WO1993009730A1 - Reinforced graft for knee ligament surgery - Google Patents

Reinforced graft for knee ligament surgery Download PDF

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Publication number
WO1993009730A1
WO1993009730A1 PCT/FR1992/001070 FR9201070W WO9309730A1 WO 1993009730 A1 WO1993009730 A1 WO 1993009730A1 FR 9201070 W FR9201070 W FR 9201070W WO 9309730 A1 WO9309730 A1 WO 9309730A1
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WO
WIPO (PCT)
Prior art keywords
bone block
braid
graft
graft according
patellar tendon
Prior art date
Application number
PCT/FR1992/001070
Other languages
French (fr)
Inventor
Jacques Bahuaud
Original Assignee
Jacques Bahuaud
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Jacques Bahuaud filed Critical Jacques Bahuaud
Priority to EP93900259A priority Critical patent/EP0614346A1/en
Publication of WO1993009730A1 publication Critical patent/WO1993009730A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • D—TEXTILES; PAPER
    • D04—BRAIDING; LACE-MAKING; KNITTING; TRIMMINGS; NON-WOVEN FABRICS
    • D04C—BRAIDING OR MANUFACTURE OF LACE, INCLUDING BOBBIN-NET OR CARBONISED LACE; BRAIDING MACHINES; BRAID; LACE
    • D04C1/00—Braid or lace, e.g. pillow-lace; Processes for the manufacture thereof
    • D04C1/06—Braid or lace serving particular purposes
    • D—TEXTILES; PAPER
    • D10—INDEXING SCHEME ASSOCIATED WITH SUBLASSES OF SECTION D, RELATING TO TEXTILES
    • D10B—INDEXING SCHEME ASSOCIATED WITH SUBLASSES OF SECTION D, RELATING TO TEXTILES
    • D10B2509/00—Medical; Hygiene

