# Patent

## Title
Ligament system for knee joint

## Abstract

A system for an anatomical joint includes a first fastener, a second fastener, a prosthetic ligament member, and a biasing member associated with at least one of the first and second fasteners. The first fastener is operable to be connected to a first bone portion. The second fastener is operable to be connected to a second bone portion. The prosthetic ligament member is flexible and is directly coupled to both the first and second fasteners to support the first bone portion and the second bone portion for relative movement. A portion of the prosthetic ligament member extends from the first fastener to the second fastener and has an adjustable length. The biasing member is operable to bias the prosthetic ligament member to thereby maintain tension in the prosthetic ligament member.

## Background
CROSS REFERENCE TO RELATED APPLICATION
This application is a divisional of U.S. patent application Ser. No. 12/788,978 filed on May 27, 2010, now U.S. Pat. No. 8,801,783, which is a continuation-in-part of U.S. patent application Ser. No. 12/489,168 filed on Jun. 22, 2009, now U.S. Pat. No. 8,361,113 issued on Jan. 29, 2013, which is a continuation-in-part of U.S. patent application Ser. No. 12/474,802 filed on May 29, 2009, now U.S. Pat. No. 8,088,130 issued on Jan. 3, 2012, which is a continuation-in-part of: (a) U.S. patent application Ser. No. 12/196,405 filed on Aug. 22, 2008, U.S. Pat. No. 8,128,658 issued on Mar. 6, 2012; (b) U.S. patent application Ser. No. 12/196,407 filed on Aug. 22, 2008, now U.S. Pat. No. 8,137,382 issued on Mar. 20, 2012; (c) U.S. patent application Ser. No. 12/196,410 filed on Aug. 22, 2008, now U.S. Pat. No. 8,118,836 issued on Feb. 21, 2012; and (d) a continuation-in-part of U.S. patent application Ser. No. 11/541,506 filed on Sep. 29, 2006, now U.S. Pat. No. 7,601,165 issued on Oct. 13, 2009.
This application is a divisional of U.S. patent application Ser. No. 12/788,978 filed on May 27, 2010, now U.S. Pat. No. 8,801,783, which is a continuation-in-part of U.S. patent application Ser. No. 12/570,854 filed on Sep. 30, 2009, now U.S. Pat. No. 8,303,604 issued on Nov. 6, 2012, which is a continuation-in-part of: (a) U.S. patent application Ser. No. 12/014,399 filed on Jan. 15, 2008, now U.S. Pat. No. 7,909,851 issued on Mar. 22, 2011; and (b) U.S. patent application Ser. No. 12/014,340 filed on Jan. 15, 2008, now U.S. Pat. No. 7,905,904 issued on Mar. 15, 2011.
This application is a divisional of U.S. patent application Ser. No. 12/788,978 filed on May 27, 2010, now U.S. Pat. No. 8,801,783, which is a continuation-in-part of U.S. patent application Ser. No. 12/702,067 filed on Feb. 8, 2010, now U.S. Pat. No. 8,672,968 issued on Mar. 18, 2014, which is a continuation of U.S. patent application Ser. No. 11/541,505 filed on Sep. 29, 2006, now U.S. Pat. No. 7,658,751 issued on Feb. 9, 2010.
This application is a divisional of U.S. patent application Ser. No. 12/788,978 filed on May 27, 2010, now U.S. Pat. No. 8,801,783, which is a continuation-in-part of U.S. patent application Ser. No. 12/196,398 filed Aug. 22, 2008, now U.S. Pat. No. 7,959,650 issued on Jun. 14, 2011; which is a continuation-in-part of U.S. patent application Ser. No. 11/784,821 filed Apr. 10, 2007.
The disclosures of all the above applications are incorporated by reference herein.


FIELD
The following relates to a knee joint and, more particularly, relates to a prosthetic ligament system for a knee joint.
BACKGROUND
The statements in this section merely provide background information related to the present disclosure and may not constitute prior art.
Articulating anatomical skeletal joints, such as knee joints include a plurality of ligaments, such as an anterior cruciate ligament (ACL). The ligaments extend between and connect the bones of the knee joint. In some cases, trauma or wear of the knee joint can necessitate replacement and/or repair of the ligament(s).
Conventional prosthetic ligaments for the knee, for example, can be made out of a graft of biological material (e.g., an autograft, allograft, xenograft, or artificial graft). These grafts are typically attached to the bones with a fastener (e.g., a bone screw, etc.) that is fixed to bone.
The following disclosure relates to a prosthetic ligament system that supports and restores normal movement of a knee joint. The prosthetic ligament system of the present disclosure can be quickly and conveniently implanted.
SUMMARY
A system for an anatomical joint with a first bone portion and a second bone portion is disclosed. The system includes a first fastener, a second fastener, and a prosthetic ligament member. The first fastener is operable to be connected to the first bone portion. The second fastener is operable to be connected to the second bone portion. The prosthetic ligament member is flexible and is directly coupled to both the first and second fasteners to support the first bone portion and the second bone portion for relative movement. According to one aspect, a portion of the prosthetic ligament member extends from the first fastener to the second fastener and has an adjustable length. According to another aspect, the system includes a biasing member associated with at least one of the first and second fasteners. The biasing member is operable to bias the prosthetic ligament member to thereby maintain tension in the prosthetic ligament member.
In various examples, the prosthetic ligament member extends from a first end to a second end, and includes an outer wall that defines a hollow longitudinal passage portion having a first end and a second end. In one example, the prosthetic ligament member is integrated one-piece device. The first end of the prosthetic ligament member extends into the first end of the longitudinal passage portion through the outer wall and out of the second end of the longitudinal passage portion through the outer wall to define a first adjustable length. The second end of the prosthetic ligament member extends into the second end of the longitudinal passage portion through the outer wall and out of the first end of the longitudinal passage portion through the outer wall to define a second adjustable length.
In another example, the prosthetic ligament member includes at least one first aperture and at least one second aperture that extend through the outer wall and are disposed between the first and second ends of the prosthetic ligament member. The at least one first and second apertures are disposed at opposite ends of the longitudinal passage portion. The first end of the prosthetic ligament member extends through the at least one first aperture and the longitudinal passage portion and out of the at least one second aperture to define a first adjustable length. The second end of the prosthetic ligament member extends through the at least one second aperture and the longitudinal passage portion and out of the at least one first aperture to define a second adjustable length. The first and second adjustable lengths extend from the first fastener to the second fastener.
A method of repairing an anatomical joint is also disclosed. The method includes operably coupling a first fastener to a first bone portion of a patient and operably coupling a second fastener to a second bone portion of the patient. The method further includes intraoperatively adjusting a tension of a prosthetic ligament member that is a flexible, integrated one-piece member directly coupled to both the first and second fasteners. The prosthetic ligament member has an outer wall that defines a hollow longitudinal passage portion. The first end extends into the longitudinal passage portion through the outer wall and out of the longitudinal passage portion through the outer wall to define a first adjustable length. The second end extends into the longitudinal passage portion through the outer wall and out of the longitudinal passage portion through the outer wall to define a second adjustable length.
Further areas of applicability will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.



