WO1994000079A1

WO1994000079A1 - Ancillary instruments for plastic surgery of the coracoclavicular ligament

Info

Publication number: WO1994000079A1
Application number: PCT/FR1993/000597
Authority: WO
Inventors: Jacques Philippe Laboureau
Original assignee: Societe Lars S.A.
Priority date: 1992-06-19
Filing date: 1993-06-17
Publication date: 1994-01-06
Also published as: CA2138413A1; RU94046260A; AU4332793A; FR2692470B1; FR2692470A1

Abstract

Ancillary instruments for plastic surgery of the coracoclavicular ligament, comprising at least one guide tube (11) with a U-shaped hook (12) at the lower end thereof for passing around the coracoid process (2) of the shoulder blade (3); a single-reeve strand (13) sliding within said guide tube (11) and having an end loop (14) on the side of the U-shaped hook (12); and a release tube (20) with a lower end extending axially away from the opening of the arm (12a) of the U-shaped hook (12) of said guide tube (11).

Description

ANCILLARY INSTRUMENTATION FOR LIGAMENTOPLASTY

CORACO-CLAVICULAR

The present invention relates to ancillary instrumentation for coraco-clavicular ligamentoplasty.

It is known that, during a dislocation of the clavicle, the acromioclavicular joint can be seriously injured. A known technique for reducing dislocation recommends screwing a metal pin, introduced through the outer edge of the acromion as far as through the acromial facet of the clavicle, where it is attached to secure the outer end of the clavicle thus put back on the acromion.

In another more recent therapy, reduction is achieved by at least partial restoration of the ligaments, often torn, of the injured joint. There are four of these ligaments, namely:

- the acromio-coracoid ligament, connecting obliquely the conacoid process to the acromial end of the clavicle,

- and the coraco-clavicular ligaments, external and internal, which connect the clavicle and the scapula, the two external coraco-clavicular ligaments bearing the names of conoid ligament and trapezoid ligament. In this ligamentoplastic reduction technique, the injured ligaments are replaced by a single artificial ligament which is passed under the underside of the coracoid process - which we recall as having a shape of a folded thumb moving horizontally forward and outside the scapula -, said artificial ligament then being hung on the clavicle so as to bring together and maintain the latter in its normal place against the acromion.

To date, the passage of the artificial ligament under the underside of the coracoid process is carried out by hand, without the aid of any specific instrumentation. However, it is not always easy to access this region of the acromioclavicular joint, rich in ligament and muscle insertions. In addition, the techniques of attachment of the free ends of the prosthetic artificial ligament to the clavicle are not satisfactory and it is desirable to improve them.

To this end, the present invention provides ancillary instrumentation for coraco-clavicular ligamentoplasty, characterized in that this instrumentation comprises:

- at least one guide tube, bent at its lower end to form a "U" hook, the opening of which is designed to engage under the coracoid process of the scapula,

- a muffled strand once, which is slidably mounted inside said guide tube, with its end loop engaged on the side of the "U" hook, - and a release tube, the lower end of which can be positioned in the extension of the free end of the U-shaped hook of said guide tube.

In this way, after passing the "U" hook of the guide tube under the coracoid process, then slide the release tube until it abuts the lower end of the latter and the free end of said hook in "U", the practitioner can slide the end loop of the muffled strand into the continuous channel formed around said process by the assembly of the two tubes. The practitioner can then recover the end loop of the strand muffled by the upper part of the release tube, then remove said tube by making it rise along said strand which, in this way, emerges directly from the free end of the "U" hook. ", while remaining perfectly accessible to said practitioner.

The guide tube still being in place under the coracoid process, the end loop of the strand is then attached to the traction wires of the artificial ligament to be put in place, which allows, by progressive withdrawal of the muffled strand inside the guide tube, to bring said ligament at the free end of the "U"hook; in this position, the practitioner can very easily slide said hook around the coracoid process, so as to carry with it the end of the ligament under the underside of said process. The complete release of the guide tube upwards, towards the collarbone, is the last step necessary for the complete passage of the ligament around the coracoid.

After having detached the traction wires from the ligament of the end loop of the strand which is engaged in the guide tube, the two free ends of said ligament are accessible to the practitioner who can fix them, according to the chosen method, on or around the clavicle .

