Abstract:
Anterior cruciate ligament reconstruction methods and devices are designed to achieve an anatomically accurate double bundle anterior cruciate ligament reconstruction by using a single femoral and tibial tunnel. The method and devices reconstruct the two bundles of the anterior cruciate ligament in a single femoral and tibial tunnel using a bone-patellar tendon-bone graft. The methods and devices enable an accurate anatomical reconstruction of the anteromedial and posterolateral bundles by creating a single femoral and tibial tunnel as opposed to creating two tunnels in the tibia and femur.

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
       [0001]    This application is a divisional application of U.S. Ser. No. 13/122,845 filed Apr. 6, 2011, which is a national phase of PCT International Application PCT/US2009/060466 filed Oct. 13, 2009, which claims priority from U.S. Patent Application 61/104,876 filed Oct. 13, 2008, all of which are incorporated herein by reference for all purposes. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH 
       [0002]    Not Applicable. 
       BACKGROUND OF THE INVENTION 
       [0003]    1. Field of the Invention 
         [0004]    The invention relates to methods and devices for ligament reconstruction in a joint. More particularly, the invention relates to a method and an implant to anatomically reconstruct the two bundles of the anterior cruciate ligament in a single femoral and tibial tunnel using a bone-patellar tendon-bone graft. 
         [0005]    2. Description of the Related Art 
         [0006]    There is a high prevalence of traumatic anterior cruciate ligament (ACL) injuries both in athletic and non-athletic population. ACL reconstruction is commonly performed to replace the injured ACL. However, osteoarthritis and knee pain have been reported among patients who had an ACL reconstruction 20 surgery. (See, Aglietti etal., “Long term study of anterior cruciate ligament reconstruction for chronic instability using the central one-third patellar tendon and a lateral extraarticular tenodesis”  Am J Sports Med.  1992; 20:38-45; Jomha etal., “Long-term osteoarthritic changes in anterior cruciate ligament reconstructed knees”  Clin Orthop Relat Res.  1999; 188-193; and Pinczewski etal., “A five-year 25 comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament”  Am J Sports Med.  2002; 30:523-536). Improving ACL reconstruction techniques that may restore normal knee stability and prevent joint degeneration remains a subject of continuing debate in sports medicine research. 
         [0007]    Single bundle AOL reconstruction has been adopted by many surgeons. However, studies have shown that single bundle ACL reconstruction fails to restore tibial rotation to the intact level. (See, Georgoulis etal., “Tibial rotation is not restored after ACL reconstruction with a hamstring graft”  Clin Orthop Relat Res.  2007; 454:89-94; and Ristanis etal., “Follow-up evaluation 2 years after ACL reconstruction with bone-patellar tendon-bone graft shows that excessive tibial rotation persists”  Clin J Sport Med.  2006; 16:111-116). These observations are attributed to the limitation of single bundle ACL reconstruction to reproduce both the functional bundles (anteromedial (AM) and posterolateral (PL)) of the ACL. In order to address this issue, double tunnel-double bundle ACL reconstruction was introduced to reconstruct the two functional bundles of the ACL. There is no consensus among the studies in literature showing a significant advantage of this technique over the conventional single bundle ACL reconstruction. Although the double tunnel-double bundle ACL reconstruction technique is capable of reproducing the two functional bundles, it is a technically challenging procedure. The double tunnel-double bundle ACL reconstruction is also associated with an increase in the duration of surgery and higher cost as compared to the traditional single bundle ACL reconstruction. (See, Caborn et al., “Single femoral socket double-bundle anterior cruciate ligament reconstruction using tibialis anterior tendon: description of a new technique”  Arthroscopy  2005; 21:1273; and Yasuda et al., “Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts”  Arthroscopy  2004; 20:1015-1025). In addition, the double tunnel-double bundle ACL reconstruction makes a revision surgery difficult. By drilling two tunnels, there is an elevated risk of bone bridge damage due to an excessive loss of bone. These limitations in the current designs of the ACL reconstruction techniques leave a large scope for an improvement to this surgery. 
         [0008]    Therefore, there is a need for improved methods and improved devices for anterior cruciate ligament reconstruction. 
