CA2272251C - Apparatus and methods for anchoring autologous or artificial tendon grafts in bone - Google Patents
Apparatus and methods for anchoring autologous or artificial tendon grafts in bone Download PDFInfo
- Publication number
- CA2272251C CA2272251C CA002272251A CA2272251A CA2272251C CA 2272251 C CA2272251 C CA 2272251C CA 002272251 A CA002272251 A CA 002272251A CA 2272251 A CA2272251 A CA 2272251A CA 2272251 C CA2272251 C CA 2272251C
- Authority
- CA
- Canada
- Prior art keywords
- graft
- bone
- aperture
- stabilizing element
- assembly
- 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.)
- Expired - Fee Related
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/686—Plugs, i.e. elements forming interface between bone hole and implant or fastener, e.g. screw
-
- 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
- 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
- A61F2002/0817—Structure of the anchor
- A61F2002/0823—Modular anchors comprising a plurality of separate parts
- A61F2002/0835—Modular anchors comprising a plurality of separate parts with deformation of anchor parts, e.g. expansion of dowel by set screw
-
- 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
- A61F2002/0852—Fixation of a loop or U-turn, e.g. eyelets, anchor having multiple holes
-
- 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
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S606/00—Surgery
- Y10S606/907—Composed of particular material or coated
Abstract
An anchor assembly (12) for autologous or artificial tendon grafts comprises an insertion element (14) and a stabilizing element (15). The insertion element has a stem (20) and a head (21) containing an aperture (13) large enough to receive a graft (10). The stabilizing element (15) is adapted to be embedded in bone, and comprises a sleeve (19) with a cavity (17) arranged to receive and hold the insertion element stem (20). In use, the stabilizing element (15) is affixed in the bone, and the stem (20) of the insertion element (14) is placed therein. A tendon graft (10) may be secured to the insertion element (14) either before or after its placement in the stabilizing element (15). Two such anchors may be linked with one or multiple grafts, in either a two- ply or four-ply arrangement.
Description
APPARATUS AND METHODS FOR ANCHORING
AUTOLOGOUS OR ARTIFICIAL TENDON GRAFTS IN BONE.
Background of the Invention This invention pertains to surgical systems and, more particularly, apparatus and methods for attaching autologous or artificial tendon grafts to bone. The invention has application in, for example, repair of the anterior cruciate ligament (ACL) of the knee. It may also be used, for example, for repair of other ligaments, such as of the elbow or ankle.
It is not uncommon for ligaments and other soft tissue to tear or detach from bone.
Athletes, for example, often suffer tears or other injuries to the anterior cruciate ligament, one of the ligaments connecting the femur (thigh bone) and the tibia (shin bone) at the center of the knee joint. The ACL, which limits hyperextension of the knee and prevents the backward sliding of the femur on the tibial plateau, may be injured when the knee is twisted beyond the normal range of motion, e.,~T., when the knee is twisted while bending and weaving during skiing and other sports activities. ACL injuries may take the form of total or partial tears.
Reconstruction is the most common form of surgery for injuries to the ACL and involves replacing the ACL with a graft of autologous or artificial tendon. An autologous tendon graft may be "harvested" from the patient's patellar ligament, which is part of the common tendon of the quadriceps femoris, connecting the patella to the tibia.
An alternative autologous tendon graft may be harvested from the semitendinosus tendon, which runs posteriorly and medially along the thigh and which connects the upper femur to the tibia.
Traditionally, patellar grafts are harvested with attacheu bone plugs that can be securely fixed at the ends of a bone tunnel drilled through the tibia and femur using a metallic interference screw, a metal screw and washer, or buttons. Drawbacks associated with the use of the patellar tendon include difficulties in harvesting the tendon and post-operative complications.
More recent success has been achieved using one or more strands of the triple-stranded semitendinosus tendon, which can be harvested with minimal post-operative complications. The strands can be used alone or in combination with the gracilis tendon, which anatomically runs parallel along the thigh to the semitendinosus tendon.
Although semitendinosus tendons are increasingly used in ACL repair, they are difficult to attach to bone, due in part to the absence of associated bone plugs.
The art suggests several techniques for attaching the semitendinosus tendon to bone in ACL repair. One such technique involves suturing the tendon to a button or staple on the exterior of the bone. Drawbacks associated with this method include stretching or failure of the suture, which may be subjected to tensile forces ranging from 30-50 pounds.
Another technique involves attaching a tendon graft to bone using metallic screws. Although such metal screws demonstrate stable fixation and good tensile strength, they have a nurnber of drawbacks. These include distortion of post-operative radiological studies, an allergic or rejection reaction resulting from metal sensitivity associated with permanently implanted metal screws, and the potential need for additional operations for removal or replacement.
Another technique involves attaching a tendon graft to an anchor affixed within a tunnel drilled in the bone. One anchor intended for this use is the Mitek Ligament Anchor available from Mitek Surgical Products, Inc. That anchor includes prongs that lodge into the bone after the anchor has been pulled into position by a suture. A
drawback of that anchor is that it must be lodged in the cortical layer near the surface of the femur and therefore necessitates the use of long tendon segments. In addition, the anchor's design necessitates that it be fabricated from metal to ensure sufficient holding strength.
An object of this invention is to provide improved surgical systems, and more particularly, improved methods and apparatus for attaching autologous or artificial tendon grafts to bone.
Another object of this invention is to provide improved methods and apparatus for attachment of autologous or artificial tendon grafts (e.g., for ACL repair) that are in which the attachment means can be fabricated from polymers or bioabsorbable materials, without the use of metals.
A related object of this invention is to provide methods and apparatus for attachment of autologous and artificial tendons that minimize or elirninate the risk of graft ~ pullout normally associated with ACL or other reconstructive orthopedic surgery.
Summary of the Invention The above objects are among,those met by the invention, which provides improved apparatus and their use for attaching autologous or artificial #endbngrafts to 1o bone, e.fi, during ligament and other.reconstructive surgery, including ACL
reconstruction. These allow anchoring the tendon graft in the bone, without metal an.' without placing undue load on sutures.
In one aspect, an assembly according to the invention comprises an insertion element and a stabilizing element. The stabilizing element has an outer surface adapted 15 for interference fit with a bone hole. The insertion element includes an aperture through which a graft may be threaded or attached, and a stem adapted to be inserted into and retained in a cavity in the stabilizing element, e.g., by an interference fit.
Additionally, the insertion element may comprise an aperture, slot, or barb, preferably at its distal end, to facilitate.its insertion into the stabilizing element.
20 According to one aspect of the invention, the stabilizing element has a threaded outer surface that can be securely turned into the bone. In addition, the stabilizing element can have an inner bore that is smaller than the outer diameter of the insertion element, such that placement of the latter into the former causes the stabilizing element to deformably expand or otherwise obtain a still stronger pressure fit with the bone hole.
25 In another aspect, the invention provides a stabilizing element that has a flanged head that rests on the surface of the bone, outside of the bone hole, and that prevents the element from entering the bone hole beyonda certain point.
In further aspects of the invention, the insertion and stabilizing elements comprise bio-compatible materials. These avoid adverse biological reactions to the elements, as 30 well as thc need for a second surgical procedure to remove the elements.
AUTOLOGOUS OR ARTIFICIAL TENDON GRAFTS IN BONE.
Background of the Invention This invention pertains to surgical systems and, more particularly, apparatus and methods for attaching autologous or artificial tendon grafts to bone. The invention has application in, for example, repair of the anterior cruciate ligament (ACL) of the knee. It may also be used, for example, for repair of other ligaments, such as of the elbow or ankle.
It is not uncommon for ligaments and other soft tissue to tear or detach from bone.
Athletes, for example, often suffer tears or other injuries to the anterior cruciate ligament, one of the ligaments connecting the femur (thigh bone) and the tibia (shin bone) at the center of the knee joint. The ACL, which limits hyperextension of the knee and prevents the backward sliding of the femur on the tibial plateau, may be injured when the knee is twisted beyond the normal range of motion, e.,~T., when the knee is twisted while bending and weaving during skiing and other sports activities. ACL injuries may take the form of total or partial tears.
Reconstruction is the most common form of surgery for injuries to the ACL and involves replacing the ACL with a graft of autologous or artificial tendon. An autologous tendon graft may be "harvested" from the patient's patellar ligament, which is part of the common tendon of the quadriceps femoris, connecting the patella to the tibia.
An alternative autologous tendon graft may be harvested from the semitendinosus tendon, which runs posteriorly and medially along the thigh and which connects the upper femur to the tibia.
Traditionally, patellar grafts are harvested with attacheu bone plugs that can be securely fixed at the ends of a bone tunnel drilled through the tibia and femur using a metallic interference screw, a metal screw and washer, or buttons. Drawbacks associated with the use of the patellar tendon include difficulties in harvesting the tendon and post-operative complications.
More recent success has been achieved using one or more strands of the triple-stranded semitendinosus tendon, which can be harvested with minimal post-operative complications. The strands can be used alone or in combination with the gracilis tendon, which anatomically runs parallel along the thigh to the semitendinosus tendon.
Although semitendinosus tendons are increasingly used in ACL repair, they are difficult to attach to bone, due in part to the absence of associated bone plugs.
The art suggests several techniques for attaching the semitendinosus tendon to bone in ACL repair. One such technique involves suturing the tendon to a button or staple on the exterior of the bone. Drawbacks associated with this method include stretching or failure of the suture, which may be subjected to tensile forces ranging from 30-50 pounds.
Another technique involves attaching a tendon graft to bone using metallic screws. Although such metal screws demonstrate stable fixation and good tensile strength, they have a nurnber of drawbacks. These include distortion of post-operative radiological studies, an allergic or rejection reaction resulting from metal sensitivity associated with permanently implanted metal screws, and the potential need for additional operations for removal or replacement.
Another technique involves attaching a tendon graft to an anchor affixed within a tunnel drilled in the bone. One anchor intended for this use is the Mitek Ligament Anchor available from Mitek Surgical Products, Inc. That anchor includes prongs that lodge into the bone after the anchor has been pulled into position by a suture. A
drawback of that anchor is that it must be lodged in the cortical layer near the surface of the femur and therefore necessitates the use of long tendon segments. In addition, the anchor's design necessitates that it be fabricated from metal to ensure sufficient holding strength.
An object of this invention is to provide improved surgical systems, and more particularly, improved methods and apparatus for attaching autologous or artificial tendon grafts to bone.
Another object of this invention is to provide improved methods and apparatus for attachment of autologous or artificial tendon grafts (e.g., for ACL repair) that are in which the attachment means can be fabricated from polymers or bioabsorbable materials, without the use of metals.
A related object of this invention is to provide methods and apparatus for attachment of autologous and artificial tendons that minimize or elirninate the risk of graft ~ pullout normally associated with ACL or other reconstructive orthopedic surgery.
Summary of the Invention The above objects are among,those met by the invention, which provides improved apparatus and their use for attaching autologous or artificial #endbngrafts to 1o bone, e.fi, during ligament and other.reconstructive surgery, including ACL
reconstruction. These allow anchoring the tendon graft in the bone, without metal an.' without placing undue load on sutures.
In one aspect, an assembly according to the invention comprises an insertion element and a stabilizing element. The stabilizing element has an outer surface adapted 15 for interference fit with a bone hole. The insertion element includes an aperture through which a graft may be threaded or attached, and a stem adapted to be inserted into and retained in a cavity in the stabilizing element, e.g., by an interference fit.
Additionally, the insertion element may comprise an aperture, slot, or barb, preferably at its distal end, to facilitate.its insertion into the stabilizing element.
20 According to one aspect of the invention, the stabilizing element has a threaded outer surface that can be securely turned into the bone. In addition, the stabilizing element can have an inner bore that is smaller than the outer diameter of the insertion element, such that placement of the latter into the former causes the stabilizing element to deformably expand or otherwise obtain a still stronger pressure fit with the bone hole.
25 In another aspect, the invention provides a stabilizing element that has a flanged head that rests on the surface of the bone, outside of the bone hole, and that prevents the element from entering the bone hole beyonda certain point.
In further aspects of the invention, the insertion and stabilizing elements comprise bio-compatible materials. These avoid adverse biological reactions to the elements, as 30 well as thc need for a second surgical procedure to remove the elements.
According to a preferred embodiment of the invention, there is provided an assembly for anchoring soft tissue grafts in bone, comprising: an insertion element comprising a stem and an aperture-containing stem head proximal to said stem, said stem head aperture being of a size sufficiently large to receive a soft tissue graft; and further comprising any one of an aperture, slot or barb disposed at the distal end of the insertion element adapted to accept a length of suture by which the insertion element can be pulled into a bone hole; and a stabilizing element adapted to be embedded in bone comprising a sleeve having a cavity, said cavity being elongated and having an inner diameter smaller than an outer diameter of said stem, such that said sleeve is capable of holding said stem by a compression fit in an operating position.
According to another embodiment of the invention, there is provided an assembly for anchoring soft tissue grafts in bone, comprising: an insertion element comprising an elongated stem and an aperture-containing stem head proximal to said stem, said stem head aperture suitably sized for passage of a soft tissue graft therethrough; and further comprising any one of an aperture, slot or barb disposed at the distal end of the insertion element adapted to accept a length of suture by which the insertion element can be pulled into a bone hole; and a stabilizing element capable of insertion into the bone hole and comprising an elongated sleeve having an axial channel, said channel having a diameter smaller than that of said elongated stem of said insertion element such that said stabilizing element will irreversibly expand upon insertion of said insertion element into said channel.
A related aspect of the invention comprises a system comprising two or more anchoring assemblies as described above. Such a system can be used with one or more natural or artificial grafts to repair or strengthen a skeletal bone or joint. In ACL repair, for example, one stabilizing element can be placed at one end of a bone hole drilled into the femur, and the other stabilizing element can be placed in an aligned tunnel drilled into the tibia.
The first and second insertion elements can then be joined by the graft and inserted into their respective stabilizing elements. The stabilization element placed in the femur can be of the type having a threaded outer surface, while that emplaced in the tibia can be of the type having a flanged head. Such a configuration exploits the strong cancellous matter in the femur, which is well adapted to holding screw threads, and relies on the surface of the tibia to ensure a hold there.
Another aspect of the invention comprises use of the invention for anchoring a graft in bone, for example for the replacement of a torn ligament. In this use, a tunnel or opening is drilled into the bone, and a stabilization element of the type described above is placed therein. A
graft is looped through the head of an insertion element which, in turn, is inserted into the stabilization element.
The insertion and stabilization elements may incorporate various structures designed to more effectively dispose and/or secure them in the bone tunnel, as described above.
For example, the stabilization element may comprise a flanged head which prevents it from being pulled into the bone tunnel when tension is applied to the tissue graft after insertion of the insertion element.
In yet another aspect, the invention comprises a system for securing a graft, e.g., for ACL replacement. The system comprises two stabilization elements adapted to be secured in bone. These can include, for example, a stabilization element adapted to be secured (e.g., in the femur) by screw threads and a stabilization element adapted to be secured (e.g., in the tibia) by a flange which prevents the element from being pulled through a bone hole.
The system further comprises two insertion elements for securing the graft to the stabilization elements. Each insertion element is provided with an aperture at the head whereby an autologous or artificial tissue graft may be attached, as well as a stem adapted for insertion into a cavity in a stabilization element. These insertion elements may also comprise an aperture, slot, or barb, to facilitate their being pulled into the corresponding stabilizing element. The system may optionally include a graft, such as a length of artificial tendon or a length of actual semitendinosus tendon.
More generally, the invention also comprises a system for connecting two or more bones with grafts, for example, for replacing ligaments of the ankle or elbow. In this aspect, the system comprises at least two stabilization elements of the types described above of appropriate size and anchoring configuration for the bones in which they are intended to be emplaced. The system further comprises a comparable number of insertion elements of the types described above intended to be inserted into the stabilization elements, each of which comprises an aperture at the head suitable for affixing a graft. The system may optionally include one or more lengths of artificial tissue, or it may be intended to be used with one or more autologous grafts.
