Ligament fixation device and method

Abstract

The invention relates to a device for attaching a ligament graft to the inside of a bone passage from a proximal location, the device including (1) a non-expansible ring having an interior passage through which the ligament graft may extend, the ring sized to fit within the bone passage; (2) a radially expansible gripping member sized to enter the ring and to press the ligament outwardly against the interior surface of the ring; and (3) an expander coupled to the expansible gripping member, constructed to expand the expansible gripping member to grip the ligament against the ring.

What is claimed is:  
     
         1 . A device for attaching a ligament graft to the inside of a predetermined bone tunnel from its proximal aspect, the device comprising: 
 a non-expansible ring having an interior passage through which the ligament graft may extend, the ring sized and adapted to fit within and be secured in the bone tunnel;    a radially expansible gripping member sized to enter the ring and to press the ligament outwardly against the interior surface of the ring; and    an expander coupled to the expansible gripping member, constructed to expand the expansible gripping member to grip the ligament against the ring.    
     
     
         2 . The device of    claim 1    in which the ring is sized smaller than the tunnel and including a securing device located proximally of the ring.  
     
     
         3 . The device of    claim 1    including a strut which extends proximally to a securing member attached to its proximal end, the securing member constructed and arranged to engage an exterior surface of the bone and to secure the ring in the cortical region of the bone passage.  
     
     
         4 . The device of    claim 1    wherein the ring is rigid.  
     
     
         5 . The device of    claim 1    in which the gripping member, when in position within the ring, has a distal portion extending beyond the ring that positions a corresponding portion of the ligament graft against or near the surface of the bone tunnel, in the path of in-growing bone.  
     
     
         6 . The device of    claim 1    wherein the ring includes at least one aperture disposed to permit in-growth of bone about the ligament graft.  
     
     
         7 . The device of    claim 1   , further comprising: 
 at least one strut extending distally from the ring; and    a distal member disposed at the distal end of the strut in position to limit distal movement of the gripping member.    
     
     
         8 . The device of    claim 7    in which there are at least two spaced apart struts that extend distally, in supporting relationship with said distal member.  
     
     
         9 . The device of    claim 7    in which the distal member is a base from which a rod extends proximally through the ring passage, upon which a member acts to expand the gripping member.  
     
     
         10 . The device of    claim 9    in which the rod is threaded and the gripping member is associated with a threaded expander engaged upon the threaded rod for expanding the expansible member.  
     
     
         11 . The device of    claim 10    in which the threaded expander is of wedge form, arranged to radially wedge apart portions of the expansible gripping member.  
     
     
         12 . The device of    claim 9   , wherein a strut extends proximally from the ring to a securing member attached to its proximal end, the securing member constructed and arranged to engage an exterior surface of the bone and to secure the ring in the cortical region of the bone passage.  
     
     
         13 . The device of    claim 1    in which the expansible gripping member comprises a set of circumferentially arranged proximally extending leg portions constructed and arranged to be splayed apart by wedging action of a centrally introduced member.  
     
     
         14 . The device of    claim 13    in which the exterior surface of the leg portions have ligament gripping projections.  
     
     
         15 . The device of    claim 14    in which the gripping projections comprise portions of at least one circumferential ledge, barb or tooth.  
     
     
         16 . The device of    claim 14    in which the gripping projections comprise screw threads.  
     
     
         17 . The device of    claim 14    in which the ring supports a threaded rod that extends through the gripping member, in combination with a threaded expander wedge constructed and arranged to be threaded on the threaded rod into the expansible gripping member in a wedging relationship.  
     
     
         18 . The device of    claim 14    in which the expansible gripping member supports a threaded rod extending proximally from the gripping member in combination with a threaded expander wedge constructed and arranged to be threaded on the threaded rod into the expansible gripping member in a wedging relationship.  
     
     
         19 . The device of    claim 14    in which the expansible gripping member has a distally extending formation arranged to deflect to lock the gripping member in position relative to the ring.  
     
     
         20 . The device of    claim 14    in which the expansible gripping member has screw threads on its exterior that are disposed to engage and thread into ligament graft lying between the ring and the gripping member during advance of the gripping member.  
     
     
         21 . The device of    claim 1    in which the expansible member supports a threaded rod extending proximally from the gripping member in combination with a threaded wedge element constructed and arranged to be threaded on the threaded rod into the expansible gripping member in a wedging relationship.  
     
