Acl implants, instruments, and methods

Abstract

Systems for single tunnel, double bundle anterior cruciate ligament reconstruction include implant constructs and instruments. The implant constructs provide a combination of cortical fixation and bone tunnel aperture fixation. The implant constructs separate a graft into distinct bundles. The instruments are used to prepare shaped bone tunnels to receive the implant constructs and graft bundles. The instruments are also used to exercise and insert the ligament graft constructs. Methods for reconstructing the antero-medial and postero-lateral bundles of the anterior cruciate ligament may rely on a single femoral tunnel, single or double tibial tunnels, and one or more ligament grafts.

1 - 35 . (canceled) 
     
     
         36 . A system for fixing a ligament graft to a bone, the system comprising:
 a first fixation device, wherein the first fixation device is expandable from a first configuration to a larger second configuration;   a second fixation device anchorable to the bone; and   a connector coupling the first fixation device to the second fixation device;   wherein, when the second fixation device is anchored to the bone, the connector suspends the first fixation device in a tunnel in the bone, and wherein, when the first fixation device is expanded, the ligament graft is compressed between the first fixation device and the bone tunnel.   
     
     
         37 . The system of  claim 36 , wherein the first fixation device further comprises a wedge configured to expand the first fixation device to the larger second configuration. 
     
     
         38 . The system of  claim 36 , wherein the second fixation device comprises a resilient material adapted to assume a first configuration and a second configuration, wherein when the second fixation device is in the first configuration, the second fixation device can slide lengthwise through a bone tunnel, and wherein, when the second fixation device is in the second configuration, the second fixation device cannot slide lengthwise through the bone tunnel. 
     
     
         39 . The system of  claim 38 , wherein the second fixation device comprises a coiled structure. 
     
     
         40 . The system of  claim 36 , wherein the second fixation device comprises a button having a length, width, and height, wherein the length of the button is greater than the width or height of the button, and wherein the button comprises a plurality of apertures. 
     
     
         41 . The system of  claim 40 , wherein the connector is elongate and flexible, and wherein the connector is routed through the plurality of apertures of the button to form a loop, wherein the loop is configured to receive the first fixation device connecting the first fixation device to the second fixation device. 
     
     
         42 . The system of  claim 41 , wherein the length of the loop is adjustable to lengthen or shorten the loop. 
     
     
         43 . The system of  claim 42 , wherein the connector includes at least one locking portion configured to selectively lock the connector once the desired loop length is achieved. 
     
     
         44 . The system of  claim 36 , further comprising a tether configured to flexibly connect the first fixation device to the connector. 
     
     
         45 . A system for fixing a ligament graft to a bone, the system comprising:
 a first fixation device suspendable in a tunnel in the bone;   at least one flexible elongate member; and   a second fixation device anchorable to an exterior cortical surf ace of the bone, wherein the ligament graft extends between the first fixation device and the tunnel, and wherein the at least one flexible elongate member is engaged with the ligament graft and the second fixation device to suspend the ligament graft from the second fixation device via cortical fixation.   
     
     
         46 . The system of  claim 45 , wherein the first fixation device is a screw construct, and wherein the second fixation device comprises an aperture configured to receive the screw construct therethrough. 
     
     
         47 . The system of  claim 46 , wherein the screw construct is polyaxially pivotable with respect to the second fixation device. 
     
     
         48 . The system of  claim 45 , wherein the first fixation device is an expandable body, and wherein a connector connects the expandable body with the second fixation device. 
     
     
         49 . The system of  claim 48 , wherein the connector is a threaded fastener with a wedge shape, and advancing the threaded fastener into the expandable body causes the expandable body to expand and force the ligament graft against the bone tunnel. 
     
     
         50 . The system of  claim 48 , wherein the connector is a wedge attached to an actuator, and wherein pulling the actuator in the proximal direction causes the wedge to move in the proximal direction and expand the expandable body forcing the ligament graft against the bone tunnel. 
     
     
         51 . The system of  claim 45 , wherein the second fixation device comprises at least one peripheral groove or slit configured to receive the at least one flexible elongate member to secure the at least one flexible elongate member to the second fixation device. 
     
     
         52 . The system of  claim 45 , wherein the second fixation device comprises at least one aperture configured to receive the at least one flexible elongate member to secure the at least one flexible elongate member to the second fixation device. 
     
     
         53 . The system of  claim 45 , wherein the second fixation device comprises at least one feature configured to receive the at least one flexible elongate member to secure the at least one flexible elongate member to the second fixation device. 
     
     
         54 - 71 . (canceled)