Method and apparatus for fixing a graft in a bone tunnel

Abstract

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

1 . A method for fixing a portion of a piece of tissue in a bone tunnel in a bone, the method comprising the steps of: 
 placing the portion of a piece of tissue in the bone tunnel; advancing spaced-apart, first and second drill means through the bone transversely of the bone tunnel so as to intersect and extend into the tissue;    removing one of the drill means and replacing the one removed drill means with a first rod; and    removing the other of the drill means and replacing the other removed drill means with a second rod;    whereby to retain the portion of a piece of tissue in the bone tunnel with said rods.    
   
   
       2 . A method according to  claim 1  wherein said drill means are advanced completely through the said portion of said piece of tissue.  
   
   
       3 . A method according to  claim 1  wherein said drill means are advanced partially through the said portion of said piece of tissue.  
   
   
       4 . A method according to  claim 1  wherein said portion of said piece of tissue is reinforced so as to resist tearing away from said drill means and said rods.  
   
   
       5 . A method according to  claim 4  wherein said portion of said piece of tissue is whip stitched with a cord-like element to provide said reinforcement.  
   
   
       6 . A method according to  claim 1  wherein said rods are formed of a substantially rigid, bio-absorbable material.  
   
   
       7 . A method according to  claim 6  wherein said material is selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
   
   
       8 . The method according to  claim 1  wherein said rods are formed of a material selected from the group consisting of substantially rigid metals, plastics and ceramics.  
   
   
       9 . The method according to  claim 1  wherein said drill means defines a tip adapted to drill through said bone by rotation about its longitudinal axis and to pierce said portion of a piece of tissue by distal movement along a projection of its longitudinal axis.  
   
   
       10 . A method according to  claim 9  wherein said drill means are selected from the group consisting of spade drills, distally pointed wires, trocars, and substantially longitudinally flighted, distally pointed drills.  
   
   
       11 . A method for fixing a portion of a piece of tissue in a bone tunnel in a bone, the method comprising the steps of: 
 placing the portion of a piece of tissue in the bone tunnel;    advancing a first drill means through a first portion of the bone and transversely of the tunnel so as to intersect and extend into said portion of a piece of tissue;    advancing a second drill means through a second portion of the bone and transversely of the tunnel so as to intersect and extend into said portion of a piece of tissue, said second drill means being spaced from said first drill means;    removing one of said first and second drill means while leaving the other of said first and second drill means in place in the bone and the portion of a piece of tissue;    advancing a first rod through a bore left by removal of the one drill means, such that the first rod extends through the bone and into said portion of a piece of tissue;    removing the other of the first and second drill means; and    advancing a second rod through a bore left by removal of the other drill means, such that the second rod extends through the bone and into said portion of a piece of tissue;    whereby to retain said portion of a piece of tissue in the bone tunnel with said rods.    
   
   
       12 . A method according to  claim 11  wherein said drill means are advanced completely through the said portion of said piece of tissue.  
   
   
       13 . A method according to  claim 11  wherein said drill means are advanced partially through the said portion of said piece of tissue.  
   
   
       14 . A method according to  claim 11  wherein said portion of said piece of tissue is reinforced so as to resist tearing away from said drill means and said rods.  
   
   
       15 . A method according to  claim 14  wherein said portion of said piece of tissue is whip stitched with a cord-like element to provide said reinforcement.  
   
   
       16 . A method according to  claim 11  wherein said rods are formed of a substantially rigid, bio-absorbable material.  
   
   
       17 . A method according to  claim 16  wherein said material is selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
   
   
       18 . The method according to  claim 11  wherein said rods are formed of a material selected from the group consisting of substantially rigid metals, plastics and ceramics.  
   
   
       19 . The method according to  claim 11  wherein said drill means defines a tip adapted to drill through said bone by rotation about its longitudinal axis and to pierce said portion of a piece of tissue by distal movement along a projection of its longitudinal axis.  
   