DRAWINGS
The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way.
FIG. 1 is a side view, partially in section, of a prosthetic ligament system according to various teachings of the present disclosure;
FIG. 2A is a top view of a prosthetic ligament member of the system of FIG. 1 shown in an unlooped state;
FIG. 2B is a top view of the prosthetic ligament member of the system of FIG. 1 shown in a looped state;
FIG. 2C is a top view of the prosthetic ligament member of the system of FIG. 1 according to additional exemplary embodiments;
FIG. 2D is a top view of the prosthetic ligament member of the system of FIG. 1 according to additional exemplary embodiments;
FIG. 3 is a perspective view of a fastener of the system of FIG. 1;
FIG. 4 is a section view of the fastener of FIG. 3 taken along the line 4-4 of FIG. 3;
FIG. 5 is a perspective view of an installation tool of the system of FIG. 1;
FIG. 6 is a perspective view of an installation tool of the system of FIG. 1 according to various additional embodiments;
FIG. 7 is a section view of a knee joint during implantation of the system of FIG. 1, wherein the prosthetic ligament member thereof has low tension;
FIG. 8 is a section view of a knee joint during implantation of the system of FIG. 1, wherein the prosthetic ligament member thereof has high tension;
FIGS. 9-13 are side views of various fasteners of the system of FIG. 1 according to various additional embodiments;
FIG. 14 is a side view of the system of FIG. 1 according to various other embodiments;
FIG. 15 is a side view of the system of FIG. 1 according to various other embodiments;
FIG. 16 is a detail view of the prosthetic ligament member of FIGS. 2A through 2D showing different fibers thereof braided together; and
FIG. 17 is a detail view of the prosthetic ligament member of FIGS. 2A through 2D according to various additional exemplary embodiments.



