WO1996029029A1 - Surgical anchoring piece for ligaments - Google Patents

Surgical anchoring piece for ligaments Download PDF

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Publication number
WO1996029029A1
WO1996029029A1 PCT/BE1995/000025 BE9500025W WO9629029A1 WO 1996029029 A1 WO1996029029 A1 WO 1996029029A1 BE 9500025 W BE9500025 W BE 9500025W WO 9629029 A1 WO9629029 A1 WO 9629029A1
Authority
WO
WIPO (PCT)
Prior art keywords
ligament
milling
tunnel
anchor
elongated body
Prior art date
Application number
PCT/BE1995/000025
Other languages
French (fr)
Inventor
Michel Collette
Original Assignee
Societe De Gestion Jarim N.V.
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 Societe De Gestion Jarim N.V. filed Critical Societe De Gestion Jarim N.V.
Priority to PCT/BE1995/000025 priority Critical patent/WO1996029029A1/en
Priority to EP95912098A priority patent/EP0814730A1/en
Priority to CA002215943A priority patent/CA2215943A1/en
Priority to AU19431/95A priority patent/AU1943195A/en
Publication of WO1996029029A1 publication Critical patent/WO1996029029A1/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
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0446—Means for attaching and blocking the suture in the suture anchor
    • A61B2017/0458—Longitudinal through hole, e.g. suture blocked by a distal suture knot
    • 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
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/087—Anchor integrated into tendons, e.g. bone blocks, integrated rings
    • 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
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0876—Position of anchor in respect to the bone
    • A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone

Definitions

  • the present invention relates to an anchor for fixing ligaments to bones, in ligament reconstruction surgery; it relates more particularly to such an anchor intended to be placed by arthroscopy.
  • anchors for sutures intended to be pushed into place using a cannula instrument.
  • the anchor to which the suture is attached is pushed through the cannula in the longitudinal position (parallel to the suture) and, once out of the cannula, the anchor is made to pivot to make an angle with respect to the suture, and thus take support on the tissues.
  • Such anchors are for example described in documents EP-A-0236427 and EP-A-0464480. It is also known in orthopedic surgery, in the reconstruction of ligaments, to drill in the joint a tunnel or blind hole, intended to receive the ends of the ligament. At its proximal end, this tunnel is extended by a narrower tunnel, or traction tunnel, intended for the passage of a grommet.
  • the ligament When the ligament is put in place, it is attached to a traction wire which is threaded through successive tunnels and pushed to the outside of the skin using a grommet, which we pass through the tunnels and pierce the skin; the traction wire is then used to pull the ligament substantially to the bottom of the tunnel. Once the ligament in position, it must be anchored securely in place.
  • the conventional method consists in knotting the ligament traction wires at the exit of the traction tunnel, on a stop means such as a button, a staple, a screw, etc. This fixation therefore requires a surgical approach to the bone region where the traction tunnel comes from.
  • An alternative method is performed entirely under arthroscopic control.
  • the anchoring member is fixed to the ligament, and the assembly is then drawn into the bony tunnels until the anchor has made entirely from the traction tunnel; by pulling in the opposite direction, the anchor then locks at the end of the pull tunnel.
  • This method is less traumatic, since it is not necessary to make an opening on the proximal side, to achieve anchoring.
  • it requires the anchor to pass through the pulling tunnel, which must therefore be wider than for the passage of the single pulling wire, and it is important that the anchor is as narrow as possible, to minimize the diameter of the tunnel. traction.
  • the push anchors mentioned above are not suitable for fixing ligaments. Indeed, this would require an enlargement of the bone tunnels to allow the simultaneous passage of the ligament and the application instrument, which is contrary to the requirements aimed at adjusting the diameter of the ligament as closely as possible to the caliber of the tunnel to promote the biological fixation.
  • the application cannula could injure the ligament structure during positioning manipulations.
  • anchors to be pulled, which allow placement without a cannula instrument.
  • Such an anchor is known for example from EP-A-0 619 982, which discloses a substantially cylindrical anchor, provided with peripheral barbs. When this anchor emerges outside, at the proximal end of the traction tunnel, the barbs anchor by resting on the surface of the cortical bone.
  • the anchor passes with hard friction in the traction tunnel, and it is difficult for the surgeon to determine with exactitude whether the anchor has or has not left the tunnel. To ensure this, it indeed exerts traction in the opposite direction (ligament side), and the barbs would then risk wedging the anchor in the bone, already inside the tunnel, so that the placement correct anchoring can only be really ensured by very precise measurement and marking of the graft provided with its anchor in relation to the length of the bone tunnels, or even by radioscopic control, all of these maneuvers being technically delicate and consuming of operating time.
  • an anchor in the form of an elongated plate, pierced with four holes substantially aligned in the longitudinal direction of the plate (EndoButton * from the company Acufex Microsurgical Inc.).
  • the two middle holes are used to fix the ligament, and the two outer holes are used to fix the traction wires.
  • This anchor is threaded longitudinally in the traction tunnel, using the traction wires, until it exits through its proximal end.
  • a traction on the posterior traction wire makes it pivot around an axis perpendicular to its longitudinal axis, and it is brought back by traction on the ligament side, so as to make it rest on the edges of the tunnel, with its longitudinal axis substantially perpendicular to the axis of the tunnel.
  • an anchor of this type simpler to produce and to handle, and especially of smaller size, so that it can be passed through a narrower traction tunnel, which weakens the bone less, or even allows it to be used for thinner or less resistant bones.
