CA2272960C

CA2272960C - Graft ligament anchor and method for attaching a graft ligament to a bone

Info

Publication number: CA2272960C
Application number: CA002272960A
Authority: CA
Inventors: Joseph H. Sklar; Harold M. Martins; Richard F. Wenstrom, Jr.
Original assignee: Individual
Current assignee: Individual
Priority date: 1996-11-27
Filing date: 1997-11-26
Publication date: 2008-01-22
Anticipated expiration: 2017-11-26
Also published as: US7578844B2; US20100121449A1; JP2001506521A; DE69728439D1; CA2272960A1; AU747963B2; JP4026857B2; US8298285B2; WO1998023229A1; US6932841B2; DE69728439T2; US20130226203A1; US20060030941A1; EP0991376B1; US5899938A; EP0991376A4; US20010047206A1; EP0991376A1; US20030144735A1; AU5512798A

Abstract

A graft ligament anchor comprises a graft liga-ment engagement member (20) disposed in an open-ing (29) in a bone, the graft ligament engagement member (20) being arranged to receive a graft lig-ament (28) alongside the engagement member (20), and a locking member (32) for disposition in the opening, and at least in part engaging with the graft ligament engagement member (20). Movement of the locking member (32) in the opening causes the locking member (32) to urge the engagement mem-ber (20), and the graft ligament (28) therewith, to-ward a wall of the opening, to secure the graft liga-ment (28) to the wall of the opening. A method for attaching a graft ligament (28) to a bone comprises providing an opening in the bone, inserting the graft ligament (28) and a graft ligament engagement mem-ber (20) in the opening, with the graft ligament (28) disposed alongside a first portion of the engagement member (20), and inserting a locking member (32) in the bone alongside a second portion of the engage-ment member (20), the locking member (32) being separated from the graft ligament (28) by the graft ligament engagement member (20). The method fur-ther comprises moving the locking member (32) to cause the locking member (32) to engage the graft ligament engagement member (20) to urge thegraft ligament engagement member (20), and the graft lig-ament (28) therewith, toward a wall of the opening to secure the graft ligament to the wall of the open-ing.

Description

GRAFT LIGAMENT ANCIIOR AND METHOD FOR
ATTl1CHING A GRAF'T LIGAMENT TO A BONE
I?ield Of 'i'he Invention This invention relates to meciical apparatus and methods in general, and more part:Lcularly to apparatus and methods for reconstructing ligaments.

Background Of The Invention Ligaments are tougl-i bands of tissue which serve to connect the articular extremities of bones, or to support or retain organs in place within the body.
Ligaments are typically coinposed (Df coarse bundles of dense white fibrous tissue which are disposed 'in a parallel or closely interlaced manner, with the fibrous tissue being pliant and flexible, but not significantly extensible.
In many cases, ligaments are torn or ruptured as a result of accidents. As a result, various procedures have been developed to repair or replace such damaged ligaments.
For example, in the human knee, the anterior and posterior cruciate ligaments (i.e., the ACL and PCL) extend between the top end of the tibia and the bottom end of the femur. The ACL and PCL cooperate, together with other ligaments and soft tissue, to provide both static and dynamic stability to the knee. Often, the anterior cruciate ligament (i.e., the ACL) is ruptured or torn as a result of, for example, a sports-related injury. Consequently, various surgical procedures have SUBSTITUTE SHEET (RULE 26) been developed for reconstructirig the ACL so as to restore normal function to the knee.
In many instances, the ACL may be reconstructed by replacing.the ruptured ACL with a graft ligament. More particularly, with such procedures, bon~.~ tunnels are typically formed in the top end of the tibia and the bottom end of the femur, with one end of the graft _ ligament being positioned in the femoral tunnel and the other end of the graft ligament being positioned in the tibial tunnel. The two ends of the graft ligament are anchored in place in various ways known in the art so that the graft ligament extends between the femur and the tibia in substantially the same way, and with substantially the same function, as the original ACL.
This graft ligament then cooperates with the surrounding anatomical structures so as to restore normal function to the knee.
In some circumstances the graft ligament may be a ligament or tendon which is harvested from elsewhere in the patient; in other circumstances the graft ligament may be a synthetic device. For the purposes of the present invention, all of the foregoing can be collectively referred to as a "graft lige.ment".
As noted above, the graft ligament may be anchored in place in various ways. See, for example, U.S.
Patent No. 4,828,562, issued May 9, 1989 to Robert V.
Kenna; U.S. Patent No. 4,744,793, issued May 17, 1988 to Jack E. Parr et al.; U.S. Patent No. 4,755,183, issued July 5, 1988 to Robert V. Kenna; U.S. Patent No.
4,927,421, issued May 22, 1990 to K. Marlowe Goble et SUBSTITUTE SHEET (RULE 26) al.; U.S. Patent No. 4, 950, 270, issued August 21, 1990 to Jerald A. Bowman et al.; U.S. Patent No. 5,062,843, issued November 5,.1991 to Thomas H. Mahony,'III; U.S.
Patent No.-5, 147, 362, issued September 15, 1992 to E.
Marlowe Goble; U.S. Patent No. 5,211,647, issued May 18, 1993 to Reinhold Schmieding; U.S. Patent No.
5, 151, 104, issued September 29, 1992 to Robert V.
Kenna; U.S. Patent No. 4,784,126, issued November 15, 1988 to Donald H. Hourahane; U.S. Patent No. 4,590,928, issued May 27, 1986 to Michael S. Hunt et al.; and French Patent Publication No. 2,590,792, filed December 4, 1985 by Francis Iienri Breard.
Despite the above-identified advances in the art, there remains a need for a graft: ligament anchor which is simple, easy to install, and inexpensive to manufacture, while providing secure, trouble-free.
anchoring of the graft ligament, typically in the knee joint of a mammal.