DETAILED DESCRIPTION
The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. It should be understood that throughout the drawings, corresponding reference numerals indicate like or corresponding parts and features.
Referring initially to FIG. 1, a system 10 for repairing a knee joint is disclosed. For instance, the system 10 can be used for repairing an anterior cruciate ligament (ACL) in some embodiments described in greater detail below. However, it will be appreciated that the system 10 can also be used for repairing any other feature of the knee joint (e.g., repair of a medial or lateral ligament of the knee joint) without departing from the scope of the present disclosure. Additionally, it will be appreciated that the system 10 can be used for repairing ligaments of the foot, ankle, hand, wrist, spine, etc. without departing from the scope of the present disclosure.
The system 10 can generally include a prosthetic ligament member 12, a first fastener 14, and a second fastener 16. As shown in FIG. 8, and as will be discussed in greater detail, the system 10 can be used, for example, for repairing and/or restoring normal movement of a knee joint to approximate such movement as naturally constrained by anatomical ligaments. More specifically, the first fastener 14 is operable to be connected to a tibia 20 (FIG. 8), and the second fastener 16 is operable to be connected to a femur 18 (FIG. 8). The prosthetic ligament member 12 can be operably coupled to both the first and second fasteners 14, 16 to support the tibia 20 and the femur 18 for relative movement, as will be discussed in greater detail below.
The prosthetic ligament member 12 can be formed according to Applicants' co-pending U.S. Patent Application Publication No. 2009/0318961, filed Jun. 22, 2009, which is hereby incorporated by reference in its entirety. More specifically, as shown in FIG. 2A, the ligament member 12 can be elongate and flexible and can extend from a first end 22 to a second end 24. The ligament member 12 can include an outer wall 23 that defines a hollow longitudinal passage portion 26, which is disposed between the first and second ends 22, 24. Moreover, the ligament member 12 can include at least one first aperture 28 that extends through the outer wall 23 and that is disposed between the first and second ends 22, 24. Furthermore, the ligament member 12 can include at least one second aperture 30 that extends through the outer wall 23 and that is disposed between the first and second ends 22, 24. More specifically, the first aperture 28 can be disposed adjacent the first end 22, and the second aperture 30 can be disposed adjacent the second end 24. In the embodiment illustrated, the ligament member 12 can include a single first aperture 28 and a single second aperture 30; however, it will be appreciated that the ligament member 12 can include a plurality of first apertures 28 and a plurality of second apertures 30. As discussed below, the first and second apertures 28, 30 can allow access into or out of the longitudinal passage portion 26 (i.e., entrance into and/or exit from the longitudinal passage portion 26).
As shown in the embodiment of FIG. 2B, the first end 22 of the ligament member 12 can extend through outer wall 23 via the first aperture 28 to enter the longitudinal passage portion 26, and the first end 22 can exit out of the longitudinal passage portion 26 through the outer wall 23 via the second aperture 30. Likewise, the second end 24 can extend through the outer wall 23 via the second aperture 30 to enter the longitudinal passage portion 26, and the second end 24 can exit out of the longitudinal passage portion 26 through the outer wall 23 via the first aperture 28. It will be appreciated that the first end 22 can enter the longitudinal passage portion 26 through the same aperture (i.e., the first aperture 28) that the second end 24 exits the longitudinal passage portion 26, and the second end 24 can enter the longitudinal passage portion 26 through the same aperture (i.e., the second aperture 30) that the first end 22 exits the longitudinal passage portion 26. As such, the first end 22 can define a first adjustable loop 32 and a first free end 36. Likewise, the second end 24 can define a second adjustable loop 34 and a second free end 38.
Furthermore, it will be appreciated that the first free end 36 can be pulled away from the longitudinal passage portion 26 to thereby reduce the size of the first adjustable loop 32. Likewise, the second free end 38 can be pulled away from the longitudinal passage portion 26 to reduce the size of the second adjustable loop 34.
It will be appreciated that the ligament member 12 can be configured differently, and the first and second adjustable loops 32, 34 can be formed in any suitable manner. For instance, as shown in FIG. 2C, the first end 22′ can extend into the longitudinal passage portion 26′ through the second aperture 30′ and can extend out of the longitudinal passage portion 26′ through the first aperture 28′. More over, the second end 24′ can extend into the longitudinal passage portion 26′ through the first aperture 28′ and out of the longitudinal passage portion 26′ through the second aperture 30′.
Also, as shown in FIG. 2D, the ligament member 12′′ can include a plurality of first apertures 28′′ and a plurality of second apertures 30′′. For instance, the ligament member 12′′ can include two first apertures 28′′ and two second apertures 30′′. Also, the first apertures 28′′ and second apertures 30′′ can be spaced apart on opposite sides of the longitudinal axis of the ligament member 12′′. As shown, the first end 22′′ can enter the longitudinal passage portion 26′′ through one of the second apertures 30′′ and can exit the longitudinal passage portion 26′′ through one of the first apertures 28′′. Also, the second end 24′′ can enter and exit the longitudinal passage portion 26′′ through different ones of the first and second apertures 28′′, 30′′ respectively. As such, the first end 22′′ enters the longitudinal passage portion 26′′ through a different aperture 30′′ from which the second end 24′′ exits the longitudinal passage portion 26′′, and the second end 24′′ enters the longitudinal passage portion 26′′ through a different aperture 28′′ from which the first end 22′′ exits the longitudinal passage portion 26′′.
It will be appreciated that the ligament member 12, 12′, 12′′ can include any suitable number of adjustable loops 32, 32′, 32′′, 34, 34′, 34′′ by extending into and out of the longitudinal passage portion 26, 26′, 26′′ any suitable number of times. Also, it will be appreciated that the ligament member 12, 12′, 12′′ can include any suitable number of apertures 28, 28′, 28′′, 30, 30′, 30′′. Moreover, the apertures 28, 28′, 28′′, 30, 30′, 30′′ can be disposed in any suitable location on the ligament member 12, 12′, 12′′ (e.g., disposed in alignment along the longitudinal axis of the ligament member 12, 12′, 12′′.
For purposes of discussion, the system 10 will be discussed largely in relation to the embodiments of the ligament member 12 illustrated in FIG. 2B. However, it will be appreciated that the system 10 can similarly incorporate any of the embodiments of the ligament member 12, 12′, 12′′ shown in FIGS. 2B-2D or any other suitable ligament member 12, 12′, 12′′ without departing from the scope of the present disclosure.
