WO1994009720A1 - Artificial ligament and process for its manufacture - Google Patents

Artificial ligament and process for its manufacture Download PDF

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Publication number
WO1994009720A1
WO1994009720A1 PCT/FR1993/001053 FR9301053W WO9409720A1 WO 1994009720 A1 WO1994009720 A1 WO 1994009720A1 FR 9301053 W FR9301053 W FR 9301053W WO 9409720 A1 WO9409720 A1 WO 9409720A1
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WIPO (PCT)
Prior art keywords
ligament
intra
width
cords
articular
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PCT/FR1993/001053
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French (fr)
Inventor
Jacques-Philippe Laboureau
Original Assignee
Laboureau Jacques Philippe
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Publication date
Application filed by Laboureau Jacques Philippe filed Critical Laboureau Jacques Philippe
Priority to JP6510770A priority Critical patent/JPH07506995A/en
Priority to AU53731/94A priority patent/AU5373194A/en
Priority to EP93924116A priority patent/EP0618787A1/en
Publication of WO1994009720A1 publication Critical patent/WO1994009720A1/en

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    • 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

Definitions

  • the present invention relates to an artificial ligament and its manufacturing process.
  • a large number of types of artificial ligaments are known which are intended to replace articular ligaments.
  • ligaments formed by folding or rolling textile bands of a biocompatible material, woven or knitted so as to leave free or, on the contrary, to bind together the longitudinal fibers of the ligament.
  • it has been proposed to produce braided ligaments, with a greater or lesser twist, with the aim of improving the elasticity qualities of the artificial ligaments by reversible deformation of the turns thus formed along said ligaments.
  • the present invention aims to further improve the response of current ligaments to the stresses to which they are subjected once implanted in the injured joints by proposing to approach as close as possible to the geometry and the configuration. fibers of a natural joint ligament.
  • the present invention relates to an artificial ligament for the replacement of a natural articular ligament, comprising two end intraosseous parts and an intermediate intra articular part, characterized in that at least said intra articular part is formed.
  • the length over which the width is slit is at most equal to that of the intra-articular part of the ligament, so that the two fiber cords of the ligament are independent of each other only in the middle of the intra-articular area of implantation of said ligament.
  • the ligament may be made from two rolled half-widths which will then be sewn at the two ends over an adequate length to constitute the intraosseous parts.
  • the structure in two twisted cords of the ligament according to the invention provides, for the replacement of the anterior cruciate ligament of the knee, a completely new and surprising biomechanical advantage compared to previously known ligaments.
  • the anterior cruciate ligament undergoes a twist of about a quarter of a turn when the knee passes from its flexion position to its maximum extension position; by implanting an artificial ligament twisted in the same direction as this natural movement of torsion between the tibia and the internal femoral condyle on the knee in flexion, one can make so that, in position of extension of the knee, the two rolled cords forming the ligament untwist, then presenting a perfectly parallel structure. If, in this geometry, provision has been made to make the ligament from a knitted width preserving the parallelism of the longitudinal fibers, the latter will then be able to withstand the forces applied to the implanted ligament in their own longitudinal direction.
  • This arrangement therefore allows the longitudinal fibers to be parallel to each other when the knee is close to the extension, that is to say in the position where it is usually traumatized during sprains; there is thus a progressive recruitment of the fibers during tensioning efforts, which is accompanied by a damping effect comparable to that of a natural ligament.
  • a width is fixed flat, knitted over all or part of its length, in a longitudinal drive device, parallel to the edges of said width,
  • the width is advanced towards a calibrated circular opening, through a converging nozzle, symmetrical in the longitudinal direction, while applying to said width a force intended to keep it flat, at least in the middle,
  • either the ligament is gradually pivoted on itself at least a quarter of a turn before being sewn.
  • the longitudinal fibers of the width used to form the ligament are stranded when knitting said width, so that after rolling, the ends of the ligament are twisted at least a quarter of a turn by compared to each other.
  • the amount of rotation of the two cords can of course be perfectly determined by means of various tests carried out at the time of knitting.
  • FIG. 1 is a partially exploded perspective view of the artificial ligament according to the invention
  • FIG. 2 is a plan view of the knitted and slit width serving to obtain by convolute rolling the ligament represented in FIG. 1,
  • FIGS 3 to 5 are views in sagittal section of the tibio-femoral joint showing the pivoting on itself of the anterior cruciate ligament of the knee between the position of extension and the position of maximum flexion.
  • the articular ligament represented in the figures comprises two end intraosseous parts 1 and an intraarticular part 2, which are obtained from a knitted textile width 3 having, along a median longitudinal axis, a slot 3 intended to form, after convolute rolling of said width 4 parallel to its lateral edges, an opening 5 separating two cords 6 of the intra-articular part 2 of the ligament.
  • the slot 3 has a length such that the intraosseous parts 1 comprising two contiguous cords, linked together by a transverse seam 1b.
  • the two intra-articular cords 6 of the ligament are therefore of identical lengths, so that the distribution of the tensile forces is distributed uniformly between the two cords 6.
  • the means for producing the ligament allow to print a final rotation of approximately 180 ° between the two intraosseous parts 1 of the ligament.
  • the rotation will be dextrorotatory or levorotatory depending on the type of right or left ligament produced.
  • the longitudinal, so-called technical, fibers of the width used for the production of the ligament are held together by a warp knitting, that is to say a knitted fabric knitted offering a high roughness and limiting the offset of said fibers. longitudinal with respect to their axis. Roughness is useful in the intraosseous areas to allow good bone re-stabilization of the implanted ligament.
  • FIGS. 3 to 5 An example of implantation of the artificial articular ligament shown in FIGS. 1 and 2 has been shown in FIGS. 3 to 5 in place of the anterior cruciate ligament of the knee.
  • the knee is shown in the position of maximum extension; in this position, the artificial ligament is stretched between the tibia 9 and the internal condyle of the femur 10 by presenting its two cords 8 parallel to each other. The longitudinal fibers making up the ligament are then recruited gradually with a damping effect already mentioned above.
  • FIG. 4 the knee is slightly bent, which causes the ligament to begin to twist as the condyles of the femur 10 roll on the tibial plates.
  • the knee is in maximum flexion; at this time, the end of the ligament implanted in the femoral tunnel has practically pivoted by an angle of 180 °. It is in this latter position that the anterior cruciate ligaments are generally implanted; we therefore understand that the pre-twisted ligament according to the invention is particularly suitable for this prosthetic operation and has, in the latter case, biomechanical qualities of stability and iso-stria almost ideal.
  • the invention is of course not limited to the description which has just been given, but on the contrary extends to the production of any articular ligament commonly implanted prosthetics, such as lateral or crossed knee ligaments, spinal ligaments and shoulder ligaments.

