CA2441050A1 - Method and apparatus for fixing a graft in a bone tunnel - Google Patents

Method and apparatus for fixing a graft in a bone tunnel Download PDF

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Publication number
CA2441050A1
CA2441050A1 CA002441050A CA2441050A CA2441050A1 CA 2441050 A1 CA2441050 A1 CA 2441050A1 CA 002441050 A CA002441050 A CA 002441050A CA 2441050 A CA2441050 A CA 2441050A CA 2441050 A1 CA2441050 A1 CA 2441050A1
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CA
Canada
Prior art keywords
bone tunnel
bone
guide rod
frame member
cross
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CA002441050A
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French (fr)
Other versions
CA2441050C (en
Inventor
Gregory R. Whittaker
Ronald L. Taylor, Jr.
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DePuy Mitek LLC
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Individual
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Filing date
Publication date
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Publication of CA2441050A1 publication Critical patent/CA2441050A1/en
Application granted granted Critical
Publication of CA2441050C publication Critical patent/CA2441050C/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1714—Guides or aligning means for drills, mills, pins or wires for applying tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1764—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0805—Implements for inserting tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1637—Hollow drills or saws producing a curved cut, e.g. cylindrical
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1675—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the knee
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/062—Measuring instruments not otherwise provided for penetration depth
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/087—Anchor integrated into tendons, e.g. bone blocks, integrated rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0876—Position of anchor in respect to the bone
    • A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone

Abstract

A method and apparatus (5) for fixing a ligament (250) in a bone tunnel (130 , 135) by cross-pinning the ligament (250) in the bone tunnel (130, 135).</SDO AB>

Claims (41)

What Is Claimed Is:
1. Apparatus for positioning at lest one cross-pin in a bone through a bone tunnel, said apparatus comprising:
a bone tunnel guide rod having a proximal end and a distal end;
a movable element slidably positioned about said bone tunnel guide rod, wherein said movable element is lockable into a position to selectably adjust the length of said guide rod between said distal end and said movable element;
a frame member having a base portion and an arm portion, said base portion attachable adjacent said proximal end of said bone tunnel guide rod;
a drill guide member connected to said arm portion of said frame member; and drilling means for drilling at least one cross-pin hole in said bone and across said bone tunnel, with said drilling means being supported in position by said drill guide member, said drill guide member in attachment with said frame member, said frame member being in attachment with said bone tunnel guide rod, and said bone tunnel guide rod being inserted into said bone tunnel, and said apparatus being held against said bone, wish said movable element limiting further insertion into said bone tunnel.
2. The apparatus of claim 1 further comprising a ratchet system to position said movable element on said bone tunnel guide rod.
3. The apparatus of claim 1 wherein said bone tunnel guide rod forms a passageway at said distal end.
4. The apparatus of claim 1 wherein said passageway is diametrical and longitudinally-elongated relative to said bone tunnel guide rod.
5. The apparatus of claim 1 wherein said bone tunnel guide rod is releasably connectable to said base portion of said frame member.
6. The apparatus of claim 5 wherein said base portion forms a bore and said bone tunnel guide rod is retained in said bore formed in said base portion by a set screw.
7. The apparatus of claim 1 wherein said bone tunnel guide rod is fixedly connected to said base portion.
8. The apparatus of claim 1 wherein said bone tunnel guide rod has a longitudinal axis and said bone tunnel guide rod further comprises being cannulated along said longitudinal axis.
9. The apparatus of claim 1 wherein said drilling means is a trocar.
10. The apparatus of claim 1 wherein said cross-pin is deployed in the cortical portion of the bone at the region of greatest bone strength.
11. The apparatus of claim 10 wherein said cross-pin is absorbable.
12. The apparatus of claim 1 wherein said drill guide member is fixedly attached to said arm portion of said frame member.
13. The apparatus of claim 1 further comprising a set screw to releasably retain said drill guide member on said arm portion or staid frame member.
19. The apparatus of claim 13 further comprising a stop means for limiting movement of said drill guide member along said arm portion of said frame member.
15. The apparatus of claim 1 wherein said guide member is configured for the direct placement of at least one cross-pin, wherein said at least one cross-pin penetrates the bone.
16. A method for fixing a ligament in a bone tunnel, said method comprising the steps of:
forming a bone tunnel in a bone, said bone tunnel comprising a first open end and a second open end, with a portion between said first open end and said second open end having a diameter sized to receive the ligament;