       SUMMARY OF THE INVENTION 
       [0009]    The present invention provides a dramatic improvement to current ACL reconstruction techniques. This invention is designed to achieve an anatomically accurate double bundle ACL reconstruction by using a single femoral and tibial tunnel. In the invention, there has been developed a method and an implant to anatomically reconstruct the two bundles of the ACL in a single femoral and tibial tunnel using a bone-patellar tendon-bone graft. 
         [0010]    The bone-patellar tendon-bone graft is split longitudinally to form the two bundles of the ACL. The graft could be split from one end to the other forming two separated bundles or 3 to 4 centimeters of the graft could be split on both ends of the graft leaving the graft attached at the intermediate section, as described further below. 
         [0011]    ACL reconstruction using the implant can be performed either by single incision or double incision techniques (See, Bach et at, “Single-incision endoscopic anterior cruciate ligament reconstruction using patellar tendon autograft. Minimum two-year follow--up evaluation”  Am J Sports Med.  1998; 26(1):30-40; Gill et al., “Anterior cruciate ligament reconstruction the two-incision technique”  Orthop Clin North Am.  2002; 33(4)127-735). The femoral and tibial tunnels are placed in a standard fashion as in the case of single bundle ACL reconstruction. The fixation plates of the implant described in detail below are attached to the four bone blocks of the split bone-patellar tendon-bone graft via sutures. 
         [0012]    Double bundle ACL reconstruction can be achieved by fixing the ends of the graft in the femoral and tibial tunnels by placing the interference screws between the fixation plates. Graft bundles are rotated until an anatomic orientation is achieved before fixing the graft in the tunnels. 
         [0013]    The implant of the present invention enables an accurate anatomical reconstruction of the AM and PL bundles by creating a single femoral and tibial tunnel as opposed to creating two tunnels in the tibia and femur. The surgical procedure to use this implant is related to single bundle ACL reconstruction that is currently being used by majority of surgeons. Hence, ACL reconstruction using this implant could be performed with great ease by any surgeon practicing single bundle ACL reconstruction. A revision surgery could be performed with fewer complications than double tunnel-double bundle ACL reconstruction. 
         [0014]    In one aspect, the invention provides an implant for ligament reconstruction in a joint. The implant includes a ligament replacement having a first strand, a second strand, a first bone block, and a second bone block. The first strand and the second strand are spaced apart at a first end section of the ligament replacement, and the first strand and the second strand are spaced apart at a second opposite end section of the ligament replacement. The first bone block is attached to the first strand at the first end section of the ligament replacement, and the second bone block is attached to the second strand at the first end section of the ligament replacement. A first fixation device is positioned between the first bone block and the second bone block. The first bone block, the second bone block, and the first fixation device are dimensioned such that the first fixation device presses an outer surface of the first bone block against an inner surface of a tunnel in a first bone of the joint and presses an outer surface of the second bone block against the inner surface of the tunnel in the first bone of the joint when the first fixation device is positioned between the first bone block and the second bone block. 
         [0015]    The ligament replacement can include a third bone block attached to the first strand of the ligament replacement at the second end section of the ligament replacement, and a fourth bone block attached to the second strand of the ligament replacement at the second end section of the ligament replacement. A second fixation device can be positioned between the third bone block and the fourth bone block. The third bone block, the fourth bone block, and the second fixation device are dimensioned such that the second fixation device presses an outer surface of the third bone block against an inner surface of a tunnel in a second bone of the joint and presses an outer surface of the fourth bone block against the inner surface of the tunnel in the second bone of the joint when the second fixation device is positioned between the third bone block and the fourth bone block. 
         [0016]    In one form, the first fixation device includes (i) a first fixation plate and a second fixation plate spaced apart from the first fixation plate, and (ii) a first interference screw positioned between the first fixation plate and the second fixation plate of the first fixation device. The first fixation plate of the first fixation device contacts the first interference screw and an inner surface of the first bone block when the first fixation device is positioned between the first bone block and the second bone block, and the second fixation plate of the first fixation device contacts the first interference screw and an inner surface of the second bone block when the first fixation device is positioned between the first bone block and the second bone block. 