  • the solution according to the invention consists in providing a surgical anchor intended to fix a ligament or the like, at the proximal outlet of a tunnel pierced in a bone, consisting of an elongated body provided with a passage means perpendicular to the longitudinal axis of the elongated body, for fixing, on the one hand a traction means, and on the other hand a means of fixing a ligament or the like, anchor intended to pivot perpendicular to its longitudinal axis, with its exit from the tunnel, in order to be in the blocking position substantially perpendicular to the axis of the tunnel, characterized in that the passage means for the traction means consists of a single milling perpendicular to the longitudinal axis of the elongated body , and - the passage means for the ligament fixing means or the like consists of a single milling perpendicular to the longitudinal axis of the elongated body.
  • the milling for the ligament fixing means is a milling of narrow and elongated section, the long side of which is parallel to the longitudinal axis of the elongated body, intended to receive a flat fixing means , similar to a ribbon, for the ligament.
  • the milling for the traction means and the milling for the attachment of the ligament form a single common milling.
  • the means for fixing the ligament or the like, threaded through the milling of the elongated body is fixed to the latter while being retained by an extra thickness at its end, which cannot pass through the milling.
  • the ligament fixing means or the like is fixed to the elongated body by being threaded through said milling in the manner of a thread in a needle.
  • the two strands of the fixing means are ligated near the surface of the elongated body.
  • FIG. 1 is a side view, partially broken away, of an anchor according to the invention
  • Figure 2 is a perspective view of the anchor of the invention, provided with a traction means and a means for fixing a ligament or the like
  • Figure 3 is a cross-sectional view of the anchor according to the invention, with another method of fixing the ligament fixing means or the like
  • FIG 4 is a view of the anchor being passed through a tunnel pierced in a bone.
  • the anchor 1 comprises an oblong, generally cylindrical body 2 pierced with a through milling 3, the longitudinal axis AA 'of which is essentially perpendicular to the longitudinal axis BB' of the cylindrical body 2.
  • the milling is in the form of a slot 3, and has an elongated cross section along the longitudinal axis BB 'of the cylindrical body 2.
  • Milling 3 is provided for threading a fixing means 4 of a ligament or the like, as well as a pulling wire 5.
  • the pulling wire 5 is used only during the operation, to allow the surgeon to pull the anchor through the ligament insertion tunnel 6 or the like, then through the narrower traction tunnel 7 which extends it, driving the ligament 8 substantially to the bottom of the insertion tunnel 6.
  • the insertion tunnels and of traction are drilled in bone 9 to which the ligament is to be attached.
  • the wire 5 is removed, most simply by pulling on one of its strands.
  • the ligament fixing means not only serves to pull the ligament substantially to the bottom of the insertion tunnel 6, during the operation, but also serves to anchor the ligament to the bone, and it must therefore be sized accordingly.
  • the milling 3 of elongated section according to the invention offers a relatively large passage section for a reduced slot width; associated with a flat fixing means 4, in the form of a ribbon, it makes it possible to give the latter a section which is sufficient to withstand the forces to which it will be subjected, and this for a small diameter of the cylindrical body 2.
  • the fixing tape 4 and the pulling wire 5 are shown threaded through the milling 3 in the manner of a wire in the eye of a needle, which is the simplest and most reliable means fixing the fixing tape 4 and the pulling wire 5 to the cylindrical body 2.
  • the two strands of the tape 4 are also tied together, as indicated by the dotted line 11.
  • the traction tape is shown provided with an extra thickness 10 at its free end, opposite the ligament, so as to prevent the threaded tape from coming out of the milling. This is, however, a less preferred embodiment because it is less reliable.
  • milling 3 which is used both for the pulling wire and for the fixing tape, and which constitutes a preferred embodiment of the invention.
  • the invention is not understood not limited to this embodiment, and one can also provide two separate millings, or a milling for the fixing tape, and a bore for the pulling wire, without however that this has a particular advantage.
  • the single milling will preferably be carried out symmetrically in the middle of the body, so that the anchor is perfectly symmetrical, and does not have a front face and a rear face.
  • the anchor is shown during passage in the traction tunnel 7 pierced in a bone 9, following the tunnel 6 for insertion of the ligament or the like.
  • the tunnels are drilled in the bone after having made an opening in the soft tissues at the distal end, and the pulling wire 5 is threaded in the tunnels 6, 7 using a pass wires which the surgeon leads outwards, proximally, by piercing the skin; once the wire is outside, the surgeon can take it directly in hand, and pull the anchor and the ligament inside the tunnels.
  • the pulling wire is arranged longitudinally relative to the cylindrical body, while the two strands of the ribbon are deformed (twisted) so as to also be presented longitudinally relative to the cylindrical body 2.
  • a dotted line 11 indicates a ligature of the two strands of the fixing tape 4, near the cylindrical body 2.
  • the purpose of this ligature is to force the ribbon to be arranged as in FIG. 4, with its edges 4 ′, 4 "substantially perpendicular to the longitudinal axis of the body 2, thus preventing the ribbon from being arranged longitudinally in the manner of the pulling wire 5, which would weaken the tendency of the body to straighten out. can however be replaced by a simple knotting of the two strands, which ensures the same effect, with however the disadvantage of a larger bulk compared to the ligature, which consequently requires a larger traction tunnel.
  • an improved surgical anchor was thus provided, allowing the anchoring of a ligament by arthroscopy, and therefore with the least trauma, by appreciably reducing the diameter of the traction tunnel to be drilled in the bone, and by ensuring a blockag sure of the anchor, without recourse to a radioscopy or the like.