According to a preferred embodiment of the invention, there is provided a system for ligament reconstruction, comprising: (a) at least two anchoring assemblies as described herein; (b) a graft having at least two ends, at least one end having a filament extending therefrom; (c) the graft being threaded through the aperture of one of the anchoring assemblies; and (d) the filament affixing the two ends of the graft to the aperture of the other anchoring assembly.
According to another embodiment of the invention, there is provided a system for ligament reconstruction, comprising: (a) at least two anchoring assemblies as described herein; (b) a graft having at least two ends, at least one end having a filament extending therefrom; (c) the graft being threaded through the aperture of one of the anchoring assemblies; and (d) the filament affixing the two ends of the graft to each other.
According to another embodiment of the invention, there is provided a system for ligament reconstruction, comprising: (a) at least two anchoring assemblies as described herein; (b) a graft having at least two ends, at least one having a filament extending therefrom; (c) the graft being threaded through the aperture of the first anchoring assembly; (d) the two ends of the graft being threaded through the aperture of the second anchoring assembly; and (e) the filament affixing the two ends of the graft to the aperture of the first anchoring assembly.
According to another embodiment of the invention, there is provided a system for ligament reconstruction, comprising: (a) at least a first anchoring assembly as described herein and a second anchoring assembly as described herein; (b) at least a first graft and a second graft, each having at least two ends, at least one end of each graft having a filament extending therefrom; (c) the first graft being threaded through the aperture of the first anchoring assembly; (d) the filament of the first graft 6a affixing the two ends of the first graft to the aperture of the second anchoring assembly; (e) the second graft being threaded through the aperture of the first anchoring assembly; and (f) the filament of the second graft affixing the two ends of the second graft to the aperture of the second anchoring assembly.
Apparatus and their use of the instant invention overcome limitations of prior art systems for affixing grafts to bone. The two-piece apertured design enables construction of an anchor assembly to attach autologous or artificial tendon grafts securely within bone without the use of metal, and without placing the high loads on sutures that are associated with sewing or tying grafts directly to bone.
Yet other aspects of the invention comprise use of the invention for ligament reconstruction, whereby various configurations of grafts are used to connect bone anchors of the types described above, or other anchors containing apertures suitable for threading grafts. These uses employ at least one graft having a filament extending from at least one of its ends. By way of example, this filament may be a suture which has been whip-stitched to the end of a tendon graft.
The graft as emplaced according to this aspect of the invention may connect the bone anchors with two or four plies of graft material. In one two-ply configuration, a single graft is used. The graft is threaded through the aperture of one bone anchor, and folded to bring its ends into proximity. The two ends are then affixed to the other bone anchor, preferably by sewing with the attached filament(s). The anchors can be affixed in bone before or after threading of the grafts.
6b A related use according to the invention also employs a single graft. The graft is threaded through the apertures in both bone anchors, and the attached filament(s) are used to connect the two ends of the graft to one another. This is preferably done by sewing the filaments at each end of the graft to the other end of the graft.
Another use according to the invention uses a single graft to connect two bone anchors via four plies of graft material, rather than by two plies as described in the previous two uses. According to this use, the graft (with at least one attached filament) is threaded through an aperture of a first bone anchor, and folded so that its ends are brought into proximity as described above. The two ends are then threaded through an aperture of a second bone anchor, and the graft is folded again, to bring its ends in contact with the first anchor. The attached filament(s) are used to connect the ends to the first anchor, preferably by sewing.
Other uses of the invention for attaching the grafts to bone anchors employ multiple grafts. These uses can lend additional strength to the reconstructed ligament.
According to one such use, a graft with attached filament(s) is threaded through an aperture of one anchor and its ends are sewn to an aperture of another anchor, as described above. In addition, a second graft is threaded through the aperture of the anchor to which the first graft is sewn, and is sewn to the aperture of the anchor through which the first graft is threaded.
Another aspect of the invention provides multiple-graft use for attachment of threads to grafts (each with at least one attached filament) through the aperture of a bone anchor. The two grafts are folded, and their ends are 6c attached to the aperture of a second bone anchor via the filaments. Each of these multiple-graft methods connects the anchors by four plies of graft material.
These and other aspects of the invention are evident in the drawings and in the description that follows.
6d Brief Description of the Drawings A more complete understanding of the invention may be attained by reference to the drawings, in which:
Figure l a depicts a frontal view of the bones of the knee and a partially torn anterior cruciate ligament (ACL);
Figure l b depicts a side view of a method for creating a stepped tunnel through the tibia and partially through the femur for insertion of an anchor assembly according to the invention;
Figure 2 depicts a frontal view of a method for affixing a tendon graft into the 1 o tunnel of Figure 1 b in accord with the invention, Figure 3 depicts a detailed side view of an embedded anchor assembly of the present invention;
Figures 4a-d depict detailed views of an anchor assembly of the present invention;
Figures 5a-5c depict detailed views of the insertion element of an anchor assembly according to an alternate embodiment of the present invention;
Figure 6 depicts a detailed view of the insertion of an assembly according to yet another alternate embodiment of the present inverition, this embodiment comprising the use of two stabilizing elements and two insertion elements;
Figure 7 depicts a detailed view of a stabilizing element comprising a flange;
Figure 8 depicts a detailed view of a graft prepared for attachment to one or more bone anchors; and Figures 9a-9f depict detailed views of graiis linking two bone anchors according to the methods of the invention.
Detailed Description of the Invention Figure 1 a depicts a partially torn ligament of the knee, e.g., the anterior cruciate ligament (ACL) 1. In the illustration, the ACL is attached to a depression in the anterior intercondylar area (not shown) on the surface of the tibial plateau 5. This tibial attachment lies in front of the anterior intercondylar tubercle and is blended with the anterior extremity of the lateral meniscus (not shown). It passes upward, backward, and laterally to be fixed into the posterior part of the medial surface of the lateral condyle (not shown) of the femur 3. The tibia 2 and the patella 4 are also shown.
According to another embodiment of the invention, there is provided an assembly for anchoring soft tissue grafts in bone, comprising: an insertion element comprising an elongated stem and an aperture-containing stem head proximal to said stem, said stem head aperture suitably sized for passage of a soft tissue graft therethrough; and further comprising any one of an aperture, slot or barb disposed at the distal end of the insertion element adapted to accept a length of suture by which the insertion element can be pulled into a bone hole; and a stabilizing element capable of insertion into the bone hole and comprising an elongated sleeve having an axial channel, said channel having a diameter smaller than that of said elongated stem of said insertion element such that said stabilizing element will irreversibly expand upon insertion of said insertion element into said channel.
A related aspect of the invention comprises a system comprising two or more anchoring assemblies as described above. Such a system can be used with one or more natural or artificial grafts to repair or strengthen a skeletal bone or joint. In ACL repair, for example, one stabilizing element can be placed at one end of a bone hole drilled into the femur, and the other stabilizing element can be placed in an aligned tunnel drilled into the tibia.
The first and second insertion elements can then be joined by the graft and inserted into their respective stabilizing elements. The stabilization element placed in the femur can be of the type having a threaded outer surface, while that emplaced in the tibia can be of the type having a flanged head. Such a configuration exploits the strong cancellous matter in the femur, which is well adapted to holding screw threads, and relies on the surface of the tibia to ensure a hold there.
Another aspect of the invention comprises use of the invention for anchoring a graft in bone, for example for the replacement of a torn ligament. In this use, a tunnel or opening is drilled into the bone, and a stabilization element of the type described above is placed therein. A
graft is looped through the head of an insertion element which, in turn, is inserted into the stabilization element.
The insertion and stabilization elements may incorporate various structures designed to more effectively dispose and/or secure them in the bone tunnel, as described above.
For example, the stabilization element may comprise a flanged head which prevents it from being pulled into the bone tunnel when tension is applied to the tissue graft after insertion of the insertion element.
In yet another aspect, the invention comprises a system for securing a graft, e.g., for ACL replacement. The system comprises two stabilization elements adapted to be secured in bone. These can include, for example, a stabilization element adapted to be secured (e.g., in the femur) by screw threads and a stabilization element adapted to be secured (e.g., in the tibia) by a flange which prevents the element from being pulled through a bone hole.
The system further comprises two insertion elements for securing the graft to the stabilization elements. Each insertion element is provided with an aperture at the head whereby an autologous or artificial tissue graft may be attached, as well as a stem adapted for insertion into a cavity in a stabilization element. These insertion elements may also comprise an aperture, slot, or barb, to facilitate their being pulled into the corresponding stabilizing element. The system may optionally include a graft, such as a length of artificial tendon or a length of actual semitendinosus tendon.
More generally, the invention also comprises a system for connecting two or more bones with grafts, for example, for replacing ligaments of the ankle or elbow. In this aspect, the system comprises at least two stabilization elements of the types described above of appropriate size and anchoring configuration for the bones in which they are intended to be emplaced. The system further comprises a comparable number of insertion elements of the types described above intended to be inserted into the stabilization elements, each of which comprises an aperture at the head suitable for affixing a graft. The system may optionally include one or more lengths of artificial tissue, or it may be intended to be used with one or more autologous grafts.
According to a preferred embodiment of the invention, there is provided a system for ligament reconstruction, comprising: (a) at least two anchoring assemblies as described herein; (b) a graft having at least two ends, at least one end having a filament extending therefrom; (c) the graft being threaded through the aperture of one of the anchoring assemblies; and (d) the filament affixing the two ends of the graft to the aperture of the other anchoring assembly.
According to another embodiment of the invention, there is provided a system for ligament reconstruction, comprising: (a) at least two anchoring assemblies as described herein; (b) a graft having at least two ends, at least one end having a filament extending therefrom; (c) the graft being threaded through the aperture of one of the anchoring assemblies; and (d) the filament affixing the two ends of the graft to each other.
According to another embodiment of the invention, there is provided a system for ligament reconstruction, comprising: (a) at least two anchoring assemblies as described herein; (b) a graft having at least two ends, at least one having a filament extending therefrom; (c) the graft being threaded through the aperture of the first anchoring assembly; (d) the two ends of the graft being threaded through the aperture of the second anchoring assembly; and (e) the filament affixing the two ends of the graft to the aperture of the first anchoring assembly.
According to another embodiment of the invention, there is provided a system for ligament reconstruction, comprising: (a) at least a first anchoring assembly as described herein and a second anchoring assembly as described herein; (b) at least a first graft and a second graft, each having at least two ends, at least one end of each graft having a filament extending therefrom; (c) the first graft being threaded through the aperture of the first anchoring assembly; (d) the filament of the first graft 6a affixing the two ends of the first graft to the aperture of the second anchoring assembly; (e) the second graft being threaded through the aperture of the first anchoring assembly; and (f) the filament of the second graft affixing the two ends of the second graft to the aperture of the second anchoring assembly.
Apparatus and their use of the instant invention overcome limitations of prior art systems for affixing grafts to bone. The two-piece apertured design enables construction of an anchor assembly to attach autologous or artificial tendon grafts securely within bone without the use of metal, and without placing the high loads on sutures that are associated with sewing or tying grafts directly to bone.
Yet other aspects of the invention comprise use of the invention for ligament reconstruction, whereby various configurations of grafts are used to connect bone anchors of the types described above, or other anchors containing apertures suitable for threading grafts. These uses employ at least one graft having a filament extending from at least one of its ends. By way of example, this filament may be a suture which has been whip-stitched to the end of a tendon graft.
The graft as emplaced according to this aspect of the invention may connect the bone anchors with two or four plies of graft material. In one two-ply configuration, a single graft is used. The graft is threaded through the aperture of one bone anchor, and folded to bring its ends into proximity. The two ends are then affixed to the other bone anchor, preferably by sewing with the attached filament(s). The anchors can be affixed in bone before or after threading of the grafts.
6b A related use according to the invention also employs a single graft. The graft is threaded through the apertures in both bone anchors, and the attached filament(s) are used to connect the two ends of the graft to one another. This is preferably done by sewing the filaments at each end of the graft to the other end of the graft.
Another use according to the invention uses a single graft to connect two bone anchors via four plies of graft material, rather than by two plies as described in the previous two uses. According to this use, the graft (with at least one attached filament) is threaded through an aperture of a first bone anchor, and folded so that its ends are brought into proximity as described above. The two ends are then threaded through an aperture of a second bone anchor, and the graft is folded again, to bring its ends in contact with the first anchor. The attached filament(s) are used to connect the ends to the first anchor, preferably by sewing.
Other uses of the invention for attaching the grafts to bone anchors employ multiple grafts. These uses can lend additional strength to the reconstructed ligament.
According to one such use, a graft with attached filament(s) is threaded through an aperture of one anchor and its ends are sewn to an aperture of another anchor, as described above. In addition, a second graft is threaded through the aperture of the anchor to which the first graft is sewn, and is sewn to the aperture of the anchor through which the first graft is threaded.
Another aspect of the invention provides multiple-graft use for attachment of threads to grafts (each with at least one attached filament) through the aperture of a bone anchor. The two grafts are folded, and their ends are 6c attached to the aperture of a second bone anchor via the filaments. Each of these multiple-graft methods connects the anchors by four plies of graft material.
These and other aspects of the invention are evident in the drawings and in the description that follows.
6d Brief Description of the Drawings A more complete understanding of the invention may be attained by reference to the drawings, in which:
Figure l a depicts a frontal view of the bones of the knee and a partially torn anterior cruciate ligament (ACL);
Figure l b depicts a side view of a method for creating a stepped tunnel through the tibia and partially through the femur for insertion of an anchor assembly according to the invention;
Figure 2 depicts a frontal view of a method for affixing a tendon graft into the 1 o tunnel of Figure 1 b in accord with the invention, Figure 3 depicts a detailed side view of an embedded anchor assembly of the present invention;
Figures 4a-d depict detailed views of an anchor assembly of the present invention;
Figures 5a-5c depict detailed views of the insertion element of an anchor assembly according to an alternate embodiment of the present invention;
Figure 6 depicts a detailed view of the insertion of an assembly according to yet another alternate embodiment of the present inverition, this embodiment comprising the use of two stabilizing elements and two insertion elements;
Figure 7 depicts a detailed view of a stabilizing element comprising a flange;
Figure 8 depicts a detailed view of a graft prepared for attachment to one or more bone anchors; and Figures 9a-9f depict detailed views of graiis linking two bone anchors according to the methods of the invention.
Detailed Description of the Invention Figure 1 a depicts a partially torn ligament of the knee, e.g., the anterior cruciate ligament (ACL) 1. In the illustration, the ACL is attached to a depression in the anterior intercondylar area (not shown) on the surface of the tibial plateau 5. This tibial attachment lies in front of the anterior intercondylar tubercle and is blended with the anterior extremity of the lateral meniscus (not shown). It passes upward, backward, and laterally to be fixed into the posterior part of the medial surface of the lateral condyle (not shown) of the femur 3. The tibia 2 and the patella 4 are also shown.
Figure lb depicts a method for creating a stepped tunnel 7 through the tibia 2 and partially through the femur 3 for insertion of an anchor assembly of the invention. In the illustration, a drill 6 is used by the surgeon to drill a tunnel beginning at the anterior surface of the tibia 2 and ending within the cancellous region of the femur 3.