As shown in FIG. 1, at least one of the first and second adjustable loops 32, 34 can receive at least one of the first and second fasteners 14, 16 of the system 10. Specifically, as shown in FIG. 1, both the first and second adjustable loops 32, 34 can encircle a portion of the first fastener 14, and the longitudinal passage portion 26 can be folded over a portion of the second fastener 16. However, it will be appreciated that the ligament member 12 can be coupled in any suitable manner to both the first and second fasteners 14, 16 (e.g., first loop 32 encircling the first fastener 14 and the second loop 34 encircling the second fastener 16). By pulling on the first and/or second free ends 36, 38, tension within the first and second adjustable loops 32, 34 and longitudinal passage portion 26 of the ligament member 12 can be adjusted (i.e., increased), and the first and second fasteners 14, 16 will be urged towards each other. In addition, friction between the first and second free ends 36, 38 and the inner surface of the longitudinal passage portion 26 can generally inhibit or lock, in a knotless fashion, the first and second free ends 36, 38 from being pulled back toward the longitudinal passage portion 26, thereby maintaining the desired tension in the ligament member 12.
It will be appreciated that if the ligament member 12′ of FIG. 2C is used, both the first and second adjustable loops 32′, 34′ can encircle the first fastener 14, and the longitudinal passage portion 26′ can be folded over the second fastener 16 as described above with relation to the embodiment of FIG. 2B. However, it will be appreciated that the ligament member 12′ can be coupled in any suitable manner to both the first and second fasteners 14, 16 (e.g., first loop 32′ encircling the first fastener 14 and the second loop 34′ encircling the second fastener 16). Furthermore, it will be appreciated that the ligament member 12′′ of FIG. 2D can be coupled to the fasteners 14, 16 in any of these ways.
The prosthetic ligament member 12 can be made out of any suitable material and can be manufactured in any suitable fashion. For instance, the ligament member 12 can be made out of a flexible and biocompatible material. More specifically, the ligament member 12 can be made out of and/or can include fibers of polyethylene, gel-spun polyethylene, polyester, polyetheretherketone (PEEK), poly-para-phenylene terephthalamide, polycaprolactone, Kevlar, carbon, collagen, polyglycolic acid (PGA), polylactic acid (PLA), polyurethane urea, and/or silk (silk from a silk worm or silk from a spider). In some embodiments, the ligament member 12 can be made out of SERICA material, which is commercially available from SERICA Technologies, Inc. of Medford, Mass. Moreover, in some embodiments, the ligament member 12 can be made out of SPIDREX material, which is commercially available from Neurotex Ltd. In addition, the ligament member 12 can be made out of a material that is injected with a natural and/or artificial collagen. Furthermore, the ligament member 12 can be made out of a partially resorbable material. Additionally, the ligament member 12 can be made out of a material that is treated with a platelet concentration to promote tissue growth. Also, the ligament member 12 can be made out of a material that is easily cuttable with a conventional blade or sharpened edge, once a desired tension is reached in the ligament member 12.
Still further, as shown in FIG. 16, the ligament member 12 can be a braided construct made out of a plurality of different fibers 13, 15 that are braided together to form a hollow tube. The fibers 13, 15 can vary in any of a variety of characteristics. For instance, the second fibers 15 can have a greater diameter than that of the first fibers 13 such that the second fibers 15 protrude from the first fibers 13 and such that the second fibers 15 increase the coefficient of friction of the ligament member 12. Furthermore, the first and second fibers 13, 15 can be made out of or include different materials. Additionally, the first fibers 13 be resiliently extendable in a longitudinal direction, whereas the second fibers 15 can be less resiliently extendable and can have a higher tensile strength (i.e., load-bearing capability). Moreover, the first fibers 13 can be a relatively high-strength fiber with a fixed length (i.e., non-resilient) while the second fibers 15 can be constructed so as to promote tissue growth (e.g., serve as a support for tissue regeneration, etc.). It will be appreciated, however, that the ligament member 12 can include a plurality of the same type of fibers without departing from the scope of the present disclosure. Furthermore, it will be appreciated that the ligament member 12 can have any number of fibers, and those fibers can differ in any suitable fashion.
In some embodiments shown in FIG. 16, the first and second fibers 13, 15 can be wrapped around the longitudinal axis of the ligament member 12. Also, in some embodiments, the first and second fibers 13, 15 can be arranged in a fixed sequence along the longitudinal axis. For instance, the first and second fibers 13, 15 can alternate in a one-to-one arrangement along the longitudinal axis, or the first and second fibers 13, 15 can be arranged at fixed intervals along the axis.
Additionally, in the embodiments of FIG. 17, the second fibers 15 can be arranged substantially parallel to the longitudinal axis of the ligament member 12. Also, the first fibers 13 are wrapped helically about the second fibers 15.
Moreover, the ligament member 12 can be specifically configured for the particular application of the ligament member 12 within the knee joint. For instance, the braiding pattern, the materials, the dimensions, and/or other features of the ligament member 12 can be adapted according to the desired level of tension, the desired load carrying capacity, the desired elasticity (e.g., to simulate the elasticity of natural ligament, the dimensions of the knee joint, etc. In addition, the ligament member 12 can incorporate one or more of the features disclosed in U.S. Patent Publication No. 2005/0119696, filed Feb. 23, 2004 by Walters et al., which is hereby incorporated by reference in its entirety.
Also, the ligament member 12 can be manufactured and configured to include the first and second loops 32, 34 as shown in FIG. 2B before surgery. Because the adjustable loop members 32, 34 are already formed, the surgeon can implant the ligament member 12 into the knee joint without having to construct the loops 32, 34. Furthermore, because of the frictionally self-containing characteristic of the looped ligament member 12, the surgeon need not tie any knots. Accordingly, the ligament member 12 greatly facilitates repair and reconstruction of the knee joint. Also, the ligament member 12 can be relatively compact and can facilitate arthroscopic knee surgery.
Referring now to FIGS. 1, 3, and 4, the fasteners 14, 16 will be discussed in greater detail. For purposes of discussion, it will be assumed that both fasteners 14, 16 are substantially similar. Thus, the following discussion of the fasteners 14, 16 will apply to both of the fasteners 14, 16. However, it will be appreciated that the fasteners 14, 16 could have different features without departing from the scope of the present disclosure.