Abstract

Artificial ligament for the replacement of a natural articular ligament, including two extreme intra-bone portions (1) and an intermediate intra-articular portion. Said artificial ligament is characterized in that at least said intra-articular portion (2) is formed from two strands (6) of independent longitudinal fibres obtained by rolling over one another two knitted fabric widths, or two half widths of a single knitted fabric partially split in its median part along a length at least equal to that of said intra-articular part (2). The two extreme intra-bone portions (1) are twisted at least a quarter of a turn in relation to one another when the ligament is positioned in the articulation. The invention also concerns a process for the manufacture of said ligament.

Description

LIGAMENT ARTIFICIEL ET SON PROCEDE DE CONFECTION ARTIFICIAL LIGAMENT AND ITS MANUFACTURING METHOD
La présente invention concerne un ligament artificiel et son procédé de confection.The present invention relates to an artificial ligament and its manufacturing process.
On connaît un grand nombre de type de ligaments artificiels destinés au remplacement de ligaments articulaires. En particulier, on connaît les ligaments formés par pliage ou roulage de bandes textiles d'un matériau biocompatible, tissées ou tricotées de manière à laisser libres ou, au contraire, à lier entre elles les fibres longitudinales du ligament. A cet égard, il a été proposé de réaliser des ligaments tressés, avec une torsion plus ou moins grande, dans l'objectif d'améliorer les qualités d'élasticité des ligaments artificiels par déformation réversible des spires ainsi formées le long desdits ligaments. On a également proposé d'enrober, sur toute ou partie de leur longueur, les ligaments ainsi tressés ou toronnés avec des résines biocompatibles visco- élastiques. On a enfin préconisé d'associer plusieurs faisceaux individualisés les uns des autres dans un même ligament, ces faisceaux étant ou non croisés. Tous ces ligaments antérieurs présentent incontestablement des qualités dynanométriques élevées. La présente invention, sans remettre en cause les techniques précédentes, vise à améliorer encore la réponse des ligaments actuels aux sollicitations auxquelles ils sont soumis une fois implantés dans les articulations lésées en proposant de s'approcher au plus près de la géométrie et de la configuration des fibres d'un ligament articulaire naturel. A cet effet, la présente invention concerne un ligament artificiel pour le remplacement d'un ligament naturel articulaire, comportant deux parties extrêmes intra-osseuses et une partie intermédiaire intra- articulaire, caractérisé en ce qu'au moins ladite partie intra-articulaire est formée de deux cordons de fibres longitudinales indépendants, obtenus par roulage sur elles-mêmes de deux laizes tricotées, ou de deux demi- laizes d'une laize tricotée unique partiellement fendue en sa partie médiane sur une longueur au moins égale à celle de ladite partie intra-articulaire, les deux parties extrêmes intra-osseuses étant tordues d'au moins un quart de tour l'une par rapport à l'autre lorsque le ligament est mis en place dans l'articulation. Préférentiellement, la longueur sur laquelle la laize est fendue est au plus égale à celle de la partie intra-articulaire du ligament, de sorte que les deux cordons de fibres du ligament ne sont indépendants l'un de l'autre qu'au milieu de la zone intra-articulaire d'implantation dudit ligament.A large number of types of artificial ligaments are known which are intended to replace articular ligaments. In particular, there are known ligaments formed by folding or rolling textile bands of a biocompatible material, woven or knitted so as to leave free or, on the contrary, to bind together the longitudinal fibers of the ligament. In this regard, it has been proposed to produce braided ligaments, with a greater or lesser twist, with the aim of improving the elasticity qualities of the artificial ligaments by reversible deformation of the turns thus formed along said ligaments. It has also been proposed to coat, over all or part of their length, the ligaments thus braided or stranded with viscoelastic biocompatible resins. Finally, it was recommended to associate several beams individualized from each other in the same ligament, these beams being or not crossed. All these anterior ligaments undoubtedly have high dynanometric qualities. The present invention, without calling into question the previous techniques, aims to further improve the response of current ligaments to the stresses to which they are subjected once implanted in the injured joints by proposing to approach as close as possible to the geometry and the configuration. fibers of a natural joint ligament. To this end, the present invention relates to an