US20160374794A1 - Helicoil Interference Fixation System For Attaching a Graft Ligament to a Bone - Google Patents

Abstract

A helicoil interference fixation system comprising:

a helicoil comprising a helical body comprising a plurality of turns separated by spaces therebetween, the helical body terminating in a proximal end and a distal end, and at least one internal strut extending between at least two turns of the helical body; and

an inserter for turning the helicoil, the inserter comprising at least one groove for receiving the at least one strut;

the helicoil being mounted on the inserter such tin at the at least one strut of the helicoil is mounted in the: at least one groove of the inserter, such that rotation of the inserter causes rotation of the helicoil.

Description

REFERENCE TO PENDING PRIOR PATENT APPLICATION
• This patent application:
• (i) is a continuation-in-part of pending prior U.S. patent application Ser. No. 11/893,440, filed Aug. 16, 2007 by Dennis G. McDevitt for COMPOSITE INTERFERENCE SCREW FOR ATTACHING A GRAFT LIGAMENT TO A BONE, AND OTHER APPARATUS FOR MAKING ATTACHMENTS TO BONE (Attorney's Docket No. INCUMED-02); and
• (ii) claims benefit of pending prior U.S. Provisional Patent Application Ser. No. 61/200,285, filed Nov. 26, 2008 by Dennis M. McDevitt et al. for HELICOIL FIXATION DEVICE (Attorney's Docket No. INCUMED-4 PROV).
• The two above-identified patent applications are hereby incorporated herein by reference.
FIELD OF THE INVENTION
• This invention relates to medical apparatus and procedures in general, and more particularly to medical apparatus and procedures for reconstructing a ligament.
BACKGROUND OF THE INVENTION
• Ligaments are tough bands of tissue which serve to connect the articular extremities of bones, and/or to support and/or retain organs in place within the body. Ligaments are typically made up of coarse bundles of dense fibrous tissue which are disposed in a parallel or closely interlaced manner, with the fibrous tissue being pliant and flexible but not significantly extensible.
• In many cases, ligaments are torn or ruptured as the result of an accident. Accordingly, various procedures have been developed to repair or replace such damaged ligaments.
• For example, in the human knee, the anterior and posterior cruciate ligaments (i.e., the “ACL” and “PCL”) extend between the top end of the tibia and the bottom end of the femur. The ACL and PCL serve, together with other ligaments and soft tissue, to provide both static and dynamic stability to the knee. Often, the anterior cruciate ligament (i.e., the ACL) is ruptured or torn as the result of, for example, a sports-related injury. Consequently, various surgical procedures have been developed for reconstructing the ACL so as to restore substantially normal function to the knee.
• In many instances, the ACL may be reconstructed by replacing the ruptured ACL with a graft ligament. More particularly, in such a procedure, bone tunnels are generally forced in both the top of the tibia and the bottom of the femur, with one end of the graft ligament being positioned in the femoral, tunnel and the other end of the graft ligament being positioned in the tibial tunnel, and with the intermediate portion of the graft ligament spanning the distance between the bottom of the femur and the top of the tibia. The two ends of the graft ligament are anchored in their respective hone tunnels in various ways well known in the art so that the graft ligament extends between the bottom end of the femur and the top end of the tibia in substantially the same way, and with substantially the same function, as the original ACL. This graft ligament then cooperates with the surrounding anatomical structures so as to restore substantially normal function to the knee.
• In some circumstances, the graft ligament may be a ligament, or tendon which is harvested from elsewhere within the patient's body, e.g., a patella tendon with or without bone blocks attached, a semitendinosus tendon and/ox a gracilis tendon. In other circumstances, the graft ligament may be harvested from a cadaver. In still other circumstances, the graft ligament may be a synthetic device. For the purposes of the present invention, all of the foregoing may be collectively referred to herein as a “graft ligament”.
• As noted above, various approaches are well known in the art for anchoring the two ends of the graft ligament in the femoral and tibial bone tunnels.
• In one well-known procedure, which may be applied to femoral fixation, tibial fixation, or both, the end of the graft ligament is placed in the bone tunnel, and then the graft ligament is fixed in place using a headless orthopedic screw, generally known in the art as an “interference” screw. More particularly, with this approach, the end of the graft ligament is placed in the bone tunnel and then the interference screw is advanced into the bone tunnel so that the interference screw extends parallel, to the bone tunnel and simultaneously engages both the graft ligament and the side wall of the bone tunnel. In this arrangement, the interference screw essentially drives the graft ligament laterally, into engagement with the opposing side wall of the bone tunnel, whereby to secure the graft ligament to the host bone with a so-called “interference fit”. Thereafter, over time (e.g., several months), the graft ligament and the host bone grow together at their points of contact so as to provide a strong, natural joinder between the ligament and the bone.
