Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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APPARATUS AND METHOD FOR
RECONSTRUCTING A LIGAMENT
Field Of The Invention
This invention relates to surgical apparatus and
procedures in general, and more particularly to surgical
apparatus and procedures for reconstructing a ligament.
Background Of The Invention
A ligament is a piece of fibrous tissue which
connects one bone to another.
20
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Ligaments are frequently damaged (e.g., detached or
torn or ruptured, etc.) as the result of injury and/or
accident. A damaged ligament can cause instability,
impede proper motion of a joint and cause pain.
Various procedures have been developed to repair or
replace a damaged ligament. The specific procedure used
depends on the particular ligament which is to be restored
and on the extent of damage.
One ligament which is frequently damaged as the
result of injury and/or accident is the anterior cruciate
ligament (i.e., the ACL). Looking first at Figs. 1 and 2,
it will be seen that the ACL 5 extends
25
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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
a damaged ACL through a graft ligament replacement. In
general, and looking next at Fig. 3, these ACL
replacement procedures involve drilling a bone tunnel
20 up through tibia 10 and drilling a bone tunnel 25 up
into femur 15. In some cases the femoral' tunnel 25 may
be in the form of a blind hole and terminate in a
distal end surface 30; in other cases the femoral
tunnel 25, or an extension of the femoral tunnel 25,
may pass completely through femur 15. Once tibial
tunnel 20 and femoral tunnel 25 have been formed, a
graft ligament 35, consisting of a harvested or
artificial ligament or tendon(s), is passed up through
tibial tunnel 20, across the interior of the knee
joint, and up into femoral tunnel 25. Then a distal
portion of graft ligament 35 is secured in femoral
70 tunnel 25 and a proximal portion of graft ligament 35
is secured in tibial tunnel 20.
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There are currently a number of different ways to
secure a graft ligament in a bone tunnel. One way is
to use an interference screw 40 (Fig. 4) to wedge the
graft ligament against'an opposing side wall of the
bone tunnel. Another way is to suspend the graft
ligament in the bone tunnel with a button 45 and a
suture 50 (Fig. 5) or with a crosspin 55 (Fig. 6).
Still another way is to pass the graft ligament
completely through the bone tunnel and affix the graft
LO ligament to the outside of the bone with a screw 60 and
washer 65 (Fig. 7) or with a staple (not shown).
The "Gold Standard" of ACL repair is generally
considered to be the so-called "Bone-Tendon-Bone"
fixation. In this procedure, a graft of the patella
L5 tendon is used to replace the natural ACL. Attached to
the opposing ends of the harvested tendon are bone
grafts, one taken from the patient's knee cap (i.e.,
the patella) and one taken from the patient's tibia
(i.e., at the location where the patella tendon
?0 normally attaches to the tibia). The graft ligament is
then deployed in the bone tunnels, with one bone graft
being secured in the femoral tunnel with an
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interference screw and the other bone graft being
secured in the tibial tunnel with another interference
screw. Over the years, this procedure has generally
yielded a consistent, strong and reliable ligament
repair. However, this procedure is also generally
considered to be highly invasive and, in many cases,
quite painful, and typically leaves unsightly scarring
on the knee and a substantial void in the knee cap.
As a result, alternative procedures have recently
been developed that incorporate the use of soft tissue
grafts such as the hamstring tendon. However, soft
tissue grafts such as the hamstring can be difficult to
stabilize within a bone tunnel. More particularly, the
use of an interference screw to aggressively wedge the
hamstring against an opposing side wall of the bone
tunnel can introduce issues such as graft slippage,
tendon winding, tissue necrosis and tendon cutting.
Furthermore, the use of a suture sling (e.g., such as
that shown in Fig. 5) and/or a crosspin (e.g., such as
?0 that shown in Fig. 6) to suspend the hamstring within
the bone tunnel can introduce a different set of
issues, e.g., it has been found that the suture sling
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and/or crosspin tend to permit the graft ligament to
move laterally within the bone tunnel, with a
so-called "windshield wiper" effect, thereby impeding
ingrowth between the graft ligament and the host bone
and/or causing abrasion and/or other damage to the
graft tissue. In addition, the use of a crosspin
(e.g., such as that shown in Fig. 6) to secure a
hamstring within the bone tunnel can introduce still
other issues, e.g., difficulties in looping the
hamstring over the crosspin, or tearing of the
hamstring along its length during tensioning if and
where the crosspin passes through the body of the
hamstring, etc.
Summary Of The Invention
As a result, one object of the present invention
is to provide improved apparatus for reconstructing a
ligament, wherein the apparatus is adapted to permit
the graft ligament to be fashioned out of various soft
tissue grafts, e.g., allografts, autografts,
xenografts, bioengineered tissue grafts or synthetic
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grafts, and further wherein the graft is intended to be
secured in place using a transverse fixation pin.
Another object of the present invention is to
provide an improved method for reconstructing a
ligament, wherein the method is adapted to permit the
graft ligament to be fashioned out of various soft
tissue grafts, e.g., allografts, autografts,
xenografts, bioengineered tissue grafts or synthetic
grafts, and further wherein the graft is intended to be
secured in place using a transverse fixation pin.
These and other objects are addressed by the
present invention which comprises, in one preferred
form of the invention, the provision and use of a graft
ligament support block which comprises a body, and a
L5 graft hole and a transverse fixation pin hole extending
through the body, with both the graft hole and the
transverse fixation pin hole preferably extending
substantially perpendicular to the longitudinal axis of
the body. In one preferred form of the invention, the
!O invention also comprises an installation tool for
inserting the graft ligament support block into the
bone tunnel and, while supporting the graft ligament
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support block in the bone tunnel, forming a transverse
tunnel in the host bone, with the transverse tunnel in
the host bone being aligned with the transverse
fixation pin hole in the graft ligament support block.
In one preferred method of use, a graft ligament
is looped through the graft hole in the graft ligament
support block, and the graft ligament support block is
mounted to the installation tool. The two free ends of
the graft ligament are then preferably secured to a
proximal portion of the installation tool under
tension, whereby to tie down the two free ends of the
graft ligament. In addition to controlling the two
free ends of the graft ligament, this arrangement will
also help hold the graft ligament support block to the
L5 installation tool. Then the installation tool is used
to advance the graft ligament support block through the
tibial tunnel, across the interior of the knee joint,
and up into the femoral tunnel, with the two free ends
of the looped graft ligament extending back out through
0 the tibial tunnel. Next, a transverse tunnel is formed
in the host bone, with the transverse tunnel being
aligned with the transverse fixation pin hole in the
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graft ligament support block. Then the graft ligament
support block is secured in place by pinning the graft
ligament support block within the femoral tunnel, i.e.,
by advancing a transverse fixation pin along the
transverse tunnel in the host bone and into the
transverse fixation pin hole in the graft ligament
support block. Then the two free ends of the looped
graft ligament are released from the installation tool,
the installation tool is detached from the graft
ligament support block, and the installation tool is
withdrawn from the surgical site. Finally, the two
free ends of the looped graft ligament are secured to
the tibia, thus completing the ACL repair. If desired,
the tibial attachment can be effected using a second
graft ligament support block.
In accordance with a further feature of the
invention, there is provided apparatus for use in
reconstructing a ligament, the apparatus comprising:
a graft ligament support block for supporting a
graft ligament in a bone tunnel, the graft ligament
support block comprising:
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a body having a distal end, a proximal end,
and a longitudinal axis extending between the distal
end and the proximal end, the proximal end being
tapered so as to facilitate withdrawal of the graft
ligament support block through a bone tunnel;
a graft hole extending through the body
transverse to the longitudinal axis and configured to
receive a graft ligament therein; and
a transverse fixation pin hole extending
10. through the body transverse to the longitudinal axis
and configured to receive a transverse fixation pin
therein.
In accordance with a still further feature of the
invention, there is provided a method for securing a
graft ligament in a bone tunnel, comprising the steps
of:
(1) looping a graft ligament through a graft hole
in a graft ligament support block, advancing the graft
ligament support block into the bone tunnel,
withdrawing the graft ligament support block back down
the bone tunnel, advancing a graft ligament support
block into the bone tunnel, with a graft ligament being
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looped through a graft hole in the graft ligament
support block, and forming a transverse tunnel in the
host bone, with a transverse fixation pin hole in the
graft ligament support block being aligned with the
transverse tunnel in the host bone; and
(2) pinning the graft ligament support block
within the bone tunnel by advancing a transverse
fixation pin along the transverse tunnel in the host
bone and into the transverse fixation pin hole in the
graft ligament support block.