The drill tunnel 7 preferably will enter the femur 3 at or near the isometric point (not shown) close to the anatomical ACL attachment site in accordance with the prior art. The angle of the drill tunnel is in accord with that practiced in the prior art for semitendinosus-style ACL
repair. The stepped hole is formed by use of a stepped drill bit such that the ledge separating the wider and narrower diameter tunnels lies within the cancellous portion of the femur 3, e.g., within 10mm to 70 mm within the femur of the posterior part of the medial surface of the lateral condyle and, preferably, within approximately 45 mm of that surface. The drill tunnel 7 may terminate within the cancellous portion of the femur 3, or, in the alternative, the surgeon may elect initially to fiilly penetrate the femur 3 with a guide wire (not shown), leaving a small exit aperture 9 on the opposing surface of the femur in accordance with the prior art covering ACL reconstructive surgery. It will be appreciated by those skilled in the art that the above-described invention is not limited to embedding an anchor assembly in the femur 3 but could also be practiced to embed an anchor in the tibia 2 or in bones comprising other joints, e.g., the ankle or elbow region, as well as in individual or groups of bones otherwise requiring repair or support.
Figure 2 depicts shows a graft anchor assembly 12 of the instant invention embedded in bone, for example in the cancellous layer of the femur 3. A tendon graft 10 is looped through the aperture (see detailed drawing in Figure 3) in an anchor assembly 12 with one or more free ends extending through other bone, for example, through the tibia 2.
Figure 3 depicts in more detail an anchor assembly 12 in operating position embedded in the stepped bone tunnel. The autologous or artificial tendon graft 10 is looped through aperture 13 in the head of the insertion element 14. The stabilizing element 15 is embedded in the bone tunnel, for example by screwing into the stepped tunnel. In another embodiment, the stabilizing element may be secured by means of a flange which opposes tension on the tendon graft, as shown in Figure 6. The insertion element 14 is held in the stabilizing element 15 for example by compression fit, but could also be held by other interference fit, e.g., screwing (though, preferably by a thread) that requires twist, e.g~, of not more than 180 (so as to avoid twisting the tendon) or by ratcheting or by other attachment mechanism for holding one element in another without excessive twisting.
Figures 4a-d depict the anchor assembly in detail. Figure 4a depicts the stabilizing element 15 which comprises ain elongated sleeve 19 containing external protrusions 16, for example, external threads. Stabilizing element 15 has a cavity 17, for example an elongated axial channel 17 extending at least partway from the proximal end of stabilizing element 15. For example, axial channel 17 could extend from the proximal to the distal end of stabilizing element 15. Stabilizing element has a flanged head 18.
Stabilizing element 15 is comprised of a biocompatible material, for example, implant grade high density polyethylene, low density polyethylene (PE 6010 and PE
2030) and polypropylene (13R9A and 23M2) all made by Rexene, Dallas, Texas or of a bioabsorbable material, for example poly-l-lactide or such as a lactide-glycolide composition. It may also be comprised of a metal, such as surgical implant grade steel.
Figure 4a also depicts insertion element 14. Insertion element 14 has an aperture 13 containing head 21 for retaining a ligament replacement. Stem head 21 has an aperture 13 of a size suitable for receiving multiple strands of autologous and/or artificial tendon, but optimally for receiving two or more strands of semitendinosus tendon. The aperture 13 may have dimensions 0. 10 inches - 0.35 inches (height) by 0.05 -0.30 inches (width), and, preferably approximately 0.220 inches by 0. 160 inches.
Insertion element 14 has a stem 20, for example an elongated stem 20. The stem has protrusions extending outwardly. Stem protrusions 22 may be inflexible. In the illustrated embodiment, the diameter of stem 20 has a larger outer diameter than the inner diameter of axial channel 17, such that stabilizing element 15 is capable of holding the insertion element 14 by compression fit upon insertion of the insertion element 14 into channel 17 of stabilizing element 15. The insertion element 14'can be tapped into the stabilizing element 15 with an emplacement device (not shown). Alternatively, the insertion element can be configured to be screwed, ratcheted or placed in other interference fit within the stabilizing element. The insertion element 14 is comprised of a biocompatible material, for examT',~ :mpiant grade high density polyethylene, low density polyethylene (PE 6010 and PE 2030) and polypropylene (13R9A-and 23M2: all made by Rexene, Dallas, Texas) or of a bioabsorbable material, for example poly-l-lactide or such as a lactide-glycolide composition. It may also be comprised of a metal, such as surgical implant grade steel.
Figure 4b depicts axial channel 17 which has a non-cylindrical cross-section (not shown), optimally a polygon such as a hexagon. Other non-cylindrical cross-sections such as a square or pentagon or even oval configurations are also envisioned. A non-cylindrical cross-section of the axial channel 17 is designed such that an emplacement device (not shown) such as a driver (not shown) with a corresponding non-cylindrical diameter can be inserted into an axial channel and turned such that the external threads 16 of the stabilizing element 15 are screwed into and grip the bone. One such driver is, e.g., an Allen wrench.
Figure 4c depicts insertion of the distal end of an insertion element 14 into the axial channel 17 at the proximal end of a stabilizing element 15. The diameter of elongated stem 20 is slightly greater than the diameter of the non-cylindrical axial channel 17 of the stabilizing element. As a result as depicted in Figure 4d, an elongated stem 20 of the insertion element 14 is held tightly in stabilizing element 15, for example by compression fit into stabilizing element 15 embedded in a stepped bone hole.
Figure 5a depicts an insertion element 510 that can be pulled into the stabilizing element 15 (Figure 4).
As above, the insertion element 510 has an aperture 512 containing a head for retaining a ligament replacement and a stem 514 with outwardly expanding protrusions. The diameter of stem is greater than the diameter of axial channel such that stabilizing element 515 is capable of holding the insertion element by compression fit upon insertion of the insertion element into the channel of the stabilizing element. Additionally, the insertion element 510 contains a structure, e.g., aperture 516, suitable for receiving a suture, a wire or other device that can be used to pull the element 510 into the stabilizing element 515 instead of, or in addition to, its being tapped into that element 515.
The aperture 516 or other such structure can be located at any point on the insertion element 510 but is preferably located at the distal end of the insertion element. Thus, for example, in an embodiment in which the stem of the insertion element is approximately 0.75 inches long with a diameter of 0.16 inches, the aperture is located 0.05-0.20 inches from the end of the insertion element and preferably 0.12 inches from the distal end.
The aperture 516 (or other such structure) is sized sufficiently to accommodate a suture, wire or other pulling device. Those of ordinary skill in the art will of course appreciate that in lieu of an aperture, a slot, barb, hook (as shown in Figures 5b and 5c) or any other structure by which the insertion element can be pulled, can be utilized.
An anchor assembly incorporating an insertion element 510 of Figure 5a is generally implanted as described above. In ACL reconstructive surgery, for example, a tunnel is drilled at the anterior surface of the tibia and ending with the cancellous region of the femur. The drill tunnel preferably enters the femur at or near the isometric point close to the anatomical ACL attachment site in accordance with the prior art. The angle of the drill tunnel is in accord with that practiced in the prior art for semitendinosis-style ACL repair. A stepped hole is formed by use of a stepped drill bit such that the ledge separating the wider and narrower diameter tunnels lies within the cancellous portion of the femur, e.g., within at least 10 mm to 70 mm within the femur of the posterior part of the medical surface of the lateral condyle and, preferably, approximately 45 mm of that surface.
Although the drill tunnel may terminate within the cancellous portion of the femur, a guide wire or K-wire is preferably used to fully penetrate the femur, leaving a small exit aperture on the opposing surface on the femur.
The stabilizing element is then embedded in the drilled bone tunnel, for example, by screwing it into the stepped tunnel.
At this point, the K-wire (which is preferably equipped with an eyelet at its end) is used to thread a suture through the skin, bone and through the channel of the stabilizing element. The suture is then looped through the aperture, hook, barb, or slot, or other such structure in the insertion element. The insertion element is then pulled into the stabilizing element using that suture. Those skilled in the art will appreciate that a wire, hook or other such apparatus can be used in place of the aforementioned suture.
Figure 6 depicts yet another embodiment of the invention, which employs two stabilizing elements and two insertion elements. In this embodiment, a stepped tunnel is drilled in the bone, beginning at the anterior surface of the tibia 602 and ending within the cancellous region of the femur 603, similar to the tunnel depicted in Figure lb. The surgeon may elect initially to fully penetrate the femur 603 with a guide wire 626, leaving a small exit aperture 609 on the opposing surface of the femur in accordance with the prior art covering ACL reconstructive surgery.
A first stabilizing element 615 is then inserted in the femoral tunnel as has been described above.
Insertion elements 612 and 624 are joined by a length of soft tissue 610, such as a tendon graft, and the first insertion element 612 is inserted into the stabilizing element 615, for example by pushing into the stabilizing element 615, or by pulling with a suture, wire, or other device 626 on a small aperture, slot, barb, or hook on the insertion element 612. The second insertion element 624 is pushed into the bone tunnel, and then the second stabilizing element 628 is placed in the bone tunnel. In the preferred embodiment depicted in Figure 6, the second stabilizing element 628 comprises a flange 630 which limits the extent to which the stabilizing element can be pulled into the bone tunnel, e.g., by the tendon graft. This element is also depicted in Figure 7 and is further discussed below. In other embodiments, the second stabilizing element may be secured by means of screw threads, an interference fit, or other methods known in the art. Finally, the second insertion element 624 is inserted into the second stabilizing element 628. In the preferred embodiment depicted in Figure 6, the second insertion element is inserted into the second stabilizing element by pulling with a suture, wire, or other device 632 on a small aperture, slot, barb, or hook on the second insertion element 624.
In an embodiment for ACL replacement for an adult, the first stabilizing element is typically of a length 20mm, an outer diameter of 8mm, and an inner diameter of 3.5mm.
The first insertion element is typically of a length 40mm and a diameter 8mm. If the insertion element is equipped with an aperture whereby it may be pulled into the stabilizing element, that aperture has a typical diameter of lmm. The aperture for attachment of the tendon graft is typically about 5mm x 8mm. The length of the tendon graft between the insertion elements is usually about 40mm. Those skilled in the art will appreciate that the foregoing dimensions are supplied merely by way of example and that stabilization and insertion elements of sizes suited for other bones, joints and grafts can be used as well.
The surgeon can adjust the tension on the tendon graft by controlling the extent to which the insertion elements are inserted into the stabilizing elements.
Insertion elements are typically designed so that full strength hold of the insertion element in the stabilizing element is obtained when the insertion element is inserted at least halfway into the stabilizing element. Thus, the depth of each insertion element is adjustable over a length of 10mm for this preferred embodiment.
The second stabilizing element 628 of Figure 6 is also illustrated in Figure 7. This element comprises an elongated body 729, having a channel 731 for receiving an insertion element. The stabilizing element also comprises a flange 730, which prevents the element from being pulled completely into the bone hole by tension on a graft attached to an insertion element deployed in channel 731. The flange 730 may be perpendicular to the elongated body 729, or may be at an oblique angle to the body 729, as depicted in Figure 7. The flange 730 may also be contoured to correspond to the shape of the outer surface of the bone in which it is to be emplaced. The surgeon may also elect to countersink the bone tunnel, so that the outer surface of the emplaced flange 730 is flush with the surface of the surrounding bone. In this embodiment, it may be desirable for the flange 730 to be tapered, having a thicker cross-section at the intersection of the flange 730 with the body 729 than at the outer edge of the flange 730.
When this embodiment is used in ACL repair as depicted in Figure 6, the second stabilizing element has a typical length of 15mm, an outer diameter of 8mm, and an inner diameter of 3.5mm. The flange has a typical outer diameter of 12mm, and a typical thickness of lmm. The second insertion element has a length 40mm and a diameter 8mm. If the second insertion element is equipped with an aperture whereby it may be pulled into the stabilizing element, that aperture has a typical diameter of imm. The aperture for attachment of the tendon graft is typically about 5mm x 8mm. Those skilled in the art will appreciate that the foregoing dimensions are supplied merely by way of example and that stabilization and insertion elements of sizes suited for other bones, joints and grafts can be used as well.
The second insertion element and second stabilizing element, like the first elements, are comprised of a biocompatible material, for example implant grade high density polyethylene, low density polyethylene (PE 6010 and PE 2030) and polypropylene (13R9A and 23M2) all made by Rexene, Dallas, Texas or of a bioabsorbable material, for example poly-l-lactide or such as a lactide-glycolide composition. These elements may also be comprised of a metal, such as surgical implant grade steel.
It will be apparent to those skilled in the art that the above-described invention is not limited to connecting the femur and tibia in an ACL reconstructive procedure, but could also be practiced to support or repair any bone or pair of bones with a length of soft tissue, e.g., in the ankle or elbow region.
The invention further comprises methods for connecting at least two bone anchors, for example those described above, with one or more lengths of graft material.
Figure 8 shows a graft 810 prepared according to a preferred embodiment of this aspect. The graft 810 may be an autologous tendon graft such as a length of semitendinosis or gracillis tendon, or an artificial graft. The graft 810 has a filament 840 (such as a suture) attached to at least one of its ends. In the preferred embodiment illustrated in Figure 8, a suture 840 is whip-stitched to each end of the graft.
The anchors may be connected with one or with multiple grafts, in either a two-ply or four-ply configuration. Some configurations according to the invention are illustrated in Figures 9a-9f. In Figure 9a, a single graft 910 is used to connect two anchors 942 and 944 in a two-ply configuration. A graft 910 prepared as illustrated in Figure 8 is threaded through an aperture in one anchor 944, and then folded so that the two ends of the graft 910 can be tied and/or sewn to an aperture in the other anchor 942 using the filament 940.
A related embodiment is illustrated in Figure 9b.
In this embodiment, the prepared graft 910 is threaded through apertures in each of the two anchors 942 and 944.
The sutures 940 attached to the prepared graft are then tied, or, preferably, sewn, to connect the ends of the graft 910. This embodiment is also a two-ply arrangement.
A four-ply connection between the anchors is achieved using a single graft in the embodiment illustrated in Figures 9c and 9d. A prepared graft 910 is first threaded through one anchor 942, and folded to bring the ends of the graft 910 into contact. These two ends are then threaded through the other bone anchor 944. Figure 9c illustrates the configuration of the graft at this point in its emplacement. The graft 910 is then folded in half again, to bring the ends back to the first anchor 942, and the ends are sewn and/or tied there with the attached filaments 940, as illustrated in Figure 9d. Section A-A of that figure shows the four plies of graft material 910 which now connect the bone anchors.
Other embodiments which achieve a four-ply connection between the anchors using multiple tendon grafts are illustrated in Figures 9e and 9f. In the first of these, one graft 910, prepared as shown in Figure 8, is threaded through an aperture in a first anchor 944, and the sutures 940 at the end of the graft are sewn and/or tied to an aperture in a second anchor 942. A second graft 946 is then passed through the aperture in the second anchor 942, and sewn and/or tied to the aperture in the first anchor 944 with its attached sutures 948. In the second embodiment, illustrated in Figure 9f, two grafts 910 and 946 are threaded through an aperture in the first anchor 944, and these two grafts are both sewn and/or tied to the aperture in the second anchor 942 with their attached sutures 940 and 948.
It will be apparent to one skilled in the art of ligament reconstruction that each of the embodiments illustrated in Figures 9a-9f has different strengths, and that the preferred configuration for a particular use of the invention will depend on the ligament being replaced, the location and type of the bone anchors, and on whether the graft is attached to the anchors before or after they are affixed to the bone.