         [0017]    In one form, the second fixation device includes (i) a third fixation plate and a fourth fixation plate spaced apart from the third fixation plate, and (ii) a second interference screw positioned between the third fixation plate and the fourth fixation plate of the second fixation device. The third fixation plate of the second fixation device contacts the second interference screw and an inner surface of the third bone block when the second fixation device is positioned between the third bone block and the fourth bone block, and the fourth fixation plate of the second fixation device contacts the second interference screw and an inner surface of the third bone block when the second fixation device is positioned between the third bone block and the fourth bone block. 
         [0018]    The first fixation plate and the second fixation plate of the first fixation device can be integral. Alternatively, the first fixation plate and the second fixation plate of the first fixation device are not connected. The first fixation plate of the first fixation device can be sutured to an inner surface of the first bone block, and the second fixation plate of the first fixation device can be sutured to an inner surface of the second bone block. 
         [0019]    The third fixation plate and the fourth fixation plate of the second fixation device can be integral. Alternatively, the third fixation plate and the fourth fixation plate of the second fixation device are not connected. The third fixation plate of the second fixation device can be sutured to an inner surface of the third bone block, and the fourth fixation plate of the second fixation device can be sutured to an inner surface of the fourth bone block. 
         [0020]    Any of the fixation plates can include one or more ribs on their outer surface for engaging an inner surface of the associated bone block. Any of the fixation plates can include one or more throughholes for receiving a suture. An inner wall of the first fixation plate and an inner wall of the second fixation plate of the first fixation device can be tapped to engage threads of the first interference screw. An inner wall of the third fixation plate and an inner wall of the fourth fixation plate of the second fixation device can be tapped to engage threads of the second interference screw. Any of the fixation plates can include a first end and a opposite second end wherein an inner wall of the fixation plate is thicker adjacent the first end of the fixation plate than adjacent the second end of the fixation plate. 
         [0021]    In one form, the first strand and the second strand are connected at an intermediate section of the ligament replacement. In another form, the first strand and the second strand are not connected. The first strand and the second strand can be selected from a patellar tendon, a hamstring tendon, an Achilles tendon, or a tibialis tendon. In yet another form, the ligament replacement is a bone-patellar tendon-bone graft split on both ends of the graft. 
         [0022]    The tunnel in the first bone and the tunnel in the second bone can be prepared by a single incision anterior cruciate ligament reconstruction technique. Alternatively, the tunnel in the first bone and the tunnel in the second bone can be prepared by a two incision anterior cruciate ligament reconstruction technique. 
         [0023]    In one use of the implant, the first bone is the femur, the second bone is the tibia, and the ligament is the anterior cruciate ligament. In another use of the implant, the first bone is the femur, the second bone is the tibia, and the ligament is the posterior cruciate ligament. 
         [0024]    In another aspect, the invention provides a method for ligament reconstruction in a joint. In the method, a ligament replacement having a first strand, a second strand, a first bone block, a second bone block, a third bone block. and a fourth bone block is obtained. The first strand and the second strand are spaced apart at a first end section of the ligament replacement, and the first strand and the second strand are spaced apart at a second opposite end section of the ligament replacement. The first bone block is attached to the first strand at the first end section of the ligament replacement, the second bone block is attached to the second strand at the first end section of the ligament replacement, the third bone block is attached to the first strand of the ligament replacement at the second end section of the ligament replacement, and the fourth bone block is attached to the second strand of the ligament replacement at the second end section of the ligament replacement. The ligament replacement can be obtained by splitting a first end of a bone-patellar tendon-bone graft longitudinally to form one end of the first strand, one end of the second strand, the first bone block, and the second bone block, and splitting a second end of the bone-patellar tendon-bone graft longitudinally to form an opposite end of the First strand, an opposite end of the second strand, the third bone block, and the fourth bone block. 