   
       20 . A method according to  claim 19  wherein said drill means are selected from the group consisting of spade drills, distally pointed wires, trocars, and substantially longitudinally flighted, distally pointed drills.  
   
   
       21 . A method for fixing a portion of a piece of tissue in a bone tunnel in a bone, the method comprising the steps of: 
 (a) placing the portion of a piece of tissue in the bone tunnel;    (b) advancing a plurality of drill means through the bone transversely of the tunnel so as to intercept and extend into said portion of a piece of tissue;    (c) removing at least one of the drill means while leaving at least one of the drill means in place, and replacing the removed at least one drill means with at least one rod;    (d) removing at least one further of the drill means and replacing the at least one further of the drill means with at least one further rod; and    (e) repeating step (d), if and as desired, until a selected number of the drill means each is replaced by a rod,    whereby to retain said portion a piece of tissue in the bone tunnel with said rods.    
   
   
       22 . A method according to  claim 21  wherein said drill means are advanced completely through the said portion of said piece of tissue.  
   
   
       23 . A method according to  claim 21  wherein said drill means are advanced partially through the said portion of said piece of tissue.  
   
   
       24 . A method according to  claim 21  wherein said portion of said piece of tissue is reinforced so as to resist tearing away from said drill means and said rods.  
   
   
       25 . A method according to  claim 24  wherein said portion of said piece of tissue is whip stitched with a cord-like element to provide said reinforcement.  
   
   
       26 . A method according to  claim 21  wherein said rods are formed of a substantially rigid, bio-absorbable material.  
   
   
       27 . A method according to  claim 26  wherein said material is selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
   
   
       28 . The method according to  claim 21  wherein said rods are formed of a material selected from the groups consisting of substantially rigid metals, plastics and ceramics.  
   
   
       29 . The method according to  claim 21  wherein said drill means defines a tip adapted to drill through said bone by rotation about its longitudinal axis and to pierce said portion of a piece of tissue by distal movement along a projection of its longitudinal axis.  
   
   
       30 . A method according to  claim 29  wherein said drill means are selected from the group consisting of spade drills, distally pointed wires, trocars, and substantially longitudinally flighted, distally pointed drills.  
   
   
       31 . A method for fixing a portion of a piece of tissue tunnel in a bone, the method comprising the steps of: 
 placing a portion of a piece of tissue in the bone tunnel;    advancing spaced-apart, first and second trocar and sleeve assemblies through the bone transversely of the bone tunnel so as to intersect and extend into said portion of a piece of tissue, the trocar in each of said assemblies being disposed within one of said sleeves of said assemblies and substantially filling said sleeve;    removing said trocar from said first of said sleeves, advancing a first rod through said first sleeve and into said portion of a piece of tissue, and then removing said first sleeve, so as to leave said first rod in said bone and said portion of a piece of tissue; and    removing said trocar from said second of said sleeves, advancing a second rod through said second sleeve and into said portion of a piece of tissue, and then removing said second sleeve, so as to leave said second rod in said bone and said portion of a piece of tissue,    whereby to retain the portion of a piece of tissue in the tunnel with said rods.    
   
   
       32 . A method according to  claim 31  wherein said drill means are advanced completely through the said portion of said piece of tissue.  
   
   
       33 . A method according to  claim 31  wherein said drill means are advanced partially through the said portion of said piece of tissue.  
   
   
       34 . A method according to  claim 31  wherein said portion of said piece of tissue is reinforced so as to resist tearing away from said drill means and said rods.  
   
   
       35 . A method according to  claim 34  wherein said portion of said piece of tissue is whip stitched with a cord-like element to provide said reinforcement.  
   
   
       36 . A method according to  claim 31  wherein said rods are formed of a substantially rigid, bio-absorbable material.  
   
   
       37 . A method according to  claim 36  wherein said material is selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
   
   
       38 . The method according to  claim 31  wherein said rods are formed of a material selected from the group consisting of substantially rigid metals, plastics and ceramics.  
   
