Method and apparatus for tibial fixation of an ACL graft

• US 8,771,352 B2
• Filed: 05/17/2011
• Issued: 07/08/2014
• Est. Priority Date: 05/17/2011
• Status: Active Grant

• Current Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Biomet Sports Medicine LLC (Zimmer Biomet Holdings, Inc.)
• Inventors: Conner, Nathanael K., Berelsman, Brian K., Denham, Gregory J., Stone, Kevin T., Slater, Nicholas R., Arnett, Jeffery D., Butters, Joshua A.
• Primary Examiner(s): IWAMAYE, ANDREW MICHAEL
• Application Number:
  US13/109,667
• Publication Number:
  US 20120296427A1
• Time in Patent Office: 1,148 Days
• Field of Search: 606103-104, 606/139, 606144-150, 606/86.R, 623 1311- 132
• US Class Current: 623/13.13
• 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 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 2017/0403 Dowels other bone dowels A61B17/68; dowels for connecting prosthetic parts A61F2002/30433
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0456 Surface features on the anchor, e.g. ribs increasing friction between the suture and the anchor
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2017/06185 hollow or tubular hollow suture needles A61B2017/061
• 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 2002/0823 Modular anchors comprising a plurality of separate parts
• CPC Class Codes: A61F 2002/0852 Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
• CPC Class Codes: A61F 2002/0882 Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone

Abstract

A tensioner system for use in tensioning graft strands in a knee reconstruction procedure can include a handle assembly, a tensioner assembly coupled relative to the handle assembly, and a drive shaft slidably received through and supported by the handle assembly. The tensioner assembly can include an arm support member rotatably coupled to the handle assembly and first and second arm members each rotatably coupled to lateral sides of the arm support member. Each arm member can include at least one graft attachment area adapted to be coupled to a graft strand. The arm support member can be configured to rotate about an axis perpendicular to a longitudinal axis of the tensioner system and perpendicular to an axis of rotation of each of the arm members. The drive shaft can include proximal and distal ends that extend beyond respective proximal and distal ends of the handle assembly.

Claims

1. A tensioner system for use in graft strand tensioning and fixation in a knee reconstruction procedure, comprising:

a handle assembly, the handle assembly includes a hollow outer handle body and an inner handle body slidably received within the outer handle body;

a tensioner assembly coupled relative to the handle assembly, the tensioner assembly including;

an arm support member rotatably coupled to a distal end of the inner handle body; and

first and second arm members each rotatably coupled to lateral sides of the arm support member, each arm member including at least one graft attachment area adapted to be coupled to a graft strand, the arm support member configured to rotate about an axis perpendicular to a longitudinal axis of the tensioner system and perpendicular to an axis of rotation of each of the first and second arm members;

a drive shaft slidably received through and supported by the handle assembly such that proximal and distal ends of the drive shaft extend beyond respective proximal and distal ends of the handle assembly; and

a ratcheting member slidably received in the outer handle body and including a plurality of ratchet teeth in selective engagement with a pawl carried by the outer handle body, the ratchet teeth configured to maintain a position of the outer handle body relative to the ratcheting member upon movement of the outer handle body relative to the ratcheting member.

2. The tensioner system of claim 1, further comprising an implant coupled to the distal end of the drive shaft.

3. The tensioner system of claim 2, wherein the implant includes a body having a proximal end, a distal end and an inner bore extending from the proximal end partially toward the distal end, and wherein the distal end of the drive shaft is received in the bore of the implant and the proximal end of the drive shaft includes an impact plate.

4. The tensioner system of claim 3, wherein the implant includes a plurality of segmented portions having an increasing diameter from the distal end to the proximal end.

5. The tensioner system of claim 3, wherein the implant further comprises four longitudinally extending ribs each equally circumferentially spaced apart from each other around an outer surface of the implant.

6. The tensioner system of claim 3, wherein the implant includes an angled surface at the proximal end adapted to correspond to an angle of a tibial bone tunnel relative to a longitudinal axis of the tibia such that a length of the implant along a superior surface is less than a length of the implant along an opposite inferior surface.

7. The tensioner system of claim 6, further comprising a projection extending radially outward from the proximal end at the superior surface of the implant.

8. The tensioner system of claim 2, wherein the handle assembly, arm support member, drive shaft and implant are cannulated.

9. The tensioner system of claim 2, further comprising:

a self-locking adjustable flexible member construct having a pair of adjustable loops adapted to be coupled to graft strands; and

a fixation member coupled to the adjustable flexible member construct;

wherein the fixation member is adapted to fix the adjustable flexible member construct relative to a bone tunnel.

