Filament management device

The present disclosure relates to tools and methods for managing surgical implants with one or more related surgical filaments, and more specifically, storage that can be used to hold the implant in preparation for a surgical procedure. Regarding cards or equipment.

Joint injuries can generally result in complete or partial detachment of ligaments, tendons, and soft tissues from the bone. Tissue detachment occurs in a wide variety of ways, including, for example, accidents such as falls, work-related activities, athletics, or the result of excessive effort in any of many other situations and / or activities. sell. These types of damage are generally the result of excessive stress or anomalous forces acting on the tissue.

In the case of partial exfoliation, commonly referred to as "sprain", the injury often heals without medical intervention, leaving the patient at rest so that the injury is not exposed to excessively intense activity during the healing process. Consider. However, if the ligament or tendon is completely detached from the associated bone attachment site, or if the ligament or tendon is torn as a result of traumatic injury, the injured joint will be fully functional. Surgical intervention may be required to recover. There are many conventional surgeries to reattach such tendons and ligaments to bone.

One such operation involves forming a femoral and tibial tunnel aligned within the knee to repair the injured anterior cruciate ligament ("ACL"). In one ACL repair operation, the ligament graft is combined with the surgical implant and secured to the femur. Common ACL means femoral fixation, including elongated "buttons" sometimes called cortical buttons. Cortical buttons are attached to filament loops that are sized to allow the proper length of the soft tissue graft to be within the femoral tunnel while providing secure external fixation. The size of the filament loop can be adjusted by the filament rim extending from the filament. In addition, the cortical button has one or more additional filaments or sutures that are attached to the button to guide the implant and ligament implant during the surgical procedure and position it in the desired position on the human body. be able to.

Although filament rims and additional filament interventions that position the implant may be useful in the procedure, it can be difficult to manage the various filaments before and during the procedure. For example, prior to surgery, it can be difficult to efficiently package the implant while limiting the possibility that the filament will entangle itself and / or other filaments associated with the implant. The possibility of filament entanglement when the implant is removed from the initial packaging material can also cause a variety of problems. For example, the location where a ligament graft should be associated with an implant can be difficult to distinguish due to the entangled filaments. As a result, the user may associate the ligament implant with the wrong filament or part of it (eg, not all of the loops when the implant contains multiple filament loops), thereby prematurely implanting. Failure or other unfavorable consequences can occur. Moreover, it can be difficult to track various filaments, even during use during the procedure, which the surgeon thinks he is pulling one filament for a particular purpose. Instead, a user error can occur of pulling another filament for a different purpose.

Furthermore, implant misuse can occur because the user does not know where the implant is located in the human body. It may be important to know the exact location of the implant and / or ligament graft to bone and tissue in the human body during the procedure so that the ligament graft can be properly secured. In other cases, the surgeon may try to fix the implant and ligament graft when it is not in the desired position, or the surgeon may try to pull the implant or ligament further undesirably. Yes, this can damage implants, ligament grafts, or parts of the human body. Measurements can be made and markings can be made on the implants to help the surgeon know the location of the implants and ligament grafts, but the mechanisms and methods of measurement and marking are to be primitive. There is no change.

<p> Therefore, there remains a need for improved tools and methods for managing implants and ligament grafts, including related filaments, before and during surgery.</p>

<p> Generally, tools and methods for managing surgical implants are provided. Implants typically have one or more filaments associated with the implant and are used in connection with ligament implants. In one exemplary embodiment, a surgical implant management device extends between a first end, a second end, and a first end and a second end. Includes a body having opposite wall portions, an upper side and a bottom side. The tool can also be described as a card. Several features can be incorporated into the tool. One such feature may be an implantable body holder configured to hold the implantable body on the upper side of the body. Another such feature can be an opening, sometimes a graft receiving opening, that is located closer to the second end of the tool than to the first end. Yet another such feature can be a crease that extends across the body and intersects the opening between the opposing walls. The crease may be configured such that the second end of the body is bent towards the bottom side of the body to form the filament loop engagement region along the crease. The filament loop engagement region may be configured to receive one or more filament loops attached to an implantable body held by an implantable body holder.</p><p> In some embodiments, the graft receiving opening may be substantially symmetric along the central longitudinal axis extending substantially parallel to the opposite wall and approximately along the crease. A pair of opposing openings can be arranged on either side of the central longitudinal axis of the body, which can itself be substantially parallel to the opposite walls. The pair of opposing openings can be crossed by a crease. The structure of the graft receiving opening and the facing opening is such that a part of the main body arranged between the facing opening and the graft receiving opening receives one or more filament loops. It can be like forming a protrusion in the joint region.</p><p> A slit can be formed in the body between the implant receiving opening and the implantable body holder. The slit can be configured to receive a second end of the body that is bent towards the bottom of the body. In some embodiments, the alignment opening may be formed adjacent to an implantable body holder. The alignment opening may be configured to align the equipment on the implant preparation board.</p><p> A further feature of the implant management tool can be one or more signs formed on the upper side of the body between the implantable body holder and the crease. The sign may be configured to be used to mark an index on one or more filament loops attached to an implantable body held by an implantable body retainer. Indicates the relevant depth for the surgical procedure, such as the depth of the bone tunnel. In some embodiments, in addition to the above-mentioned markings, or in alternatives to the above-mentioned markings, the markings may be formed on the upper side of the body between the crease and the second end. Marks are configured to be used to mark indicators on ligament implants associated with one or more filament loops attached to an implantable body held by an implantable body retainer. Gain, indicators indicate the depth of association for the surgical procedure.</p><p> One or more filament holding features may also be incorporated as part of the tool. In some embodiments, the feature may be placed between the first end and the implantable body holder. One embodiment of such a feature may be a pair of opposing tabs extending below the bottom side of the body, with one or two tabs extending from the implantable body associated with the tool. It is configured to hold the above filament rim. Further, a hole can be formed in the body and communicate with a slit formed in the first end. The holes may be configured to receive one or more filament rims extending from the implantable body through the slits. Another embodiment of the filament holding feature may be a hole formed in the body communicating with a slit formed in one of the opposite walls. The holes may be configured to hold one or more filament rims extending from the implantable body associated with the tool. The rim can be slid into the hole through the slit. Yet a further embodiment of the filament holding feature may be a tab formed from two slits formed in one of the opposed wall portions. The tab may be configured to hold one or more filament rims extending from the implantable body associated with the tool.</p><p> In some embodiments, the device can be associated with an implant management tool. The tool can have a variety of configurations, but in one exemplary embodiment, the tool comprises an implantable body and one or more filament loops attached to the body. One or more filament loops may have at least one rim extending from the loop. In some embodiments, the rim may be configured to adjust the size of one or more of the loops when tension is applied to the rim. The implantable body can be held by the implantable body holder, the loop can be held in tension by the filament loop engagement region, and the rim can be held by one or more of the filament holding features of the tool. Can be kept tense. In some embodiments, the implant may further comprise at least one of a shuttle filament and a toggle filament attached to an implantable body. The reciprocating and / or toggle filament can be held in tension by one or more of the filament holding features.</p><p> Another exemplary embodiment of a surgical implant management instrument comprises a body having opposed first and second surfaces and opposed first and second ends. The tool can also be described as a card, and some features can be incorporated into the tool. One such feature can be an implantable body holder positioned between the first and second ends. Another such feature may be a first filament receiving region located at the second end of the body. The first filament receiving region may include at least one feature that projects from the second end in a direction that is substantially parallel to the longitudinal axis of the body. In addition, the first filament receiving region may be configured to receive one or more filament loops attached to an implantable body held by an implantable body holder. Yet another feature may be an opening located between the implantable body holder and the first filament receiving region. The opening, sometimes referred to as the graft receiving opening, is a ligament that can extend between the first and second surfaces of the body and should be attached to one or more of the filament loops. It can be configured to receive a graft. Moreover, a further feature of the tool can be one or more signs formed on the first surface of the body. The mark can be located between the implantable body holder and the first filament receiving area and is used to mark one or more of the indicators on one or more of the one or more filament loops. Can be configured as Indicators may indicate the relevant depth for the surgical procedure, such as the depth of the bone tunnel.</p><p> The implant management tool may also include a second filament receiving region formed in close proximity to the first end of the body. One or more of the various filament holding features may be included as part of the second filament receiving area, thus such features are the first end and implantable body holder. Can be placed between and. For example, the region may include a pair of opposing tabs raised above the second surface of the body, which tabs may include one or more filament rims extending from the implantable body associated with the tool. Configured to hold. As a further embodiment, holes can be formed within the body and communicate with slits formed within the first end. The holes may be configured to receive one or more filament rims extending from the implantable body through the slits. Moreover, a further embodiment of the filament holding feature, which is installed as part of the second filament receiving region, is in the body and in the first opposed wall portion and the second opposed wall portion. It can be a hole formed in communication with a slit formed in one of them, and the opposite walls both extend between the first and second ends. The holes may be configured to extend from the implantable body and hold one or more filament rims slid into the holes through slits. A still further embodiment of the filament holding feature is a tab formed from two slits formed in the opposite walls of the body. The tabs may be configured to hold one or more filament rims extending from the implantable body.</p><p> In some embodiments, at least one protruding feature of the first filament region may include two protrusions. In certain configurations, the space between the two protrusions can form an opening path to the implant receiving opening located between the implantable body holder and the first filament receiving region. Another feature of the implant management tool may be an aligned opening formed adjacent to the implantable body holder. The alignment opening can extend between the first surface and the second surface and can be configured to align the tool on the implant preparation base board.</p><p> Implant management tools may also include one or more second signs. A second sign can be formed on the second surface of the body between the second end of the body and the end of the graft receiving opening located at a distance from the second end. .. Marks are configured to be used to mark indicators on ligament implants associated with one or more filament loops attached to an implantable body held by an implantable body retainer. Gain, indicators indicate the depth of association for the surgical procedure. In some embodiments, a portion of the second surface is a crease that extends substantially laterally to the longitudinal axis of the body at a location between the implantable body holder and the second end. It can result from bending the body of the tool along.</p><p> The implantable body holder may include a pair of opposing tabs. The base of the first tab may be located on the first side surface of the central longitudinal axis extending longitudinally through the body, and the end of the tab may be located on the second opposite side of the central longitudinal axis. .. The base of the second tab can be located on the second side of the central longitudinal axis and the end of the tab can be located on the first side of the central longitudinal axis. The distance between the second tab and the first end can be shorter than the distance between the first tab and the first end.</p><p> In some embodiments, the device can be associated with an implant management tool. The tool can have a variety of configurations, but in one exemplary embodiment, the tool comprises an implantable body and one or more filament loops attached to the body. One or more filament loops may have at least one rim extending from the loop. In some embodiments, the rim may be configured to adjust the size of one or more of the loops when tension is applied to the rim. The implantable body can be held by the implantable body holder, the loop can be held tense by the filament receiving area, and the rim can be held tense by the second filament receiving area.</p><p> One exemplary embodiment of the method of preparing a ligament implant for implantation involves positioning the ligament implant through the implant receiving opening of the implant management card. An implantable body can be placed on the card, the body having one or more filament loops associated with the body. At least a portion of the graft receiving opening may be placed within the loop opening of at least one of the one or more filament loops. A method in which a ligament implant can be prepared may further include applying tension to the ligament implant and marking the depth on at least one of the filament loops, with a first depth. The markings used for marking are placed on the first surface of the implant management card. In some embodiments, the first depth to be marked can be the overall bone reserve depth.</p><p> The method may further include disconnecting the implantable body and the filament loop associated with the body from the implant management card. In some embodiments, a second depth can be marked, the depth being marked on the ligament implant. The marking used in marking the second depth can be placed on the surface of the implant management card on the second opposite side. The marked second depth may indicate the in-tunnel graft depth. When marking the second depth on the ligament implant, the method may include spreading the implant management card to indicate the indicia used in marking the second depth. Furthermore, applying tension to the ligament graft positions the struts of the implant preparation board within the alignment opening of the implant management card and struts the ligament graft to apply tension to the ligament graft. It can include moving away from.</p>

The present invention will be more fully understood by reading the following detailed description in conjunction with the accompanying drawings.<figref num="1A">FIG. 3 is a perspective view of one exemplary embodiment of a prior art surgical implant.</figref><figref num="1B">FIG. 3 is a perspective view of another exemplary embodiment of a prior art surgical implant.</figref><figref num="2A">FIG. 3 is a plan view of one exemplary embodiment of a surgical implant management instrument in an unfolded configuration.</figref><figref num="2B">It is a top view of the tool of the folded block diagram 2A.</figref><figref num="2C">FIG. 2 is a perspective plan view of the tool of FIG. 2B with the associated implant of FIG. 1A.</figref><figref num="2D">It is a perspective bottom view of the tool of FIG. 2C.</figref><figref num="3A">FIG. 3 is a plan view of another exemplary embodiment of a surgical implant management instrument in an unfolded configuration.</figref><figref num="3B">It is a top view of the tool of the folded block diagram 3A.</figref><figref num="4">FIG. 5 is a plan view of yet another exemplary embodiment of a surgical implant management tool.</figref><figref num="5">FIG. 3 is a plan view of another exemplary embodiment of a surgical implant management tool.</figref><figref num="6">FIG. 3 is a plan view of yet another exemplary embodiment of a surgical implant management tool.</figref><figref num="7">FIG. 5 is a plan view of an exemplary embodiment of a surgical implant management tool.</figref><figref num="8">FIG. 3 is a plan view of another exemplary embodiment of a surgical implant management tool.</figref><figref num="9">FIG. 3 is a plan view of yet another exemplary embodiment of a surgical implant management instrument in an unfolded configuration.</figref><figref num="10A">FIG. 3 is a plan view of another exemplary embodiment of a surgical implant management instrument in an unfolded configuration.</figref><figref num="10B">FIG. 3 is a plan view of yet another exemplary embodiment of a surgical implant management instrument in an unfolded configuration.</figref><figref num="11">FIG. 3 is a plan view of an exemplary embodiment of a surgical implant management instrument in an unfolded configuration.</figref><figref num="12">FIG. 3 is a plan view of another exemplary embodiment of a surgical implant management instrument in an unfolded configuration.</figref><figref num="13">FIG. 3 is a plan view of yet another exemplary embodiment of a surgical implant management instrument in an unfolded configuration.</figref><figref num="14A">It is one exemplary embodiment of a filament management tool used with a surgical implant management tool.</figref><figref num="14B">For example, another exemplary embodiment of the filament management tool used with the surgical implant management tool of FIG.</figref><figref num="15A">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15B">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15C">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15D">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15E">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15F">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15G">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15H">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15I">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15J">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15K">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15L">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15M">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15N">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15O">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15P">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15Q">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15R">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="15S">FIG. 10 is a continuum showing one exemplary embodiment of forming the surgical implant management instrument of FIG. 10A and associating the implant of FIG. 1A with the instrument.</figref><figref num="16">FIG. 3 is a perspective view of one exemplary embodiment of a graft preparation tool.</figref><figref num="17A">FIG. 15S is a perspective view of the surgical implant management tool and the implant coupled to the implant preparation tool, the implant and the draft preparation tool having a ligament implant associated with the surgical implant management tool.</figref><figref num="17B">FIG. 17A is a perspective view of a surgical implant management tool, an implant, a implant preparation tool, and a ligament implant showing a user marking a ligament implant.</figref><figref num="18A">FIG. 6 is a schematic continuum of one exemplary embodiment of implanting the ligament implant of FIG. 17B into a bone tunnel using the implant of FIG. 15S previously associated with the implant preparation tool of FIG. 17B.</figref><figref num="18B">FIG. 6 is a schematic continuum of one exemplary embodiment of implanting the ligament implant of FIG. 17B into a bone tunnel using the implant of FIG. 15S previously associated with the implant preparation tool of FIG. 17B.</figref><figref num="18C">FIG. 6 is a schematic continuum of one exemplary embodiment of implanting the ligament implant of FIG. 17B into a bone tunnel using the implant of FIG. 15S previously associated with the implant preparation tool of FIG. 17B.</figref><figref num="18D">FIG. 6 is a schematic continuum of one exemplary embodiment of implanting the ligament implant of FIG. 17B into a bone tunnel using the implant of FIG. 15S previously associated with the implant preparation tool of FIG. 17B.</figref><figref num="18E">FIG. 6 is a schematic continuum of one exemplary embodiment of implanting the ligament implant of FIG. 17B into a bone tunnel using the implant of FIG. 15S previously associated with the implant preparation tool of FIG. 17B.</figref><figref num="18F">FIG. 6 is a schematic continuum of one exemplary embodiment of implanting the ligament implant of FIG. 17B into a bone tunnel using the implant of FIG. 15S previously associated with the implant preparation tool of FIG. 17B.</figref><figref num="19A">FIG. 15 is a schematic representation of one exemplary embodiment of a knee in which a femoral tunnel configured to receive a ligament graft of FIG. 17B using the implant of FIG. 15S is formed.</figref><figref num="19B">FIG. 19A is a schematic view of the knee of FIG. 19A with the ligament graft of FIG. 17B and the associated implant.</figref>