  • a body diameter 2 of about 2.5 mm or even 2 mm compared with a transverse dimension of the order of 4 mm for the wafer EndoButton ®, or to a diameter of the order of 5 mm for the anchor according to EP-A-0 619 982.
  • milling in the present description means a piercing right through the body of the anchor, which can be carried out with a milling cutter, but also by any other means, for example with a laser.

Abstract

This invention relates to a surgical anchoring piece (1) for fitting a ligament or the like (8) at the proximal outlet of a tunnel (6, 7) bored in a bone (9). In a preferred embodiment, the anchoring piece (1) is made of an elongate body (2) provided with a milled section (3) perpendicular to the longitudinal axis of the elongate body which is designed for sliding and fastening of a pull wire (5) and a tape (4) for fastening the ligament or the like. The ligament, which is fastened to the anchoring piece (1) by the tape (4) is driven towards the end of the tunnel (6) by pulling on the wire (5); once out of the tunnel (7), the anchoring piece (1) pivots until it lies across the mouth of the tunnel (7) and locks the ligament in position in the tunnel (6).

Description

ANCRE CHIRURGICALE POUR LIGAMENTS SURGICAL ANCHOR FOR LIGAMENTS
La présente invention concerne une ancre pour fixer des ligaments à des os, en chirurgie de reconstruction ligamentaire; elle concerne plus particulièrement une telle ancre prévue pour être placée par arthroscopie. On connaît en chirurgie arthroscopique des ancres pour fils de suture, destinées à être poussées en place à l'aide d'un instrument à canule. L'ancre à laquelle est attaché le fil de suture est poussée à travers la canule en position longitudinale (parallèlement au fil de suture) et, une fois sortie de la canule, l'ancre est amenée à pivoter pour faire un angle par rapport au fil de suture, et prendre ainsi appui sur les tissus.The present invention relates to an anchor for fixing ligaments to bones, in ligament reconstruction surgery; it relates more particularly to such an anchor intended to be placed by arthroscopy. Known in arthroscopic surgery are anchors for sutures, intended to be pushed into place using a cannula instrument. The anchor to which the suture is attached is pushed through the cannula in the longitudinal position (parallel to the suture) and, once out of the cannula, the anchor is made to pivot to make an angle with respect to the suture, and thus take support on the tissues.
De telles ancres sont par exemples décrites dans les documents EP-A-0236427 et EP-A-0464480. II est d'autre part connu en chirurgie orthopédique, dans la reconstruction de ligaments, de forer dans l'articulation un tunnel ou trou borgne, destiné à recevoir les extrémités du ligament. A son extrémité proximale, ce tunnel est prolongé par un tunnel plus étroit, ou tunnel de traction, destiné au passage d'un passe-fils.Such anchors are for example described in documents EP-A-0236427 and EP-A-0464480. It is also known in orthopedic surgery, in the reconstruction of ligaments, to drill in the joint a tunnel or blind hole, intended to receive the ends of the ligament. At its proximal end, this tunnel is extended by a narrower tunnel, or traction tunnel, intended for the passage of a grommet.
Lors de la mise en place du ligament, celui-ci est attaché à un fil de traction qui est enfilé à travers les tunnels successifs et poussé jusqu'à l'extérieur de la peau à l'aide d'un passe-fils, que l'on fait passer dans les tunnels et percer la peau; le fil de traction sert ensuite à tirer le ligament sensiblement jusqu'au fond du tunnel. Une fois le ligament en position, il faut l'ancrer solidement en place.When the ligament is put in place, it is attached to a traction wire which is threaded through successive tunnels and pushed to the outside of the skin using a grommet, which we pass through the tunnels and pierce the skin; the traction wire is then used to pull the ligament substantially to the bottom of the tunnel. Once the ligament in position, it must be anchored securely in place.
La méthode classique consiste à nouer les fils de traction du ligament à la sortie du tunnel de traction, sur un moyen d'arrêt tel qu'un bouton, une agrafe, une vis, etc. Cette fixation nécessite donc un abord chirurgical de la région osseuse où fait issue le tunnel de traction.The conventional method consists in knotting the ligament traction wires at the exit of the traction tunnel, on a stop means such as a button, a staple, a screw, etc. This fixation therefore requires a surgical approach to the bone region where the traction tunnel comes from.
Une méthode alternative est réalisée entièrement sous contrôle arthroscopique. Dans cette méthode, et après réalisation des tunnels osseux, l'organe d'ancrage est fixé au ligament, et l'ensemble est ensuite attiré dans les tunnels osseux jusqu'à ce que l'ancre ait fait entièrement issue du tunnel de traction; par traction en sens inverse, l'ancre se bloque ensuite à l'extrémité du tunnel de traction.An alternative method is performed entirely under arthroscopic control. In this method, and after completion of the bone tunnels, the anchoring member is fixed to the ligament, and the assembly is then drawn into the bony tunnels until the anchor has made entirely from the traction tunnel; by pulling in the opposite direction, the anchor then locks at the end of the pull tunnel.
Cette méthode est moins traumatisante, puisqu'il n'est pas nécessaire de pratiquer une ouverture du côté proximal, pour réaliser l'ancrage. Elle demande cependant de faire passer l'ancre par le tunnel de traction qui doit donc être plus large que pour le passage du seul fil de traction, et il est important que l'ancre soit la plus étroite possible, pour minimiser le diamètre du tunnel de traction.This method is less traumatic, since it is not necessary to make an opening on the proximal side, to achieve anchoring. However, it requires the anchor to pass through the pulling tunnel, which must therefore be wider than for the passage of the single pulling wire, and it is important that the anchor is as narrow as possible, to minimize the diameter of the tunnel. traction.
