Bone-tendon- bone assembly with cancellous allograft bone block

• US 7,309,356 B2
• Filed: 08/11/2003
• Issued: 12/18/2007
• Est. Priority Date: 03/08/2002
• Status: Active Grant

• Current Assignee: Musculoskeletal Transplant Foundati
• Original Assignee: Musculoskeletal Transplant Foundation
• Inventors: Steiner, Anton J.
• Primary Examiner(s): Sweet, Thomas J.
• Application Number:
  US10/637,577
• Publication Number:
  US 20040030385A1
• Time in Patent Office: 1,590 Days
• Field of Search: 623/13.11, 623/13.12, 623/13.13, 623/13.14, 623/13.15, 623/13.16, 623/13.17, 623/13.18, 623/13.19, 623/13.2
• US Class Current: 623/13.14
• CPC Class Codes: A61B 17/06166 Sutures suture materials A61L17/00; manufacture of artificial threads D01D; treatment of threads D06M
• CPC Class Codes: A61F 2/08 Muscles; Tendons; Ligaments sutures A61B17/04
• CPC Class Codes: A61F 2/0811 Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2/28 Bones joints A61F2/30
• 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 2002/087 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
• CPC Class Codes: A61F 2002/2817 Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]
• CPC Class Codes: A61F 2002/2839 Bone plugs or bone graft dowels
• CPC Class Codes: A61F 2002/30062 (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/30228 Cylinders of elliptical or oval basis
• CPC Class Codes: A61F 2002/30235 tubular, e.g. sleeves
• CPC Class Codes: A61F 2002/30785 parallel
• CPC Class Codes: A61F 2002/30787 inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30881 Circumferential ribs, flanges or fins
• CPC Class Codes: A61F 2002/30891 Plurality of protrusions
• CPC Class Codes: A61F 2002/30892 parallel
• CPC Class Codes: A61F 2002/30894 inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/4649 Bone graft or bone dowel harvest sites
• CPC Class Codes: A61F 2210/0004 : bioabsorbable
• CPC Class Codes: A61F 2230/0069 : cylindrical
• CPC Class Codes: A61F 2310/00179 : Ceramics or ceramic-like structures
• CPC Class Codes: A61L 2430/10 : for reconstruction of tendons or ligaments
• CPC Class Codes: A61L 27/3604 : characterised by the human or animal origin of the biological material, e.g. hair, fascia, fish scales, silk, shellac, pericardium, pleura, renal tissue, amniotic membrane, parenchymal tissue, fetal tissue, muscle tissue, fat tissue, enamel
• CPC Class Codes: A61L 27/3608 : Bone, e.g. demineralised bone matrix [DBM], bone powder
• CPC Class Codes: A61L 27/365 : Bones
• CPC Class Codes: A61L 27/3662 : Ligaments, tendons
• CPC Class Codes: A61L 27/3691 : characterised by physical conditions of the treatment, e.g. applying a compressive force to the composition, pressure cycles, ultrasonic/sonication or microwave treatment, lyophilisation
• CPC Class Codes: A61L 27/3695 : characterised by the function or physical properties of the final product, where no specific conditions are defined to achieve this A61L27/3687, A61L27/3691 take precedence
• CPC Class Codes: A61L 27/3804 : characterised by specific cells or progenitors thereof, e.g. fibroblasts, connective tissue cells, kidney cells
• CPC Class Codes: A61L 27/3847 : Bones
• CPC Class Codes: A61L 27/386 : Ligaments, tendons

Abstract

The invention is directed toward a bone-tendon-bone assembly extended between two shaped cancellous bone blocks and a method of inserting same in a joint. Each substantially cylindrically shaped cancellous bone block has a central through going bore, a flat exterior longitudinal surface and a channel longitudinally cut in the exterior of the bone block body opposite the flat longitudinal surface. A tendon replacement member is inserted through the central through going bore around the end of each block and looped back along the flat longitudinal side with each block being in a reversed orientation position as to the other block. A channel cut in the exterior surface of each block is adapted to receive an interference screw to keep the block anchored in a bone tunnel previously cut in the respective bones of a joint.

Claims

1. A sterile bone-tendon-bone assembly comprising:

a first biocompatible bone block defining an outer curved surface, a central throughgoing bore having a cross section which will allow a tendon replacement member to be passed therethrough and a longitudinal channel cut in its outer exterior surface;

an exterior surface of said bone block positioned away from said channel forming a planar surface, a tendon replacement member extending through said central throughgoing bore of said bone block;

a second biocompatible bone block having the same construction as the first bone block with said tendon replacement member extending through said central bore of said second bone block, said second bone block being in reversed orientation to said first bone block with the channels of said bone blocks being positioned so that they do not engage said tendon replacement member.

2. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein said first and second bone blocks central through going bore has a substantially oval cross section and each block further includes at least one suture hole drilled radially through each of said bone blocks spaced away from said longitudinal channel through to the central bore.

3. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein said first and second bone blocks are constructed of allograft cancellous bone.

4. A sterile bone-tendon-bone assembly as claimed in claim 3 wherein said first and second bone block constructed of allograft cancellous bone are taken from a group of bones consisting of a cancellous patella, femoral head, long bone condyles and talus.

5. A sterile bone-tendon-bone assembly as claimed in claim 3 wherein said first and second bone block are taken from a group of bones consisting of a cancellous patella, femoral head, long bone condyles and talus.

6. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein said first and second bone blocks are constructed of ceramic.

7. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein said first and second bone blocks are constructed of bioabsorbable polymers.

8. A sterile bone-tendon-bone assembly as claimed claim 1 wherein at least one bone block includes an additive taken from a group of additives consisting of living cells, chondrocytes, red blood cells, white blood cells, platelets, blood plasma, bone marrow cells, mesenchymal stem cells, pluripotential cells, osteoblasts, osteoclasts, fibroblasts, epithelial cells and entothial cells, natural extracts, tissue transplants, and growth factors consisting of transforming growth factor (TGF-beta), insulin growth factor (IGF-1), platelet derived growth factor (PDGF), fibroblast growth factor (FGF)(Numbers 1-23), platelet derived growth factor (PDGF),vascular endothelial growth factor (VEGF), osteopontin;

somatotropin; and

growth hormones.

9. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein at least one of said bone blocks is constructed of ceramic.

10. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein said tendon replacement member comprises at least one tendon taken from a group of tendons consisting of a semitendinous tendon, a patellar tendon, gracilis tendon, quadriceps tendon, adductor magnus tendon, peroneus tendons, tibialis tendons and hallucis Achilles tendon.

11. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein at least one bone block is constructed of xenograft bone.

12. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein at least one bone block is constructed of allograft bone.

13. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein said tendon replacement member comprises a semitendinosus tendon.

14. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein said tendon replacement member comprises a patellar tendon.

15. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein said tendon replacement member comprises a gracilis tendon.

16. A sterile bone-tendon-bone assembly as claimed claim 1 wherein said bone block includes an additive taken from a group of additives consisting of living cells, cell elements such as chondrocytes, red blood cells, white blood cells, platelets, blood plasma, bone marrow cells, mesenchymal stem cells, pluripotential cells, osteoblasts, osteoclasts, fibroblasts, epithelial cells and entothial cells, natural extracts, and tissue transplants.

17. A sterile bone-tendon-bone assembly as claimed in claim 1 wherein each bone block includes an additive taken from a group of additives consisting of transforming growth factor (TGF-beta), insulin growth factor (IGF-1), platelet derived growth factor (PDGF), fibroblast growth factor (FGF)(Numbers 1-23), platelet derived growth factor (PDGF),vascular endothelial growth factor (VEGF), osteopontin, somatotropin, and growth hormones.

18. A sterile bone-tendon-bone assembly comprising:

first and second substantially cylindrical allograft cancellous bone blocks, each bone block defining a central through going bore, a channel cut in its outer surface and a longitudinal planar surface cut on the opposite side of said bone block from said channel, a tendon replacement member extending between said first and second bone blocks through said central bore, and seated over said planar surface alongside each of said first and second bone blocks and at least one suture hole cut transverse to said central bore away from said channel and intersecting said central bore;

said second bone block being in a reversed orientation of said first bone block with said channel being positioned on the outside of said assembly.

19. A sterile bone-tendon-bone assembly as claimed in claim 18 wherein said tendon replacement member comprises a first tendon replacement strand and a second tendon replacement strand.

20. A sterile bone-tendon-bone assembly as claimed in claim 18 wherein said tendon replacement member comprises a plurality of strands.

21. The sterile bone-tendon-bone assembly of claim 20 wherein at least one of said tendon replacement strands is xenograft tissue.

22. The sterile bone-tendon-bone assembly of claim 20 wherein said at least one of said tendon replacement strands is allograft tissue.