   
       39 . The method according to  claim 31  wherein said drill means defines a tip adapted to drill through said bone by rotation about its longitudinal axis and to pierce said portion of a piece of tissue by distal movement along a projection of its longitudinal axis.  
   
   
       40 . A method according to  claim 39  wherein said drill means are selected from the group consisting of spade drills, distally pointed wires, trocars, and substantially longitudinally flighted, distally pointed drills.  
   
   
       41 . A method according to  claim 10  wherein said trocar comprises only one trocar, and said trocar removed from said first of said sleeves is thereafter placed in said second of said sleeves.  
   
   
       42 . A method according to  claim 10  wherein said first trocar and sleeve assembly comprises a first trocar and said first of said sleeves, and said second trocar and sleeve assembly comprises a second trocar and said second of said sleeves.  
   
   
       43 . A method for fixing a portion of a piece of tissue in a bone tunnel in a bone, the method comprising the steps of: 
 placing a portion of a piece of tissue in the bone tunnel;    advancing spaced-apart, first and second trocar and sleeve assemblies thorough the bone transversely of the bone tunnel so as to intersect and extend into said portion of a piece of tissue, the trocar in each of said assemblies being disposed within one of said sleeves of said assemblies and substantially filling said sleeve;    removing said trocar from said sleeves;    advancing rods through said sleeves and into said portion of a piece of tissue; and    removing said sleeves from said-portion of a piece of tissue and said bone and said rods so as to leave said rods in said portion of a piece of tissue and said bone,    whereby to retain the portion of a piece of tissue in the tunnel with said rods.    
   
   
       44 . A method according to  claim 43  wherein said drill means are advanced completely through the said portion of said piece of tissue.  
   
   
       45 . A method according to  claim 43  wherein said drill means are advanced partially through the said portion of said piece of tissue.  
   
   
       46 . A method according to  claim 43  wherein said portion of said piece of tissue is reinforced so as to resist tearing away from said drill means and said rods.  
   
   
       47 . A method according to  claim 46  wherein said portion of said piece of tissue is whip stitched with a cord-like element to provide said reinforcement.  
   
   
       48 . A method according to  claim 43  wherein said rods are formed of a substantially rigid, bio-absorbable material.  
   
   
       49 . A method according to  claim 48  wherein said material is selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
   
   
       50 . The method according to  claim 43  wherein said substantially rigid rods are formed of a material selected from the group consisting of substantially rigid metals, plastics and ceramics.  
   
   
       51 . The method according to  claim 43  wherein said drill means defines a tip adapted to drill through said bone by rotation about its longitudinal axis and to pierce said portion of a piece of tissue by distal movement along a projection of its longitudinal axis.  
   
   
       52 . A method according to  claim 51  wherein said drill means are selected from the group consisting of spade drills, distally pointed wires, trocars, and substantially longitudinally flighted, distally pointed drills.  
   
   
       53 . A method for fixing a portion of a piece of tissue in a bone tunnel in a bone covered by skin, the method comprising the steps of: 
 placing the portion of a piece of tissue 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 a piece of tissue 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 a piece of tissue; and    removing the sleeve, so as to leave the rod in the bone and the portion of the piece of tissue, whereby to retain the portion of the piece of tissue in the bone tunnel.    
   
   
       54 . A method according to  claim 53  wherein said drill means are advanced completely through the said portion of said piece of tissue.  
   
   
       55 . A method according to  claim 53  wherein said drill means are advanced partially through the said portion of said piece of tissue.  
   
   
       56 . A method according to  claim 53  wherein said portion of said piece of tissue is reinforced so as to resist tearing away from said drill means and said rods.  
   
   
       57 . A method according to  claim 56  wherein said portion of said piece of tissue is whip stitched with a cord-like element to provide said reinforcement.  
   
   
       58 . A method according to  claim 53  wherein said rods are formed of a substantially rigid, bio-absorbable material.  
   