In accordance with a further feature of the
invention, there is provided a method for revising a
graft ligament in a bone tunnel, the method comprising
the steps of:
unpinning a graft ligament support block within a
bone tunnel by withdrawing a transverse fixation pin
from a transverse fixation pin hole in the graft
ligament support block and from a transverse tunnel a
host bone;
=
withdrawing the graft ligament support block back
down the bone tunnel;
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advancing a graft ligament support block into the
bone tunnel so that a transverse fixation pin hole in
the support block is aligned with the transverse
tunnel; and
pinning the graft ligament support block within
the bone tunnel by advancing the transverse fixation
pin along the transverse tunnel in the host bone and
into the transverse fixation pin hole in the graft
ligament support block.
LO In accordance with a further feature of the
invention, there is provided apparatus for use in
reconstructing a ligament, the apparatus comprising:
a graft ligament support block for supporting a
graft ligament in a bone tunnel, the graft ligament
_5 support block comprising:
a body having a distal end, a proximal end,
and a longitudinal axis extending between the distal
end and the proximal end;
a graft hole extending through the body
!O transverse to the longitudinal axis and configured to
receive a graft ligament therein, the graft hole having
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a given length along the longitudinal axis, the given
length being substantially equal to a given
cross-sectional dimension of the graft ligament; and
a transverse fixation pin hole extending
through the body transverse to the longitudinal axis
and configured to receive a transverse fixation pin
therein.
In accordance with a still further feature of the
invention, there is provided a method for securing a
graft ligament in a bone tunnel, comprising the steps
of:
selecting a graft ligament support block with a
graft hole sized substantially equal to a given
cross-sectional dimension of a graft ligament;
looping the graft ligament through the graft hole
in a graft ligament support block;
advancing the graft ligament support block into
the bone tunnel;
forming a transverse tunnel in the host bone, with
a transverse tunnel being aligned with a transverse
fixation pin hole in the graft ligament support block;
and
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pinning the graft ligament support block within
the bone tunnel by advancing a transverse fixation pin
along the transverse tunnel in the host bone and into
the transverse fixation pin hole in the graft ligament
support block.
In accordance with another feature of the
invention, there is provided a method for securing a
graft ligament in a bone tunnel, the method comprising
the steps of:
forming a transverse tunnel in the host bone;
selecting a graft ligament support block with a
graft hole sized substantially equal to a given
cross-sectional dimension of a graft ligament;
looping the graft ligament through the graft hole
L5 in the graft ligament support block;
advancing the graft ligament support block into
the bone tunnel so that a transverse fixation pin hole
in the graft ligament support block is aligned with the
transverse tunnel; and
!O pinning the graft ligament support block within
the bone tunnel by advancing a transverse fixation pin
along the transverse tunnel in the host bone and into
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the transverse fixation pin hole in the graft ligament
support block.
In accordance with a further feature of the
invention, there is provided apparatus for use in
reconstructing a ligament, the apparatus comprising:
a graft ligament support block for supporting a
graft ligament in a bone tunnel, the graft ligament
support block comprising:
a body having a distal end, a proximal end,
and a longitudinal axis extending between the distal
end and the proximal end;
a graft hole extending through the body
transverse to the longitudinal axis and configured to
receive a graft ligament therein; and
a transverse fixation pin hole extending
through the body transverse to the longitudinal axis
and configured to receive a transverse fixation pin
therein; and
a transverse fixation pin having a proximal end
70 and a distal end, and the proximal end forming an
internal tapped hole therein so as to aid removal of
the transverse fixation pin from the bone tunnel.
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In accordance with a still further feature of the
invention, there is provided a method for revising a
graft ligament in a bone tunnel, comprising the steps
of:
engaging an internal tapped hole in a transverse
fixation pin with a removal tool;
withdrawing the transverse fixation pin from the
bone tunnel with removal tool engaged with the internal
tapped hole, and withdrawing a graft ligament support
block back down the bone tunnel;
positioning a graft ligament support block into
=
the bone tunnel;
pinning the graft ligament support block within
the bone tunnel by advancing a transverse fixation pin
along a transverse tunnel in the host bone and into the
transverse fixation pin hole in the graft ligament
support block.
In accordance with a further feature of the
invention, there is provided a system for use in
reconstructing a ligament, the system comprising:
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a graft ligament support block for supporting a
graft ligament in a bone tunnel, the graft ligament
support block comprising:
a body having a distal end, a proximal end,
and a longitudinal axis extending between the distal
end and the proximal end;
a graft hole extending through the body
transverse to the longitudinal axis and configured to
receive a graft ligament therein;
a stepped fixation pin having a distal end, a
proximal end, a longitudinal axis extending between the
distal end and the proximal end, a first portion at the
distal end, a second portion at the proximal end, the
first portion having a smaller diameter than second
portion, and an annular shoulder configured between the
first portion and the second portion, wherein the first
portion, the second portion and the annular shoulder
form a given profile in a cross-section of a given
plane perpendicular to the longitudinal axis; and
a stepped transverse tunnel drill having a distal
end, a proximal end, and a longitudinal axis extending
between the distal end and the proximal end, the
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stepped transverse drill corresponding to the given
profile of the stepped fixation pin so as to provide a
stepped transverse tunnel through a portion of the bone
tunnel configured to align with a pathway of the
transverse fixation pin hole, wherein the transverse
fixation pin hole extends through the body transverse
to the longitudinal axis and is configured to receive a
transverse fixation pin therein.
In accordance with a further feature of the
LO invention, there is provided a method for securing a
graft ligament in a bone tunnel, comprising the steps
of:
looping a graft ligament through a graft hole in a
graft ligament support block;
L5 advancing the graft ligament support block into
the bone tunnel;
forming a stepped transverse tunnel in the host
bone with a stepped transverse tunnel drill, with the
stepped transverse tunnel being aligned with a
20 transverse fixation pin hole in the graft ligament
support block; and
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pinning the graft ligament support block within
the bone tunnel by advancing a stepped transverse
fixation pin along the transverse tunnel in the host
bone and into the transverse fixation pin hole in the
graft ligament support block.
=
In accordance with a still further feature of the
invention, there is provided a method for securing a
graft ligament in a bone tunnel, the method comprising
the steps of:
forming a stepped transverse tunnel in the host
bone with a stepped transverse tunnel drill;
looping a graft ligament through a graft hole in a
graft ligament support block;
advancing the graft ligament support block into
the bone tunnel so that a transverse fixation pin hole
in the graft ligament support block is aligned with the
stepped transverse tunnel; and
pinning the graft ligament support block within
the bone tunnel by advancing a stepped transverse
fixation pin along the stepped transverse tunnel in the
host bone and into the transverse fixation pin hole in
the graft ligament support block.
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In accordance with a further feature of the
invention, there is provided a system for use in
reconstructing a ligament, the system comprising:
a graft ligament support block for supporting a
graft ligament in a bone tunnel, the graft ligament
support block comprising:
a body having a distal end, a proximal end, a
longitudinal axis extending between the distal end and
the proximal end, and at least one element for
engagement by an installation tool;
a graft hole extending through the body
transverse to the longitudinal axis and configured to
receive a graft ligament therein; and
a transverse fixation pin hole extending
through the body transverse to the longitudinal axis
and configured to receive a transverse fixation pin
therein;
an installation tool comprising:
a holder, the holder comprising:
a shaft having a distal end, a proximal
end, and a longitudinal axis extending between the
distal end and the proximal end, the proximal end of
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the shaft configured to engage the at least one element
of the body;
a handle mounted to the proximal end of
the shaft;
a drill guide adapted to be releasably
secured to the holder, the drill guide comprising:
an outrigger comprising a distal end and
a proximal end, the proximal end of the outrigger
configured to be releasably secured to the holder; and
a drill sleeve moveably attached to the
distal end of the outrigger, the drill sleeve
comprising a drilling lumen extending therethrough, and
the drill sleeve having depth markers thereon, wherein
the distal end of the outrigger and the depth markers
on the drill sleeve are configured so as to indicate a
proper transverse tunnel depth; and
a transverse tunnel drill having a distal end and
a proximal end, the distal end of the transverse tunnel
drill configured for placement through the drill sleeve
so as to drill a transverse bone tunnel through the
bone tunnel, the transverse tunnel drill having markers
disposed thereon between the proximal end and the
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distal end thereof, wherein the depth markers on the
transverse tunnel drill and the drill sleeve are
configured so as to indicate a given depth of the
distal end of the transverse tunnel drill.
In accordance with a further feature of the
invention, there is provided a method for securing a
graft ligament in a bone tunnel, comprising the steps
of:
looping a graft ligament through a graft hole in a
graft ligament support block;
advancing the graft ligament support block into
the bone tunnel;
positioning a drill guide in attachment to the
graft support block, the drill guide comprising an
outrigger and a drill sleeve movably attached to the
outrigger, and the drill sleeve having depth markers
thereon;
determining a proper transverse tunnel depth with
the drill sleeve and the outrigger by moving the drill
sleeve within the outrigger toward the bone tunnel and
reading the depth markers on the drill sleeve;
=
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forming a transverse tunnel in the host bone to a
proper transverse tunnel depth by drilling a transverse
tunnel drill to a given depth according to markers
disposed on thereon, with the transverse tunnel being
aligned with a transverse fixation pin hole in the
graft ligament support block; and
pinning the graft ligament support block within
the bone tunnel by advancing a transverse fixation pin
along the transverse tunnel in the host bone and into
the transverse fixation pin hole in the graft ligament
support block.
