Method and apparatus for fixing a graft in a bone tunnel

Abstract

A method for fixing a bone block in a bone tunnel comprising the steps of placing the bone block in the bone tunnel, advancing spaced-apart first and second metal wires through the bone, transversely of the bone tunnel, so as to intersect the bone block and extend through the bone block, removing one of the wires and replacing the one removed wire with a first absorbable rod, and removing the other of the wires and replacing the other removed wire with a second absorbable rod, whereby to retain the bone block in the bone tunnel with the absorbable rods.

What is claimed is:  
     
         1 . A method for fixing a bone block in a bone tunnel in a bone, said method comprising the steps of: 
 forming a bone tunnel in the bone, said bone tunnel comprising an open end, a portion adjacent said open end having a transverse diameter sized to receive the bone block and an at least partially closed end located internally of the bone;    locating the bone block in said bone tunnel such that one end thereof is disposed substantially adjacent to the at least partially closed end of said bone tunnel;    advancing a drill means through the bone transversely of the bone tunnel such that the drill means intersects and extends through the bone tunnel and back into the bone substantially adjacent the other end of the bone block; and    removing the drill means from the bone and replacing the drill means with a rod;    whereby to retain the bone block in said bone tunnel between said at least partially closed end and said rod.    
     
     
         2 . A method according to  claim 1  wherein said rod is formed of bio-absorbable material.  
     
     
         3 . A method according to  claim 2  wherein said bio-absorbable material is selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
     
     
         4 . A method according to  claim 1  wherein said rod is formed of a material selected from the group consisting of substantially rigid metal, plastic and ceramic.  
     
     
         5 . A method according to  claim 1  wherein said drill means comprises, in combination, a trocar and a trocar sleeve, and wherein said removing and replacing step includes removing said trocar from said sleeve so as to thereby leave said sleeve extending into said bone and across said bone tunnel, inserting said rod into said sleeve such that one end of said rod engages said bone adjacent the distal end of said sleeve, and removing said sleeve from said rod and said bone so as to thereby leave said rod in said bone extending across said bone tunnel substantially adjacent said other end of said bone block.  
     
     
         6 . A method according to  claim 1  wherein said bone block has a length of tissue attached to it which extends outwardly from said open end of said bone tunnel when said bone block is located therein, and said rod does not penetrate said length of tissue when disposed across said bone tunnel.  
     
     
         7 . A method according to  claim 1  wherein said bone block has a length of tissue attached to it which extends outwardly from said open end of said bone tunnel when said bone block is located therein, and said rod extends through said length of tissue when disposed across said bone tunnel.  
     
     
         8 . A method for deploying an element in bone, said method comprising the steps of: 
 providing a trocar and trocar sleeve combination comprising a hollow sleeve having a distal end, a proximal end and a longitudinal length, wherein the interior of said sleeve defines a substantially cylindrical longitudinal passageway between said proximal end and said distal end, and a pair of opposing grooves in the sidewall of said passageway, said grooves extending respectively from said proximal end of said sleeve to opposing closed ends spaced from said distal end of said sleeve; and    a trocar including a shaft having a transverse cross-section adapted to be slidingly received in said passageway, a pointed distal end adapted for drilling into bone and a pair of opposing projections adapted to be slidingly received in said grooves when said shaft is located in said passageway such that the extension of said pointed end out of said distal end is limited according to the longitudinal distance between said pointed end and said projections in relation to the longitudinal spacing of said closed groove ends from said distal end of said shaft;    whereby when said trocar is inserted into said passageway, the resulting trocar and trocar sleeve combination may be rotated and drilled distally into bone as a unit and said trocar may be slidably, proximally removed from said sleeve;    drilling said trocar and trocar sleeve combination into the bone;    removing said trocar from said trocar sleeve;    inserting said element into said bone through said passageway of said sleeve; and    removing said sleeve from said element and said bone.    
     