Definitions

  • the present invention relates to autograft ligamentoplasty of the human knee and more specifically to a reinforced graft intended for the replacement of the anterior cruciate ligament of the knee.
  • the basic principle of such an autograft ligament is well known.
  • a graft is taken from the patellar tendon and the two bony ends, tibial and patellar, are preserved. Cha of the bone blocks thus preserved will allow the superior and inferior anchoring of the graft whose aim is to replace the anterior cruciate ligament very often ruptured during severe sprains of the knee.
  • This graft can be placed as it is in the knee joint by doing it not in a tibial tunnel dug in the drill bit, then in a femoral tunnel dug in the same way.
  • the two bone bls are fixed in the tunnels by special interference screws di wedging these bone blocks against the femoral and tibial tunnel walls.
  • the autograft obtained in this way is not used as such but is the subject of a reinforcement obtained by adding a strand of biocompatible woven or braided textile which is placed in the graft, which has the shape of a flat band whose sides are folded so as to wrap the implant strand) of reinforcement and are sutured longitudinally by overlock or separate stitches.
  • fixation at the ends is done by a bony suture on the upper bone block which will be placed in the femoral well and by a reinforcement suture on the part lower patellar tendon just before the tibial bone block.
  • the reinforcing element has the form of a flat rectangle of braid or fabric which is not very practical to fix on the graft and is particularly lacking in elasticity when folded in half lengthwise.
  • the aim of the present invention is to propose a new technique for reinforcing such a graft facilitating the placement of the graft and increasing the dynamic resist of the reinforcing element.
  • the subject of the invention is a renal graft for knee ligamentoplasty, of the constituted type removal from the patellar tendon in the form of apl band, the longitudinal edges of which are folded down and sutured, so as to include an element inside.
  • reinforcing braided or woven fibers fixed, on the one hand, to the patellar ten and, on the other hand, to the bone block of said tendon intended to be received in a tunnel formed in the femur, characterized in that said reinforcing element is a tubular.
  • Such a reinforced graft has a dynami resistance much greater than that provided by reinforcing elements in the form of a flattened strip, the longitudinal bo of which are folded down during the packaging of the element by the graft.
  • the reinforcing element in the form of a tubular braid is made integral, on the one hand, at one of its ends, of the femoral bone block by means of a flat endpiece integral with said braid, plated held by any means suitable against an inclined face arranged for this purpose in the rear face of said bl femoral bone and, on the other hand, over its entire length, patellar tendon, by all appropriate means.
  • the attachment of the reinforcing element and the femoral bone b is for example produced by a wire made of biocompatible material engaged in a hole provided for this purpose in said end of the braid and encircling said bone block.
  • the strengthening of the patellar tendon and reinforcing element is ensured for example by longitudinal U-shaped f of biocompatible material, placed in place along said reinforcing element.
  • Figure 1 is a perspective view of a reinforcement element consisting of a tubular braid
  • Figure 2 is a top view of a graft provided with its reinforcing element, before covering it;
  • Figure 3 is a side elevational view device of Figure 2;
  • FIG. 4 is a view similar to that of the figure illustrating the recovery of the reinforcement element by the graft
  • Figure 5 is a cross section of the reinforced graft of Figure 4.
  • Figure 6 is an enlarged view of the femora end of the reinforced graft
  • - Figure 7 is a perspective view of the reinforced graft ready to be put in place.
  • a reinforcing element consisting of a tubular braid 1 in a fiber of a biocompatible material, for example polypropylene terminated, at one end, by a connection end piece in the same material as the fibers.
  • This end piece 2 is flat and elongated, one of the ends is welded to the end of the tubular braid and a hole 3 is drilled in the end piece 2.
  • the hole 3 e capable of receiving a wire or link intended to a sutu trans bone on the femoral bone block of the graft and / contribute to the establishment of said bone block by fitting into its tunnel.
  • a therapeutic graft taken from the patellar tendon and comprising a tendon pa 5 in the form of a rectangular flat band connecting its ends to two bony blocks, femor and tibial respectively 7 which will be placed in tunnels arranged at effect in the femur and tibia in place of the anterior cruciate liga.
  • the tubular reinforcement element 1 of FIG. 1 is placed against the posterior of part 5 of the patellar tendon, which is sutured on one of its ends (tip side 2) on the femoral bone block 6, the element 1 is fixed to the patellar tendon 5, from p in place, by longitudinal U-shaped wires 8 (FIG. 2 and for example made of polypropylene, and the known manner is wrapped or wrapped, the element 1 by folding each other of the longitudinal edges of the tendon 5 ( Figure 4).
  • the patellar tendon 5 is then sutured edge to edge (fi).
  • Figure 5 illustrates in section the assembly thus obtained consisting of an outer tubular envelope formed by patellar tendon 5 and the hollow tubular braid 1 inter coaxial with the tendon.
  • the end piece 2 of the tubular braid 1 is pressed against the inclined face 10 (FIG. 3) formed for this purpose on the posterior f of the femoral bone block 6 and sutured with the a of a link 11 passing through the hole 3 of the tip 2 encircling the bone block 6.
  • the other end (4) of the braid 1 stops at the tibial bone b 7 and is simply in contact with this d ni
  • the end of the femoral bone block 6 intended to receive the end piece 2 will be arranged, for example digging slightly for better integration of the end piece, the thickness of which can advantageously be reduced in direction from the end, the essential goal being that the tip 2 pl on the bone block 6 does not protrude relative to the latter and does not interfere with its introduction into the receiving femoral bone tunnel and its fixation.
  • the fixation of the bone block 6, as well as that of the bone b 7 in its tibial tunnel, is carried out in the known manner, by so-called interference screws screwed astride the bone of the femur and on the bone blocks (6 , 7) and p specifically the cortical part, 6a and 7a respectively of said bone blocks.
  • FIG 7 there is shown in perspective a graft according to the invention seen by its proximal end (femoral bone block 6).
  • This bone block 6 like the bone block 7, has a triangular section with an anterior face formed the cortical bone (6a, 7a), the remaining part (6b, 7b) of the bony bl being spongy bone.
  • the presence of the link 11 is especially necessary during the manipulation and the placement of the graft, until the interference screw is fixed.
  • the bone blocks 6, 7 are also provided with 12 "wires to facilitate the handling of the graft and its placement in the bone tunnels.
  • the wires 12 of the femoral bone block 6 can be used jointly with a wire which would have passed through the hole 3 the end piece, when the bone block 6 is placed in the bone housing consisting of a well, the bottom of which is per a channel for the passage of said wires.
  • a traction exerted on these wires thus makes it possible to insert and block the bone bl 6 in its well.
  • the provision of a tubular reinforcement element ensures, on the one hand, a homogeneous and isotropic distribution of physical properties (tensile strengths, torsion of said element and, on the other hand, excellent elasticity flexibility, in particular capacities remarkable axial elbnga and retraction.
  • the invention is not limited to the embodiment shown and described above but on the contrary covers all variants, in particular as regards the means of attachment between the reinforcing element and the tendon part 5, as well that the femoral bone block

Abstract

Reinforced graft for knee ligament surgery of the type consisting of a flattened strip (5) taken from the patellar tendon. The strip's longitudinal edges are folded down and stitched, so as to include a reinforcing element (1) of braided or woven fibres fixed to the patellar tendon (5) to the bone end (6) of said tendon which is to be secured in a passage formed in the femur. The graft is characterized in that said reinforcing element (1) is a tubular braid. Application in knee ligament surgery.