In accordance with a still further feature of the
invention, there is provided a method for securing a
graft ligament in a bone tunnel, the method comprising
the steps of:
positioning a drill guide in attachment to a
=
reamer inserted into the bone tunnel, the drill guide
comprising an outrigger and a drill sleeve movably
attached to the outrigger, and the drill sleeve having
70 depth markers thereon;
determining a proper transverse tunnel depth with
the drill sleeve and the outrigger by moving the drill
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sleeve within the outrigger toward the bone tunnel and
reading the depth markers on the drill sleeve;
forming a transverse tunnel in the host bone to a
proper transverse tunnel depth by drilling a transverse
tunnel drill to a given depth according to markers
disposed thereon;
removing the reamer from the bone tunnel;
looping a graft ligament through a graft hole in a
graft ligament support block;
advancing the graft ligament support block into
the bone tunnel so that a transverse fixation pin hole
in the graft ligament support block is aligned with the
transverse tunnel; and
pinning the graft ligament support block within
the bone tunnel by advancing a transverse fixation pin
along the transverse tunnel in the host bone and into
the transverse fixation pin hole in the graft ligament
support block.
In accordance with a further feature of the
invention, there is provided a system for use in
reconstructing a ligament, the system comprising:
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a graft ligament support block for supporting a
graft ligament in a bone tunnel, the graft ligament
support block comprising:
a body having a distal end, a proximal end, a
longitudinal axis extending between the distal end and
the proximal end, and at least one element for
engagement by an installation tool;
a graft hole extending through the body
transverse to the longitudinal axis and configured to
receive a graft ligament therein; and
a transverse fixation pin hole extending
through the body transverse to the longitudinal axis
and configured to receive a transverse fixation pin
therein;
an installation tool comprising:
a holder, the holder comprising:
a shaft having a distal end, a proximal
end, and longitudinal axis extending between the distal
end and the proximal end, the proximal end of the shaft
configured to engage the at least one element of the
body;
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a handle mounted to the proximal end of
the shaft;
a drill guide adapted to be releasably
secured to the holder, the drill guide comprising:
an outrigger comprising a distal end and
a proximal end, the proximal end of the outrigger
configured to be releasably secured to the holder; and
a drill sleeve moveably attached to the
distal end of the outrigger, and the drill sleeve
LO comprising a drilling lumen extending therethrough; and
a transverse tunnel drill having a distal end and
a proximal end, the distal end of the transverse tunnel
drill configured for placement through the drill sleeve
so as to drill a transverse bone tunnel through the
L5 bone tunnel, the transverse tunnel drill having a stop
element configured to engage the drill sleeve so as to
limit drilling to a predetermined depth.
In accordance with a further feature of the
invention, there is provided a system for use in
70 reconstructing a ligament, the system comprising:
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a graft ligament support block for supporting a
graft ligament in a bone tunnel, the graft ligament
support block comprising:
a body having a distal end, a proximal end,
and a longitudinal axis extending between the distal
end and the proximal end; and
a graft hole extending through the body
transverse to the longitudinal axis and configured to
receive a graft ligament therein;
. a stepped transverse fixation pin having a distal
end, a proximal end, a longitudinal axis extending
between the distal end and the proximal end, a first
portion at the distal end, a second portion at the
proximal end, the first portion having a smaller
diameter than second portion, and an annular shoulder
configured between the first portion and the second
portion, wherein the first portion, the second portion
and the annular shoulder form a given profile in a
cross-section of a given plane perpendicular to the
?0 longitudinal axis;
a stepped transverse tunnel drill having a distal
end, a proximal end and a longitudinal axis extending
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between the distal end and the proximal end, the
stepped transverse drill corresponding to the given
profile of the stepped transverse fixation pin so as to
provide a stepped transverse tunnel through the bone
tunnel configured to receive the given profile of the
stepped transverse fixation pin; and
a depth gauge having a distal end and a proximal
end, the distal end of the depth gauge configured for
placement through a drill sleeve to engage a portion of
the stepped transverse tunnel corresponding to the
annular shoulder of the stepped fixation pin, and the
depth gauge having markings thereon between the distal
end and the proximal end so as to indicate the
transverse fixation pin hole depth between the portion
corresponding to the annular shoulder of the stepped
fixation pin and a bone surface.
In accordance with a still further feature of the
invention, there is provided a method for securing a
graft ligament in a bone tunnel, comprising the steps
of:
looping a graft ligament through a graft hole in a
graft ligament support block;
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advancing the graft ligament support block into
the bone tunnel;
determining a proper transverse tunnel depth by
reading a position of a first set of depth markers on a
drill sleeve relative to an outrigger;
forming a transverse tunnel in the host bone using
a transverse tunnel drill having a second set of depth
markers thereon so as to drill the transverse tunnel to
the proper transverse tunnel depth, with a transverse
tunnel being aligned with a transverse fixation pin
hole in the graft ligament support block; and
pinning the graft ligament support block within
the bone tunnel by selecting a transverse fixation pin
based on the proper transverse tunnel depth determined
by the first set of depth markers on the drill sleeve
and advancing the selected transverse fixation pin
along the transverse tunnel in the host bone and into
the transverse fixation pin hole in the graft ligament
support block.
In accordance with a further feature of the
invention, there is provided a method for securing a'
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graft ligament in a bone tunnel, comprising the steps
of:
looping a graft ligament through a graft hole in a
graft ligament support block;
advancing the graft ligament support block into
the bone tunnel;
determining a proper transverse tunnel depth by
reading a position of a first set of depth markers on a
drill sleeve relative to an outrigger;
forming a transverse tunnel in the host bone using
a transverse tunnel drill having a second set of depth
markers thereon so as to drill the transverse tunnel to
the proper transverse tunnel depth, with the transverse
tunnel being aligned with a transverse fixation pin
hole in the graft ligament support block; and
pinning the graft ligament support block within
the bone tunnel by selecting a transverse fixation pin
based on the proper transverse tunnel depth determined
by the first set of depth markers on the drill sleeve
and advancing the selected transverse fixation pin
along the transverse tunnel in the host bone and into
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the transverse fixation pin hole in the graft ligament
support block.
In accordance with a further feature of the
invention, there is provided a method for securing a
graft ligament in a bone tunnel, comprising the steps
of:
looping a graft ligament through a graft hole in a
graft ligament support block;
advancing the graft ligament support block into
the bone tunnel;
forming a transverse tunnel in the host bone to a
predetermined depth using a transverse tunnel drill
having a stop element at a predetermined distance from
a distal end of the transverse tunnel drill, the stop
element configured to engage a drill sleeve so as to
limit drilling to the predetermined depth, with said
transverse tunnel being aligned with a transverse
fixation pin hole in the graft ligament support block;
and
pinning the graft ligament support block within
the bone tunnel by advancing a transverse fixation pin
along the transverse tunnel in the host bone and into
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the transverse fixation pin hole in the graft ligament
support block.
In accordance with a still further feature of the
invention, there is provided a method for securing a
graft ligament in a bone tunnel, the method comprising
the steps of:
forming a transverse tunnel in the host bone to a
predetermined depth using a transverse tunnel drill
having a stop element at a predetermined distance from
.0 a distal end of the transverse tunnel drill, the stop
element configured to engage a drill sleeve so as to
limit drilling to the predetermined depth;
looping a graft ligament through a graft hole in a
graft ligament support block;
L5 advancing the graft ligament support block into
the bone tunnel so that a transverse fixation pin hole
in the graft ligament support block is aligned with the
transverse tunnel; and
pinning the graft ligament support block within
20 the bone tunnel by advancing a transverse fixation pin
along the transverse .tunnel in the host bone and into
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the transverse fixation pin hole in the graft ligament
support block.
In accordance with a further feature of the
invention, there is provided apparatus for use in
reconstructing a ligament, the apparatus comprising:
a graft ligament support block for supporting a
graft ligament in a bone tunnel, the graft ligament
support block comprising:
a body having a distal end, a proximal end,
LO and a longitudinal axis extending between the distal
end and the proximal end, the proximal end being
tapered so as to facilitate withdrawal of the graft
ligament support block through the bone tunnel;
a graft hole extending through the body
transverse to the longitudinal axis and configured to
receive a graft ligament therein; and
. a region configured for drilling a transverse
fixation pin hole through the body transverse to the
longitudinal axis as a transverse hole is drilled
through the bone tunnel.
