Adjustable suture-button construct for knotless stabilization of cranial cruciate deficient ligament stifle
An adjustable, knotless button/loop/needle construct for fixation of cranial cruciate ligament deficient stifle. The adjustable, knotless construct includes two fixation devices (for example, two buttons), at least one flexible, adjustable loop attached to at least one of the fixation devices (e.g., the buttons), and two needles (each needle being attached to one fixation device, e.g., the buttons). The adjustable, knotless construct has an adjustable loop length and allows adjustment in one direction while preventing or locking the construct from loosening in the opposite direction, due to applied tensile forces. The construct and technique of the present invention provides an improved knotless system for cruciate ligament repair.
1. A method of stabilizing a cranial cruciate ligament deficient stifle, comprising the steps of:
drilling a femoral hole across a distal femur by entering the femur cranial and distal to a lateral fabella and exiting on the medial distal diaphysis of the femur;
drilling a tibial hole in a tibia by entering the tibia on the lateral side just distal to the articular margin of the proximal tibia and within the extensor groove underneath the LDE tendon and exiting the tibia on a medial side;
providing a knotless repair construct comprising a first button/loop construct having a first button and a first adjustable loop connected to the first button; a second button/loop construct having a second button and a second adjustable loop connected to the second button; a first needle attached to the first button through a first suture; and a second needle attached to the second button through a second suture, wherein the first and second adjustable loops are interconnected;
passing the first needle through the femoral hole so that the first button advances through the femoral hole, and pulling the first suture until the first button exits the femoral hole and engages the femoral cortex;
passing the second needle through the tibial hole so that the second button advances the through the tibial hole, and pulling the second suture until the second button exits the tibial hole and engages the tibial cortex; and
applying tension on the knotless repair construct to adjust the length of at least one of the first and second adjustable loops, and to secure the first button against the femur and the second button against the tibia.
2. The method of claim 1 , further comprising the step of cutting and removing the first and second sutures and the first and second needles.
3. The method of claim 1 , wherein the first and second buttons have an elongate configuration.
4. A method of stabilizing a cranial cruciate ligament deficient stifle, comprising:
providing a construct comprising a first fixation device connected to a second fixation device by at least one continuous loop of flexible material attached to the first and second fixation devices, the loop of flexible material having an adjustable length and being provided with two splices that are interconnected;
inserting the construct within a femoral tunnel and a tibia tunnel by advancing a first needle attached to the first fixation device through the femoral tunnel so that the first fixation device exits the femur and pivots and engages a cortical surface of the femur, and advancing a second needle attached to the second fixation device through the tibia tunnel so that the second fixation device exits the tibia and pivots and engages a cortical surface of the tibia; and
adjusting the length of the continuous loop, to fixate the construct within the femoral and tibia tunnels.
5. The method of claim 4 , wherein the first and second fixation devices are buttons with an elongate, oblong body and two apertures, and wherein the loop is passed through all apertures of one of the first and second buttons.
6. The method of claim 4 , wherein the construct comprises a first continuous loop of flexible material attached to the first fixation device, and a second continuous loop of flexible material attached to the second fixation device, wherein the first and second continuous loops are connected to each other, and wherein at least one of the first and second continuous loops is a self-cinching knotless loop having an adjustable length and an adjustable perimeter, and being provided with two splices that are interconnected.