Surgery – Instruments – Orthopedic instrumentation
Reexamination Certificate
1999-09-14
2001-02-13
Philogene, Pedro (Department: 3732)
Surgery
Instruments
Orthopedic instrumentation
C606S098000, C606S104000
Reexamination Certificate
active
06187011
ABSTRACT:
TECHNICAL FIELD
This invention relates to positioning a tibial tunnel in anterior cruciate ligament (ACL) reconstruction.
BACKGROUND INFORMATION
A damaged ACL is often replaced with a graft from a patellar tendon or a semitendinosus tendon. Generally, the patellar tendon graft has small bone pieces attached to its ends, whereas the semitendinosus tendon graft does not. Tunnels are formed in the tibia and femur for use in implanting the graft in the patient's knee. The graft is then secured in the tunnels by fixation means, such as, for example, interference screws or sutures tied to screw posts.
SUMMARY
This invention features a guide for positioning a tibial tunnel in anterior cruciate ligament (ACL) reconstruction.
In one general aspect of the invention, the guide includes a guide arm and a drill sleeve connected to the guide arm. A distal tip of the guide arm is configured to contact a femoral surface, and a distal tip of the drill sleeve is configured to contact a tibial surface when the distal tip of the guide arm contacts the femoral surface.
Embodiments may include one or more of the following features. For example, the guide may include a handle to which the guide arm and the drill sleeve may be connected, such that the guide arm and the drill sleeve are connected through their connections to the handle. The guide arm may be located at one end of the handle, and the drill sleeve may be located at an opposite end of the handle.
An orientation of the guide arm may be adjusted with respect to the drill sleeve. The guide arm may have markings for indicating the orientation of the guide arm with respect to the drill sleeve.
The drill sleeve may be configured to direct a guidewire into the tibial surface to locate the tibial tunnel. The drill sleeve may have markings for measuring the length of the tibial tunnel. The distal tip of the drill sleeve may include an angled opening surrounded by teeth.
The distal tip of the guide arm may include a hook configured to contact the femoral surface at, for example, the posterior cortex of the femoral notch. The guide arm may provide an offset from a point at which the distal tip contacts the femoral surface (e.g., the posterior cortex of the femoral notch) to a longitudinal axis of the drill sleeve (i.e., the axis of the tibial tunnel).
The distal tip of the guide arm also may include a spike configured to contact a tibial plateau. The size of the spike may vary depending on the desired ease of insertion of the guide arm. For example, the guide arm is easy to insert into the patient's knee when the spike is short.
In other embodiments, the guide arm may include a first distal arm portion having a hook configured to contact the femoral surface and a second distal arm portion having a spike configured to contact the tibial plateau. When the guide arm includes two distal arm portions, the guide may be adjusted to compensate for various femoral offsets and femoral notch heights.
The first distal arm portion may be configured to slide over the second distal arm portion. This permits adjustment of the guide to compensate for various femoral offsets. Alternatively, the first distal arm portion may be attached to the second distal arm portion by a spring. This permits adjustment of the guide to compensate for various femoral notch heights. In other embodiments, the first distal arm portion may be attached to the second distal arm portion by a linkage or at a pivot point. The guide arm is easy to insert into the patient's knee when the two distal arm portions are attached at a pivot point because the pivot point permits the spike to be deployed into the tibial plateau.
In other embodiments, the guide may include a device for indicating isometry. Isometry exists when the distance between the femoral tunnel opening and the tibial tunnel opening remains constant during extension of the knee. The device may be an isometry linkage. The length of the isometry linkage may be adjusted to compensate for various femoral notch heights by using hydraulic means or another extending mechanism. The device also may be an isometry mechanism located outside the patient's knee or an isometry suture.
Another general aspect of the invention features a method for positioning a tibial tunnel using the guide discussed above. In use, the guide is positioned in a patient's knee so that the distal tip of the drill sleeve contacts the tibial surface and the distal tip of the guide arm contacts a femoral surface (e.g., the posterior cortex of the femoral notch). Next, a guidewire is inserted through the drill sleeve and drilled through the tibia. The guide is removed from the patient's knee, leaving the guidewire in place to locate the tibial tunnel. Finally, a cannulated drill bit is placed over the guidewire for drilling the tibial tunnel.
Among other advantages, the invention provides an efficient and accurate way of positioning the tibial tunnel. For example, the guide references a bone surface (e.g., a femoral surface) for positioning the tibial tunnel, rather than a soft tissue surface. Moreover, the guide references a particular region of the femoral surface (e.g., the posterior cortex of the femoral notch) for positioning the tibial tunnel.
Other features and advantages of the invention will be apparent from the following detailed description, including the drawings, and from the claims.
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