     
         9 . A method according to  claim 8  further comprising the steps of: 
 providing a second trocar including a distal portion having a first transverse cross-section and a proximal portion having a second transverse cross-section, said first transverse cross-section being smaller than said second transverse cross-section, and a distally facing shoulder at the joinder of said first and second transverse cross-sections,  
 and after removing said trocar but before inserting said element, drilling said second trocar into said bone at the distal end of said sleeve a longitudinal length substantially equal to said proximal portion of said trocar, such that said shoulder abuts said bone at said distal end of said sleeve.  
 
     
     
         10 . A method according to  claim 9  wherein the longitudinal passageway through said sleeve includes internal stop means adapted to engage said trocar shoulder so as to further limit the longitudinal travel of said second trocar through said sleeve and into said bone at said distal end of said sleeve.  
     
     
         11 . A method according to  claim 9  wherein said bone defines a bone tunnel, said trocar and trocar sleeve combination penetrates into said bone transversely of said bone tunnel but not into said bone tunnel, a bone block is located in said bone tunnel in axial alignment with said trocar and trocar sleeve combination, and said second trocar penetrates through the bone between the distal end of said sleeve and said bone tunnel and into said bone block, and said element comprises a rod.  
     
     
         12 . The method of  claim 9  wherein said element is selected from the group consisting of substantially rigid rods, medications, prosthetic materials and substitute tissue.  
     
     
         13 . The method of  claim 11  wherein said rods are formed of bio-absorbable material.  
     
     
         14 . The method of  claim 13  wherein said bioabsorbable material is selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
     
     
         15 . The method of  claim 11  wherein said rod is formed of a material selected from the group consisting of substantially rigid metals, plastics, and ceramics.  
     
     
         16 . The method of  claim 11  wherein said second trocar penetrates through said bone block and back into said bone.  
     
     
         17 . The method of  claim 11  wherein said second trocar does not penetrate all the way through said bone block.  
     
     
         18 . The method of  claim 11  wherein said bone comprises a reduced fracture, said element comprises a rigid rod, and said trocar and trocar sleeve combination extends across said reduced bone fracture.  
     
     
         19 . A method for fixing a portion of a graft in a bone tunnel, said method comprising: 
 advancing a trocar and trocar sleeve combination into a bone transversely to a bone tunnel formed therein such that said trocar and trocar sleeve combination extends through the bone and across the bone tunnel;    removing said trocar from said trocar sleeve;    inserting an absorbable rod into said bone through said sleeve and removing said sleeve so as to leave said absorbable rod extending across said bone tunnel;    attaching one end of a length of cord-like material to said graft adjacent the portion thereof which is to be located in said bone tunnel;    threading the other end of said length of cord-like material into an open end of said bone tunnel, around said absorbable pin extending across said bone tunnel, and back out of said open end of said bone tunnel; and    pulling on said other end of said cord-like material so as to draw said portion of said graft into said open end of said bone tunnel, around said absorbable pin extending across said bone tunnel, and back out of said open end of said bone tunnel, whereby said portion of said graft is looped over said absorbable pin within said bone tunnel for fixation therein by securement of the portions of said piece of tissue extending out of said open end of said bone tunnel.    
     
     
         20 . The method of  claim 19  wherein said bio-absorbable rod is formed of a material selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
     
     
         21 . A method for fixing a bone block in a bone tunnel in a bone, said method comprising the steps of: 
 placing a solid bone block in the bone tunnel;    advancing at least one trocar and trocar sleeve assembly into the bone transversely of the bone tunnel such that the distal end of said at least one trocar and trocar sleeve assembly resides in said bone proximate the sidewall of said bone tunnel, the trocar in said at least one assembly being disposed within and substantially filling its associated trocar sleeve;    removing said trocar from said at least one trocar and trocar sleeve assembly and inserting a rod into said at least one sleeve;    slidably inserting one end of an elongate shaft into said sleeve so as to abut said rod;    tapping the other end of said elongate shaft so as to drive said rod out of said sleeve, through said bone and into said bone block.    
     
     
         22 . The method of  claim 21  wherein a piece of tissue is fixed in said bone tunnel instead of a bone block.  
     