Description

GREFFON RENFORCE POUR LIGAMENTOPLASTIE DU GENOU REINFORCED GRAFT FOR KNEE LIGAMENTOPLASTY
La présente invention à trait à la ligamentoplastie autogreffe du genou humain et plus précisément à un gref renforcé destiné au remplacement du ligament croisé antéri du genou. Le principe de base d'une telle ligamentoplastie autogreffe est bien connu.The present invention relates to autograft ligamentoplasty of the human knee and more specifically to a reinforced graft intended for the replacement of the anterior cruciate ligament of the knee. The basic principle of such an autograft ligament is well known.
On prélève un greffon sur le tendon rotulien en conser les deux extrémités osseuses, tibiale et rotulienne. Cha des blocs osseux ainsi conservés permettra l'ancrage supéri et inférieur du greffon dont le but est de remplacer ligament croisé antérieur très souvent rompu au cours entorses graves du genou. Ce greffon peut être mis en pl tel quel dans l'articulation du genou en le faisant pas dans un tunnel tibial creusé à la mèche de perçage, puis d un tunnel fémoral creusé de la même manière. Les deux bl osseux sont fixés dans les tunnels par des vis spéciales di d'interférence calant ces blocs osseux contre les parois tunnels fémoral et tibial.A graft is taken from the patellar tendon and the two bony ends, tibial and patellar, are preserved. Cha of the bone blocks thus preserved will allow the superior and inferior anchoring of the graft whose aim is to replace the anterior cruciate ligament very often ruptured during severe sprains of the knee. This graft can be placed as it is in the knee joint by doing it not in a tibial tunnel dug in the drill bit, then in a femoral tunnel dug in the same way. The two bone bls are fixed in the tunnels by special interference screws di wedging these bone blocks against the femoral and tibial tunnel walls.
L'autogreffe obtenue ainsi n'est pas utilisée telle que mais fait l'objet d'un renforcement obtenu par l'adjonct d'un brin de textile biocompatible tissé ou tressé que l place dans le greffon, lequel a la forme d'une bande aplat dont on rabat les côtés de façon à emballer le brin implant) de renforcement et on suture longitudinale ent par surjet ou des points séparés.The autograft obtained in this way is not used as such but is the subject of a reinforcement obtained by adding a strand of biocompatible woven or braided textile which is placed in the graft, which has the shape of a flat band whose sides are folded so as to wrap the implant strand) of reinforcement and are sutured longitudinally by overlock or separate stitches.
La fixation aux extrémités se fait par une suture tr osseuse sur le bloc osseux supérieur qui ira se placer dans puits fémoral et par une suture de renfort sur la partie plus basse du tendon rotulien juste avant le bloc os tibial.The fixation at the ends is done by a bony suture on the upper bone block which will be placed in the femoral well and by a reinforcement suture on the part lower patellar tendon just before the tibial bone block.
Une fois le greffon uni à son implant de renforcement le fixe dans lesdits tunnels osseux. Dans ce mode de renforcement, l'élément de renforcemen présente sous la forme d'un rectangle plat de tresse o tissu peu pratique à fixer sur le greffon et manq singulièrement d'élasticité une fois plié en deux dans le de la longueur. Le but de la présente invention est de proposer nouvelle technique de renforcement d'un tel greffon facili la mise en place du greffon et augmentant la résist dynamique de l'élément de renforcement.Once the graft is united with its reinforcement implant, it is fixed in said bone tunnels. In this method of reinforcement, the reinforcing element has the form of a flat rectangle of braid or fabric which is not very practical to fix on the graft and is particularly lacking in elasticity when folded in half lengthwise. The aim of the present invention is to propose a new technique for reinforcing such a graft facilitating the placement of the graft and increasing the dynamic resist of the reinforcing element.
A cet effet, l'invention a pour objet un greffon renf pour ligamentoplastie du genou, du type constitué prélèvement sur le tendon rotulien en forme de bande apl dont les bords longitudinaux sont rabattus et suturés, sorte d'inclure à l'intérieur un élément de renforcement fibres tressées ou tissées, fixé, d'une part, au ten rotulien et, d'autre part, au bloc osseux dudit tendon dest à être reçu dans un tunnel ménagé dans le fémur, caractér en ce que ledit élément de renforcement est une tre tubulaire.To this end, the subject of the invention is a renal graft for knee ligamentoplasty, of the constituted type removal from the patellar tendon in the form of apl band, the longitudinal edges of which are folded down and sutured, so as to include an element inside. reinforcing braided or woven fibers, fixed, on the one hand, to the patellar ten and, on the other hand, to the bone block of said tendon intended to be received in a tunnel formed in the femur, characterized in that said reinforcing element is a tubular.