artificial ligament for the replacement of a natural articular ligament, comprising two end intraosseous parts and an intermediate intra articular part, characterized in that at least said intra articular part is formed. of two independent longitudinal fiber cords, obtained by rolling on themselves two knitted widths, or two half-widths of a single knitted width partially split in its middle part over a length at least equal to that of said intra-articular part, the two end intra-osseous parts being twisted by at least a quarter of a turn relative to each other when the ligament is placed in the joint. Preferably, the length over which the width is slit is at most equal to that of the intra-articular part of the ligament, so that the two fiber cords of the ligament are independent of each other only in the middle of the intra-articular area of implantation of said ligament.
Dans une autre variante exactement opposée, le ligament pourra être fabriqué à partir de deux demi-laizes roulées qui seront ensuite cousues aux deux extrémités sur une longueur adéquate pour constituer les parties intra- osseuses.In another exactly opposite variant, the ligament may be made from two rolled half-widths which will then be sewn at the two ends over an adequate length to constitute the intraosseous parts.
On a mis en évidence qu'un ligament à deux cordons présentait des qualités de résistance à la traction très supérieures à celles d'un ligament obtenu par roulage en un seul cordon de la même laize, qu'il présente ou non une torsion. A cet égard, on a même pu constater que, contrairement à l'opinion généralement admise, une torsion trop importante du cordon s'avérait étonnement néfaste à la résistance en traction. En fait, on comprend que la répartition des efforts entre les deux cordons légèrement tordus d'un ligament artificiel selon l'invention soit relativement bonne, et en tout cas meilleure que celle que l'on peut obtenir avec un ensemble ultifilamentaire tressé avec une torsion beaucoup plus importante, chaque fibre de cet ensemble ne travaillant alors plus dans sa direction longitudinale propre. En outre, des études mécaniques ont démontré qu'un ligament artificiel idéal serait constitué de fibres longitudinales agencées librement autour de plusieurs centres, normalement deux, ce qui permet de reconstituer assez fidèlement la progressivité et la spécificité du recrutement ligamentaire lors de la flexion-extension.It has been demonstrated that a ligament with two cords exhibited qualities of tensile strength far superior to those of a ligament obtained by rolling in a single cord of the same width, whether or not it has a twist. In this regard, it has even been observed that, contrary to generally accepted opinion, too great a twist of the cord was surprisingly harmful to the tensile strength. In fact, it is understood that the distribution of the forces between the two slightly twisted cords of an artificial ligament according to the invention is relatively good, and in any case better than that which can be obtained with an ultifilamentary assembly braided with a twist. much larger, each fiber of this assembly then no longer working in its own longitudinal direction. In addition, mechanical studies have shown that an ideal artificial ligament would consist of longitudinal fibers arranged freely around several centers, normally two, which allows to fairly faithfully reconstruct the progressiveness and specificity of ligament recruitment during flexion-extension. .
D'un autre côté, la structure en deux cordons tordus du ligament selon l'invention procure, pour le remplacement du ligament croisé antérieur du genou, un avantage biomécanique tout à fait nouveau et surprenant par rapport aux ligaments antérieurement connus. En effet, on sait que le ligament croisé antérieur subit une torsion d'environ un quart de tour lorsque le genou passe de sa position de flexion à sa position d'extension maximales ; en implantant un ligament artificiel torsadé dans le même sens que ce mouvement naturel de torsion entre le tibia et le condyle fémoral interne sur le genou en flexion, on peut faire en sorte que, en position d'extension du genou, les deux cordons roulés formant le ligament se détordent, présentant alors une structure parfaitement parallèle. Si, dans cette géométrie, on a prévu de réaliser le ligament à partir d'une laize tricotée préservant le parallélisme des fibres longitudinales, ces dernières pourront alors supporter les efforts appliqués au ligament implanté suivant leur direction longitudinale propre.On the other hand, the structure in two twisted cords of the ligament according to the invention provides, for the replacement of the anterior cruciate ligament of the knee, a completely new and surprising biomechanical advantage compared to previously known