• Interference screws have proven to be an effective means for securing a graft ligament in a bone tunnel. However, the interference screw itself generally takes up a substantial amount of space within the bone tunnel, which can limit the surface area contact established between the graft ligament and the side wall of the bone tunnel. This in turn limits the region of bone-to-ligament in-growth, and hence can affect the strength of the joinder. By way of example but not limitation, it has been estimated that the typical interference screw obstructs about 50% of the potential bone-to-ligament integration region.
• For this reason, substantial efforts have been made to provide interference screws fabricated from, absorbable materials, so that the interference screw can eventually disappear over time and bone-to-ligament in-growth can take place about the entire perimeter of the bone tunnel. To this end, various absorbable interference screws have been developed which are made from biocompatible, bioabsorbable polymers, e.g., polylactic acid (PLA), polyglycolic acid (PGA), etc. These polymers generally provide the substantial mechanical strength needed to advance the interference screw into position, and to thereafter hold the graft ligament in position while bone-to-ligament in-growth occurs, without remaining in position on a permanent basis.
• In general, interference screws made from such biocompatible, bioabsorbable polymers have proven clinically successful. However, these absorbable interference screws still suffer from several disadvantages. First, clinical evidence suggests that the quality of the bone-to-ligament in-growth is somewhat different than natural bone-to-ligament in-growth, in the sense that the aforementioned bioabsorbable polymers tend to be replaced by a fibrous mass rather than a well-ordered tissue matrix. Second, clinical evidence suggests that absorption generally takes a substantial period of time, e.g., on the order of three years or so. Thus, during this absorption time, the bone-to-ligament in-growth is still significantly limited by the presence of the interference screw. Third, clinical evidence suggests that, for many patients, absorption is never complete, leaving a substantial foreign mass remaining within the body. This problem is exacerbated somewhat by the fact that absorbable interference screws generally tend to be fairly large in order to provide them with adequate strength, e.g., it is common for an interference screw to have a diameter (i.e., an outer diameter) of 8-12 mm and a length of 20-25 mm.
• Thus, there is a need for a new and improved interference fixation system which (i) has the strength needed to hold the graft ligament in position while bone-to-ligament in-growth occurs, and (ii) promotes superior bone-to-ligament in-growth.
SUMMARY OF THE INVENTION
• These and other objects are addressed by the provision and use of a novel helicoil interference fixation system for attaching a graft ligament to a bone.
• In one preferred form of the invention, there is provided a novel helicoil interference fixation on system comprising:
• a helicoil comprising a helical body comprising a plurality of turns separated by spaces therebetween, the helical body terminating in a proximal end and a distal end, and at least one internal strut extending between at least two turns of the helical body; and
• an inserter for turning the helicoil, the inserter comprising at least one groove for receiving the at least one strut;
• the helicoil being mounted on the inserter such that the at least one strut of the helicoil is mounted in the at least one groove of the inserter, such that rotation of the inserter causes rotation of the helicoil.
• In another preferred form of the invention, there is provided, a novel method for attaching a graft ligament to a bone, the method comprising;
• providing a helicoil interference fixation system comprising:
• a helicoil comprising a helical body comprising a plurality of turns separated by spaces therebetween, the helical body terminating in a proximal end and a distal end, and at least one internal strut extending between at least two turns of the helical body; and
• an inserter for turning the helicoil, the inserter comprising at least one groove for receiving the at least one strut;
• the helicoil being mounted on the inserter such that the at least one strut of the helicoil is mounted in the at least one groove of the inserter, such that rotation of the inserter causes rotation of the helicoil;
• forming a bone tunnel in the bone, and providing a graft ligament;
• inserting the graft ligament into the bone tunnel; and