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Brief Description Of the Drawings
These and other objects and features of the
present invention will be more fully disclosed or
rendered obvious by the following detailed description
of the preferred embodiments of the invention, which is
to be considered together with the accompanying
drawings wherein like numbers refer to like parts and
further wherein:
Fig. 1 is a schematic view of a knee joint, as
LO viewed from the anterior side;
Fig. 2 is a schematic view of a knee joint, as
viewed from the posterior side;
Fig. 3 is a schematic view of a generic ACL
reconstruction;
Fig. 4 is a schematic view of an ACL
reconstruction effected using an interference screw;
Fig. 5 is a schematic view of an ACL
reconstruction effected using a suture sling;
Fig. 6 is a schematic view of an ACL
reconstruction effected using a crosspin;
Fig. 7 is a schematic view of an ACL
reconstruction effected using a screw and washer;
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Fig. 8 is a schematic view of a graft ligament
support block formed in accordance with the present
invention;
Fig. 9 is a partially exploded view showing the
graft ligament support block of Fig. 8 and an
installation tool for deploying the same;
Figs. 10-12 are various views showing the graft
ligament support block of Fig. 8 mounted to the distal
end of the installation tool shown in Fig. 9;
_O Fig. 13 is a partial perspective view showing
details of the proximal end of the installation tool
shown in Fig. 9;
Fig. 14 is a side view, partially in section,
showing further details of the construction of the
L5 installation tool shown in Fig. 9;
Fig. 15 is a side sectional view of the
installation tool's drill sleeve;
Fig. 16 is a perspective view of a transverse
fixation pin which may be used in conjunction with the
?0 graft ligament support block of Fig. 8 and the
installation tool of Fig. 9;
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Figs. 17-33 are a series of schematic views
showing an ACL reconstruction being effected in
accordance with the present invention;
Fig. 34 is a schematic view showing another form
of graft ligament support block formed in accordance
with the present invention;
Fig. 35 is an enlarged side view showing an
alternative construction for a portion of the
installation tool;
Fig. 36 is a sectional view taken along line 36-36
of Fig. 35;
Fig. 37 is a schematic view showing a reamer drill
guide formed in accordance with the present invention;
Fig. 38 is a schematic view showing the reamer
element of the reamer drill guide shown in Fig. 37;
Figs. 39-44 are a series of schematic views
showing an ACL reconstruction being effected in
accordance with the present invention;
Figs. 45, 46A and 46B are schematic views of graft
ligament support blocks, with each one showing a
tapered distal edge configuration;
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Fig. 47 is a schematic view of a transverse
fixation pin having an internal tapped hole formed at
its proximal end;
Fig. 48 is a schematic view of a retraction tool
having a threaded projection configured to engage the
internal tapped hole of the transverse fixation pin
shown in Fig. 47;
Fig. 49 is a schematic view showing a stepped
transverse tunnel drill having a narrow cutting portion
and a wide cutting portion;
Fig. 50 is a schematic view of an ACL
reconstruction procedure effected using the stepped
transverse tunnel drill shown in Fig. 49;
Figs. 51A, 513 and 52 are schematic views of a
system for use in reconstructing a ligament, the system
including a stepped transverse tunnel drill with depth
markers thereon and a drill sleeve with depth markers
thereon;
Figs. 53 and 54 are schematic views of a
transverse tunnel drill having a stop element
configured thereon; and
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Figs. 55 and 56 are schematic views of a system
for use in reconstructing a ligament, the system
including a transverse pin inserter depth gauge
configured to determine the placement depth of a
transverse pin inserted into the transverse tunnel.
Detailed Description Of the Preferred Embodiment
Looking next at Fig. 8, there is shown a graft
ligament support block 100 which comprises one
preferred form of the invention. Graft ligament
support block 100 comprises a body 105, and a graft
hole 110 and a transverse fixation pin hole 115
extending through body 105, with both graft hole 110
and transverse fixation pin hole 115 preferably
extending substantially perpendicular to the
longitudinal axis 120 of body 105. In one preferred
form of the invention, graft hole 110 and transverse
fixation pin hole 115 extend diametrically across body.
105, with graft hole 110 and transverse fixation pin
hole 115 extending substantially parallel to one
another. Preferably graft hole 110 resides closer to
the proximal end 125 of body 105 than transverse
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fixation pin hole 115, and transverse fixation pin hole
115 resides closer to the distal end 130 of body 105
than graft hole 110. In one preferred form of the
invention, the distal end of body 105 has a circular
cross-section, although it may also have an oval cross-
section or a polygonal cross-section (e.g., square or
rectangular or triangular, etc.). In one preferred
construction, the distal end of body 105 has a cross-
section sized just slightly smaller than the diameter
of the bone tunnel, so as to provide a close interface
between body 105 and the walls of the bone tunnel. In
one preferred form of the invention, the distal end 130
of body 105 is tapered so as to facilitate advancement
of graft ligament support block 100 through a bone
tunnel. And in a preferred form of the invention, the
proximal end of body 105 is sculpted away, e.g. such as
shown at 135, so as to provide more room for a graft
ligament looped,through graft hole 110 and extending
distally therefrom. Body 105 also includes a pair of
recesses 140 for mounting body 105 to an appropriate
installation tool, as will hereinafter be discussed in
further detail.
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If desired, graft ligament support block 100 may
also include suture hole 145 for receiving a tow
suture, as will hereinafter be discussed in further
detail.
Additionally, if desired, the proximal end of
graft hole 110 may be tapered as shown at 150 so as to
provide a less traumatic bearing surface for a graft
ligament looped through graft hole 110, and/or the
entrance of transverse fixation pin hole 115 may be
tapered as shown at 155 so as to facilitate entry of a
transverse fixation pin into transverse fixation pin
hole 115.
Body 105 may be formed out of a polymer, a
bioabsorbable or bioremodelable material, allograft
bone, a metal, a ceramic, coral, a fiber composite, a
composite including at least one of the foregoing, etc.
By forming body 105 out of a relatively strong
material, the graft ligament can be held under tension
even where body 105 is relatively small, or where one
.or more of the holes 110, 115 and/or 145 is located
fairly close to the periphery of body 105.
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Looking next at Figs. 9-15, there is shown an
installation tool 200 which may be used in conjunction
with graft ligament support block 100. Installation
tool 200 generally comprises a holder 205 and an
associated drill guide 210.
Holder 205 comprises a shaft 215 having a pair of
fingers 220 at its distal end and a handle 225 at its
proximal end. Fingers 220 allow installation tool 200
to mate with, and releasably hold, graft ligament
support block 100 by selectively fitting into the
recesses 140 (Fig. 8) formed on the proximal end of
graft ligament support block 100. See Figs. 9-12 and
14. In essence, fingers 220 and recesses 140 comprise
a male/female connection; if desired, the locations of
the male and female members may be reversed (i.e., with
the male portion on support block 100 and the female
portion on holder 205); or an alternative type of
connection (e.g., a grasper) may be used. Preferably
one or more suture posts 227 are formed on the proximal
end of shaft 215 adjacent to handle 225. Suture posts
227 allow the two free ends of a graft ligament to be
secured to the installation tool, as will hereinafter
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be discussed in further detail. Handle 225 allows
installation tool 200 to be conveniently grasped by a
user. Handle 225 includes a post hole 230. Post hole
230 allows drill guide 210 to be releasably secured to
holder 205, as will hereinafter be discussed in further
detail.
Drill guide 210 comprises an outrigger 235 having
a threaded bore 240 (Fig. 14) formed in its distal end
245, and a slot 250 (Fig. 9) and post 255 at its
LO proximal end 260. The end of post 255 is threaded,
e.g., as shown at 265.
The threaded bore 240 (Fig. 14) in the outrigger's
distal end 245 is sized to receive a drill sleeve 270
therein. Drill sleeve 270 has threads 275 along its
length and terminates in a proximal head 280. Head 280
can be used to manually rotate drill sleeve 270 within
the outrigger's threaded bore 240, whereby to move
drill sleeve 270 relative to the distal end 245 of
outrigger 235. A lumen 285 extends through drill
sleeve 270.
Slot 250 and post 255 permit outrigger 235 to be
releasably mounted to holder 205. More particularly,
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outrigger 235 may be mounted to holder 205 by fitting
the holder's shaft 215 in the outrigger's slot 250
(Figs. 13 and 14), fitting the outrigger's post 255 in
the holder's post hole 230, and then tightening nut 290
onto the threaded end 265 of post 255.
As will hereinafter be described, graft ligament
support block 100 and installation tool 200 are
intended to be used in conjunction with a transverse
fixation pin. One preferred transverse fixation pin
300 is shown in Fig. 16. Transverse fixation pin 300
generally comprises a solid shaft 305 terminating in a
tapered distal end 310, and a ribbed (or barbed or
threaded) section 315. A non-circular socket 320 is
formed in the proximal end of transverse fixation pin
300, whereby transverse fixation pin 300 may be engaged
by a driver.