Certain exemplary embodiments will be described below so that the principles of structure, function, manufacture, and use of the devices and methods disclosed herein are comprehensively understood. One or more examples of these embodiments are shown in the accompanying drawings. It is defined herein that the devices and methods described in detail herein and shown in the accompanying drawings are non-limiting exemplary embodiments, and that the scope of the invention is defined solely by the claims. Those skilled in the art will understand. The features exemplified or described in the context of one exemplary embodiment can be combined with the features of another embodiment. Such modifications and modifications shall be included within the scope of the present invention. As a result, one exemplary embodiment of a surgical implant management tool includes, to the extent that it includes a particular feature, one of ordinary skill in the art, including in various embodiments of the tool as defined herein. , And other tools used to manage implants known to those of skill in the art, the features of which may be incorporated into other surgical implant management tools.

In the present disclosure, similar numbered components of embodiments generally have similar features and / or objectives. In addition, as long as linear or circular dimensions are used in the disclosed system, device, and method descriptions, such dimensions are of shapes that can be used with such systems, devices, and methods. It does not try to limit the type. It will be appreciated by those skilled in the art that it is possible to easily determine dimensions corresponding to these linear and circular dimensions for any geometric shape. The size and shape of the implant management tool, and the components associated with the device, are the anatomy of the subject in which the implant will be used, the size and shape of the component in which the implant management tool will be used. It may depend, at least to some extent, on the shape and the methods and procedures in which the system and tools will be used. To the extent that the features are described herein as "first features" or "second features", such numerical ordering is largely arbitrary and therefore such numbering. Can be replaceable.

The drawings specified herein are not necessarily on exact scale. Further, to the extent that arrows are used to describe the direction in which the components are pulled or pulled, these arrows are exemplary and each component is pulled or pulled. It does not limit the direction. One of ordinary skill in the art will recognize other methods and directions for achieving the desired tension or movement. Similarly, in some embodiments, the movement of one element is described for another, but one of ordinary skill in the art will recognize that other movements are possible. In addition, various terms may be used interchangeably throughout the disclosure, which will be appreciated by those skilled in the art. As a non-limiting example, the terms "suture" and "filament", "bent", and "bent" may be used interchangeably.

The present disclosure generally relates to surgical implant management tools that selectively hold surgical implants or other components. The management tool can also be used to hold the implant components prior to use in the surgical procedure, and at least to some extent, for some of the features provided as part of the tool, of the surgical procedure. It can also be used to facilitate preparation. For example, as described in more detail below, the device helps the user better know the location of the implant and ligament implant during the surgical procedure so that the user can better know the location of the implant and / or the implant. Can include features that allow easy marking of specific distances on ligament implants associated with. The tool can include additional tools, such as features that are incorporated with the tool, such as a measurement mark on the surface of the tool so that the ruler is not needed to determine a particular distance or length. .. Furthermore, the various configurations defined herein can make it easier to prevent the filaments of the implant from becoming entangled in order to more easily identify the filaments, and generally the implants. It can be used to make it easier to perform implant-related procedures.

Surgical implant Although the disclosures defined herein can be used in connection with a variety of implants, two non-limiting exemplary embodiments are shown in Figures 1A and 1B. Each of the implants 10, 10'is generally an implant associated with one or more filaments in which at least one filament forms one or more adjustable coils, or loops 14, 14'. Includes possible body 12, 12'. More specifically, FIG. 1A shows an implant 10 containing a body 12 having a through hole formed therein and a first suture filament 11 associated with it. The first filament 11, sometimes referred to herein as a graft-holding suture, either binds to the body 12 or is otherwise associated with the body 10 to implant the graft ligament. Can be configured to hold in. In an exemplary embodiment, a portion of the first filament 11 is formed in a plurality of adjustable coils or loops 14 defined by a self-locking knot 13 located on the upper 12t of the body 10 and loops 14. Is mainly arranged on the lower surface 12b of the main body 12. Filament 11 comprises, as shown, at least one adjustable rim or tail extending from knot 13, i.e., a first adjustable rim 15a and a second adjustable rim 15b. The rims 15a, 15b can act to adjust the size of one or more openings 14o formed when tension is applied to the loop by one or more of the loops 14. It can be possible.

One or more additional filaments may be detachably associated with the body 12 to help control the implant during the surgical procedure. As shown, the second filament 16 is located in a through hole located within the first end of the body 12, sometimes referred to herein as a reciprocating suture or filament, or anterior suture or filament. A third filament 18, sometimes referred to herein as a posterior or toggle suture or filament, is located in a through hole located within the second end of the body 12. These two filaments 16, 18 collectively referred to as guide filaments, can be used to help position and set the implant 10, so the ligament implant can be used at the desired implant location. Associated with implants. In an exemplary embodiment, the first rim 16a and the second rim 16b of the second filament 16 extend from both sides of one through hole and the first rim 18a and the second of the third filament 18 Rim 18b extends from both sides of another through hole.

Further, in some exemplary embodiments, the respective rims 16a, 16b have receiving portions 17a, 17b configured to receive the respective portions of the first and second adjustable rims 15a, 15b. Can include. Placement within the receiving portions 17a, 17b of the rims 15a, 15b assists filament management, as well as any cutting of the first and second adjustable rims 15a, 15b provides the integrity of the self-locking knot 13. It can provide a convenient way to help ensure that it is not detrimental. More specifically, parts of the rims 15a, 15b located within the receiving portions 17a, 17b can be trimmed to maintain the integrity of the knot 13. Those skilled in the art will recognize that the integrity of the knot 13, and therefore the strength of the implant 10, can be compromised when the rims 15a, 15b are cut too close to the body 12. Further details regarding implants of the properties shown in Figure 1A can be found in "Implant Having Filament Limbs of an Adjustable Loop Disposed in a" filed on December 11, 2013. It is described in US Patent Application No. 14 / 103,167 entitled "Shuttle Suture", the content of which is incorporated herein by reference in its entirety.

The implant of FIG. 1B is another exemplary embodiment of implant 10'that can be used in connection with implant management tools and the surgical procedures defined herein. As shown, implant 10'is similar to implant 10 in FIG. 1A, except that it provides an alternative configuration that protects the integrity of the knot of the first filament. Like the implant 10, the implant 10'has a body 12'with a through hole formed therein and a first filament that is attached to or otherwise associated with the body 12'. Includes 11'and second and third filaments 16', 18' that are removably coupled to the opposing through holes of the body 12'. A portion of the first filament 11'can be formed into a plurality of adjustable coils or loops 14' defined by self-locking knots 13' located on the upper side 12b' of the body 12', loop 14'. Is mainly arranged on the lower surface 12b'of the main body 12'. The filament 11'has at least one adjustable rim or tail extending from the knot 13', i.e. the first adjustable rim 15a'and the second adjustable rim 15b', as shown. The rims 15a', 15b' can include one or more openings 14o'formed when tension is applied to the loop by one or more of the loops 14'. Can be actuated to adjust the size of. The second and third filaments 16', 18'can act as anterior and posterior filaments, with the first and second rims 16a', 16b' of the second filament 16' being one. Extending from both sides of the through hole d, the first and second rims 18a', 18b' of the third filament 18'extend from both sides of another through hole.

Unlike the embodiment of FIG. 1A, the second filament 16'does not receive part of the adjustable rims 15a', 15b'. Instead, a sleeve or spacer 19'is adjacent to the top surface of the body 12', at the top 12t' of the body 12', and part of the first and second adjustable rims 15a', 15b'. Placed on top. More specifically, as illustrated, the sleeve 19'is a single suture filament with multiple holes formed in it to receive the first and second adjustable rims 15a', 15b'. is there. The sleeve 19'can be placed around a portion of the first rim 15a'on the top 12t', wound around the bottom of the body 12', and then placed around a portion of the second rim 12b'. It can be wound again on the upper 12t'as possible. When the sleeve 19'is wound around the bottom of the body 12', the adjustable rims 15a', 15b' end 15t when the rims 15a'15b' are tense.₁', 15t₂It can help minimize the proximal movement of the sleeve 19'towards. 1st end 15t₁'Can enter the sleeve 19' in the first hole 19a'and exit the slave 19' in the second hole 19b', while the second end 15t₂'Can enter the sleeve 19' through the third hole 19c'and exit the sleeve 19' through the fourth hole 19d'. Similar to the receiving portion 17 of the implant 10, the sleeve 19'can help prevent the surgeon from cutting the rims 15a', 15b'too close to the body 12'. More specifically, for this embodiment, the sleeve 19'can generally have elastic properties such that it bundles when compressive forces are applied, and the surgeon then approaches holes 19b', 19d'. Rim 15a', 15b' can be cut at the place. Further details regarding implants of the properties shown in Figure 1B can be found in U.S. Patent Application No. 13 / 793,514 entitled "Implant Having Adjustable Filament Coils" filed March 11, 2013. , The whole is incorporated herein by reference.

Implants of the properties specified herein, as well as various other configurations of other types of implants, may be used in connection with the disclosure made herein in relation to implant management tools and methods. As a non-limiting example, in some embodiments, one or more loops associated with the implant body may be non-adjustable and fixed, and one or more extending from the body. Two or more rims can be configured for other purposes as well as adjusting the size of the loop, such purposes are known to those of skill in the art.

Implant Management Tools Figures 2A and 2B show one exemplary embodiment of the Surgical Implant Management Tool 100, sometimes referred to herein as an implant management card. The unfolded card 100 is shown in FIG. 2A, while the configuration of the folded card 100, which may be referred to herein as a compact configuration, is shown in FIG. 2B. More specifically, FIG. 2B shows the result of bending the second portion 128 of the card 100 under the illustrated top side or top surface 112, i.e. toward the bottom side or bottom surface 114 of the card 100 (FIG. 2D). can get. This results in the marking 136 being formed on the second portion 128, as shown in FIG. 2A, which is visible on the bottom side 114 of the card 100, as shown in FIG. 2D. In a folded, or compact configuration, the second portion 128, in particular the indicia 136 formed in that portion, can be part of the bottom surface 114 for all intent and purpose.

The body 102 of the card 100 itself may have various shapes and configurations, some of which are shown herein and many others can be derived under the present disclosure, but in an exemplary embodiment, the body 102 , Has a generally rectangular shape defined by opposite wall portions 108, 110 extending between the first end 104, the second end 106, and the two ends 104, 106. The tool also includes an upper side or top surface 112, referred to as the first side or surface, and a bottom side or bottom 114, sometimes referred to as the second side or surface. The central longitudinal axis L can extend the length of the body 102 and can be located approximately equidistant from the two opposing sides 108, 110. For ease of reference, the central longitudinal axis L will be used in each of the embodiments described herein, even when other reference numbers change. The body 102 can be generally defined as having a length l, a width w, and a thickness t (not described, but extending between the top surface 112 and the bottom surface 114). Depending on the configuration of the card 100, any of the length l, width w, and thickness t may change when the card 100 is moved from an unfolded configuration to a folded configuration.

Although the body 102 is described as being approximately rectangular in shape, those skilled in the art will appreciate a single straight line in which the first and second ends 104, 106 are perpendicular to the central longitudinal axis L, as is a typical rectangle. You will find that it is not. Instead, the ends 104, 106, respectively, taper towards the midpoints 104M, 106M, thus creating symmetrical ends. As discussed below, the first and second ends 104, 106, without departing from the spirit of the present disclosure, at least to some extent, other features, shapes, and various other shapes depending on the dimensions of the card. Can have. In an exemplary embodiment, the length l in the unfolded configuration can be approximately in the range of about 100 mm to about 250 mm, and in the folded configuration is approximately in the range of about 80 mm to about 220 mm. The width w in the folded or unfolded configuration can be in the range of approximately 35 mm to about 80 mm, and the thickness t in the unfolded configuration is approximately 0.01. It can be in the range of millimeters to about 1 millimeter, the thickness t varies for each part of the card in the folded configuration based on the amount of folds made, and such thickness changes are easily made by those skilled in the art. It is possible to judge. In one exemplary embodiment, the length l in the unfolded configuration can be approximately 160 mm, the length l in the folded configuration can be approximately 130 mm, and the width w can be approximately 55 mm. It can be millimeters and the thickness t in the unfolded configuration can be approximately 0.5 millimeters.

The Surgical Implant Management Tool 100 includes several different features that enhance the user's ability to manage filaments before and during the surgical procedure. One such feature is the implantable body holder 116. As shown, the implantable body holder includes two staggered facing tabs 118, 120 configured to grip the opposite ends of the implantable body. The tabs 118, 120 can be configured to hold the body at a specific location in line with the marks 134, 136 formed on the tool 100. Therefore, the first tab 118 can be adjacent to the 0 mm mark line, and the second tab 120 is closer to the first end 104 than the first tab 118 of the first tab 118. Get away from the location. Both tabs 118, 120 are pivoted at their respective bases 118b, 120b so that the ends 118e, 120e of the tabs 118, 120 can exit the plane extending substantially through the top surface 112. Can be configured in. As designed, both tabs 118, 120 can pivotally come to the page as shown in Figure 2C, so that the implant body is pushed under the tabs 118, 120 and the other on the top surface 112. Can be supported by the part of. Thus, in an exemplary embodiment, tabs 118, 120 act to hold the implant body onto the top surface 112 of the implant management tool 100.