• using the inserter to turn the helicoil into the bone tunnel so as to secure the graft ligament to the bone using an interference fit.
• In another preferred form of the invention, there is provided a novel helicoil comprising a helical body comprising a plurality of turns separated by spaces therebetween, the helical body terminating in a proximal end and a distal end, and at least one internal strut extending between at least two turns of the helical body, wherein the at least one internal strut comprises a helical construction.
BRIEF DESCRIPTION OF THE DRAWINGS
• These and other objects and features of the present invention will be more fully disclosed or rendered obvious by the following detailed description of the preferred embodiments of the invention, which is to be considered together with the accompanying drawings wherein like numbers refer to like parts, and further wherein:
• FIGS. 1-7 are schematic views showing a first helicoil interference fixation system formed in accordance with the present invention;
• FIGS. 8-13 are schematic views showing a second helicoil interference fixation system formed in accordance with the present invention;
• FIGS. 14-20 are schematic views showing a femoral fixation using the second helicoil interference fixation system ofFIGS. 8-13;
• FIGS. 21-25 are schematic views showing a full ACL reconstruction using the second helicoil interference fixation system ofFIGS. 8-13;
• FIGS. 26-28 are schematic views showing a soft tissue ACL fixation using the second helicoil interference fixation system ofFIGS. 8-13;
• FIGS. 29-31 are schematic views showing a third helicoil interference fixation system formed in accordance with the present invention;
• FIG. 32 is schematic view showing a fourth helicoil interference fixation system formed in accordance with the present, invention;
• FIG. 33 is a schematic view showing a fifth helicoil Interference fixation system formed in accordance with the present invention;
• FIGS. 34-36 are schematic views showing a sixth helicoil interference fixation system formed in accordance with the present invention;
• FIG. 37 is a schematic view showing a seventh helicoil interference fixation system formed in accordance with the present invention;
• FIG. 38 is a schematic view showing an eighth helicoil interference fixation system formed in accordance with the present invention; and
• FIG. 39 is a schematic view showing a ninth helicoil interference fixation system formed in accordance with the present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• The present invention comprises the provision and use of a novel helicoil interference fixation system for attaching a graft ligament to a bone or other tissue.
• For convenience, the present invention will hereinafter be discussed in the context of its use for an ACL tibial and/or femoral fixation; however, it should be appreciated that the present invention may also be used for the fixation of other graft ligaments to the tibia and/or the femur; and/or the fixation of other graft ligaments to other bones or to other tissue such as organs.
• Looking first atFIGS. 1-7, there is shown a novel helicoil interference fixation system5 for securing a graft ligament to a bone. Helicoil interference fixation system5 generally comprises ahelicoil10 for disposition in a bone tunnel so as to hold the graft ligament in position while bone-to-ligament in-growth occurs. Helicoil interference fixation system5 also comprises aninserter15 for deployinghelicoil10 in the bone tunnel.
• More particularly, and looking now atFIGS. 1-6, and particularly atFIG. 5,helicoil10 generally comprises ahelicoil body20 terminating in adistal end25 and aproximal end30.Helical body20 is constructed so that there are substantial spaces or gaps35 between theturns40 of the helical body. Spaces or gaps35 facilitate bone-to-ligament in-growth, i.e., by providing large openings through the helical body. These large openings facilitate the flow of cell- and nutrient-bearing fluids through the helicoil, and permit the in-growth of tissue across the helicoil, so as to enhance bone-to-ligament in-growth.
• One ormore struts45 are disposed within the interior ofhelical body20, with the one ormore struts45 being secured to the interior surfaces50 ofhelical body20. The one ormore struts45 provide a means for turninghelicoil10 during deployment within the body, as will hereinafter be discussed in further detail. In addition, the one ormore struts45 can provide structural support for theturns40 ofhelical body20. The one ormore struts45 may be formed integral with helical body20 (e.g., by a molding process), or they may be formed separately fromhelical body20 and then attached tohelical body20 in a separate manufacturing process (e.g., by welding). Where the one ormore struts45 are formed integral withhelical body20, the one ormore struts45 can be used to help flow melt into position.
• In one preferred form of the invention, the one ormore struts45 comprise helical structures. And in one particularly preferred form of the invention, the one ormore struts45 comprise helical structures which spiral in the opposite direction from the spiral ofhelical body20, and the one ormore struts45 have a pitch which is substantially greater than the pitch ofhelical body20. SeeFIG. 5.
