Abstract:
A ligament mounting and method for its use for endosteally mounting an end of a ligament graft in a prepared bone tunnel section in a surgical procedure to replace a patient&#39;s ligament. The ligament mounting includes a strap and footing combination that are suitable for human implanting and may be formed from a material that is absorbed by the patient&#39;s body during the healing process. The strap is formed as a section of flexible material, includes a proximal end for passage through a footing that is for arrangement across a cortex end of the ligament tunnel section, and with the strap distal end arranged to connect to a ligament graft end. The strap and footing are formed to allow for passage of the strap in one direction and to bind when the footing is compressed to crimp onto said strap, prohibiting it from being pulled back through the footing when a pulling force is applied, maintaining a ligament graft under tension in the tunnel section endosteum.

Description:
This is a division of application Ser. No. 08/717,094, filed Sep. 20, 1996, now abandoned. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to devices and methods for use in a ligament repair or replacement surgical procedure for fitting and mounting a ligament graft end in a prepared ligament tunnel. 
     2. Prior Art 
     In a practice of an arthroscopic surgical procedure for repair or replacement on an anterior or posterior cruciate ligament, that the invention is suitable for use in, a pair of tunnel sections are drilled into the distal femur and proximal tibia, respectively, to intersect the ligament points of origin. 
     In which procedure a system is provided for fitting a ligament graft in the tunnel sections, securing one end therein and applying a desired tension to the other ligament end and securing it. A number of systems have been developed to provide for fitting a ligament graft end into which tunnel sections, including a mounting of a ligament graft end to a device for pulling it through a tunnel section end. One such device is a suture sling that is suitable for such use and can be arranged for use with the present invention. 
     Such a suture sling can be utilized with the present invention that is mounted to a bone end of a bone tendon bone graft. The suture sling is used for pulling a graft bone end through aligned tunnel sections with the ligament mounting of the present invention secured to the suture sling and for mounting in the ligament tunnel or at a tunnel end. 
     Additionally, one or both of the inventors have heretofore developed a number of cruciate ligament mounting arrangements and methods such as, for example, U.S. Pat. Nos. 4,772,286; 4,870,957; 4,927,421; 4,997,433; 5,129,902; 5,147,362 and Re. 34,293, and other persons have also developed ligament graft mountings, for example U.S. Pat. Nos. 4,301,551; 4,605,414; 4,744,793; 4,950,270 and 5,139,520. None of which earlier devices, arrangements and methods, however, have involved a device secured to a ligament end to slide through a footing to lock thereto that, for the invention, includes a combination of the straight flexible strap and footing and includes locking members for locking the strap in the footing, which strap, in turn, connects to a suture sling or other ligament attachment arrangement, nor have such earlier devices and arrangements taught a method like that of the invention. 
     While graft attachment and anchoring devices have been heretofore utilized, and such an arrangement for anchoring a ligament graft in a ligament replacement procedure is shown in U.S. Pat. No. 5,306,301 such provides a footing only and teaches a complicated draw string arrangement that is different to use and secure and is unlike the strap and footing of the invention and its use. Also while strap and footings have been heretofore used, and examples of such arrangements and their uses are shown in U.S. Pat. Nos. 5,306,301; 5,500,000; and 5,520,691, such have been as mounting for securing an item, such as a ligament suture, or the like onto a bone surface, none have utilized a sliding strap and footing with a locking arrangement combination, along with a ligament end tether such as a suture sling arrangement, or the like, to easily adjust tension on and mount a bone tendon bone type ligament graft, or the like, in a tunnel section proximate to or at a tunnel segment cortex end, that is like that of the present invention. 
     SUMMARY OF THE INVENTION 
     It is a principal object of the present invention to provide embodiments of an adjustable length strap and footing with locking arrangement for use for mounting a ligament end, where the strap distal end is for connecting to a ligament graft end as by a suture or suture sling or directly thereto, and enables a pulling of the ligament graft end along a tunnel section or sections, with the proximal strap end to fit through a footing positioned across the tunnel section cortex end and provides for locking the strap to the footing at a selected point along that strap where a proper tension is applied to the ligament end as a ligament end mounting. 
