Surgery – Instruments – Orthopedic instrumentation
Patent
1995-04-27
1998-03-31
Tucker, Guy V.
Surgery
Instruments
Orthopedic instrumentation
606 96, A61B 1717
Patent
active
057332894
DESCRIPTION:
BRIEF SUMMARY
This application is a 35 USC 371 of PCT/GB93/02207, filed Oct. 26, 1993.
This invention is concerned generally with the harvesting of a ligament graft from a knee joint of a patient for use as a replacement knee ligament.
It is known to manufacture a prosthetic knee ligament from woven implantable material, and to introduce the ligament through bone tunnels formed in the adjoining tibial and femoral knee components of the patient. The ends of the prosthetic ligament which project beyond the entrances of the tunnels are then anchored by bone staples or other anchoring devices to suitable sites on the femur and the tibia near the entrances to the bone tunnels.
One advantageous ligament fixation system comprises the FASTLOK (trade mark) anchoring system which is the subject of International Publication No WO91/06249.
It is also known to use autogenous tissue in the implantation of ligaments, and this is considered by some surgeons to be beneficial, in that the tissue is derived from the host patient, and will therefore be compatible with the patient, and readily allow tissue ingrowth over a period of time to further anchor the replacement ligament in position.
One example of a method of carrying out ACL reconstruction with a bone-patellar ligament bone graft is shown in FIGS. 1 and 2 of the accompanying drawings, and which will now be described.
Referring first to FIG. 1, first of all bone tunnels 10 and 11 are formed in the femoral and tibial components 12, 13 of a knee joint 14, and into which a replacement ligament 15 derived from autogenous tissue is to be implanted. The ends of the ligament 15 are prolonged by sutures or tapes 16, and are then anchored at suitable sites adjacent to the entrances to the bone tunnels by staples or other anchor devices 17 driven into bone.
The ligament 15 is shown schematically in FIG. 1, and an actual example is shown in FIG. 2, which comprises a unitary graft composed of a central portion 18 derived from the tendon of the host patient, and bone plugs 19, 20 respectively derived from the patella (not shown) and the tibial component 17 of the patient.
Existing methods of harvesting the bone-patellar-ligament-bone graft are relatively unsophisticated, and one involves use of a hand-operated helical "tube saw" which has to be manipulated to harvest a portion of tendon from the patient, with patella and tibial bone plugs integrally attached thereto, and a successful harvesting of a suitable graft is dependent entirely upon the particular skill and attention devoted to the task by the surgeon. The reamer is mechanically weak due to the open tube structure and also requires upward guided movement (distal to proximal on the patella) under the manual control of the surgeon.
The invention seeks to provide an improved harvesting technique, and novel harvesting tools for use in the technique, which enable reliable grafts to be harvested more readily than with existing tools and techniques.
According to one aspect of the invention there is provided a method of harvesting autogenous tissue from a patient to form a prosthetic knee ligament, the tissue being harvested from the patella, patellar tendon and tibial component of the knee of the patient, and the method comprising:
clamping a patellar reamer guide to the patella of the patient, so as to overlie the patella and to define a guide passage to guide the movement of a reamer through the outer surface of the patella;
driving the reamer through said guide passage so as to form a plug of patellar bone attached to an elongate portion of tendon;
removing the reamer and unclamping the reamer guide;
clamping a tibial reamer guide to the tibia of the patient and which defines a further guide passage to guide the movement of the reamer, or a further reamer, through the outer periphery of the tibia and substantially in line with the patellar bone plug and the elongate portion of tendon;
feeding the patellar bone plug and elongate portion of tendon through the reamer, or further reamer, and driving the latter through said further passage so as
REFERENCES:
patent: 4565192 (1986-01-01), Shapiro
patent: 4696308 (1987-09-01), Meller et al.
patent: 5192321 (1993-03-01), Strokon
patent: 5197967 (1993-03-01), Wilson
Collins Simon
Seedhom Bahaa Botros
Neoligaments Limited
Reip David O.
Tucker Guy V.
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