Described above are apparatus and methods meeting the objects set forth above. Those skilled in the art will appreciate that the illustrated embodiments are shown and described by way of example only, and that other methods and apparatus incorporation modifications therein fall within the scope of the invention. For example, in addition to ACL
reconstruction, the invention can be beneficially applied in connection with other soft tissue-to-bone attachments using bone tunnels, such as (by way of non-limiting example) repair of ligaments and tendons in other joints such as the elbow and ankle. In view of the foregoing, what we claim is:
The drill tunnel 7 preferably will enter the femur 3 at or near the isometric point (not shown) close to the anatomical ACL attachment site in accordance with the prior art. The angle of the drill tunnel is in accord with that practiced in the prior art for semitendinosus-style ACL
repair. The stepped hole is formed by use of a stepped drill bit such that the ledge separating the wider and narrower diameter tunnels lies within the cancellous portion of the femur 3, e.g., within 10mm to 70 mm within the femur of the posterior part of the medial surface of the lateral condyle and, preferably, within approximately 45 mm of that surface. The drill tunnel 7 may terminate within the cancellous portion of the femur 3, or, in the alternative, the surgeon may elect initially to fiilly penetrate the femur 3 with a guide wire (not shown), leaving a small exit aperture 9 on the opposing surface of the femur in accordance with the prior art covering ACL reconstructive surgery. It will be appreciated by those skilled in the art that the above-described invention is not limited to embedding an anchor assembly in the femur 3 but could also be practiced to embed an anchor in the tibia 2 or in bones comprising other joints, e.g., the ankle or elbow region, as well as in individual or groups of bones otherwise requiring repair or support.
Figure 2 depicts shows a graft anchor assembly 12 of the instant invention embedded in bone, for example in the cancellous layer of the femur 3. A tendon graft 10 is looped through the aperture (see detailed drawing in Figure 3) in an anchor assembly 12 with one or more free ends extending through other bone, for example, through the tibia 2.
Figure 3 depicts in more detail an anchor assembly 12 in operating position embedded in the stepped bone tunnel. The autologous or artificial tendon graft 10 is looped through aperture 13 in the head of the insertion element 14. The stabilizing element 15 is embedded in the bone tunnel, for example by screwing into the stepped tunnel. In another embodiment, the stabilizing element may be secured by means of a flange which opposes tension on the tendon graft, as shown in Figure 6. The insertion element 14 is held in the stabilizing element 15 for example by compression fit, but could also be held by other interference fit, e.g., screwing (though, preferably by a thread) that requires twist, e.g~, of not more than 180 (so as to avoid twisting the tendon) or by ratcheting or by other attachment mechanism for holding one element in another without excessive twisting.
Figures 4a-d depict the anchor assembly in detail. Figure 4a depicts the stabilizing element 15 which comprises ain elongated sleeve 19 containing external protrusions 16, for example, external threads. Stabilizing element 15 has a cavity 17, for example an elongated axial channel 17 extending at least partway from the proximal end of stabilizing element 15. For example, axial channel 17 could extend from the proximal to the distal end of stabilizing element 15. Stabilizing element has a flanged head 18.
Stabilizing element 15 is comprised of a biocompatible material, for example, implant grade high density polyethylene, low density polyethylene (PE 6010 and PE
2030) and polypropylene (13R9A and 23M2) all made by Rexene, Dallas, Texas or of a bioabsorbable material, for example poly-l-lactide or such as a lactide-glycolide composition. It may also be comprised of a metal, such as surgical implant grade steel.
Figure 4a also depicts insertion element 14. Insertion element 14 has an aperture 13 containing head 21 for retaining a ligament replacement. Stem head 21 has an aperture 13 of a size suitable for receiving multiple strands of autologous and/or artificial tendon, but optimally for receiving two or more strands of semitendinosus tendon. The aperture 13 may have dimensions 0. 10 inches - 0.35 inches (height) by 0.05 -0.30 inches (width), and, preferably approximately 0.220 inches by 0. 160 inches.
Insertion element 14 has a stem 20, for example an elongated stem 20. The stem has protrusions extending outwardly. Stem protrusions 22 may be inflexible. In the illustrated embodiment, the diameter of stem 20 has a larger outer diameter than the inner diameter of axial channel 17, such that stabilizing element 15 is capable of holding the insertion element 14 by compression fit upon insertion of the insertion element 14 into channel 17 of stabilizing element 15. The insertion element 14'can be tapped into the stabilizing element 15 with an emplacement device (not shown). Alternatively, the insertion element can be configured to be screwed, ratcheted or placed in other interference fit within the stabilizing element. The insertion element 14 is comprised of a biocompatible material, for examT',~ :mpiant grade high density polyethylene, low density polyethylene (PE 6010 and PE 2030) and polypropylene (13R9A-and 23M2: all made by Rexene, Dallas, Texas) or of a bioabsorbable material, for example poly-l-lactide or such as a lactide-glycolide composition. It may also be comprised of a metal, such as surgical implant grade steel.
Figure 4b depicts axial channel 17 which has a non-cylindrical cross-section (not shown), optimally a polygon such as a hexagon. Other non-cylindrical cross-sections such as a square or pentagon or even oval configurations are also envisioned. A non-cylindrical cross-section of the axial channel 17 is designed such that an emplacement device (not shown) such as a driver (not shown) with a corresponding non-cylindrical diameter can be inserted into an axial channel and turned such that the external threads 16 of the stabilizing element 15 are screwed into and grip the bone. One such driver is, e.g., an Allen wrench.
Figure 4c depicts insertion of the distal end of an insertion element 14 into the axial channel 17 at the proximal end of a stabilizing element 15. The diameter of elongated stem 20 is slightly greater than the diameter of the non-cylindrical axial channel 17 of the stabilizing element. As a result as depicted in Figure 4d, an elongated stem 20 of the insertion element 14 is held tightly in stabilizing element 15, for example by compression fit into stabilizing element 15 embedded in a stepped bone hole.
Figure 5a depicts an insertion element 510 that can be pulled into the stabilizing element 15 (Figure 4).
As above, the insertion element 510 has an aperture 512 containing a head for retaining a ligament replacement and a stem 514 with outwardly expanding protrusions. The diameter of stem is greater than the diameter of axial channel such that stabilizing element 515 is capable of holding the insertion element by compression fit upon insertion of the insertion element into the channel of the stabilizing element. Additionally, the insertion element 510 contains a structure, e.g., aperture 516, suitable for receiving a suture, a wire or other device that can be used to pull the element 510 into the stabilizing element 515 instead of, or in addition to, its being tapped into that element 515.
The aperture 516 or other such structure can be located at any point on the insertion element 510 but is preferably located at the distal end of the insertion element. Thus, for example, in an embodiment in which the stem of the insertion element is approximately 0.75 inches long with a diameter of 0.16 inches, the aperture is located 0.05-0.20 inches from the end of the insertion element and preferably 0.12 inches from the distal end.
The aperture 516 (or other such structure) is sized sufficiently to accommodate a suture, wire or other pulling device. Those of ordinary skill in the art will of course appreciate that in lieu of an aperture, a slot, barb, hook (as shown in Figures 5b and 5c) or any other structure by which the insertion element can be pulled, can be utilized.
An anchor assembly incorporating an insertion element 510 of Figure 5a is generally implanted as described above. In ACL reconstructive surgery, for example, a tunnel is drilled at the anterior surface of the tibia and ending with the cancellous region of the femur. The drill tunnel preferably enters the femur at or near the isometric point close to the anatomical ACL attachment site in accordance with the prior art. The angle of the drill tunnel is in accord with that practiced in the prior art for semitendinosis-style ACL repair. A stepped hole is formed by use of a stepped drill bit such that the ledge separating the wider and narrower diameter tunnels lies within the cancellous portion of the femur, e.g., within at least 10 mm to 70 mm within the femur of the posterior part of the medical surface of the lateral condyle and, preferably, approximately 45 mm of that surface.
Although the drill tunnel may terminate within the cancellous portion of the femur, a guide wire or K-wire is preferably used to fully penetrate the femur, leaving a small exit aperture on the opposing surface on the femur.
The stabilizing element is then embedded in the drilled bone tunnel, for example, by screwing it into the stepped tunnel.
At this point, the K-wire (which is preferably equipped with an eyelet at its end) is used to thread a suture through the skin, bone and through the channel of the stabilizing element. The suture is then looped through the aperture, hook, barb, or slot, or other such structure in the insertion element. The insertion element is then pulled into the stabilizing element using that suture. Those skilled in the art will appreciate that a wire, hook or other such apparatus can be used in place of the aforementioned suture.
Figure 6 depicts yet another embodiment of the invention, which employs two stabilizing elements and two insertion elements. In this embodiment, a stepped tunnel is drilled in the bone, beginning at the anterior surface of the tibia 602 and ending within the cancellous region of the femur 603, similar to the tunnel depicted in Figure lb. The surgeon may elect initially to fully penetrate the femur 603 with a guide wire 626, leaving a small exit aperture 609 on the opposing surface of the femur in accordance with the prior art covering ACL reconstructive surgery.
A first stabilizing element 615 is then inserted in the femoral tunnel as has been described above.
Insertion elements 612 and 624 are joined by a length of soft tissue 610, such as a tendon graft, and the first insertion element 612 is inserted into the stabilizing element 615, for example by pushing into the stabilizing element 615, or by pulling with a suture, wire, or other device 626 on a small aperture, slot, barb, or hook on the insertion element 612. The second insertion element 624 is pushed into the bone tunnel, and then the second stabilizing element 628 is placed in the bone tunnel. In the preferred embodiment depicted in Figure 6, the second stabilizing element 628 comprises a flange 630 which limits the extent to which the stabilizing element can be pulled into the bone tunnel, e.g., by the tendon graft. This element is also depicted in Figure 7 and is further discussed below. In other embodiments, the second stabilizing element may be secured by means of screw threads, an interference fit, or other methods known in the art. Finally, the second insertion element 624 is inserted into the second stabilizing element 628. In the preferred embodiment depicted in Figure 6, the second insertion element is inserted into the second stabilizing element by pulling with a suture, wire, or other device 632 on a small aperture, slot, barb, or hook on the second insertion element 624.
In an embodiment for ACL replacement for an adult, the first stabilizing element is typically of a length 20mm, an outer diameter of 8mm, and an inner diameter of 3.5mm.
The first insertion element is typically of a length 40mm and a diameter 8mm. If the insertion element is equipped with an aperture whereby it may be pulled into the stabilizing element, that aperture has a typical diameter of lmm. The aperture for attachment of the tendon graft is typically about 5mm x 8mm. The length of the tendon graft between the insertion elements is usually about 40mm. Those skilled in the art will appreciate that the foregoing dimensions are supplied merely by way of example and that stabilization and insertion elements of sizes suited for other bones, joints and grafts can be used as well.
The surgeon can adjust the tension on the tendon graft by controlling the extent to which the insertion elements are inserted into the stabilizing elements.
Insertion elements are typically designed so that full strength hold of the insertion element in the stabilizing element is obtained when the insertion element is inserted at least halfway into the stabilizing element. Thus, the depth of each insertion element is adjustable over a length of 10mm for this preferred embodiment.
The second stabilizing element 628 of Figure 6 is also illustrated in Figure 7. This element comprises an elongated body 729, having a channel 731 for receiving an insertion element. The stabilizing element also comprises a flange 730, which prevents the element from being pulled completely into the bone hole by tension on a graft attached to an insertion element deployed in channel 731. The flange 730 may be perpendicular to the elongated body 729, or may be at an oblique angle to the body 729, as depicted in Figure 7. The flange 730 may also be contoured to correspond to the shape of the outer surface of the bone in which it is to be emplaced. The surgeon may also elect to countersink the bone tunnel, so that the outer surface of the emplaced flange 730 is flush with the surface of the surrounding bone. In this embodiment, it may be desirable for the flange 730 to be tapered, having a thicker cross-section at the intersection of the flange 730 with the body 729 than at the outer edge of the flange 730.
When this embodiment is used in ACL repair as depicted in Figure 6, the second stabilizing element has a typical length of 15mm, an outer diameter of 8mm, and an inner diameter of 3.5mm. The flange has a typical outer diameter of 12mm, and a typical thickness of lmm. The second insertion element has a length 40mm and a diameter 8mm. If the second insertion element is equipped with an aperture whereby it may be pulled into the stabilizing element, that aperture has a typical diameter of imm. The aperture for attachment of the tendon graft is typically about 5mm x 8mm. Those skilled in the art will appreciate that the foregoing dimensions are supplied merely by way of example and that stabilization and insertion elements of sizes suited for other bones, joints and grafts can be used as well.
The second insertion element and second stabilizing element, like the first elements, are comprised of a biocompatible material, for example implant grade high density polyethylene, low density polyethylene (PE 6010 and PE 2030) and polypropylene (13R9A and 23M2) all made by Rexene, Dallas, Texas or of a bioabsorbable material, for example poly-l-lactide or such as a lactide-glycolide composition. These elements may also be comprised of a metal, such as surgical implant grade steel.
It will be apparent to those skilled in the art that the above-described invention is not limited to connecting the femur and tibia in an ACL reconstructive procedure, but could also be practiced to support or repair any bone or pair of bones with a length of soft tissue, e.g., in the ankle or elbow region.
The invention further comprises methods for connecting at least two bone anchors, for example those described above, with one or more lengths of graft material.
Figure 8 shows a graft 810 prepared according to a preferred embodiment of this aspect. The graft 810 may be an autologous tendon graft such as a length of semitendinosis or gracillis tendon, or an artificial graft. The graft 810 has a filament 840 (such as a suture) attached to at least one of its ends. In the preferred embodiment illustrated in Figure 8, a suture 840 is whip-stitched to each end of the graft.
The anchors may be connected with one or with multiple grafts, in either a two-ply or four-ply configuration. Some configurations according to the invention are illustrated in Figures 9a-9f. In Figure 9a, a single graft 910 is used to connect two anchors 942 and 944 in a two-ply configuration. A graft 910 prepared as illustrated in Figure 8 is threaded through an aperture in one anchor 944, and then folded so that the two ends of the graft 910 can be tied and/or sewn to an aperture in the other anchor 942 using the filament 940.
A related embodiment is illustrated in Figure 9b.
In this embodiment, the prepared graft 910 is threaded through apertures in each of the two anchors 942 and 944.
The sutures 940 attached to the prepared graft are then tied, or, preferably, sewn, to connect the ends of the graft 910. This embodiment is also a two-ply arrangement.
A four-ply connection between the anchors is achieved using a single graft in the embodiment illustrated in Figures 9c and 9d. A prepared graft 910 is first threaded through one anchor 942, and folded to bring the ends of the graft 910 into contact. These two ends are then threaded through the other bone anchor 944. Figure 9c illustrates the configuration of the graft at this point in its emplacement. The graft 910 is then folded in half again, to bring the ends back to the first anchor 942, and the ends are sewn and/or tied there with the attached filaments 940, as illustrated in Figure 9d. Section A-A of that figure shows the four plies of graft material 910 which now connect the bone anchors.
Other embodiments which achieve a four-ply connection between the anchors using multiple tendon grafts are illustrated in Figures 9e and 9f. In the first of these, one graft 910, prepared as shown in Figure 8, is threaded through an aperture in a first anchor 944, and the sutures 940 at the end of the graft are sewn and/or tied to an aperture in a second anchor 942. A second graft 946 is then passed through the aperture in the second anchor 942, and sewn and/or tied to the aperture in the first anchor 944 with its attached sutures 948. In the second embodiment, illustrated in Figure 9f, two grafts 910 and 946 are threaded through an aperture in the first anchor 944, and these two grafts are both sewn and/or tied to the aperture in the second anchor 942 with their attached sutures 940 and 948.
It will be apparent to one skilled in the art of ligament reconstruction that each of the embodiments illustrated in Figures 9a-9f has different strengths, and that the preferred configuration for a particular use of the invention will depend on the ligament being replaced, the location and type of the bone anchors, and on whether the graft is attached to the anchors before or after they are affixed to the bone.