Un tel greffon renforcé présente une résistance dynami bien supérieure à celle procurée pas des éléments renforcements en forme de bande aplatie dont les bo longitudinaux sont rabattus lors de l'emballage de l'élém par le greffon.Such a reinforced graft has a dynami resistance much greater than that provided by reinforcing elements in the form of a flattened strip, the longitudinal bo of which are folded down during the packaging of the element by the graft.
En effet, un tel repliage de la bande de renforcem altère ses propriétés mécaniques alors qu'un élément renforcement tubulaire conforme à l'invention préserve capital d'élasticité de la tresse dont la forme générale n' pas modifiée lors de la mise en place à l'intérieur greffon. Avantageusement, l'élément de renforcement en forme tresse tubulaire est rendu solidaire, d'une part, à l'une ses extrémités, du bloc osseux fémoral par l'intermédia d'un embout plat solidaire de ladite tresse , plaqué maintenu par tous moyens appropriés contre une face incli aménagée à cet effet dans la face postérieure dudit bl osseux fémoral et, d'autre part, sur toute sa longueur, tendon rotulien, par tous moyens appropriés.Indeed, such a folding of the reinforcement strip alters its mechanical properties while a tubular reinforcement element in accordance with the invention preserves the elasticity of the braid, the general shape of which is not modified during the positioning at inside graft. Advantageously, the reinforcing element in the form of a tubular braid is made integral, on the one hand, at one of its ends, of the femoral bone block by means of a flat endpiece integral with said braid, plated held by any means suitable against an inclined face arranged for this purpose in the rear face of said bl femoral bone and, on the other hand, over its entire length, patellar tendon, by all appropriate means.
La solidarisation de l'élément de renforcement et du b osseux fémoral est par exemple réalisé par un fil en matér biocompatible engagé dans un trou ménagé à cet effet d ledit embout de la tresse et ceinturant ledit bloc osseux.The attachment of the reinforcing element and the femoral bone b is for example produced by a wire made of biocompatible material engaged in a hole provided for this purpose in said end of the braid and encircling said bone block.
La solidarisation de l'élément de renforcement et tendon rotulien est assurée par exemple par des f longitudinaux en U en matériau biocompatible, disposés place en place le long dudit élément de renforcement.The strengthening of the patellar tendon and reinforcing element is ensured for example by longitudinal U-shaped f of biocompatible material, placed in place along said reinforcing element.
D'autres caractéristiques et avantages ressortiront de description qui va suivre d'un mode de réalisation dispositif selon l'invention, description donnée à tit d'exemple uniquement et en regard des dessins annexés s lesquels :Other characteristics and advantages will emerge from the following description of an embodiment of the device according to the invention, description given by way of example only and with reference to the accompanying drawings, in which:
Figure 1 est une vue en perspective d'un élément renforcement constitué d'une tresse tubulaire ;Figure 1 is a perspective view of a reinforcement element consisting of a tubular braid;
Figure 2 est une vue de dessus d'un greffon muni son élément de renforcement, avant le recouvrement celui-ci ;Figure 2 is a top view of a graft provided with its reinforcing element, before covering it;
Figure 3 est une vue en élévation latérale dispositif de la figure 2 ;Figure 3 is a side elevational view device of Figure 2;
- Figure 4 est une vue similaire à celle de la figure illustrant le recouvrement de l'élément renforcement par le greffon ;- Figure 4 is a view similar to that of the figure illustrating the recovery of the reinforcement element by the graft;
Figure 5 est une coupe transversale du greff renforcé de la figure 4 ;Figure 5 is a cross section of the reinforced graft of Figure 4;
Figure 6 est une vue agrandie de l'extrémité fémora du greffon renforcé, et - Figure 7 est une vue en perspective du greff renforcé prêt à être mis en place.Figure 6 is an enlarged view of the femora end of the reinforced graft, and - Figure 7 is a perspective view of the reinforced graft ready to be put in place.