inserting a guide god into staid bone tunnel, said guide rod having a proximal end and a distal end;
positioning said distal end of said guide rod adjacent said second open end of said bone tunnel;
positioning a movable element on said guide rod against the bone at the open end of said bone tunnel;
drilling at least ene cross-pin hole transversely through said bone and across said bone tunnel, using drilling means for drilling said cross-pin hole, said drilling means being supported in position by a drill guide member, with said drill guide member being in attachment with a frame member, said frame member being in attachment with said bone tunnel guide rod, said bone tunnel guide rod being inserted into said bone tunnel, and with said movable element limiting further insertion of the bone tunnel guide rod into said bone tunnel; and inserting at least one cress-pin through said at least one cross-pin holy.
17. The method of claim 1H wherein said frame member is attached to said bore tunnel guide rod after the step of positioning a movable element on said guide rod against the bone at the open end of the bone tunnel and before the step of drilling at least one cross-pin hole transversely through said bone and across said bone tunnel.
18. The method of claim 16 wherein said frame member is attached to said bone tunnel guide rod before the step of inserting said guide rod into said bone tunnel.
19. An apparatus for positioning at least one cross-pin in a bone through a bone tunnel, said apparatus comprising:
a bone tunnel guide rod having a proximal end and a distal end, with said bone tunnel guide rod having a gradiated index between said proximal end end said distal end, wherein said gradiated index is read at a given position in said bone tunnel in relation to an intended position of at least one cross-pin hole;
a frame member having a base portion and an arm portion, said base portion attachable adjacent to said proximal end of said bone tunnel guide rod, and said arm portion of said frame member having a scale corresponding with said gradiated index of said bone tunnel guide rod;
a drill guide member attachable to said arm portion of said frame member, said drill guide member being selectively adjustable relative to said scale of said frame member; and drilling means for drilling said at least one cross-pin hole in said bone through said bone tunnel, said drilling means being supported in position by said drill guide member, said drill guide member being in attachment with said frame member, and said frame member being in attachment with said bone tunnel guide rod, with said bone tunnel guide rod being inserted into said bone tunnel, with sai distal end of apparatus being held against sad a terminal end of said bone tunnel, limiting further insertion into said bone tunnel.
20. The apparatus of claim 19 wherein said bone tunnel guide rod forms a diametrical, longitudinally-elongated passageway therethrough at said distal end.
21. The apparatus of clam 19 wherein, said bone tunnel guide rod is releasably connectable to said base portion of said frame member.
22. The apparatus of claim 19 wherein said bone tunnel guide rod has a longitudinal axis and said bone tunnel guide rod further comprises being cannulated along said longitudinal axis.
23. The apparatus of claim 19 wherein said base portion forms a bore and said bone tunnel guide rod is retained in said bone formed in said base portion by a set screw.
24. The apparatus of claim 19 wherein said bone tunnel guide rod is fixedly connected to said base portion.
25. The apparatus of claim 19 wherein said drilling means is a trocar.
26. The apparatus of claim 19 wherein said cross-pin is deployed in the cortical portion of the bone at the region of greatest bone strength.
27. The apparatus of claim 19 wherein said cross-pin is absorbable.
28. The apparatus of claim 19 further comprising a set screw to releasably retain said drill guide member on said arm portion of said frame member.
29. The apparatus of claim 28 further comprising a stop means for limiting movement of said drill guide member along said arm portion of said frame member.
30. The apparatus of claim 19 wherein said drill guide member is configured for the direct placement of at least one cross-pin, wherein said at least one cross-pin penetrates the bone.
31. The apparatus of claim 19 wherein the position of said gradiated index in relation to the intended position of said at least one cross-pinning hole is read using an arthroscope.
32. The apparatus cf claim 19 wherein said drill guide member is set to a position on said frame member relative to said scale corresponding with said gradiated index, whereby said drilling means drill said at least one cross-pin hole in said bone through said bone tunnel.
33. A method for fixing a ligament in a bone tunnel, said method comprising the steps of forming a bone tunnel in a bone, said bone tunnel comprising a first portion and a second portion, said first portion having a first open end and a second open end, and said second portion having a third open end and a fourth terminal end, and a portion between said first open end and said fourth terminal end having a diameter sized to receive said ligaments inserting a bone tunnel guide rod into said bone tunnel, said bone tunnel guide rod having a proximal end and a distal end, and said bone tunnel guide rod having a gradiated index between said proximal end and said distal end;

positioning said distal end of said guide rod against said fourth terminal end of said bone tunnel;
determining the position of said gradiated index relative to said second open end of said bone tunnel;
positioning a drill guide attached to a frame member, said frame member including a scale corresponding with said gradiated index of said bone tunnel guide rod, said gill guide being positioned relative to said scale in accordance with said gradiated index relative to said second open end of said bone tunnel;
drilling at least one cross-pin hole transversely through said bore into said bone tunnel using drilling means for drilling said cross-pin hole, said drilling means supported in position by said drill guide member, said drill guide member being in attachment with said frame member, said frame member being in attachment with said bore tunnel guide rod, said bone tunnel guide rod being inserted into said bone tunnel, and said fourth terminal end of the bone tunnel limiting further insertion into said bone tunnel; and inserting at least one cross-pin through said cross-pin hole.
39. The method of claim 33 wherein the step of determining the position of said gradiated index relative to said second open end of said bone tunnel includes using an arthroscope.
35. Apparatus for positioning at least one cross-pin in a bone through a bone tunnel, said apparatus comprising:
a kit of bone tunnel guide rods, each of said bone tunnel guide rods including a proximal end and a distal end, and each of said bore tunnel guide rods including insertion limiting means for limiting insertion into said bone tunnel, said insertion limiting means of each of said bone tunnel guide rods being located a given distance from its distal end, said kit including at least two bone tunnel guide rods, with said given distance of each of said bone tunnel guide rods being different from one another, and wherein selection from said kit is made by inserting at least one of said bone tunnel guide rods into said bone tunnel and selecting a bone tunnel guide rod that has its distal end aligned with a bone surface when said insertion limiting means is in engagement with another bone surface;