10. The tensioner system of claim 1, further comprising a spring positioned within the outer handle body about the inner handle body and biasing the arm support member and arms in a direction toward and against the outer handle body, wherein movement of the outer handle body relative to the inner handle body increases a longitudinal length of the tensioner system.

11. The tensioner system of claim 1, wherein when the arm support member and arms are biased against the outer handle body, the arm support member and arms are locked in a non-deployed or deployed position;

and

wherein when tension is applied to the tensioner assembly such that the outer handle body moves apart from the arms and arm support member, the arms and arm support member are free to independently rotate about each of their respective axes.

12. The tensioner system of claim 1, further comprising a tension release member coupled to the outer handle body and in engagement with the pawl, the tension release member configured to allow engagement of the pawl with the ratchet teeth in a first position and to disengage the pawl from the ratchet teeth upon movement of the tension release member from the first position to a second position.

13. The tensioner system of claim 1, wherein the arm support member is rotatably coupled to the inner handle body at a longitudinally central portion of the arm support member such that each arm is positioned on an opposite side of and laterally spaced apart from the inner handle body and the ratcheting member.

14. The tensioner system of claim 1, wherein the ratcheting member includes a throughbore slidably receiving a portion of the drive shaft and a C-shaped distal end adapted to be aligned with a tibial bone tunnel and receive the drive shaft therethrough.

15. The tensioner system of claim 14, wherein the ratcheting member further comprises a bone engaging member protruding from the distal end thereof beyond a bone engaging surface of the C-shaped distal end.

16. The tensioner system of claim 1, wherein the inner handle body includes a U-shaped channel having an open end, and wherein the ratcheting member includes a second side opposite a first side having the ratchet teeth, the second side slidably abutting the open end of the U-shaped channel of the inner handle body.

17. The tensioner system of claim 16, wherein the drive shaft is received within the U-shaped channel of the inner handle body so as to have at least a portion surrounded by the inner handle body and the ratcheting member.

18. The tensioner system of claim 1, wherein each arm member includes a pair of graft strand attachment portions at opposed ends thereof such that the tensioner assembly is adapted to be coupled to four graft strands with each arm adapted to be coupled to a pair of the four graft strands.

19. The tensioner system of claim 18, wherein the attachment portions include slots adapted to receive a respective suture coupled to each graft strand.

20. The tensioner system of claim 1, wherein the inner handle body includes a scale positioned about a proximal end thereof having indicia indicative of an amount of tension being applied by the tensioner system.

21. A tensioner system for use in graft strand tensioning and fixation in a knee reconstruction procedure, comprising:

a handle assembly including a hollow outer handle body and an inner handle body slidably received within the outer handle body, an arm support member rotatably coupled to a distal end of the inner handle body;

a tensioner assembly coupled relative to the handle assembly;

a ratcheting member slidably received in the outer handle body and including a plurality of ratchet teeth in selective engagement with a pawl carried by the outer handle body, the ratchet teeth configured to maintain a position of the outer handle body relative to the ratcheting member upon movement of the outer handle body relative to the ratcheting member; and

a drive shaft slidably received through and supported by the handle assembly such that proximal and distal ends of the drive shaft extend beyond respective proximal and distal ends of the handle assembly;

wherein the ratcheting member includes a throughbore slidably receiving a portion of the drive shaft and a C-shaped distal end adapted to be aligned with a tibial bone tunnel and receive the drive shaft therethrough.

22. The tensioner system of claim 21, wherein the tensioner assembly includes:

first and second arm members each rotatably coupled to lateral sides of the arm support member, each arm member including at least one graft attachment area adapted to be coupled to a graft strand, the arm support member configured to rotate about an axis perpendicular to a longitudinal axis of the tensioner system and perpendicular to an axis of rotation of each of the first and second arm members.

23. The tensioner system of claim 22, further comprising a spring positioned within the outer handle body about the inner handle body and biasing the arm support member and arms in a direction toward and against the outer handle body, wherein movement of the outer handle body relative to the inner handle body increases a longitudinal length of the tensioner system.

24. The tensioner system of claim 22, wherein when the arm support member and arms are biased against the outer handle body, the arm support member and arms are locked in a non-deployed or deployed position;

and

wherein when tension is applied to the tensioner assembly such that the outer handle body moves apart from the arms and arm support member, the arms and arm support member are free to independently rotate about each of their respective axes.

25. The tensioner system of claim 22, wherein the arm support member is rotatably coupled to the inner handle body at a longitudinally central portion of the arm support member such that each arm is positioned on an opposite side of and laterally spaced apart from the inner handle body and the ratcheting member.