Sur la figure 1, on a représenté un élément renforcement constitué d'une tresse tubulaire 1 en fibr d'un matériau biocompatible, par exemple du polypropylèn terminée, à une extrémité, par un embout de raccordement dans le même matériau que les fibres.In Figure 1, there is shown a reinforcing element consisting of a tubular braid 1 in a fiber of a biocompatible material, for example polypropylene terminated, at one end, by a connection end piece in the same material as the fibers.
Cet embout 2 est de forme plate et allongée, l'une des s extrémités est soudée à l'extrémité de la tresse tubulaire et un trou 3 est percé dans l'embout 2. Le trou 3 e susceptible de recevoir un fil ou lien destiné à une sutu trans osseuse sur le bloc osseux fémoral de la greffe et/ contribuer à la mise en place dudit bloc osseux par emboî dans son tunnel.This end piece 2 is flat and elongated, one of the ends is welded to the end of the tubular braid and a hole 3 is drilled in the end piece 2. The hole 3 e capable of receiving a wire or link intended to a sutu trans bone on the femoral bone block of the graft and / contribute to the establishment of said bone block by fitting into its tunnel.
A l'autre extrémité de la tresse tubulaire 1 les fi sont bloquées à leur extrémité par une simple sou terminale 4.At the other end of the tubular braid 1, the fi are blocked at their end by a simple terminal sou 4.
Sur la figure 2, on a représenté un greffon traditio prélevé sur le tendon rotulien et comprenant une pa tendineuse 5 en forme de bande plate rectangulaire reli ses extrémités à deux blocs osseux, respectivement fémor et tibial 7 qui iront se placer dans des tunnels ménagés à effet dans le fémur et le tibia aux lieu et place du liga croisé antérieur.In Figure 2, there is shown a traditio graft taken from the patellar tendon and comprising a tendon pa 5 in the form of a rectangular flat band connecting its ends to two bony blocks, femor and tibial respectively 7 which will be placed in tunnels arranged at effect in the femur and tibia in place of the anterior cruciate liga.
Conformément à l'invention, on place contre la postérieure de la partie 5 du tendon rotulien l'élément renforcement tubulaire 1 de la figure 1, que l'on sutur l'une de ses extrémités (côté embout 2) sur le bloc os fémoral 6, on fixe l'élément 1 au tendon rotulien 5, de p en place, par des fils longitudinaux en U 8 (figure 2 et par exemple en polypropylène, et l'on enveloppe ou emballe la manière connue, l'élément 1 par rabattement l'un l'autre des bords longitudinaux du tendon 5 (Figure 4) .In accordance with the invention, the tubular reinforcement element 1 of FIG. 1 is placed against the posterior of part 5 of the patellar tendon, which is sutured on one of its ends (tip side 2) on the femoral bone block 6, the element 1 is fixed to the patellar tendon 5, from p in place, by longitudinal U-shaped wires 8 (FIG. 2 and for example made of polypropylene, and the known manner is wrapped or wrapped, the element 1 by folding each other of the longitudinal edges of the tendon 5 (Figure 4).
Le tendon rotulien 5 est alors suturé bord à bord (fiThe patellar tendon 5 is then sutured edge to edge (fi
4) sur toute sa longueur à l'aide d'un fil 9 de même type le fil 8.4) over its entire length using a wire 9 of the same type, wire 8.
La figure 5 illustre en coupe l'ensemble ainsi obt constitué d'une enveloppe tubulaire externe formée par tendon rotulien 5 et de la tresse tubulaire creuse 1 inter coaxiale au tendon. L'embout 2 de la tresse tubulaire 1 est plaqué contre face inclinée 10 (figure 3) ménagée à cet effet sur la f postérieure du bloc osseux fémoral 6 et suturé avec l'a d'un lien 11 passant dans le trou 3 de l'embout 2 ceinturant le bloc osseux 6. L'autre extrémité (4) de la tresse 1 s'arrête au b osseux tibial 7 et est simplement en contact avec ce d niFigure 5 illustrates in section the assembly thus obtained consisting of an outer tubular envelope formed by patellar tendon 5 and the hollow tubular braid 1 inter coaxial with the tendon. The end piece 2 of the tubular braid 1 is pressed against the inclined face 10 (FIG. 3) formed for this purpose on the posterior f of the femoral bone block 6 and sutured with the a of a link 11 passing through the hole 3 of the tip 2 encircling the bone block 6. The other end (4) of the braid 1 stops at the tibial bone b 7 and is simply in contact with this d ni
Cette extrémité est reçue dans un léger creux exist naturellement ou ménagé à cet effet dans la zone intéressée bloc osseux 7. On évite ainsi toute détérioration ultérieure du b osseux distal 7.This end is received in a slight hollow naturally existing or formed for this purpose in the area concerned bone block 7. This prevents any further deterioration of the distal bone b 7.