   
       59 . A method according to  claim 58  wherein said material is selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
   
   
       60 . The method according to  claim 53  wherein said rods are formed of a material selected from the group consisting of substantially rigid metals, plastics and ceramics.  
   
   
       61 . The method according to  claim 53  wherein said drill means defines a tip adapted to drill through said bone by rotation about its longitudinal axis and to pierce said portion of a piece of tissue by distal movement along a projection of its longitudinal axis.  
   
   
       62 . A method according to  claim 61  wherein said drill means are selected from the group consisting of spade drills, distally pointed wires, trocars, and substantially longitudinally flighted, distally pointed drills.  
   
   
       63 . A method for fixing a portion of a piece of tissue in a bone tunnel in a bone, the method comprising the steps of: 
 placing the portion of a piece of tissue in the bone tunnel;    advancing spaced-apart, first and second trocar and sleeve assemblies through skin covering the bone and through the bone transversely of the bone tunnel so as to intersect and extend into the portion of a piece of tissue, the trocar in each of said assemblies being disposed within one of said sleeves of said assemblies and substantially filling said sleeve;    removing said trocar from said first of said sleeves, advancing a first rod through said first sleeve and into said portion of a piece of tissue, and then removing said first sleeve, so as to leave said first rod in said bone and said portion of a piece of tissue; and    removing said trocar from said second of said sleeves, advancing a second rod through said second sleeve into said portion of a piece of tissue, and then removing said second sleeve, so as to leave said second rod in said bone and said portion of a piece of tissue,    whereby to retain the portion of a piece of tissue in the bone tunnel with said rods.    
   
   
       64 . A method according to  claim 63  wherein said drill means are advanced completely through the said portion of said piece of tissue.  
   
   
       65 . A method according to  claim 63  wherein said drill means are advanced partially through the said portion of said piece of tissue.  
   
   
       66 . A method according to  claim 63  wherein said portion of said piece of tissue is reinforced so as to resist tearing away from said drill means and said rods.  
   
   
       67 . A method according to  claim 66  wherein said portion of said piece of tissue is whip stitched with a cord-like element to provide said reinforcement.  
   
   
       68 . A method according to  claim 63  wherein said rods are formed of a substantially rigid, bio-absorbable material.  
   
   
       69 . A method according to  claim 68  wherein said material is selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
   
   
       70 . The method according to  claim 63  wherein said rods are formed of a material selected from the group consisting of substantially rigid metals, plastics and ceramics.  
   
   
       71 . The method according to  claim 63  wherein said drill means defines a tip adapted to drill through said bone by rotation about its longitudinal axis and to pierce said portion of a piece of tissue by distal movement along a projection of its longitudinal axis.  
   
   
       72 . A method according to  claim 71  wherein said drill means are selected from the group consisting of spade drills, distally pointed wires, trocars, and substantially longitudinally flighted, distally pointed drills.  
   
   
       73 . A method for fixing a portion of a piece of tissue in a bone tunnel in a bone, said method comprising the steps of: 
 advancing first and second spaced-apart drill means through the bone transversely of the bone tunnel so as to intersect and permissibly extend through the bone tunnel;    withdrawing said first and second spaced-apart drill means from said bone tunnel;    locating a portion of a piece of tissue in said bone tunnel in transverse alignment with the paths of said first and second spaced-apart drill means through said bone;    advancing third and fourth spaced-apart drill means into, and permissibly through, said portion of a piece of tissue;    removing the third of the drill means and replacing the third removed drill means with a first rod; and    removing the fourth of said drill means and replacing the fourth of said drill means with a second rod;    whereby to retain the portion of a piece of tissue in the bone tunnel with the rods.    
   
   
       74 . The method according to  claim 73  wherein said first drill means is the same as said third drill means, and said second drill means is the same as said fourth drill means.  
   