ligaments. Indeed, we know that the anterior cruciate ligament undergoes a twist of about a quarter of a turn when the knee passes from its flexion position to its maximum extension position; by implanting an artificial ligament twisted in the same direction as this natural movement of torsion between the tibia and the internal femoral condyle on the knee in flexion, one can make so that, in position of extension of the knee, the two rolled cords forming the ligament untwist, then presenting a perfectly parallel structure. If, in this geometry, provision has been made to make the ligament from a knitted width preserving the parallelism of the longitudinal fibers, the latter will then be able to withstand the forces applied to the implanted ligament in their own longitudinal direction.
Cette disposition permet donc aux fibres longitudinales de se retrouver parallèles entre elles lorsque le genou est proche de l'extension, c'est-à-dire dans la position où il est habituellement traumatisé lors des entorses ; il se produit ainsi un recrutement progressif des fibres lors des efforts de tension, qui s'accompagne d'un effet d'amortisseur comparable à celui d'un ligament naturel.This arrangement therefore allows the longitudinal fibers to be parallel to each other when the knee is close to the extension, that is to say in the position where it is usually traumatized during sprains; there is thus a progressive recruitment of the fibers during tensioning efforts, which is accompanied by a damping effect comparable to that of a natural ligament.
On observera néanmoins que cet effet n'est vraiment sensible sur un ligament artificiel, que dans la mesure où un nombre suffisant de fibres longitudinales, entourant au plus près la fibre neutre isométrique, sont mises en action d'emblée ; à cet égard, on rappelle que la fibre neutre d'un ligament est celle qui passe par l'axe isométrique joignant les points isométriques des têtes osseuses de l'articulation concernée (dans le cas du remplacement d'un ligament croisé antérieur du genou, il s'agit, bien entendu, des points isométriques du tibia et du fémur) .It will nevertheless be observed that this effect is only really noticeable on an artificial ligament, insofar as a sufficient number of longitudinal fibers, surrounding as closely as possible the isometric neutral fiber, are put into action from the start; in this regard, it is recalled that the neutral fiber of a ligament is that which passes through the isometric axis joining the isometric points of the bony heads of the joint concerned (in the case of the replacement of an anterior cruciate ligament of the knee, these are, of course, isometric points of the tibia and femur).
Sur genou fléchi à 90°, les deux cordons du ligament croisé antérieur sont tordus dans le sens horaire pour le genou gauche, et dans le sens anti-horaire pour le genou droit. De ce fait, suivant une caractéristique complémentaire de l'invention spécifique à la plastie du genou, on imprimera un sens de rotation différent aux deux cordons du ligament artificiel selon que l'on désirera obtenir un ligament croisé antérieur gauche ou un ligament croisé antérieur droit.On knee bent at 90 °, the two cords of the anterior cruciate ligament are twisted clockwise to left knee, and counterclockwise for the right knee. Therefore, according to a complementary characteristic of the invention specific to the knee plasty, we will print a different direction of rotation to the two cords of the artificial ligament depending on whether we want to obtain a left anterior cruciate ligament or a right anterior cruciate ligament .
Un procédé de confection d'un ligament artificiel à deux cordons présentant toutes les caractéristiques précédentes consiste successivement en ce que :A method of making an artificial ligament with two cords having all the above characteristics successively consists in that:
- on fixe à plat une laize, tricotée sur toute ou partie de sa longueur, dans un dispositif d'entraînement longitudinal, parallèle aux lisières de ladite laize,- a width is fixed flat, knitted over all or part of its length, in a longitudinal drive device, parallel to the edges of said width,
- on fait progresser la laize vers une ouverture circulaire calibrée, au travers d'une tuyère convergente, symétrique dans le sens longitudinal, tout en appliquant sur ladite laize un effort destiné à la maintenir à plat, au moins en son milieu,the width is advanced towards a calibrated circular opening, through a converging nozzle, symmetrical in the longitudinal direction, while applying to said width a force intended to keep it flat, at least in the middle,