An ACL reconstruction effected in accordance with
the present invention will now be described.
First, the surgical site is prepared for the graft
ligament, e.g., by clearing away the damaged ACL, etc.
Then a guidewire 400 (Fig. 17) is drilled up through
tibia 10 and into the interior of the knee joint.
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Preferably guidewire 400 is stopped short of engaging
the bottom of femur 15 (Fig. 18). Then a cannulated
tibial drill 500 (Fig. 19) is loaded onto guidewire 400
and drilled up through tibia 10 and into the interior
of the knee joint (Fig. 20). Then cannulated tibial
drill 500 is withdrawn back down the guidewire
(Fig. 21), leaving a tibial tunnel 20.
Next, guidewire 400 is drilled an appropriate
distance into the interior of femur 15. If desired,
guidewire 400 may be drilled all the way through femur
(Fig. 22), for reasons which will hereinafter be
described. Then a cannulated femoral drill 600 (e.g.,
an acorn drill) is loaded onto guidewire 400 (Fig. 22),
passed through tibial tunnel 20, across the interior of
15 the knee joint, and then drilled up into femur 15,
stopping within the interior of femur 15 (Fig. 23).
Then cannulated femoral drill 600 is withdrawn back
down the guidewire, leaving a femoral tunnel 25 (Fig.
24).
Next, a graft ligament 35 is mounted to graft
ligament support block 100 by threading one end of the
graft ligament through graft hole 110, and then graft
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ligament support block 100 is Mounted to the distal end
of shaft 215, i.e., by seating fingers 220 in recesses
140. The two free ends of graft ligament 35 are
preferably held taut, e.g., by passing sutures 70
through the two free ends of graft ligament 35 and then
securing those sutures (e.g., by winding) to suture
posts 227. This arrangement will help control the two
free ends of graft ligament 35 and will help hold graft
ligament support block 100 to holder 205. Then
installation tool 200 is used to push graft ligament
support block 100, and hence graft ligament 35, up
through tibial tunnel 20 (Fig. 25), across the interior
of the knee joint, and up into femoral tunnel 25
(Fig. 26).
If desired, all of the force required to advance
graft ligament support block 100 and graft ligament 35
through tibial tunnel 20, across the interior of the
knee joint, and up into femoral tunnel 25 may be
supplied by pushing distally on installation tool 200.
Alternatively, if guidewire 400 has been drilled
completely through femur 15 (e.g., such as is shown in
Fig. 22), and if the proximal end of guidewire 400
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includes a suture eyelet (e.g., such as the suture
eyelet 405 shown in Figs. 23 and 24), a suture may be
used to help tow graft ligament support block 100 and
graft ligament 35 up into position. More particularly,
a suture 700 (Fig. 25) may be looped through the suture
hole 145 in graft ligament support block 100 and
through suture eyelet 405 on guidewire 400; then, by
pulling distally on the portion of guidewire 400
extending out of the top end of femur 15, suture 700
can be used to help tow graft ligament support block
100 and graft ligament 35 up into position (Fig. 26).
Such an arrangement will help reduce the amount of
force which needs to be delivered by installation tool
200 to push graft ligament support block 100 and graft
ligament 35 up into position.
Once graft ligament support block 100 and graft
ligament 35 have been advanced into position (Fig. 26),
drill sleeve 270 is advanced into tight engagement with
femur 15 (Fig. 27). This action will help stabilize
installation tool 200 relative to femur 15. Then a
transverse tunnel drill 800 (Fig. 28) is used to drill
a transverse tunnel 75 through the lateral portion of
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femur 15, through transverse fixation pin hole 115 in
graft ligament support block 100, and into the medial '
portion of femur 15. In this respect it will be
appreciated that transverse tunnel drill 800 will be
accurately and consistently directed through transverse
fixation pin hole 115 in graft ligament support block
100 (Fig. 28) due to the fact that the orientation of
graft ligament support block 100 and installation tool
200 (and hence drill sleeve 270) is regulated by the
engagement of fingers 220 in recesses 140.
Once transverse tunnel drill 800 has been used to ,
drill transverse tunnel 75, transverse tunnel drill 800
is removed (Fig. 29). Then drill sleeve 270 is
loosened and outrigger 210 dismounted from holder 205
(Fig. 30). Then transverse fixation pin 300, mounted
on a driver 325, is advanced into transverse tunnel 75
=
and across transverse fixation pin hole 115 in graft
ligament support block 100 (Fig. 31), whereby to secure
graft ligament support block 100 (and hence graft
ligament 35) in femoral tunnel 25. Depending on
whether section 315 of transverse fixation pin 300 is
ribbed or barbed or threaded, the transverse fixation
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= pin may be advanced by driver 325 by tapping on the
proximal end of the driver with a mallet or by rotating
the driver and/or both. The driver 325 is then removed
(Fig. 32). Next, the two free ends of graft ligament
35 are detached from the handle's suture posts 227, and
holder 205 is withdrawn (Fig. 33). In this respect it
will be appreciated that graft ligament support block
100 will be held in position in femoral tunnel 25 when
holder 205 is withdrawn due to the presence of
transverse fixation pin 300 in transverse tunnel 75 and
transverse fixation pin hole 115. Finally, the two
free ends of graft ligament 35 are secured to tibia 10,
thereby completing the ACL reconstruction procedure.
In the embodiment disclosed above, transverse "
fixation pin hole 115 (Fig. 8) is pre-formed in body
105. Such a construction is generally advantageous,
since it eliminates the need to drill through body 105
after graft ligament support block 100 has been
positioned in the femoral tunnel and before transverse
fixation pin 300 has been passed through body 105. In
addition, by pre-forming transverse fixation pin hole
115 in body 105, transverse fixation pin hole 115 can
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be given a desired geometry, e.g., it permits the
entrance to crosspin hole 115 to be tapered, such as is
shown at 155 in Fig. 8, whereby to help center
transverse fixation pin 300 in transverse fixation pin
hole 115. However, it should also be appreciated that,
if desired, transverse fixation pin hole 115 may not be
pre-formed in body 105. Instead, transverse fixation
pin hole 115 may be formed in situ, at the time of
surgery, e.g., by drilling across body 105 when forming
transverse tunnel 75 with transverse tunnel drill 800.
Where transverse fixation pin hole 115 is to be formed
in situ, it is of course necessary for body 105 to be
formed out of a drillable material. In addition, where
transverse fixation pin hole 115 is to be formed in
situ, it is preferred that body 105 be formed out of a
relatively strong material, since then any misplacement
(i.e., any off-center placement) of transverse fixation
pin hole 115 will be well tolerated by body 105.
Additionally, in the embodiment disclosed above,
the outer surface of body 105 is sculpted away proximal
to graft hole 110, such as is shown at 135 in Fig. 8,
so as to help accommodate the graft ligament in femoral
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tunnel 25. In Fig. 8, sculpting is effected so as to
produce a substantially planar surface at 135.
However, if desired, sculpting can be effected so as to
provide alternative geometries, e.g., a surface groove,
etc. Thus, for example, in Fig. 34 body 105 is shown
with a pair of surface grooves 165 communicating with,
and extending proximally from, graft hole 110. Surface
grooves 165 are sized so as to provide a recess for
seating portions of the graft ligament as the graft
ligament extends proximally from graft hole 110.
Also, in the embodiment disclosed above, body 105
is shown (see, for example, Fig. 8) as having a
relatively smooth outer surface. However, if desired,
body 105 may have spikes or ribs, etc. formed on a side
wall thereof so as to help stabilize body 105 within
the bone tunnel.
Furthermore, in the embodiment disclosed above,
drill sleeve 270 is movably connected to outrigger 235
via a screw connection (i.e., screw threads 275 on the
exterior of drill sleeve 270 and threaded bore 240 in
outrigger 235). This arrangement provides a simple and
cost-effective way to movably secure drill sleeve 270
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to outrigger 235. However, if desired, other types of
arrangements could also be used. For example, and
looking now at Figs. 35 and 36, drill sleeve 270 could
have a smooth or ribbed or roughed (e.g. knurled)
exterior 275A that slides through a non-threaded bore
240A in outrigger 235, with a locking pin 235A being
selectively advanceable (through a threaded bore 235B)
into engagement with drill sleeve 270, whereby to
selectively lock the drill sleeve to the outrigger.
Still other possible arrangements for selectively
locking drill sleeve 270 to outrigger 235 will be
apparent to those skilled in the art of drilling and
drill sleeves.
Also, in the embodiment disclosed above, drill
guide 210 is shown (see, for example, Fig. 14) as being--
releasably secured to holder 205 via a post 255 and
tightening nut 290. However, it should be appreciated
that other types of connections (e.g., a "quick
release" clamping mechanism) may also be used to
releasably secure drill guide 210 to holder 205.