         [0025]    A first fixation device is positioned between the first bone block and the second bone block, and a second fixation device is positioned between the third bone block and the fourth bone block. A first tunnel is formed in a first bone of the joint, and a second tunnel is formed in a second bone of the joint. The first bone block, the second bone block, and the first fixation device are located in the first tunnel, and the outer dimension of the first fixation device is adjusted such that the first fixation device presses an outer surface of the first bone block against an inner surface of the first tunnel and presses an outer surface of the second bone block against the inner surface of the first tunnel. The third bone block, the fourth bone block, and the second fixation device are located in the second tunnel, and the outer dimension of the second fixation device is adjusted such that the second fixation device presses an outer surface of the third bone block against an inner surface of the second tunnel and presses an outer surface of the fourth bone block against the inner surface of the second tunnel. In one use of the method, the first bone is the femur, the second bone is the tibia, and the ligament being reconstructed is the anterior cruciate ligament. 
         [0026]    The first fixation device can include a first fixation plate, a second fixation plate spaced apart from the first fixation plate, and a first interference screw. The second fixation device can include a third fixation plate, a fourth fixation plate spaced apart from the third fixation plate, and a second interference screw. The step of adjusting the outer dimension of the first fixation device can comprise driving the first interference screw between the first fixation plate and the second fixation plate such that the first fixation plate presses the outer surface of the first bone block against the inner surface of the first tunnel and the second fixation plate presses the outer surface of the second bone block against the inner surface of the first tunnel. The step of adjusting the outer dimension of the second fixation device can comprise driving the second interference screw between the third fixation plate and the fourth fixation plate such that the third fixation plate presses the outer surface of the third bone block against the inner surface of the second tunnel and the fourth fixation plate presses the outer surface of the fourth bone block against the inner surface of the second tunnel. 
         [0027]    The step of positioning the first fixation device between the first bone block and the second bone block can include suturing the first fixation plate of the first fixation device to the first bone block, and suturing the second fixation plate of the fixation device to the second bone block. The step of positioning the second fixation device between the third bone block and the fourth bone block can include suturing the third fixation plate of the second fixation device to the third bone block, and suturing the fourth fixation plate of the second fixation device to the fourth bone block. 
         [0028]    In the method, the first fixation device can be rotated until an anatomic orientation of the first strand and the second strand is achieved before driving the first interference screw between the first fixation plate and the second fixation plate. Likewise, the second fixation device can be rotated until an anatomic orientation of the first strand and the second strand is achieved before driving the second interference screw between the third fixation plate and the fourth fixation plate. 
         [0029]    In one version of the method, the first interference screw and the second interference screw are driven in substantially the same direction. In another version of the method, the first interference screw and the second interference screw are driven in substantially opposite directions. The steps of forming the first tunnel in the first bone of the joint and forming the second tunnel in the second bone of the joint can comprise preparing the first tunnel in the first bone and the second tunnel in the second bone by a two incision anterior cruciate ligament reconstruction technique. The steps of forming the first tunnel in the first bone of the joint and forming the second tunnel in the second bone of the joint can comprise preparing the first tunnel in the first bone and the second tunnel in the second bone by a single incision anterior cruciate ligament reconstruction technique. 
         [0030]    These and other features, aspects, and advantages of the present invention will become better understood upon consideration of the following detailed description, drawings, and appended claims. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0031]      FIG. 1  shows a side view schematic of a fixation device of an implant according to the invention including two fixation plates and an interference screw. 
           [0032]      FIG. 2  shows a detailed perspective view of the fixation plates of the fixation device of  FIG. 1 . 
           [0033]      FIG. 3  shows the inner wall architecture of the two fixation plates of  FIGS. 1 and 2 . 
           [0034]      FIG. 4  shows a schematic of a bone-patellar tendon-bone graft split into two bundles on either ends with the intermediate section attached and both the ends fixed onto the fixation plates via sutures in accordance with the invention. 
           [0035]      FIG. 5  shows a perspective view of the bone-patellar tendon-bone graft with the fixation plates attached after the interference screw is inserted in between them in accordance with the invention. 
           [0036]      FIG. 6  shows a schematic of a bone-patellar tendon-bone graft split into two bundles from one end to the other, with the ends fixed onto the fixation plates via sutures in accordance with the invention. 
           [0037]      FIG. 7  shows a schematic of the bone-patellar tendon-bone graft with the fixation plates attached after the interference screw is inserted in between them in accordance with the invention. 