De préférence, on aménagera l'extrémité du bloc oss fémoral 6 destinée à recevoir l'embout 2, par exemple creusant légèrement pour une meilleure intégration de l'emb dont l'épaisseur peut avantageusement se réduire en dir ct de l'extrémité, le but essentiel étant que l'embout 2 en pl sur le bloc osseux 6 ne fasse pas saillie par rapport à dernier et ne gêne pas son introduction dans le tunnel oss fémoral récepteur et sa fixation.Preferably, the end of the femoral bone block 6 intended to receive the end piece 2 will be arranged, for example digging slightly for better integration of the end piece, the thickness of which can advantageously be reduced in direction from the end, the essential goal being that the tip 2 pl on the bone block 6 does not protrude relative to the latter and does not interfere with its introduction into the receiving femoral bone tunnel and its fixation.
La fixation du bloc osseux 6, de même que celle du b osseux 7 dans son tunnel tibial, s'effectue à la mani connue, par des vis dite d'interférence vissées à cheval l'os du fémur et sur les blocs osseux (6,7) et p précisément la partie corticale, 6a et 7a respectiveme desdits blocs osseux.The fixation of the bone block 6, as well as that of the bone b 7 in its tibial tunnel, is carried out in the known manner, by so-called interference screws screwed astride the bone of the femur and on the bone blocks (6 , 7) and p specifically the cortical part, 6a and 7a respectively of said bone blocks.
Sur la figure 7, on a représenté en perspective un gref selon l'invention vu par son extrémité proxi ale (bloc oss fémoral 6) .Ce bloc osseux 6, comme le bloc osseux 7, a section triangulaire avec une face antérieure constituée l'os cortical (6a, 7a) , la partie restante (6b, 7b) du bl osseux étant de l'os spongieux.In Figure 7, there is shown in perspective a graft according to the invention seen by its proximal end (femoral bone block 6). This bone block 6, like the bone block 7, has a triangular section with an anterior face formed the cortical bone (6a, 7a), the remaining part (6b, 7b) of the bony bl being spongy bone.
La fixation de l'embout 2 s'effectuant sur la fa postérieure (os spongieux 6b) la présence de la v d'interférence sur le côté du bloc osseux 6 n'endommage aucune manière l'extrémité de l'élément de renforcement 1.The attachment of the endpiece 2 being effected on the posterior FA (cancellous bone 6b) the presence of the interference v on the side of the bone block 6 does not in any way damage the end of the reinforcing element 1.
La présence du lien 11 est surtout nécessaire le temps la manipulation et de la mise en place du greffon, jusqu'à fixation de la vis d'interférence. Les blocs osseux 6, 7 sont également munis de fils 12 po faciliter la manipulation de la greffe et sa mise en pla dans les tunnels osseux.The presence of the link 11 is especially necessary during the manipulation and the placement of the graft, until the interference screw is fixed. The bone blocks 6, 7 are also provided with 12 "wires to facilitate the handling of the graft and its placement in the bone tunnels.
Les fils 12 du bloc osseux fémoral 6 peuvent servi conjointement avec un fil qui serait passé dans le trou 3 l'embout, à la mise en place du bloc osseux 6 dans s logement osseux constitué d'un puits dont le fond est per d'un canal pour le passage desdits fils. Une traction exerc sur ces fils permet ainsi d'insérer et de bloquer le bl osseux 6 dans son puits. La prévision d'un élément de renforcement tubulai assure, d'une part, une répartition homogène et isotrope propriétés physiques (résistances à la traction, à la tors dudit élément et, d'autre part, d'excellentes élasticit souplesse, notamment des capacités remarquables d'élbnga et de rétraction axiales.The wires 12 of the femoral bone block 6 can be used jointly with a wire which would have passed through the hole 3 the end piece, when the bone block 6 is placed in the bone housing consisting of a well, the bottom of which is per a channel for the passage of said wires. A traction exerted on these wires thus makes it possible to insert and block the bone bl 6 in its well. The provision of a tubular reinforcement element ensures, on the one hand, a homogeneous and isotropic distribution of physical properties (tensile strengths, torsion of said element and, on the other hand, excellent elasticity flexibility, in particular capacities remarkable axial elbnga and retraction.
Bien entendu, l'invention n'est pas limitée au mode réalisation représenté et décrit ci-dessus mais en couvre contraire toutes les variantes, notamment en ce qui conc les moyens de solidarisation entre l'élément de renforceme et la partie tendineuse 5, ainsi que le bloc osseux fémoral Of course, the invention is not limited to the embodiment shown and described above but on the contrary covers all variants, in particular as regards the means of attachment between the reinforcing element and the tendon part 5, as well that the femoral bone block