Les ancres à pousser mentionnées ci-dessus ne conviennent pas pour la fixation de ligaments. En effet, cela nécessiterait un agrandissement des tunnels osseux pour permettre le passage simultané du ligament et de l'instrument d'application, ce qui est contraire aux exigences visant à ajuster le plus étroitement possible le diamètre du ligament au calibre du tunnel pour favoriser la fixation biologique.The push anchors mentioned above are not suitable for fixing ligaments. Indeed, this would require an enlargement of the bone tunnels to allow the simultaneous passage of the ligament and the application instrument, which is contrary to the requirements aimed at adjusting the diameter of the ligament as closely as possible to the caliber of the tunnel to promote the biological fixation.
En outre, la canule d'application risquerait de blesser la structure ligamentaire pendant les manipulations de mise en place.In addition, the application cannula could injure the ligament structure during positioning manipulations.
Pour ce type d'application, on a dès lors développé des ancres à tirer, qui permettent la mise en place sans instrument à canule.For this type of application, we have therefore developed anchors to be pulled, which allow placement without a cannula instrument.
Une telle ancre est connue par exemple par EP-A-0 619 982, qui divulgue une ancre sensiblement cylindrique, pourvue de barbes périphériques . Lorsque cette ancre débouche à l'extérieur, à l'extrémité proximale du tunnel de traction, les barbes assurent l'ancrage en prenant appui sur la surface de l'os cortical.Such an anchor is known for example from EP-A-0 619 982, which discloses a substantially cylindrical anchor, provided with peripheral barbs. When this anchor emerges outside, at the proximal end of the traction tunnel, the barbs anchor by resting on the surface of the cortical bone.
Cette ancre est cependant délicate à mettre en oeuvre; en effet, les barbes doivent être courtes pour éviter qu'elles ne coincent dans les tunnels osseux, de sorte que le tunnel de traction doit être fort ajusté. S'il ne l'était pas, les courtes barbes "flotteraient" à l'intérieur, et ne pourraient prendre appui sur l'os cortical à la sortie du tunnel.This anchor is however delicate to implement; in fact, the beards must be short to prevent them from jamming in the bony tunnels, so that the traction tunnel must be tightly adjusted. If it were not, the short beards would "float" at inside, and could not rest on the cortical bone at the exit of the tunnel.
Dès lors, l'ancre passe à frottement dur dans le tunnel de traction, et il est difficile pour le chirurgien de déterminer avec exactitude si l'ancre est ou non sortie du tunnel. Pour s'en assurer, il exerce en effet une traction en sens inverse (côté ligament), et les barbes risqueraient alors de coincer l'ancre dans l'os, déjà à l'intérieur du tunnel, de sorte que la mise en place correcte de l'ancre ne peut être vraiment assurée que par mensuration et marquage très précis de la greffe munie de son ancre par rapport à la longueur des tunnels osseux, ou encore par contrôle radioscopique, l'ensemble de ces manoeuvres étant techniquement délicates et consommatrices de temps opératoire.Consequently, the anchor passes with hard friction in the traction tunnel, and it is difficult for the surgeon to determine with exactitude whether the anchor has or has not left the tunnel. To ensure this, it indeed exerts traction in the opposite direction (ligament side), and the barbs would then risk wedging the anchor in the bone, already inside the tunnel, so that the placement correct anchoring can only be really ensured by very precise measurement and marking of the graft provided with its anchor in relation to the length of the bone tunnels, or even by radioscopic control, all of these maneuvers being technically delicate and consuming of operating time.
Un autre inconvénient de cette ancre est encore que la surface de l'os sur laquelle les barbes prennent appui n'est en général pas plane, ni perpendiculaire à l'axe longitudinal de l'ancre, auquel cas l'appui se fait sur seulement deux barbes.Another disadvantage of this anchor is that the surface of the bone on which the beards are supported is generally not flat, nor perpendicular to the longitudinal axis of the anchor, in which case the support is made only on two beards.
On connaît également une ancre en forme de plaquette allongée, percée de quatre trous sensiblement alignés dans le sens longitudinal de la plaquette (EndoButton* de la société Acufex Microsurgical Inc.). Les deux trous médians servent à fixer le ligament, et les deux trous extérieurs servent à la fixation de fils de traction.There is also known an anchor in the form of an elongated plate, pierced with four holes substantially aligned in the longitudinal direction of the plate (EndoButton * from the company Acufex Microsurgical Inc.). The two middle holes are used to fix the ligament, and the two outer holes are used to fix the traction wires.
Cette ancre est enfilée longitudinalement dans le tunnel de traction, à l'aide des fils de traction, jusqu'à sortir par son extrémité proximale. Une fois sortie du tunnel, une traction sur le fil de traction postérieur la fait pivoter autour d'un axe perpendiculaire à son axe longitudinal, et elle est ramenée en arrière par traction côté ligament, de manière à lui faire prendre appui sur les bords du tunnel, avec son axe longitudinal sensiblement perpendiculaire à l'axe du tunnel.This anchor is threaded longitudinally in the traction tunnel, using the traction wires, until it exits through its proximal end. Once out of the tunnel, a traction on the posterior traction wire makes it pivot around an axis perpendicular to its longitudinal axis, and it is brought back by traction on the ligament side, so as to make it rest on the edges of the tunnel, with its longitudinal axis substantially perpendicular to the axis of the tunnel.
