Method and apparatus for reconstructing a ligament

Abstract

A new approach for reconstructing a ligament, the new approach comprising: creating a bone tunnel within a host bone, the bone tunnel having a proximal end and a distal end, and defining a central axis extending from the proximal end to the distal end; creating an intervening layer of bone between the central axis of the bone tunnel and a rigid portion of the host bone, the intervening layer having a first side and a second side in opposition to one another, the first side of the intervening layer facing toward the central axis of the bone tunnel and the second side of the intervening layer facing toward the rigid portion of the surrounding host bone; and compressing the intervening layer of bone against a graft ligament positioned within the bone tunnel.

1 - 8 . (canceled)  
   
   
       9 . Apparatus for reconstructing a ligament, the apparatus comprising: 
 creation means for creating an intervening layer of bone between a central axis of a bone tunnel and a rigid portion of the host bone, the intervening layer of bone having a first side and a second side in opposition to one another, the first side of the intervening layer facing toward the central axis of the bone tunnel and the second side of the intervening layer facing toward the rigid portion of the host bone; and    compression means for compressing the intervening layer of bone against a graft ligament positioned within the bone tunnel.    
   
   
       10 . The apparatus of  claim 9  wherein said creation means comprise an osteotome for dividing bone adjacent to a bone tunnel, the osteotome comprising: 
 a handle having a proximal end and a distal end, and defining a longitudinal axis extending from the proximal end to the distal end;    a blade disposed at the distal end of the handle, the blade having a first side and a second side in opposition to one another, the first side being configured for placement toward the bone tunnel; and    at least one of the handle and the blade defining a lumen therethrough, the lumen being substantially parallel to the longitudinal axis of the handle;    wherein the osteotome is configured for advancement over a guide device chosen from a group consisting of a guide pin and a guidewire, the guide device extending from the host bone adjacent to the bone tunnel, the osteotome is advanced into the host bone, and the osteotome is withdrawn from the host bone so as to create an opening through the host bone adjacent to the bone tunnel with an intervening layer of bone therebetween.    
   
   
       11 . The apparatus of  claim 9  wherein the creation means comprise an osteotome system for dividing bone adjacent to a bone tunnel, the osteotome system comprising: a guide instrument for placement of a guide device chosen from a group consisting of a guide pin and a guidewire adjacent to the bone tunnel, the guide instrument comprising: 
 a handle having a proximal end and a distal end, and defining a first longitudinal axis extending from the proximal end to the distal end;    a foot extending from the distal end of the handle, the foot having a first surface and a second surface in opposition to one another, the first surface configured for placement into the bone tunnel toward a center region thereof, and the second surface configured for placement into the bone tunnel toward a wall thereof; and    an aimer extending from a given surface of the handle, the aimer defining a bore at a given height from the second surface of the handle, and the bore configured to align the guide device through the bone adjacent to the bone tunnel toward the center region of the bone tunnel; and    an osteotome for dividing bone adjacent to the bone tunnel, the osteotome comprising:    a handle having a proximal end and a distal end, and defining a longitudinal axis extending from the proximal end to the distal end;    a blade disposed at the distal end of the handle, the blade having a first side and a second side in opposition to one another, the first side being configured for placement toward the bone tunnel; and    at least one of the handle and the blade defining a lumen therethrough, the lumen being substantially parallel to the longitudinal axis of the handle;    wherein the osteotome is configured for advancement over the guide device, the guide device extending from the bone adjacent to the host bone tunnel, the osteotome is advanced into the host bone, and the osteotome is withdrawn from the host bone so as to create an opening through the host bone adjacent to the bone tunnel with an intervening layer of bone therebetween.    
   
   
       12 . The apparatus of  claim 9  wherein the compression means comprise an interference compression device, and further wherein the interference compression device is positioned between the intervening layer of bone and the rigid portion of the host bone so as to compress the intervening layer of bone against a graft ligament positioned within the bone tunnel.  
   
   
       13 . An osteotome for dividing bone adjacent to a bone tunnel, the osteotome comprising: 
 a handle having a proximal end and a distal end, and defining a longitudinal axis extending from the proximal end to the distal end;    a blade disposed at the distal end of the handle, the blade having a first side and a second side in opposition to one another, the first side being configured for placement toward the bone tunnel; and    at least one of the handle and the blade defining a lumen therethrough, the lumen being substantially parallel to the longitudinal axis of the handle;    wherein the osteotome is configured for advancement over a guide device chosen from a group consisting of a guide pin and a guidewire, the guide    device extending from bone adjacent to the bone tunnel, the osteotome is advanced into the bone, and the osteotome is withdrawn from the bone so as to create an opening through the bone adjacent to the bone tunnel with an intervening layer of bone therebetween.    
   
   
       14 . The osteotome of  claim 13  wherein the blade comprises a given width, the bone tunnel has a given diameter, and the given width of the blade is less than the given diameter of the bone tunnel.  
   
   
       15 . The osteotome of  claim 13  wherein the blade further comprises flanges extending away from the first side thereof so as to aid in dividing bone in an intact portion from surrounding bone adjacent to the bone tunnel.  
   
   
       16 . The osteotome of  claim 13  wherein the second side of the blade comprises an actuate shape so as to provide a rounded entry point in a surface of the bone for placement of a fixation device therein.  
   