As shown in FIGS. 3 and 4, the fasteners 14, 16 can include a cylindrical base 40 having a first end 42 and a second end 44. The base 40 can be hollow to define an interior space 46 therein. The ends 42, 44 can be open to the interior space 46. In some embodiments, the second end 44 can be disposed at an angle, a, relative to the first end 42 (FIG. 4). Moreover, the interior portion of the second end 44 can include a fillet 48 (FIG. 4). As will be discussed, the angle, a, and the fillet 48 of the second end 44 can reduce the likelihood of the fastener 14, 16 abrading the ligament member 12, thereby reducing the likelihood of wear of the ligament member 12. Also, the angle, a, can reduce the likelihood of the fastener 14, 16 intruding into the intra-articular space.
Moreover, an outer surface 50 of the base 40 of the fastener 14, 16 can be threaded along the longitudinal direction. Thus, as shown in FIGS. 7 and 8, the fasteners 14, 16 can be threadably and fixably attached to the tibia 20 and femur 18, respectively. It will be appreciated that the fasteners 14, 16 can be additionally attached to the tibia 20 and femur 18 by any additional means, such as bone cement, cross pins, additional fasteners, and the like.
As shown in FIGS. 3 and 4, the fasteners 14, 16 additionally include an attachment portion 52. In some embodiments, the attachment portion 52 can be a rod or post that extends transverse (e.g., perpendicular to the longitudinal axis of the fasteners 14, 16). The attachment portion 52 can be fixed at both ends to the interior walls of the base 40. Furthermore, as shown in FIG. 4, the attachment portion 52 can have a circular cross-section; however, the attachment portion 52 can have an ovate cross-section or any other suitable shape. Also, in some embodiments, the attachment portion 52 can be removably attached to the base 40 (e.g., inserted and removed in a direction transverse to the axis of the base 40).
Still further, the fasteners 14, 16 can be polygonal and/or can include at least one flat inner surface 54 (i.e., drive portion). For instance, in the embodiments represented in FIGS. 3 and 4, the fasteners 14, 16 can include a plurality of flat inner surfaces 54 adjacent the first end 42. As such, the flat inner surfaces 54 can collectively define an octogonal shape or any other suitable polygon.
It will be appreciated that the fasteners 14, 16 can have any suitable base 40 for attachment to the tibia 20 or femur 18 of the patient. Furthermore, it will be appreciated that the fasteners 14, 16 can have any suitable attachment portion 52 for operably coupling to the ligament member 12.
When attached to the first and second fasteners 14, 16 (FIG. 1), the ligament member 12 can be received in the hollow interior space 46 of each in order to operably connect to the respective attachment portions 52. More specifically, the first and second adjustable loops 32, 34 can extend continuously about (and encircle) the attachment portion 52 of the first fastener 14 in order to operably couple to the first fastener 14. Also, the longitudinal passage portion 26 can wrap, fold, or bend about the attachment portion 52 of the second fastener 16 to operably couple to the second fastener 16. Accordingly, by pulling on the first and second free ends 36, 38, the surgeon can tension the first and second loops 32, 34 and reduce the size of the first and second loops 32, 34 in order to tighten and tension the ligament member 12. This increase in tension can urge the first and second fasteners 14, 16 toward each other. Accordingly, when the first and second fasteners 14, 16 are attached to the tibia 20 and the femur 18, the increased tension can draw the tibia 20 and femur 18 together, and the tensioned ligament member 12 can constrain the tibia 20 and femur 18 relative to each other while permitting normal articulation of the knee joint. As such, the ligament member 12 can be used as an artificial prosthesis for replacing an anterior cruciate ligament, a posterior cruciate ligament, or any other suitable ligament.
It will be appreciated that the ligament member 12 can be coupled to the fasteners 14, 16 in any suitable fashion. For instance, in some embodiments, the first loop 32 can be attached to the first fastener 14, and the second loop 34 can be attached to the second fastener 16, or vice-versa. Moreover, the first and second ends 22, 24 can be routed through the first and second apertures 28, 30 in order to produce any suitable number of loops 32, 34, and those loops can be operably attached to the fasteners 14, 16 in any suitable fashion without departing from the scope of the present disclosure.
Moreover, it will be appreciated that the system 10 can be manufactured such that the ligament member 12 is preassembled and attached to the first and second fasteners 14, 16 before implantation surgery. Accordingly, the surgeon can attach the first and second fasteners 14, 16 to the tibia 20 and the femur 18, respectively, and the ligament member 12 will be substantially in position within the joint for tensioning. Thus, the system 10 can greatly facilitate repair and reconstruction of the knee joint. However, it will be appreciated that the system 10 can be such that the surgeon operably couples the ligament member 12 to the first fastener 14 and/or second fastener 16 intraoperatively without departing from the scope of the present disclosure.
Implantation of the system 10 will now be discussed in greater detail with reference to FIGS. 7 and 8. For purposes of discussion, the system 10 will be discussed in relation to replacement of an anatomical anterior cruciate ligament; however, it will be appreciated that the system 10 can be used for any suitable ligament in the knee joint. It will be appreciated that the system 10 can be implanted during an arthroscopic surgical procedure.
Initially, the surgeon can make one or more incisions in the patient in order to at least partially expose the femur 18 and/or the tibia 20 of the patient. Then, the surgeon can form a bone tunnel 51, which includes a femur portion 53 and a tibia portion 55. The bone tunnel 51 can be formed using any suitable tool for removal of bone. More specifically, the surgeon can generally put the knee in flexion and drill through the tibia 20 into the femur 53 to form the tunnel 51. In some embodiments, the femur portion 53 of the tunnel 51 can be a blind bore.
Next, the surgeon can attach and fix the fastener 16 to the femur 18 and the fastener 14 to the tibia 20. In some embodiments, a tool 56, such as the type shown in FIG. 5, can be used to implant the first and second fasteners 14, 16. The tool 56 shown in FIG. 5 can include a head 58 with flat surfaces that correspond in shape to the flat interior surfaces 54 of the fasteners (FIGS. 3 and 4). Thus, the head 58 can mate with the flats of the interior surfaces 54, and the tool 56 can transmit rotational forces about the longitudinal axis of the fastener 14, 16 to drivingly rotate the fastener 14, 16. The tool 56 can also include a shaft 61 and a handle portion 63. Furthermore, in some embodiments, the tool 56 can include a clearance member 60, such as a groove 62 in the head 58 that provides clearance for the ligament member 12. More specifically, when the head 58 is mated with the fastener 14, 16, the ligament member 12 can extend along the groove 62 without impinging on the head 58. Thus, to implant the first and second fasteners 14, 16, the head 58 can be mateably inserted into the inner surface 54 of the respective fastener 14, 16, and the tool 56 can be rotated to threadably advance and attach the respective fastener 14, 16 to the tibia 20 or femur 18.