           [0038]      FIG. 8  shows a schematic of a bone-patellar tendon-bone graft attached to the fixation plates of the implants as used in single incision ACL reconstruction technique in accordance with the invention. 
           [0039]      FIG. 9  shows a schematic of the bone-patellar tendon-bone graft with the fixation plates attached after the interference screw is inserted in between them as used in single incision ACL reconstruction technique in accordance with the invention. 
           [0040]      FIG. 10  shows a perspective view of an anatomical reconstruction of the ACL that reproduces the positioning of anteromedial and posterolateral bundles using the bone-patellar tendon-bone graft of  FIG. 7 . 
       
    
    
       [0041]    Like reference numerals will be used to refer to like parts from Figure to Figure in the following description of the drawings. 
       DETAILED DESCRIPTION OF THE INVENTION 
       [0042]    The invention is capable of fixing the two graft bundles in the anatomic positions of anteromedial and posterolateral bundles by placing a single femoral and tibial tunnel. This anterior cruciate ligament reconstruction is a minimally invasive surgery that can be performed arthroscopically. Although the description of the invention is targeted towards anterior cruciate ligament reconstruction, the present invention could potential be adapted for, but not limited to, posterior cruciate ligament reconstruction and other ligament reconstructions in various joints. Anterior cruciate ligament reconstruction using the present invention can be accomplished by surgeons who are familiar with single bundle ACL reconstruction. 
         [0043]    Embodiments of the invention feature two implants  69 ,  78  and a bone-patellar tendon-bone graft  68  to reconstruct the two bundles of the ACL. In one version of the invention, the bone-patellar tendon-bone graft  68  can be obtained by removing the central portion of the patient&#39;s patellar tendon using a scalpel and motorized tool. The ends of the patellar tendon are attached to bone blocks from the patient&#39;s patella and tibia. First implant  69  includes fixation plates  19 ,  20  and an interference screw  10 . The second implant features similar fixation plates  60 ,  61  and an interference screw  47  as in the first implant  69 . In one of the forms, the bone-patellar tendon-bone graft  68  is split from one end to the other and used with the implants  69 ,  78 . In other embodiment, the bone-patellar tendon-bone graft  68  is split only by 3 to 4 centimeters on either ends leaving the intermediate section  46  intact and fixed with the implants  69 ,  78  in the tibial tunnel  65  and femoral tunnel  66 . The architecture of only the first implant  69  is described in detail below since both the implants  69 ,  78  have the same architecture in the example embodiment. 
         [0044]    Referring to  FIGS. 1-5 , the first implant  69  includes two fixation plates  19 ,  20  and an interference screw  10 . The outer walls  17 ,  22  of the fixation plates  19 ,  20  include rib like protrusions  21 ,  23  to prevent any slippage between the first and second bone blocks  38 ,  42  and the fixation plates  19 ,  20 . Throughholes  27  running from outer wall  17  to the inner wall  71  are present on one side of the fixation plate  20  to attach the bone blocks  38  of the bone-patellar tendon-bone graft  68  via sutures  57 . Throughholes  28  running from outer wall  17  to the inner wall  71  are present on an opposite side of the fixation plate  20  to attach the bone blocks  38  of the bone-patellar tendon-bone graft  68  via sutures  57 . Fixation plate  19  has throughholes  33  running from the outer wall  22  to the inner wail  70  on one side of the fixation plate  19  to attach the bone block  42  of the bone-patellar tendon-bone graft  68  via sutures  56 . Fixation plate  19  has throughholes  34  running from the outer wall  22  to the inner wall  70  on an opposite side of the fixation plate  19  to attach the bone block  42  of the bone-patellar tendon-bone graft  68  via sutures  56 . 
         [0045]    Throughholes  29 ,  30  are present on the fixation plates  20 ,  19  respectively to pass strands of sutures  48 ,  51  used to apply tension to the graft  68 . Throughholes  45 ,  15  are present on the fixation plates  19 ,  20  respectively to pass strands of sutures  100 ,  101  that will be used to apply tension to the graft  68  while using a single incision ACL reconstruction technique. The inner walls  16 ,  18  of the fixation plates  20 ,  19  respectively have a variable thickness to match the variable diameter of the interference screw  10  (see  FIG. 1 ). This prevents the fixation plates  19 ,  20  from collapsing at the posterior ends  24 ,  25  and helps to maintain a desired separation between the graft bundles  40 ,  44 . 