     Another object of the present invention is to provide an adjustable length strap and footing for ligament mounting where the strap is arranged to slide through a hole formed through the footing shortening the distance between the strap distal end and footing, with the footing arranged to lock onto the strap thereat, providing a desired strap length relative to the footing. 
     Another object of the present invention is to provide an adjustable length strap and footing for ligament mounting where the strap is arranged to receive, preferably secured to its distal end, a ligament graft end or a suture or suture sling arrangement that, in turn, connects to a ligament graft end. 
     Still another object of the present invention is to provide an adjustable length strap and footing for ligament mounting where the strap is formed as a single unit, preferably from a flexible material, such as a plastic, to include locking members formed at spaced intervals therealong, that is formed as a disk with a center hole therethrough which footing hole is formed to slightly compress each locking member as it passes therethrough, and flexes outwardly to where the locking member edge extends over the hole edge locking thereto when a force is applied to pull the strap distal end back through the footing hole. 
     Still another object of the present invention is in another embodiment of an adjustable length strap arranged as a thread, chain, cable, or the like, or even a suture, to fit through a footing that can be crimped onto the strap at a selected position therealong. 
     Still another object of the present invention is to provide still another embodiment where the adjustable length strap can be smooth walled or have greater and lesser diameter segments formed therealong for fitting through a footing center hole that is formed to include a locking panel or cantilever elements to be elevated by passage of the strap through the footing in one direction and lock to the strap when pulled oppositely as when the connected ligament graft is placed under tension. 
     Still another object of the present invention is to provide an adjustable length strap and footing for ligament mounting of a ligament graft end, under tension, in a prepared ligament tunnel, that is easy, convenient and reliable to use in a ligament repair procedure and, as appropriate, can be formed of a material to be absorbed by a patient&#39;s body during a healing process. 
     The present invention is in an adjustable length strap and footing for use in mounting a ligament graft end in a prepared ligament tunnel formed into a bone. For mounting the femoral end of a ligament graft utilizing the invention, the femoral tunnel is initially drilled as a first tunnel section to within the bone endosteum, with further drilling then taking place to extend the tunnel as a second tunnel section, that passes through the posterior cortex utilizing a same or lesser diameter drill than used to drill the first tunnel section. The invention provides a straight strap for mounting directly or through sutures to a ligament graft end on its distal end. The strap body includes, locking members, formed therealong that can be a series of right angle teeth that slope towards the strap distal end, a number of spaced cone members that slope towards the strap distal end, a chain having greater diameter and adjacent lesser diameter components, or a straight bar can be employed that is for fitting into a footing that includes a locking panel. Further, a thread, cord, chain, or even a suture section the strap for fitting through a footing that can be squeezed or crimped thereon, or the like. The strap is preferably pointed at its proximal end that is to fit through the footing, that for the series of teeth, spaced cones, or the like, is preferably a washer or disk having a center transverse hole that is slightly smaller in diameter than the strap cross section at a tooth apex or a cone skirt. Whereby the individual spaced teeth or cones will travel therethrough, traveling past an edge or lip of which center transverse hole, to lock against that edge or lip when the strap is pulled back through the hole as when a tension is applied to the strap distal end, providing a ligament end mounting. 
     The strap may be formed as a straight section from a flexible material, such as a plastic, fabric, chain, material, or the like, and includes, as a distal end, a transverse eyelet, and is preferably pointed at its proximal end. The transverse eyelet end can receive a ligament graft, or the like, looped therethrough or can receive a suture, sutures, or a suture sling, that is preferably an arrangement of at least a pair of sutures, or can be connected directly to a ligament graft end. Such ligament graft, for example, can be a bone tendon bone ligament graft. 