Tabs 118, 120 of the implantable body retainer 116 may have various shapes and sizes, at least to some extent, depending on the size and shape of the implant management tool and other parts of the implant itself, but in the exemplary embodiments. , Two tabs 118, 120 have a finger shape that can also be described as oblong and semi-elliptical. The lengths of the tabs 118 and 120, respectively, are such that the bases 118b and 120b extend on one side of the central longitudinal axis L, while the ends 118d and 120e of the same tabs 118 and 120 face the central longitudinal axis L. It's like extending on the side of doing things. This external shape can help secure the implant body to the surface 112 during use.

Another feature of the tool 100 may be the filament loop engagement region 122, sometimes referred to herein as the first filament receiving region, one of which extends below the bottom side of the implant body. Alternatively, it can be used to hold and tension two or more filament loops. The filament loop engagement region 122 can have many different configurations. In the embodiment illustrated in FIG. 2B, the filament loop engagement region 122 includes at least one protruding feature, as shown by the two protrusions 124, and the filament loop can be placed around the feature. As a result, all of the implant loops can be held together in tension by a single component. The protrusion 124 can be formed by bending a part of the tool 100 along the crease 126 formed in the main body 102. More specifically, the second portion 128 of the tool 100 is the portion of the tool 100 disposed between the crease 126 and the second end 106 as shown, but towards the bottom surface 114, i.e., by way of example. You can fold into the page as you do. As a result, the combination of the opposed cutouts formed through the body 102, i.e. the opening 130, and the central cutout formed through the body, i.e. the opening 132, opposes the protrusions. 124 can be formed. In an exemplary embodiment, the opposed openings 130 have a generally triangular shape, but various other shapes can be used to form the opposed openings. Further, as shown, the crease 126 intersects and substantially bisects the triangular shaped cutout 130. The tapered portion formed by the sides of the triangular shaped cutout 130 can help prevent the loop from slipping off the protrusion 124.

The crease 126 can extend between the opposite wall portions 108 and 110 over the width w of the main body 102. Those skilled in the art will appreciate that the location of the crease 126, and thus the end of the protrusion 124, will depend on a variety of factors, including the implant used in connection with the implant management tool and the type of procedure in which the implant is used. You will recognize that. In some exemplary embodiments, the fold 126 is approximately positioned to allow tension to be applied to the loop as a result of the loop engaging the protrusion 124. In some implant embodiments, the size of the loop can be adjusted using filament rims so that the loop can be properly tensioned at the protrusion 124.

The protrusion 124 forming the filament loop engagement region 122 illustrated in FIG. 2B is formed by bending over a portion of the body 102, as other configurations engage with the filament loop extending from the implant body. Can be used for. For example, in some embodiments, the filament loop engagement region 122 may be preformed on the tool 100 such that no bending or other modification to the initial configuration is required to form the filament loop engagement region 122. .. Thus, in some embodiments, the protrusion 124 may be preformed at the second end 106 of the tool 100.

The opening 132, which forms a portion of the protrusion 124, can also be used to receive a ligament implant. As shown, at least a portion of the implant receiving opening 132 can be placed between the implantable body holder 116 and the protrusion 124, when the ligament implant is passed through the opening 132. In addition, as described in more detail below, the implant is threaded through at least one of the filament loop openings. In an exemplary embodiment, the opening 132 is closer to the second end 106 than the first end 104.

The openings 132 can have any number of shapes and sizes, but in an exemplary embodiment, they are symmetrical along the central longitudinal axis L. The opening 132 can also be bisected by the crease 126 and can therefore be symmetrical with respect to the crease 126. As a result, when the second portion 128 is bent towards the bottom side 114, the resulting configuration is that one half of the opening 132 is substantially the other half of the opening 132. It is a configuration that is aligned with each other.

In an exemplary embodiment, the approximate shape of the opening 132 in the unfolded configuration can be similar to a dumbbell. When folded, the larger portion 132a of the dumbbell-shaped opening 132 can be large enough to receive the ligament implant, while the smaller portion 132b of the opening 132 forms the shape of the protrusion 124. Can help. In particular, the portion of the tool 100 disposed between the smaller portion 132b and the facing opening 130 forms a protrusion 124 of the filament loop engagement region 122. As shown in FIG. 2B, the space 124s between the two protrusions 124 can form an open path to the rest of the opening 132. In other embodiments, the material may be placed between the two protrusions 124, thus eliminating the open path.

Another feature of the tool 100 may be a first sign 134 formed on the upper 112 side. The first sign 134 may be used for a variety of reasons, but in one exemplary embodiment it may help the user mark a particular measurement result on the loop of the implant coupled to the tool 100. .. In some examples, the first mark 134 can be used to mark a particular measurement result on a ligament implant. In an exemplary embodiment, the first mark 134 begins in close proximity to the first tab 118 at 0 mm and extends to 50 mm, the mark being located approximately at crease 126. Each marking line extends substantially parallel to crease 126. Each solid line indicates a 10 mm increment, and each dotted dotted line indicates a 5 mm increment between each 10 mm mark line. Other signs are also allowed on the top surface of the tool. For example, the second mark 136 may be made between the crease 126 and the second end 106 at the top 112. As shown, an additional 30 mm is marked in 5 mm increments between the crease 126 and the second end 106. The second mark 136 may be used to assist in marking specific measurement results on the ligament implant associated with the implant or on the filament of the implant, depending on the implant and implant management tool configuration.

A receiving slit 138 that receives the second end 106 when the main body is bent toward the bottom side 114 can be formed in the main body 102. As shown in FIG. 2A, the receiving slit 138 can be arranged between the crease 126 and the first end 104 and can extend substantially parallel to the crease 126. In an exemplary embodiment, the receiving slit 138 is actually between the implantable body holder 116 and the crease 126. However, the location of the receiving slit 138 can be largely dependent on the shape and length of the second end 106 that is bent towards the bottom side 114. Therefore, the length between the crease 126 and the receiving slit 138 can be approximately the same as the length of the second portion 128. The length and shape of the slit 138 can correspond to the shape of the second end 106 configured to receive the slit.

Another feature that can be incorporated into the tool 100 is the alignment opening 140 that associates the tool 100 with the implant preparation tool. In an exemplary embodiment, the alignment opening 140 is located between the implantable body holder 116 and the crease 126, adjacent to the implantable body holder 116. The hole 140 may have a variety of shapes and sizes adapted to receive the struts of the implant preparation tool. Those skilled in the art will use the implant preparation tool with the ligament implant so that in light of the disclosure provided herein, appropriate notation can be made on the ligament implant and on the implant management instrument. You will recognize that you will get. Examples of implant preparation tools will be discussed below, but those skilled in the art will recognize the various graft preparation tool configurations that the Implant Management Tool 100 may be adapted for use in combination. The alignment opening 140 can be generally elongated and, in the exemplary embodiments, generally teardrop-shaped. The first end 140a of the opening 140 can be configured to complement the size of the graft preparation tool struts, while the second end 140b receives the struts first and is an implant management tool. It can have a diameter larger than the first end 140 to make it easier to position the 100 so that the stanchion engages the tool 100 at the first end 140a.

Several features that help manage the rim and other filaments that generally extend from the upper side of the implant may also be included as features of the tool 100. These features may be broadly referred to as filament holding features, and at least a portion of these features on the tool 100 may sometimes be referred to as a second filament receiving region 142. At least some of these features may apply tension to the filament to help retain the filament associated with the implant as well as keep the filament out of the way.

An embodiment of the filament retention feature is shown in opposite tabs 144, 146 and FIGS. 2A and 2B formed between the implantable body retainer 116 and the first end 104. As shown, it can be explained that the tabs 144 and 146 can be separated from the central longitudinal axis L at approximately equal distances and are arranged horizontally with respect to the central longitudinal axis L. Each tab 144, 146 can include two folds 144b, 144c and 146b, 146c. The first, more centrally located creases 144b, 146b can be formed between the tabs 144, 146 and the body 102, so that the tabs 144, 146 extend substantially through the body 102. It can be taken out from the existing plane. In an exemplary embodiment, tabs 144, 146 can be configured to move in opposite directions to the implantable body holder tabs 118, 120, as shown in FIG. 2D, and thus the page when folded. Can be extended inward. The tabs 144, 146 can be folded along the second creases 144c, 146c to provide receiving areas 144r, 146r on which filaments can be wound. As shown in FIG. 2D, the end portions 144e, 146e of the tabs 144, 146 can be substantially parallel to a plane extending substantially through the body 102. Any part of any filament associated with the implant can be wound around tabs 144, 146, as described in more detail below. Tabs 144, 146 can help keep the various filaments together and also reduce the likelihood that any filament will become entangled. The filament can also be kept tense when wound around tabs 144, 146.

The centrally located slit 148 can be formed within the first end 104 and extend towards the tabs 144, 146. The slit 148 can act as an access point for the filament to be placed before winding around the tabs 144, 146. As shown , the slit 148 terminates at a hole 150 extending through the body 102. A portion of the filament can be placed in the hole 150 before being wound around the tabs 144, 146.

Another feature that holds the filament is provided by means of a hole 152 that extends through the body 102 and is configured to receive any of the filaments. The hole 152 is located in the second filament receiving region 142 close to the first end 104 between the centrally located slit 148 and one of the first and second opposed wall portions 108, 110. Can be placed in. The slit 154 can communicate with the hole 152 and extend to the opposite wall portion closest to the hole 152, the first wall portion 108, as shown. As shown by FIGS. 2C and 2D, the filament can be wound around tabs 144, 146 and extend from tabs 144, 146 towards hole 152 and slid into hole 152. The slit 154 can be passed through. In addition to tabs 144, 146 that maintain tension within the filament, in some embodiments the hole 152 is also similar to, for example, the hole 152 being the total diameter of the filament placed in the hole. When having a diameter, it can help maintain tension in the filament.

The retention tab 156 can be installed as an additional feature to assist filament retention and management. As shown, the holding tab 156 can be located along one of the opposite walls 108, 110, the first wall 108 as shown, and along the wall 108. It can be placed more centrally than the holes 152 and slits 154. In particular, the holding tab 156 can be arranged along the length l of the body 102 between the opposing tabs 144, 146 and the implantable body holder 116. The retention tab 156 can be formed substantially parallel to the crease 126 by two slits 158, 160 extending from the wall 108 and towards the central longitudinal axis L, and the two slits 158, 160. Can include two creases 156b, 156c formed within the tab approximately perpendicular to. The folds 156b, 156 can allow the tab 156 to form a sleeve that receives the filament, and in at least some examples tension is applied to the filament placed within the tab and / or Tension can be maintained in the filament. The more centered crease 156b can be formed between the body 102 and the tab 156 so that the tab 156 extends inward or out of the page. The second fold 156c can allow the end 156e of the tab 156 to be folded back towards the body 102 to form the sleeve, as shown in FIGS. 2C and 2D. By keeping the filament towards the edge of the tool 100, the user can more easily see the implant loop, the ligament implant, and the marks 134, 136 without the filament disfiguring.

2C and 2D show the tool 100 with the associated implant 10. As shown, the body 12 of the implant 10 can be held in place by an implantable body holder 116 such that the start of the loop 14 extending from the bottom side 12b is a nearly 0 mm line. it can. The loop can extend towards the filament loop engagement region 122 and can be held in place in tension by the protrusions 124. As a result, the opening 132 that receives the ligament implant is bordered by the loop 14.

Adjustable rims 15a, 15b, as well as each of the two guide filaments 16, 18 associated with the body 12, can extend from the body 12 towards the first end 104. The rims 15a, 15b and the guide filaments 16, 18 can extend through the slit 148 to the centrally located hole 150, and then to the tabs 144, 146 below the bottom side 114 of the tool 100. Can be wound. The rims 15a, 15b and the guide filaments 16 and 18 can extend towards the first wall 108, at which the rim and filament access the hole 152. It can be placed in the side slit 154. The rims 15a, 15b and guide filaments 16, 18 can then extend towards the filament loop engagement region 122 and are gripped by a sleeve formed by the retaining tab 156 prior to final termination. be able to. Further details regarding the technique of attaching the implant to the tool or card will be described in more detail with respect to FIGS. 15L-S.

As shown, the first mark 134 can be used to mark the measurement result on the loop 14, but the 0 mm mark line coincides with the approximate starting point of the loop 14 relative to the body 12. Because it does. The second sign 136 can be used in one of two methods. As shown in FIG. 2D, the second sign 136 is located on the bottom side 114 of the tool. In one exemplary embodiment, the second end 106 can be removed from the receiving slit 138 and returned approximately in place in an unbent configuration. A ligament implant then placed in loop 14 and extending away from the process in direction A is marked on the implant using a second mark 136, as described in more detail below. Can have the measured results. Alternatively, the bottom so that the second mark 136 can be used to mark the measurement result on the ligament implant when the ligament implant is associated with the loop and then the body 102 is in a folded configuration. It can extend along the side 114 towards the first end 104.

Alternative Embodiments of Implant Management Tools Figures 3A-13 define various other embodiments of implant management tools. The feature portions exemplified by these embodiments include other feature portions and / or the same feature portions described with respect to the tools of FIGS. 2A to 2D in combination with alternative embodiments of the same feature portions of the tools of FIGS. 2A to 2D. Some of them are mentioned. Those skilled in the art will appreciate that, to the extent that these embodiments include the features of one embodiment but not the features of the other embodiments, all embodiments are generally specific without departing from the spirit of the present disclosure. You will recognize that it can be modified to include or exclude features. Further, to the extent that some features are exemplified in a plurality of embodiments, such features cannot be described in each embodiment for efficiency. One of ordinary skill in the art will recognize how these illustrated features can be constructed and used in the light of the entire disclosure and the knowledge of those skilled in the art. In general, features that have similar configurations between different embodiments are similarly numbered (eg, 198, 298, 398), while features that serve similar purposes but have different configurations are similar. Is numbered but has ancillary names (eg, 198, 298', 398'').

Figures 3A and 3B show the implant management tool or card 200 in an unfolded and folded or compact configuration, respectively. The tool 200 has a generally rectangular shape defined by opposite wall portions 208, 210 extending between the first end 204, the second end 206, and the two ends 204, 206. In that it has a body 202, i.e. has a central longitudinal axis L that extends the length of the body 202, and also includes a top side or top surface 212 and a bottom side or bottom surface 214 (not shown). It is similar to the tools shown in Figures 2A to 2D. The tool is formed as part of the filament loop engagement region 222 resulting from bending the implantable body holder 216, the alignment opening 240, the second portion 228 along the crease 226, and at the second end. Formed within a protrusion 224 that inserts the portion 206 into the holding slit 238, an opposed opening 230, a graft receiving opening 232, a first mark 234, a second mark 236, and a second filament receiving area 242. Further includes featured filament holding features such as horizontally arranged filament holding tabs 244, 246, plurality of holes 250, 252 and slits 248, 254, and holding tab 256.