Described above are apparatus and methods meeting the objects set forth above. Those skilled in the art will appreciate that the illustrated embodiments are shown and described by way of example only, and that other methods and apparatus incorporation modifications therein fall within the scope of the invention. For example, in addition to ACL
reconstruction, the invention can be beneficially applied in connection with other soft tissue-to-bone attachments using bone tunnels, such as (by way of non-limiting example) repair of ligaments and tendons in other joints such as the elbow and ankle. In view of the foregoing, what we claim is:
Claims (50)
1. An assembly for anchoring soft tissue grafts in bone, comprising:
an insertion element comprising a stem and an aperture-containing stem head proximal to said stem, said stem head aperture being of a size sufficiently large to receive a soft tissue graft; and further comprising any one of an aperture, slot or barb disposed at the distal end of the insertion element adapted to accept a length of suture by which the insertion element can be pulled into a bone hole; and a stabilizing element adapted to be embedded in bone comprising a sleeve having a cavity, said cavity being elongated and having an inner diameter smaller than an outer diameter of said stem, such that said sleeve is capable of holding said stem by a compression fit in an operating position.
an insertion element comprising a stem and an aperture-containing stem head proximal to said stem, said stem head aperture being of a size sufficiently large to receive a soft tissue graft; and further comprising any one of an aperture, slot or barb disposed at the distal end of the insertion element adapted to accept a length of suture by which the insertion element can be pulled into a bone hole; and a stabilizing element adapted to be embedded in bone comprising a sleeve having a cavity, said cavity being elongated and having an inner diameter smaller than an outer diameter of said stem, such that said sleeve is capable of holding said stem by a compression fit in an operating position.
2. The assembly according to claim 1, wherein at least one of said stem of said insertion element and said sleeve of said stabilizing element are elongate and have protrusions on their outer surfaces.
3. The assembly according to claim 2, wherein said protrusions on said stabilizing element comprise threading amenable to being screwed into the bone hole.
4. The assembly according to any one of claims 1 to 3, wherein said stabilizing element comprises a flange at its distal end, whereby upon embedding of the stabilizing element in the bone hole, the flange is disposed at least partially outside the bone hole in a configuration to oppose further movement of the stabilizing element into the bone hole.
5. An assembly for anchoring soft tissue grafts in bone, comprising:
an insertion element comprising an elongated stem and an aperture-containing stem head proximal to said stem, said stem head aperture suitably sized for passage of a soft tissue graft therethrough; and further comprising any one of an aperture, slot or barb disposed at the distal end of the insertion element adapted to accept a length of suture by which the insertion element can be pulled into a bone hole; and a stabilizing element capable of insertion into the bone hole and comprising an elongated sleeve having an axial channel, said channel having a diameter smaller than that of said elongated stem of said insertion element such that said stabilizing element will irreversibly expand upon insertion of said insertion element into said channel.
an insertion element comprising an elongated stem and an aperture-containing stem head proximal to said stem, said stem head aperture suitably sized for passage of a soft tissue graft therethrough; and further comprising any one of an aperture, slot or barb disposed at the distal end of the insertion element adapted to accept a length of suture by which the insertion element can be pulled into a bone hole; and a stabilizing element capable of insertion into the bone hole and comprising an elongated sleeve having an axial channel, said channel having a diameter smaller than that of said elongated stem of said insertion element such that said stabilizing element will irreversibly expand upon insertion of said insertion element into said channel.
6. The assembly according to claim 5, wherein said stabilizing element can be deformably expanded to obtain a pressure fit within the bone hole upon insertion of said insertion element into said axial channel of said stabilizing element.
7. The assembly according to any one of claims 1 to 6, wherein said insertion and stabilizing elements comprise bio-compatible material.
8. The assembly according to any one of claims 1 to 7, wherein said stabilizing element has a flanged proximal end.
9. The assembly according to any one of claims 1 to 8, further comprising:
a second insertion element comprising a stem and an aperture-containing stem head proximal to said stem, said aperture being of a size sufficiently large to receive a soft tissue graft; and a second stabilizing element adapted to be embedded in bone comprising a sleeve having a cavity, said cavity being arranged and constructed so as to receive and hold the stem of the second insertion element.
a second insertion element comprising a stem and an aperture-containing stem head proximal to said stem, said aperture being of a size sufficiently large to receive a soft tissue graft; and a second stabilizing element adapted to be embedded in bone comprising a sleeve having a cavity, said cavity being arranged and constructed so as to receive and hold the stem of the second insertion element.
10. The assembly of claim 9, wherein the second insertion element further comprises any one of an aperture, slot, or barb by which said insertion element can be pulled into a second bone hole.
11. The assembly of claim 9 or 10, wherein the second stabilizing element comprises a flange at its distal end, whereby upon embedding of the stabilizing element in the second bone hole, the flange is disposed at least partially outside the second bone hole in a configuration to oppose further movement of the stabilizing element into the second bone hole.
12. Use for anchorage of soft tissue within bone of the assembly according to any one of claims 1 to 4.
13. The use according to claim 12, wherein the soft tissue is a tendon graft.
14. The use according to claim 12 or 13, wherein the bone hole is a drilled stepped bone opening.
15. The use according to claim 14, wherein the stepped bone opening has at least two different diameters, one less than the diameter of the stabilizing element, and one greater than the diameter of the stem head.
16. The use according to claim 15, wherein said elongated sleeve of said stabilizing element is adapted to be screwed into the stepped bone opening at the diameter where said stepped bone opening is slightly smaller than that of said elongated sleeve.
17. Use for anchorage of soft tissue within bone of the assembly according to any one of claims 5 to 8.
18. The use according to claim 17, wherein the soft tissue is a tendon graft.
19. The use according to claims 17 or 18, wherein the bone hole is a drilled stepped bone opening.
20. The use according to claim 19, wherein the stepped bone opening has at least two different diameters, one less than the diameter of the stabilizing element, and one greater that the diameter of the stem head.
21. The use according to claim 20, wherein said elongated sleeve of said stabilizing element is adapted to be screwed into the stepped bone opening at the diameter where said stepped bone opening is slightly smaller than that of said elongated sleeve.
22. The use according to any one of claims 17 to 21, wherein said stabilizing element is adapted to be screwed into the stepped bone opening by use of an emplacement device fitted into said axial channel.
23. Use for anchorage of soft tissue within bone of the assembly according to any one of claims 9 to 11.
24. The use according to claim 23, wherein the soft tissue is a tendon graft.
25. The use according to claims 23 or 24, wherein, the bone hole is a drilled stepped bone opening.
26. The use according to claim 25, wherein the stepped bone opening has at least two different diameters, one less than the diameter of the stabilizing element, and one greater than the diameter of the stem head.
27. The use according to claim 26, wherein said elongated sleeve of said stabilizing element is adapted to be screwed into the stepped bone opening at the diameter where said stepped bone opening is slightly smaller than that of said elongated sleeve.
28. The use according to any one of claims 25 to 27, wherein said stabilizing element is adapted to be screwed into the stepped bone opening by use of an emplacement device fitted into said axial channel.
29. The use according to any one of claims 16, 22 and 28, wherein said insertion element for retaining the soft tissue is adapted for insertion into said stabilizing element when said stabilizing element is in said stepped bone opening.
30. Use for replacing a torn ligament of the assembly according to any one of claims 1 to 8, wherein the stem head aperture of said insertion element is adapted to receive a tendon graft.
31. The use of claim 30, wherein said ligament is an anterior cruciate ligament and the bone is a femur or a tibia.
32. The use according to claim 30 or 31, wherein said stabilizing element is affixed into bone by interference fit.
33. Use for replacing a torn ligament of the assembly according to any one of claims 9 to 11, wherein the stem head aperture of said second insertion element is adapted to receive a tendon graft.
34. The use of claim 32, wherein said ligament is an anterior cruciate ligament and the bone is a femur or a tibia.
35. The use according to claim 33, wherein the ligament is an anterior cruciate ligament, said bone hole is in a femur, and said second bone hole is in a tibia.
36. The use according to any one of claims 33 to 35, wherein at least one of said stabilizing element and said second stabilizing element is affixed into bone by an interference fit.
37. The use according to any one of claims 33 to 35, wherein at least one of said stabilizing element and said second stabilizing element is affixed into bone by means of screw threads.
38. A system for ligament reconstruction, comprising:
(a) at least two anchoring assemblies as defined in claim 1;
(b) a graft having at least two ends, at least one end having a filament extending therefrom;
(c) the graft being threaded through the aperture of one of the anchoring assemblies; and (d) the filament affixing the two ends of the graft to the aperture of the other anchoring assembly.
(a) at least two anchoring assemblies as defined in claim 1;
(b) a graft having at least two ends, at least one end having a filament extending therefrom;
(c) the graft being threaded through the aperture of one of the anchoring assemblies; and (d) the filament affixing the two ends of the graft to the aperture of the other anchoring assembly.
39. A system for ligament reconstruction, comprising:
(a) at least two anchoring assemblies as defined in claim 1;
(b) a graft having at least two ends, at least one end having a filament extending therefrom;
(c) the graft being threaded through the aperture of one of the anchoring assemblies; and (d) the filament affixing the two ends of the graft to each other.
(a) at least two anchoring assemblies as defined in claim 1;
(b) a graft having at least two ends, at least one end having a filament extending therefrom;
(c) the graft being threaded through the aperture of one of the anchoring assemblies; and (d) the filament affixing the two ends of the graft to each other.
40. A system for ligament reconstruction, comprising:
(a) at least two anchoring assemblies as defined in claim 1;
(b) a graft having at least two ends, at least one having a filament extending therefrom;
(c) the graft being threaded through the aperture of the first anchoring assembly;
(d) the two ends of the graft being threaded through the aperture of the second anchoring assembly; and (e) the filament affixing the two ends of the graft to the aperture of the first anchoring assembly.
(a) at least two anchoring assemblies as defined in claim 1;
(b) a graft having at least two ends, at least one having a filament extending therefrom;
(c) the graft being threaded through the aperture of the first anchoring assembly;
(d) the two ends of the graft being threaded through the aperture of the second anchoring assembly; and (e) the filament affixing the two ends of the graft to the aperture of the first anchoring assembly.
41. A system for ligament reconstruction, comprising:
(a) at least a first anchoring assembly as defined in claim 1 and a second anchoring assembly as defined in claim 1;
(b) at least a first graft and a second graft, each graft having at least two ends, at least one end of each graft having a filament extending therefrom;
(c) the first graft being threaded through the aperture of the first anchoring assembly;
(d) the filament of the first graft affixing the two ends of the first graft to the aperture of the second anchoring assembly;
(e) the second graft being threaded through the aperture of the second anchoring assembly; and (f) the filament of the second graft affixing the two ends of the second graft to the aperture of the first anchoring assembly;
(a) at least a first anchoring assembly as defined in claim 1 and a second anchoring assembly as defined in claim 1;
(b) at least a first graft and a second graft, each graft having at least two ends, at least one end of each graft having a filament extending therefrom;
(c) the first graft being threaded through the aperture of the first anchoring assembly;
(d) the filament of the first graft affixing the two ends of the first graft to the aperture of the second anchoring assembly;
(e) the second graft being threaded through the aperture of the second anchoring assembly; and (f) the filament of the second graft affixing the two ends of the second graft to the aperture of the first anchoring assembly;
42. A system for ligament reconstruction, comprising:
(a) at least a first anchoring assembly as defined in claim 1 and a second anchoring assembly as defined in claim 1;
(b) at least a first graft and a second graft, each having at least two ends, at least one end of each graft having a filament extending therefrom;
(c) the first graft being threaded through the aperture of the first anchoring assembly;
(d) the filament of the first graft affixing the two ends of the first graft to the aperture of the second anchoring assembly;
(e) the second graft being threaded through the aperture of the first anchoring assembly; and (f) the filament of the second graft affixing the two ends of the second graft to the aperture of the second anchoring assembly.
(a) at least a first anchoring assembly as defined in claim 1 and a second anchoring assembly as defined in claim 1;
(b) at least a first graft and a second graft, each having at least two ends, at least one end of each graft having a filament extending therefrom;
(c) the first graft being threaded through the aperture of the first anchoring assembly;
(d) the filament of the first graft affixing the two ends of the first graft to the aperture of the second anchoring assembly;
(e) the second graft being threaded through the aperture of the first anchoring assembly; and (f) the filament of the second graft affixing the two ends of the second graft to the aperture of the second anchoring assembly.
43. The system according to any one of claims 38 to 42, wherein at least one filament is a suture.
44. The system according to any one of claims 38 to 43, wherein the anchoring assemblies are adapted to be embedded in bone tunnels.
45. The system according to claim 44, wherein the bone tunnels are collinear.
46. The system according to any one of claims 38 to 45, wherein the graft is an autologous tendon graft.
47. The system of according to claim 46, wherein the graft is one of a length of semitendinosus tendon and a length of gracillis tendon.
48. The system according to any one of claims 38 to 45, wherein the graft is an artificial tendon graft.
49. The system according to any one of claims 38 to 48, wherein the system is for repair of an anterior cruciate ligament.
50. Use of the system according to any one of claim 38 to 49 for ligament reconstruction, the first anchoring assembly and the second anchoring assembly of the system affixed in bone.
