Surgery – Miscellaneous – Methods
Reexamination Certificate
2000-07-27
2002-12-31
McDermott, Corrine (Department: 3738)
Surgery
Miscellaneous
Methods
C623S013110
Reexamination Certificate
active
06499486
ABSTRACT:
FIELD OF THE INVENTION
This invention relates to medical devices and procedures in general, and more particularly to medical devices and procedures for reconstructing a ligament.
BACKGROUND OF THE INVENTION
A ligament is a piece of fibrous tissue which connects one bone to another.
Ligaments are frequently damaged (e.g., detached or torn or ruptured, etc.) as the result of injury and/or accident. A damaged ligament can impede proper motion of a joint and cause significant pain.
Various procedures have been developed to repair or replace a damaged ligament. The specific procedures used depend on the particular ligament which is to be restored and on the extent of the damage.
One ligament which is frequently damaged as the result of injury and/or accident is the anterior cruciate ligament (ACL). Looking now at
FIG. 1
, the ACL
5
extends between the top of the tibia
10
and the bottom of the femur
15
. A damaged ACL can cause instability of the knee joint and cause substantial pain and arthritis.
Numerous procedures have been developed to restore the ACL through a graft ligament replacement. In general, and looking now at
FIG. 2
, these ACL replacement procedures involve drilling a bone tunnel
20
through tibia
10
and up into femur
15
. Then a graft ligament
25
, consisting of a harvested or artificial ligament or tendon(s), is passed through the tibial portion
30
of tunnel
20
(sometimes referred to as “the tibial tunnel”), across the interior of the joint, and up into the femoral portion
35
of tunnel
20
(sometimes referred to as “the femoral tunnel”). Then a distal portion of graft ligament
25
is secured in femoral tunnel
35
, and a proximal portion of graft ligament
25
is secured in tibial tunnel
30
.
There are numerous ways in which graft ligament
25
may be positioned in tunnel
20
and secured in position.
One such way is disclosed in U.S. Pat. No. 5,918,604, issued 07/06/99 to Whelan for METHOD OF LOADING TENDONS INTO THE KNEE. According to this patent, the ligament may be towed up tibial tunnel
30
and femoral tunnel
35
and then secured in femoral tunnel
35
with a crosspin.
More particularly, and looking now at
FIG. 3
, the bone tunnel
20
is formed by drilling through tibia
10
and up into femur
15
, whereby to form tibial tunnel
30
and femoral tunnel
35
. Then a transverse bone tunnel
40
is formed in femur
15
so that transverse bone tunnel
40
intersects femoral tunnel
35
. Bone tunnel
20
bifurcates transverse bone tunnel
40
into two tunnel portions, a first transverse bone tunnel portion
45
and a second transverse bone tunnel portion
50
.
After transverse bone tunnel
40
has been formed, a flexible member
55
is used to draw graft ligament
25
up into place.
More particularly, according to the aforementioned U.S. Pat. No. 5,918,604, this is done by threading flexible member
55
through transverse bone tunnel
40
. Then a crochet-hook device (not shown in
FIG. 3
) is passed up tibial tunnel
30
, across the interior of the knee joint, and up femoral tunnel
35
. The crochet-hook device is used to hook flexible member
55
at the intersection of bone tunnel
20
and transverse bone tunnel
40
. Then the crochet-hook device is used to pull flexible member
55
down femoral tunnel
35
, across the interior of the knee joint, down tibial tunnel
30
, and out the front side of tibia
10
. Next, graft ligament
25
is looped over flexible member
55
(FIG.
3
). One or both free ends of flexible member
55
is/are then pulled away from femur
15
, whereby to pull flexible member
55
, and hence the looped graft ligament
25
, up tibial tunnel
30
, across the interior of the knee joint, and then up into femoral tunnel
35
(FIG.
4
).