Selon l'invention, on se propose de fournir une ancre de ce type, plus simple à réaliser et à manipuler, et surtout de dimension moindre, de sorte que l'on puisse la faire passer dans un tunnel de traction plus étroit, ce qui affaiblit moins l'os, ou encore permet de l'utiliser pour des os plus fins ou moins résistants. La solution selon l'invention consiste à prévoir une ancre chirurgicale destinée à fixer un ligament ou analogue, à la sortie proximale d'un tunnel percé dans un os, constituée d'un corps allongé pourvu d'un moyen de passage perpendiculaire à l'axe longitudinal du corps allongé, pour la fixation, d'une part d'un moyen de traction, et d'autre part d'un moyen de fixation d'un ligament ou analogue, ancre prévue pour pivoter perpendiculairement à son axe longitudinal, à sa sortie du tunnel, pour se disposer en position de blocage sensiblement perpendiculaire à l'axe du tunnel, caractérisée en ce que le moyen de passage pour le moyen de traction est constitué d'un seul fraisage perpendiculaire à l'axe longitudinal du corps allongé, et - le moyen de passage pour le moyen de fixation du ligament ou analogue est constitué d'un seul fraisage perpendiculaire à l'axe longitudinal du corps allongé.According to the invention, it is proposed to provide an anchor of this type, simpler to produce and to handle, and especially of smaller size, so that it can be passed through a narrower traction tunnel, which weakens the bone less, or even allows it to be used for thinner or less resistant bones. The solution according to the invention consists in providing a surgical anchor intended to fix a ligament or the like, at the proximal outlet of a tunnel pierced in a bone, consisting of an elongated body provided with a passage means perpendicular to the longitudinal axis of the elongated body, for fixing, on the one hand a traction means, and on the other hand a means of fixing a ligament or the like, anchor intended to pivot perpendicular to its longitudinal axis, with its exit from the tunnel, in order to be in the blocking position substantially perpendicular to the axis of the tunnel, characterized in that the passage means for the traction means consists of a single milling perpendicular to the longitudinal axis of the elongated body , and - the passage means for the ligament fixing means or the like consists of a single milling perpendicular to the longitudinal axis of the elongated body.
Selon une autre caractéristique de l'invention, le fraisage pour le moyen de fixation du ligament est un fraisage de section étroite et allongée, dont le long côté est parallèle à l'axe longitudinal du corps allongé, destiné à recevoir un moyen de fixation plat, semblable à un ruban, pour le ligament.According to another characteristic of the invention, the milling for the ligament fixing means is a milling of narrow and elongated section, the long side of which is parallel to the longitudinal axis of the elongated body, intended to receive a flat fixing means , similar to a ribbon, for the ligament.
Selon une autre caractéristique de l'invention, le fraisage pour le moyen de traction et le fraisage pour la fixation du ligament forment un seul fraisage commun.According to another characteristic of the invention, the milling for the traction means and the milling for the attachment of the ligament form a single common milling.
Selon une autre caractéristique de l'invention, le moyen de fixation du ligament ou analogue, enfilé dans le fraisage du corps allongé, est fixé à celui-ci en étant retenu par une surépaisseur à son extrémité, ne pouvant passer dans le fraisage.According to another characteristic of the invention, the means for fixing the ligament or the like, threaded through the milling of the elongated body, is fixed to the latter while being retained by an extra thickness at its end, which cannot pass through the milling.
Selon une autre caractéristique de l'invention, le moyen de fixation du ligament ou analogue est fixé au corps allongé en étant enfilé dans ledit fraisage à la manière d'un fil dans une aiguille.According to another characteristic of the invention, the ligament fixing means or the like is fixed to the elongated body by being threaded through said milling in the manner of a thread in a needle.
Selon une autre caractéristique de l'invention, les deux brins du moyen de fixation sont ligaturés à proximité de la surface du corps allongé.According to another characteristic of the invention, the two strands of the fixing means are ligated near the surface of the elongated body.
Selon une autre caractéristique de l'invention, les deux brins du moyen de fixation sont noués à proximité de la surface du corps allongé. Selon une autre caractéristique de l'invention, le corps allongé est de section essentiellement cylindrique. D'autres aspects, caractéristiques et avantages de l'invention apparaîtront de la description détaillée qui suit, et des dessins annexés, sur lesquels: La figure 1 est une vue de profil, avec arrachage partiel, d'une ancre selon l'invention,According to another characteristic of the invention, the two strands of the fastening means are knotted near the surface of the elongated body. According to another characteristic of the invention, the elongated body is of essentially cylindrical section. Other aspects, characteristics and advantages of the invention will appear from the detailed description which follows, and from the appended drawings, in which: FIG. 1 is a side view, partially broken away, of an anchor according to the invention,
La figure 2 est une vue en perspective de l'ancre de l'invention, pourvue d'un moyen de traction et d'un moyen de fixation d'un ligament ou analogue, La figure 3 est une vue en coupe transversale de l'ancre selon l'invention, avec un autre mode de fixation du moyen de fixation du ligament ou analogue,Figure 2 is a perspective view of the anchor of the invention, provided with a traction means and a means for fixing a ligament or the like, Figure 3 is a cross-sectional view of the anchor according to the invention, with another method of fixing the ligament fixing means or the like,
La figure 4 est une vue de l'ancre en cours de passage dans un tunnel percé dans un os. En se reportant au dessin, l'ancre 1 comprend un corps oblong, généralement cylindrique 2 percé d'un fraisage traversant 3, dont l'axe longitudinal A-A' est essentiellement perpendiculaire à l'axe longitudinal B-B' du corps cylindrique 2. Comme on le voit au dessin, le fraisage est en forme de fente 3, et présente une section transversale allongée selon l'axe longitudinal B-B' du corps cylindrique 2.Figure 4 is a view of the anchor being passed through a tunnel pierced in a bone. Referring to the drawing, the anchor 1 comprises an oblong, generally cylindrical body 2 pierced with a through milling 3, the longitudinal axis AA 'of which is essentially perpendicular to the longitudinal axis BB' of the cylindrical body 2. As seen in the drawing, the milling is in the form of a slot 3, and has an elongated cross section along the longitudinal axis BB 'of the cylindrical body 2.