The tool 200 of FIGS. 3A and 3B is significantly longer than the tool 100 of FIGS. 2A-2D, despite having many similar features. As shown, in the unfolded configuration, the tool length l is approximately 220 mm, and in the folded configuration, the length l is approximately 160 mm. This longer tool 200 allows the crease 226 to be approximately 80 millimeters away from the implantable body retainer 216, allowing a longer measuring section to be specified on the loop of the implant associated with the tool. it can. Longer tools may be useful for collateral ligament repair, eg, medial collateral ligament ("MCL") or medial patellofemoral ligament ("MPFL") repair, in which the length of the implant loop is greater. However, it is typically large, ranging from about 80 mm to about 120 mm. In some embodiments, the length of the implant loop can be about 80 mm, and in some other embodiments, the length of the implant loop can be about 90 mm. Shorter tools, such as tool 100, may be useful for cruciate ligament repair, such as ACL or posterior cruciate ligament ("PCL") repair, in which the length of the implant loop is typically only about. It is 50 mm to about 70 mm. In some embodiments, the length of the implant loop can be about 60 millimeters.

Another feature included as part of the tool 200 is the instruction marking, as shown by arrow 262. The arrow 262 may be located adjacent to the implant receiving opening 232, so that the user is informed that the ligament implant should be placed within the opening 232 when in use. Other instructional markings may also be applied on the top and bottom surfaces 212, 214, and some further non-limiting examples of such markings are defined in other embodiments. The instructional markings can be particularly useful when the device is pre-packaged so that the user can easily identify the various features and functionality of the tool.

Similar to the tool 100, the holding slit 238 that receives the second end 206 can be placed between the first end 204 and the start of the graft receiving opening 232. However, in the illustrated embodiment, the length of the second portion 228 is substantially similar to the length of the second portion 128 of the first tool 100, but with the first end 204 and the crease. The slit 238 is located farther from the implantable body holder 216 than the corresponding slit 138, as the length between it and the tool 100 is substantially longer than the tool 100.

Figures 4-8 show further alternative configurations of implant management tools. Unlike the previous two embodiments, these embodiments do not exhibit an unfolded or folded, or compact, configuration. Only compact configurations are illustrated in the tools of FIGS. 4-8, but the illustrated configurations are the result of bending described herein or otherwise using techniques known to those of skill in the art. possible. Alternatively, the illustrated configuration can only be the configuration of the body to be defined, and as a result, the bending that results in the illustrated configuration is unnecessary.

Each of these alternative configurations of FIGS. 4-8 has a first end 304, 404, 504, 604, 704, a second end 306, 406, 506, 606, 706, and two ends 304. And 306, 404 and 406, 504 and 506, 604 and 606, 704 and 706, defined by opposite walls 308 and 310, 408 and 410, 508 and 510, 608 and 610, 708 and 710. It relates to an implant management tool 300, 400, 500, 600, 700 having a body 302, 402, 502, 602, 702 having a generally rectangular shape. Each also includes a top side or top surface 312, 412, 512, 612, 712 and a bottom side or bottom surface 314, 414, 514, 614, 714 and of the main bodies 302, 402, 502, 602, 702. It has a central longitudinal axis L that extends its length, and the location of the axis L is defined earlier for other embodiments. Since the illustrated embodiment has a compact configuration, the second ends 306, 406, 506, 606, 706 are exemplified as being located at the portion of the previous embodiment identified as creases 126, 226. .. Such identification does not preclude the unfolded configuration of tools 300, 400, 500, 600, 700 having a second end held in the holding slit as described for tools 100, 200. Absent.

In the implant management tool 300 of FIG. 4, the tool 300 is located on the filament loop engagement region 322 located at the second end 306, eg, the protrusion 324, the graft receiving opening 332, and the top surface 312. Includes 334'and. The illustrated embodiment does not include an implantable body retainer. Instead, the user can hold the implant with a 0 mm marking line and mark the loops and ligament implants as desired. Further, as shown, the mark 334'can be moved slightly obliquely compared to the approximate straight line formed by the first end 304. Inclined lines can allow a more accurate representation of the anatomical tissue of the marked loop. However, in most examples, it turns out that any difference in the accuracy of marking a slanted line as a sign using a straight line is negligible.

Implant management tools include a plurality of filament holding features that hold filaments extending from the implant, such as an adjustable rim, anterior filaments, and posterior filaments. The feature portion can be formed within the second filament receiving region 342 of the body 302 and may include, for example, a pair of opposing tabs 344', 346'. Tabs 344', 346'in this embodiment differ from both tabs 144, 146 and 244, 246 because they are formed differently and are located in different locations.

Tabs 344', 346' are formed only from a single crease 344b', 346b'. The tabs 344', 346'can be bent to extend in or out of the page, and the filament is then in close proximity to the creases 344b', 346b', tab 344'. , 346'can be wound. Both tabs 344', 346'can be centered on the tool 300 so that the central longitudinal axis L substantially bisects the tabs 344', 346' in terms of location. It can be said herein that the tabs extending in this direction are arranged perpendicular to the central longitudinal axis L. As shown, the two tabs 344', 346' are approximately equidistant from the 0 mm mark line, but other locations are certainly possible, including some positions specified herein. .. In some examples, filaments wound around tabs 344', 346' can help maintain the location of the implant body in the absence of implantable body holders. There are no slits extending from one of the walls and towards tabs 344', 346', such as the slits 148 and 248 of the tools 100 and 200, but such slits are an alternative configuration of the tool 300. Can be included in.

The second filament receiving region 342 can also include a plurality of holes formed within the region, three holes 352a, 352b, 352c as shown, the respective holes 352a, 352b, 352c. , Has slits 354a, 354b, 354c associated with the hole extending from the first end 304. The holes 352a, 352b, 352c, respectively, can be used to hold different filaments. For example, the first hole 352a can be used to hold the adjustable rim, the second hole 352b can be used to hold the anterior suture, and the third hole 352c can be used to hold the posterior suture. Can be used to hold sutures. By using each hole to hold a different filament, the hole can improve the user's ability to distinguish between different filaments and can also help reduce the possibility of entanglement between filaments. In an exemplary embodiment, the third hole 352c has a diameter greater than the diameters of the first and second holes 352a, 352b, but any combination of diameter sizes and any number of holes are at least To some extent, it can be used depending on the number and size of filaments associated with the implant.

The tool 400 illustrated in FIG. 5 is similar to the tool 300 in FIG. 4 except that it includes a retainer 416'for integration with the graft preparation tool, as well as an implantable body alignment opening 440'. belongs to. Further, the marks 434'and 436'provided on the upper surface 412 can be used in both directions. Filament loop engagement region 422, eg, protrusion 424, implant receiving opening 432, and filament retaining features formed within the second filament receiving region 442, eg, vertically arranged filament retaining tabs 444'. , 446', and features of tools such as holes 452a, 452b, 452c and slits 454a, 454b, 454c are essential as described herein with respect to FIG. 4 and other disclosed embodiments. possible.

The implantable body retainer 416'allows the body of the implant to extend approximately horizontally with respect to the central longitudinal axis L, i.e., horizontal orientation. In the embodiment described above, the implant body is held in a vertical orientation. The tabs on the implantable body holder 416'can be configured to fold or fold back against the paper along the creases 416b' to allow the implant body to be pushed under the tabs. .. Further, in some embodiments, the tab may include one or more finger-shaped portions 416f' configured to make it easier for the user to grip the tab 416'.

The alignment opening 440'as defined in FIG. 5 is substantially circular as opposed to the longer configuration illustrated for the alignment openings 140, 240 of tools 100, 200. Those skilled in the art can, at least to some extent, use various other shapes to help integrate the implant management tool with the graft preparation tool, depending on the shape and size of the corresponding struts on the graft preparation tool. Will recognize.

The markings 434', 436' on the top surface 412 are different from any of the markings of the embodiments described above, but the markings are located in the same place and on the same side of the tool without the need to spread the tool 400. This is because it is configured to allow easy use in both directions. As shown, the first sign 434'starts at 0 mm at the implantable body holder 416', becomes 50 mm near the protrusion 424, and becomes the second sign. The 436'starts at 0 mm in the vicinity of the protrusion 424 and reaches 50 mm in the place of the implantable body holder 416'. Applying a second sign 436'to this location may allow easy ligament graft measurements based on a mark located on the top surface 412 in a compact configuration, but the starting point for such measurements. However, in general, it can occur at or near the second end 406.

FIG. 6 shows another embodiment of the implant management tool 500. The tool 500 includes an implantable body holder 516', an aligned opening 540', a graft receiving opening 532, a protrusion 524 formed as part of the filament loop engagement region 522, and first and second. FIG. 5 in FIG. 5 in that the markings 534', 536' and the filament holding features formed within the second filament receiving region 542, such as the vertically arranged filament holding tabs 544', 546', are included. It is similar to the tool 400. Further, holes 550, 552 and slits 548, 554'similar to the holes 150, 152 and slits 148, 154 of the tool 100 of FIGS. 2A-2D are also provided as filament holding features. The filament holding tabs 544', 546'of the tool 500 are arranged vertically like the equivalent tabs 444', 446' of the tool 400, but the filament holding tabs are arranged at different locations. In addition, the tool 500 provides a further embodiment of the instruction markings made on the top surface 512.

As shown, the filament holding tabs 544', 546' are still opposed to each other, and the longitudinal axis L'dividing the tabs 544', 546' is substantially parallel to the central longitudinal axis L, but said tab. Is not centered on the tool 500, unlike tabs 444', 446', which are centered on the tool 400. Instead, the tabs 544', 546' are offset unilaterally to the central longitudinal axis L and are closer to the first wall 508 than the second wall 510, as shown. In addition, the length l of the tool is substantially longer than the length of the tool 400, thereby separating the filament holding tabs 544', 546'with distances from the 534', 536' formed on the top surface 512. Can be made to. As a result, when the filaments are placed around the filament holding tabs 544', 546', the wound filaments are not placed directly above some of the marks 534', 536', thus marking 534', 536. 'Because it can be easier to see.

Slits 548 and holes 550 can be used to assist in arranging filaments around filament holding tabs 544', 546'. The slit 548 is formed within the first end 504, i.e., substantially parallel to one end of tabs 544', 546', the slit extending a portion of the length of the central longitudinal axis L. It can be placed in the center on the main body 502 so as to. The slit 548 can extend towards the filament holding tabs 544', 546'and be terminated by a hole 550 extending through the body 502. A portion of the filament can be passed through slit 548 and placed in hole 550 before winding the filament around tabs 544', 546'.

The second slit 554'and hole 552 combination can be formed along the edge of the body 502 to receive the filament after the filament has been wound around the filament holding tabs 544', 546'. As shown, the second slit 554'can be formed in the first wall portion 508 in close proximity to the corner of the body 502. The slit 554'can extend diagonally with respect to the central longitudinal axis L and can be terminated at the second hole 552. Filaments extending from filament holding tabs 544', 546' can be routed through slits 554'and placed in holes 552 to help manage the filament. The second slit 554'and the hole 552 are located near the edge of the body 502 to help keep the slit, hole and filament out of the user's view, so the loop, ligament implant, And the signs 534', 536' can be seen more easily.

The tool of FIG. 6 further shows two additional instruction markings placed on the top surface 512. One such marking is an alternative embodiment of arrow 562'indicating the user where the ligament implant should be placed. Arrow 562'serves a similar purpose as arrow 262 of tool 200, but has a different appearance. A variety of skill in the art can be used to indicate where the ligament graft or portion of the implant itself should be placed or otherwise placed when using the equipment specified herein. It will recognize other arrow forms, as well as other forms of instructions. The second such marking is image 564 of the writing instrument. Image 564 shows the user that this side of the tool 500, i.e. the upper side 512, can be used to mark indicators on the tool itself, implants and ligament implants and everything else.

A further embodiment of the implant management tool 600 is shown in FIG. The tool 600 includes an implantable body retainer 616, a graft opening 632, a protrusion 624 formed as part of the filament loop engagement region 622, a mark 634, and a filament retention feature within a second filament receiver region 642. The slit 654 includes parts, such as vertically arranged filament holding tabs 644', 646', and some of the features discussed above, including holes 650, 652 and slits 648, 654. Formed within the second wall 610, the associated hole 652 is located in close proximity to the second wall 610. The vertically arranged filament holding tabs 644', 646'are centrally arranged so that the central longitudinal axis L bisects the two tabs 644', 646', and the tabs are separated from the mark 634 by a distance. Will be done. The tool further includes an additional filament management feature 666 located between the implantable body holder 616 and the filament loop engagement region 622.

As shown, feature 666 can include two staggered opposed tabs 668, 670, similar to tabs 118, 120 of the implantable body holder 116 of tool 100. Tabs 668, 670 can be located between the implantable body holder 616 and the graft receiving hole 632. Both tabs 668, 670 are pivoted at their respective bases 668b, 670b so that the ends of the tabs 668, 670, 668e, 670e, can substantially exit the plane extending through the body 602. Can be configured in. As designed, both tabs 668, 670 are pivotally exited relative to the page, resulting in tab 668 part of the loop extending from the bottom side of the implant associated with the implantable body retainer 616. , 670 can be pushed down and held in place in close proximity to the top surface 612. The loop then extends from tabs 668, 670 and towards protrusion 624, yet borders the graft receiving opening 632 so that the loop can receive the ligament graft. Tabs 668, 670 can help prevent the various loops from getting entangled with each other, and are properly placed so that each loop that is supposed to receive a ligament implant receives a ligament implant. It can help ensure that it is positioned. In an exemplary embodiment, the tabs 668, 670 are located approximately centrally so that the tabs are substantially bisected by the longitudinal axis L. Further, as illustrated, the tabs 668, 670 can be substantially aligned longitudinally such that the base 668b of one tab 668 is substantially aligned with the end 670e of the other tab 670. In another aspect, the tabs 668, 670 are such that the end 670e of the tab 670 terminates in front of the base 668b of the tab 668, similar to the alignment of the tabs 118 and 120 of the implantable body holder 116 of the tool 100. Can be aligned longitudinally.

The second slit 654 and the second hole 652 are positioned on the body 602 such that the slit and hole are aligned with the base 646b'of the tab 646'. As a result, the filament wound around the tabs 644', 646' extends horizontally over the base of the tab 646' and straight to the second slit 654 for holding near the edge of the body 602. You can enter and then enter the second hole 652. This alignment can help reduce unwanted tension in the filament while still keeping the filament out of the way of the user.

A further configuration of the implant management tool 700 is shown in FIG. The tool 700 includes an implantable body holder 716, a graft opening 732, a protrusion 724 formed as part of the filament loop engagement area 722, markings 734, arrow 762, and other indicator markings, as well as a second. Filament holding features within the filament receiving region 742, including, for example, vertically arranged filament holding tabs 744'', 746'', and holes 750a, 752a and slits 748a, 754a, of the features discussed above. Including some. The vertically arranged filament holding tabs 744 , 746 differ from the previous embodiment in that the tabs face each other but deviate from each other.