         [0046]    Referring to  FIG. 1 , the interference screw  10  includes threads  11  that run along the entire length of the screws  10 . The diameter of the interference screw  10  is larger at the anterior end  72  than the diameters at the posterior end  73 . The interference screws  10  and the fixation plate  19  include a flat cut  12 ,  14  at the posterior end  73  and anterior end  13  respectively to allow easy insertion of the interference screws  10  between the fixation plates  19 ,  20 . 
         [0047]    Referring to  FIG. 3 , the inner walls  16 ,  18  of the fixation plates  19 ,  20  are tapped  31 ,  35  to accommodate the threads  11  of the interference screws  10 . Protrusions  26  and  37  are inserted into the throughholes  32  and  36  respectively to attach the fixation plates  19 ,  20  together before the interference screw  10  is inserted between the inner walls  16 ,  18  of the fixation plates  19 ,  20 . 
         [0048]    Referring to  FIGS. 4-7 , a bone-patellar tendon-bone autograft or allograft  68  is preferred for reconstructing the functional bundle of the ACL. However, other graft materials such as hamstring tendon, Achilles tendon or tibialis tendon can also be used with the present invention. The bone-patellar tendon-bone graft  68  is split longitudinally by an oscillating saw either the entire length of the graft  68 , or by 3 to 4 centimeters on both of the ends of the graft  68  as preferred by the surgeon to form two graft bundles  40 , 44 . 
         [0049]    Referring to  FIG. 10 , a schematic of the knee joint  64  is shown with femur  67 , tibia  63  and fibula  62 . The tibial tunnel  65  and the femoral tunnel  66  are prepared in standard fashion either by single incision or double incision ACL reconstruction techniques. 
         [0050]    Referring to  FIG. 6-7 , an example embodiment of implants  69 ,  78  according to the invention for ligament reconstruction is shown. The implant  69  includes a ligament replacement  68  having a first end section  74 , and a second end section  75 . The ligament replacement  68  includes a first strand  44  and a second strand  40 . The first strand  44  and the second strand  40  are spaced apart at the first end section  74  of the ligament replacement  68 . The first strand  44  and the second strand  40  are spaced apart at the second end section  75  of the ligament replacement  68 . The ligament replacement  68  can comprise a patellar tendon, a hamstring tendon, an Achilles tendon, or a tibialis tendon autograft or allograft 
         [0051]    Implant  69  includes a first fixation plate  19  and a second fixation plate  20  spaced apart from the first fixation plate  19 . The first fixation plate  19  and the second fixation plate  20  are shown as separate components; however, they could be formed integrally. Implant  69  also includes an interference screw  10  inserted between the first fixation plate  19  and the second fixation plate  20  of the first implant  69 . The first fixation plate  19  of the implant  69  contacts the interference screw  10  and a surface of the first bone block  42  when the implant  69  is positioned between the first bone block  42  and the second bone block  38 . The second fixation plate  20  of the implant  69  contacts the interference screw  10  and a surface of the second bone block  38  when the implant  69  is positioned between the first bone block  42  and the second bone block  38 . Suture  56  connects the first fixation plate  19  of the implant  69  to the first bone block  42 , and suture  57  connects the second fixation plate  20  of the implant  69  to the second bone block  38 . 
         [0052]    The first implant  69  is positioned between the first bone block  42  and the second bone block  38 . When the fixation device  69  is positioned between the first bone block  42  and the second bone block  38 , the implant  69  presses an outer surface  76  of the first bone block  42  against an inner surface of a tunnel  66  in the femur  67  of the knee joint  64 , and the implant  69  presses an outer surface  77  of the second bone block  38  against the inner surface of the tunnel  66  in the femur  67  of the knee joint  64 . 