Claims

R E V E N D I C A T I O N S
1. Greffon renforcé pour ligamentoplastie du genou, type constitué d'un prélèvement sur le tendon rotulien forme de bande aplatie (5) dont les bords longitudinaux so rabattus et suturés, en sorte d'inclure à l'intérieur élément de renforcement (1) de fibres tressées ou tissée fixé, d'une part, au tendon rotulien (5) et, d'autre part, bloc osseux (6) dudit tendon destiné à être reçu dams tunnel ménagé dans le fémur, caractérisé en ce que led élément de renforcement (1) est une tresse tubulaire. 1. Reinforced graft for knee ligamentoplasty, type consisting of a levy on the patellar tendon in the form of a flattened band (5) whose longitudinal edges are folded down and sutured, so as to include inside the reinforcement element (1) of braided or woven fibers fixed, on the one hand, to the patellar tendon (5) and, on the other hand, bone block (6) of said tendon intended to be received in a tunnel formed in the femur, characterized in that the element of reinforcement (1) is a tubular braid.
2. Greffon suivant la revendication 1, caractérisé en que ledit élément de renforcement (1) en forme de tres tubulaire est rendu solidaire, d'une part, à l'une de s extrémités, du bloc osseux fémoral (6) par l'intermédiai d'un embout plat (2) solidaire de ladite tresse (1), plaq et maintenu par tous moyens appropriés contre une fa inclinée (10) aménagée à cet effet dans la face postérieu dudit bloc osseux fémoral et, d'autre part, sur toute longueur, du tendon rotulien (5) , par tous moyens appropriés.2. Graft according to claim 1, characterized in that said reinforcing element (1) in the shape of a very tubular is made integral, on the one hand, at one of s ends, of the femoral bone block (6) by the intermediai of a flat tip (2) integral with said braid (1), plate and held by any suitable means against an inclined fa (10) arranged for this purpose in the posterior face of said femoral bone block and, on the other hand, over any length, patellar tendon (5), by any appropriate means.
3. Greffon suivant la revendication 2, caractérisé en que la solidarisation de l'élément de renforcement (1) e"t bloc osseux fémoral (6) est réalisée par un fil en matéri biocompatible (11) engagé dans un trou (3) ménagé à cet eff dans ledit embout (2) de la tresse (1) et ceinturant led bloc osseux (6) . 3. Graft according to claim 2, characterized in that the connection of the reinforcement element (1) and "femoral bone block (6) is carried out by a wire made of biocompatible material (11) engaged in a hole (3) provided for this purpose in said end piece (2) of the braid (1) and surrounding the bone block led (6).
4. Greffon suivant la revendication 1 ou 2, caractérisé ce que la solidarisation de l'élément de renforcement (1) du tendon rotulien (5) est assurée par des fils longitudina en U (8) en matériau biocompatible, disposés de place en pla le long dudit élément de renforcement (1) . 4. Graft according to claim 1 or 2, characterized in that the connection of the reinforcement element (1) of the patellar tendon (5) is ensured by longitudinal U-shaped wires (8) made of biocompatible material, placed in place in place. along said reinforcing element (1).
5. Greffon suivant l'une des revendications 2 à caractérisé en ce que ledit embout (2) de la tresse (1) e reçu dans un creux ménagé à cet effet dans ladite fa postérieure (10) du bloc osseux fémoral (6) .5. Graft according to one of claims 2 to characterized in that said tip (2) of the braid (1) e received in a hollow formed for this purpose in said posterior fa (10) of the femoral bone block (6).
6. Greffon suivant l'une des revendications 2 à caractérisé en ce que l'extrémité de la tresse (1) oppos audit embout (2) est constituée d'une soudure (4) de bloca des fibres de la tresse (1) , reçue dans un creux exista naturellement ou ménagé à cet effet dans la zone intéressé bloc osseux tibial (7) .6. Graft according to one of claims 2 to characterized in that the end of the braid (1) opposite to said end piece (2) consists of a weld (4) of block of fibers of the braid (1), received in a hollow existed naturally or arranged for this purpose in the area concerned tibial bone block (7).
7. Greffon suivant l'une des revendications 1 à caractérisé en ce que l'élément de renforcement tubulaire est constitué de fibres tressées de polypropylène. 7. Graft according to one of claims 1 to characterized in that the tubular reinforcing element consists of braided polypropylene fibers.
PCT/FR1992/001070 1991-11-18 1992-11-18 Reinforced graft for knee ligament surgery WO1993009730A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP93900259A EP0614346A1 (en) 1991-11-18 1992-11-18 Reinforced graft for knee ligament surgery

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR91/14460 1991-11-18
FR9114460A FR2683716B1 (en) 1991-11-18 1991-11-18 REINFORCED GRAFT FOR LIGAMENTOPLASTY OF THE KNEE.