As shown, each tab 744'', 746'' can include a first wall 744a'', 746a'' and a second wall 744b'', 746b'', The second wall 744b'' of the first tab 744'' is close to the first wall 746a'' of the second tab 746'' and is aligned perpendicular to the first wall. To. As also illustrated, the second wall portion 746b'' of the second tab 746'' can be aligned approximately with the central longitudinal axis L. Further, the widths of the tabs 744'', 746'', 744w'', 746w'', are the widths of the corresponding filament holding tabs, eg, filament holding tabs 144, 146 and 644', 646' in the embodiments described above. Can be smaller than. As shown, the widths of the first and second tabs 744'' and 746'', respectively, 744w'' and 746w'' are approximately half the width of the corresponding filament holding tabs in the embodiments described above. is there. However, because the tabs are offset from each other, between the first wall 744a'' of the first tab 744'' and the second wall 746b'' of the second tab 746'' The width formed by the distance can be approximately equal to the width of the corresponding filament holding tabs of the embodiments described above. As shown, the two folds 744b'', 744c'' and 746b'', 746c''can be formed within the tabs 744'', 746'', respectively, and the folds 744b'', 744c' 'And 746b'', 746c'' behave like the creases 144b, 144c and 146b, 146c of tabs 144, 146 of tool 100.

Two slits 748a, 754a and holes 750a, 752a formed within the body 702 are filament holding tabs 744'to guide and / or maintain filaments extending from the upper side of the implant body associated with the tool 700. Can work in relation to', 746''. The centrally located slit 748a and hole 750a can be aligned substantially perpendicular to the second wall portion 746b'' of the second tab 746''. The second slit 754a and hole 752a may have a similar structure to the slit 748a and hole 750a, but are substantially perpendicular to the first wall portion 744a'' of the first tab 744'' as shown. Can be aligned with. Thus, a portion of the filament can be passed through a centrally located slit 748a and placed in the hole 750a before winding the filament around tabs 744'', 746'', and then another filament. The portion can be passed through the second slit 754a and the filament can be wound around the tabs 744'', 746'' before being placed in the second hole 752a. Substantial vertical alignment of slits 748a, 754a and holes 750a, 752a with walls 746b'' and 744a'' can help prevent filament entanglement and reduce unwanted tension in the filament. it can. In addition, the second tab 746'' intersects part of the sign 734, so it is used due to the miniaturization of tab 746'' and the fact that the tab is deviated from the center of the body 702. Sometimes the visual impairment caused by folding down tab 746'' (to fold against the page) can be reduced. This configuration can also help reduce the visual impairment that occurs in the marks formed on the bottom side of the body 702, eg, to assist in making measurements on the ligament implant.

Figures 9 and 10A define two alternative implant management tools 800, 900 in an unfolded configuration, exemplifying non-limiting examples of second ends 806', 906'' of different shapes, respectively. To do. In general, tools 800, 900 include many of the same features illustrated with respect to tools 100, 200 of FIGS. 2A-2D and 3A-3B. Thus, as illustrated, the tools 800, 900 both have a first end 804, 904, a second end 806', 906'', and two ends 804, 806'and, respectively. It has bodies 802,902 with a generally rectangular shape defined by opposite walls 808, 810 and 908, 910, extending between 904, 906''. Each of the tools 800, 900 further includes a central longitudinal axis L that extends the length of the body 802, 902, with the top side or top surface 812, 912 and the bottom side or bottom surface 814, 914 (not shown). Is further included. Further features specified in the tool include implantable body holders 816, 916 with opposed tabs 818, 820 and 918, 920, aligned openings 840, 940, filament loop engagement regions including protrusions. Second part 828, 928, facing openings 830, 930, configured to fold towards the bottom side 814, 914 along creases 826, 926, i.e. to fold against the page. Graft receiving openings 832, 932, first markings 834, 934, second markings 836, 936, and filament holding features 842, 942 formed within the second filament receiving region, eg, horizontally. Retention tabs with arranged filament retention tabs 844, 846 and 944, 946, multiple holes 850, 852 and 950, 952, and slits 848, 854 and 948, 954, and slits 858, 860 and 958, 960. 856 and 956 can be mentioned.

As shown in FIG. 9, in one alternative embodiment, the second end may include a U-shaped cutout 872. The two tapered edges 806a', 806b' can extend from the end 872t of the cutout 872 to the opposite wall 808, 810. The two tapered edges 806a', 806b' are creases when the body 802 is bent along crease 826 so that the second part 828 penetrates into the page and moves towards the bottom side 814. It can be placed in complementary retaining slits 838a', 838b' formed in the body 802 between the 826 and the first end 804. As shown, the holding slits 838a', 838b' are placed in close proximity to the plantable body holder 816 and aligned with part of the aligned opening 840, but the length of the second part 828 is This is because it is almost the same length as the length extending from the 0 mm mark line to the crease 826. The U-shaped cutout 872 helps prevent the body 802 from interfering with the implant preparation tool by allowing the alignment opening 840 to remain unobstructed. Therefore, in this configuration, the mark 826 on the second portion 828 is the tool 800, the implant, or other structure used in connection with the tool, implant, eg, other features of the graft preparation tool. Can be useful when applied for a length long enough to prevent.

An alternative embodiment of FIG. 10A comprises a second end 906'' having a sawtooth shape. In an exemplary embodiment, the second end 906'' is such that there are three terminal peaks 906a'', 906c'', 906e'' and two terminal valleys 906b'', 906d''. It has an M-shape or a W-shape. The holding slit 938 formed between the crease 926 and the first end 904 extends between the two terminal valleys 906b'' and 906d'', including the central terminal peak 906c''. It can be configured to receive part of the end 906''. Again, the location of the slit 938 can depend on the length of the second portion 928 that is folded towards the bottom side 914, i.e. folded relative to the page. In an exemplary embodiment, the retaining slit 938 is closer to the end 940t of the alignment opening 940 than to the end 932t of the graft receiving opening 932.

FIG. 10B is generally configured as the tool 900 of FIG. 10A, but with a different configuration of implantable body holder 916'and different configurations of filament holding features, more specifically the holding tab 956 of FIG. 10A. An alternative embodiment of the tool 900'including the holding tabs 956a', 956b', which has a different configuration from the above. As shown, the opposite tabs 918', 920' of the implantable body holder 916' in FIG. 10B have a larger surface area than the tabs 916, 918 of the tool 900 in FIG. 10A. These larger tabs 918', 920' allow the larger implant body to be easily held by the tool 900'. The larger implant body can be used in surgery requiring a larger bone hole or in an example of perforating a larger bone hole than originally predicted by the surgeon. In such an example, the length or diameter of the implant body can be configured to be greater than the diameter of the bone hole, thus preventing the implant body from dropping the bone hole and the implant from losing its implant location. Will be done.

Retention tabs 956a', 956b' serve similar purposes as retention tabs 956 and can therefore retain excess filament extending from the upper side of the implant body. Although many configurations can be used to hold filaments, in an exemplary embodiment, tabs 956a', 956b' are opposed tabs of implantable body holders as defined herein, eg, FIG. 10A. It is configured in the same manner as the opposing tabs 918, 920, or the opposing tabs 668, 670 in FIG. As shown, the tabs 956a', 956b' are located close to the wall 908'of the body 902', so that the placed filaments are marked on the top surface 912' of the body 902'. It is kept away from 934'and staggered with respect to each other. Both tabs 956a', 956b' have their respective bases 956ab' so that the ends 956ae', 956be' of the tabs 956a', 956b' can be pulled out of a plane extending substantially through the body 902'. , 956bb'can be configured to be pivotal. As designed, both tabs 956a', 956b' pivoted out against the page, thus pushing the filament under the tabs 956a', 956b'and supported by the rest of the top surface 912'. can do. In an exemplary embodiment, the tabs 956a', 956b' are substantially longitudinally aligned such that the base 956ab'of one tab 956a' is approximately aligned with the end 956be' of the other tab 956b'. Similarly, the tab 956b'base 956bb' is approximately aligned with the end 956ae' of the tab 956a'. In other embodiments, tabs 956a', 956b' are such that the end of one tab terminates before the base of the other tab, such as the base 956ab' of tab 956a', such as the end 956be'of tab 956b'. Can be aligned longitudinally.

FIG. 11 shows another embodiment of the implant management tool, the Card 1000, in an unfolded configuration. The card 1000 specifically directs the card itself to assist the user in converting an unfolded card into a folded card with an implant held on top and a ligament implant associated with the implant. Designed as shown above. In particular, in increasing numbers, dots 1076, 1078, 1080 and 1082 bend the card 1000, add implants, add ligament implants, and the user to hold the implant-related filaments on the card 1000. Specified on the top surface 1012 to indicate the order of steps to be performed by.

As shown, the card 1000 is defined by opposite walls 1008, 1010 extending between the first end 1004', the second end 1006, and the two ends 1004', 1006. It also has a body 1002 that has a roughly rectangular shape. The card 1000 has a central longitudinal axis L that extends the length of the body 1002 and also includes a top surface 1012 and a bottom surface 1014 (not shown). A pair of creases 1025, 1026 extending substantially horizontally on the central longitudinal axis L, and the unfolded configuration is in the first section 1074a, the second section 1074b, and the third section 1074c. It is divided.

A first dot 1076 is placed in close proximity to the implantable body holder 1016'', which holder itself is located approximately centrally on the second section 1074b. The implantable body holder 1016'' in the illustrated embodiment has a different configuration from the implantable body holder described above. As shown, the implantable body holder 1016'' is a single vertical slit that extends substantially in line with the central longitudinal axis L. The first step, indicated by the first dot 1076, allows the implant body to be implanted from the top 1012 to the bottom 1014, while maintaining at least a portion of the filament extending from the body at the top 1012. It may include the step of passing through the slit of the main body holder 1016''. The filament forming the loop of the implant can extend from the implant body through the first hole 1015'' formed at the end of the vertical slit, the filament from the adjustable rim, the anterior suture. , And the posterior suture can extend from the implant body through a second hole 1017'' formed at the opposite end of the vertical slit. This configuration can therefore hold the implant in place on the card 1000. In an exemplary embodiment, the second hole 1017'' has a diameter larger than the diameter of the first hole 1015'', whereas the second hole 1017'' has a larger thickness of filament in the hole. Holes of other sizes may be used, at least to some extent, depending on the type, number, and thickness of the filament associated with the implant, although it can be configured to hold in.

The location of the implant body, once located on the card 1000, is typically 0 mm to ensure that the part of the loop closest to the implant body provides accurate markings on the tool, ligament graft and / or implant. It can be like being substantially aligned with the line. In an exemplary embodiment, the sign 1034'on the top surface 1012 extends diagonally with respect to the central longitudinal axis L. In addition, as illustrated, the instructional markings on image 1064 of the writing instrument are presented to show that the user can use the mark 1034'to mark indicators on the instrument itself, implants and ligament implants and everything else. To.

Two dots 1078 can be located on the second portion 1074b in close proximity to the crease 1026. The two dots 1078 can be located on the third part 1074c, in close proximity to the crease 1026, just as easily. Arrow 1084 can be located next to the two dots 1078, and in the embodiment illustrated by the second step, the third portion 1074c is directed towards the bottom side 1014, i.e. to the page. It can be configured to indicate that it involves folding. As a result, the mark 1036 on the third portion 1074c is substantially perpendicular to the longitudinal axis L as shown, but on the bottom surface 1014 for purposes as described elsewhere herein. Is placed in. The second end 1006, which is part of the third portion 1074c, is a central flap with a rounded edge configured to be received by a receiving slit 1038 formed on the second portion 1074b. Can include 1007. As in other embodiments, the receiving slit 1038 can be placed between the implant receiving opening 1032 and the first end 1004'. In this embodiment, the slit 1038 is actually located between the second hole 1017'' and the second crease 1025, because the length of the third portion 1074c is so long.

The first fold 1026 can substantially bisect the graft receiving opening 1032, and thus folding the third portion 1074c onto the second portion 1074b results in others herein. An opening similar to the opening described in the embodiment is obtained. However, unlike the embodiments described above, there are no two triangular shaped openings that are also bisected by the crease 1026. Instead, when the opposing corresponding openings 1030', formed equidistant from the central longitudinal axis L, terminate at crease 1026 and the third portion 1074c is folded onto the second portion 1074b. , A part of the third part 1074c is designed to block the opening 1030'from the bottom side 1014. Nevertheless, the loop from the implant is still placed on the two protrusions 1024 formed as a result of bending the third part 1074c onto the second part 1074b, at least due to the flexible nature of the card 1000. can do. The protrusion 1024 can hold the loop in a tense state, and the illustrated configuration allows the loop to receive a ligament implant placed within the implant receiving opening 1032.

Three dots 1080 can be located on the third portion 1074c, adjacent to the arrow 1062'pointing towards the graft receiving opening 1032. The three dots 1080 indicate that the third step is to place the ligament implant through the implant receiving opening 1032 and is therefore received by the implant loop, which is in tension by the protrusion 1024. Can be done. An image of the ligament graft 1086 may also be provided on the top surface 1012 to aid in indicating the purpose of arrow 1062'.

A filament extending from the upper side of the implant body, which may include adjustable rims, anterior and posterior sutures, extends from the implantable body retainer 1016'' and towards the first portion 1074a. Can be configured to. The first portion 1074a may include one or more filament holding features. As shown in the figure, the filament holding feature portion of the card 1000 includes a slit 1048 and a hole 1050 arranged in the center, and two facing portions formed in the first and second wall portions 1008 and 1010 of the main body 1002. A substantially V-shaped cutout 1088 can be mentioned. The filament can be passed through slit 1048, some of which can be held in the hole 1050, after which the rest of the filament has two Vs in a direction substantially perpendicular to the central longitudinal axis L. It can be wound around the character-shaped cutout part 1088.

The four dots 1082 can be located on the second portion 1074b in close proximity to the crease 1025. The four dots 1082 can be located on the first part 1074a, in close proximity to the crease 1025, just as easily. Arrow 1090 can be located next to the four dots 1082, and in the embodiment illustrated by the fourth step, fold the first portion 1074a towards the bottom side 1014, i.e. to the page. It can be configured to indicate that it includes. Alternatively, the first portion 1074a may wrap towards the top 1012, i.e. to the page, in the exemplary embodiment. The first end 1004'can include a central flap 1005' with a rounded edge configured to be received by a second receiving slit 1039' formed on the second portion 1074b. .. As shown, the second receiving slit 1039'may be close to the first receiving slit 1038, but the location of both slits is the first and third portions 1074a configured to receive the slit. , Can depend on the size of 1074c.

By bending over the first part 1074a, some of the filament wound around the V-shaped cutout 1088 can be protected from unintentional wear or cutting, but part of the filament is two parts. This is because it is placed between 1074a and 1074b. A centrally located diamond-shaped opening 1092 can be provided between the first and second portions 1074a, 1074b, the opening when the first portion 1074a is folded over the second portion 1074b. It becomes a V-shaped opening. The diamond-shaped opening 1092 can help give the filament the desired amount of tension as the filament approaches the implant body when the first portion 1074a is bent towards the second portion 1074b. it can. As a result, the filament does not undesirably relax and interfere with the user during operation.