     The strap, with a ligament graft secured to its distal end, is moved through a prepared ligament tunnel section to where the strap proximal pointed end extends through a cortex end of the tunnel section. Thereat, the footing, that has a center hole formed therethrough, is fitted onto the strap proximal end. In which fitting, the strap pointed end will have passed through the footing center hole, and the strap, is then pulled therethrough. The footing center hole is formed to have a diameter or shape such that its edge will resist passage of the strap therethrough, causing a locking member component of the strap or footing, to be some what compressed. The locking member that is a skirt, edge, tooth apex, or the like, on the strap or a locking pawl, cantilever, elements, or the like formed in the footing hole, will flex to lock the footing and shaft together when a force is applied to the strap to pull it back through the hole. Travel of the strap through the disk hole thereby continues until a tension is applied to the strap to pull it back through the disk hole whereat the locking member locks the strap and footing together. When such force is applied to the strap, in the embodiments where the strap has locking members formed therealong, the edge of the locking member that has just passed through the disk hole extends across the disk hole edge and prevents strap passage back through the disk hole. Alternatively, the locking member can be a straight thin bar, cord, chain or strand, the passes across a footing locking pawl, or cantilever elements formed adjacent to the footing hole, the pawl or cantilever elements engaging the bar, cord, chain, or strand surface when it is pulled back. A tension can be applied through strap as by placing the ligament graft opposite end in tension. Thereafter, should an increase in the tensile stress applied to the ligament graft be required, the strap can be further pulled through the footing, the locking member releasing and then connecting to the strap to prohibit strap withdrawal, or, where the strap is a cord, thread, chain, or the like, the footing can be arranged as a cylinder to be crimped onto to lock to a selected site or location along that strap when the connected ligament is under a selected tension. 
     The strap that includes a locking member or members is preferably formed from a strong but flexible material, preferably a plastic, and that plastic can be selected to be biodegradable so as to be absorbed by the body during healing. The locking members that are arranged along the strap are preferably integral thereto and may, as with a use of a series of cones connected apex to base, or the like, as the strap, can be used to form the strap, or the locking members, such as right angle teeth, can be formed along a shaft side during formation of the strap, or the like. Preferably, the narrow bar strap is also formed of a plastic where the locking pawl can bite therein and may be biodegradable, and the cord, thread, or chain can also be formed to be biodegradable. For each locking member arrangement the footing is provided with a transverse hole that is formed to pass the strap upwardly therethrough, and includes an edge or edges, locking pawl, cantilever elements, or the like, to prohibit the strap from being pulled back out of the footing. The embodiments of the strap, locking members and footings of the invention are all to provide a ligament mounting to an end of a ligament graft that is placed under tension. 
    
    
     DESCRIPTION OF THE DRAWINGS 
     In the drawings that illustrate that which is present regarded as the best modes for carrying out the invention: 
     FIG. 1 is a profile perspective view of a first embodiment of an adjustable length strap and footing of the invention, showing a strap distal end thereof connected to a suture sling arrangement that is, in turn, secured to a bone end of a bone tendon bone ligament graft, with the strap shown formed from a number of frustum cones that are connected end to end as locking members, and with a strap proximal end shown as pointed and aligned for passage through a footing that is shown as a disk with a center hole formed therethrough; 
     FIG. 2 is a profile perspective view like that of FIG. 1 of a second embodiment of an adjustable length strap and disk shaped footing of the invention showing the strap as including a rack of right angle teeth formed along one edge as the locking members; 
     FIG. 3 is a side elevation view of a section of bone wherein a first tunnel section is shown as having been drilled with a lesser diameter second tunnel section shown extending from the first tunnel section end and passing through the bone cortex, and showing the adjustable length strap of FIG. 1, whereto a ligament graft is connected by sutures that have been fitted through the first tunnel section and into the second tunnel section with a footing positioned across the second tunnel section cortex end; 
     FIG. 4 is a view like that of FIG. 3 only showing the strap as having been pulled through the footing, and with the strap shown as having been cut off above a locking member and showing a bone end of the ligament graft connected to the strap by a pair of sutures; 
     FIG. 5 is a view like FIG. 3 only showing the second embodiment the adjustable length strap and footing for ligament mounting of FIG. 2 with the strap proximal end shown fitted through the footing; 
     FIG. 6 is a view like that of FIG. 5 only showing the strap as having been pulled through the footing and cut off above a right angle tooth with a bone end of the ligament graft, shown connected to the strap end by a pair of sutures, and positioned in the first tunnel section. 
