Fan folded fascia lata for cruciate ligament substitution and method and apparatus for making the same
View Patent ↗Cruciate ligament substitutes are formed using fan-folded iliotibial band grafts of fascia lata. Devices of making the same and methods of making and using the same are described herein. The thick fan-folded grafts of fascia lata cruciate ligament substitutes disclosed herein are used in a single-loop fashion and have surprisingly exhibited load to failure and stiffness values that compare favorably with conventional grafts, including tibialis anterior, tibialis posterior, peroneus longus, and bone-patellar tendon-bone (BPTB) half-patella specimens, when the harvested iliotibial band grafts of fascia lata avoid portions thicker than 5 mm, or even 3 mm.
1. A method of fan-folding a fascia lata, comprising the steps of:
harvesting a fascia lata sheet in a length of at least 20 cm from the iliotibial band in a central region of the thigh to avoid portions that are thicker than 5 mm;
providing a fascia lata sheet having longitudinally-oriented first and second edges opposite one another and laterally-oriented first and second ends opposite one another providing an apparatus for handling a fascia lata, having first and second removable anchoring members for removal prior to implanting the fan-folded fascia lata, each of said removable anchoring members comprising a base having a first surface, a post extending from said first surface, and a fastener for removable attachment to said base, wherein said fastener comprises a cavity for receiving said post when said fastener is attached to said base; a frame having a first end and a second end at opposite ends of said frame, wherein said first end comprises a first cavity for receiving said first removable anchoring member and said second end comprises a second cavity for receiving said second removable anchoring member, and wherein said frame has a folding plate, said folding plate including said first and second cavities and a folding surface extending between said first and second cavities, wherein said post of said first removable anchoring member extends above said folding surface when said base of said first removable anchoring member is placed in said first cavity, wherein said post of said second removable anchoring member extends above said folding surface when said base of said second removable anchoring member is placed in said second cavity;
attaching a first portion of said fascia lata sheet proximate said first end and said first edge to a post extending from said first removable anchoring member;
attaching a second portion of said fascia lata sheet proximate said second end and said first edge to a post extending from said second removable anchoring member;
(i) folding said fascia lata to form a longitudinal fold line, wherein said fascia lata comprises an anchored portion between said first edge and said longitudinal fold line and a free portion between the longitudinal fold line and said second edge;
(ii) attaching a portion of said free portion proximate said first end to said post extending from said first removable anchoring member;
(iii) attaching a portion of said free portion proximate said second end to said post extending from said second removable anchoring member
repeating steps (i)-(iii) at least three times, prior to implanting the fan-folded fascia lata permanent anchors are introduced to permanently anchor the fan-folded fascia lata, thereafter the removable fasteners are removed prior to implantation.
2. The method according to claim 1 , further comprising: repeating steps (i)-(iii), in order to form a fan-folded fascia lata sheet comprising at least four layers.
3. The method according to claim 1 , further comprising: repeating steps (i)-(iii), in order to form a fan-folded fascia lata sheet comprising at least five layers.
4. The method according to claim 1 , further comprising:
fastening a fastener of said first removable anchoring member to said base of said first removable anchoring member; or
fastening a fastener of said second removable anchoring member to said base of said second removable anchoring member; or
both.