a frame member having a base portion and an arm portion, said base portion attachable adjacent to said proximal end of said selected bone tunnel guide rod;

a drill guide member attached to said arm portion of said frame member;
drilling means for drilling said at least one cross-pin hole in said bone through said bone tunnel, said drilling means being supported in position by said drill guide member, said drill guide member being in attachment with said frame member, and said frame member being in attachment with said selected bone tunnel guide rod, with said selected bone tunnel guide rod being inserted into said bone tunnel, with said insertion limiting means preventing further insertion into said bone tunnel.
36. The apparatus of claim 35 wherein said insertion limiting means are a first stepped portion and a second stepped portion, wherein said first stepped portion is at said distal portion of said bone tunnel guide rod and is sized to pass within the bone tunnel, and said second stepped portion is of said proximal portion of staid bone tunnel guide rod and is sized to be impeded by the bore adjacent to the bone tunnel.
37. A method for fixing a ligament in a bone tunnel, said method comprising she steps of:

forming a bone tunnel in a bore, said bone tunnel comprising a first open end and a second open end, with a portion between said first open end end said second open end having a diameter sized to receive the ligament;

inserting at least one guide rod from a kit of bone tunnel guide rods into said bone tunnel, each of said bone tunnel guide rods including a proximal end and a distal end, and each of said bone tunnel guide rods including insertion limiting means for limiting insertion into said bone tunnel, said insertion limiting means of each of said bone tunnel guide rods being located a given distance from its distal end, said kit including at least two bore tunnel guide rods, with said given distance of each of said bone tunnel guide rods being different from one another;
inserting at least one of to bone tunnel guide rods into the bone tunnel and selecting a bone tunnel guide rod, that has its distal end aligned with said second end of said bone tunnel when said insertion limiting means is in engagement with the bone adjacent the first end of the bone tunnel;

drilling at least one cross-pin hole transversely through said bone and across said bone tunnel, using drilling means for drilling said cross-pin hole, said drilling means being supported in position by a drill guide member, with said drill guide member being in attachment with a frame member, said frame member being in attachment with said selected bone tunnel guide rod, said selected bone tunnel guide rod being inserted into said bone tunnel, and with said insertion limiting means limiting further insertion of the bone tunnel guide rod into said bone tunnel; and inserting at least one cross-pin through said at least one cross-pin hole.
38. The method of claim 37 wherein said frame member is attached to said at least one guide rod from said kit of bone tunnel guide rods after the step of forming the bone tunnel in the bone and prior to the step of inserting at least one guide rod from said kit of bone tunnel guide rods into the bone tunnel.
39. The method of claim 37 wherein said frame member is attached to said selected bone tunnel guide rod after the step of selecting said one of said bone tunnel guide rods that aligns with said distal end of said bone tunnel and prior to the step of drilling at least one cross-pin hole transversely through the bone and across the bone tunnel.
40. The method of claim 39 further comprising the step of removing said selected bone tunnel guide rod prior to attachment with said frame member and re-inserting said selected bone tunnel guide rod prior to the step of drilling at least one cross-pin hole transversely through the bone and across the bone tunnel.
41. The method of claim 39 wherein said frame member is attached to said selected bene tunnel guide rod without removing said selected bone tunnel guide rod from the bone tunnel.
CA2441050A 2001-03-13 2002-03-13 Method and apparatus for fixing a graft in a bone tunnel Expired - Fee Related CA2441050C (en)

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
US27543101P 2001-03-13 2001-03-13
US60/275,431 2001-03-13
US09/865,274 2001-05-25
US09/865,274 US6517546B2 (en) 2001-03-13 2001-05-25 Method and apparatus for fixing a graft in a bone tunnel
PCT/US2002/007810 WO2002071958A1 (en) 2001-03-13 2002-03-13 Method and apparatus for fixing a graft in a bone tunnel

Publications (2)

Publication Number Publication Date
CA2441050A1 true CA2441050A1 (en) 2002-09-19
CA2441050C CA2441050C (en) 2011-07-19

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Family Applications (1)

Application Number Title Priority Date Filing Date
CA2441050A Expired - Fee Related CA2441050C (en) 2001-03-13 2002-03-13 Method and apparatus for fixing a graft in a bone tunnel

Country Status (7)

Country Link
US (5) US6517546B2 (en)
EP (1) EP1377226B1 (en)
JP (3) JP4195298B2 (en)
AU (2) AU2002247337B2 (en)
CA (1) CA2441050C (en)
DE (1) DE60223348T2 (en)
WO (1) WO2002071958A1 (en)

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