   
       75 . The method according to  claim 73  wherein said first, second, third and fourth drill means are selected from the group consisting of distally pointed metal wires, trocars, spade drills, substantially longitudinally flighted distally pointed drills, and trocar/sleeve combinations wherein the trocar substantially fills and releasably interlocks with the sleeve in a position in which the pointed distal end of the trocar extends distally of the distal end of the sleeve.  
   
   
       76 . The method according to  claim 73  wherein each of said drill means comprises a trocar/sleeve combination and wherein said removing and replacing steps comprise removing the trocar from its associated sleeve, replacing the trocar with a rod, and removing the sleeve from the bone and the rod.  
   
   
       77 . A method according to  claim 73  wherein said drill means are advanced completely through the said portion of said piece of tissue.  
   
   
       78 . A method according to  claim 73  wherein said drill means are advanced partially through the said portion of said piece of tissue.  
   
   
       79 . A method according to  claim 73  wherein said portion of said piece of tissue is reinforced so as to resist tearing away from said drill means and said rods.  
   
   
       80 . A method according to  claim 79  wherein said portion of said piece of tissue is whip stitched with a cord-like element to provide said reinforcement.  
   
   
       81 . A method according to  claim 73  wherein said rods are formed of a substantially rigid, bio-absorbable material.  
   
   
       82 . A method according to  claim 81  wherein said material is selected from the group consisting of polylactic acid, polyglycolic acid and polydiaxanone.  
   
   
       83 . The method according to  claim 73  wherein said rods are formed of a material selected from the group consisting of substantially rigid metals, plastics and ceramics.  
   
   
       84 . The method according to  claim 73  wherein said drill means defines a tip adapted to drill through said bone by rotation about its longitudinal axis and to pierce said portion of a piece of tissue by distal movement along a projection of its longitudinal axis.  
   
   
       85 . A rack assembly for cross-pinning a portion of a piece of tissue in a bone tunnel extending through a first bone on one side of a skeletal joint and into a second bone on the other side of said skeletal joint, said rack assembly comprising: 
 an L-shaped member having a base portion and an arm portion extending transversely of said base portion;    a cannulated sleeve for movement through the bone tunnel in said first bone and into the bone tunnel in said second bone, said cannulated sleeve having a head portion at a free end thereof for disposition in the bone tunnel in said second bone and being connectable to the base portion of the L-shaped member at an opposite end, said head defining a window therethrough oriented substantially parallel to the base portion of the L-shaped member when said cannulated sleeve is connected to said base portion of thereof;    a trocar sleeve guide member removably connectable to said arm portion of the L-shaped member and having bores extending therethrough at an angle normal to a projection of the longitudinal axis of said cannulated sleeve;    first and second trocar sleeves for movable disposition in the bores, respectively;    at least one trocar for disposition in said trocar sleeves, the trocar being interconnectable with said trocar sleeve in which the trocar is disposed, said trocar sleeve and said trocar therein being movable axially toward said head portion of said cannulated sleeve and rotatable together such that said interconnected trocar and trocar sleeve are adapted for drilling into the second bone and at least said trocar is adapted to penetrate through the window in said head of said cannulated sleeve and a portion of a piece of tissue subsequently substituted therefore;    said trocar being removable from said trocar sleeves; and    said trocar sleeves being adapted to receive rods slidable through the trocar sleeves and through the portion of a piece of tissue, said trocar sleeves being removable from the second bone and from the rods so as to leave the rods in the portion of a piece of tissue and the second bone.    
   
   
       86 . A rack assembly according to  claim 85  wherein said trocar sleeve guide member includes separable first and second parts.  
   
   
       87 . A rack assembly according to  claim 85  and further comprising said rods.  
   
   
       88 . A rack assembly according to  claim 85  wherein said rods are formed of a bio-absorbable material.  
   
   
       89 . A rack assembly according to  claim 85  wherein said trocar guide member bores are aligned with said window in said head, the axes of said bores being spaced from, and substantially parallel to, the plane containing said L-shaped member.