Objects Of The Invention Accordingly, one object of the present invention is to provide an improved graft ligament anchor which is relatively simple in construction and therefore inexpensive to manufacture, relatively easy to handle and install, and reliable and safe in operation.
Another object of the present invention is to provide an improved method for attaching a graft ligament to a bone.

SUBSTITUTE SHEET (RULE 26) Summary Of The Invention These and oLher objects of Lhe present invention are addressed by Llie provision and use of a novel graft ligament anchor coinprisirig graft ligament engagement means for disposiLion in an openirig in a bone, such that a wall of Lhe grafL ligainenL engagemenL means resides adjacent to aL- leasL- one graft ligament disposed in the operiing, and locking means for disposition in the opening in the bone and at least partially engageable witli L=he graft ligament- engageinent means. '1'he eleineriLs of Llie graft ligament anchor are adapLed sucli Lt-aL -novemenL of. Lhe lock:ing ineans in the opening in the bone causes at least a part of the locking ineans L-o engage Lhe graft ligament engagement means so as Lo urge Lhe graft ligament engagement ineans, and hence Llie portion of Llie graft ligament disposed adjacenL LliereLo, Loward a wall of the opening in the bone, whereby Lo secure the graft ligament to the wallof the opening.
In use, an openiiig is inade in the bone, and the graft ligament and the graft ligament engageinent means are inserted into Llie opening, wiLh a portion of the graft ligamenL beiric~ disposed alongside a wall of the graft ligament engageinenL ineans. In accordance with the present invenLion; Lhe locking means are also positioned in the operiing in the bone, alongside the graft liga-nent engagement niearis, with the locking means being separated fro-n Lhe graft ligament by a portion of the graft ligarnenL engagement means. The ntethod further includes inoving the locking mean-~ in the SUBSTITUTE SHEET (RULE 26) opening in the bone so as to cause at least a portion thereof to urge the graft ligament engagement means, and hence the porLion of the qraft ligament disposed adjacent thereto, toward a wall of the opening, whereby to secure the grafL ligament to t:he wall of the opening.

Brief Descr ipl:ion 0 C'1'he Dr. aw'. Lngs These and other objecLs and features of the present invention will be more fully disclosed or rendered obvious by Llie following deLailed description of the preferred embodimenLs of the invention, which are to be considered togeLlier with the accompanying drawings wherein like numbers refer to like parts, and further wherein:
Fig. 1 is a diagraTmnaLic sectional view of one form of graft li.gamenL anchor made in accordance with the present invention;
Fig. 2 is similar to Fig. 1, but shows the graft ligament anchor components in different operating positions;
Fig. 3 is similar Lo Fig. 1, but shows an alternative embodiment of the present invention;
Fig. 4 is a diagrammatic sectional view of another form of graft ligament anchor made in aceprdance with the present invention;
Fig. 5 is similar to Fig. 4, but-shows the graft ligament anchor components in different operating positions;

SUBSTITUTE SHEET (RULE 26) Fig. 6 is a diagrammatic sectional view of another form of graft ligament anchor made in accordance with the present invention;
Fig. =7 is a diagrammatic sectional view of still another form of graft ligament anchor made in accordance with the present invention;
Fig. 8 is a diagrammatic sectional view of yet.
another.form of graft ligament anchor made in accordance with the present invention;
Fig. 9 is a perspective view of one of the components of the graft ligament anchor shown in Fig.
8;
Fig. 10 is a diagrammatic sectional view of still another form of graft ligament anchor made in accordance with the present invention;
Fig. 11 is a diagrainmatic view of still another form of graft ligament anchor made in accordance with the present invention;
Fig. 12 is a diagrammatic sectional view of yet another form of graft ligament anchor ma(ie in accordance with the present invention;
Fig. 13.is similar to Fig. 12, but shows the graft ligament anchor components in different operating conditions;
E'ig. 13A is a diagrammatic sectional view of still another form of ligament anchor inade in accordance with the present invention;
Fig. 14 is a top plan view of still another form of graft ligament anchor made in accordance with the present invention;