Those skilled in the art will appreciate the instructions described with respect to the Card 1000 to tools and cards with various configurations and various different features, such as holes, openings, slits, tabs, without departing from the spirit of the present disclosure. You will recognize that it can be applied. Moreover, one of ordinary skill in the art can vary in the number, quantity and form of instructions, at least to some extent, depending on the composition of the card and the form of treatment in which the card will be used, and thus more, less, or. It will be appreciated that instructions involving different steps can be derived from the present disclosure described herein. The teachings of the instructions provided herein can be readily adapted to any of the tools and card configurations disclosed herein, can be derived from the tools and card configurations, or are known to those of skill in the art. Can be adapted to implant management tools and other configurations of cards.

FIG. 12 is another embodiment of the implant management tool 1100 in an unfolded configuration that can be folded to protect at least a portion of the implant. Protection of each part of the implant is to prevent unintentional wear or tear of the filament associated with the implant, for distribution and sale, or at the site of the surgical procedure before and during the surgical procedure. It can be useful when packaging management tools.

As shown, the implant 1100 is approximately rectangular, defined by a first end 1104, a second end 1106, and contradictory walls 1108', 1110' that extend between the ends. It has a body 1102 with a shape. The body 1102 includes two parts 1102a'and 1102b' divided by crease 1109'. As shown, the crease 1109' extends substantially parallel to the central longitudinal axis L, and the central longitudinal axis L in this embodiment is centrally located through the first portion 1102a'. The second section 1102b'so that the filament wound around the vertically arranged filament holding tabs 1144', 1146' can be protected between the first and second sections 1102a', 1102b'. It may fold towards the bottom side 1114 (not shown) of the first section 1102a', i.e. to the page. The first and second locking slits 1194a and 1194b allow the second portion 1102b'to be secured to the first portion 1102a', respectively, so that the first and second wall portions 1108' , Can be formed within 1110'. As shown, the first locking slit 1194a extends substantially perpendicular to the central longitudinal axis L and the second locking slit 1194b extends substantially obliquely to the central longitudinal axis L. Exists. One of the portions 1102a', 1102b' can be twisted at the location of slits 1194a, 1194b to allow one slit to engage with the other, forming a secure, interlocking connection. Slit. Those skilled in the art will recognize other methods in which locking connections can be formed between the two parts 1102a', 1102b'. In addition, the tool 1100 has a filament loop engagement region 1122 located at the second end 1106, such as a protrusion 1124, a graft receiving opening 1132, a mark 1134 located on the top surface 1112 of the body 1102, and a filament retainer. Features, such as vertically arranged filament holding tabs 1144', 1146', as well as holes 1150a, 1152a.

The implant management tool 1200 of FIG. 13 provides yet another embodiment of a tool that can be folded to protect at least a portion of the implant. As shown in the figure, the tool 1200 has the lengths of the opposite wall portions 1208, 1210 and the main body 1202 extending between the first end 1204, the second end 1206, and the two ends 1204, 1206. It has a body 1202 with a generally rectangular shape defined by a central longitudinal axis L and a top side or top surface 1212 and a bottom side or bottom surface 1214 (not shown). As shown, the body 1202 includes two parts 1202a'' and 1202b'' divided by the crease 1226, which extends substantially perpendicular to the central longitudinal axis L. The second section 1202b'' may be folded towards the bottom side 1214, i.e. with respect to the page, so that the second end 1206 is located close to the first end 1204. A first locking slit 1294a may be formed within each of the first and second wall portions 1208, 1210 of the first portion 1202a'', and a second locking slit 1294b may also be a second. It can be formed within the first and second wall portions 1208, 1210 of part 1202b'', respectively. The locking slits 1294a, 1294b can operate in the same manner as the locking slits 1194a, 1194b of the tool 1100, resulting in a secure interlocking connection between the first and second parts 1202a'' and 1202b''. It is formed. As a result, any filament stored on the bottom side 1214 of the first portion 1202a'' can be protected by the second portion 1202b''. Implantable Body Holder 1216', Graft Receiving Opening 1232, Projection 1224 and Filament Loop Engagement Region 1222, First and Second Marks 1234, 1236, and Ligament Implantation The featured parts such as the one-sided arrow 1262'and the instruction markings such as image 1286 may be similar to the featured parts described above.

The tool 1200 also includes a filament holding feature. In an exemplary embodiment, the filament retention feature is located in a second center close to a centrally located slit 1248 terminating at a centrally located hole 1250 and an implantable body retainer 1216'. Includes holes 1251 and. As discussed in more detail below with respect to FIG. 14B, hole 1251 can be used in connection with filament management tool 1400 to help retain excess filament. Slits 1248 and holes 1250 relate to the filament management tool 1400 of FIG. 14B with respect to other embodiments to help retain excess filament resulting from the use of hole 1251 and guide it towards the filament holding feature. It can be used in the manner described. In an alternative embodiment, the extra filament can only be retained by slits 1248 and holes 1250, and / or while the extra filament is placed between the first and second portions 1202a'', 1202b''. Can remain relatively free.

Although the exemplary embodiments of implant management tools have been described as having a generally rectangular shape, those skilled in the art will recognize other shapes that can be used to include the various tool features defined herein. There will be. Moreover, all of the implant management tools specified herein can be made of a variety of different materials. In some exemplary embodiments, the tool is made of a polymer such as polyolefin or high density polyethylene for waterproofing purposes. Other non-limiting examples of materials that can be used to form implant management tools include metals, paper-based materials (eg, paperboard, cardboard), and biocompatible materials. .. Optionally, the tool may be covered with one or more waterproofing materials. One exemplary non-limiting method of forming an implant management tool is to die-cut a sheet of polyethylene. The weight of the implant management tool itself can be approximately in the range of about 1 g to about 28 g (about 0.05 ounces to about 1.0 ounce). This weight provides the desired amount of stability during the graft preparation phase. In addition, a variety of different techniques and forms of material can be used to mark or otherwise make markings, instructions, or other markings on the implant management device. Non-limiting examples of marking, instructing, or other marking techniques include printing with ink, etching, embossing, and laser marking. For embodiments involving printing on implant management tools, various inks, or other medical treatments, including waterproof inks such as Germany, Tamm's Marabu GmbH &amp; Co. KG Tampapur TPU 980, two-component epoxy inks. And / or bio-inks can be used.

Filament Management Tool Figure 14A is an exemplary embodiment of the Filament Management Tool 1300 that may be used in connection with a tool specified herein or otherwise known in the art. Is shown. The tool can be used to hold the filaments extending from the implant and to align the ends of the implant filaments so that the various filaments can be moved and / or cut to the desired length.

The filament management tool 1300 of FIG. 14A has a body 1302 that is generally circular in shape and has a top surface 1312 and a bottom surface 1314 (not shown). The tool 1300 may also include a slit 1348 extending from the outer periphery of the body 1302 to a hole 1350 located approximately in the center of the circular body 1302. Filaments such as the exemplary adjustable rims 1315a, 1315b, anterior suture 1316 rims 1316a, 1316b, and posterior suture 1318 rims 1318a, 1318b can be passed through slit 1348 and placed within hole 1350. The filament management tool 1300 can then be used to move the filament rim and / or cut it to an extra length. The extra length can mean equal lengths, or at least to some extent, the filaments in which the filament management tool is used and the type of treatment in which the filaments are used, or can mean the desired unequal lengths. .. In an example where the user wants all of the filaments extending from the implant body to have equal lengths, the filaments can be strained and the tool 1300 will be at the end of the filament at the desired length of the tool 1300. It can be slid along the length of the filament until it is close to what appears to be. The filament can then be cut to the desired length.

In an example used to cut out the filament length of the tool 1300, the tool 1300 may be disconnected from the filament. Alternatively, tool 1300 was associated with filaments to help manage the filaments, eg, by making it easier to track various filaments and by preventing the filaments from becoming entangled. It can be up to. In some embodiments, at least one of the top or bottom 1312, 1314, to inform the user that one or more instructional markings can place the implant-related filament within the hole 1350. Can be applied one level up. For example, specific examples of adjustable rims 1315a, 1315b, anterior suture 1316 rims 1316a, 1316b, and posterior suture 1318 rims 1318a, 1318b can be formed on the top surface 1312.

The filament can be associated with the filament management tool 1300 just before the implant is removed from the implant management tool. As a result, the filament previously associated with the filament holding feature of the implant management tool can be held by the filament management tool 1300. This can prevent the filament from becoming entangled or damaged as the implant moves from the location where the ligament implant was prepared, eg, the location of the implant preparation tool, to the patient's body. The filament management tool 1300 can then break its relationship with the filament shortly before it is placed in the body. Alternatively, the filament management tool 1300 can be used for a period of time while the implant is still associated with the implant management tool. For example, a user may use the filament management tool 1300 to form rim margin while the implant is still attached to the implant management tool or otherwise associated with the implant management tool. Good.

The tool 1400 illustrated in FIG. 14B provides non-limiting examples with different alternative configurations of filament management tools. In one exemplary embodiment, the tool 1400 can be used in connection with the implant management tool 1200.

As shown, the management tool 1400 has a body 1402 that is generally circular in shape and has a top surface 1412 and a bottom surface 1414 (not shown). The tool 1400 may also include a hole 1450 located approximately in the center of the circular body 1402. Hole 1450 may be configured to join hole 1251 of the implant management tool 1200 such that the top surface 1412 is approximately parallel to the top surface 1212. Those skilled in the art will recognize the various components that can be used to join the filament management tool 1400 to the implant management tool 1200, but in one exemplary embodiment, a cylindrical grommet (not shown). ) Can be placed between the two tools 1200, 1400, and the holes 1251, 1450 of the tools 1200, 1400 receive the opposite bases of the grommet. The base of the grommet can be open or closed. The resulting configuration can be spool-like, tools 1200, 1400 act as the ends of the spool, and the cylindrical wall extending between the two bases of the grommet can be placed with extra filament. It acts as a surface.

A second hole 1452 can also be formed through the body 1402 at a distance from the center. The slit 1454 can extend from the outer circumference of the circular body 1402 to the second hole 1452, providing an access point for the filament to pass through the hole 1452. The second hole 1452 can be used to help manage the filaments by making it easier to track the various filaments and by preventing the filaments from becoming entangled. For example, the end of the filament wound around the grommet extending between the implant management tool 1200 and the filament management tool 1400 can be placed through slit 1454 and into hole 1452. By having a second hole 1452 away from the center, it may be easier to pass the filament through the hole 1452 and remove it from the hole 1452, although the filament may be easier than when the hole is centered. This is because the distance traveled is shorter, and thus the possibility of the filament getting caught in the slit 1454 as it passes through the slit 1454 is reduced. Similar to the tool 1300, in some embodiments, one or more markings are made on one or both of the top and bottom 1412, 1414 to indicate the particular purpose of the features of the tool 1400. obtain.

Tools 1300, 1400 can be sized and molded to complement the size and shape of implant management tools and implants. Any material suitable for forming implant management tools is also suitable for forming filament management tools 1300, 1400. Grommets used in connection with the tool 1400, or other components that serve similar purposes to grommets, include, but are not limited to, of materials suitable for forming implant management tools. Either can be produced.

Attaching a Surgical Implant to an Implant Management Tool Figures 15A-15S exemplify one exemplary embodiment of installing an implant management tool in a compact configuration, as shown in Tool 900 of FIG. 10A. As shown in FIG. 15A, the tool 900 may have a flat die-cut configuration, with the markings 934, 936 formed on the top surface 912, the graft receiving opening 932, and the opposing opening 930. It has an alignment opening 940 and a plurality of holes 950, 954 (Fig. 15B) and slits 938, 948, 954 (Fig. 15B), 958, 960 that act as filament holding features already formed in the tool. The implantable body retainer 916, the creases 926 used to form the protrusions 924 of the filament loop engagement area 922, the horizontally placed filament retaining tabs 944, 946, and the retaining tabs 956 are still in shape. It can start in a configuration that does not.

The second portion 928 can be bent towards the bottom surface 914 of the body 902, as shown in FIG. 15B, and the second end 906 is placed within the holding slit 938, as shown in FIG. 15C. Can be done. The resulting configuration is shown in FIG. 15D, in which the second portion 928 is held in a fixed location adjacent to the bottom surface 914 and the mark 936 on the second portion 928 is the bottom surface. You can see it when you see 914. Further, the graft receiving opening 932 and the opposing opening 930 form a protrusion 924 of the filament loop engaging region 922. The opening also forms a new end of the body 902 when in a compact configuration.

As shown in FIG. 15E, the opposing tabs 918, 920 (920 are hidden and invisible in FIG. 15E) forming the implantable body holder 916 are planes that substantially extend through the top surface 912. It can be bent or bent so that it is no longer flush. FIG. 15E illustrates a tab 918 being bent away from the body 902 towards the top surface 912 (rather than towards the bottom surface 914). The other tab 920 can be similarly bent towards the top surface 912.

The horizontally arranged filament holding tabs 944, 946 can also be bent or bent so that the tabs are no longer flush with the plane extending substantially through the top surface 912. As shown in FIG. 15F, the second tab 946 can be bent towards the top surface 912 (rather than towards the bottom surface 914) at the first crease 946b, so that the tab is described above. It is out of the plane. The tab 946 can then be re-bent down towards the bottom 914 along the crease 946b so that the tab 946 is eventually located below the bottom 914. In an alternative embodiment, the tab 946 can be bent down exactly towards the bottom surface 914. The second tab 946 can also be folded back towards the body 902 at the second fold 946c, as shown in FIG. 15G. As a result, the end portion 946e of the tab 946 can be substantially parallel to the plane described above, as shown in FIG. 15H. Figures 15F-15H also illustrate that these same bending or bending measures were applied to the first tab 944.

The retention tab 956 disposed within the first wall 908 can be bent or bent such that the tab is configured to be disposed around the filament to at least some extent. FIG. 15I illustrates that the tab 956 can be folded towards the top surface 912 along a more centered crease 956c. The tab 956 can then fold back towards the body 902 along the second crease 956b, as shown in FIG. 15J. This results in the formation of sleeves on which filaments can be placed, as described in more detail herein.

After all bending and flexing is complete, the implant management tool 900 can look like a tool as illustrated in Figure 15K. One of ordinary skill in the art will recognize that the various steps leading up to this configuration can be performed in any order, generally without departing from the spirit of the present disclosure. Thus, as a non-limiting example, the horizontally arranged retention tabs 944, 946 may be formed after the retention tabs 956 or before the second portion 928 is folded towards the bottom surface 914.

FIG. 15L illustrates one option of the starting step of associating the implant 10 of FIG. 1A with the implant management tool 900. As shown, the loop 14 is placed around the protrusion 924 and the rest of the implant 10 is moved towards the first end 904. All of the loops 14 may be kept aligned so that the loops 14 do not twist or intersect and more clearly constitute the graft receiving opening 932, as illustrated in FIG. 15M more clearly. Can be beneficial.