Other characteristics and advantages of the present invention will emerge more clearly from the description which follows of a preferred embodiment of ancillary instrumentation for coraco-clavicular ligamentoplasty, given by way of nonlimiting example with reference to the attached drawings. on which ones :

FIG. 1 is an anterior view of the acromioclavicular joint schematically representing the result obtained according to a first known technique of coraco-clavicular ligamentoplasty,

FIG. 2 is an anterior view of the acromioclavicular joint schematically representing the result obtained according to a second known technique of coraco-clavicular ligament,

- Figure 3 is an anterior view of the acromioclavicular joint schematically representing the result obtained according to a third known technique of coraco-clavicular ligamentoplasty, - Figure 4 is a posterior view of the acromioclavicular joint schematically representing the introduction of the hook of the guide tube of the ancillary instrumentation under the coracoid process, - Figure 5 is a rear view of the acromioclavicular joint schematically showing the placement of the release tube at the free end of said hook, FIG. 6 is a rear view of the acromioclavicular joint schematically representing the muffled strand and its terminal loop, after passage of said strand in the channel formed by all of the guide and release tubes abutted according to the previous figure, then retriat of said release tube,

FIG. 7 is a rear view of the acromioclavicular joint schematically showing the attachment of the traction wires of the ligament to be placed on the terminal loop of the muffled strand,

FIG. 8 is a partial upper view of the acromioclavicular joint, detailing the drilling of the insertion tunnels of the ends of the ligament according to a new ligamentoplasty technique,

FIG. 9 is a partial top view of the acromioclavicular joint, detailing the direction of passage of the ends of said ligament inside said insertion tunnels,

- Figure 10 is a partial upper view of the acromioclavicular joint, detailing the fixation of the ends of the ligament in said insertion tunnels, - Figure 11 is an anterior view of the acromioclavicular joint schematically showing the result obtained according to the coraco-clavicular ligamentoplasty method described with reference to the three figures 8 to 10. FIGS. 1 to 3 show, in perspective and schematically, three prior techniques of coraco-clavicular ligament, that is to say of placement of a prosthetic artificial ligament 1 under the underside of the coracoid process 2 of the scapula 3, this process 2 having the shape of a thumb bent forwards and outside of said scapula 3.

According to a first laying technique shown in Figure 1, the two ends la, lb_ of ligament 1 are fixed in two vertical holes 4, drilled for this purpose between the upper face 5 and the lower face 6 of the collarbone 7; these vertical holes 4 are positioned in vertical planes situated on each side of the coracoid process 2, the folded edges of the two ends 1a, 1b of the ligament 1 being held by two ligament staples 8 against the upper face 5 of the clavicle 7.

According to a second positioning technique shown in FIG. 2, the ligament 1 is simply hung around the collarbone 7, the two ends 1a, 1b of said ligament 1 being connected by a knot.

Finally, according to a third laying technique, previously known, represented in FIG. 3, substantially horizontal insertion tunnels 9, 10 are drilled between the posterior edges 7a, and the anterior 7b_ of the collarbone 7, in vertical planes located on each side of the coracoid process 2; the end there. of the ligament 1 is introduced in a postero-anterior direction into the insertion tunnel 9, while the end 1b of said ligament 1 is introduced in an anteroposterior direction into the other insertion tunnel 10. These two ends the , lb are fixed by screws in said tunnels 9, 10 or, by staples, respectively on the upper 5 and lower 6 faces of the collarbone 7.

In the three ligamentoplastic techniques described above, the first operational step consists in passing the ligament 1 under the coracoid process 2. To this end, the invention recommends using the ancillary instrument, the description of which will now be given with reference to Figures 4 to 7. This instrumentation includes:

- A straight guide tube 11, the lower end of which is bent to form a hook 12 in a "U" shape, the second branch 12a of which. is preferably ent parallel to the rectilinear part of the guide tube 11; the opening of the hook 12 is provided so that the latter can be fairly easily introduced under the face lower part of the coracoid process 2, as shown in particular in Figure 4;

a metal strand 13 (FIGS. 6, 7), muffled once so as to present an end loop 14, and which is slidably and coaxially mounted inside the guide tube 11, with its end loop 14 engaged with the side of the hook 12 in "U"; preferably, the length of the strand 13 and that of the guide tube 11 are provided so that, in an initial position, the end of the loop 14 can come flush with the opening of the branch 12a. hook 12 in "U";

- A handle 15, of a dimension facilitating its gripping by the hand of the practitioner, is mounted in the upper extension of the straight branch of the guide tube 11; the upper free ends of the muffled strand 13 are fixed, inside this handle 15, to a slider 16, arranged along a groove 17 provided for this purpose along said handle 15; this cursor 16 thus controls the sliding of the strand 13 inside the guide tube 11, between an initial position (FIGS. 4, 5), cursor 16 in high stop in the groove 17, where the end loop 14 is flush with the the opening of the branch 12a, of the hook 12 in a "U" shape, and a second position (FIG. 6), cursor 16 in bottom stop in the groove 17, allowing said loop 14 to emerge out of the opening of said branch 12a, of a maximum length exactly equal to the distance separating the upper and lower stops of the cursor 16; - A sighting barrel 18, arranged at the end of a lateral appendage 19 of the handle 15, to constitute a substantially vertical guide making it possible to introduce a release tube 20 in the exact extension of the opening of the branch 12a. the hook 12 in "U" of the guide tube 11 (Figure 5); in this way, the practitioner can slide the end loop 14 of the muffled strand 13 into the continuous channel formed, around the coracoid process 2, by the assembly of the two tubes of guide 11 and clearance 20.