     FIG. 7 is a profile perspective view, like that of FIGS. 1 and 2, of a third embodiment of an adjustable length strap and a footing for crimping thereto of the invention showing a braided pair of sutures, that attach, as a cradle, to a ligament end, with the braided distal end aligned for fitting through a cylindrical footing; 
     FIG. 8A is a side elevation view of a section of bone wherein a first tunnel section is shown as having been drilled, with a lesser diameter second tunnel section shown extending from the first tunnel section end, and passing through the bone cortex and showing the strap of FIG. 7 fitted through the first tunnel section, with the strap end fitted through the crimping footing to where the ligament end is pulled fully into the first tunnel section; 
     FIG. 8B is a view like FIG. 8 only showing the footing sides as having been squeezed together crimping it onto to so as to lock it onto the strap; 
     FIG. 9 is a profile perspective view like that of FIGS. 1,  2  and  7 , showing a fourth embodiment of an adjustable length strap and footing where the strap is a single strand of a cable, chain, suture, or the like, that has been sewn into a ligament end with the opposite end shown passed through a disk shaped footing that includes radial pie shaped sections around the transverse hole that act as cantilever elements; 
     FIG. 10A is a side elevation view like that of FIG. 8 showing first and second tunnel sections with the single strand shown pulled through the second tunnel section and fitted through the footing, with the ligament end shown pulled fully into the first tunnel section, and the single strap shown pulled through the footing urging the ends of the pie shaped segments thereof upwardly that engage the side of the single strand. 
     FIG. 10B is a top plan view of the footing of FIGS. 10 and 10A; and 
     FIG. 11 is a profile perspective view like that of FIGS. 1,  2 ,  7  and  10 , showing a fifth embodiment of an adjustable length strap and footing with the strap shown as a flat bar with an eyelet distal end wherethrough sutures are of a suture sling are fitted with the bar proximal end shown aligned for fitting through a footing that includes a locking pawl formed adjacent to its transverse hole. 
    
    
     DETAILED DESCRIPTION 
     FIG. 1 shows a first embodiment of an adjustable length strap and footing for a mounting  10  of the invention for mounting a ligament end in a bone tunnel, hereinafter identified as ligament mounting  10 . The ligament mounting  10  is shown in this embodiment to include a strap  11 , that is preferably formed as a single unit, and is shown in FIG. 1 as a series or chain of cone shaped locking members  13 , that are each frustum cones, and extend at equal spaced intervals outwardly from along a center rod body  12 . A top or distal strap end is shown as having a pointed cone  14  formed thereacross that is aligned for fitting through a footing  15 . Footing  15  is here shown as flat disk  16  that has a center hole  17  formed therethrough. The strap distal end is here shown as a cylinder  18  as an axial extension of the body  12  that includes a slot  19  formed therethrough to function as an eyelet and receives a pair of sutures  20  threaded therethrough. The sutures  20  are here shown configured as a sling. 