Le fraisage 3 est prévu pour l'enfilage d'un moyen de fixation 4 d'un ligament ou analogue, ainsi que d'un fil de traction 5.Milling 3 is provided for threading a fixing means 4 of a ligament or the like, as well as a pulling wire 5.
Le fil de traction 5 sert uniquement lors de l'opération, pour permettre au chirurgien de tirer l'ancre à travers le tunnel 6 d'insertion du ligament ou analogue, puis à travers le tunnel de traction 7 plus étroit qui le prolonge, en entraînant le ligament 8 sensiblement jusqu'au fond du tunnel d'insertion 6. Les tunnels d'insertion et de traction sont forés dans l'os 9 auquel le ligament doit être accroché.The pulling wire 5 is used only during the operation, to allow the surgeon to pull the anchor through the ligament insertion tunnel 6 or the like, then through the narrower traction tunnel 7 which extends it, driving the ligament 8 substantially to the bottom of the insertion tunnel 6. The insertion tunnels and of traction are drilled in bone 9 to which the ligament is to be attached.
Une fois l'ancre en place, le fil 5 est enlevé, le plus simplement par traction sur l'un de ses brins.Once the anchor in place, the wire 5 is removed, most simply by pulling on one of its strands.
Le moyen de fixation du ligament sert non seulement à tirer le ligament sensiblement jusqu'au fond du tunnel d'insertion 6, au cours de l'opération, mais sert également d'ancrage du ligament à l'os, et il doit donc être dimensionné en conséquence.The ligament fixing means not only serves to pull the ligament substantially to the bottom of the insertion tunnel 6, during the operation, but also serves to anchor the ligament to the bone, and it must therefore be sized accordingly.
Le fraisage 3 de section allongée selon l'invention offre une section de passage relativement grande pour une largeur de fente réduite; associé à un moyen de fixation 4 plat, en forme de ruban, il permet de donner à celui-ci une section suffisante pour résister aux efforts auxquels il sera soumis, et ce pour un faible diamètre du corps cylindrique 2.The milling 3 of elongated section according to the invention offers a relatively large passage section for a reduced slot width; associated with a flat fixing means 4, in the form of a ribbon, it makes it possible to give the latter a section which is sufficient to withstand the forces to which it will be subjected, and this for a small diameter of the cylindrical body 2.
A la figure 2, le ruban de fixation 4 et le fil de traction 5 sont représentés enfilés dans le fraisage 3 à la manière d'un fil dans le chas d'une aiguille, ce qui constitue le moyen de plus simple et le plus fiable de fixer le ruban de fixation 4 et le fil de traction 5 au corps cylindrique 2. Les deux brins du ruban 4 sont d'autre part ligaturés ensemble, comme indiqué par le trait en pointillés 11.In Figure 2, the fixing tape 4 and the pulling wire 5 are shown threaded through the milling 3 in the manner of a wire in the eye of a needle, which is the simplest and most reliable means fixing the fixing tape 4 and the pulling wire 5 to the cylindrical body 2. The two strands of the tape 4 are also tied together, as indicated by the dotted line 11.
Dans la variante de la figure 3, le ruban de traction est représenté muni d'une surépaisseur 10 à son extrémité libre, opposée au ligament, de manière à empêcher le ruban enfilé de sortir du fraisage. Ceci constitue cependant un mode de réalisation moins préféré, parce que moins fiable.In the variant of FIG. 3, the traction tape is shown provided with an extra thickness 10 at its free end, opposite the ligament, so as to prevent the threaded tape from coming out of the milling. This is, however, a less preferred embodiment because it is less reliable.
Dans les dessins, on n'a représenté qu'un seul fraisage 3, qui sert aussi bien pour le fil de traction que pour le ruban de fixation, et qui constitue un mode de réalisation préféré de l'invention. L'invention n'est bien entendu pas limitée à ce mode de réalisation, et on peut également prévoir deux fraisages séparés, ou encore un fraisage pour le ruban de fixation, et un alésage pour le fil de traction, sans toutefois que cela présente un avantage particulier.In the drawings, only one milling 3 has been shown, which is used both for the pulling wire and for the fixing tape, and which constitutes a preferred embodiment of the invention. The invention is not understood not limited to this embodiment, and one can also provide two separate millings, or a milling for the fixing tape, and a bore for the pulling wire, without however that this has a particular advantage.
Pour des raisons de commodité, le fraisage unique sera de préférence réalisé symétriquement au milieu du corps, de sorte que l'ancre soit parfaitement symétrique, et ne possède pas une face avant et une face arrière. A la figure 4, l'ancre est représentée en cours de passage dans le tunnel de traction 7 percé dans un os 9, à la suite du tunnel 6 d'insertion du ligament ou analogue.For reasons of convenience, the single milling will preferably be carried out symmetrically in the middle of the body, so that the anchor is perfectly symmetrical, and does not have a front face and a rear face. In Figure 4, the anchor is shown during passage in the traction tunnel 7 pierced in a bone 9, following the tunnel 6 for insertion of the ligament or the like.
