portion;

providing an enlargement on the wire, moving the wire in a proximal direction until the enlargement engages against a distal surface of the femur, moving the knee joint through a range of motion while observing changes in the position of a wire relative to the tibia to determine the suitability of the location of the bore in the femur;

attaching a replacement ligament to the wire;

and, moving the wire in a proximal direction to carry the replacement ligament to a position where it extends from the tibia to the femur.

27. A kit of instruments for performing anterior cruciate ligament reconstructive surgery, comprising,

a cannulated drilling and wire-guiding means having a longitudinal bore and an annular leading end provided with cutting means,

obturator means located in said bore and obstructing said bore adjacent to said cutting means to prevent matter from entering said bore during a drilling procedure, said obturator means being removable from said bore,

a wire which is insertable in said bore and is movable through said drilling and wire-guiding means, and

stop means for providing a stop which is fixed on said wire to stop lengthwise movement of the wire through a bore which is formed in a bone, said stop means being larger diametrically than said drilling and wire-guiding means.

28. A kit of instruments according to claim 27 which also includes a cannulated tool-guiding sheath means having a bore which is larger than said wire so that said sheath means is capable of moving on said wire precisely to a surgical site and then guiding an element for longitudinal and rotary movement along said wire.

29. A kit of instruments according to claim 27 wherein the wire has a resilient leading end portion with a bend therein, said drilling and wire-guiding means having a shape which keeps the bend straight until it exits the drilling and wire-guiding means.

31. A method of performing surgery using a cannulated wire-guiding means with inlet and outlet ends, and a wire which has a resilient leading end portion provided with a bend having a bent shape, said method including the steps of placing the outlet end of the wire-guiding means at a surgical site, positioning the leading end portion of the wire in the wire-guiding means to straighten said bend, and moving the wire lengthwise in the wire-guiding means until the bend passes beyond the outlet end of the wire guiding means and resumes its bent shape to cause the leading end portion of the wire to move in a direction determined by the orientation of the bend.