         [0053]    A second implant  78  is positioned between the third bone block  43  and the fourth bone block  41 . When the implant  78  is positioned between the third bone block  43  and the fourth bone block  41 , the implant  78  presses an outer surface  80  of the third bone block  43  against an inner surface of a tunnel  65  in the tibia  63  of the knee joint  64  and the implant  78  presses an outer surface  79  of the fourth bone block  41  against an inner surface of the tunnel  65  in the tibia  63  of the knee joint  64 . 
         [0054]    The implant  78  includes a first fixation plate  60  and a second fixation plate  61  spaced apart from the first fixation plate  60 . The first fixation plate  60  and the second fixation plate  61  are shown as separate components; however, they could be formed integrally. The implant  78  also includes an interference screw  47  inserted between the first fixation plate  60  and the second fixation plate  61  of the implant  78 . The first fixation plate  60  of the implant  78  contacts the interference screw  47  and a surface of the third bone block  43  when the implant  78  is positioned between the third bone block  43  and the fourth bone block  41 . The second fixation plate  61  of the implant  78  contacts the interference screw  47  and a surface of the fourth bone block  41  when the implant  78  is positioned between the third bone block  43  and the fourth bone block  41 . Suture  59  connects the first fixation plate  60  of the implant  78  to the third bone block  43 , and suture  58  connects the second fixation plate  61  of the implant  78  to the fourth bone block  41 . 
         [0055]    Sutures  48 ,  51  will be used to pass the first bone block  42  and the second bone block  38  attached to the fixation plates  19 ,  20  respectively through the tunnel  65  in the tibia  63  and placed into the tunnel  66  of the femur  67  for double incision ACL reconstruction technique. For single incision technique, sutures  100 ,  101  will be used to pass the first bone block  42  and the second bone block  38  attached to the fixation plates  19 ,  20  respectively through the tunnel  65  in the tibia  63  and placed into the tunnel  66  of the femur  67 . The two strands  40 ,  44  are rotated until an anatomic orientation is achieved before the interference screw  10  is inserted between the fixation plates  19 ,  20  of the implant  69 . A first insert (interference screw  10 ) is then inserted by a driver between the first fixation plate  19  and the second fixation plate  20  of the implant  69 . As the interference screw  10  is driven toward the posterior ends  24 ,  25  of the fixation plates  19 ,  20 , the fixation plates  19 ,  20  move away from each other thereby pressing the outer surface  76  of the first bone block  42  against an inner surface of a tunnel  66  in the femur  67  of the knee joint  64  and pressing the outer surface  77  of the second bone block  38  against the inner surface of the tunnel  66  in the femur  67  of the knee joint  64 . The first bone block  42  and the second bone block  38  heal against the tunnel  66  in the femur  67  (“bone to bone” healing). The third bone block  43  and the fourth bone block  41  attached to the fixation plates  60 ,  61  respectively are placed into the tunnel  66  in the tibia  63 . The two strands  40 ,  44  are oriented anatomically before the interference screw  47  is inserted between the fixation plates  60 ,  61  of the implant  78 . While applying an axial graft tension of 40 N through the sutures  52 ,  54 , a second insert (interference screw  47 ) is inserted by a driver between the first fixation plate  60  of the second implant  78  and the second fixation plate  61  of the second implant  78 . As the interference screw  47  is driven toward the posterior ends of the fixation plates  60 ,  61 , the fixation plates  60 ,  61  move away from each other thereby pressing the outer surfaces of the third bone block  43  and the fourth bone block  41  against the inner surface of the tunnel  65  in the tibia  63 . The third bone block  43  and the fourth bone block  41  heal against the tunnel  65  in the tibia  63  (“bone to bone” healing). 
         [0056]    Thus, the invention provides methods and devices for ligament reconstruction in a joint. More particularly, the invention provides a method and an implant to anatomically reconstruct the two bundles of the anterior cruciate ligament in a single femoral and tibial tunnel using a bone-patellar tendon-bone graft. 
         [0057]    Although the present invention has been described in detail with reference to certain embodiments, one skilled in the art will appreciate that the present invention can be practiced by other than the described embodiments, which have been presented for purposes of illustration and not of limitation. Therefore, the scope of the claims should not be limited to the embodiments described herein.