26. The tensioner system of claim 21, further comprising an implant coupled to the distal end of the drive shaft.

27. The tensioner system of claim 21, further comprising a tension release member coupled to the outer handle body and in engagement with the pawl, the tension release member configured to allow engagement of the pawl with the ratchet teeth in a first position and to disengage the pawl from the ratchet teeth upon movement of the tension release member from the first position to a second position.

28. The tensioner system of claim 21, wherein the ratcheting member further comprises a bone engaging member protruding from the distal end thereof beyond a bone engaging surface of the C-shaped distal end.

29. The tensioner system of claim 21, wherein the inner handle body includes a U-shaped channel having an open end, and wherein the ratcheting member includes a second side opposite a first side having the ratchet teeth, the second side slidably abutting the open end of the U-shaped channel of the inner handle body.

30. A tensioner system for use in graft strand tensioning and fixation in a knee reconstruction procedure, comprising:

a handle assembly including a hollow outer handle body and an inner handle body slidably received within the outer handle body, an arm support member rotatably coupled to a distal end of the inner handle body;

a tensioner assembly coupled relative to the handle assembly, the tensioner assembly including first and second arm members each rotatably coupled to lateral sides of the arm support member;

a ratcheting member slidably received in the outer handle body and including a plurality of ratchet teeth in selective engagement with a pawl carried by the outer handle body, the ratchet teeth configured to maintain a position of the outer handle body relative to the ratcheting member upon movement of the outer handle body relative to the ratcheting member; and

a drive shaft slidably received through and supported by the handle assembly such that proximal and distal ends of the drive shaft extend beyond respective proximal and distal ends of the handle assembly;

wherein when the arm support member and arms are biased against the outer handle body, the arm support member and arms are locked in a non-deployed or deployed position; and

wherein when tension is applied to the tensioner assembly such that the outer handle body moves apart from the arms and arm support member, the arms and arm support member are free to independently rotate about each of their respective axes.

31. The tensioner system of claim 30, each arm member including at least one graft attachment area adapted to be coupled to a graft strand, the arm support member configured to rotate about an axis perpendicular to a longitudinal axis of the tensioner system and perpendicular to an axis of rotation of each of the first and second arm members.

32. The tensioner system of claim 30, further comprising an implant coupled to the distal end of the drive shaft.

33. The tensioner system of claim 30, further comprising a spring positioned within the outer handle body about the inner handle body and biasing the arm support member and arms in a direction toward and against the outer handle body, wherein movement of the outer handle body relative to the inner handle body increases a longitudinal length of the tensioner system.

34. The tensioner system of claim 30, further comprising a tension release member coupled to the outer handle body and in engagement with the pawl, the tension release member configured to allow engagement of the pawl with the ratchet teeth in a first position and to disengage the pawl from the ratchet teeth upon movement of the tension release member from the first position to a second position.

35. The tensioner system of claim 30, wherein the arm support member is rotatably coupled to the inner handle body at a longitudinally central portion of the arm support member such that each arm is positioned on an opposite side of and laterally spaced apart from the inner handle body and the ratcheting member.

36. The tensioner system of claim 30, wherein the ratcheting member includes a throughbore slidably receiving a portion of the drive shaft and a C-shaped distal end adapted to be aligned with a tibial bone tunnel and receive the drive shaft therethrough.

37. The tensioner system of claim 30, wherein the handle assembly, arm support member, drive shaft, and implant are cannulated.

38. The tensioner system of claim 30, wherein each arm member includes a pair of graft strand attachment portions at opposed ends thereof such that the tensioner assembly is adapted to be coupled to four graft strands with each arm adapted to be coupled to a pair of the four graft strands.

39. A tensioner system for use in graft strand tensioning and fixation in a knee reconstruction procedure, comprising:

a handle assembly including a hollow outer handle body and an inner handle body slidably received within the outer handle body, an arm support member rotatably coupled to a distal end of the inner handle body;

a tensioner assembly coupled relative to the handle assembly, the tensioner assembly including first and second arm members each rotatably coupled to lateral sides of the arm support member;

a ratcheting member slidably received in the outer handle body and including a plurality of ratchet teeth in selective engagement with a pawl carried by the outer handle body, the ratchet teeth configured to maintain a position of the outer handle body relative to the ratcheting member upon movement of the outer handle body relative to the ratcheting member;

a drive shaft slidably received through and supported by the handle assembly;

a self-locking adjustable flexible member construct having a pair of adjustable loops adapted to be coupled to graft strands; and

a fixation member coupled to the adjustable flexible member construct;

wherein the fixation member is adapted to fix the adjustable flexible member construct relative to a bone tunnel.