- on fait passer la laize, ainsi roulée en deux cordons serrés l'un contre l'autre, dans un dispositif d'entrainement à galets rapprochant les dernières spires des deux cordons l'une de l'autre,- the width is passed, thus rolled into two cords tight against one another, in a roller drive device bringing the last turns of the two cords together,
- on coud les dernières spires des cordons ainsi rapprochées. La légère rotation du ligament artificiel sur lui- même peut-être obtenu de deux manières :- the last turns of the cords are thus sewn together. The slight rotation of the artificial ligament on itself can be obtained in two ways:
- soit le ligament est progressivement pivoté sur lui-même d'au moins un quart de tour avant d'être cousu.- either the ligament is gradually pivoted on itself at least a quarter of a turn before being sewn.
- soit, préférentiellement, les fibres longitudinales de la laize servant à former le ligament sont toronnées au moment du tricotage de ladite laize, de sorte qu'après roulage, les extrémités du ligament soient torsadées sur au moins un quart de tour l'une par rapport à l'autre. L'importance de la rotation des deux cordons pourra bien sûr être parfaitement déterminé au moyen de divers essais effectué au moment du tricotage.- Or, preferably, the longitudinal fibers of the width used to form the ligament are stranded when knitting said width, so that after rolling, the ends of the ligament are twisted at least a quarter of a turn by compared to each other. The amount of rotation of the two cords can of course be perfectly determined by means of various tests carried out at the time of knitting.
Les deux techniques précédentes ne sont d'ailleurs pas exclusives l'une de l'autre. En outre, même un ligament à deux cordons non tordus au repos pourra être tordu juste au moment de la pose par le praticien ; un tel ligament une fois posé ne saurait bien entendu sortir du cadre de la présente invention. D'autres caractéristiques et avantages de la présente invention ressortiront mieux de la description qui va suivre d'un mode d'exécution d'un ligament prothétique pour le remplacement du ligament croisé antérieur du genou, donné à titre d'exemple non limitatif en référence aux dessins annexés sur lesquels :The two previous techniques are also not mutually exclusive. Furthermore, even a ligament with two cords not twisted at rest can be twisted just at the time of installation by the practitioner; such a ligament once placed cannot, of course, depart from the scope of the present invention. Other characteristics and advantages of the present invention will emerge more clearly from the description which follows of an embodiment of a prosthetic ligament for the replacement of the anterior cruciate ligament of the knee, given by way of nonlimiting example with reference to the accompanying drawings in which:
- la figure 1 est une vue en perspective partiellement éclatée du ligament artificiel conforme à l'invention,FIG. 1 is a partially exploded perspective view of the artificial ligament according to the invention,
- la figure 2 est une vue en plan de la laize tricotée et fendue servant à obtenir par roulage convolute le ligament représenté sur la figure 1,FIG. 2 is a plan view of the knitted and slit width serving to obtain by convolute rolling the ligament represented in FIG. 1,
- les figures 3 à 5 sont des vues en coupe sagittale de l'articulation tibio-fémorale montrant le pivotement sur lui-même du ligament croisé antérieur du genou entre la position d'extension et la position de flexion maximales.- Figures 3 to 5 are views in sagittal section of the tibio-femoral joint showing the pivoting on itself of the anterior cruciate ligament of the knee between the position of extension and the position of maximum flexion.
Le ligament articulaire représenté sur les figures comporte deux parties extrêmes intra-osseuses 1 et une partie intra-articulaire 2, qui sont obtenus à partir d'une laize textile 3 tricotée présentant, suivant un axe longitudinal médian, une fente 3 destinée à former, après roulage convolute de ladite laize 4 parallèlement à ses bords latéraux, une ouverture 5 séparant deux cordons 6 de la partie intra-articulaire 2 du ligament. La fente 3 présente une longueur telle que les parties intra-osseuses 1 comportant deux cordons la jointifs, liés entre eux par une couture transversale lb. Par construction, les deux cordons intra-articulaires 6 du ligament sont donc de longueurs identiques, de sorte que la répartition des efforts de traction se répartissent de manière uniforme entre les deux cordons 6.The articular ligament represented in the figures comprises two end intraosseous parts 1 and an intraarticular part 2, which are obtained from a knitted textile width 3 having, along a median longitudinal axis, a slot 3 intended to form, after convolute rolling of said width 4 parallel to its lateral edges, an opening 5 separating two cords 6 of the intra-articular part 2 of the ligament. The slot 3 has a length such that the intraosseous parts 1 comprising two contiguous cords, linked together by a transverse seam 1b. By construction, the two intra-articular cords 6 of the ligament are therefore of identical lengths, so that the distribution of the tensile forces is distributed uniformly between the two cords 6.