• Preferably, the number ofstruts45, and their size, are selected so as to close off an insignificant portion of the spaces or gaps35 between theturns40 ofhelical body20, whereby to substantially not impede the passage of fluids and tissue through the helicoil. At the same time, however, the number ofstruts45, their size, and composition, are selected so as to provide an adequate means for turninghelicoil10 during deployment, and to provide any necessary support for theturns40 ofhelical body20.
• In one preferred form of the present invention, onestrut45 is provided.
• In another preferred form of the present invention, a plurality of struts45 (e.g., two, three, four or more struts) are provided.
• And in one preferred form of the present invention, thestruts45 collectively close off less than fifty percent (50%) of the spaces or gaps35 between theturns40 ofhelical body20.
• And in one particularly preferred form of the present invention, thestruts45 collectively close off less than twenty percent (20%) of the spaces or gaps35 between theturns40 ofhelical body20.
• Helicoil10 is formed out of one or more biocompatible materials. These biocompatible materials may be non-absorbable (e.g., stainless steel or plastic) or absorbable (e.g., a bioabsorbable polymer). In one preferred form of the present invention, helicoil10 preferably comprises a bioabsorbable polymer such, as polylactic acid (PLA), polyglycolic acid (PGA), etc. In any case, however, helicoil10 comprises a material which is capable of providing the strength needed to set the fixation device into position and to hold the graft ligament in position while bone-to-ligament in-growth occurs.
• Inserter15 is shown inFIGS. 1-4 and 7.Inserter15 generally comprises a shaft55 having adistal end60 and a proximal end65. One ormore grooves70 are formed on the distal end of shaft55.Grooves70 receive the one ormore struts45 ofhelicoil10, in order that helicoil10 may be mounted en the distal end of shaft55 and rotated by rotation of shaft55. A tapered seat-forming thread75 (e.g., a tapered cutting thread, a tapered opening or dilating thread, etc.) is formed in shaft55 distal togrooves70. Tapered seat-formingthread75 serves to precedehelicoil10 into the space between the graft ligament and the wail of the bone tunnel, and then to form a lead-in or opening in the graft ligament and the wail of the bone tunnel for receiving theturns40 ofhelical body20, in much the same manner as a tap that creates the thread form, as will hereinafter be discussed, in further detail. Ahandle80 is mounted on the proximal end of shaft55 in order to facilitate rotation of shaft55 by the surgeon.
• It should be appreciated, that tapered seat-formingthread75 is matched tohelicoil10 so that when helicoil10 is mounted oninserter15, tapered seat-formingthread75 provides the proper lead-in forhelicoil10.
• Preferably, interior surfaces50 ofhelical body20 anddistal end60 ofinserter15 are tapered, expanding outwardly in the proximal direction, so thathelicoil10 andinserter15 form a positive seat such that the interior surface of the helicoil is in direct contact with the tapered body diameter of the inserter.
• Thus it will be seen that, whenhelicoil10 is mounted on the distal end of shaft55,inserter15 may be used to advance the helicoil to a surgical site and, via rotation ofhandle80, turn helicoil10 into the gap between a graft ligament and the wall of a bone tunnel, whereby to create an interference fixation of the graft ligament in the bone tunnel. Significantly, inasmuch asinserter15 has a tapered seat-formingthread75 formed on its distal end in advance ofhelicoil10, the tapered seat-forming thread can form a seat into the tissue in advance ofhelicoil10 thereby to permit the helicoil to advance a easily into the tissue and create the desired interference fixation. Accordingly, helicoil10 does not need to have any penetrating point on its distal end in order to penetrate the tissue.
• If desired,inserter15 may be cannulated so that the inserted andhelicoil10 may be deployed over a guidewire, as will hereinafter be discussed.
• FIGS. 8-13 show another helicoil interference fixation system5, whereinhelicoil10 comprises twostruts45 andinserter15 comprises twogrooves70. The use of twostruts45, rather than onestrut45, may be advantageous since it may distribute the load imposed during rotation over a larger surface area. This may be important wherehelicoil10 is formed out of a bioabsorbable polymer.
• Helicoil interference fixation system5 may be utilized in a manner generally similar to that of a conventional interference screw system in order to attach a graft ligament to a bone.
• More particularly, and looking now atFIGS. 14-25, there are shown various aspects of an ACL reconstruction effected using helicoil interference fixation system5.