It is also possible to form transverse tunnel 75
before graft ligament support block 100 and graft
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ligament 35 are positioned in femoral tunnel 25. More
particularly, in one possible arrangement, a reamer
drill guide 200A (Fig. 37) may be used. Reamer drill
guide 200A is substantially identical to the
installation tool 200 described above, except as will
hereinafter be described. More particularly, reamer
drill guide 200A comprises a reamer 205A and the drill
guide 210. Reamer 205A is substantially identical to
the holder 205 described above, except that it has a
cylindrical element 220A (Figs. 37 and 38) at its
distal end having a transverse hole 220B extending
therethrough, and it omits the suture posts 227 which
are preferably provided on holder 205. Reamer 205A is
configured so that (i) its cylindrical element 220A has
a diameter approximately equal to the diameter of
femoral tunnel 25, and (ii) when drill guide 210 is
attached to reamer 205A, the lumen 285 in drill sleeve
270 will be aligned with transverse hole 220B in reamer
205A.
0 Graft ligament support block 100, holder 205 and
reamer drill guide 200A may be used to effect an ACL
reconstruction as follows.
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First, the surgical site is prepared for the graft
ligament, e.g., by clearing away the damaged ACL, etc.
Then a guidewire 400 (Fig. 17) is drilled up through
tibia 10, across the interior of the knee joint.
Preferably guidewire 400 is stopped short of engaging
the bottom of femur 15 (Fig. 18). Then a cannulated
tibial drill 500 (Fig. 19) is loaded onto guidewire 400
and drilled up through tibia 10 and into the interior
of the knee joint (Fig. 20). Then cannulated tibial
drill 500 is withdrawn back down the guidewire (Fig.
21), leaving a tibial tunnel 20.
Next, guidewire 400 is drilled an appropriate
distance into the interior of femur 15. Then a
cannulated femoral drill 600 (e.g., an acorn drill of
the type shown in Fig. 22) is loaded onto guidewire
400, passed through tibial tunnel 20, across the
interior of the knee joint, and then drilled up into
femur 15, stopping within the interior of femur 15.
Then cannulated femoral drill 600 is withdrawn back
down the guidewire, leaving a femoral tunnel 25, and
then guidewire 400 is withdrawn (see Fig. 39).
=
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Next, reamer drill guide 200A is advanced so that
its cylindrical element 220A is advanced through tibial
tunnel 20, across the interior of the knee, and up into
femoral_ tunnel 25. In this respect it should be
appreciated that as reamer drill guide 200A is advanced
through tibial tunnel 20 and femoral tunnel 25, its
cylindrical element 220A will ream both bone tunnels,
clearing out any intervening debris.
Once reamer drill guide 200A has been advanced
into position, drill sleeve 270 is advanced into tight
engagement with femur 15. This action will help
stabilize reamer drill guide 200A relative to femur 15.
Then a transverse tunnel drill 800 (Fig. 40) is used to
drill a transverse tunnel 75 through the lateral
.5 portion of femur 15, through transverse hole 220B in
cylindrical element 220A, and into the medial portion
of femur 15. In this respect it will be appreciated
that transverse tunnel drill 800 will be accurately and
consistently directed through transverse hole 220B in
cylindrical element 220A (Fig. 40) due to the fact that
the relative orientation of cylindrical element 220A
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and drill sleeve 270 is regulated by the pre-defined
engagement of drill guide 210 with reamer 205A.
Once transverse tunnel drill 800 has been used to
drill transverse tunnel 75, transverse tunnel drill 800
is removed. Then drill sleeve 270 is loosened and
reamer drill guide 200A is withdrawn from the surgical
site (Fig. 41).
Next, a graft ligament 35 is mounted to graft
ligament support block 100 by threading one end of the
graft ligament through graft hole 110, and then graft
ligament support block 100 is mounted to the distal end
of shaft 215, i.e., by seating fingers 220 in recesses
140. The two free ends of graft ligament 35 are
preferably held taut, e.g., by passing sutures 70
through the two free ends of graft ligament 35 and then
securing these sutures (e.g., by winding) to suture
posts 227. This arrangement will help control the two
free ends of graft ligament 35 and will help hold graft
ligament support block 100 to holder 205. Then holder
205 is used to push graft ligament support block 100,
and hence graft ligament 35, up through tibial. tunnel
20, across the interior of the knee joint, and up into
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femoral tunnel 25 (Fig. 42). As graft ligament support
block is advanced in femoral tunnel 25, or after it has
been advanced an appropriate distance into femoral
tunnel 25, it is rotated as necessary, by turning
handle 225 as necessary, so as to align the transverse
fixation pin hole 115 with transverse tunnel 75. Such
alignment may be facilitated by providing an alignment
marker (e.g., such as the alignment marker 225A shown
in Fig. 43) on handle 225.
Then transverse fixation pin 300, mounted on a
driver 325, is advanced into transverse tunnel 75 and
across transverse fixation pin hole 115 in graft
ligament support block 100 (Fig. 44), whereby to secure
graft ligament support block 100 (and hence graft
ligament 35) in femoral tunnel 25. Then driver 325 is
removed. Next, the two free ends of graft ligament 35
are detached from the handle's suture posts 227, and
holder 205 is withdrawn. In this respect it will be
appreciated that graft ligament support block 100 will
be held in position in femoral tunnel 25 when holder
205 is withdrawn due to the presence of transverse
fixation pin 300 in transverse tunnel 75 and transverse
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fixation pin hole 115. Finally, the two free ends of
graft ligament 35 then secured to tibia 10, thereby
completing the ACL reconstruction procedure.
Looking next at Figs. 45 and 46, there is shown a
modified graft ligament support block 1500 which
comprises one preferred form of the invention. Graft
ligament support block 1500 comprises a body 1505, and
a graft hole 1510 and a transverse fixation pin hole
1515 extending through body 1505, with both graft hole
1510 and transverse fixation pin hole 1515 preferably
extending substantially perpendicular to the
longitudinal axis 1520 of body 1505. In one preferred
form of the invention, graft hole 1510 and transverse
fixation pin hole 1515 extend diametrically across body
L5 1505, with graft hole 1510 and transverse fixation pin
hole 1515 extending substantially parallel to one
another. Preferably graft hole 1510 resides closer to
the proximal end 1525 of body 1505 than transverse
fixation pin hole 1515, and transverse fixation pin
!O hole 1515 resides closer to the distal end 1530 of body
1505 than graft hole 1510. In one preferred form of
the invention, the distal end of body 1505 has a
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circular cross-section, although it may also have an
oval cross-section or a polygonal cross-section (e.g.,
square or rectangular or triangular, etc.). In one
preferred construction, the distal end of body 1505 has
a cross-section sized just slightly smaller than the
diameter of the bone tunnel, so as to provide a close
interface between body 1505 and the walls of the bone
tunnel. In one preferred form of the invention, the
distal end 1530 of body 1505 is tapered so as to
facilitate advancement of graft ligament support block
100 through a bone tunnel. And in a preferred form of
the invention, the proximal end of body 1505 is
sculpted away, e.g. such as shown at 1535, so as to
provide more room for a graft ligament looped through
graft hole 1510 and extending distally therefrom. Body
1505 also includes one or more recesses (not shown, but
preferably similar to or analogous to the recesses 140
provided in body(105)) for mounting body 1505 to an
appropriate installation tool.
If desired, graft ligament support block 1500 may
also include suture hole 1545 for receiving a tow
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suture, as will hereinafter be discussed in further
detail.
Additionally, if desired, the proximal end of
graft hole 1510 may be tapered as shown at 1550 so as
to provide a less traumatic bearing surface for a graft
ligament looped through graft hole 1510, and/or the
entrance of transverse fixation pin hole 1515 may be
tapered as shown at 1555 so as to facilitate entry of a
transverse fixation pin into transverse fixation pin
hole 1515.
Body 1505 may be formed out of a polymer, a
bioabsorbable or bioremodelable material, allograft
bone, a metal, a ceramic, coral, a fiber composite, a
composite including at least one of the foregoing, etc.
By forming body 1505 out of a relatively strong
material, the graft ligament can be held under tension
even where body 1505 is relatively small, or where one
or more of the holes 1510, 1515 and/or 1545 is located
fairly close to the periphery of body 1505.
Still looking at Figs. 45, 46A and 46B, there is
shown a tapered portion 1560 at the proximal end 1525
of body 1505. Tapered portion 1560 facilitates
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retraction of graft block 1505 out of a bone tunnel if
the same is needed, e.g., for an interoperative
revision. This is beneficial in that other designs
with squared corners tend to bind in the bone tunnel if
the body is retracted proximally out of a bone tunnel.
Referring now to Figs. 46A and 46B, there is shown
body 1505 having a graft hole 1510 with a length X
(Fig. 46A), which is substantially equal to the width
of a graft ligament. Graft hole 1510 provides an
opening which is shorter than length Y of graft hole
110 of body 105 (Fig. 46B), which in turn provides
increased contact of the graft with the tunnel wall.