De manière connue, les tunnels sont forés dans l'os après avoir pratiqué une ouverture dans les tissus mous à l'extrémité distale, et le fil de traction 5 est enfilé dans les tunnels 6, 7 à l'aide d'un passe-fils que le chirurgien fait déboucher à l'extérieur, de manière proximale, en perçant la peau; une fois le fil à l'extérieur, le chirurgien peut le prendre directement en main, et tirer l'ancre et le ligament à l'intérieur des tunnels.In known manner, the tunnels are drilled in the bone after having made an opening in the soft tissues at the distal end, and the pulling wire 5 is threaded in the tunnels 6, 7 using a pass wires which the surgeon leads outwards, proximally, by piercing the skin; once the wire is outside, the surgeon can take it directly in hand, and pull the anchor and the ligament inside the tunnels.
Comme on le voit à la figure 4, le fil de traction se dispose longitudinalement par rapport au corps cylindrique, tandis que les deux brins du ruban se déforment (se tordent) pour se présenter également longitudinalement par rapport au corps cylindrique 2.As can be seen in FIG. 4, the pulling wire is arranged longitudinally relative to the cylindrical body, while the two strands of the ribbon are deformed (twisted) so as to also be presented longitudinally relative to the cylindrical body 2.
Lorsque l'ancre sort du tunnel 7, elle tend à se redresser (à pivoter perpendiculairement à son axe longitudinal), entre autre sous l'effet de la fixation asymétrique du ruban 4. Elle ne reste dès lors pas alignée avec l'axe du tunnel de traction et, lorsque le chirurgien exerce une traction en sens inverse, côté ligament, l'extrémité arrondie de l'ancre entre en contact avec la paroi osseuse à la sortie du tunnel . En poursuivant la traction côté ligament - éventuellement associée à de courtes tractions côté fil de traction, le chirurgien amène alors l'ancre en appui, transversalement à l'axe du tunnel de traction .When the anchor comes out of the tunnel 7, it tends to straighten (to pivot perpendicularly to its longitudinal axis), inter alia under the effect of the asymmetrical fixing of the ribbon 4. It therefore does not remain aligned with the axis of the traction tunnel and, when the surgeon exerts traction in the opposite direction, on the ligament side, the rounded end of the anchor comes into contact with the bone wall at the exit of the tunnel. Continuing the traction on the ligament side - possibly associated with short pulls on the traction wire side, the surgeon then brings the anchor in support, transverse to the axis of the tunnel traction.
A la figure 2, on a indiqué par un trait en pointillés 11 une ligature des deux brins du ruban de fixation 4, à proximité du corps cylindrique 2. Cette ligature a pour but de forcer le ruban à se disposer comme à la figure 4, avec ses bords 4', 4" sensiblement perpendiculaires à l'axe longitudinal du corps 2, en empêchant donc le ruban de se disposer longitudinalement à la manière du fil de traction 5, ce qui affaiblirait la tendance du corps à se redresser. Cette ligature peut cependant être remplacée par un simple nouage des deux brins, qui assure le même effet, avec toutefois l'inconvénient d'un plus fort encombrement par rapport à la ligature, ce qui exige dès lors un tunnel de traction plus gros. Selon l'invention, on a ainsi fourni une ancre chirurgicale perfectionnée, permettant l'ancrage d'un ligament par arthroscopie, et donc avec le moindre traumatisme, en réduisant sensiblement le diamètre du tunnel de traction à forer dans l'os, et en assurant un blocage sûr de l'ancre, sans recours à une radioscopie ou analogue.In FIG. 2, a dotted line 11 indicates a ligature of the two strands of the fixing tape 4, near the cylindrical body 2. The purpose of this ligature is to force the ribbon to be arranged as in FIG. 4, with its edges 4 ′, 4 "substantially perpendicular to the longitudinal axis of the body 2, thus preventing the ribbon from being arranged longitudinally in the manner of the pulling wire 5, which would weaken the tendency of the body to straighten out. can however be replaced by a simple knotting of the two strands, which ensures the same effect, with however the disadvantage of a larger bulk compared to the ligature, which consequently requires a larger traction tunnel. invention, an improved surgical anchor was thus provided, allowing the anchoring of a ligament by arthroscopy, and therefore with the least trauma, by appreciably reducing the diameter of the traction tunnel to be drilled in the bone, and by ensuring a blockag sure of the anchor, without recourse to a radioscopy or the like.
Ainsi selon l'invention on atteint facilement un diamètre du corps 2 de l'ordre de 2,5 mm ou même de 2 mm, à comparer à une dimension transversale de l'ordre de 4 mm pour la plaquette EndoButton®, ou encore à un diamètre de l'ordre de 5 mm pour l'ancre selon EP-A-0 619 982.Thus according to the invention is easily reached a body diameter 2 of about 2.5 mm or even 2 mm, compared with a transverse dimension of the order of 4 mm for the wafer EndoButton ®, or to a diameter of the order of 5 mm for the anchor according to EP-A-0 619 982.
Par "fraisage" dans la présente description, on entend un percement de part en part du corps de l'ancre, qui peut être réalisé à la fraise, mais également par tout autre moyen, par exemple au Laser. By "milling" in the present description means a piercing right through the body of the anchor, which can be carried out with a milling cutter, but also by any other means, for example with a laser.