• FIG. 14 snows a typical knee joint205, with the joint having been prepared for an ACL reconstruction, i.e., with the natural ACL having been removed, and with atibial bone tunnel210 having been formed intibia215, and with afemoral bone tunnel220 having been formed infemur225.
• FIG. 15 is a view similar to that ofFIG. 14, except that agraft ligament230 has been positioned infemoral bone tunnel220 andtibial bone tunnel210 in accordance with ways well known in the art. By way of example,graft ligament230 may be “towed” up throughtibial bone tunnel210 and intofemoral bone tunnel220 using atow suture235.
• FIGS. 16 and 17show graft ligament230 being made fast infemoral tunnel220 using helicoil interference fixation system5. More particularly, in accordance with the present invention, helicoil10 is mounted on the distal end ofinserter15 by fitting thestruts45 ofhelicoil10 into thegrooves70 of the inserter. Then the inserter is used to advancehelicoil10 throughtibial tunnel210, across the interior of knee joint205, and up into thefemoral tunnel220. If desired,inserter15 may be cannulated, so that, the inserter and helicoil are advanced over a guidewire of the sort well known in the art. As the distal tip of the inserter is advanced, the tapered seat-formingthread75 first finds its way into the space between thegraft ligament230 and the side wall offemoral bone tunnel220. Then, as the inserter is turned, tapered seat-formingthread75 forms a seat into the tissue in advance ofhelicoil10, andhelicoil10 is advanced into the tissue so that the turns ofhelical body20 seat themselves in the seat formed by seat-formingthread75. As this occurs, the graft ligament is driven laterally, into engagement with the opposing side wall of the bone tunnel. This action setshelicoil10 between the side wall offemoral bone tunnel220 andgraft ligament230, thereby securing the interference fit betweengraft ligament230 and the side wall of the bone tunnel, whereby to securegraft ligament230 to the bone.
• Thereafter, and looking now atFIGS. 18 and 19,inserter15 is withdrawn, leavinghelicoil10 lodged in position between the graft ligament and the side wall of the bone tunnel. As seen inFIG. 20,helicoil10 maintains the interference fit established betweengraft ligament220 and the side wall of the bone tunnel, thereby securing the graft ligament to the bone.
• If desired, helicoil interference fixation system5 can then be used in a similar manner to form a tibial, fixation. SeeFIGS. 21-25.
• Significantly, forming the fixation device in the form of an open helical coil has proven particularly advantageous, inasmuch as the open helical coil provides the strength needed to set the fixation device into position, and hold the graft ligament in position while bone-to-ligament in-growth occurs, while still providing extraordinary access through the body of the fixation device. Thus, cell- and nutrient-bearing fluids can move substantially unimpeded through the body ofhelicoil10, and tissue in-growth can occur across the body ofhelicoil10.
• Furthermore, it has been found that when the graft ligament thereafter imposes axial loads on the interference fit, struts45 help maintain the structural integrity ofturns40 ofhelical body20, whereby to ensure the integrity of the interference fit.
• InFIGS. 16-24,graft ligament230 is shown to include bone blocks at the ends of the ligament, e.g.,graft ligament10 may be a patella tendon with bone blocks attached. However, as seen inFIGS. 26-28,graft ligament230 can also constitute only soft-tissue, e.g.,graft ligament230 may comprise a semitendinosus tendon and/or a gracilis tendon, and/or a synthetic device.
• InFIGS. 5 and 11, the one ormore struts15 are shown as having a helical structure. However, the one ormore struts45 may also be formed with a straight configuration. See, for example,FIGS. 29-30, which show a helicoil10 with a singlestraight strut45, andFIG. 31 which shows ahelicoil10 with multiplestraight struts45.
• Furthermore, as seen inFIG. 32, the one ormore struts45 may be interrupted betweenturns40 or, as seen inFIG. 33, the one ormore struts45 may be selectively interrupted betweenturns40.
• It should also be appreciated that an interference fit may be formed using a plurality ofhelicoils10. Thus, as seen inFIGS. 34-36, a Plurality ofhelicoils10 may be loaded on aninserter15 and used for a collective interference fit.
• If desired, and looking now atFIG. 37, the one ormore struts45 may be replaced withrecesses45A. In this case,grooves70 oninserter15 are replaced by corresponding ribs (not shown), whereby to permitinserter15 to rotatably drivehelicoil10.
• As seen inFIG. 38, the period ofterns40 may change along the length ofhelicoil10.
• Additionally, if desired, helicoil10 can be tapered between itsdistal end25 and itsproximal end30.
• Modifications
• It will be appreciated that still further embodiments of the present invention will be apparent to those skilled in the art in view of the present disclosure. It is to be understood that the present invention is by no means limited to the particular constructions and method steps herein disclosed and/or shown in the drawings, but also comprises any modifications or equivalents within the scope of the invention.

