Tibial cross-pin fixation techniques and instrumentation
Techniques and reconstruction systems for ACL repair by providing cross-pin fixation of a graft within a tibial tunnel. The invention provides tibial fixation techniques according to which cross-pin fixation of a graft (for example, an Anterior Tibialis allograft) is achieved on the tibial side, close to the jointline, by a single incision and with cortical fixation.
1. A method of surgery, comprising the steps of:
forming a tibial socket in tibia by drilling with a retrograde cutter from an articular surface of the tibia and into the tibia, the tibial socket having an entrance in communication with an articular joint space and a sidewall;
introducing a flexible strand transversely into the tibial socket through the sidewall of the tibial socket;
pushing the flexible strand with the retrograde cutter into the articular joint space and pulling a portion of the strand out through the socket entrance to form a loop in the flexible strand outside the entrance to the tibial socket;
engaging a graft, in the articular joint space, with the loop of the flexible strand out of the socket entrance; and
pulling the flexible strand and the graft engaged thereto into the tibial socket.
2. The method of claim 1 , wherein the step of forming a tibial socket further comprises forming the socket in a retrograde manner by introducing a guide pin through the tibia, introducing the retrograde cutter into the joint space, and retrograde cutting into the tibia from the articular surface of the tibia and into the tibia.
3. The method of claim 2 , wherein the retrograde cutter is a dual-sided rotary drill cutter comprising two opposed sides provided with cutting surfaces on both sides, such that the rotary drill cutter is configured for cutting in two directions.
4. The method of claim 2 , wherein the retrograde cutter is a flip retrograde cutter comprising a shaft and a blade at a distal end of the shaft, the blade being securely engaged to the shaft and capable of movement from a first position generally aligned with the longitudinal axis of the body to a second position which is not aligned with the longitudinal axis.
5. The method of claim 1 , further comprising the step of forming a loop in the graft and engaging the loop in the graft with the loop of the flexible strand pulled out through the tibial socket.
6. The method of claim 1 , further comprising the step of supporting the graft in the tibial socket.
7. The method of claim 6 , wherein the step of supporting the graft in the tibial socket is performed using a transverse implant.
8. The method of claim 7 , wherein the transverse implant is cannulated, the method further comprising the step of guiding the transverse implant using the strand.
9. The method of claim 1 further comprising the step of providing a guide system comprising a handle, a hook attached to the handle, and a guide including a passageway oriented at an angle to allow drilling about parallel to the tibial plateau.
10. The method of claim 1 further comprising the step of drilling transversely through the tibia and the tibial socket, and above the growth plate in a pediatric patient.
11. The method of claim 1 further comprising the steps of attaching the graft to a fixation device and subsequently securing the graft in the femur.
12. The method of claim 11 , wherein the fixation device is a suture/button loop construct having a button with at least one eyelet and a continuous suture loop attached to the eyelet.
13. The method of claim 12 further comprising the steps of positioning the graft attached to the suture/button loop construct into a femoral socket, and securing the button to the femoral cortex.
14. The method of claim 13 , wherein the femoral socket is formed by retrograde drilling from an articular surface of the femur and into the femur, by accessing the articular surface of the femur and drilling so that an opening of the femoral socket is flush with the articular surface of the femur and another opening of the femoral socket is located within the femur.
15. A method of cross-pin ACL reconstruction, comprising the steps of:
forming a tibial socket in tibia in a retrograde manner by drilling with a retrograde cutter from an articular surface of the tibia and into the tibia, the socket having an entrance in communication with an articular joint space and a sidewall;
drilling a guide pin through a guide member oriented about parallel to the tibial plateau, and through the sidewall of the bone tibial socket so as to transversely intersect the tibial socket;
pulling a flexible strand transversely through the guide member and through the tibial socket using the guide pin;
pushing the flexible strand with the retrograde cutter into the articular joint space to form a loop in the flexible strand and pulling the loop in the flexible strand out through the entrance of the tibial socket;
engaging a graft, in the articular joint space, with the loop in the flexible strand pulled out of the entrance of the tibial socket;
pulling the flexible strand in a direction transverse to the tibial socket so as to draw the graft engaged therewith into the tibial socket;
passing an implant transversely through a loop formed in the graft in the tibial socket; and
securing the graft in a femoral socket by attaching the graft to a fixation device.
16. The method of claim 15 further comprising the step of drilling transversely through the tibia and the tibial socket above the growth plate.
17. The method of claim 15 , wherein the guide member is provided with spikes for engaging the tibial cortex.
18. The method of claim 15 , wherein the femoral socket is formed in a retrograde manner.
19. The method of claim 15 , wherein the graft is a ligament, a tendon, or an allograft.
20. The method of claim 15 , wherein the fixation device is an interference screw or a suture/button loop construct having a button with at least one eyelet and a continuous suture loop attached to the eyelet.