     The sutures  20  are configured as a sling from a pair of sutures that are each connected to be continuous, but, of course can be a single suture only, and an end of which sling is passed through the eyelet slot  19 . In practice, the pair of continuous sutures are each formed into a fold for fitting, respectively, through lower and upper transverse holes  23   a  and  23   b , that are formed through a bone end  22  of a bone tendon bone ligament graft  21 . These transverse holes  23   a  and  23   b  are preferably parallel, are spaced apart and are drilled so as to align with one another. A preferred method for mounting the sutures  20 , as a sling, to the bone end  22 , involves fitting a first suture  20 , at a fold therein, through one end of the lower transverse hole  23   a . Whereafter, the first suture  20  fold is opened, forming loop that is then passed over a top surface  22   a  of the bone end  22  and is slid down along the bone end surface. So arranged, the fold will be approximately positioned over the lower transverse hole  23   a  end that the first suture was fitted into. The first suture  20  is then pulled back through the transverse hole  23   a , tightening the loop around the bone end  22  surface. Thereafter, a loop is formed in the other or second suture  20  that is then fitted through the upper transverse hole  23   b . The suture  20  fold travels through the transverse hole  23   b  end that is opposite to the end of the lower transverse hole  23   a  that the first suture  20  fold was fitted into. Thereafter, the second suture  20  fold is opened into a loop that is fitted over the bone end face  22   a . The second suture  20  is then pulled back through the upper hole  23   b , tightening it around the bone end, as shown in FIG.  1 . So arranged, the sutures  20  extend along the bone end  22  and are spaced apart from one another. 
     When the suture  20  sling is pulled axially through a ligament tunnel section the bone end  22  will essentially follow it along that ligament tunnel section. The same suture sling method of formation is appropriate for mounting to all the bone ends of the bone tendon bone ligament grafts shown in FIGS. 1,  2  and  7 , and a single suture utilized as a suture sling is shown mounted to a bone end in FIGS. 3,  4 ,  6 ,  9  and  10 A. It should therefore be understood that any sling arrangement for mounting to a ligament end is suitable for use with the embodiments of the invention as set out and described herein, within the scope of this disclosure. 
     FIGS. 3 and 4 show the ligament mounting  10  as including the single suture  20  loop fitted through the strap  11  eyelet slot  19 . In FIG. 4, the suture  20  loop is shown passed through hole  23  formed in a bone end  22  of bone tendon bone graft  21 . Shown in FIG. 3, with the ligament graft mounted by suture  20  to the strap  11 , the strap is passed into a first straight tunnel section  26  that has been formed in a bone section  25  that is a section of a patient&#39;s bone, such as their distal femur. In such procedure the ligament graft  21  is used as a replacement for a patient&#39;s damaged ligament. Though, it should be understood the embodiments of the strap and footing of the invention, as shown and described herein, can be used for a number of procedures that involve securing a ligament graft end in a patient&#39;s bone. 
     The first tunnel section  26 , as shown in FIGS. 3 and 4, terminates in tunnel end  26   a  in the bone section  25  endosteum. A second straight tunnel section  27  is then drilled through the first tunnel section end  26   a , axially to that first tunnel section, to exit the bone cortex at  27   a . In FIG. 3, the footing  15 , shown herein as a disk  16 , is positioned across the second tunnel section end  27   a  such that the center hole  17  formed therethrough is in alignment with the second tunnel section cortex end and the pointed end of a top cone  14  of the series of frustum cones that form the strap  11 . 
     FIG. 4 shows the bone end  22  of the ligament graft  21  connected to a single suture  20  that has been passed through hole  23  and through the eyelet slot  19 . The bone end  21  is shown as having been pulled fully into the first tunnel section  26  and the strap  11  is shown as having been pulled through footing  15 . When pressure on the strap  11  to pull it through the footing  15  is released, or a force is applied to pull the strap back through the footing, a cone skirt edge  13   a  will slide over the edge of the disk hole  17 , prohibiting withdrawal, and allowing the strap to be cut off across the body  12 , providing a flat apex cone shaped locking member  13 . In practice, the locking member  13  will pass through the footing disk  16  center hole  17  and, during which passage, the cone skirt edge  13   a  will be somewhat compressed. After which travel of the footing member  13  through the center hole  17 , the locking member skirt edge  13   a  will flex or spring outwardly to its original attitude, so as to extend across the edge of the disk center hole  17 , as shown in FIG.  4 . So arranged, the skirt edge  13   a  rests on the edge or lip of footing hole  17  prohibiting the strap  11  from being pulled back through the disk  16 . Cutting of the body  12 , above the lock member  13 , completes the ligament graft end endosteal mounting. 