FIG. 15M also illustrates the implant body 12 that is being associated with tabs 918, 920 of the implantable body holder 916. The tab 916, which is closer by the 0 mm mark line, can be bent towards the second wall 910 to allow the body 12 to pass under the second wall 910, after which the tab is It can be bent again towards the body 902 to help secure one end of the body 12 to the tool 900. The other tab 920 is then placed under the wall to help secure the other end of the body 12 to the tool 900 towards the first wall 908. After that, it can be bent toward the main body 902 again. The end of the body 12 associated with the closer tab 918 is typically near 0 to help ensure accurate use, such as when the user is marking on the top surface 912 or loop 14. It can be located on the millimeter mark line. As shown in FIG. 15N, the filament extending from the upper 12t of the body 12, ie, the adjustable rims 15a, 15b, the anterior suture 16 and the posterior suture 18, ensures that the implant body 12 is relative to the tool 900. Can be pulled tightly to confirm proper installation.

After the body 12 is secured by the implantable body holder 916, the adjustable rims 15a, 15b, anterior suture 16 and posterior suture 18 are inserted into the central slit 948, as shown in FIG. 15O. Moreover, it can be arranged in the hole 950 at which the slit 948 ends. Tension may be applied to the rims 15a, 15b, and sutures 16 and 18, respectively, to ensure that the loose filament does not interfere with viewing the top surface 912 and implant 10. While maintaining tension, the rims 15a, 15b and sutures 16, 18 can be wound around the horizontally arranged filament holding tabs 944, 946, as shown in FIG. 15P. More specifically, the rims 15a, 15b and sutures 16, 18 are wound around the receiving areas 944r, 946r of tabs 944, 946 until the rest of the rims 15a, 15b and sutures 16, 18 are of the desired length. Can be turned. FIG. 15Q illustrates an embodiment of rims 15a, 15b and sutures 16, 18 of the desired length, while the rest of filaments 15a, 15b, 16, 18 are held by other filament holding features. It can be done, but the extra filament is not in the way of the user. In one exemplary embodiment, filaments 15a, 15b, 16, 18 are wound almost completely three times on tabs 944, 946 before the rest is guided to additional filament holding features.

As shown in FIG. 15R, the rims 15a, 15b and sutures 16 and 18 can be moved towards the slit 954 formed in the first wall 908. The rims 15a, 15b and sutures 16, 18 can be passed through slit 954 and enter hole 952 to be held in the slit. The excess portions of rims 15a, 15b and sutures 16, 18 can then be advanced at altitude towards the retention tab 956. As shown in FIG. 15S, the retaining tab 956 can engage the rims 15a, 15b and sutures 16, 18 to secure the location of the suture along the edge of the body 902. The excess portion of the rims 15a, 15b and sutures 16 and 18 may extend from the retention tab 956 towards the filament loop engagement area 922, but this amount is up to the user's view of the top surface 912 or the surgical procedure. It may preferably not interfere with the preparatory steps performed in.

The methods described with respect to FIGS. 15A-15S can be performed in the field, eg, by a user in the operating room, or the implant 10 is implanted at the manufacturing facility prior to shipping and packaging the combination of tool 900 and implant 10. Can be associated with management tool 900. In addition, one of ordinary skill in the art will appreciate that implants are, at least to some extent, implant management tools and implant management tools in view of the present disclosure as defined herein, depending on the composition of the implant management tool and implant and the type of procedure in which the tool and implant are used. You will recognize various other methods that can be associated with.

Graft preparation tool Once the implant is attached to the implant management tool, the tool can be used in connection with the graft preparation tool or board to assist in making measurements. Graft preparation tools are generally known to those of skill in the art and therefore only an overview of such tools is provided herein. As illustrated in FIG. 16, the implant preparation tool 2000 can include a platform 2002 having a first holding element 2004 and an opposing second holding element 2006 extending from the platform 2002. The retaining elements 2004, 2006 can generally be configured to grip the opposite ends 3000a, 300b of the ligament implant 3000. In an exemplary embodiment, the retaining elements 2004, 2006 include jaws 2008, 2010 and 2012, 2014, which grip the ends 3000a, 3000b, of the ligament graft 3000, respectively, but various other techniques are prepared. It can be used to secure the location of the ligament implant 3000 relative to the tool 2000. The tension element 2016 can mechanically collaborate with the first holding element 2004 and acts to provide tension to the ligament implant by linearly displacing the first gripping element 2004 along the platform 2002. It can be possible. As shown, the sliding screw shaft 2018 can extend between the tension element 2016 and the first holding element 2004 to support the linear displacement. Mark 2020 may be applied on platform 2002 to help read the length of the ligament implant or to apply markings or indicators onto the ligament implant. Further details regarding the graft preparation tool are presented in US Pat. No. 6,796,977 of Yap et al., Which content is incorporated herein by reference in its entirety.

17A and 17B illustrate alternative embodiments of the implant preparation tool or board 2000'used in connection with the implant management tool 900 and implant 10 of FIG. 15S. The graft preparation tool 2000'may include a platform 2002' and first and second retaining elements 2004', 2006' extending from the platform. As shown, the first retaining element 2004'contains the jaws 2008', 2010' that grip the ligament graft 3000', and the second retaining element 2006' is the aligned opening 940 of the implant management tool 900. Includes stanchions 2022'configured to receive. The ligament implant 3000'is placed through the implant receiving opening 932 as shown and is therefore coupled to loop 14, but from the implant management tool 900 and towards the first retaining element 2004'. Can be extended to. In an exemplary embodiment, the ligament implant 3000'is not long enough to reach the first retaining element 2004', so that one or more free rims of suture 3002'are the ligament implant 3000'. Both ends of'3000a', 3000b'can be sewn up. The suture 3002'is then wound around the first retaining element 2004' to secure the suture 3002' to the first retaining element 2004' and apply tension to the ligament implant 3000'. obtain. When the tension is supplied to the first holding element 2004'by the tension element 2016', the tension moves through the sliding screw shaft 2018', through the suture 3002', and to the ligament graft 3000'. To do. As the ligament implant 3000'moves away from the strut 2022', the tension within the ligament implant 3000' increases. Those skilled in the art will recognize various other methods in which the implant tool 900 and the ligament graft 3000'can be associated with the graft preparation tool to provide the desired tension.

As shown in FIG. 17B, due to the configuration of the implant management tool 900 and, in particular, the markings 934, 936 applied on the top surface 912, marking, or marking, or when the desired tension is applied to the ligament graft 3000'. The index can be applied on a tool 900 implant 10, eg, loop 14 and / or ligament graft 3000', without relying on a separate measuring instrument such as a ruler formed on the graft preparation tool, i.e., a sign. .. The indicators can then be used by the surgeon during the surgical procedure to provide valuable feedback about the location of implant 10 and graft 3000'. The second part 928 of the tool 900 can actually be returned to an unfolded configuration so that measurements related to the ligament implant 3000'can be made, as illustrated.

Those skilled in the art will recognize that various measurement results and related indicators can be applied using this setup, at least to some extent, depending on the equipment used and the type of treatment being performed. As a non-limiting example, some surgical procedures, such as ACL repair, can form tunnels with two different diameters. Implant 10 may be configured to have a final implant site with the smaller diameter in the tunnel, while ligament implant 3000'may have a final implant site with the larger diameter in the tunnel. The user measures the depth of the tunnel and uses the marks 934, 936 to place the loop 14 and ligament graft 3000'so that the user knows when the implant 10 and ligament graft 3000'are in the desired position. Can be marked. Examples of measurements in the form of work that can be performed during ACL repair are shown below for Figures 18A-18F.

ACL repair using indicators made on implants and ligament implants As illustrated in Figure 18A, the knee 4000 is used for ACL repair procedures by forming the required tunnels 4020, 4022 within the femur 4002 and tibia 4004. Can be prepared for. Techniques known to those of skill in the art can be used to form these tunnels. The femoral tunnel 4022 can include both the main path 4024 and the transit path 4026, which has a smaller diameter than the main pathway 4024. Tibial tunnel 4020 allows components routed from tibial tunnel 4020 to easily pass through the glenoid fossa 4006 between tibial 4004 and femur 4002 and enter the main pathway 4024 of femur tunnel 4022. Can be located in.

The depth of the various tunnels can be measured and the results of those measurements can be displayed by marking or indexing on any of the implant management tool, implant 10, and ligament graft 3000'. In some embodiments, marking of indicators on tools, implants and ligament implants can be done in connection with, ie, at the same time as the tunneling in the bone. This eliminates measurements in separate bone tunnels. In addition, if the first person forms a bone tunnel while the second person simultaneously applies markings or indicators of bone tunnel depth, it may contribute to a more accurate and efficient process than the previous surgical procedure. ..

Implant 10, Tool 900, and Ligament Graft 3000'see some of the details of the preparatory steps that can be prepared prior to marking indicators on at least one of these components Figure 15A ~. As discussed earlier with respect to 15S and Figures 17A-17B, in general, if the implant is not yet packaged as an implant and ligament graft 3000'can be prepared for attachment to loop 14 of the implant, tool 900 Can be combined with. Ligament graft 3000'can be washed by removing any excess tissue, after which the free rim of suture 3002' is overhanging on both ends 3000a', 3000b' of ligament graft 3000'. Can be sewn. The ligament implant 3000'can be passed through the implant receiving opening, the approximate central portion of the ligament implant 3000' engages the implant filament loop 14, and the ends 3000a', 3000b' are relative to each other. Almost adjacent to each other on both sides of the loop 14. The free rim of suture 3002'can then be combined with the first holding element 2004' and the strut 2022' can be engaged with the alignment opening 940 of the tool 900. Tension can be applied to the free rim of suture 3002'to position the tool 900, implant 10, and ligament implant 3000'in a suitable position for marking.

In one exemplary embodiment, the total depth of the femoral tunnel 4022 can be marked on loop 14 of implant 10. This measurement result is sometimes referred to as the overall bone reserve depth. In such an embodiment, if the depth of the femoral tunnel 4022 is 40 mm, the user is 40 mm away from the implant body 12 and on the loop 14, eg, as shown in FIG. 18B, of the loop 14. Both the first side 14f and the second side 14g may be subjected to one or more indicators 14d. By keeping the implant 10 on the tool 900, the user can mark the index 14d on the loop 14 by relying on the indicia 934 placed between the implantable body holder 916 and the protrusion 924. The surgeon can then rely on indicator 14d during the procedure, as discussed in more detail below.

In addition, the depth of the main pathway 4022 only can be marked on the ligament graft 3000'. This measurement is sometimes referred to as the in-tunnel graft depth. In such an embodiment, if the depth of the main pathway 4022 is 25 mm, the user can see that the ligament graft 3000'is 25 mm away from where the ligament graft 3000'is in contact with loop 14 of the implant 10. 'On top, for example, as shown in FIG. 18B, one or more markings or indicators 3000d' can be made on the first side 3000f'and the second side 3000g' of the ligament implant 3000'. By keeping the implant 10 on the tool 900, the user can mark the index 3000d'on the implant 3000', relying on the sign 936 placed on the second portion 928. The surgeon can then rely on the indicator 3000d'during the procedure, as discussed in more detail below.

After the indicators 14d, 3000d'are applied on the implant 14 and the ligament implant 3000', the implant 10 can be detached from the implant management tool 900 or otherwise disconnected. In some procedures, the implant 10 may be removed from the tool 900 in the reverse order in which the implant 10 was originally associated with the tool 900. Thus, adjustable rims 15a, 15b, anterior suture 16, and posterior suture 18 are pulled out of the retention tab 956, as well as the holes 952 and slit 954, and then the horizontally placed filament retention tab 944. , Can be delivered from 946. The rims 15a, 15b and sutures 16 and 18 can then be pulled out of the holes 950 and slit 948, the implant body 12 can be removed from the implantable body holder 916, and the loop 14 is pulled away from the protrusion 924. obtain. The resulting configuration of the implant 10, which is no longer associated with the tool 900, is illustrated in FIG. 18B. As shown, the ligament graft 3000'is placed in loop 14, and the ligament graft index 3000d' is formed on the first and second sides 3000f', 3000g' of the ligament graft 3000', looping. Index 14d is formed on the first and second sides 14f, 14g of loop 14. Implant 10 can extend into the receiving portions 17a, 17b of the anterior suture rims 16a, 16b as shown, the rims 16a, 16b, posterior suture of the anterior suture 16 capable of folding the loop 14. 18 rims 18a, 18b, and adjustable rims 15a, 15b are further included. In addition, the free rim of suture 3002'helps to apply tension to the ligament graft 3000' when using the graft preparation tool and during the surgical procedure to otherwise control the graft. It is associated with the end 3002a', 3002b' of the ligament graft 3000'.

As shown in FIG. 18C, a transit loop suture or reciprocating suture 3004'can be used to help first pull the implant 10 through the tibial and femoral tunnels 4020, 4022. Passing loop sutures, i.e. reciprocating sutures, are known to those of skill in the art, but in an exemplary embodiment, they move a loop 3006'and a loop 3006' that receive filaments formed within the suture. Includes a first end 3004a'with a second end 3004b' which is a rim 3008' which can be grasped by a surgeon for. Each portion of the anterior suture 16, the posterior suture 18, and the adjustable rims 15a, 15b can be inserted into loop 3006'and then through the glenoid fossa 4006 from the tibial tunnel 4020. It can also proceed with the passing loop suture 3004'when entering and passing through the femoral tunnel 4022. In some embodiments, only about 7 cm to about 10 cm of the anterior suture 16, the posterior suture 18, and the adjustable rims 15a, 15b, and the filaments 15a, 15b, 16, 18 tunnel. It should be threaded through tunnels 4020, 4022 with a passing loop suture 3004'so that it does not get caught in 4020, 4022.

Once the implant body 12 has entered the glenoid fossa 4006, the anterior suture 16, the posterior suture 18, and parts of the adjustable rims 15a, 15b, respectively, have the suture and rim outside the tunnel 4022. It can be placed through the femoral tunnel 4022 so that it can be grasped by the surgeon. The implant body 12 can be seen in the glenoid fossa 4006 using some techniques known to those of skill in the art, but in some embodiments the surgeon has an endoscope or other visual tool in the glenoid fossa. Can be inserted into 4006. The implant body 12 can then be retracted into the femoral tunnel 4022 by applying most of the tension to the anterior suture 16. At the same time, the appropriate tension, such that the posterior suture 18 and the adjustable rims 15a, 15b, are at least not strained by the tension applied to the anterior suture 16. It may be beneficial to maintain the posterior suture 18 as well as the adjustable rims 15a, 15b. In addition, tension can also be applied through the tibial tunnel 4020 or to the ligament graft 3000'extending to the free rim of the suture 3002' associated with the ligament graft 3000', with tension in direction M. Apply and move away from the femoral tunnel 4022 and towards the tibial tunnel 4020. Direction M is illustrated in FIG. 18D, but FIG. 18D will be described in more detail below.