Once flexible member
55
and graft ligament
25
have assumed the position shown in
FIG. 4
, the graft ligament may be retained in that position by passing a cannulated crosspin
60
over flexible member
55
into transverse bone tunnel
40
so that the crosspin extends under graft ligament
25
and supports the looped graft ligament within femoral tunnel
35
. Then flexible member
55
is withdrawn from the surgical site.
Unfortunately, the method taught in U.S. Pat. No. 5,918,604 suffers from a number of drawbacks.
For one thing, use of this method can result in erosion of the patient's bone. More particularly, and looking now at
FIG. 5
, flexible member
55
must first be drawn down femoral tunnel
35
, across the interior of the knee joint, and then down tibial tunnel
30
in order to pick up graft ligament
25
; and then later, flexible member
55
must be drawn back up tibial tunnel
30
, across the interior of the knee joint, and then back up femoral tunnel
35
in order to carry graft ligament
25
into position. These actions cause flexible member
55
to engage the bone which is located at the intersection of femoral tunnel
35
and transverse bone tunnel
40
, i.e., to engage the bone edges
65
(FIG.
5
). This engagement between flexible member
55
and bone edges
65
can cause bone edges
65
to be eroded. This erosion can be particularly significant where substantial forces are required to draw flexible member
55
out of bone tunnel
20
(e.g., where a metallic flexible member
55
is used); or when substantial forces are required to draw flexible member
55
and graft ligament
25
up bone tunnel
25
(e.g., where graft ligament
25
makes a tight engagement with the walls of bone tunnel
20
).
For another thing, the method taught in U.S. Pat. No. 5,918,604 can be tedious to practice. More particularly, when flexible member
55
and ligament graft
25
are in the position shown in
FIG. 5
, flexible member
55
will form the angle &thgr;; however, when flexible member
55
and ligament graft
25
are in the position shown in
FIG. 6
, flexible member
55
will form a different angle &thgr;. In this respect it will be appreciated that it will be considerably more difficult to pull graft ligament
25
upwards as the angle &thgr; increases from the position shown in
FIG. 5
to the position shown in FIG.
6
.
OBJECTS OF THE INVENTION
As a result, an object of the present invention is to provide an improved method for reconstructing a ligament.
And another object of the present invention is to provide an improved method for reconstructing a ligament which substantially avoids the problems associated with the prior art.
SUMMARY OF THE INVENTION
These and other objects of the present invention are addressed by a novel method for reconstructing a ligament.
In one preferred form of the invention, the invention comprises a method for securing a graft ligament in a bone tunnel, the method comprising the steps of: (1) forming a first bone tunnel in a bone, and forming a second bone tunnel in the same bone, the second bone tunnel being transverse to, and intersecting, the first bone tunnel; (2) positioning a flexible member in the second transverse bone tunnel so that the flexible member extends across the first bone tunnel, and positioning the graft ligament in the first bone tunnel, independently of the flexible member, so that the graft ligament is looped over the flexible member; and (3) positioning a crosspin over the flexible member and in the second transverse bone tunnel so that the graft ligament is looped over, and may be supported by, the crosspin.
REFERENCES:
patent: 5139520 (1992-08-01), Rosenburg
patent: 5393302 (1995-02-01), Clark et al.
patent: 5601562 (1997-02-01), Wolf et al.
patent: 5918604 (1999-07-01), Whelan
patent: WO 99/15095 (1999-04-01), None
Chervitz Alan
Fallin T. Wade
Justin Daniel F.
Barrett Thomas
Ethicon Inc.
McDermott Corrine
Pandiscio & Pandiscio P.C.
LandOfFree
Method for reconstructing a ligament does not yet have a rating. At this time, there are no reviews or comments for this patent.
If you have personal experience with Method for reconstructing a ligament, we encourage you to share that experience with our LandOfFree.com community. Your opinion is very important and Method for reconstructing a ligament will most certainly appreciate the feedback.
Profile ID: LFUS-PAI-O-2991310