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US75456696A | 1996-11-21 | 1996-11-21 | |
US08/754,566 | 1996-11-21 | ||
US88758097A | 1997-07-03 | 1997-07-03 | |
US08/887,580 | 1997-07-03 | ||
PCT/US1997/022061 WO1998022048A1 (en) | 1996-11-21 | 1997-11-21 | Apparatus and methods for anchoring autologous or artificial tendon grafts in bone |
Publications (2)
Publication Number | Publication Date |
---|---|
CA2272251A1 CA2272251A1 (en) | 1998-05-28 |
CA2272251C true CA2272251C (en) | 2009-07-07 |
Family
ID=27115938
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA002272251A Expired - Fee Related CA2272251C (en) | 1996-11-21 | 1997-11-21 | Apparatus and methods for anchoring autologous or artificial tendon grafts in bone |
Country Status (8)
Country | Link |
---|---|
US (3) | US6616694B1 (en) |
EP (3) | EP1419747B1 (en) |
JP (1) | JP4083813B2 (en) |
AU (1) | AU738044B2 (en) |
CA (1) | CA2272251C (en) |
DE (1) | DE69734606T2 (en) |
ES (1) | ES2252800T3 (en) |
WO (1) | WO1998022048A1 (en) |
Families Citing this family (180)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US8496705B2 (en) | 1996-11-21 | 2013-07-30 | DePuy Mitek, LLCR | Method of anchoring autologous or artificial tendon grafts in bone |
EP1419747B1 (en) | 1996-11-21 | 2015-04-01 | Ethicon, Inc. | Apparatus for anchoring autologous or artificial tendon grafts in bone. |
US6554862B2 (en) | 1996-11-27 | 2003-04-29 | Ethicon, Inc. | Graft ligament anchor and method for attaching a graft ligament to a bone |
US5899938A (en) | 1996-11-27 | 1999-05-04 | Joseph H. Sklar | Graft ligament anchor and method for attaching a graft ligament to a bone |
US7083647B1 (en) | 1996-11-27 | 2006-08-01 | Sklar Joseph H | Fixation screw, graft ligament anchor assembly, and method for securing a graft ligament in a bone tunnel |
WO1999001084A2 (en) * | 1997-07-03 | 1999-01-14 | Innovasive Devices, Inc. | Apparatus and methods for anchoring autologous or artificial tendon grafts in bone |
US6387129B2 (en) * | 1998-03-18 | 2002-05-14 | Arthrex, Inc. | Bicortical tibial fixation of ACL grafts |
US6086591A (en) * | 1999-01-29 | 2000-07-11 | Smith & Nephew, Inc. | Soft tissue anchor |
US9521999B2 (en) | 2005-09-13 | 2016-12-20 | Arthrex, Inc. | Fully-threaded bioabsorbable suture anchor |
US8343186B2 (en) | 2004-04-06 | 2013-01-01 | Arthrex, Inc. | Fully threaded suture anchor with transverse anchor pin |
US6132442A (en) * | 1999-03-25 | 2000-10-17 | Smith & Nephew | Graft clamp |
FR2797178B1 (en) * | 1999-08-05 | 2002-02-22 | Tornier Sa | MALLEOLAR IMPLANT FOR PARTIAL OR TOTAL ANKLE PROSTHESIS AND ANCILLARY MATERIAL FOR PLACING SUCH AN IMPLANT |
US7993369B2 (en) | 2000-06-22 | 2011-08-09 | Arthrex, Inc. | Graft fixation using a plug against suture |
DE20101791U1 (en) * | 2001-02-02 | 2001-05-03 | Aesculap Ag & Co Kg | Implant |
FR2820302B1 (en) * | 2001-02-07 | 2003-08-01 | Phusis | IMPLANTABLE DEVICE FOR ANCHORING SUTURE STRANDS WITHIN A BONE TUNNEL, SYSTEM AND KIT COMPRISING SAME |
US7195642B2 (en) * | 2001-03-13 | 2007-03-27 | Mckernan Daniel J | Method and apparatus for fixing a graft in a bone tunnel |
US7344539B2 (en) * | 2001-03-30 | 2008-03-18 | Depuy Acromed, Inc. | Intervertebral connection system |
US7144413B2 (en) * | 2001-04-20 | 2006-12-05 | Synthes (U.S.A.) | Graft fixation system and method |
US20030040795A1 (en) * | 2001-05-31 | 2003-02-27 | Elson Robert J. | Anterior cruciate ligament reconstruction system |
GB0116605D0 (en) | 2001-07-07 | 2001-08-29 | Atlantech Medical Devices Ltd | Expandable bone anchor |
US6887271B2 (en) | 2001-09-28 | 2005-05-03 | Ethicon, Inc. | Expanding ligament graft fixation system and method |
US20090306718A1 (en) * | 2001-10-18 | 2009-12-10 | Orthoip, Llc | Filament and cap systems and methods for the fixation of bone fractures |
US20100312292A1 (en) * | 2001-10-18 | 2010-12-09 | Orthoip, Llc | Lagwire system and method for the fixation of bone fractures |
US20080243132A1 (en) * | 2001-10-18 | 2008-10-02 | Fx Devices, Llc | Tensioning system and method for the fixation of bone fractures |
US8702768B2 (en) | 2001-10-18 | 2014-04-22 | Orthoip, Llc | Cannulated bone screw system and method |
US20090131990A1 (en) * | 2001-10-18 | 2009-05-21 | Kishore Tipirneni | Bone screw system and method |
US9060809B2 (en) | 2001-10-18 | 2015-06-23 | Orthoip, Llc | Lagwire system and method for the fixation of bone fractures |
US8828067B2 (en) | 2001-10-18 | 2014-09-09 | Orthoip, Llc | Bone screw system and method |
US8679167B2 (en) | 2001-10-18 | 2014-03-25 | Orthoip, Llc | System and method for a cap used in the fixation of bone fractures |
US6736819B2 (en) * | 2001-10-18 | 2004-05-18 | Kishore Tipirneni | System and method for fixation of bone fractures |
US20100268285A1 (en) * | 2001-10-18 | 2010-10-21 | Orthoip, Llc | Bone screw system and method for the fixation of bone fractures |
AU2002255144A1 (en) * | 2002-05-03 | 2003-11-17 | Ahmed Mohamed Hosny Khashaba | Ligament tensioning device |
DE20207781U1 (en) * | 2002-05-13 | 2002-08-08 | Aesculap Ag & Co Kg | implant |
US7682392B2 (en) | 2002-10-30 | 2010-03-23 | Depuy Spine, Inc. | Regenerative implants for stabilizing the spine and devices for attachment of said implants |
US7588586B2 (en) * | 2003-05-27 | 2009-09-15 | Ethicon, Inc. | Tissue fixation device |
US20050090827A1 (en) * | 2003-10-28 | 2005-04-28 | Tewodros Gedebou | Comprehensive tissue attachment system |
US7326247B2 (en) * | 2003-10-30 | 2008-02-05 | Arthrex, Inc. | Method for creating a double bundle ligament orientation in a single bone tunnel during knee ligament reconstruction |
US7608092B1 (en) | 2004-02-20 | 2009-10-27 | Biomet Sports Medicince, LLC | Method and apparatus for performing meniscus repair |
US7407511B2 (en) | 2004-05-13 | 2008-08-05 | Wright Medical Technology Inc | Methods and materials for connective tissue repair |
US7500983B1 (en) | 2004-06-09 | 2009-03-10 | Biomet Sports Medicine, Llc | Apparatus for soft tissue attachment |
US8109965B2 (en) | 2004-06-09 | 2012-02-07 | Biomet Sports Medicine, LLP | Method and apparatus for soft tissue fixation |
US7819898B2 (en) | 2004-06-09 | 2010-10-26 | Biomet Sports Medicine, Llc | Method and apparatus for soft tissue fixation |
US7695503B1 (en) | 2004-06-09 | 2010-04-13 | Biomet Sports Medicine, Llc | Method and apparatus for soft tissue attachment |
US8137382B2 (en) | 2004-11-05 | 2012-03-20 | Biomet Sports Medicine, Llc | Method and apparatus for coupling anatomical features |
US7857830B2 (en) | 2006-02-03 | 2010-12-28 | Biomet Sports Medicine, Llc | Soft tissue repair and conduit device |
US7749250B2 (en) | 2006-02-03 | 2010-07-06 | Biomet Sports Medicine, Llc | Soft tissue repair assembly and associated method |
US7905903B2 (en) | 2006-02-03 | 2011-03-15 | Biomet Sports Medicine, Llc | Method for tissue fixation |
US9801708B2 (en) | 2004-11-05 | 2017-10-31 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US8088130B2 (en) | 2006-02-03 | 2012-01-03 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US7905904B2 (en) | 2006-02-03 | 2011-03-15 | Biomet Sports Medicine, Llc | Soft tissue repair device and associated methods |
US8298262B2 (en) | 2006-02-03 | 2012-10-30 | Biomet Sports Medicine, Llc | Method for tissue fixation |
US9017381B2 (en) | 2007-04-10 | 2015-04-28 | Biomet Sports Medicine, Llc | Adjustable knotless loops |
US8118836B2 (en) | 2004-11-05 | 2012-02-21 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US7909851B2 (en) | 2006-02-03 | 2011-03-22 | Biomet Sports Medicine, Llc | Soft tissue repair device and associated methods |
US8128658B2 (en) | 2004-11-05 | 2012-03-06 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to bone |
US7601165B2 (en) | 2006-09-29 | 2009-10-13 | Biomet Sports Medicine, Llc | Method and apparatus for forming a self-locking adjustable suture loop |
US8303604B2 (en) | 2004-11-05 | 2012-11-06 | Biomet Sports Medicine, Llc | Soft tissue repair device and method |
US8840645B2 (en) | 2004-11-05 | 2014-09-23 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US20060189993A1 (en) | 2004-11-09 | 2006-08-24 | Arthrotek, Inc. | Soft tissue conduit device |
US8361113B2 (en) | 2006-02-03 | 2013-01-29 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US8998949B2 (en) | 2004-11-09 | 2015-04-07 | Biomet Sports Medicine, Llc | Soft tissue conduit device |
US7651528B2 (en) | 2004-11-18 | 2010-01-26 | Cayenne Medical, Inc. | Devices, systems and methods for material fixation |
US20080033441A1 (en) * | 2005-02-25 | 2008-02-07 | Meira Corporation | Ligament graft-fixing apparatus |
KR100653875B1 (en) * | 2005-05-13 | 2006-12-05 | 주식회사 엠아이텍 | Ligament supporting device |
US8092528B2 (en) | 2005-05-27 | 2012-01-10 | Depuy Spine, Inc. | Intervertebral ligament having a helical bone fastener |
EP1762186B1 (en) | 2005-09-12 | 2011-02-16 | Arthrex, Inc. | Suture anchor with eyelet |
US8652172B2 (en) | 2006-02-03 | 2014-02-18 | Biomet Sports Medicine, Llc | Flexible anchors for tissue fixation |
US8562645B2 (en) | 2006-09-29 | 2013-10-22 | Biomet Sports Medicine, Llc | Method and apparatus for forming a self-locking adjustable loop |
US8652171B2 (en) | 2006-02-03 | 2014-02-18 | Biomet Sports Medicine, Llc | Method and apparatus for soft tissue fixation |
US10517587B2 (en) | 2006-02-03 | 2019-12-31 | Biomet Sports Medicine, Llc | Method and apparatus for forming a self-locking adjustable loop |
US7959650B2 (en) | 2006-09-29 | 2011-06-14 | Biomet Sports Medicine, Llc | Adjustable knotless loops |
US8251998B2 (en) | 2006-08-16 | 2012-08-28 | Biomet Sports Medicine, Llc | Chondral defect repair |
US9538998B2 (en) | 2006-02-03 | 2017-01-10 | Biomet Sports Medicine, Llc | Method and apparatus for fracture fixation |
US8936621B2 (en) | 2006-02-03 | 2015-01-20 | Biomet Sports Medicine, Llc | Method and apparatus for forming a self-locking adjustable loop |
US9149267B2 (en) | 2006-02-03 | 2015-10-06 | Biomet Sports Medicine, Llc | Method and apparatus for coupling soft tissue to a bone |
US8771352B2 (en) | 2011-05-17 | 2014-07-08 | Biomet Sports Medicine, Llc | Method and apparatus for tibial fixation of an ACL graft |
US11311287B2 (en) | 2006-02-03 | 2022-04-26 | Biomet Sports Medicine, Llc | Method for tissue fixation |
US8968364B2 (en) | 2006-02-03 | 2015-03-03 | Biomet Sports Medicine, Llc | Method and apparatus for fixation of an ACL graft |
US8506597B2 (en) | 2011-10-25 | 2013-08-13 | Biomet Sports Medicine, Llc | Method and apparatus for interosseous membrane reconstruction |
US8801783B2 (en) | 2006-09-29 | 2014-08-12 | Biomet Sports Medicine, Llc | Prosthetic ligament system for knee joint |
US8574235B2 (en) | 2006-02-03 | 2013-11-05 | Biomet Sports Medicine, Llc | Method for trochanteric reattachment |
US8562647B2 (en) | 2006-09-29 | 2013-10-22 | Biomet Sports Medicine, Llc | Method and apparatus for securing soft tissue to bone |
US8597327B2 (en) | 2006-02-03 | 2013-12-03 | Biomet Manufacturing, Llc | Method and apparatus for sternal closure |
US9271713B2 (en) | 2006-02-03 | 2016-03-01 | Biomet Sports Medicine, Llc | Method and apparatus for tensioning a suture |
US9078644B2 (en) | 2006-09-29 | 2015-07-14 | Biomet Sports Medicine, Llc | Fracture fixation device |
US11259792B2 (en) | 2006-02-03 | 2022-03-01 | Biomet Sports Medicine, Llc | Method and apparatus for coupling anatomical features |
US7967861B2 (en) | 2006-03-20 | 2011-06-28 | Cayenne Medical, Inc. | Devices, systems and methods for material fixation |
US7828820B2 (en) | 2006-03-21 | 2010-11-09 | Biomet Sports Medicine, Llc | Method and apparatuses for securing suture |
US7862573B2 (en) * | 2006-04-21 | 2011-01-04 | Darois Roger E | Method and apparatus for surgical fastening |
EP2043555A1 (en) * | 2006-06-23 | 2009-04-08 | Michel Collette | Bone anchoring device |
WO2008010948A2 (en) | 2006-07-18 | 2008-01-24 | Davol Inc. | Method and apparatus for surgical fastening |
AU2007275351B2 (en) * | 2006-07-20 | 2013-10-24 | Lee D. Kaplan | Surgical instruments |
US8202295B2 (en) | 2006-07-20 | 2012-06-19 | Kaplan Lee D | Surgical instruments |
FR2904527B1 (en) * | 2006-08-03 | 2009-04-03 | Tettra Trading Ltd | SURGICAL NECESSARY OF LIGAMENTOPLASTY |
US8226714B2 (en) | 2006-09-29 | 2012-07-24 | Depuy Mitek, Inc. | Femoral fixation |
US8672969B2 (en) | 2006-09-29 | 2014-03-18 | Biomet Sports Medicine, Llc | Fracture fixation device |
US9918826B2 (en) | 2006-09-29 | 2018-03-20 | Biomet Sports Medicine, Llc | Scaffold for spring ligament repair |
US8500818B2 (en) | 2006-09-29 | 2013-08-06 | Biomet Manufacturing, Llc | Knee prosthesis assembly with ligament link |
US11259794B2 (en) | 2006-09-29 | 2022-03-01 | Biomet Sports Medicine, Llc | Method for implanting soft tissue |
US7674276B2 (en) * | 2006-10-06 | 2010-03-09 | Biomet Sports Medicine, Llc | Rotational securing of a suture |
FR2906999B1 (en) | 2006-10-13 | 2009-06-05 | Tornier Sas | PROTHETIC SET OF ANKLE |
US7963983B2 (en) * | 2006-10-17 | 2011-06-21 | Arthroscopic Innovations Llc | Fixation device for surgical repair |
EP2086433B1 (en) | 2006-10-24 | 2015-10-21 | Cayenne Medical, Inc. | Tendon Anchor |
US7909882B2 (en) * | 2007-01-19 | 2011-03-22 | Albert Stinnette | Socket and prosthesis for joint replacement |
US20080255664A1 (en) * | 2007-04-10 | 2008-10-16 | Mdesign International | Percutaneously deliverable orthopedic joint device |
JP5328763B2 (en) * | 2007-04-10 | 2013-10-30 | アーティキュリンクス, インコーポレイテッド | Percutaneous delivery and retrieval system for a shape change orthopedic joint device |