     
         23 . The method of  claim 21  wherein said rod penetrates through said bone block.  
     
     
         24 . The method of  claim 21  wherein said rod does not penetrate all the way through said bone block.  
     
     
         25 . The method of  claim 21  wherein the inserted end of said rod is substantially pointed.  
     
     
         26 . The method of  claim 21  wherein said rod is formed of a bio-absorbable material.  
     
     
         27 . The method of  claim 26  wherein said bioabsorbable material is selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
     
     
         28 . The method of  claim 21  wherein said rod is formed of a material selected from the group consisting of substantially rigid metals, plastics and ceramics.  
     
     
         29 . A method of maintaining reduced fractures in bone in position for healing, said method comprising the steps of: 
 advancing at least one trocar and trocar sleeve assembly though the bone on one side of a reduced fracture, across the reduced fracture and into the bone on the other side of said reduced fracture, the trocar in each of said at least one trocar and trocar sleeve assembly substantially filling its associated sleeve;    removing said trocar from said at least one trocar and trocar sleeve assemblies;    inserting a rod through said at least one sleeve and into said bone on said other side of said reduced fracture; and    removing said at least one sleeve from said bone and said rod so as to leave said rod in said bone extending across said reduced fracture.    
     
     
         30 . A method for delivering materials into the interior of bones, said method comprising the steps of: 
 advancing at least one trocar and trocar sleeve assembly into the interior of a bone, the trocar in said at least one trocar and trocar sleeve assembly substantially filling its associated sleeve;    removing said trocar from said at least one trocar and trocar sleeve assembly;    delivering said materials to the interior of said bone through said at least one sleeve; and    removing said at least one sleeve from said bone.    
     
     
         31 . A method for fixing a bone block in a bone tunnel, said method comprising the steps of: 
 providing a rack assembly including an L-shaped member having a base portion and an arm portion extending transversely of said base portion, a cannulated sleeve at one end thereof releasably connectable to said base portion of said L-shaped member and, at the other end thereof, adapted for disposition in said bone tunnel to align said rack assembly relative to the intended fixation location of said bone block, a trocar sleeve guide member removably connectable to said arm portion of said L-shaped member such that bores extending therethrough are disposed at an angle transverse to the intended fixation location of said bone block in the bone tunnel, first and second trocar sleeves for movable disposition in said bores, respectively, at least one trocar for movable disposition in said trocar sleeves, said at least one trocar being interconnectable with the trocar sleeve in which it is disposed, each said trocar sleeve, when said at least one trocar is located therein, being movable axially toward the intended fixation location of said bone block and rotatable together with said trocar such that said interconnected trocar and trocar sleeve are adapted for drilling into the bone, said at least one trocar being respectively removable from said trocar sleeves, and rods for sliding into said trocar sleeves;    with said cannulated sleeve in its aligning position in the bone tunnel and said sleeve guide member connected to said arm, advancing said trocar and trocar sleeve assemblies into said bone but not into said bone tunnel;    removing said at least one trocar from said trocar and trocar sleeve assemblies;    removing said cannulated sleeve from said bone tunnel and said first and second sleeves from said sleeve guide;    locating a bone block in the bone tunnel in alignment with axial projections of said first and second sleeves disposed in said bone;    providing a first elongate trocar and advancing said first trocar through said first sleeves, through the bone located between the distal ends of the first sleeves and the bone tunnel, and into the bone block;    providing a second elongate trocar and advancing said second trocar though said second sleeve, through the bone between the distal end of the second sleeve and the bone tunnel, and into the bone block;    removing said second elongate trocar from said bone block, said bone and said second sleeve;    inserting a rigid rod through said second sleeve and into said bone and said bone block;    removing said first elongate trocar from said bone block, said bone and said first sleeve;    inserting another rigid rod though said first sleeve into said bone and said bone block; and    removing said first and second sleeves from said bone.    
     