In a preferred embodiment of the invention, there
is provided a method for securing a graft ligament in a
bone tunnel. The method comprises a first step of
selecting a graft ligament support block with a graft
hole sized substantially equal to a given width of a
graft ligament. The method comprises a step of looping
the graft ligament through the graft hole in the graft
ligament support block. The method comprises a further
step of advancing the graft ligament support block into
the bone tunnel. The method comprises a step of
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forming a transverse tunnel in the host bone, with a
transverse tunnel being aligned with a transverse
fixation pin hole in the graft ligament support block.
The final step of the method comprises pinning the
graft ligament support block within the bone tunnel by
advancing a transverse fixation pin along the
transverse tunnel in the host bone and into the
transverse fixation pin hole in the graft ligament
support block.
In another preferred embodiment of the present
invention, there is provided a method for securing a
graft ligament in a bone tunnel. The method comprises
the step of forming a transverse tunnel in the host
bone. The method comprises the step of selecting a
graft ligament support block with a graft hole sized
substantially equal to a given width of a graft
ligament. The method also comprises the step of
looping the graft ligament through the graft hole in
the graft ligament support block. The graft ligament
support block is advanced into the bone tunnel so that
a transverse fixation pin hole in the graft ligament
support block is aligned with the transverse tunnel.
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The final step comprises pinning the graft ligament
support block within the bone tunnel by advancing a
transverse fixation pin along the transverse tunnel in
the host bone and into the transverse fixation pin hole
in the graft ligament support block.
Looking now at Figs. 47 and 48, in a preferred
embodiment of the present invention, there is shown a
removable transverse fixation pin 1600 (Fig.47) which
is configured to be used in a similar fashion as
transverse fixation pin 300 (Fig. 16) described
hereinabove. Removable fixation pin 1600 (Fig. 47)
generally comprises a solid shaft 1605 terminating in a
tapered distal end 1610, and a ribbed (or barbed or
threaded) section 1615. A socket 1620 is formed in the
proximal end of removable transverse fixation pin 1600,
whereby transverse fixation pin 1600 may be engaged by
a driver. Socket 1620 may be adapted to receive a
rotational-type driver (e.g., a hex driver) or a
mallet-type driver. Socket 1620 further includes an
internal tapped hole 1625 formed therein. Internal
tapped hole 1625 is configured to engage a retraction
tool 1630 (Fig. 48) so as to aid in the removal of
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removable fixation pin 1600 from a transverse bone
tunnel.
Retraction tool 1630 generally comprises a shaft
1635 having a handle 1640 at one end and a threaded
projection 1645 at the other end. Threaded projection
1645 is configured for threadable engagement with
internal tapped hole 1625 formed in removable fixation
pin 1600. When threaded projection 1645 is securely
mated with internal tapped hole 1625, removable
transverse fixation pin 1600 may be withdrawn from a
bone tunnel by applying appropriate forces on handle
1640.
In a preferred embodiment of the present
invention, there is provided a method for revising a
graft ligament in a bone tunnel. The method comprises
of engaging an internal tapped hole in a transverse
fixation pin with a removal tool. The method also
comprises the step of withdrawing the transverse
fixation pin from the bone tunnel with the removal tool
engaged with the internal tapped hole. The method
comprises a further step of repositioning the graft
ligament support block into the bone tunnel. The
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method comprises a final step of pinning the graft
ligament support block within the bone tunnel by
advancing a transverse fixation pin along a transverse
tunnel in the host bone and into the transverse
fixation pin hole in the graft ligament support block.
Referring now to Fig. 49, and in a preferred
embodiment of the present invention, there is shown a
stepped transverse tunnel drill 1700 having a shaft
1705 with a narrow cutting portion 1710 along a first
length of the distal end thereof, a wide cutting
portion 1715 along a second length proximally of the
narrow cutting portion 1710, and a discontinuous
portion 1720 formed at the junction of narrow cutting
portion 1710 and wide cutting portion 1715.
Looking now at Fig. 50, stepped transverse tunnel
drill 1700 is used so as to drill a stepped transverse
tunnel 1725 (Fig. SO) through the lateral potion of
femur 15, through a portion of bone tunnel 25, and into
the medial portion of femur 15 as described herein.
Transverse tunnel 1725 includes a narrow portion 1730
and a wide portion 1735 corresponding to narrow cutting
portion 1710 and wide cutting portion 1715 of stepped
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transverse tunnel drill 1700, respectively. A stepped
portion (not shown) within transverse tunnel 1725
provides an annular shoulder to stop the advancement of
a transverse tunnel pin (not shown).
In a preferred embodiment of the present invention
(not shown), there is provided a stepped fixation pin
having a profile of a portion of stepped transverse
tunnel drill 1700. The stepped fixation pin is
preferably configured with an annular shoulder formed
between a narrow portion at its distal end and a wide
portion at its proximal end. The annular shoulder
allows the stepped fixation pin to be positionably
seated at a known distance within transverse tunnel
1725 so as to position the narrow portion of the
stepped fixation pin within narrow portion 1730 of
transverse tunnel 1725 and the wide portion of the
stepped fixation pin within wide portion 1735 of
transverse tunnel 1725.
In a preferred embodiment of the present
invention, a method is provided for securing a graft
ligament in a bone tunnel. The method comprises
looping a graft ligament through a graft hole in a
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graft ligament support block (not shown). The method
further comprises advancing the graft ligament support
block into bone tunnel 25. The method also comprises a
step of forming stepped transverse tunnel 1725 (Fig.
50) in host bone 15 with stepped transverse tunnel
drill 1700 (Fig. 49), with the stepped transverse
tunnel 1725 (Fig. 50) being aligned with a transverse
fixation pin hole (not shown) in the graft ligament
support block. The method comprises a final step of
pinning the graft ligament support block within bone
tunnel 25 by advancing a stepped transverse fixation
pin (not shown) along transverse tunnel 1725 in host
bone 15 and into the transverse fixation pin hole (not
shown) in the graft ligament support block (not shown).
In a preferred embodiment of the present
invention, an installation tool is used to advance the
graft ligament support block into the bone tunnel prior
to the step of forming stepped transverse tunnel 1725
in host bone ,15 (Fig. 50). Preferably, the
?0 installation tool is used together with the stepped
transverse tunnel drill to form the stepped transverse
tunnel in the host bone.-
SCAN-17
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In another preferred embodiment to the present
invention, a tow suture is used to advance the graft
ligament support block into the bone tunnel prior to
the step of forming stepped transverse tunnel 1725 in
host bone 15 (Fig. 50).
In a preferred embodiment of the present
invention, there is provided another method for
securing a graft ligament in a bone tunnel. This
method comprises a first step of forming a stepped
transverse tunnel 1725 (Fig. 50) in host bone 15 with
stepped transverse tunnel drill 1700 (Fig. 49). The
method comprises a subsequent step of looping a graft
ligament through a graft hole in a graft ligament
support block. This is followed by the step of
advancing the graft ligament support block into bone
tunnel 25 so that a transverse fixation pin hole in the
graft ligament support block (not shown) is aligned
with the stepped transverse tunnel 1725. The method
comprises a final the step of pinning the graft
ligament support block within bone tunnel 25 by
advancing a stepped transverse fixation pin (not shown)
along the stepped transverse tunnel 1725 in host bone
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15 and into the transverse fixation pin hole (not
shown) in the graft ligament support block (not shown).
In a preferred embodiment of the present invention
(not shown), an installation tool is used to advance
the graft ligament support block into the bone tunnel
subsequent to the steps of forming the stepped
transverse tunnel and looping the graft ligament
through the graft hole.
Referring now to Figs. 51A, 51B and 52, and in a
preferred embodiment of the present invention, there is
shown a calibrated graft ligament reconstruction system
1740 (Fig. 52) which generally includes a holder 1745
and an associated drill guide 1750.
Drill guide 1750 has a similar configuration to
drill guide 210 described hereinabove. Preferably,
drill guide 1750 comprises an outrigger 1755 having a
smooth bore 1760 formed in its distal end 1765 and
sized to receive a drill sleeve 1770 therin. A first
set of clioth markers 1775 disposed on drill sleeve 1770
are configured to indicate the distance from a distal
tip 1780 of the drill sleeve 1770 to a preselected
portion within femur 15. Preferably, depth markers
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1775 are read relative to a proximal opening 1785 of
smooth bore 1760.
Referring now to Figs. 51B and 52, and in a
preferred embodiment of the present invention, there is
shown stepped transverse drill 1700 having a second set
of depth markers 1790 thereon. Depth markers 1790 are
configured to indicate the distance to the preselected
portion within femur 15. Preferably, depth markers
1790 are read relative to a proximal opening 1795 (Fig.
52) of drill sleeve 1770.