     A second embodiment of an adjustable length strap and footing for use as a ligament mounting  30  is shown in FIG. 2, and is hereinafter referred to as ligament mounting  30 , with its use shown in FIGS. 5 and 6. The ligament mounting  30 , like ligament mounting  10  is preferably for use in endosteally mounting a ligament graft end, shown herein as a bone end  22  of ligament graft  21 , in an end  41   a  of a prepared first straight ligament tunnel section  41  that has been formed in a bone  40 . The bone  40 , first tunnel section  41  and a second straight tunnel section  42  are like the tunnel sections  26  and  27 , described above. The second tunnel section  42 , like the second tunnel section  27 , extends axially from the first tunnel section, from end  41   a  thereof and exits the bone cortex at  42   a . The function of which first and second tunnel sections  41  and  42  are essentially the same as the tunnel sections  26  and  27  shown and described in relation to FIGS. 3 and 4, and so will not be further described herein. 
     The ligament mount  30 , as shown best in FIG. 2, includes a strap  31  that is shown as having a straight body  32  of a uniform cross section along its length, with three sides that connect at right angles and with a straight rack of equal spaced right angle teeth  33  formed along its fourth side. Each tooth  33  has an apex end  33   a  with its hypotenuse side sloping towards the strap distal end. The teeth  33  are to each function as a locking member, as set out hereinbelow. A straight body  32  top or proximal end  32   a  is preferably pointed, and the straight body bottom or distal end is preferably formed into a cylinder  34  wherein a longitudinal slot is formed as an eyelet slot  35 , though, of course, a tab with a hole formed therethrough can be so employed to mount a suture sling, or the like thereto within the scope of this disclosure. 
     A suture or sutures  20  that are arranged as a sling, are shown in FIGS. 2,  7  and  11 , and is fitted through the eyelet slot  35  and connect through transverse holes  23   a  and  23   b  formed in bone end  22  of ligament graft  21 , as described above. With a single suture  20  shown fitted through eyelet slot  35  and connect through bone end  22  transverse hole  23  shown in FIGS. 3,  4 ,  5  and  6 ,  8 A,  8 B,  9  and  10 A. These various suture couplings to the ligament end have been set out and described above with reference to the ligament member  21 , and ligament member shown in FIGS. 9 and 10A below, and so will not be further described herein. Accordingly, it should be understood that the ligament graft bone end  22  of ligament graft  21  is preferred connected by a suture or sutures to the ligament mountings  10  and  30  and the ligament mountings  45 ,  55  and  70 , within the scope of this disclosure. Also, for example, it should be understood that, a tendon as a ligament graft, could be passed through the eyelet slot  19  or  35  and folding upon itself, forming a two strand ligament graft, within the scope of this disclosure. 
     A ligament mounting  30  strap  31  body  32  pointed top or distal end  32   a , as shown in FIG. 2, are aligned for fitting through a center hole  38  that has been formed through a disk  37 , that is a footing  36 . In FIG. 5, the strap  31  body  32  pointed proximal end  32   a  is shown as having passed through the disk  37  hole  38  with the hypotenuse sides of several of the individual teeth  33  shown as having traveled across an edge or lip  38   a  of the disk  37  hole  38 . In which passage the apex end  33   a  of each tooth  33 , in turn, is slightly collapsed inwardly so as to allow it to pass through the hole  38 , and will thereafter flexes outwardly to its original attitude after exiting the hole  38 , engaging the hole  38  edge  38   a.    
     FIG. 6 shows the ligament mounting  30  strap  31  as having been pulled through the footing  36  to where the ligament graft  21  bone end  22  has been pulled into the first tunnel section  41 , approximately to the end  41   a  thereof. Here, it should be understood a, tensile force can be applied through the ligament graft and body  32  to set a tooth  33  apex edge  33   a  firmly across edge or lip  38   a  of disk  37  hole  38 . The tooth apex surface thereby passes over the disk hole edge to prohibit a pulling of the strap  31  back through the footing  36 . So arranged, a permanent ligament graft end endosteal mounting in the first tunnel section  41  is provided. Thereafter, the body  32  can be cut off above the tooth  33  whose apex end  33   a  engages the disk hole edge or lip  38   a , as shown in FIG. 6, completing the ligament mounting. 
