Abstract:
A fixation device includes a member, a woven material attached to the member, and suture extending through the woven material and including free regions for securing the woven material to a tissue graft. A method of securing a tissue graft includes providing a fixation member having a woven material attached thereto and suture extending through the woven material; determining a desired distance between the fixation member and a tissue graft; and attaching the woven material to the tissue graft using the suture at a position to obtain the desired distance.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    The present application claims priority from U.S. Provisional Application Ser. No. 61/614,878, filed Mar. 23, 2012, titled “TISSUE GRAFT ANCHORING,” the contents of which are incorporated herein by reference in their entirety. 
     
    
     TECHNICAL FIELD 
       [0002]    This document relates to tissue graft anchoring. 
       BACKGROUND 
       [0003]    An anterior cruciate ligament (ACL) that has ruptured and is non-repairable is generally replaced arthroscopically by a tissue graft. The tissue graft can be harvested from a portion of a tendon/bone reconstruction tissue, i.e., Achilles tendon; patellar; or quadriceps tendon having so called “bone blocks” on at least one end, and from the semitendinosus and gracilis. These can be harvested as autographs or allographs. Alternatively, the tissue graft can be formed from synthetic materials or from a combination of synthetic and natural materials. 
         [0004]    The replacement tissue graft is implanted by securing one end of the tissue graft in a socket formed in a passage within the femur, and passing the other end of the graft through a passage formed in the tibia. Generally, sutures are used to affix each end of the tissue graft to a fastener (e.g., an interference screw or a post), which is then secured to the bone. 
         [0005]    It is also known to use a graft fixation member, e.g., a fixation button, to secure the tissue graft at the femoral cortex, as described in U.S. Pat. No. 5,306,301 (“the &#39;301 patent”) hereby incorporated by reference in its entirety. When using a fixation button, the femoral passage generally includes a relatively larger diameter portion for receiving the graft, and a smaller diameter, passing channel near the femoral cortex for receiving a length of suture that runs from the tissue graft to the fixation button. By measuring the total length of the femoral passage and the length of the larger diameter portion of the femoral passage, the surgeon determines the appropriate length of suture material for attaching the fixation button to the tissue graft. 
       SUMMARY 
       [0006]    According to one aspect, a fixation device includes a member, a woven material attached to the member, and suture extending through the woven material and including free regions for securing the woven material to a tissue graft. 
         [0007]    According to another aspect, a method of securing a tissue graft includes providing a fixation member having a woven material attached thereto and suture extending through the woven material, determining a desired distance between the fixation member and a graft ligament, and attaching the woven material to the tissue graft using the suture at a position to obtain the desired distance. 
         [0008]    Implementations of either of these aspects may include one or more of the following features. For example, the member may define at least one opening. The member may be elongated in a first dimension defining a length that extends between first and second ends of the member, and the member may have a second dimension transverse to the first dimension that is smaller than the length. 
         [0009]    The woven material may include a Chinese finger trap. The woven material may be attached to the member by direct fixation of the woven material through the openings or may be attached to the member by fibers that are fed through the openings and woven through the woven material. Needles may be attached to the suture. Attaching the woven material to the tissue graft using the suture may include attaching the woven material using the needles attached to the suture 
         [0010]    The woven material may be in the form of a “V” shape and configured to be sutured to the tissue graft. 
         [0011]    The woven material may be in the form of two lengths of material that are attached at one end to the member and may be configured to be sewn together around the tissue graft. Attaching the woven material to the tissue graft may include sewing the two lengths of material together around the tissue graft. 
         [0012]    A tubular element defining a slot may be attached to the member and the woven material may form an open mesh around the tubular element. Attaching the woven material to the tissue graft using the suture may include attaching the woven material and tubular element to the tissue graft using needles attached to the suture. 
         [0013]    The woven material may be about 30 mm long and 10 mm in diameter. 
         [0014]    The details of one or more implementations are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the disclosure will be apparent from the description and drawings, and from the claims. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0015]      FIG. 1  illustrates a tissue graft secured within the knee by a graft fixation member. 
           [0016]      FIG. 2  is another view of the knee joint of  FIG. 1 . 
           [0017]      FIG. 3  is a perspective view of a fixation device. 
           [0018]      FIGS. 4A-4C  are side, end and perspective views of a fixation device. 
           [0019]      FIGS. 5A and 5B  are side and perspective views of an additional embodiment of a fixation device. 
           [0020]      FIG. 6  is a perspective view of an additional embodiment of a fixation device. 
       