SUBSTITUTE SHEET (RULE 26) _ 7 Fig. 15 is a side view, in section, of the graft ligainent anchor sliown in I'ig. 14;
Fig. 16 is a side view showing the graft ligament anchor of .Figs. 14 and 15 securing a graft ligament to a bone;
Fig. 17 is similar to a portion of Fig. 16, but showing components of the graft ligament anchor and graft ligament of L'ig. 16 in alternative positions;
Fig. 18 is a top plari view of yet another form of graft ligament anchor made in accordance with the present invenLion;
Fig. 19 is a side view, in section, of the graft ligament anchor shown in Fig. 18;
Fig. 20 is a diagr.anunaLic sectional view Qf still another form of graft ligamerit anchor -nade in accordance wi.tli the preseriL invention;
Fig. 21 is a perspective view of a component of the graft ligamenL anchor shown in Fig. 20;
Fig. 22 is a diagranunatic sectional view of still another form of graft liganleilt anchor made in accordance with the pr.esenL invenL'ion; and Fig. 23 is a perspective view of components of the graft ligament anchor of Fi.g. 22.

Detailed Description Of The Preferr.ed Cinbodiments Referring first to Fig. 1, it will be seen that one illustrative embodiment of the present invention includes a graft ligameriL engagement nieans 20 comprising a deformable sleeve 22, preferably formed out of inetal or p1.as-tic, and adapted to be inserted SUBSTITUTE SHEET (RULE 26) into an opening 24 for.med in a bone B. One or more graft ligamenLs 28 are d:i.sposed alongside an interior wall 30 of sleeve 22.
The embodiment illustrated in Fig. 1 further includes locking ineans 32, which may be a pivotally movable rocker arin 34, wliich may be provided with a slot 36 for receiving a key meinber (not shown) for turning rocker arm 34.
Referring to Fig. 2, it will be seen that turning rocker arm 34 enables a portion of the rocker arin to impinge upon an exterior surface 40 of sleeve 22 so as to force sleeve 22, and hence graft ligaments 28 contained therein, Loward sidewall 38 of opening 24, whereby to secure sleeve 22 and graft ligaments 28 between opening sidewall 38 and locking means 32.
In operation, opening 24 is first made in bone B
and then graft ligaments 28 and graft ligament engagement means 20 are inserLed into opening 24, with graft ligament-s 28 being disposed alongside a first wall, i.e., the interior wall 30, of sleeve 22.
Locking means 32 are iiiserted into opening 24 alongside the exterior surface 40 of sleeve 22. Locking means 32 are thus separated from graft- ligainents 28 by graft ligament- engagement means 20, i.e., sleeve 22. As noted above, movemenL' of locking ineans 32 causes at least a portion Lhereof to engage sleeve 22 and to crimp the sleeve inward].y upon grafL ligaments 28, and to push both sleeve 22 and grafL ligatnents 28 against sidewall 38 of opening 24.