In other embodiments, the first and second fasteners 14, 16 can be implanted using the tool 56′ shown in FIG. 6. The tool 56 includes a slot 64′ and a clearance member 60′ such as a cannula 66′ that extends longitudinally through the tool 56′. Thus, during implantation, the tool 56′ can mate with the respective fastener 14, 16, and the slot 64′ can receive the attachment portion 52 of the respective fastener 14, 16 in order to rotatably engage the fastener 14, 16. Also, the ligament member 12 can be received within the cannula 66′ during installation. It will be appreciated that the tool 56′ can engage either end of the fasteners 14, 16 for greater versatility.
Assuming the ligament member 12 has already been coupled to both the first and second fasteners 14, 16, the free ends 36, 38 can extend out of the tibial portion 55 of the tunnel 51, away from the femur 18. In other embodiments, both free ends 36, 38 can extend out of the femoral portion 53 of the tunnel 51, away from the tibia 20. In still other embodiments, one of the free ends 36 can extend out of the tibial portion 55 of the tunnel 51, and the other free end 38 can extend out of the femoral portion 53 of the tunnel 51.
The surgeon can then pull on the first and second free ends 36, 38 to reduce the length of (i.e., eliminate slack in) the ligament member 12 and increase tension in the ligament member 12. Accordingly, the femur 18 and the tibia 20 can draw together and the ligament member 12 can be tensioned to support relative movement of the femur 18 and the tibia 20. Once the proper length and tension has been achieved, the surgeon can cut the first and second free ends 36, 38.
It will be appreciated that the fasteners 14, 16 of the system 10 can be made out of any suitable type, other than those shown in the embodiments of FIGS. 1-8. For instance, FIGS. 9-15 show additional features of the first and second fasteners that can be included within the system 10.
For instance, FIG. 9 shows fastener 114, 116 of the system 110. Although only one fastener 114, 116 is shown in FIG. 9, it will be appreciated that each of the first and second fasteners 114, 116 can be similar to the illustrated embodiments. It will also be appreciated that components that are similar to the embodiments of FIGS. 1, 3, 4, 7, and 8 are identified with corresponding reference numerals increased by 100.
The fasteners 114, 116 can include an elongate base 140 and an attachment portion 152 that is attached to the base 140, similar to the TOGGLELOCTM fastener, which is commercially available from Biomet, Inc. of Warsaw, Ind. The base 140 and the attachment portion 152 can be made out of a substantially rigid material, such as a biocompatible metal, ceramic, polymer, or a composite thereof. More specifically, the fastener 114, 116 can be made out of titanium, cobalt chrome (CoCr), stainless steel, polyether ether ketone (PEEK), and/or RADEL polyphenylsulfone (PPSU). Furthermore, the fasteners 114, 116 can be of a type disclosed in Ser. No. 11/203,481 filed Aug. 12, 2005, now U.S. Patent Publication No. 2005-0277961, published Dec. 15, 2005, which is incorporated herein by reference in its entirety.
Also, the attachment portion 152 can be an eyelet that is integrally attached to the base 140 at a middle portion thereof. The ligament member 112 can be received in and threaded through (e.g., looped or partially wrapped around) the attachment portion 152, similar to the embodiments of FIGS. 1-8.
In addition, the fasteners 114, 116 can have a first position (shown in phantom lines) in which the base 140 is operable to move within the bone tunnel 151. The fasteners 114, 116 can also have a second position (shown in solid lines), in which the base 140 is operable to seat against the bone 118, 120 outside of the bone tunnel 151. More specifically, the base 140 can have a width W that is greater than the width W′ of the bone tunnel 151. Thus, in the second position, the base 140 can be arranged so as to be transverse (e.g., perpendicular) to the axis X of the bone tunnel 151 in order to seat against the bone 118, 120. Also, in the first position, the base 140 can be arranged so as to be substantially aligned with the axis X of the bone tunnel 151 in order to move along the axis X of the bone tunnel 151.
Accordingly, during implantation of the system 110, the fastener 114, 116 can be moved along the axis X of the bone tunnel 151 in the first position, thereby pulling the ligament member 112 along the axis X. Then, once the fastener 114, 116 emerges from the tunnel 151, the fastener 114, 116 can be turned to the second position to seat against the bone 118, 120.
Referring now to FIG. 10, additional features of the fasteners 214, 216 are illustrated. Features that are common to those of the embodiments of FIGS. 1-8 are indicated with corresponding reference numerals increased by 200.
As shown in FIG. 10, the fasteners 214, 216 can include an elongate cross pin 270. The pin 270 can be embedded within and attached to the femur 218 or tibia 220. More specifically, the pin 270 can extend transversely to the axis X of the bone tunnel 251, and can extend across the bone tunnel 251 to be secured at both ends in the femur 218 or tibia 220. Furthermore, the ligament member 212 can extend about the pin 270 in order to operably attach to the pin 270. It will be appreciated that the fastener 214, 216 can include various features to those disclosed in Ser. No. 11/059,869 filed Feb. 16, 2005, now U.S. Patent Publication No. 2005-0149187, published Jul. 7, 2005, which is hereby incorporated by reference in its entirety.
Referring now to FIG. 11, additional features of the fasteners 314, 316 are illustrated. Features that are similar to the embodiments of FIGS. 1-8 are indicated with corresponding reference numerals increased by 300.
The fasteners 314, 316 can include a base 340 that is disk-shaped and attachment portion 352 (e.g., an eyelet) that is integrally attached to the base 340, so as to be monolithic. The diameter D of the base 340 can be greater than the diameter D′ of the bone tunnel 351. Accordingly, the base 340 can seat to the bone 318, 320 to thereby secure the base 340 to the bone 318, 320. Moreover, the ligament member 312 can be received within and can extend through the attachment portion 352. More specifically, the attachment portion 352 can extend continuously about the ligament member 312 to thereby encircle the ligament member 312. As such, the attachment portion 352 can inhibit movement of the ligament member 312 outside of the attachment portion 352. As stated above, the ligament member 312 can be manufactured and supplied to the surgeon pre-attached to the attachment portion 352. Alternatively, the system 310 can be employed such that the surgeon threads the attachment portion 312 through the attachment portion 352 intraoperatively.
Referring now to FIG. 12, additional features of the fasteners 414, 416 are illustrated. Components that are similar to the embodiments of FIGS. 1-8 are indicated with corresponding reference numerals increased by 400.