23. A sterile bone-tendon-bone assembly of claim 20 wherein said tendon replacement strands comprise at least one tendon taken from a group of tendons consisting of a semitendinous tendon, a patellar tendon, gracilis tendon, quadriceps tendon, adductor magnus tendon, peroneus tendons, tibialis tendons and hallucis Achilles tendon.

24. A sterile bone-tendon-bone assembly as claimed claim 18 wherein each bone block includes an additive taken from a group of additives consisting of living cells , cell elements such as chondrocytes, red blood cells, white blood cells, platelets, blood plasma, bone marrow cells, mesenchymal stem cells, pluripotential cells, osteoblasts, osteoclasts, fibroblasts, epithelial cells and entotbial cells, natural extracts, and tissue transplants.

25. A sterile bone-tendon-bone assembly as claimed in claim 18 wherein each bone block includes an additive taken from a group of additives consisting of transforming growth factor (TGF-beta), insulin growth factor (IGF-1), platelet derived growth factor (PDGF), fibroblast growth factor (FGF)(Numbers 1-23), platelet derived growth factor (PDGF),vascular endothelial growth factor (VEGF), osteopontin, growth hormones such as somatotropin.

26. A sterile bone-tendon-bone assembly as claimed in claim 18 wherein said bone block is constructed of allograft bone which is partially demineralized.

27. A sterile reconstructed cruciate tendon assembly comprising:

first and second allograft substantially cylindrical bone blocks;

each bone block comprising a body of cancellous bone with a central through going bore, a channel cut in the outer surface of said substantially cylindrical body and a flat surface forming a cord cut into the outer surface of substantially cylindrical body opposite said channel, a tendon replacement strand extending between said first and second bone blocks is inserted through said central bore and attached longitudinally alongside each of said first and second bone blocks adjacent said flat surface with said first and second bone blocks each having at least one suture hole extending radially through said bone block from said central bore through to an outer surface and said bone blocks have an angled beveled end surface, said second allograft bone block being positioned on said tendon replacement member in a reversed position from said first allograft bone block.

28. A sterile bone-tendon-bone assembly as claimed in claim 27 wherein said tendon replacement member comprises a plurality of strands.

29. The sterile bone-tendon-bone assembly of claim 28 wherein at least one of said tendon replacement strands is xenograft tissue.

30. The sterile bone-tendon-bone assembly of claim 28 wherein said at least one of said tendon replacement strands is allograft tissue.

31. A sterile bone-tendon-bone assembly of claim 27 wherein said tendon replacement strands comprise at least one tendon taken from a group of tendons consisting of a semitendinous tendon, a patellar tendon, gracilis tendon, quadriceps tendon, adductor magnus tendon, peroneus tendons, tibialis tendons and hallucis Achilles tendon.

32. A method of inserting a bone-tendon-bone assembly in a joint comprising the steps of:

a) cutting a bone tunnel in each of two bones of a joint;

b) placing a bone block of bone-tendon-bone assembly comprising a first biocompatible bone block defining an outer curved surface , a central through going bore having a cross section which will allow a tendon replacement member to be passed therethrough and a longitudinal channel cut in its outer exterior surface;

an exterior surface of said bone block positioned away from said channel forming a planar surface, a tendon replacement member extending through said central throughgoing bore of said bone block, a second biocompatible bone block having the same construction as the first bone block with said tendon replacement member extending through said central bore of said second bone block, said second bone block being in reversed orientation to said first bone block with the channels of said bone blocks being positioned so that they do not engage said tendon replacement member;

c) sliding the bone blocks along the tendon replacement member until the correct length for support and flexure is reached;

d) fastening the bone blocks in place on the tendon replacement member; and

e) sequentially fastening each bone block in place in a bone tunnel cut in each of said two bones of a joint.

33. A method of inserting a bone-tendon-bone assembly as claimed in claim 32 wherein said fastening step comprises inserting an interference screw into said bone block channel and a side wall of a bone tunnel.

34. A method of inserting a bone-tendon-bone assembly as claimed in claim 32 wherein said placing step comprises inserting a suture through holes cut in said bone block and pulling said bone block into a bone tunnel.

35. A method of inserting a bone-tendon-bone assembly as claimed in claim 32 wherein a first bone block is fastened in place on a tendon replacement member and then fastened in said bone tunnel prior to the second bone block being fastened in place on said tendon replacement member.