Method of replacing an anterior cruciate ligament in the knee
Inventors
May, Thomas C. • Whittaker, Gregory
Assignees
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Publication Number
US-7458975-B2
Publication Date
2008-12-02
Expiration Date
Abstract
A method of reconstructing a ruptured anterior cruciate ligament in a human knee. Femoral and tibial tunnels are drilled into the femur and tibia. A transverse tunnel is drilled into the femur to intersect the femoral tunnel. A filamentary loop is threaded through the femoral tunnel and tibial tunnel and partially through the transverse tunnel. A replacement graft is formed into a loop and moved into the tibial tunnels using a surgical needle and suture. A flexible filamentary member is simultaneously moved along with the loop into the femoral and transverse tunnels. The filamentary member is used as a guide wire in the transverse tunnel to insert a cannulated cross-pin to secure a top of the looped graft in the femoral tunnel.
Core Innovation
The invention concerns a method of repairing a knee by performing an anterior cruciate ligament replacement using drilled tibial and femoral longitudinal tunnels and a substantially transverse tunnel through the femoral tunnel that intersects the femoral tunnel and is in communication therewith. The method provides an anterior cruciate ligament replacement graft having opposed ends, and includes folding the graft to form a graft loop having an opening. An endless-loop filamentary member interacts with the graft loop opening during graft passage and positioning.
The method includes threading the endless-loop filamentary member through the knee so that a first loop segment extends out from one end of the transverse tunnel and a second loop segment extends out through a bottom opening of the tibial tunnel. A surgical needle and attached surgical suture are provided, and the suture passes through the graft loop opening. The graft loop is pulled up and into the tibial tunnel by pulling on the needle and suture, while the filamentary member is tensioned to form a substantially straight configuration substantially in alignment with the transverse tunnel.
The upper end of the graft loop is secured in the femoral tunnel by providing a cannulated bone cross-pin and passing the cannulated cross-pin over the filamentary member and through the graft loop opening, and mounting the cross-pin in the transverse tunnel. The endless-loop filamentary member functions as a transverse guide wire for cross-pin placement while the graft loop opening is aligned with the transverse tunnel.
Claims Coverage
The document provides one independent claim defining an arthroscopic ACL replacement repair workflow with a transverse femoral tunnel and an endless-loop filamentary member used for aligning and mounting a cannulated bone cross-pin through a graft loop opening. Dependent claims refine the method by adding tibial graft-loop securement and specifying structural/material options for the cannulated cross-pin.
Endless-loop filamentary member for transverse alignment
Providing a filamentary member comprising an endless loop; threading the filamentary member through the knee such that a first loop segment extends out from one end of the transverse tunnel and a second loop segment extends out through a bottom opening of the tibial tunnel; manipulating the filamentary member such that it is tensioned to form a substantially straight configuration substantially in alignment with the transverse tunnel.
Graft loop opening engaged by suture and filamentary member
Folding the graft to form a graft loop having an opening; engaging the graft with the suture such that the suture passes through the graft loop opening; engaging the graft with the filamentary member such that it passes through the graft loop opening; pulling the graft loop up and into the tibial tunnel by pulling on the needle and suture.
Cannulated bone cross-pin mounting through transverse tunnel
Providing a cannulated bone cross-pin having an outer surface; securing the upper end of the graft loop in the femoral tunnel by passing the cannulated cross-pin over the filamentary member and through the graft loop opening, and mounting the cross-pin in the transverse tunnel.
Tibial securement of graft loop lower end
Providing a tibial securement member and securing the lower end of the graft loop in the tibial tunnel by inserting the securement member into the tibial tunnel.
Threaded outer surface on cannulated cross-pin
The cannulated cross-pin includes at least one section of threads on its outer surface.
Absorbable polymer cannulated cross-pin
The cannulated cross-pin is made of an absorbable polymer.
Biocompatible metal cannulated cross-pin
The cannulated cross-pin is made of a biocompatible metal.
Biocompatible material selection set for cannulated cross-pin
The cannulated cross-pin is made from a biocompatible material selected from allograft bone, autograft bone, ceramics, or composites.
Across the independent method claim, the core inventive coverage lies in using an endless-loop filamentary member threaded through a knee to align a folded ACL replacement graft loop opening with a transverse femoral tunnel, and then securing the graft loop in the femoral tunnel by passing a cannulated bone cross-pin over the filamentary member through the graft loop opening and mounting the cross-pin in the transverse tunnel. Dependent claims add tibial securement and specify threaded and material characteristics for the cannulated cross-pin.
Stated Advantages
Improved efficiency.
Reduced or minimized bone damage in the transverse tunnel compared with guide-wire pulling approaches.
Documented Applications
Arthroscopic knee surgery for anterior cruciate ligament (ACL) reconstruction using drilled tibial and femoral tunnels, a transverse femoral tunnel, an endless-loop filamentary member, and a cannulated bone cross-pin to secure an ACL replacement graft loop.
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