SUBSTITUTE SHEET (RULE 26) - 9 =- -If it is desired to thereafLer release graft ligaments 28, rocker arm 34 miay be movec.'. back to the position shown in Fig. 1. To this end, graft ligameryt engagement= means 20 preferably are formed out of a resilient material, whereby engagement- means 20 can return to substantially tl-ie same position shown in Fig.
1 when locking means 32 reLurn to the position shown in Fig.- 1.
If desired, substantially all of sleeve 22 can be formed so as to be deformable; alternatively, some of sleeve 22 can be formed so as to be rigid. By way of example, L-he porLion of sleeve 22 contacted by locking means 32 can be formed so as to be substantially rigid.
Graft ligaments 28 inay comprise natural or synthetic graft ligament material, and the anchor can be used to attach natural or synthetic graft ligaments and/or tendons to bone. Sleeve 22 preferably is provided with inwardly-e:ctending protrusions 42, such as spikes 44, for securely retaining graft: ligaments 28 therein.
Locking ineans 32 may be a rocker arm type, such as the rocker arm member 34 shown in Figs. 1 and 2, or a generally conically-shaped expansion plug 46, as shown in Fig. 3, with the exparision plug preferably being threaded such Lhat as-the plug is screwed into place, an increasing diameLer of tlie plug engages sleeve 22 in a wedge-like maiiner so as to force the sleeve against interior wall 38 of open-i_ng 24.
In I'ig. 4, lliere is shown an alternative embodiment in whi_ch graft ligaments 28 are disposed SUBSTITUTE SHEET (RULE 26) alongside exterior wall 40 of sleeve 22, and locking means 32 is disposed within sleeve 22. With this embodiment, locking means 32 operate to engage interior wall 30 of=the sleeve (Fig. 5), whereby to force graft ligaments 28 against sidewall 38 of oper~-*Mg 24. Again, locking means 32 may be a rocker arm type, such as the rocker arm member 34 shown in Figs. 4 and 5, or may.be an expansion plug 46, preferably threaded, of the sort shown in Fig. 3. With the embodiment shown in Figs. 4 and 5, sleeve 22 may be provided with protrusions 42 (in the form of spikes 44, for example) on the exterior wall 40 thereof for engagement with graft ligaments 28.
In many instances, it is beneficial to provide at least two discrete graft ligaments 28 and, in such cases, it is preferable that the graft ligaments be disposed on substantially opposite diametric sides of the sleeve, as shown in L'igs. 4 and 5.
In Fig. 6, there is shown an embodiment similar to that shown in Figs. 4 and 5, but provided with an expandable sleeve 22A, rather than a deformable metal or plastic sleeve 22 as shown in Figs. 1-5. Sleeve 22A
may be formed out of an elastomeric material, and it is expanded radially outwardly by engagement with a centrally disposed locking means 32 (preferably in the form of a threaded expansion plug 46) so as to force graft ligaments 28 outward into a secured position between sleeve 22A and opening sidewall 38.
In operation, the embodiments shown in Figs. 4-6 function similarly to the embodiments shown in Figs. 1-3 in attaching graft ligaments 28 to bone B. Opening SUBSTITUTE SHEET (RULE 26) 24 is first niade in bone B. Graft ligainenLs 28 and graft ligament engagemcnL- means 20 (in the form of sleeve 22 or sleeve 22A) are inser. ted .ir:to opening 24, wiLh grafl= ligamenl:s 28 disposed alongside exterior wall 40 of Llie grafL ligainenL engageinenl: means, i.e., alongside the exterior wall 40 of sleeve 22 or sleeve 2211. Locking iueans 32 (in the form of a rocker arm_ niei(ilier. 34 or a l:i-r.eaclecJ expansion plug 4G) are inserted axial].y into Llie sleeve, alongside inLerior wall 30 of Llie sleeve. Locking means 32 are Llius separated froin Llie grafL l.i.gament:s 20 by Lhc sleeve (22 or. 22A) . Then locking means 32 are manipu.laLed so as to engage Lhe sleeve (22 or 2211) and thereby urge the sleeve, and lience graft ligameiiLs 28, lowar.d opening sidewall 38, wliereby Lo secur.e L1-c sleeve and gi-aft ligaments to the wall of the open:i.ng.
If and wlien it i.s desired Lo adjusL Lension on graft ligainents 28, locking means 32 may be backed off, LhaL is, if locking nicans 32 coinprise the rocker arm type can- member 34, Ll-e ai-m nee(a only be roLaL'ed 90 froin the posiLior-s .,liown in Figs. 2 anct S, to rel:urn to the posiLions shown, respectively, in Figs. 1 and 4;
if, on Lhe other hand, locking means 32 coinprise expansion plug 4G, the plug need only be unscrewed or otherwise axially withdrawn so as to release the securing of Lhe graCL ligainenLs.
Referring nexL Lo 1='ig. 7, it will be seen that in an alL-ernal:ive embodiment, grafL l:igament engagemenL-means 20 comprises plaLe iuearis 40 whicli are movable transversely w.i.Lh.in Lhe bone opening. 11s in the SUBSTITUTE SHEET (RULE 26) embodiments previously described, graft ligaments 28 are disposed alongside a wall 50 of graft ligament engagement means 20, which in this instance is a first inajor surface of plate means 40. Graft ligament engagement means 20 are disposed between graft ligaments 28 and locking means 32. Locking means 32 may be, as in the above-described embodiments, an expansion plug 46 (as shown in Fig. 7), or locking means 32 may be a rocker arm type of cam member 34 (of the sort shown in Figs. 1, 2, 4 and 5). Locking means 32 are adapLed to impinge upori a second inajor surface 52 of plate ineans 48. Plate means 48, in the embodiment shown in Fig. 7, comprises a single plate 54 having, on first major surface 50 Lliereof, one=or more concavities 56 for nesting one or more graft ligaments 28, respectively.
In the attachineriL of one or more graft ligaments 28 to a bone B, using the embodiment of Fig. 7, locking means 32.are inariipulated so as to bear against plate 54 so as to move plate 54 into engageinenl with graft ligaments 28, and Lhence to fur.ther move plate 54 so as to secure the grafL ligaments against sidewall 38 of opening 24.
Referring next to Fig. 8, it will be seen that locking means 32 may comprise the threaded expansion plug 46 deployed partly in opening 24 and threaded partly into bone B, thus serving as a so-called interference screw. Witli Lliis arrangement; plug 46 is thereby (i) in part along its length disposed in opening 24, pr.otrudi-ng into the opening from opening SUBSTITUTE SHEET (RULE 26) WO 98/23229 PCT/1JS97/21910 ' wall 38, and (ii) in part along its length threadedly engaged with bone B. Screwing in plug 46 causes the plug to engage plate 54 which, in turn, compacts one or more grafL ligaments 28 against wall 38 of opening 24.
In lieu of, or in addition to, the aforementioned concavities 56 shown in Fig. 7, plate 54 may be provided wiLh gripper ribs 58 for engaging graft ligaments 28, as shown in Figs. 8 and 9.