Claims

REVENDICATIONS
1. Ancre chirurgicale ( 1 ) destinée à fixer un ligament ou analogue, à la sortie proximale d'un tunnel percé dans un os, constituée d'un corps allongé (2) pourvu d'un moyen de passage perpendiculaire à l'axe longitudinal (B-B') du corps allongé, pour la fixation, d'une part d'un moyen de traction <5), et d'autre part d'un moyen de fixation (4) d'un ligament ou analogue, ancre prévue pour pivoter perpendiculairement à son axe longitudinal (B-B1), à sa sortie du tunnel, pour se disposer en position de blocage sensiblement perpendiculaire à l'axe du tunnel, caractérisée en ce que le moyen de passage pour le moyen de traction est constitué d'un seul fraisage perpendiculaire à l'axe longitudinal du corps allongé, et le moyen de passage pour le moyen de fixation du ligament ou analogue est constitué d'un seul fraisage perpendiculaire à l'axe longitudinal du corps allongé. 1. Surgical anchor (1) intended to fix a ligament or the like, at the proximal outlet of a tunnel pierced in a bone, consisting of an elongated body (2) provided with a passage means perpendicular to the longitudinal axis (B-B ') of the elongated body, for the fixing, on the one hand of a traction means <5), and on the other hand of a fixing means (4) of a ligament or the like, anchor designed to pivot perpendicular to its longitudinal axis (BB 1 ), at its exit from the tunnel, in order to be in the locking position substantially perpendicular to the axis of the tunnel, characterized in that the passage means for the traction means is constituted of a single milling perpendicular to the longitudinal axis of the elongated body, and the passage means for the ligament fixing means or the like consists of a single milling perpendicular to the longitudinal axis of the elongated body.
2. Ancre selon la revendication 1, caractérisée en ce que le fraisage pour le moyen de fixation du ligament est un fraisage (3) de section étroite et allongée, dont le long côté est parallèle à l'axe longitudinal (B-B' ) du corps allongé (2), destiné à recevoir un moyen de fixation (4) plat, semblable à un ruban, pour le ligament. 2. Anchor according to claim 1, characterized in that the milling for the ligament fixing means is a milling (3) of narrow and elongated section, the long side of which is parallel to the longitudinal axis (BB ') of the body elongated (2), intended to receive a fixing means (4) flat, similar to a ribbon, for the ligament.
3. Ancre selon la revendication 1 ou 2 , caractérisée en ce que le fraisage pour le moyen de traction et le fraisage pour la fixation du ligament forment un seul fraisage (3) commun.3. Anchor according to claim 1 or 2, characterized in that the milling for the traction means and the milling for the attachment of the ligament form a single common milling (3).
4. Ancre selon l'une quelconque des revendication 1 à 3, caractérisée en ce que le moyen de fixation (4) du ligament ou analogue, enfilé dans le fraisage (3) du corps allongé (2), est fixé à celui-ci en étant retenu par une surépaisseur (10) à son extrémité, ne pouvant passer dans le fraisage. 4. An anchor according to any one of claims 1 to 3, characterized in that the fixing means (4) of the ligament or the like, threaded into the milling (3) of the elongated body (2), is fixed to the latter being retained by an extra thickness (10) at its end, which cannot pass through the milling.
5. Ancre selon l'une quelconque des revendications 1 à 3, caractérisée en ce que le moyen de fixation (4) du ligament ou analogue est fixé au corps allongé (2) en étant enfilé dans ledit fraisage (3) à la manière d'un fil dans une aiguille.5. An anchor according to any one of claims 1 to 3, characterized in that the fixing means (4) of the ligament or the like is fixed to the elongated body (2) being threaded through said milling (3) in the manner of a thread in a needle.
6. Ancre selon la revendication 5, caractérisée en ce que les deux brins du moyen de fixation (4) sont ligaturés (11) à proximité de la surface du corps allongé.6. Anchor according to claim 5, characterized in that the two strands of the fixing means (4) are ligated (11) near the surface of the elongated body.
7. Ancre selon la revendication 5, caractérisée en ce que les deux brins du moyen de fixation (4) sont noués à proximité de la surface du corps allongé (2).7. Anchor according to claim 5, characterized in that the two strands of the fixing means (4) are knotted near the surface of the elongated body (2).
8. Ancre selon l'une quelconque des revendications précédentes, caractérisée en ce que le corps allongé (2) est de section essentiellement cylindrique. 8. An anchor according to any one of the preceding claims, characterized in that the elongated body (2) is of essentially cylindrical section.
PCT/BE1995/000025 1995-03-21 1995-03-21 Surgical anchoring piece for ligaments WO1996029029A1 (en)

Priority Applications (4)

Application Number Priority Date Filing Date Title
PCT/BE1995/000025 WO1996029029A1 (en) 1995-03-21 1995-03-21 Surgical anchoring piece for ligaments
EP95912098A EP0814730A1 (en) 1995-03-21 1995-03-21 Surgical anchoring piece for ligaments
CA002215943A CA2215943A1 (en) 1995-03-21 1995-03-21 Surgical anchoring piece for ligaments
AU19431/95A AU1943195A (en) 1995-03-21 1995-03-21 Surgical anchoring piece for ligaments

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PCT/BE1995/000025 WO1996029029A1 (en) 1995-03-21 1995-03-21 Surgical anchoring piece for ligaments
CA002215943A CA2215943A1 (en) 1995-03-21 1995-03-21 Surgical anchoring piece for ligaments

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AU (1) AU1943195A (en)
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