   
       17 . An osteotome system for dividing bone adjacent to a bone tunnel, the osteotome system comprising: 
 a guide instrument for placement of a guide device chosen from a group consisting of a guide pin and a guidewire adjacent to the bone tunnel, the guide instrument comprising:    a handle having a proximal end and a distal end, and defining a first longitudinal axis extending from the proximal end to the distal end;    a foot extending from the distal end of the handle, the foot having a first surface and a second surface in opposition to one another, the first surface configured for placement into the bone tunnel toward a center region thereof, and the second surface configured for placement into the bone tunnel toward a wall thereof; and    an aimer extending from a given surface of the handle, the aimer defining a bore at a given height from the second surface of the handle, and the bore configured to align the guide device through the bone adjacent to the bone tunnel toward the center region of the bone tunnel; and    an osteotome for dividing bone adjacent to the bone tunnel, the osteotome comprising:    a handle having a proximal end and a distal end, and defining a longitudinal axis extending from the proximal end to the distal end;    a blade disposed at the distal end of the handle, the blade having a first side and a second side in opposition to one another, the first side being configured for placement toward the bone tunnel; and    at least one of the handle and the blade defining a lumen therethrough, the lumen being substantially parallel to the longitudinal axis of the handle;    wherein the osteotome is configured for advancement over the guide device, the guide device extending from the bone adjacent to the bone tunnel, the osteotome is advanced into the bone, and the osteotome is withdrawn from the bone so as to create an opening adjacent to the bone tunnel with an intervening layer of bone therebetween,    
   
   
       18 . A system for reconstructing a ligament, the system comprising: 
 a guide instrument for placement of a guide device chosen from a group consisting of a guide pin and a guidewire adjacent to the bone tunnel, the guide instrument comprising:    a handle having a proximal end and a distal end, and defining a first longitudinal axis extending from the proximal end to the distal end;    a foot extending from the distal end of the handle, the foot having a first surface and a second surface in opposition to one another, the first surface configured for placement into the bone tunnel toward a center region thereof, and the second surface configured for placement into the bone tunnel toward a wall thereof; and    an aimer extending from a given surface of the handle, the aimer defining a bore at a given height from the second surface of the handle, and the bore configured to align the guide device through the bone adjacent to the bone tunnel toward the center region of the bone tunnel;    an osteotome for dividing bone adjacent to the bone tunnel, the osteotome comprising:    a handle having a proximal end and a distal end, and defining a longitudinal axis extending from the proximal end to the distal end;    a blade disposed at the distal end of the handle, the blade having a first side and a second side in opposition to one another, the first side being configured for placement toward the bone tunnel; and    at least one of the handle and the blade defining a lumen therethrough, the lumen being substantially parallel to the longitudinal axis of the handle;    wherein the osteotome is configured for advancement over the guide device, the guide device extending from the bone adjacent to the bone tunnel, the osteotome is advanced into the bone, and the osteotome is withdrawn from the bone so as to create an opening through the bone adjacent to the bone tunnel with an intervening layer of bone therebetween and    an interference compression device for compressing the intervening layer of bone against a graft ligament positioned within the bone tunnel.    
   
   
       19 . An interference screw comprising: 
 a shaft having a distal end and a proximal end; and    at least one helical thread extending between said distal end and said proximal end;    said distal end of said shaft being configured for piercing a graft ligament.    
   
   
       20 . The interference screw of  claim 19  wherein said shaft has a central lumen extending therethrough.  
   
   
       21 . The interference screw of  claim 19  wherein said proximal end of said shaft includes a recess for turning the screw.  
   
   
       22 . A construct for a ligament reconstruction, the construct comprising: 
 a host bone having a bone tunnel formed therein, the bone tunnel having a proximal end and a distal end, and the bone tunnel defining a central axis extending from the proximal end to the distal end;    a graft ligament disposed within the bone tunnel;    the host bone having an opening formed therein adjacent to the bone tunnel, the opening forming an intervening layer of bone between the central axis of the bone tunnel and a rigid portion of the host bone, the intervening layer having a first side and a second side in Opposition to one another, the first side of the intervening layer facing toward the central axis of the bone tunnel and the second side of the intervening layer facing toward the rigid portion of the host bone, and the opening configured to incompletely break away the intervening layer of bone from the rigid portion of the host bone so as to hinge inwardly toward the central axis of the bone tunnel and maintain bone-to-bone opposition between the intervening layer and the rigid portion of the host bone; and    an interference compression device positioned between the second side of the intervening layer of bone and the rigid portion of the host bone so as to compress the intervening layer of bone against the graft ligament positioned within the bone tunnel.    
   
   
       23 - 27 . (canceled)  
   
   
       28 . Apparatus according to  claim 12  wherein said interference compression device comprises an interference screw.  
   
   
       29 . Apparatus according to  claim 12  wherein said interference compression device comprises one of the group consisting of a wedge, frustoconical pin and a cylindrical pin.  
   
   
       30 . An osteotome system for dividing bone adjacent to a bone tunnel, the osteotome system comprising: 
 a handle having a proximal end and a distal end, and defining a longitudinal axis extending from the proximal end to the distal end;    a blade disposed at the distal end of the handle, the blade having a first side and a second side in opposition to one another, the first side being configured for placement toward the bone tunnel; and    a guide tip extending distally away from the blade;    wherein the osteotome is configured for advancement into the bone by advancing the guide tip into a guide hole formed in the bone adjacent to the bone tunnel, with the osteotome being advanced into the bone, and then withdrawn from the bone, so as to create an opening through the bone adjacent to the bone tunnel with an intervening layer of bone therebetween.