In Fig. 10, it is shown that plate means 48 may include first and second plates 60, 62, each having a wall 50 facing one or more graft ligaments 28, and a wal]. 52 facing locking means 32. Plates 60, 62 may be joined together by a link 64 which may be molded integrally wiLh plates 60, 62 so as to form a so-called "living hinge" link. Locking means 32 are depicted in Fig. 10 as a rocker arm type of cam member 34, but it will be appreciated LhaL an expansion plug type of locking means (e.g., a plug 46 such as that shown in Figs. 3,. 6 and 7) might also be used.
In operation, rotative movement of rocker arm 34 (or axial movement of expansion plug 46) causes plates 60, 62 to move outwardly from each other so as to urge graft ligaments 28 against wall 38 of opening 24.
Walls 50 of plates 60, 62 may be provided with concavities 56, as shown in Fig. 10, or with ribs 58 of the sort shown in Fig. 9, or both.
Referring next to Fig. 11, it will be seen that still anoL-her embodiment of the present invention includes, as gr.afL ligamenL engagement means 20, a V-shaped strip 94, preferably made out of a resilient SUBSTITUTE SHEET (RULE 26) metal or plastic material. An end portion 96 of a graft ligament 28 is disposed between first and second leg portions 98, 100 of V-shaped strip 9a, and graft ligament 28 extends alongside an exterior surface 102 of second leg portion 100. Locking means 32 comprise a threaded expansion plug 46 disposed partly in opening 24 and partly in borie B, along sidewall 38 of opening 24, in a manner similar to the disposition of threaded expansion plug 46 shown in Fig. 8.
Upon screwing in expansion plug 46, the expansion plug engages first leg 98 of graft ligament engagement means 20 (i.e., the V-shaped strip 94) to force first leg 98 to close upon secorid leg 100 with the graft ligament end portion 96 sandwiched therebetweeft and, upon further screwing in of threaded expansion plug 46, to force graft ligament engagement means 20 and graft ligament 28 against wall 38 of opening 24. To release graft ligament 28, an operator need only back out expansion plug 46.
When attaching a graft ligament to a bone with the graft ligament anchor shown in Fig. 11, an opening is first drilled, or otherwise made, in the bone. Then the V-shaped strip 94 is inserted into the opening, with a nose portion 104 thereof pointed inwardly of the bone. Next, end portion 96 of graft ligament 28 is inserted between first and second leg portions 98, 100 of V-shaped strip 94. Threaded expansion plug 46 is then inserted into opening wall 38 such that a first portion 106 of the lengthwise extent of plug 46 is disposed in opening'24, and second portion 108 of the SUBSTITUTE SHEET (RULE 26) lengthwise extent of plug 46 is threadedly engaged with bone B. Expansion plug 46 is then screwed further down so as to cause plug 46 to engage first leg 98 of V-shaped strip 94 so as to secure graft ligament end portion 96 in V-shaped strip 94, and then screwed down further to wedge strip 94 and graft ligament 28 against wall 38 of openirig 24.
Still referring to Fig. 11, it is to be appreciated that bone opening 24 may be formed with a constant diameter throughout its length or, if desired, may be formed with two different diameters along its length, in the manner shown in 1:'ig. 11, so as to form an annular shoulder 110 within the bone opening. The provision of an annular shoulde:r 110 can be ve'ry helpful in ensuring that the graft ligament anchor is prevented from migrating furthe:r into bone B, even if graft ligament 28 should thereafter be subjected to substantial retraction forces.
In a modification (not shown) of the Fig. 11 embodiment, the expansion plug 46 may be entered alongside graft ligament 28 and second leg portion 100 of strip 94. In this modified version, the expansion plug 46 operates as described above, except that expansion plug 46 engages graft ligament 28 and forces strip first leg 98 against wall. 38 of opening 24.
Looking next at Figs. 12 and 13, yet another form of graft ligament anchor is disclosed. This graft ligament anchor is similar to the embodiment shown in Fig. 6, except that the expandable sleeve 22B is in the form of a cylindrical coil. S:leeve 22B is formed out SUBSTITUTE SHEET (RULE 26) of an elastomeric material and is expanded radially outwardly by engageinent with a centrally disposed locking means 32 (preferably an axially-movable threaded ekpansion plug 46) so as to force graft ligament 28 outward into a secured position between sleeve 22B and bone B.
In Fig. 13A there is shown an embodiment similar to that shown in Fig. 10, but in which the first and second plates 60, 62 are discrete plates and not connected to each other. With this arrangement, locking means 32 is inserted into a central recess 74 defined by plate walls 52, and may comprise either an expansion plug 46 of the type shown in F'r.gs. 6 and 7 or a rocker arm type of cam member 34 of the type'shown in Figs. 1 and 2.
Looking next at Figs. 14 and 15, another gra'ft ligament anchor 200 is shown. Anchor 200 includes graft ligament engagement means 20 comprising a flat .plate 201, a pair of through-holes 202, 204 and a threaded through-hole 206. In use, and looking now at Figs. 14, 15 and 16, the free end 96 of graft ligament 28 is passed downward through hole 202 and then back upward again through hole 204, and then a screw 208 is used to secure anchor 200 to the wall 210 of the bone opening by threading the shank of screw 208 through hole 206, through graft ligament 28, and into bone B.
This will cause screw 208 and plate 201 to securely attach graft ligament 28 to bone B.
As shown in Fig. 17, alternatively, graft ligament 28 may be passed upwardly through hole 202 and SUBSTITUTE SHEET (RULE 26) downwardly through hole 204. Screw 208 is then threaded through hole 206 and graft ligament 28 and into bone B. Thus, as in the embodiment shown in Fig.
16, screw .208 and plate 201 secu:re graft ligament 28 to bone B.
Figs. 18 and 19=show another graft ligament anchor 200A. Graft ligament anchor 200A is simi.lar to graft ligament anchor 200, except that it includes a plurality of spikes 212 for projecting into wall 210 (Fig. 16) of bone B when the graft ligament anchor is deployed against the bone. Also, graft ligament anchor 200A has an enlarged configuration 214 in the region of through-hole 206A, as shown in r'ig. 18.
Referring next to Fig. 20, there is shown=a still further alternative embodiment of graft ligament anchor, similar to that shown iri Fig. 7, wherein graft ligament engagement means 20 comprises plate means 48 formed in a U-shaped configuratiLon (Fig. 21) movable transversely within bone opening 24. At least one graft ligament 28 is disposed alongside wall 50 of graft ligament engagement means 20, which in this instance is a first major surface of plate means 48.
Graft ligament engagement means 20 is disposed between graft ligament 28 and locking means 32. Locking means 32 may be an expansion plug 46, as shown in Fig. 20 and in Fig. 7, or a rocker arm type cam membi::r 34, as shown in Fig. 1, or an interference screw type expansion plug 46, as shown in Fig. 11, or a transverse screw 208, as shown in Fig. 16.