Publications (1)

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WO1993009730A1 true WO1993009730A1 (en) 1993-05-27

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PCT/FR1992/001070 WO1993009730A1 (en) 1991-11-18 1992-11-18 Reinforced graft for knee ligament surgery

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AU (1) AU3163593A (en)
FR (1) FR2683716B1 (en)
WO (1) WO1993009730A1 (en)

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US5397357A (en) * 1993-02-18 1995-03-14 Arthrex, Inc. Method for preparing a bone-tendon-bone core graft
WO1995008295A2 (en) * 1993-09-20 1995-03-30 Bartlett Edwin C Apparatus and method for anchoring sutures
WO1995019141A2 (en) * 1994-01-13 1995-07-20 Mcguire David A Bone-cutting guide
FR2729559A1 (en) * 1995-01-25 1996-07-26 Cousin Freres Sa Textile ligament reinforcement, esp. for knee joint
FR2743294A1 (en) * 1996-01-05 1997-07-11 Ethnor Mesh anchor for bone anchorage of a ligamentary transplant especially for repairing ligaments of the knee
FR2745710A1 (en) * 1996-03-11 1997-09-12 Rippstein Pascal Francois TENDON PASSING DEVICE
US5681320A (en) * 1991-12-13 1997-10-28 Mcguire; David A. Bone-cutting guide
US5961538A (en) * 1996-04-10 1999-10-05 Mitek Surgical Products, Inc. Wedge shaped suture anchor and method of implantation
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Publication number Priority date Publication date Assignee Title
US5681320A (en) * 1991-12-13 1997-10-28 Mcguire; David A. Bone-cutting guide
US5397357A (en) * 1993-02-18 1995-03-14 Arthrex, Inc. Method for preparing a bone-tendon-bone core graft
US8021390B2 (en) 1993-09-20 2011-09-20 Bartlett Edwin C Apparatus and method for anchoring sutures
WO1995008295A3 (en) * 1993-09-20 1995-06-15 Edwin C Bartlett Apparatus and method for anchoring sutures
US6749620B2 (en) 1993-09-20 2004-06-15 Edwin C. Bartlett Apparatus and method for anchoring sutures
US7998171B2 (en) 1993-09-20 2011-08-16 Depuy Mitek, Inc. Apparatus and method for anchoring sutures
US7217280B2 (en) 1993-09-20 2007-05-15 Bartlett Edwin C Apparatus and method for anchoring sutures
WO1995008295A2 (en) * 1993-09-20 1995-03-30 Bartlett Edwin C Apparatus and method for anchoring sutures
US5782863A (en) * 1993-09-20 1998-07-21 Bartlett; Edwin C. Apparatus and method for anchoring sutures
US5879372A (en) * 1993-09-20 1999-03-09 Bartlett; Edwin C. Apparatus and method for anchoring sutures
US6923823B1 (en) 1993-09-20 2005-08-02 Edwin C. Bartlett Apparatus and method for anchoring sutures
WO1995019141A2 (en) * 1994-01-13 1995-07-20 Mcguire David A Bone-cutting guide
WO1995019141A3 (en) * 1994-01-13 1995-08-31 David A Mcguire Bone-cutting guide
FR2729559A1 (en) * 1995-01-25 1996-07-26 Cousin Freres Sa Textile ligament reinforcement, esp. for knee joint
FR2743294A1 (en) * 1996-01-05 1997-07-11 Ethnor Mesh anchor for bone anchorage of a ligamentary transplant especially for repairing ligaments of the knee
US6143029A (en) * 1996-03-11 2000-11-07 Rippstein; Pascal Francois Tendon guide device
WO1997033535A1 (en) * 1996-03-11 1997-09-18 Rippstein Pascal Francois Tendon guide device
FR2745710A1 (en) * 1996-03-11 1997-09-12 Rippstein Pascal Francois TENDON PASSING DEVICE
US6270518B1 (en) 1996-04-10 2001-08-07 Mitek Surgical Products, Inc. Wedge shaped suture anchor and method of implantation
US6726707B2 (en) 1996-04-10 2004-04-27 Mitek Surgical Products Inc. Wedge shaped suture anchor and method of implementation
US5961538A (en) * 1996-04-10 1999-10-05 Mitek Surgical Products, Inc. Wedge shaped suture anchor and method of implantation
US7232455B2 (en) 1996-04-10 2007-06-19 Depuy Mitek, Inc. Wedge shaped suture anchor and method of implantation
DE10131699A1 (en) * 2001-06-29 2003-01-16 Tutogen Medical Gmbh implant

Also Published As

Publication number Publication date
FR2683716A1 (en) 1993-05-21
AU3163593A (en) 1993-06-15
EP0614346A1 (en) 1994-09-14
FR2683716B1 (en) 1994-01-21

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