     A third embodiment of an adjustable ligament strap and footing  45  for use for mounting a ligament  21  in a bone tunnel section  50  is shown in FIGS. 7,  8 A and  8 B. For this embodiment, a sling formed from sutures  20 , like the arrangements set out above, is preferably utilized for securing the bone end  22  of ligament graft  21 . This sling is also for fitting through transverse holes  23   a  and  23   b , as described above, and accordingly its mounting onto the bone end  22  that includes a flat top  22   a , will not be further described herein. 
     Unique to the suture sling of FIG. 7 is that the pair of sutures  20  have been twisted, braided, or otherwise formed into a chain or cable  46  whose upper or proximal end  47  is aligned for fitting through a footing  48  that is preferably formed as a cylinder as from a soft metal to allow it to be crimped, as with a crimping tool, whose opposing jaws  52   a  and  52   b  are shown in FIG.  8 A. The jaws  52   a  and  52   b , as shown, are aligned for clamping onto a cylindrical body  51  of the footing  48 , crushing the footing center hole  49  tightly onto the cable  46 , securing it thereto. The jaws  52   a  and  52   b , as shown in FIG. 8A include opposing surfaces  53   a  and  53   b  that are arranged to fit into like surfaces formed over footing body  51 . So arranged, a tight non-slip grip is provided to crimp the footing when the opposing tool jaws surfaces  53   a  and  53   b  are brought together as shown in FIG.  8 B. 
     In FIG. 8A, the cable  46  is shown fitted through first straight tunnel section  50  and then through a second straight tunnel section  50   a , that extends axially from the end of the first tunnel section and exits a bone cortex. Shown in FIGS. 8A and 8B, the cable  46  receives the footing  48  crimped thereon with the footing bottom  51   a  having a greater diameter than that of the cortex end of the second tunnel section to extend thereacross, precluding the cable  46  that is mounted to the bone end  22  from pulling out of the footing  48 , even when the ligament graft  21  is under tension. This completes the ligament mounting. Of course, it should be understood, the cable  46  can be formed of two or more sutures, as shown in FIG. 7, or can be a single suture fitted through a single transverse hole  23 , formed through the bone end  22 , as shown in FIGS. 8A and 8B or other appropriate chain, cable, or strand within the scope of this disclosure. 
     Still another or fourth embodiment of an adjustable ligament strap and footing  55  is shown in FIGS. 9 and 10A and is arranged for connection, as by sewing a single cable type strap  57  thereof onto an end  56   a  of a ligament graft  56 , with a footing  58  of which adjustable length strap and footing  55  shown also in FIG.  10 B. Shown in FIGS. 9 and 10A, the adjustable length strap and footing  55  preferably includes the cable type strap  57 , but can be a suture, metal cable, wire, or the like, within the scope of this disclosure. The strap  57  is connected to end  56   a  of ligament graft  56  as by passing it through a hole  56   b  that has been formed therethrough. Thereafter, the strap  57  distal end can be knotted, or the like, to prohibit its being pulled out of the ligament graft end  56   a . As shown, the strap  57  can to sewn in the ligament graft end  56   a , increasing purchase and pull-out strength, as required. 