SUBSTITUTE SHEET (RULE 26) In attachment of one or more graft ligaments 28 to a bone B, using the embodiment of Fig. 20, locking means 32 is manipulated so as to bear against a second major surface 52 of plate means 48 and thereby move plate means 48 into engagement with graft ligament 28, and thence to drive free ends 49 of plate means 48 into sidewall 38 of opening 24 so as to fasten graft ligament 28 to sidewall 38 and, thereby, to bone B.
Referring to Figs. 22 and 23, there is shown still another alternative embodiment of graft ligament anchor including a tubular member 300, open at first and second ends 302, 304 and having an opening 306 in the sidewall thereof. Otherwise, the graft ligament anchor of Fig. 22 is similar to the graft ligament anchor of Fig. 20, described hereinabove.
In attachment of one or more graft ligaments-.28 to a bone, using the embodiment of Figs. 22 and 23, locking means 32 are manipulated to bear against second major surface 52 of plate means 48 so as to move plate means 48 through tubular member opening :s06 and into engagement with graft ligament 28, and thence further to drive free ends 49 of plate means 48 into sidewall 38 of opening 24, whereby to fasten tubular member 300 and graft ligament 28 to sidewall 38 and, thereby, to bone B. In this embodiment, and in the embodiments shown in Figs. 1-3, an operator may fasten the graft ligament to the bone without the graft ligament contacting the bone. The tubular meinber 300 preferably is of a plastic or metallic material and the plate means 48 is of a plastic or inetallic material. In the SUBSTITUTE SHEET (RULE 26) WO 98/23229 PCT/{JS97/21910 embodiments shown in Figs. 20 and 22, the plate means 48 may be provided with interior teeth 47 for gripping graft ligament 28.
It is=to be understood that the present invention is by no means limited to the particular constructions and methods herein disclosed and/or shown in the drawings, but also comprises any modifications or equivalents within the scope of tlie claims.
SUBSTITUTE SHEET (RULE 26)