The fasteners 414, 416 can include a base 440 and an attachment portion 452. The base can be substantially disk-shaped and can have a diameter D that is greater than the diameter of the bone tunnel (not shown), such that the base 440 can seat against the bone, similar to the embodiments of FIG. 11. The attachment portion 452 can include one or more openings 472 (e.g., notches, slots, etc.) that extend inwardly from the outer periphery of the base 440. The ligament member 412 can extend over the base 440 and can be received in the openings 472 to be retained therein. For instance, the ligament member 412 can be looped or at least partially wrapped around the base 440 to be received in the openings 472. It will be appreciated that the openings 472 allow the ligament member 412 to selectively move in and out of the attachment portion 452. Accordingly, the surgeon can intraoperatively attach and detach the ligament member 412 from the fastener 414, 416.
Referring now to FIG. 13, additional features of the fasteners 514, 516 are illustrated. Components that are similar to the embodiments of FIGS. 1-8 are indicated by corresponding reference numerals increased by 500.
The fasteners 514, 516 can be similar to EZLOCTM fasteners, which are commercially available from Biomet, Inc. of Warsaw, Ind. Furthermore, the fasteners 514, 516 can include various features of the type disclosed in Ser. No. 12/047,048 filed Mar. 12, 2008, now U.S. Patent Publication No. 2008-0161852, published Jul. 3, 2008, which is hereby incorporated by reference in its entirety. Accordingly, the fasteners 514, 516 can include a base 540 and an attachment portion 552. The attachment portion 552 can receive the ligament member 512. For instance, the ligament member 512 can loop around or at least partially wrap around the ligament member 512 to attach to the fastener 514, 516.
Moreover, the base 540 can be movably (e.g., pivotally) attached to the attachment portion 552. As such, the fastener 514, 516 can be selectively collapsible and extendable. More specifically, in the collapsed position (partially shown in phantom), the base 540 can be rotated relative to the attachment portion 552 such that the fastener 514, 516 is substantially aligned with the axis X of the bone tunnel 551, thereby allowing the fastener 514, 516 to move along the axis X of the bone tunnel 551. In addition, when the fastener 514, 516 is extended, the base 540 can be rotated to be substantially perpendicular to the axis X of the bone tunnel 551, and the base 540 can seat against the femur 518 or tibia 520. Accordingly, during implantation of the system 510, the fastener 514, 516 can be collapsed and moved through the tunnel 551, thereby pulling the ligament member 512 along the axis X of the tunnel 551. Then, when the base 540 sufficiently emerges from the tunnel 551, the fastener 514, 516 can be selectively moved to the extended position, such that the base 540 can be seated.
Referring now to FIG. 14, additional features of the fasteners 614, 616 are illustrated. Components that are similar to the embodiments of FIGS. 1-8 are indicated with corresponding reference numerals increased by 600.
As shown, the fasteners 614, 616 can be substantially similar to the embodiments of FIGS. 1, 3, 4, 7, and 8. However, the fasteners 614 can include a base 640 and a removably attached attachment portion 652. It will be appreciated that the fasteners 616 can also include a removably attached attachment portion 652. The attachment portion 652 can include one or more projections 674, such as posts, rails, and the like. The projections 674 can be received within a corresponding recess 675, such as a slot, within the base 640 in order to lock (i.e., key) the attachment portion 652 against rotation about the axis X relative to the base 640. It will be appreciated that the base 640 could include projections 674 and the attachment portions 652 could include corresponding recesses that receive the projection 674, without departing from the scope of the present disclosure. It will also be appreciated that the attachment portion 652 could be keyed against rotation about the axis X in any suitable manner.
Implantation of the system 610 will be discussed, with the assumption that the ligament member 612 is attached to the second fastener 616 and also to the attachment portion 652 of the first fastener 614. The first fastener 616 can be threadably attached to the femur (not shown). Similarly, the second fastener 616 can be threadably attached to the tibia (not shown). It will be appreciated that the ligament member 612 could become twisted helically about the axis X during the attachment of the second fastener 616 and/or the attachment of the base 640 of the first fastener 614. However, because the attachment portion 652 remains detached from the base 640, the surgeon can untwist the ligament member 612 and subsequently pull on the free ends 636, 638 in order to draw the attachment portion 652 into the base 640 and key the attachment portion 652 against rotation about the axis X. As such, the ligament member 612 can be substantially untwisted and yet the ligament member 612 can be securely attached to both the first and second fasteners 614, 616.
Referring now to FIG. 15, additional features of the fastener 714, 716 will be described in greater detail. Components that are similar to the embodiments of FIGS. 1-8 are indicated by corresponding reference numerals increased by 700.
The second fastener 716 can be substantially similar to the second fasteners of the embodiments described above. However, the first fastener 714 can include different features which will be described herein below. It will be appreciated that the second fastener 716 can include the same features as the first fastener 714 without departing from the scope of the present disclosure.
The first fastener 714 can include a base 740 and an attachment portion 752. The attachment portion 752 can be detached and spaced away from the base 740. Moreover, the system 710 can include a biasing member 776. The biasing member 776 can be made out of any suitable type, such as a helical spring, one or more Belleville washers (coned-disk spring washer), etc. The biasing member 776 can be disposed between and can abut the base 740 and the attachment portion 752. Accordingly, the biasing member 776 can bias the attachment portion 752 away from the base 740 to thereby maintain a predetermined amount of tension in the ligament member 712.
It will be appreciated that the prosthetic ligament system of the present disclosure can be attached to the patient's anatomy using any combination of the fasteners 14, 16, 114, 116, 214, 216, 314, 316, 414, 416, 514, 516, 614, 616, 714, 716 disclosed herein. Moreover, the foregoing discussion discloses and describes merely exemplary embodiments of the present disclosure. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings and claims, that various changes, modifications and variations may be made therein without departing from the spirit and scope of the disclosure as defined in the following claims. For instance, the sequence of the blocks of the method described herein can be changed without departing from the scope of the present disclosure.