Claims (21)

1-32. (canceled)

33. An open helicoil comprising:

a proximal end, a distal end, and a plurality of turns of screw threads extending between the proximal and distal ends, the plurality of turns of screw threads defining an internal volume communicating with a region exterior to the open helicoil through a spacing between the plurality of turns of screw threads; and

at least one strut extending through the internal volume between at least two turns of the plurality of turns of screw threads;

wherein the open helicoil comprises a bioabsorbable material.

34. The open helicoil ofclaim 33, wherein the bioabsorbable material is a bioabsorbable polymer.

35. The open helicoil ofclaim 34, wherein the bioabsorbable polymer is polylactic acid (PLA).

36. The open helicoil ofclaim 34, wherein the bioabsorbable polymer is polyglycolic acid (PGA).

37. The open helicoil ofclaim 33, wherein the at least one strut extends between the proximal end and the distal end of the open helicoil.

38. The open helicoil ofclaim 33, wherein the at least one strut is linear.

39. The open helicoil ofclaim 33, wherein the at least one strut is formed integrally with the plurality of turns of screw threads.

40. The open helicoil ofclaim 33, wherein the distal end of the open helicoil is blunt.

41. An open helicoil comprising:

a proximal end, a distal end, and a plurality of turns of screw threads extending between the proximal and distal ends, the plurality of turns of screw threads defining an internal volume communicating with a region exterior to the open helicoil through a spacing between the plurality of turns of screw threads; and

a plurality of struts extending through the internal volume between at least two turns of the plurality of turns of screw threads;

wherein the open helicoil comprises a bioabsorbable material.

42. The open helicoil ofclaim 41, wherein the bioabsorbable material is a bioabsorbable polymer.

43. The open helicoil ofclaim 42, wherein the bioabsorbable polymer is polylactic acid (PLA).

44. The open helicoil ofclaim 42, wherein the bioabsorbable polymer is polyglycolic acid (PGA).

45. The open helicoil ofclaim 41, wherein at least one of the plurality of struts extends between the proximal end and the distal end of the open helicoil.

46. The open helicoil ofclaim 41, wherein each of the plurality of struts are linear.

47. The open helicoil ofclaim 41, wherein each of the plurality of struts are formed integrally with the plurality of turns of screw threads.

48. The open helicoil ofclaim 41, wherein the distal end of open helicoil is blunt.

49. A method for attaching a graft ligament to a bone, the method comprising:

mounting an open helicoil on an inserter such that at least one strut of the open helicoil is captured by at least one groove of the inserter whereby rotation of the inserter causes rotation of the open helicoil, the open helicoil further comprising:

a proximal end, a distal end, and a plurality of turns of screw threads extending between the proximal and distal ends, the plurality of turns of screw threads defining an internal volume communicating with a region exterior to the open helicoil through a spacing between the plurality of turns of screw threads, the at least one strut extending through the internal volume between at least two turns of the plurality of turns of screw threads, the open helicoil comprising a bioabsorbable material; forming a bone tunnel in bone;

inserting a graft ligament into the bone tunnel; and

using the inserter to turn the open helicoil into the bone tunnel so as to secure the graft ligament to the bone using an interference fit.

50. The method ofclaim 49, wherein the bioabsorbable material is a bioabsorbable polymer,

51. The method ofclaim 50, wherein the bioabsorbable polymer is polylactic acid (PLA).

52. The method ofclaim 50, wherein the bioabsorbable polymer is polyglycolic acid (PGA).

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