Claims

What Is Claimed Is:

1. A graft ligament anchor comprising:
graft ligament engagement means for disposition in an opening in a bone so that a wall of said graft ligament engagement means is disposed adjacent to at least one graft ligament disposed in said opening, said graft ligament engagement means comprising a deformable tubular sleeve;
and locking means for disposition in said opening and at least in part engageable with said graft ligament engagement means;
whereby movement of said locking means in said opening causes at least a part of said locking means to engage said graft ligament engagement means so as to urge said graft ligament engagement means, and hence said graft ligament, toward a wall of said opening, whereby to secure said graft ligament to said wall of said opening.

2. The graft ligament anchor according to claim 1 wherein said graft ligament is disposed alongside an interior wall of said sleeve.

3. A graft ligament anchor according to claim 2 wherein said interior wall of said sleeve is provided with inwardly extending protrusions for engaging said graft ligament.

4. A graft ligament anchor according to claim 2 wherein said locking means comprise a selected one of a group consisting of a rocker arm, an expansion plug, a threaded expansion plug, and a transverse screw.

5. A graft ligament anchor according to claim 2 wherein said graft ligament engagement means is arranged so as to be disposed between said locking means and said graft ligament.

6. A graft ligament anchor according to Claim 5 wherein said locking means are disposed outside of said sleeve.

7. A graft ligament anchor according to claim 2 wherein said graft ligament engagement means are adapted to accommodate a discrete second graft ligament disposed alongside said interior wall of said sleeve.

8. A graft ligament anchor according to claim 1 wherein said sleeve is made out of metal.

9. A graft ligament anchor according to claim 1 wherein said graft ligament is disposed alongside an exterior wall of said sleeve.

10. A graft ligament anchor according to claim 9 wherein said locking means comprise a selected one of a group consisting of a rocker arm, an expansion plug, and a threaded expansion plug.

11. A graft ligament anchor according to claim 9 wherein said graft ligament engagement means are adapted to accommodate a discrete second graft ligament disposed alongside said exterior wall of said sleeve.

12. The graft ligament anchor according to claim 11 wherein said locking means are disposed inside of said sleeve.

13. A graft ligament anchor comprising:
graft ligament engagement means for disposition in an opening in a bone so that a wall of said graft ligament engagement means is disposed adjacent to at least one graft ligament disposed in said opening;
locking means for disposition in said opening and at least in part engageable with said graft ligament engagement means;
whereby movement of said locking means in said opening causes at least a part of said locking means to engage said graft ligament engagement means so as to urge said graft ligament engagement means, and hence said graft ligament, toward a wall of said opening, whereby to secure said graft ligament to said wall of said opening; and wherein said graft ligament engagement means comprise a deformable sleeve adapted to accommodate said graft ligament alongside an interior wall of said sleeve, and said locking means comprise a selected one of a group consisting of a rocker arm, an expansion plug, a threaded expansion plug, and a transverse screw, with said locking means being arranged for disposition outside of said sleeve, and said locking means being operable to urge said sleeve, with said graft ligament, against said wall of said bore.

14. A graft ligament anchor according to claim 13 wherein said graft ligament engagement means are adapted to accommodate a discrete second graft ligament disposed alongside said interior wall of said sleeve, said locking means being operable to urge said sleeve, with said graft ligaments therein, against said wall of said bore.

15. A graft ligament anchor comprising:
graft ligament engagement means for disposition in an opening in a bone so that a wall of said graft ligament engagement means is disposed adjacent to at least one graft ligament disposed in said opening;
locking means for disposition in said opening and at least in part engageable with said graft ligament engagement means;
whereby movement of said locking means in said opening causes at least a part of said locking means to engage said graft ligament engagement means so as to urge said graft ligament engagement means, and hence said graft ligament, toward a wall of said opening, whereby to secure said graft ligament to said wall of said opening; and wherein said graft ligament engagement means comprise a deformable sleeve adapted to accommodate at least one graft ligament alongside an exterior wall of said sleeve, and said locking means comprise a selected one of a group consisting of a rocker arm, an expansion plug, and a threaded expansion plug, with said locking means being arranged for disposition within said sleeve, and said locking means being operable to urge said sleeve, and said graft ligament, against said wall of said bore.