## Claims

1. A system for an anatomical joint with a first bone portion and a second bone portion, the system comprising:
a first fastener threadably attachable to the first bone portion;
a second fastener threadably attachable to the second bone portion; and
a prosthetic ligament member that is a flexible, integrated one-piece device and that is directly coupled to both the first and second fasteners for supporting the first bone portion and the second bone portion for relative movement, the prosthetic ligament member extending from a first end to a second end, the prosthetic ligament member including an outer wall that defines a hollow longitudinal passage portion having a first end and a second end, the first end of the prosthetic ligament member extending into the first end of the longitudinal passage portion through the outer wall and out of the second end of the longitudinal passage portion through the outer wall to define a first adjustable loop, the second end of the prosthetic ligament member extending into the second end of the longitudinal passage portion through the outer wall and out of the first end of the longitudinal passage portion through the outer wall to define a second adjustable loop, wherein the second fastener includes a threaded base and an attachment portion that is separate from the threaded base, and wherein, when the first fastener is in a fixed position in the first bone portion, the threaded base of the second fastener is in a fixed position in the second bone portion, and the prosthetic ligament member is coupled to the first fastener and the attachment portion of the second fastener, the attachment portion can be rotated relative to the first fastener and the threaded base of the second fastener for twisting or untwisting the prosthetic ligament member between the first fastener and the attachment portion of the second fastener, and wherein the second fastener includes a biasing member disposed between and abutting the threaded base and the attachment portion, the biasing member operable to bias the entirety of the attachment portion away from the entirety of the threaded base for maintaining a predetermined amount of tension in the prosthetic ligament member when loads are applied to the prosthetic ligament member.

2. The system of claim 1, wherein at least part of the biasing member is located outside the threaded base.

3. The system of claim 2, wherein the biasing member includes at least one of a helical spring and a Belleville washer.

4. The system of claim 1, wherein the first adjustable loop and the second adjustable loop comprise a single adjustable length of a portion of the prosthetic ligament member spanning between the first fastener and the attachment portion of the second fastener.

5. The system of claim 1, wherein the prosthetic ligament member is directly coupled to the first fastener at a first location, the prosthetic ligament member is directly coupled to the attachment portion of the second fastener at a second location, the first adjustable loop is disposed on one side of an axis extending through the first and second locations, and the second adjustable loop is disposed on the other side of the axis.

6. The system of claim 1, wherein the anatomical joint is a knee joint, the first bone portion includes at least a portion of a tibia, and the second bone portion includes at least a portion of a femur.

7. The system of claim 1, wherein the first and second adjustable loops extend from the first fastener to the attachment portion of the second fastener.

8. The system of claim 1, wherein the first and second adjustable loops are independently adjustable to adjust tension in the prosthetic ligament member.

9. The system of claim 1, wherein the first end of the prosthetic ligament member is pullable to reduce a size of the first adjustable loop and the second end of the prosthetic ligament member is pullable to reduce a size of the second adjustable loop.

10. A system for an anatomical joint with a first bone portion and a second bone portion, the system comprising:
a first fastener threadably attachable to the first bone portion;
a second fastener threadably attachable to the second bone portion, wherein the second fastener includes a threaded base and an attachment portion that is separate from the threaded base; and
a prosthetic ligament member that is flexible and that is directly coupled to both the first and second fasteners for supporting the first bone portion and the second bone portion for relative movement, the prosthetic ligament member extending from a first end to a second end, the prosthetic ligament member including an outer wall that defines a hollow longitudinal passage portion, the prosthetic ligament member also including at least one first aperture extending through the outer wall and disposed between the first and second ends, the prosthetic ligament member further including at least one second aperture extending through the outer wall and disposed between the first and second ends, the at least one first and second apertures being disposed at opposite ends of the longitudinal passage portion, the first end of the prosthetic ligament member extending through the at least one first aperture and the longitudinal passage portion and out of the at least one second aperture to define a first adjustable loop, the second end of the prosthetic ligament member extending through the at least one second aperture and the longitudinal passage portion and out of the at least one first aperture to define a second adjustable loop, the first and second adjustable loops extending from the first fastener to the attachment portion of the second fastener, wherein, when the first fastener is in a fixed position in the first bone portion, the threaded base of the second fastener is in a fixed position in the second bone portion, and the prosthetic ligament member is coupled to the first fastener and the attachment portion of the second fastener, the attachment portion can be rotated relative to the first fastener and the threaded base of the second fastener for twisting or untwisting the prosthetic ligament member between the first fastener and the attachment portion of the second fastener, and wherein the second fastener includes a biasing member disposed between and abutting the threaded base and the attachment portion, the biasing member operable to bias the entirety of the attachment portion away from the entirety of the threaded base for maintaining a predetermined amount of tension in the prosthetic ligament member when loads are applied to the prosthetic ligament member.

11. The system of claim 10, wherein the attachment portion, while abutting the biasing member, is positioned fully outside the threaded base.

12. The system of claim 11, wherein the biasing member includes at least one of a helical spring and a Belleville washer.

13. The system of claim 10, wherein the first and second adjustable loops are independently adjustable to adjust tension in the prosthetic ligament member.

14. The system of claim 10, wherein the first end of the prosthetic ligament member is pullable to reduce a size of the first adjustable loop and the second end of the prosthetic ligament member is pullable to reduce a size of the second adjustable loop.

15. The system of claim 10, wherein the anatomical joint is a knee joint, the first bone portion includes at least a portion of a tibia, and the second bone portion includes at least a portion of a femur.