     
         32 . A method according to  claim 31  wherein said cannulated sleeve includes a substantially flat portion defining a window therethrough at the end thereof adapted for disposition in said bone tunnel, said flat portion being adapted for disposition in a plane normal to said axial projections of said trocar and trocar sleeve assemblies such that said elongated trocars may be advanced through said sleeves, through the bone between the distal ends of said sleeves and said bone tunnel, and through said window in said flat portion, prior to the removal of said cannulated sleeve from said bone tunnel.  
     
     
         33 . A trocar and trocar sleeve assembly for use in forming passageways in bone, said assembly comprising: 
 a trocar comprising a shaft, a distal drilling tip and at least one projection extending radially of said shaft at a pre-selected longitudinal distance proximally of said distal tip; and    a trocar sleeve having a distal end and a proximal end defining a longitudinal bore extending between said distal end and said proximal end, and at least one longitudinal groove in the sidewall of said bore extending from said proximal end of said sleeve to a closed distal end located a pre-selected longitudinal distance proximally of said distal end of said sleeve;    said trocar being adapted to slidingly engage said bore of said sleeve with said at least one radial projection slidingly engaging said at least one longitudinal groove, and said pre-selected longitudinal distance being such that when said at least one radial projection engages said closed end of said at least one longitudinal groove, said distal drilling tip of said trocar projects distally of said distal end of said sleeve,    whereby said trocar and said trocar sleeve may be releasably interconnected with one another for integral rotational and distally directed longitudinal movement.    
     
     
         34 . The assembly according to  claim 33  wherein the distal end of the sleeve is bevelled from its inner edge to its outer edge at an angle relative to the longitudinal axis of the sleeve, said angle being substantially equal to the angle at which the distal drilling tip is disposed relative to the longitudinal axis of the trocar.  
     
     
         35 . The assembly according to  claim 33  wherein the distal end of the sleeve is disposed in a plane located at a distally pointed angle of about 15° to the longitudinal axis of the sleeve, and the distal drilling tip of the trocar, when fully engaged with the sleeve, extends distally of the distalmost portion of the distal end of the sleeve.  
     
     
         36 . The assembly according to  claim 33  further comprising a second, elongated trocar for use in substitution for said trocar after said trocar and trocar sleeve assembly has been positioned in bone, said second, elongated trocar comprising a distal portion having a first transverse cross-section, a proximal portion having a second transverse cross-section, said second transverse cross-section being larger than said first transverse cross-section, and a distally facing shoulder at the joinder of said distal portion and said proximal portion, said shoulder being adapted to engage the bone at the distal end of the sleeve as the second trocar is advanced into the bone through the sleeve so as to limit the depth of penetration of said second trocar into said bone.  
     
     
         37 . A surgical kit for locating objects or materials in bone, said kit comprising: 
 at least two trocar sleeves, at least one trocar adapted for releasable interconnection with said sleeves for integral rotational and distal longitudinal movement therewith, at least one elongated, stepped trocar adapted for slidable and rotational movement through said sleeves and into bone, a rack assembly adapted for controlling the angle at which said sleeves and trocars penetrate the bone so as to provide passageways into which said objects and/or materials may be inserted, and plunger and tapping means adapted to pass said objects and/or materials into said bone via passageways formed therein by said sleeves and trocars.    
     
     
         38 . The method of  claim 19  wherein said graft comprises tissue harvested from a human body.  
     
     
         39 . The method of  claim 19  wherein said graft comprises an artificial prosthetic device not harvested from a human body.  
     
     
         40 . A method for fixing a portion of an artificial prosthetic device in a bone tunnel in a bone covered by skin, the method comprising the steps of: 
 placing the portion of an artificial prosthetic device in the bone tunnel;    advancing a trocar and sleeve assembly through the skin and through the bone transversely of the bone tunnel so as to intersect the portion of an artificial prosthetic device and extend at least partially therethrough, the trocar of said assembly being disposed within the sleeve of said assembly;    removing the trocar from the sleeve;    advancing a rod through the sleeve and through the skin and into the portion of an artificial prosthetic device; and    removing the sleeve, so as to leave the rod in the bone and the portion of an artificial prosthetic device, whereby to retain the portion of an artificial prosthetic device in the bone tunnel.