WO2008134504A1 (en) * | 2007-04-25 | 2008-11-06 | Alaska Hand Research, Llc | Method and device for stabilizing joints with limited axial movement |
US20090043337A1 (en) * | 2007-08-07 | 2009-02-12 | Martin Daniel L | Suture-Retaining Device And Anchor |
WO2009055800A1 (en) | 2007-10-25 | 2009-04-30 | Smith & Nephew, Inc. | Anchor assembly |
US9445842B2 (en) * | 2008-01-24 | 2016-09-20 | Globus Medical, Inc. | Facet fixation prosthesis |
US20090234386A1 (en) * | 2008-03-11 | 2009-09-17 | Dean John C | Suture Cleat for Soft Tissue Injury Repair |
US8142501B2 (en) | 2008-04-21 | 2012-03-27 | The Board Of Regents Of The University Of Texas System | Artificial ligaments and tendons comprising multifilaments and nanofibers and methods for making |
US20090281581A1 (en) | 2008-05-06 | 2009-11-12 | Berg Jeffery H | Method and device for securing sutures to bones |
US8858565B1 (en) | 2008-05-08 | 2014-10-14 | Cayenne Medical, Inc. | Inserter for soft tissue or bone-to-bone fixation device and methods |
US8123806B1 (en) | 2008-05-09 | 2012-02-28 | Cayenne Medical, Inc | Method of tensioning a tissue graft having suture bundles using a cleated bar |
CN102098969B (en) | 2008-07-17 | 2013-07-17 | 史密夫和内修有限公司 | Surgical devices |
US8333802B2 (en) * | 2008-08-19 | 2012-12-18 | Dougherty Christopher P | Single tunnel double bundle anterior cruciate ligament reconstruction |
EP2339985A4 (en) * | 2008-09-12 | 2013-07-03 | Articulinx Inc | Tether-based orthopedic joint device delivery methods |
US20100121355A1 (en) | 2008-10-24 | 2010-05-13 | The Foundry, Llc | Methods and devices for suture anchor delivery |
US8523902B2 (en) | 2009-01-30 | 2013-09-03 | Kfx Medical Corporation | System and method for attaching soft tissue to bone |
US8206446B1 (en) * | 2009-03-10 | 2012-06-26 | Cayenne Medical, Inc. | Method for surgically repairing a damaged ligament |
JP5457544B2 (en) * | 2009-03-31 | 2014-04-02 | アイエムディーエス コーポレイション | Double bundle ACL repair |
US8845725B2 (en) | 2009-04-17 | 2014-09-30 | Lumaca Orthopaedics Pty Ltd | Tenodesis system |
EP2421445B1 (en) | 2009-04-19 | 2019-05-29 | Slobodan Tepic | Suture attachment |
US20100292733A1 (en) | 2009-05-12 | 2010-11-18 | Foundry Newco Xi, Inc. | Knotless suture anchor and methods of use |
US20100292731A1 (en) | 2009-05-12 | 2010-11-18 | Foundry Newco Xl, Inc. | Methods and devices to treat diseased or injured musculoskeletal tissue |
US8343227B2 (en) | 2009-05-28 | 2013-01-01 | Biomet Manufacturing Corp. | Knee prosthesis assembly with ligament link |
EP2451373B1 (en) * | 2009-07-06 | 2017-06-07 | Synthes GmbH | Expandable fixation assemblies |
AU2010271431B2 (en) * | 2009-07-09 | 2015-12-24 | Smith & Nephew, Inc. | Tissue graft anchor assembly and instrumentation for use therewith |
US8956395B2 (en) | 2009-07-09 | 2015-02-17 | Smith & Nephew, Inc. | Tissue graft anchor assembly and instrumentation for use therewith |
EP2475334A4 (en) | 2009-09-11 | 2014-10-22 | Articulinx Inc | Disc-shaped orthopedic devices |
ES2908450T3 (en) | 2009-10-13 | 2022-04-29 | Conmed Corp | System to fix tissue to bone |
CN102711632B (en) | 2009-11-10 | 2015-11-25 | 史密夫和内修有限公司 | Tissue repair apparatus |
US20110118838A1 (en) * | 2009-11-16 | 2011-05-19 | George Delli-Santi | Graft pulley and methods of use |
US8449612B2 (en) | 2009-11-16 | 2013-05-28 | Arthrocare Corporation | Graft pulley and methods of use |
US9044313B2 (en) | 2010-10-08 | 2015-06-02 | Kfx Medical Corporation | System and method for securing tissue to bone |
ES2873024T3 (en) | 2011-04-13 | 2021-11-03 | Conmed Corp | Tissue-to-bone fixation system |
ES2948066T3 (en) | 2011-04-16 | 2023-08-30 | Kyon Ag | Prosthetic system for orthopedic repair |
US9237887B2 (en) * | 2011-05-19 | 2016-01-19 | Biomet Sports Medicine, Llc | Tissue engaging member |
US20130035721A1 (en) * | 2011-08-04 | 2013-02-07 | John Eric Brunelle | Surgical anchor |
EP3791797A1 (en) | 2011-10-04 | 2021-03-17 | ConMed Corporation | Dual expansion anchor |
US8968402B2 (en) | 2011-10-18 | 2015-03-03 | Arthrocare Corporation | ACL implants, instruments, and methods |
US9357991B2 (en) | 2011-11-03 | 2016-06-07 | Biomet Sports Medicine, Llc | Method and apparatus for stitching tendons |
US9370350B2 (en) | 2011-11-10 | 2016-06-21 | Biomet Sports Medicine, Llc | Apparatus for coupling soft tissue to a bone |
US9357992B2 (en) | 2011-11-10 | 2016-06-07 | Biomet Sports Medicine, Llc | Method for coupling soft tissue to a bone |
US9381013B2 (en) | 2011-11-10 | 2016-07-05 | Biomet Sports Medicine, Llc | Method for coupling soft tissue to a bone |
US9259217B2 (en) | 2012-01-03 | 2016-02-16 | Biomet Manufacturing, Llc | Suture Button |
US8926662B2 (en) | 2012-02-01 | 2015-01-06 | Smith & Nephew, Inc. | Tissue graft anchoring |
JP2015512701A (en) * | 2012-03-23 | 2015-04-30 | ユニヴァーシティ オブ ピッツバーグ オブ ザ コモンウェルス システム オブ ハイアー エデュケイション | Tissue graft fixation |
US9554836B2 (en) * | 2012-06-29 | 2017-01-31 | The Cleveland Clinic Foundation | Intramedullary bone stent |
US10631994B2 (en) | 2012-10-12 | 2020-04-28 | Smith & Nephew, Inc. | Fusion Implant |
US9757119B2 (en) | 2013-03-08 | 2017-09-12 | Biomet Sports Medicine, Llc | Visual aid for identifying suture limbs arthroscopically |
ES2959496T3 (en) | 2013-03-14 | 2024-02-26 | Conmed Corp | Tissue Capture Bone Anchor |
US9918827B2 (en) | 2013-03-14 | 2018-03-20 | Biomet Sports Medicine, Llc | Scaffold for spring ligament repair |
US9585695B2 (en) | 2013-03-15 | 2017-03-07 | Woven Orthopedic Technologies, Llc | Surgical screw hole liner devices and related methods |
BR112015022461B1 (en) | 2013-03-15 | 2021-11-23 | Conmed Corporation | EXPANDABLE BONE ANCHOR |
CN103315798B (en) * | 2013-06-28 | 2015-02-18 | 四川大学华西医院 | Bone tunnel fixator for anterior cruciate ligament reconstruction |
GB2517153A (en) * | 2013-08-15 | 2015-02-18 | Biomet Uk Healthcare Ltd | Ligament assembly |
EP3060167B1 (en) | 2013-10-25 | 2022-05-04 | Kyon AG | Holding and adjustment mechanism for surgical tether |
US10136886B2 (en) | 2013-12-20 | 2018-11-27 | Biomet Sports Medicine, Llc | Knotless soft tissue devices and techniques |
US20150289866A1 (en) * | 2014-04-10 | 2015-10-15 | Bowen Mark K | Locking Device and Method of Use |
US10245017B2 (en) | 2014-05-30 | 2019-04-02 | Biomet Manufacturing, Llc | Knotless twist suture anchor |
US9615822B2 (en) | 2014-05-30 | 2017-04-11 | Biomet Sports Medicine, Llc | Insertion tools and method for soft anchor |
US9700291B2 (en) | 2014-06-03 | 2017-07-11 | Biomet Sports Medicine, Llc | Capsule retractor |
US8956394B1 (en) | 2014-08-05 | 2015-02-17 | Woven Orthopedic Technologies, Llc | Woven retention devices, systems and methods |
US9907593B2 (en) | 2014-08-05 | 2018-03-06 | Woven Orthopedic Technologies, Llc | Woven retention devices, systems and methods |
US10039543B2 (en) | 2014-08-22 | 2018-08-07 | Biomet Sports Medicine, Llc | Non-sliding soft anchor |
US9943351B2 (en) | 2014-09-16 | 2018-04-17 | Woven Orthopedic Technologies, Llc | Woven retention devices, systems, packaging, and related methods |
USD740427S1 (en) | 2014-10-17 | 2015-10-06 | Woven Orthopedic Technologies, Llc | Orthopedic woven retention device |
US10575883B2 (en) | 2014-12-15 | 2020-03-03 | Smith & Nephew, Inc. | Active fracture compression implants |
US9955980B2 (en) | 2015-02-24 | 2018-05-01 | Biomet Sports Medicine, Llc | Anatomic soft tissue repair |
US9974534B2 (en) | 2015-03-31 | 2018-05-22 | Biomet Sports Medicine, Llc | Suture anchor with soft anchor of electrospun fibers |
US10555758B2 (en) | 2015-08-05 | 2020-02-11 | Woven Orthopedic Technologies, Llc | Tapping devices, systems and methods for use in bone tissue |
CN105078526B (en) * | 2015-09-21 | 2017-06-23 | 中南大学湘雅医院 | A kind of device for repairing ligament or Tendon Defection |
US9924935B2 (en) | 2015-10-23 | 2018-03-27 | Smith & Nephew, Inc. | Suture anchor assembly with slip fit tip |
US10213223B2 (en) * | 2015-12-18 | 2019-02-26 | Olympus Corporation | Arthroscopic surgery method for ankle ligament reconstruction |
WO2018081374A1 (en) | 2016-10-31 | 2018-05-03 | Smith & Nephew, Inc. | Suture passer and grasper instrument and method |
EP3551105A4 (en) | 2016-12-09 | 2020-07-29 | Woven Orthopedic Technologies, LLC | Retention devices, lattices and related systems and methods |
US10940016B2 (en) | 2017-07-05 | 2021-03-09 | Medos International Sarl | Expandable intervertebral fusion cage |
WO2020102438A1 (en) * | 2018-11-13 | 2020-05-22 | Genesis Biologics, Inc. | Systems and methods of preparing a graft |
Family Cites Families (136)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2381050A (en) | 1943-12-04 | 1945-08-07 | Mervyn G Hardinge | Fracture reducing device |
US3036482A (en) | 1960-09-02 | 1962-05-29 | Kenworthy Kenneth | Axial-impact type hand tool |
US3525365A (en) * | 1966-10-17 | 1970-08-25 | Pneumo Dynamics Corp | Expansion plug |
US3566739A (en) | 1969-02-07 | 1971-03-02 | Charles S Lebar | Anchoring device |
US3708883A (en) | 1971-01-04 | 1973-01-09 | S Flander | Dental implant and method for using the same |
US3842824A (en) | 1973-03-19 | 1974-10-22 | A Neufeld | Notched surgical pin and breaking tool therefor |
US3953896A (en) * | 1974-09-06 | 1976-05-04 | Richards Manufacturing Company, Inc. | Prosthetic ligament |
IL46030A0 (en) | 1974-11-11 | 1975-02-10 | Rosenberg L | Orthopaedic screw |
IL48826A (en) | 1976-01-13 | 1978-08-31 | Aginsky Yacov | Intramedullary compression nail for the treatment of bone fractures |
DE2613499A1 (en) | 1976-03-30 | 1977-10-13 | Heinrich B Schaefers | STRUCTURAL ANCHORS AND METHOD FOR ANCHORING IT |
US4492226A (en) | 1979-10-10 | 1985-01-08 | Vsesojuzny Nauchno-Issledovatelsky I Ispytatelny Institut Meditsinskoi Tekhniki | Device for uniting bone fragments |
CH648197A5 (en) | 1980-05-28 | 1985-03-15 | Synthes Ag | IMPLANT AND SCREW FASTENING ON ITS BONE. |
GB2084468B (en) | 1980-09-25 | 1984-06-06 | South African Inventions | Surgical implant |
CH648477A5 (en) | 1981-02-18 | 1985-03-29 | Sulzer Ag | SPREADABLE MARKER LOCK. |
US4400833A (en) * | 1981-06-10 | 1983-08-30 | Kurland Kenneth Z | Means and method of implanting bioprosthetics |
US4408938A (en) | 1981-08-24 | 1983-10-11 | Maguire James V | Expansion sleeve |
US4741330A (en) | 1983-05-19 | 1988-05-03 | Hayhurst John O | Method and apparatus for anchoring and manipulating cartilage |
US4467478A (en) * | 1982-09-20 | 1984-08-28 | Jurgutis John A | Human ligament replacement |
IT8321064V0 (en) | 1983-03-09 | 1983-03-09 | Tac Riveting System Di Oggioni | EXPANSION PERFECTED METALLIC DOWEL, FOR FIXING VARIOUS OBJECTS TO FULL WALLS, PROVIDED WITH A THREADED PORTION INTENDED TO EXTEND FRONTLY FROM THE WALL. |
US4506670A (en) | 1983-03-30 | 1985-03-26 | United States Surgical Corporation | Two-part surgical fastener applying apparatus with frangible member |
DE3406961A1 (en) | 1984-02-25 | 1985-09-05 | Stiefel Laboratorium GmbH, 6050 Offenbach | Skin punch |
US4873976A (en) | 1984-02-28 | 1989-10-17 | Schreiber Saul N | Surgical fasteners and method |
US4605414A (en) * | 1984-06-06 | 1986-08-12 | John Czajka | Reconstruction of a cruciate ligament |
DE3445738A1 (en) * | 1984-12-14 | 1986-06-19 | Draenert Klaus | IMPLANT FOR BONE REINFORCEMENT AND ANCHORING OF BONE SCREWS, IMPLANTS OR IMPLANT PARTS |
CN1006954B (en) | 1985-03-11 | 1990-02-28 | 阿图尔·费希尔 | Fastening elements for osteosynthesis |
DE8520206U1 (en) | 1985-07-12 | 1985-12-19 | Fischer, Artur, Dr.H.C., 7244 Waldachtal | Fixing element for osteosynthesis |
DE3601865A1 (en) | 1985-07-12 | 1987-01-22 | Fischer Artur Dr H C | Fastening element for osteosynthesis |
US4632100A (en) | 1985-08-29 | 1986-12-30 | Marlowe E. Goble | Suture anchor assembly |
US4744793A (en) | 1985-09-06 | 1988-05-17 | Zimmer, Inc. | Prosthetic ligament connection assembly |
US4708132A (en) | 1986-01-24 | 1987-11-24 | Pfizer-Hospital Products Group, Inc. | Fixation device for a ligament or tendon prosthesis |
US4759765A (en) * | 1986-03-17 | 1988-07-26 | Minnesota Mining And Manufacturing Company | Tissue augmentation device |
US4738255A (en) | 1986-04-07 | 1988-04-19 | Biotron Labs, Inc. | Suture anchor system |
US4776330A (en) | 1986-06-23 | 1988-10-11 | Pfizer Hospital Products Group, Inc. | Modular femoral fixation system |
US4712542A (en) * | 1986-06-30 | 1987-12-15 | Medmetric Corporation | System for establishing ligament graft orientation and isometry |
GB8622563D0 (en) | 1986-09-19 | 1986-10-22 | Amis A A | Artificial ligaments |
DE3662967D1 (en) | 1986-12-12 | 1989-06-01 | Aesculap Werke Ag | Anchoring element for fastening an osteosynthesis plate to a bone |
USRE34293F1 (en) | 1987-02-17 | 1998-04-07 | Globe Marlowe E | Ligament attachment method and apparatus |
US4898156A (en) | 1987-05-18 | 1990-02-06 | Mitek Surgical Products, Inc. | Suture anchor |
CA1329089C (en) | 1987-09-02 | 1994-05-03 | Russell Warren | Surgical fastener |
FR2622430B1 (en) | 1987-10-30 | 1997-04-25 | Laboureau Jacques | SURGICAL CLIP FOR THE IMMEDIATE FIXATION OF ARTIFICIAL LIGAMENTS AND ANCILLARY INSTRUMENT FOR ITS IMPLANTATION INTO THE BONE |
US4940467A (en) | 1988-02-03 | 1990-07-10 | Tronzo Raymond G | Variable length fixation device |
US4828562A (en) | 1988-02-04 | 1989-05-09 | Pfizer Hospital Products Group, Inc. | Anterior cruciate ligament prosthesis |