     
         22 . A device for attaching a ligament graft to the inside of a bone tunnel from a proximal aspect, the device comprising: 
 a non-expansible ledge structure providing an interior passage through which the ligament graft may extend, the structure sized and adapted to fit within and be secured in the bone tunnel;    a gripping member sized to be opposed to the ledge structure and to grip the ligament against a portion of the ledge structure; and    at least one strut extending distally from the portion of the ledge structure against which the ligament is gripped,    a distal member disposed at the distal end of the strut in position to limit distal movement of the gripping member.    
     
     
         23 . The device of    claim 22    in which the gripping member is expansible radially to grip the ligament against the ledge structure and position the ligament for incorporation by in-growth of bone from the wall of the tunnel.  
     
     
         24 . The device of    claim 22    in which the ledge structure is carried on a continuous ring.  
     
     
         25 . A device for attaching a ligament graft to the inside of a bone tunnel from an extra-articular location, the device comprising: 
 a rigid ring having an interior passage through which the ligament graft may extend, the ring sized to fit within the bone tunnel;    a gripping member constructed and arranged to grip a ligament graft against the interior surface of the rigid ring; and    at least one strut extending proximally from the ring,    a securing member attached to the proximal end of the strut, the securing member sized to engage an exterior surface of the bone to secure the ring in the cortical region of the bone tunnel.    
     
     
         26 . The device of    claim 25    in which the peripheral outer surface of the ring is cylindrical.  
     
     
         27 . The device of    claim 25    in which a bone-penetrating formation is carried by the securing member.  
     
     
         28 . The device of    claim 25    in which the securing member is a flange.  
     
     
         29 . The device of    claim 28    in which the flange has bone-penetrating formations.  
     
     
         30 . The device of    claim 25    in which the securing member is a flange having a hole sized to receive an awl-like tool to hold the member in position against rotation while a portion of the device is turned during the procedure.  
     
     
         31 . The device of    claim 25    in which the gripping member is expansible to grip the ligament against the ring; and 
 an expander is coupled to the expandable gripping member, constructed to expand the gripping member to grip the ligament against the ring.  
 
     
     
         32 . The device of    claim 31    in which the gripping member, when in position within the ring, has a distal portion extending beyond the ring that positions a corresponding portion of the ligament near or against the surface of the bone passage in the path of in-growing bone.  
     
     
         33 . A device for attaching a ligament graft to the inside of a bone tunnel from a proximal aspect, the device comprising: 
 a non-expansible ring having an interior passage through which the ligament graft may extend, the ring sized and adapted to fit within and be secured in the bone passage;    strut portions extending proximally and distally from the ring;    a securing member attached to the end of the proximally-extending strut portion, the securing member sized to engage an exterior surface of the bone to secure the ring in the cortical region of the bone tunnel;    a base member attached to the distal end of the distally extending strut portion;    a threaded rod extending proximally from the base member through the ring;    and a gripping member disposed between the rod and the ring, the gripping member constructed to grip the ligament against the ring.    
     
     
         34 . The device of    claim 25    in which the gripping member is expansible to grip the ligament against the ring.  
     
     
         35 . A method of attaching a ligament graft to the inside of a bone tunnel from a proximal location, the method comprising: 
 providing a device comprising providing a structure comprising a non-expansible ring, a rigid rings, or a ledge structure that provides an interior passage through which the ligament graft may extend, the structure sized to fit within the bone tunnel; 
 a gripping member sized to press the ligament outwardly against the interior surface of the structure; and  
 providing a cylindrical bone tunnel within a bone;  
   inserting the non-expansible ring into the bone tunnel;    passing the ligament graft through the interior passage of the ring;    inserting the gripping member through the interior passage of the ring;    expanding or otherwise urging the gripping member into a position that the gripping member grips the ligament against the structure, thereby securing the ligament graft to the inside of the bone tunnel.    
     
     
         36 . The method of    claim 35   , wherein an expander is screwed into a gripping member to expand it to grip the ligament graft.  
     
     
         37 . The method of    claim 35   , wherein a radially expansible gripping member is screwed into the interior passage of the ring.  
     
     
         38 . The method of    claim 35    employed in cruciate ligament grafts in which the graft is secured to the femur.  
     
     
         39 . The method of    claim 38    in which multiple strands of graft extend through the tunnel and are affixed in spaced apart positions.