In a preferred embodiment of the present
invention, a method is disclosed for securing a graft
ligament in a bone tunnel. The method comprises a
first step of looping a graft ligament through a graft
hole in a graft ligament support block. The method
comprises a subsequent step of advancing the graft
ligament support block into the bone tunnel. This step
is followed by the step of positioning a drill guide in
attachment to the graft support block, the drill guide
comprising an outrigger and a drill sleeve moveably
attached to the outrigger, and the drill sleeve having
depth markers thereon. The method further comprises a
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step of determining a proper transverse tunnel depth
with the drill sleeve and the outrigger by moving the
drill sleeve within the outrigger toward the bone
tunnel and reading the depth markers on the drill
sleeve. The method comprises the step of forming a
transverse tunnel in the host bone to a proper
transverse tunnel depth by drilling a transverse tunnel
drill to a given depth according to markers disposed on
thereon, with the transverse tunnel being aligned with
a transverse fixation pin hole in the graft ligament
support block. The method comprises a final step of
pinning the graft ligament support block within the
bone tunnel by advancing a transverse fixation pin
along the transverse tunnel in the host bone and into
the transverse fixation pin hole in the graft ligament
support block.
In another preferred embodiment of the present
invention, a method is disclosed for securing a graft
ligament in a bone tunnel. The method comprises a
first step of positioning a drill guide in attachment
to a bone tunnel guide inserted into the bone tunnel,
the drill guide comprising an outrigger and a drill
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sleeve moveably attached to the outrigger, and the
drill sleeve having depth markers thereon. The method
comprises a subsequent step of determining a proper
transverse tunnel depth with the drill sleeve and the
outrigger by moving the drill sleeve within the
outrigger toward the bone tunnel and reading the depth
markers on the drill sleeve. The method comprises the
step of forming a transverse tunnel in the host bone to
a proper transverse tunnel depth by drilling a
transverse tunnel drill to a given depth according to
markers disposed thereon. The method calls for the
step of looping a graft ligament through a graft hole
in a graft ligament support block. The method
comprises the step of advancing the graft ligament
support block into the bone tunnel so that a transverse
fixation pin hole in the graft ligament support block
is aligned with the transverse tunnel. The method
comprises a final step of pinning the graft ligament
support block within the bone tunnel by advancing a
transverse fixation pin along the transverse tunnel in
the host bone and into the transverse fixation pin hole
in the graft ligament support block.
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Looking at Figs. 53 and 54, and in a preferred
embodiment of the present invention, there is shown a
depth limiting transverse tunnel drill 1800 having a
stop element 1805 disposed thereon. Drill 1800 may
have anyone of the many tips known in the orthopedic
art, e.g., a standard fluted tip, a trocar tip, and a
spade tip, etc. Stop element 1805 is placed at a
position along the length of depth limiting transverse
tunnel drill 1800 so as to limit the depth of
penetration of a distal tip 1810 of transverse tunnel
drill 1800 into femur 15 (Fig. 54). Stop element 1805
limits the distal penetration of transverse tunnel
drill 1800 by engaging outrigger 1755 at distal end
1765 adjacent to proximal opening 1785, which allow
_5 only a distal portion 1815 to pass therethrough.
In a preferred embodiment of the present
invention, stop element 1805 is adjustably or fixedly
positioned along a portion of depth limiting transverse
tunnel drill 1800 and further comprises a locking
device so as to selectively determine the depth of
penetration of transverse tunnel drill 1800 into femur
15.
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Referring now to Figs. 55 and 56, and in a
preferred embodiment of the present invention, there is
shown a depth gauge 1900 with a series of depth gauge
markings 1905 configured thereon. Depth gauge 1900 is
configured to engage a transverse fixation pin 1910 at
a distal end 1915 thereof for insertion and proper
placement into femur 15 (Fig. 56). Depth gauge
markings 1905 of depth gauge 1900 indicate the position
of distal end 1915, and hence the proximal end of the
depth gauge, within femur 15. Preferably, depth gauge
markings 1905 are read relative to proximal opening
1795 of drill sleeve 1775, which inserter 1900 passes
therethrough.
Referring to Fig. 52, and in a preferred
embodiment of the present invention, a method is
disclosed for securing a graft ligament in a bone
tunnel. The method comprises a first step of looping a
graft ligament through a graft hole in a graft ligament
support block. This step is followed by the step of
advancing the graft ligament support block into the
bone tunnel. The method comprises a further step of
determining a proper transverse tunnel depth by reading
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a position of depth markers 1775 on drill sleeve 1770
relative to outrigger 1755. The method comprises a
subsequent step of forming a transverse tunnel in the
host bone using transverse tunnel drill 1770 having
depth markers 1790 thereon so as to drill the
transverse tunnel to the proper transverse tunnel
depth, transverse is aligned a transverse fixation pin
hole in the graft ligament support block. The method
comprises a final step of pinning the graft ligament
support block within the bone tunnel by selecting a
transverse fixation pin based on the proper transverse
tunnel depth determined by depth markers 1775 on drill
sleeve 1770 and advancing the selected transverse
fixation pin along the transverse tunnel in the host
L5 bone and into the transverse fixation pin hole in the
graft ligament support block.
Referring still to Fig. 52, and in a preferred
embodiment of the present invention, a method is
disclosed for securing a graft ligament in a bone
!O tunnel. The method comprises a first step of
determining a proper transverse tunnel depth by reading
a position of depth markers 1775 on drill sleeve 1770
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relative to outrigger 1755. The method comprises a
further step of forming a transverse tunnel in the host
bone using transverse tunnel drill 1700 having depth
markers 1790 thereon so as to drill the transverse
tunnel to the proper transverse tunnel depth. The
method comprises a subsequent step of looping a graft
ligament through a graft hole in a graft ligament
support block. This step is followed by the step of
advancing the graft ligament support block into the
bone tunnel so that a transverse fixation pin hole in
the graft ligament support block is aligned with the
transverse tunnel. The method comprises a final step
of pinning the graft ligament support block within the
bone tunnel by selecting a transverse fixation pin
based on the proper transverse tunnel depth determined
by depth markers 1775 on drill sleeve 1770 and
advancing a transverse fixation pin along the
transverse tunnel in the host bone and into the
transverse fixation pin hole in the graft ligament
support block.
Referring now to Figs. 53 and 54, and in a
preferred embodiment of the present invention, a method
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76
is disclosed for securing a graft ligament in a bone
tunnel. The method comprises a first step of looping a
graft ligament through a graft hole in a graft ligament
support block. The method comprises a subsequent step
of advancing the graft ligament support block into the
bone tunnel. The method comprises another step of
forming a transverse tunnel in host bone 15 to a
predetermined depth using transverse tunnel drill 1800
having stop element 1805 at a predetermined distance
from the distal end therof, and stop element 1805 is
configured to engage drill sleeve 1265 or distal end
1765 of outrigger 1755 so as to limit drilling to the
predetermined depth, with said transverse tunnel being
aligned with a transverse fixation pin hole in the
graft ligament support block. The method comprises a
final step of pinning the graft ligament support block
within the bone tunnel by advancing a transverse
fixation pin along the transverse tunnel in the host
bone and into the transverse fixation pin hole in the
?.0 graft ligament support block.
Referring still to Figs. 53 and 54, and in a
preferred embodiment of the present invention, a method
gram-17
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is disclosed for securing a graft ligament in a bone
tunnel. The method comprises a first step of forming a
transverse tunnel in host bone 15 to a predetermined
depth using transverse tunnel drill 1800 having stop
element 1805 at a predetermined distance from the
distal end thereof, and stop element 1805 configured to
engage a drill sleeve or distal end 1765 of outrigger
1755 so as to limit drilling to the predetermined
depth. The method comprises a subsequent step of
looping a graft ligament through a graft hole in a
graft ligament support block. The method comprises a
further step of advancing the graft ligament support
block into the bone tunnel so that a transverse
fixation pin hole in the graft ligament support block
.5 is aligned with the transverse tunnel. The method
comprises a final step of pinning the graft ligament
support block within the bone tunnel by advancing a
transverse fixation pin along the transverse tunnel in
the host bone and into the transverse fixation pin hole
0 in the graft ligament support block.
In a preferred embodiment of the present invention
(not shown), a modified graft ligament support block
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similar to support block 1500 (Fig. 45) and support
block 100 (Fig. 8) is provided for supporting a graft
ligament in a bone tunnel. The modified graft ligament
support block comprises a region configured therein for
drilling a transverse fixation pin hole through the
body transverse to the longitudinal axis as a crosspin
hole is drilled through the bone tunnel. Preferably,
the modified graft ligament support block further
comprises a tapered proximal end so as to facilitate
withdrawal of the graft ligament support block through
the bone tunnel.
In the preceding discussion, the present invention
has been discussed on the context of an ACL
reconstruction. However, it should also be appreciated
that the present invention may also be used in
connection with the other types of ligament
reconstructions and/or other types of anatomical
reconstructions.