En outre, les moyens de réalisation du ligament, par exemple ceux qui seront décrits par la suite, permettent d'imprimer une rotation définitive d'environ 180° entre les deux parties intra-osseuses 1 du ligament. A cet égard, la rotation sera dextrogyre ou lévogyre selon le type de ligament droit ou gauche réalisé. Préférentiellement, les fibres longitudinales, dites techniques, de la laize servant à la réalisation du ligament sont maintenues entre elles par un tricotage- chaîne, c'est-à-dire un tricot à mailles jetées offrant une grande rugosité et limitant le déport desdites fibres longitudinales par rapport à leur axe. La rugosité est utile dans les zones intra-osseuses pour permettre une bonne réabilitation osseuse du ligament implanté.In addition, the means for producing the ligament, for example those which will be described below, allow to print a final rotation of approximately 180 ° between the two intraosseous parts 1 of the ligament. In this regard, the rotation will be dextrorotatory or levorotatory depending on the type of right or left ligament produced. Preferably, the longitudinal, so-called technical, fibers of the width used for the production of the ligament are held together by a warp knitting, that is to say a knitted fabric knitted offering a high roughness and limiting the offset of said fibers. longitudinal with respect to their axis. Roughness is useful in the intraosseous areas to allow good bone re-stabilization of the implanted ligament.
On a montré, sur les figures 3 à 5, un exemple d'implantation du ligament articulaire artificiel représenté sur les figures 1 et 2 en lieu et place du ligament croisé antérieur du genou. Sur la figure 3, le genou est représenté en position d'extension maximale ; dans cette position, le ligament artificiel est tendu entre le tibia 9 et le condyle interne du fémur 10 en présentant ses deux cordons 8 parallèles entre eux. Les fibres longitudinales composant le ligament sont alors recrutées progressivement avec un effet amortisseur déjà mentionné plus haut. Sur la figure 4, le genou est légèrement fléchi, ce qui provoque un début de torsion du ligament au fur et à mesure que les condyles du fémur 10 roulent sur les plateaux tibiaux. Enfin, sur la figure 5, le genou est en flexion maximale ; à ce moment, l'extrémité du ligament implanté dans le tunnel fémoral a pratiquement pivoté d'un angle de 180°. C'est dans cette dernière position que les ligaments artificiels croisés antérieurs sont généralement implantés ; on comprend donc que le ligament pré-torsadé conforme à l'invention convienne particulièrement bien à cette opération prothétique et présente, dans ce dernier cas, des qualités biomécaniques de stabilité et d'iso étrie presque idéales. L'invention n'est bien entendu pas limitée à la description qui vient d'en être donnée mais s'étend au contraire à la réalisation de tout ligament articulaire prothétique couramment implanté, tel que les ligaments latéraux ou croisés du genou, les ligaments rachidiens et les ligaments d'épaule. An example of implantation of the artificial articular ligament shown in FIGS. 1 and 2 has been shown in FIGS. 3 to 5 in place of the anterior cruciate ligament of the knee. In Figure 3, the knee is shown in the position of maximum extension; in this position, the artificial ligament is stretched between the tibia 9 and the internal condyle of the femur 10 by presenting its two cords 8 parallel to each other. The longitudinal fibers making up the ligament are then recruited gradually with a damping effect already mentioned above. In FIG. 4, the knee is slightly bent, which causes the ligament to begin to twist as the condyles of the femur 10 roll on the tibial plates. Finally, in Figure 5, the knee is in maximum flexion; at this time, the end of the ligament implanted in the femoral tunnel has practically pivoted by an angle of 180 °. It is in this latter position that the anterior cruciate ligaments are generally implanted; we therefore understand that the pre-twisted ligament according to the invention is particularly suitable for this prosthetic operation and has, in the latter case, biomechanical qualities of stability and iso-stria almost ideal. The invention is of course not limited to the description which has just been given, but on the contrary extends to the production of any articular ligament commonly implanted prosthetics, such as lateral or crossed knee ligaments, spinal ligaments and shoulder ligaments.