The complete placement of an artificial ligament 1 will now be described with reference to FIGS. 4 to 11.

After passing the hook 12 in a "U" shape from the guide tube 11 under the coracoid process 2 (FIG. 4), then slide the release tube 20 into the aiming barrel 18, until it abuts the lower end of said tube 20 and the opening of the branch 12a, of the hook 12 in a "U" shape of the guide tube 11 (FIG. 5), the practitioner moves the cursor 16 of the handle 15 downwards, slides the end loop 14 of the strand muffled 13 in the release tube 20. Therefore, the practitioner can recover the end loop 14 of the muffled strand 13 by the upper part of the release tube 20, then remove said tube 20 by making it rise along said strand 13, in its sights 18.

After removal of the tube 20 (Figure 6), the loop 14 emerges from the opening of the branch 12a. hook 12 in a "U" shape, while remaining perfectly accessible to the practitioner.

The guide tube 11 still being in place under the coracoid process 2, the end loop 14 of the strand 13 is then attached to the traction wires 21 of the artificial ligament 1 to be put in place (FIG. 7). By bringing the cursor 16 to the top of the groove 17 of the handle 15, the practitioner can thus gradually remove the muffled strand 13 inside the guide tube 11, which allows him to bring the ligament 1 to the level of the opening of the branch 12a. hook 12 in "U"; in this position, the practitioner can then very easily slide said hook 12 around the coracoid process 2, so as to engage the end of the ligament 1 under the underside of said process 2. Complete release of the guide tube 11 upwards, towards the collarbone 7, is the last step necessary for the complete passage of the ligament 1 around the coracoid 2.

After having detached the traction wires 21 from the ligament 1 of the terminal loop 14 of the strand 13, the two free ends 1a, 1b of the ligament 1 are accessible to the practitioner who can fix them according to a conventional method, as mentioned above with reference to FIGS. 1 to 3 or, according to a preferred method which will now be explained in more detail in accordance with FIGS. 8 to 11.

This preferred method consists in successively carrying out the following operations: drilling, according to FIG. 8, of two inclined insertion tunnels 22, 23, which are directed from bottom to top and in respective postero-anterior and antero-posterior directions, so as to "cross at a distance" in separate vertical planes normally located on each side of the coracoid process 2;

the ends of the ligament 1 are then introduced according to the arrows F shown in FIG. 8, so as to obtain the situation in FIG. 9;

these ends 1a, 1b of the ligament 1 are finally wedged in the insertion tunnels 22, 23 by bone corners 24, or anchoring screws, this in a conventional manner, the protruding parts of said ligament 1 being cut at flush with the clavicular cortex.

FIG. 11 represents, in an anterior view of the acromioclavicular joint, the artificial ligament 1 placed according to the preferred method described above.

Claims

1 - Ancillary instrumentation for coraco-clavicular ligamentoplasty, characterized in that this instrumentation comprises:

- at least one guide tube (11), bent at its lower end to form a hook (12) in a "U" shape, the opening of which is designed to engage under the coracoid process (2) of the scapula (3), - a strand (13) muffled once, which is slidably mounted inside said guide tube (11), with its end loop (14) engaged on the side of the hook (12) in "U" shape,

- And a release tube (20) whose lower end can be positioned in the extension of the opening of the branch (12a.) of the hook (12) in "U" of said guide tube (11).

2 - Ancillary instrumentation according to the preceding claim, characterized in that the guide tube (11) is rectilinear.

3 - Ancillary instrumentation according to the preceding claim, characterized in that the hook (12) in "U", the second branch (12a,) is preferably parallel to the straight portion of the guide tube (11).

4 - Ancillary instrumentation according to any one of the preceding claims, characterized in that the length of the strand (13) and that of the guide tube (11) are provided so that, in an initial position, the end of the loop ( 14) can come flush with the opening of the branch (12a.) Of the hook (12) in a "U" shape.

5 - Ancillary instrumentation according to any one of the preceding claims, characterized in that a handle (15) is mounted in the upper extension of the guide tube (11).

6 - Ancillary instrumentation according to any one of the preceding claims, characterized in. that the upper free ends of the strand Muffled (13) are fixed, inside this handle (15), to a slider (16) which is arranged along a groove (17) provided for this purpose along said handle (15).

7 - Ancillary instrumentation according to any one of the preceding claims, characterized in that a sighting cannon (18) is arranged at the end of a lateral appendage (19) of the handle (15), to constitute a substantially guide vertical for introducing the release tube (20) in the exact extension of the opening of the branch (12a.) of the hook (12) in "U" of the guide tube (11).