When the implant body 12 is routed through the femoral tunnel 4022, once the implant body 12 has passed through the entire tunnel, including the passage 4026, the surgeon will set the implant location for the body 12. It can be useful to know that the body 12 is in an inverted position or otherwise in contact with the femoral cortex 4008. Although it may not be easy for the surgeon to know that the implant body 12 has exited the passageway, the resistance provided by the tissue and other body parts surrounding the femoral cortex 4008 is placed within the femoral tunnel 4022. This is because it can be similar to the resistance that existed at that time. Moreover, due to the tissue and other components in close proximity to the femoral cortex 4008, it may be more difficult to place a visual device such as an endoscope near the femoral cortex 4008 rather than in the glenoid fossa 4006. Therefore, the surgeon may continue to try to pull the implant body 12 through the femoral tunnel 4022 without knowing if the implant has exited the femoral tunnel 4022, and in the end, he actually pulls the implant body 12 into the body tissue. Or it is found to be drawn through to other parts, which in turn damages implants, grafts, and / or body tissues or other parts.

However, index 14d on loop 14 can remedy the problem of not knowing when the implant excited the femoral tunnel 4022. The surgeon may use an endoscope or other visual instrument placed within the glenoid fossa 4006 to look at the entrance to the main path 4024 and observe the location of index 14d relative to the main path 4024. Since the indicator 14d is located within the main pathway 4024, when the indicator is no longer visible in the glenoid fossa 4006, the surgeon knows that the implant body 10 has exited the transit pathway 4026, but the location of the indicator 14d is the femoral tunnel 4022. This is because it represents the length of. The surgeon then finds that he or she can flip the plant body 12 or otherwise position it in contact with the femoral cortex 4008. Various techniques known to those of skill in the art can be used to invert the body 12 or abut and reorient to the femoral cortex 4008, but in the illustrated embodiment of FIG. 18D, anterior sutures. And posterior sutures 16 and 18 are manipulated so that the bottom surface 12c of the implant body 12 abuts on cortex 4008 and rests. Alternatively, or in addition, the force is in an approximate direction so that the ligament graft 3000'is strained and the body 12 is "flipping" to aid in manipulating the body 12 to the desired position. It can be selectively applied to the ligament implant 3000'to M. After the surgeon has oriented the implant body 12 as desired, the surgeon uses the tactile feedback received by pulling the anterior and posterior filaments 16, 18 and the ligament graft 3000'and / or uses visual aids. Various techniques can be used to determine its position when lying snugly on the femoral cortex 4008, directly adjacent to the femoral tunnel 4022.

Once the body 12 is placed in its desired location, tension can be applied in direction N to the adjustable rims 15a, 15b to reduce the margins of the loop 14, resulting in association with the rim. Ligament graft 3000'is further drawn to the main pathway 4024. This tension can be applied in a variety of ways, including simply by pulling in direction N. In some embodiments, as shown in FIG. 18E, the adjustable rims 15a, 15b can be wound around an object, tool 3010'as shown, to help achieve the desired tension. .. The downward tension in direction M with respect to the ligament implant 3000'and the tension so that the free rim of the ligament implant 3000' and the suture 3002' associated with the implant is not moved too quickly in direction N. Can be applied while applying to the adjustable rims 15a, 15b.

It is useful to know that once the ligament graft 3000'is placed directly adjacent to the transit pathway 4026, once the ligament graft 3000' has passed through the main pathway 4024 and advances towards the transit pathway 426. possible. If this is not the case, the surgeon may continue to pull the ligament graft 3000'through the transit path 4026, even if the transit path 4026 is not generally configured to have the ligament graft placed inside. Attempting to pull ligament graft 3000'into passage 4026 can cause unwanted harm to implant 10, ligament graft 3000', and / or knee 4000.

However, the index 3000d'on the ligament graft 3000'can remedy the problem of not knowing when the ligament graft 3000' is directly adjacent to the transit path 4026. Again, the surgeon can use an endoscope or other visual instrument placed within the glenoid fossa 4006 to look at the entrance to the main path 4024 and observe the location of the index 3000d'with respect to the main path 4024. Since the 3000d'is located within the main pathway 4024, when the indicator is not visible in the glenoid fossa 4006 for a long time, the surgeon knows that the ligament graft 3000'is located directly adjacent to the transit pathway 4026, but the indicator. This is because the location of 3000d'represents the length of the main path 4024. The surgeon thus finds that the ligament implant 3000'does no longer need to be routed through the femoral tunnel 4022, but otherwise the implant is undesirably in transit path 4026. There is a risk of being drawn in. Figure 18F illustrates the configuration resulting from the body 12 being placed on the femoral cortex 4008 and the ligament graft 3000'placed directly adjacent to the transit path 4026.

Once the implant 10 and ligament graft 3000'are secured, the knee 4000 can be cycled as desired to remove excess looseness from the system. The adjustable rims 15a, 15b can then be re-tensioned to secure the desired location for the ligament graft 3000'. Tibial fixation can then be initiated using techniques known to those of skill in the art. In addition, the adjustable rims 15a, 15b can be cut off so that there are no extra rims placed at the surgical site. The rims 15a, 15b should generally be cut out without sacrificing the integrity of the loop 14 and the connection to the implant body 12, where the rims 15a, 15b receive the anterior suture 16 17a. , Assisted by being placed within 17b. In addition, the anterior and posterior sutures 16 and 18 may be disconnected from the implant body 12 after the body is preferably positioned. The suture can be removed by pulling out or cutting and pulling out the suture, depending on how the suture is initially associated with the implant body 12.

MPFL Repair Figures 19A and 19B exemplify parts of the MPFL repair procedure that may be performed in light of the present disclosure as defined herein. As shown in FIG. 19A, a femoral tunnel 5022 can be formed within the femur 5002, the tunnel 5022 includes a main path 5024 and a transit path 5026, the transit path 5026 having a diameter smaller than that of the main pathway 5024. Has. Implants, implant management tools, and ligament implants can be prepared as described above and using techniques as described herein or otherwise known to those of skill in the art. Can be inserted into tunnel 5022. In one exemplary embodiment, the implant 10'' and the ligament implant 3000' are routed into the main pathway 5024 using the techniques described with respect to FIGS. 18A-18F, for some of which the main. It is passed through Route 5024 and Passage Route 5026. Implant 10'' may be previously associated with either a surgical implant management tool as described herein, or an embodiment derivable from the surgical implant management tool, including tool 900. ..

For FIGS. 18A-18F, the configuration that occurs during some of the procedures described above is shown in FIG. 19B, where the body 12'' of implant 10'' is adjacent to the opening in the transit path 5026 in the femoral cortex. Abuting and resting on the 5008, the loop 14'' is substantially located within the transit path 5026 and the implant 3000'is located within the main pathway 5024. As shown, the free rim of suture 3002'is associated with one side graft 3000' of knee 5000, with rim 15'' and suture 16'', 18'' implants on the opposite side of knee 4000. Associated with the body 12'', but at least one of the sutures 3002'and the free rims of the sutures 16'', 18'' has the respective graft 3000'and the implant body 12'to complete the implant procedure. The relationship with'can be broken. In an exemplary embodiment, the implant 10'' comprises a single adjustable rim 15'' associated with the loop 14'' to adjust the diameter of the loop 14'', and the anterior suture 16'' The posterior suture 18'' also includes the body during the procedure, including a single rim extending from the body 12'' to help guide the body 12'' through the femoral tunnel 5022. Includes two rims to assist in guiding and installing the 12''. Accordingly, this implant 10 represents another non-limiting example of the implant used herein in the context of the present disclosure. In an exemplary embodiment, the adjustable rim 15 and anterior suture 16 can be cut or cut to the desired length to break the relationship with the body 12 and the posterior suture. 18'' can be completely disconnected from the main body 12''. In other embodiments, the anterior suture 16'' may also be completely disconnected from the body 12'' and / or the posterior suture 18'' may also include a single rim. ..

The ACL and MPFL repair methods specified herein are only two examples of surgical procedures that can be performed using the implant management tool 900 and implant 10 specified herein. Those skilled in the art will appreciate the implant management tools 900 and / or implant 10, and other implant management tools and implants specified herein or otherwise known to those of skill in the art. A variety of other surgical procedures will be recognized, including variants relating to cruciate and collateral ligament repair that can be used without deviation from. Some non-limiting exemplary embodiments of the method of using implants of the properties specified herein are disclosed in U.S. Patent Application Nos. 13 / 793,514 and 14 / 103,167. And each of these contents has already been incorporated herein by reference in its entirety.

Furthermore, one of ordinary skill in the art can take many other methods of making specific markings or indicators on any of the implant management tools, implants, and ligament grafts without departing from the spirit of the present disclosure. You will recognize. As a non-limiting example, the indicator on the ligament graft is not given so that when it disappears from view, the ligament graft has reached the desired location, but instead the indicator appears in view. , The ligament implant may be configured to show that it has reached the desired location. In such an example, the depth of the main pathway is not marked on the ligament graft, but instead extends to the depth of the main pathway and even between the femoral and tibial tunnels. The distance can be marked on the ligament implant. The index then exits the tibial tunnel and is visible in the glenoid fossa, allowing the surgeon to know that the ligament graft is in the desired location. In yet further embodiments, the index may still indicate the desired location, but may be applied so that it is visible outside the knee and therefore not within the glenoid fossa. Various other indicator configurations may be derived from this disclosure as defined herein without departing from the spirit of this disclosure.

One of ordinary skill in the art will recognize further features and advantages of the invention based on the embodiments described above. Therefore, the present invention is not limited to the contents specifically illustrated and described, except when specified by the appended claims. For example, embodiments of implant management tools as defined herein are configured for use with implants that have cortical buttons, but various tools and features thereof may be in other forms, such as suture anchors of any form. Can be adapted for use with implants. Similarly, the present disclosure presents several variations of a particular feature, eg, an implantable body retainer, but one of ordinary skill in the art will recognize other configurations that can achieve similar results. Let's do it. Thus, as a non-limiting example, other configurations that maintain the location of the implant body on the tool, eg, suture, and hold the body on the tool can be utilized without departing from the spirit of the present disclosure. Furthermore, although the various features described herein are shown for a particular location, those skilled in the art will appreciate that in many embodiments, the features will not adversely affect the performance of the tool. You will recognize that it can be located elsewhere. For example, some of the slits and holes used to hold the filament can be placed in alternative positions. All publications and references cited herein are incorporated herein by reference in their entirety.

[Implementation] (1) A surgical implant management tool extending between a first end, a second end, and the first end and the second end. The main body is provided with a facing wall portion, an upper side, and a bottom side, and the main body is configured to hold an implantable main body on the upper side of the main body. Between the main body holder, the opening arranged closer to the second end than the first end, and the opposite wall, extending over the main body and said. Further comprising a crease that intersects the opening, the fold has the second end of the body towards the bottom side of the body to form a filament loop engagement region along the fold. Configured to be folded, the filament loop engagement region is configured to receive one or more filament loops coupled to an implantable body held by the implantable body holder. , Surgical implant management tool. (2) The tool according to embodiment 1, wherein the opening is substantially symmetrical along a central longitudinal axis extending substantially parallel to the opposed wall portion and along the crease. (3) A pair of facing openings arranged on any side of the central longitudinal axis of the main body extending substantially parallel to the opposed wall portion is further provided, and the pair of facing openings is provided with the pair of facing openings. A portion of the body crossed by the crease and located between the pair of opposed openings and the openings is a protrusion in the filament loop engagement region that receives one or more filament loops. The tool according to embodiment 1, wherein the device is formed. (4) The second end portion of the main body is further provided with a slit formed between the opening and the implantable main body holder, and the slit is bent toward the bottom side of the main body. The device according to embodiment 1, which is configured to receive. (5) Embodiment 1 further comprises an alignment opening formed adjacent to the implantable body holder, the alignment opening being configured to align the instrument on a implant preparation board. The tools listed in.

(6) The tool according to embodiment 1, further comprising one or more filament holding features disposed between the first end and the implantable body holder. (7) The one or more filament holding features include a pair of opposing tabs extending below the bottom side of the body, the tabs extending from the implantable body 1 The tool according to embodiment 6, which is configured to hold one or more filament limbs. (8) Further provided with a hole formed in the main body and in communication with the slit formed in the first end portion, and the hole extends from the implantable main body through the slit. 7. The tool according to embodiment 7, configured to receive the one or more filament rims. (9) The one or more filament holding feature portions include a hole formed in the main body and in communication with a slit formed in one of the opposite wall portions. 6. The tool according to embodiment 6, configured to extend from an implantable body and hold one or more filament rims slid into the hole through the slit. .. (10) The one or more filament holding features include a tab formed from two slits formed in one of the opposed wall portions, the tab being implantable. The tool according to embodiment 6, configured to hold one or more filament rims extending from the body.

(11) Further comprising an implantable body and one or more filament loops attached to the implantable body, the one or more filament loops extending from the loop. The implantable body is held by the implantable body holder and the one or more filament loops are held in tension by the filament loop engagement region. The tool according to embodiment 6, wherein the at least one rim is held in tension by the one or more filament holding features. (12) Further comprising at least one of the shuttle filament and the toggle filament bonded to the implantable body, the at least one of the shuttle filament and the toggle filament is one or more of the above. 11. The tool according to embodiment 11, which is held in tension by the filament holding feature of the device. (13) Further comprising one or more markings formed on the upper side of the body between the implantable body holder and the crease, the markings are held by the implantable body holder. It is configured to be used to mark an index on one or more filament loops attached to an implantable body, the index indicating the relevant depth for a surgical procedure. The tool according to embodiment 1. (14) Further provided with one or more markings formed on the upper side of the body between the crease and the second end, the markings being provided by the implantable body holder. It is configured to be used to mark indicators on ligament implants associated with one or more filament loops attached to a retained implantable body, said indicators for surgical procedures. The tool according to embodiment 1, which indicates the depth of association. (15) A method for making a ligament graft for implantation. Positioning the ligament graft through the implant receiving opening of the implant management card, said implant management card has an implantable body with one or more associated filament loops on the card. At least a portion of the implant receiving opening is located within the loop opening of at least one of the one or more filament loops, and the tension is applied to the ligament implant. Applying to a piece and marking a first depth on at least one of the one or more filament loops, in marking the first depth. A method comprising providing a sign to be used on the first surface of the implant management card.

(16) The method of embodiment 15, further comprising disconnecting the implantable body and the one or more filament loops associated with the body from the implant management card. (17) A second contralateral surface of the implant management card, further comprising marking a second depth on the ligament implant, and a mark used in marking the second depth. The method of embodiment 15 provided above. (18) The method of embodiment 17, further comprising expanding the implant management card to show the indicia used in marking the second depth. (19) The method of embodiment 17, wherein the marked second depth indicates the depth of the implant in the tunnel. (20) The method of embodiment 15, wherein the marked first depth indicates the total bone stock depth.

(21) Applying tension to the ligament implant positions the implant preparation board strut within the alignment opening of the implant management card and moves the ligament implant away from the strut to apply tension to the ligament. 15. The method of embodiment 15, further comprising applying to the implant.