Claims

REVENDICATIONS
1 - Ligament artificiel pour le remplacement d'un ligament naturel articulaire, comportant deux parties extrêmes intra-osseuses (1) et une partie intermédiaire intra-articulaire (2), caractérisé en ce qu'au moins ladite partie intra-articulaire (2) est formée de deux cordons (6) de fibres longitudinales indépendants, obtenus par roulage sur elles-mêmes de deux laizes tricotées, ou de deux demi-laizes d'une laize tricotée unique partiellement fendue en sa partie médiane sur une longueur au moins égale à celle de ladite partie intra- articulaire (2), les deux parties extrêmes intra- osseuses (1) étant tordues d'au moins un quart de tour l'une par rapport à l'autre lorsque ledit ligament est posé dans l'articulation.1 - Artificial ligament for the replacement of a natural articular ligament, comprising two intra-osseous end parts (1) and an intra-articular intermediate part (2), characterized in that at least said intra-articular part (2) is formed by two cords (6) of independent longitudinal fibers, obtained by rolling on themselves two knitted widths, or two half-widths of a single knitted width partially split in its middle part over a length at least equal to that of said intra-articular part (2), the two end intra-osseous parts (1) being twisted by at least a quarter of a turn relative to each other when said ligament is placed in the joint.
2 - Ligament artificiel selon la revendication 1, caractérisé en ce qu'au moins ladite partie intra- articulaire (2) est formée de deux cordons (6) de fibres longitudinales indépendants, obtenus par roulage sur elles-mêmes de deux laizes tricotées, ou de deux demi- laizes d'une laize tricotée unique partiellement fendue en sa partie médiane sur une longueur au plus égale à celle de ladite partie intra-articulaire (2) , les deux parties extrêmes intra-osseuses (1) étant tordues d'au moins un quart de tour l'une par rapport à l'autre lorsque ledit ligament est posé dans l'articulation.2 - Artificial ligament according to claim 1, characterized in that at least said intra-articular part (2) is formed by two cords (6) of independent longitudinal fibers, obtained by rolling on themselves two knitted widths, or of two half-widths of a single knitted width partially split in its middle part over a length at most equal to that of said intra-articular part (2), the two end intraosseous parts (1) being twisted at least minus a quarter of a turn relative to each other when said ligament is placed in the joint.
3 - Ligament artificiel selon l'une quelconque des revendications précédentes, caractérisé en ce que 1'on imprime un sens de rotation horaire ou antihoraire aux deux cordons dudit ligament artificiel selon que l'on désire obtenir un ligament croisé antérieur gauche ou un ligament croisé antérieur droit.3 - artificial ligament according to any one of the preceding claims, characterized in that one prints a sense of clockwise or counterclockwise rotation to the two cords of said artificial ligament depending on whether one wishes to obtain a left anterior cruciate ligament or a cruciate ligament anterior right.
4 - Ligament artificiel selon l'une quelconque des revendications précédentes, caractérisé en ce que les fibres longitudinales de la laize servant à former le ligament sont toronnées au moment du tricotage de ladite laize, de sorte qu'après roulage, les extrémités du ligament soient torsadées sur au moins un quart de tour l'une par rapport à l'autre.4 - Artificial ligament according to any one of the preceding claims, characterized in that the longitudinal fibers of the width serving to form the ligament are stranded when knitting said width, so that after rolling, the ends of the ligament are twisted at least a quarter turn one in relation to the other.
5 - Procédé de confection d'un ligament artificiel selon l'une quelconque des revendications précédentes, caractérisé en ce qu'il consiste successivement à : - fixer à plat une laize tricotée et fendue en son milieu dans un dispositif d'entraînement longitudinal, parallèle aux lisières de ladite laize,5 - A method of making an artificial ligament according to any one of the preceding claims, characterized in that it consists successively in: - fixing flat a knitted and split width in the middle in a longitudinal, parallel drive device at the edges of said width,
- faire progresser la laize vers une ouverture circulaire calibrée, au travers d'une tuyère convergente, symétrique dans le sens longitudinal, tout en appliquant sur ladite laize un effort destiné à la maintenir à plat, au moins en son milieu,advancing the width towards a calibrated circular opening, through a convergent nozzle, symmetrical in the longitudinal direction, while applying to said width a force intended to keep it flat, at least in the middle,
- faire passer la laize, ainsi roulée en deux cordons serrés l'un contre l'autre, dans un dispositif d'entraine ent à galets rapprochant les dernières spires des deux cordons l'une de l'autre,- pass the width, thus rolled into two cords tight against each other, in a drive device ent with rollers bringing the last turns of the two cords together,
- coudre les dernières spires des cordons ainsi rapprochés.- sew the last turns of the cords thus brought together.
6 - Procédé de confection d'un ligament artificiel selon la revendication précédente, caractérisé en ce que le ligament est progressivement pivoté sur lui-même d'au moins un quart de tour avant d'être cousu. 6 - Method of making an artificial ligament according to the preceding claim, characterized in that the ligament is gradually pivoted on itself at least a quarter of a turn before being sewn.
PCT/FR1993/001053 1992-10-28 1993-10-27 Artificial ligament and process for its manufacture WO1994009720A1 (en)