     Like the above described tunnel mountings of the first three embodiments, this fourth embodiment preferably provides for mounting of the ligament graft  56  proximal end  56   a  in a first straight tunnel section  65 , as shown in FIG. 10A, with the strap  57  fitted through a second smaller straight tunnel section  66 , that is formed to extend axially from that first tunnel section endosteal end, and exits the bone cortex at  66   a , as shown in FIG.  10 A. Upon exiting the second tunnel section  66  the footing  58  receives the strap  57  fitted through a center hole  60 , as shown in FIG. 10B, and is slid along the strap  57  to the attitude shown in FIG.  10 A. The footing  58 , to provide for locking to the strap  57 , is shown as having a flat disk shaped body  59  with the center hole  60  formed therethrough, as shown best in FIG.  10 B. From the center hole  60  a plurality of equal spaced radial slots or grooves  61  are formed into the disk center portion, thereby dividing that disk center portion into like pie shaped sections  62  that each include an apex end  63 . In practice, the strap  57  is formed to be slightly larger in diameter than the center hole  60 , whereby urging the strap through the hole  60  tends to flex the pie shaped sections  62  upwardly, the pie shaped sections  62  each functioning as cantilever elements, as shown in FIGS. 9 and 10A. With the footing engaging the bone cortex, spanning the second tunnel section cortex end  66   a , the pie shaped section  62  apex  63  tend to engage the strap  57  side when a force is applied on the ligament graft  56  to pull it and the connected strap  57  out of the first tunnel section, providing for locking the footing  58  onto the strap  57 , completing the ligament graft  56  mounting, as shown in FIG.  10 A. 
     A final or fifth embodiment of the present invention in an adjustable ligament strap and footing  70  is shown in FIG.  11 . This fifth embodiment is also for use for mounting a bone end  22  of a bone tendon bone ligament graft  21  in a first straight tunnel section formed in a bone, as described above. In this mounting, a straight bar  71  is fitted through a second straight tunnel section that extends axially from the endosteal end of the first tunnel section, the bar  71  exiting the bone cortex, as set out above. Accordingly, the first and second tunnel sections, as shown in FIGS. 3,  4 ,  5 ,  6 ,  8 A,  8 B and  10 B, it should be understood, are also preferred for use with this fifth embodiment and will not be further described herein. Similarly, this fifth embodiment can be used with a sling arrangement like those described above, for mounting a suture sling formed from sutures  20  fitted through transverse holes  23   a  and  23   b  formed in a bone end  22  having a flat top end  22   a , and so will not be further described herein. Though, it should be understood, this fifth embodiment can be used with any connecting arrangement for linking it to a ligament graft, within the scope of this disclosure. 
     Like the above set out first and second embodiments, this fifth embodiment includes a distal section  72  formed with a hole  73  therethrough as an eyelet end for receiving the sutures  20  passed therethrough. Further, as shown in FIG. 11, a top or proximal end  74  of bar  71  is shown squared off, though it can be pointed, aligned to fit through a hole  77 , in disk  75 , which hole  77  is shown as having a rectangular shape, that is formed through the center of a disk body  76 . The disk  75  is shown as being flat and is the footing of this embodiment. The disk body  76 , as shown, includes a pair of parallel spaced lateral slots  78   a  and  78   b  formed at right angles from the hole  77  into the disk body, to leave a center section  79  therebetween. The center section  79 , as shown, has a flat outer edge  80  that extends into the slot  77  and is to function as a locking pawl to flex upwardly as the bar  71  is passed therethrough, with outer edge  80  to flex into binding against the bar surface when a force is applied to pull the ligament graft and connected bar out from the tunnel sections. The center section  79  thereby functions as a locking pawl to slide along a flat surface and to ratchet over an uneven surface, such as a chain, cable, or the like. So arranged, the center section edge  80 , as shown, tends to bind into the bar  71  surface prohibiting its withdrawal and to permanently lock the bar  71  footing  75  in place over the second tunnel section cortex end, completing the mounting. With, for a bar  71  with an other than flat surface, the edge  80  will travel thereover and lock in a slot, groove, depression, or the like, completing the mounting. 
     While preferred embodiments of ligament mountings  10 ,  30 ,  40 ,  55  and  70  and their function for endosteally mounting an end of a ligament graft in a prepared tunnel section have been shown and described herein, it should be understood that the present disclosure is made by way of example only and that variations and changes are possible without departing from the subject matter and reasonable equivalency thereof coming within the scope of the following claims, which claims we regard as our invention.