Prosthesis (i.e. – artificial body members) – parts thereof – or ai – Implantable prosthesis – Ligament or tendon
Patent
1990-05-29
1993-06-22
Isabella, David
Prosthesis (i.e., artificial body members), parts thereof, or ai
Implantable prosthesis
Ligament or tendon
A61F 100
Patent
active
RE0342939
DESCRIPTION:
BRIEF SUMMARY
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates to surgical implants and more particularly, to surgical procedures and appliances for intraarticular anterior and posterior ligament reconstruction.
2. Prior Art
It is well known by anyone who has participated in athletics that the human knee is injury prone, particularly from lateral forces applied thereto. Where the knee joint is considered by most laymen to be essentially a hinged joint, in reality it provides a complicated mechanical movement that would be nearly impossible to duplicate with present technology. In operation, the human knee joint permits movement of flexion and extension in certain positions and even provides for a slight inward and outward rotation. Considering only movement of flexion and extension, the mechanical actions that take place in such movement include a certain amount of gliding and rotation along with the hinge action such that the same part of one articular surface of the distal fem ur or proximal tibia will not always be applied to the same part of the other articular surface, and the axis of motion is not fixed. In fact, if the knee joint is examined while a condition of extreme flexion, the posterior part of the articular surfaces of the tibia will be found to be in contact with the fem ur posterior around the extremities of the condyles. Whereas, if the movement was simple hinge like movement, the axis around which the revolving movement of the tibia would occur should be in the back part of the condyle. With the same leg brought forward into a position of semi-flexion, the upper surface of the tibia will seem to glide over the condyle of the fem ur, such that the middlepart of the articular facets are in contact, and the axis of rotation is therefore shifted forward to near the center of the condyle. When the leg is brought into the extended position, still further gliding takes place as does a further shifting forward of the axis of rotation. Knee joint flexure and extension is therefore not a simple movement but is accompanied by a certain amount of outward rotation around a vertical axis drawn through the center of the head of the tibia. This rotation is due to the greater length of the internal condyle, and to the fact that the anterior portion of its articular surface is inclined obliquely outward. In consequence, toward the close of the movement of extension, just before complete extension, the tibia will glide obliquely upward and outward over the oblique surface of the inner condyle, and the leg will be necessarily rotated outwardly. In flexation of the joint, the converse of these movements takes place, the tibia gliding backwardly around the end of the fem ur, at the commencement of which movement, the tibia is directed downward and inward along the oblique curve of the inner condyle, thus causing an inward rotation to the leg.
The above sets out a brief summary of knee joint functioning that takes place in knee flexure and extension. It is provided to show that this functioning is far more than a hinge movement and involves inward and outward rotation. It should be apparent therefore that in a repair of one or more ligaments of the knee, particularly in an intraarticular anterior and posterior ligament reconstruction that involves the cruciate ligaments, it is of significant value that the replacement ligaments, either a graft or proshetic ligament, be fitted so as to, as nearly as possible, duplicate the positioning of the natural ligament. Heretofore, procedures and devices for use in preparing damaged ligaments, particularly the cruciate ligaments, have generally involved attaching the ligament device across the knee at the juncture of the distal fem ur and proximal tibia surfaces. Where an attempt has been made to replace a cruciate ligament that involves securing the replacement ligament ends to the points on the opposing bone surfaces where that natural ligament was attached, such procedure has involved extensively opening the patient's knee area and/or forming intersection
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Goble E. Marlowe
Somers W. Karl
Isabella David
Russell M. Reid
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