16. A graft ligament anchor according to claim 15 wherein said graft ligament engagement means are adapted to accommodate a discrete second graft ligament disposed alongside said exterior wall of said sleeve, said locking means being operable to urge said sleeve, and said graft ligaments, against said wall of said bore.

17. A graft ligament anchor according to claim 16 wherein said graft ligament engagement means are adapted to accommodate said graft ligaments on substantially opposite diametric sides of said sleeve.

18. A graft ligament anchor comprising:
graft ligament engagement means for disposition in an opening in a bone so that a wall of said graft ligament engagement means is disposed adjacent to at least one graft ligament disposed in said opening;
locking means for disposition in said opening and at least in part engageable with said graft ligament engagement means;

whereby movement of said locking means in said opening causes at least a part of said locking means to engage said graft ligament engagement means so as to urge said graft ligament engagement means, and hence said graft ligament, toward a wall of said opening, whereby to secure said graft ligament to said wall of said opening; and wherein said graft ligament engagement means comprises first and second plates, said graft ligament engagement means being adapted to accommodate a first graft ligament alongside a first major surface of said first plate and a discrete second graft ligament alongside a first major surface of said second plate, said locking means being disposed between second major surfaces of said first and second plates and adapted to urge said first and second plates away from each other to urge said graft ligaments against said wall of said opening.

19. A graft ligament anchor according to claim 18 wherein said locking means comprise a selected one of a group consisting of a rocker arm, an expansion plug, and a threaded expansion plug.

20. A graft ligament anchor according to claim 18 wherein said first and second plates are hingedly connected to each other.

21. A graft ligament anchor comprising:
graft ligament engagement means for disposition in an opening in a bone so that a wall of said graft ligament engagement means is disposed adjacent to at least one graft ligament disposed in said opening;
locking means for disposition in said opening and at least in part engageable with said graft ligament engagement means;
whereby movement of said locking means in said opening causes at least a part of said locking means to engage said graft ligament engagement means so as to urge said graft ligament engagement means, and hence said graft ligament, toward a wall of said opening, whereby to secure said graft ligament to said wall of said opening; and wherein said graft ligament engagement means comprise a V-shaped strip, said graft ligament engagement means being adapted to accommodate an end of said graft ligament disposed between first and second legs of said V-shaped strip, and another portion of said graft ligament extending alongside an exterior surface of said second of said legs, and said locking means comprise a threaded expansion plug disposed partly in said opening and partly in said bone along said wall of said opening, said expansion plug being adapted to engage one of said legs of said graft ligament engagement means to force said one leg to close upon the other of said legs, with said graft ligament end clamped between said first and second legs, and to force said graft ligament engagement means and said graft ligament against said wall of said opening.

22. A graft ligament anchor according to claim 21 wherein said one of said legs comprises said first leg and said other of said legs comprises said second leg.

23. A graft ligament anchor according to claim 15 wherein said sleeve comprises a cylindrically-shaped coil adapted to uncoil and expand upon said operation of said locking means within said sleeve.

24. A graft ligament anchor comprising:
graft ligament engagement means for disposition in an opening in a bone so that a wall of said graft ligament engagement means is disposed adjacent to at least one graft ligament disposed in said opening;
locking means for disposition in said opening and at least in part engageable with said graft ligament engagement means;

whereby movement of said locking means in said opening causes at least a part of said locking means to engage said graft ligament engagement means so as to urge said graft ligament engagement means, and hence said graft ligament, toward a wall of said opening, whereby to secure said graft ligament to said wall of said opening;
wherein said graft ligament engagement means comprises a U-shaped plate having two free ends, and said locking means is engageable with an outside back surface of said plate, whereby said movement of said locking means causes at least said part of said locking means to engage said said back surface of said plate to urge said plate and said graft ligament toward said wall of said opening to drive said plate free ends into said wall of said opening to secure said graft ligament to said wall of said opening;
wherein said locking means comprises one selected from a group consisting of a cam member, an expansion plug, a threaded interference screw, and a transverse screw; and wherein said anchor further comprises a tubular member for disposition in said opening in said bone and having open first and second ends and an opening in a side wall portion of said member, said graft ligament extending through said first and second ends of said member, and said plate being movable through said opening in said side wall of said tubular member to engage said graft ligament and to lodge in said bone opening wall.