    
    
     DETAILED DESCRIPTION 
       [0021]    Referring to  FIG. 1 , a knee joint has a tissue graft  10  (for example, a semitendinosus and gracilis graft) implanted in an anterior cruciate ligament (ACL) repair and reconstruction procedure. Prior to implanting tissue graft  10 , a femoral channel  14  for receiving one end of tissue graft  10  is then drilled from notch  12  a predetermined distance within the femur with a passing channel  16  of reduced diameter drilled further through the femur from femoral channel  14  to a region of femoral cortex  18 . A tibial channel  20  for receiving the other end of tissue graft  10  is drilled from an anterior region of the tibia to a region near the opening of femoral channel  14 . 
         [0022]    The tissue graft  10  is secured at femoral cortex region  18  with a graft fixation member  26  of a fixation device  27 . The tissue graft  10  is connected to the graft fixation member  26  by a woven construct  24 , discussed below. The other end of tissue graft  10  includes a length of suture  28  which is attached to the tibia, for example, with a fixation screw  30 . A washer  32  either attached to or positioned under the head of fixation screw  30  helps in holding the suture in place when screw  30  is tightened. 
         [0023]    The graft fixation member  26  is positioned using pull threads (not shown) attached to the member. The pull threads are passed through the channels  14  and  16  from the notch  12  to the cortex  18  and used to pull the graft fixation member  26  through the channels  14  and  16  with a long axis of the graft fixation member aligned with the channels. After exiting the channel  16 , the pull threads are used to flip the graft fixation member  26  so that the member  26  lies flat against the cortex. 
         [0024]    Referring to  FIG. 2 , length (L) of femoral channel  14  is selected by the surgeon in accordance with the desired insertion distance of tissue graft  10  within the femur. The additional span of construct  24 , designated as SS, is approximately that of passing channel  16  so that the sum of the desired insertion length (L) and span of the construct (SS) is the measured total length (TL) from the opening of femoral channel  14  to the opening at femoral cortex  18 . Each of these dimensions is measured prior to implanting the tissue graft so that during the implantation procedure, the surgeon, under arthroscopic observation, can be assured that tissue graft  10  has been properly positioned within femoral channel  14 . 
         [0025]    Referring to  FIG. 3 , the graft fixation member  26  is elongated in a first dimension defining a length, L, that extends between a first end  42  and a second end  44  of the member  26 , a second dimension transverse to the first dimension that has a width, W, smaller than the length, L, and a third dimension transverse to the first and second dimensions that has a height, H, small than the length, L. The graft fixation member has a bone contacting side  46  and an opposite side  48 . Extending between the sides  46 ,  48  are four holes  50 ,  52 ,  54  and  56 . The holes  50  and  56  receive the passing sutures, not shown. 
         [0026]    The length, width and height of the fixation member  26 , is for example, 12 mm×4 mm×1.5 mm. 
         [0027]    Referring to  FIGS. 4A-4C , a fixation device  100  includes a woven or braided construct  24 , for example, a Chinese Finger Trap  90  to hold the tissue graft in place at a predetermined distance from the graft fixation member  26 . The predetermined distance ranges from 0 mm up to the length of the finger trap, for example, about 30 mm. The distance between the graft fixation member  26  and the tissue graft is determined by the surgeon prior to placing the graft, and set by loading the Chinese Finger Trap  90  onto the tissue graft to create the desired distance. 
         [0028]    The finger trap is attached to the graft fixation member  26  by either direct fixation of the finger trap through the button through holes or by additional fibers  92  which are fed through the button through holes and then woven through the length of the finger trap. As shown in  FIG. 4A , the fibers  92  can extend out of the base of the Chinese Finger Trap  90  with needles  94  attached so that the fibers can be stitched back through the Chinese Finger Trap  90  and the tissue graft once the tissue graft is positioned in the Chinese Finger Trap  90  prior to implanting the construct. The Chinese Finger Trap  90  is, for example, about 30 mm long and 10 mm in diameter. The fibers  92  can be woven or braided suture, for example, #5 Ultrabraid™ suture 
         [0029]    Rather than a Chinese Finger Trap  90 , a stiff woven material can be made into a hot dog bun or extruded “V” shape and sutured to the tissue graft at the desired location. The stiff woven material can also be in the form of two lengths of material that attached at one end to the fixation device and sewn together around the tendon. Referring to  FIGS. 5A and 5B , a fixation device  110  includes a tubular element  112  defining a slot  114 . The tubular element  112  is formed of a stiff woven material, for example, polyethylene fiber. In use the tissue graft is placed within the tubular element  112  and the tubular element  112  is sutured to the tissue graft at a desired location. The tubular element  112  is surrounded by an open mesh  116  (not shown in  FIG. 5B ), and a suture  118  having needles (not shown) at its ends is weaved through the open mesh  116  and secured to the graft fixation member  26 . The needled suture  118  is used by the operating room personnel to suture the tubular element  112  to the tissue graft. In  FIG. 6 , the tubular element  112  has been replaced by two, tubular sections  120   a,    120   b  that receive a tissue graft therebetween. 
         [0030]    Other implementations are within the scope of the following claims.