Priority Applications (3)

Application Number Priority Date Filing Date Title
JP6510770A JPH07506995A (en) 1992-10-28 1993-10-27 Artificial ligament and its manufacturing process
AU53731/94A AU5373194A (en) 1992-10-28 1993-10-27 Artificial ligament and process for its manufacture
EP93924116A EP0618787A1 (en) 1992-10-28 1993-10-27 Artificial ligament and process for its manufacture

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR9212840A FR2697151B1 (en) 1992-10-28 1992-10-28 Artificial ligament and its method of making.
FR92/12840 1992-10-28

Publications (1)

Publication Number Publication Date
WO1994009720A1 true WO1994009720A1 (en) 1994-05-11

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EP (1) EP0618787A1 (en)
JP (1) JPH07506995A (en)
AU (1) AU5373194A (en)
CA (1) CA2126459A1 (en)
FR (1) FR2697151B1 (en)
WO (1) WO1994009720A1 (en)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5514181A (en) * 1993-09-29 1996-05-07 Johnson & Johnson Medical, Inc. Absorbable structures for ligament and tendon repair

Families Citing this family (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2755846B1 (en) * 1996-11-20 1998-12-31 Jacques Philippe Laboureau PRE-ORIENT PROSTHETIC LIGAMENT AND METHOD OF MAKING
US20020133229A1 (en) 2000-03-24 2002-09-19 Laurencin Cato T. Ligament and tendon replacement constructs and methods for production and use thereof
FR2865380B1 (en) 2004-01-23 2006-03-03 L A R S Laboratoire D Applic E METHOD FOR ATTACHING TRACTION WIRES TO THE END OF A PROTHETIC LIGAMENT
CA2762903C (en) 2009-05-22 2013-07-30 Soft Tissue Regeneration, Inc. Mechanically competent scaffold for ligament and tendon regeneration
US8574296B2 (en) * 2011-03-31 2013-11-05 Biomet Manufacturing Corporation Dual tendon bundle
JP6411382B2 (en) * 2013-02-22 2018-10-31 スポーツ メディシン イノベーションズ アーゲー System for anatomically valid ligament reconstruction

Citations (4)

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Publication number Priority date Publication date Assignee Title
FR2135825A5 (en) * 1971-04-30 1972-12-22 Rhone Poulenc Sa
FR2596641A1 (en) * 1986-04-04 1987-10-09 Ordi Sa Artificial ligament
DE3923580A1 (en) * 1989-07-17 1991-01-24 Olaf Tulaszewski Alloplastic hamstring replacement - made of specified plastic material with specified weave pattern
FR2651994A1 (en) * 1989-09-19 1991-03-22 Laboureau Jacques Philippe Prosthetic ligament comprising a network of synthetic or natural fibres impregnated with collagen

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2135825A5 (en) * 1971-04-30 1972-12-22 Rhone Poulenc Sa
FR2596641A1 (en) * 1986-04-04 1987-10-09 Ordi Sa Artificial ligament
DE3923580A1 (en) * 1989-07-17 1991-01-24 Olaf Tulaszewski Alloplastic hamstring replacement - made of specified plastic material with specified weave pattern
FR2651994A1 (en) * 1989-09-19 1991-03-22 Laboureau Jacques Philippe Prosthetic ligament comprising a network of synthetic or natural fibres impregnated with collagen

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5514181A (en) * 1993-09-29 1996-05-07 Johnson & Johnson Medical, Inc. Absorbable structures for ligament and tendon repair
US5595621A (en) * 1993-09-29 1997-01-21 Johnson & Johnson Medical, Inc. Method of making absorbable structures for ligament and tendon repair

Also Published As

Publication number Publication date
JPH07506995A (en) 1995-08-03
FR2697151B1 (en) 1994-12-23
CA2126459A1 (en) 1994-05-11
EP0618787A1 (en) 1994-10-12
AU5373194A (en) 1994-05-24
FR2697151A1 (en) 1994-04-29

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