US4998233A (en) * | 1988-02-12 | 1991-03-05 | International Business Machines Corporation | Acquiring focus in optical systems using a focus error signal and a laser drive signal |
DE3811345C1 (en) | 1988-04-02 | 1989-09-07 | Aesculap Ag, 7200 Tuttlingen, De | |
CH674705A5 (en) | 1988-04-27 | 1990-07-13 | Sulzer Ag | |
US4944742A (en) | 1988-06-06 | 1990-07-31 | Johnson & Johnson Orthopaedics, Inc. | Bone pin |
US5037426A (en) | 1988-09-19 | 1991-08-06 | Marlowe Goble E | Procedure for verifying isometric ligament positioning |
US4871289A (en) | 1988-11-25 | 1989-10-03 | Olympic Manufacturing Group, Inc. | Expansion fastener |
US4901711A (en) | 1988-12-27 | 1990-02-20 | Marlowe Goble E | Drill guide |
US4870957A (en) * | 1988-12-27 | 1989-10-03 | Marlowe Goble E | Ligament anchor system |
US4988351A (en) | 1989-01-06 | 1991-01-29 | Concept, Inc. | Washer for use with cancellous screw for attaching soft tissue to bone |
US5059206A (en) | 1989-04-12 | 1991-10-22 | Winters Thomas F | Method and apparatus for repairing a tear in a knee meniscus |
US4927421A (en) | 1989-05-15 | 1990-05-22 | Marlowe Goble E | Process of endosteal fixation of a ligament |
DE3923411A1 (en) | 1989-07-13 | 1991-01-24 | Mecron Med Prod Gmbh | CONNECTING ELEMENT FOR OSTEOSYNTHESIS |
US5108433A (en) | 1989-08-18 | 1992-04-28 | Minnesota Mining And Manufacturing Company | Tensioning means for prosthetic devices |
EP0415874A1 (en) * | 1989-08-28 | 1991-03-06 | GebràDer Sulzer Aktiengesellschaft | Tubular traction aid |
US5151104A (en) * | 1989-10-26 | 1992-09-29 | Pfizer Hospital Products Group, Inc. | Self-locking joint connector |
DE3936703A1 (en) | 1989-11-03 | 1991-05-08 | Lutz Biedermann | BONE SCREW |
US5062843A (en) * | 1990-02-07 | 1991-11-05 | Mahony Iii Thomas H | Interference fixation screw with integral instrumentation |
US5013316A (en) | 1990-03-26 | 1991-05-07 | Marlowe Goble E | Soft tissue anchor system |
US5129902A (en) | 1990-04-20 | 1992-07-14 | Marlowe Goble E | Endosteal ligament retainer and process |
US5002578A (en) | 1990-05-04 | 1991-03-26 | Venus Corporation | Modular hip stem prosthesis apparatus and method |
US5102421A (en) | 1990-06-14 | 1992-04-07 | Wm. E. Anpach, III | Suture anchor and method of forming |
US5224946A (en) | 1990-07-02 | 1993-07-06 | American Cyanamid Company | Bone anchor and method of anchoring a suture to a bone |
US5236445A (en) | 1990-07-02 | 1993-08-17 | American Cyanamid Company | Expandable bone anchor and method of anchoring a suture to a bone |
US5037422A (en) | 1990-07-02 | 1991-08-06 | Acufex Microsurgical, Inc. | Bone anchor and method of anchoring a suture to a bone |
US5417533A (en) | 1990-07-13 | 1995-05-23 | National Medical Specialty, Inc. | Bone screw with improved threads |
US5141373A (en) | 1990-08-15 | 1992-08-25 | Kendall James W | Flush breaking interference fit blind fastener |
US5385567A (en) | 1990-09-07 | 1995-01-31 | Goble; E. Marlowe | Sight barrel arthroscopic instrument |
US5725529A (en) | 1990-09-25 | 1998-03-10 | Innovasive Devices, Inc. | Bone fastener |
AU653752B2 (en) | 1990-09-25 | 1994-10-13 | Ethicon Inc. | Bone fastener |
US5152790A (en) | 1991-03-21 | 1992-10-06 | American Cyanamid Company | Ligament reconstruction graft anchor apparatus |
US5354298A (en) | 1991-03-22 | 1994-10-11 | United States Surgical Corporation | Suture anchor installation system |
US5480403A (en) | 1991-03-22 | 1996-01-02 | United States Surgical Corporation | Suture anchoring device and method |
US5152763A (en) | 1991-04-02 | 1992-10-06 | Johnson Lanny L | Method for grafting bone |
US5258015A (en) | 1991-05-03 | 1993-11-02 | American Cyanamid Company | Locking filament caps |
US5116337A (en) | 1991-06-27 | 1992-05-26 | Johnson Lanny L | Fixation screw and method for ligament reconstruction |
US5207679A (en) | 1991-09-26 | 1993-05-04 | Mitek Surgical Products, Inc. | Suture anchor and installation tool |
GB2260585A (en) | 1991-10-09 | 1993-04-21 | Avdel Systems Ltd | Self-plugging blind rivet |
US5141520A (en) | 1991-10-29 | 1992-08-25 | Marlowe Goble E | Harpoon suture anchor |
US5501695A (en) | 1992-05-27 | 1996-03-26 | The Anspach Effort, Inc. | Fastener for attaching objects to bones |
US5326205A (en) | 1992-05-27 | 1994-07-05 | Anspach Jr William E | Expandable rivet assembly |
US5176682A (en) | 1992-06-01 | 1993-01-05 | Chow James C Y | Surgical implement |
CA2094111C (en) | 1992-06-15 | 1999-02-16 | Daniel R. Lee | Suture anchoring device and method |
US5234434A (en) | 1992-08-17 | 1993-08-10 | Marlowe Goble E | Mutliple guide sleeve drill guide |
US5266075A (en) * | 1992-10-05 | 1993-11-30 | Roy Clark | Tendon threader for endosteal ligament mounting |
ATE197665T1 (en) * | 1992-11-02 | 2000-12-15 | Sulzer Orthopaedie Ag | ANCHORING FOR AN ARTIFICIAL BAND |
US5403320A (en) | 1993-01-07 | 1995-04-04 | Venus Corporation | Bone milling guide apparatus and method |
US5354300A (en) | 1993-01-15 | 1994-10-11 | Depuy Inc. | Drill guide apparatus for installing a transverse pin |
US5397356A (en) | 1993-01-15 | 1995-03-14 | Depuy Inc. | Pin for securing a replacement ligament to a bone |
US5350380A (en) | 1993-01-15 | 1994-09-27 | Depuy Inc. | Method for securing a ligament replacement in a bone |
US5431651A (en) | 1993-02-08 | 1995-07-11 | Goble; E. Marlowe | Cross pin and set screw femoral and tibial fixation method |
US5380334A (en) | 1993-02-17 | 1995-01-10 | Smith & Nephew Dyonics, Inc. | Soft tissue anchors and systems for implantation |
US5352229A (en) | 1993-05-12 | 1994-10-04 | Marlowe Goble E | Arbor press staple and washer and method for its use |
US5505735A (en) * | 1993-06-10 | 1996-04-09 | Mitek Surgical Products, Inc. | Surgical anchor and method for using the same |
US5632748A (en) * | 1993-06-14 | 1997-05-27 | Linvatec Corporation | Endosteal anchoring device for urging a ligament against a bone surface |
US5372604A (en) | 1993-06-18 | 1994-12-13 | Linvatec Corporation | Suture anchor for soft tissue fixation |
US5370662A (en) | 1993-06-23 | 1994-12-06 | Kevin R. Stone | Suture anchor assembly |
EP0636346A1 (en) * | 1993-07-23 | 1995-02-01 | Massimo Santangelo | Device for preventive support of the femur |
USD368777S (en) | 1993-09-15 | 1996-04-09 | Zimmer, Inc. | Orthopaedic washer |
US5324308A (en) | 1993-10-28 | 1994-06-28 | Javin Pierce | Suture anchor |
US5545180A (en) | 1993-12-13 | 1996-08-13 | Ethicon, Inc. | Umbrella-shaped suture anchor device with actuating ring member |
US5417692A (en) | 1994-01-04 | 1995-05-23 | Goble; E. Marlowe | Bone fixation and fusion system |
US5425490A (en) | 1994-01-18 | 1995-06-20 | Goble; E. Marlowe | Instrument with dual holding feature |
US5417712A (en) | 1994-02-17 | 1995-05-23 | Mitek Surgical Products, Inc. | Bone anchor |
US5486197A (en) | 1994-03-24 | 1996-01-23 | Ethicon, Inc. | Two-piece suture anchor with barbs |
US5458601A (en) | 1994-03-28 | 1995-10-17 | Medical University Of South Carolina | Adjustable ligament anchor |
US5411523A (en) | 1994-04-11 | 1995-05-02 | Mitek Surgical Products, Inc. | Suture anchor and driver combination |
US5489210A (en) | 1994-05-13 | 1996-02-06 | Hanosh; Frederick N. | Expanding dental implant and method for its use |
DE4420930C2 (en) | 1994-06-16 | 1997-05-22 | Daimler Benz Ag | Device and method for controlling an automatic shifting device of a gear change transmission of a motor vehicle |
US5472452A (en) | 1994-08-30 | 1995-12-05 | Linvatec Corporation | Rectilinear anchor for soft tissue fixation |
US5730744A (en) | 1994-09-27 | 1998-03-24 | Justin; Daniel F. | Soft tissue screw, delivery device, and method |
US5522845A (en) | 1994-09-27 | 1996-06-04 | Mitek Surgical Products, Inc. | Bone anchor and bone anchor installation |
US5569252A (en) | 1994-09-27 | 1996-10-29 | Justin; Daniel F. | Device for repairing a meniscal tear in a knee and method |
US5464427A (en) | 1994-10-04 | 1995-11-07 | Synthes (U.S.A.) | Expanding suture anchor |
ES2259179T3 (en) * | 1994-12-02 | 2006-09-16 | Omeros Corporation | REPAIR SYSTEM FOR TENDONS AND LIGAMENTS. |
FR2728779B1 (en) * | 1995-01-02 | 1997-07-18 | Caffiniere Jean Yves De | DEVICE FOR ANCHORING BY IMPACTION IN THE SPONGIOUS BONE OF THE FIXATION THREADS USED IN SURGERY |
US5681289A (en) | 1995-08-14 | 1997-10-28 | Medicinelodge Inc. | Chemical dispensing system |
US5665110A (en) | 1995-09-21 | 1997-09-09 | Medicinelodge, Inc. | Suture anchor system and method |
US5645568A (en) | 1995-11-20 | 1997-07-08 | Medicinelodge, Inc. | Expandable body suture |
USD374286S (en) | 1995-12-12 | 1996-10-01 | Zimmer, Inc. | Orthopaedic washer |
USD374482S (en) | 1995-12-12 | 1996-10-08 | Zimmer, Inc. | Orthopaedic washer |
USD374287S (en) | 1995-12-12 | 1996-10-01 | Zimmer, Inc. | Orthopadeic washer |
US5697933A (en) | 1995-12-18 | 1997-12-16 | Medicinelodge, Inc. | Bone-tendon-bone drill guide |
US5702397A (en) * | 1996-02-20 | 1997-12-30 | Medicinelodge, Inc. | Ligament bone anchor and method for its use |
US5688284A (en) | 1996-09-20 | 1997-11-18 | Medicinelodge, Inc. | Variable angle drill guide and ligament fixation method |
US5766250A (en) * | 1996-10-28 | 1998-06-16 | Medicinelodge, Inc. | Ligament fixator for a ligament anchor system |
EP1419747B1 (en) | 1996-11-21 | 2015-04-01 | Ethicon, Inc. | Apparatus for anchoring autologous or artificial tendon grafts in bone. |
US5782918A (en) * | 1996-12-12 | 1998-07-21 | Folsom Metal Products | Implant abutment system |
US5707395A (en) * | 1997-01-16 | 1998-01-13 | Li Medical Technologies, Inc. | Surgical fastener and method and apparatus for ligament repair |
US5918604A (en) * | 1997-02-12 | 1999-07-06 | Arthrex, Inc. | Method of loading tendons into the knee |
US5935129A (en) | 1997-03-07 | 1999-08-10 | Innovasive Devices, Inc. | Methods and apparatus for anchoring objects to bone |
US5888218A (en) * | 1997-03-27 | 1999-03-30 | Folsom Metal Products | Implant micro seal |
US5899921A (en) * | 1997-07-25 | 1999-05-04 | Innovasive Devices, Inc. | Connector device and method for surgically joining and securing flexible tissue repair members |
US5871504A (en) * | 1997-10-21 | 1999-02-16 | Eaton; Katulle Koco | Anchor assembly and method for securing ligaments to bone |
US6887271B2 (en) * | 2001-09-28 | 2005-05-03 | Ethicon, Inc. | Expanding ligament graft fixation system and method |
-
1997
- 1997-11-21 EP EP03078619.8A patent/EP1419747B1/en not_active Expired - Lifetime
- 1997-11-21 DE DE69734606T patent/DE69734606T2/en not_active Expired - Lifetime
- 1997-11-21 WO PCT/US1997/022061 patent/WO1998022048A1/en active IP Right Grant
- 1997-11-21 JP JP52401398A patent/JP4083813B2/en not_active Expired - Fee Related
- 1997-11-21 EP EP15161947.5A patent/EP2913028A1/en not_active Withdrawn
- 1997-11-21 AU AU72972/98A patent/AU738044B2/en not_active Ceased
- 1997-11-21 CA CA002272251A patent/CA2272251C/en not_active Expired - Fee Related
- 1997-11-21 US US08/976,257 patent/US6616694B1/en not_active Expired - Lifetime
- 1997-11-21 EP EP97949722A patent/EP1006948B1/en not_active Expired - Lifetime
- 1997-11-21 ES ES97949722T patent/ES2252800T3/en not_active Expired - Lifetime
-
2003
- 2003-07-18 US US10/623,212 patent/US7637949B2/en not_active Expired - Fee Related
-
2009
- 2009-11-12 US US12/617,392 patent/US8100969B2/en not_active Expired - Fee Related
Also Published As
Publication number | Publication date |
---|---|
EP1419747A2 (en) | 2004-05-19 |
US8100969B2 (en) | 2012-01-24 |
EP1006948A1 (en) | 2000-06-14 |
JP2001505107A (en) | 2001-04-17 |
EP1419747B1 (en) | 2015-04-01 |
US20040097943A1 (en) | 2004-05-20 |
ES2252800T3 (en) | 2006-05-16 |
EP1006948B1 (en) | 2005-11-09 |
EP2913028A1 (en) | 2015-09-02 |
DE69734606D1 (en) | 2005-12-15 |
DE69734606T2 (en) | 2006-08-03 |
JP4083813B2 (en) | 2008-04-30 |
US7637949B2 (en) | 2009-12-29 |
US20100121450A1 (en) | 2010-05-13 |
EP1419747A3 (en) | 2008-08-27 |
WO1998022048A1 (en) | 1998-05-28 |
EP1006948A4 (en) | 2001-02-28 |
AU7297298A (en) | 1998-06-10 |
AU738044B2 (en) | 2001-09-06 |
US6616694B1 (en) | 2003-09-09 |
CA2272251A1 (en) | 1998-05-28 |
Similar Documents
Publication | Publication Date | Title |
---|---|---|
CA2272251C (en) | Apparatus and methods for anchoring autologous or artificial tendon grafts in bone | |
US8496705B2 (en) | Method of anchoring autologous or artificial tendon grafts in bone | |
CA2294787C (en) | Apparatus and methods for anchoring autologous or artificial tendon grafts in bone | |
US8636798B2 (en) | Apparatus and method for reconstructing a ligament | |
US6302886B1 (en) | Method and apparatus for preventing migration of sutures through transosseous tunnels | |
AU2004201994B2 (en) | Tissue fixation device | |
US20030216780A1 (en) | Two piece cross-pin graft fixation | |
US20070225805A1 (en) | Ligament Fixation Using Graft Harness/Bolt Assembly | |
US20070055255A1 (en) | Bioabsorbable Endosteal Fixation Device and Method of Use | |
US20070123988A1 (en) | Tapered anchor for tendon graft | |
EP2001405A2 (en) | Devices, systems, and methods for material fixation | |
CA2353206C (en) | Apparatus and method for reconstructing a ligament | |
KR19990065287A (en) | LCI Screw for Reconstruction of the Cruciate Ligament of the Knee | |
AU5070602A (en) | Methods for anchoring autologous or artificial tendon grafts in bone | |
AU2013200756B2 (en) | Devices, systems, and methods for material fixation |
Legal Events
Date | Code | Title | Description |
---|---|---|---|
EEER | Examination request | ||
MKLA | Lapsed |
Effective date: 20171121 |