Bi-directional adjustable collar suspension device for securing soft tissue grafts

Abstract

The invention provides devices for securing soft tissue grafts at a surgical site. A suspension graft securing device (100) for securing a replacement graft ligament in a bone tunnel includes an elongated anchor member (102) having a top surface (114) and a bottom surface (116) and adjacent first and second suture receiving holes (110, 112) extending from the top surface to the bottom surface thereof. A graft support loop element is attached to the anchor member and is formed from a suture (104) having first and second branches (124, 126). The suture passes through the first and second suture receiving holes such that first and second loops (132, 134) are formed in the suture. The first and second loops extend from the bottom surface while the first and second branches extend from the top surface. A joint (136) is formed in the second branch extending from the top surface and the first branch extends through the joint.

Description

[0001] Cross-reference to related applications

[0002] This application claims priority to U.S. Provisional Patent Application Serial No. 62 / 555081, entitled “2-Way Adjustable Loop Suspension Device”, filed on September 7, 2017. Background Technology 1. Technical Field

[0004] This disclosure relates generally to surgical devices for repairing and reconstructing soft tissue injuries, and more specifically, to devices and methods for securing soft tissue grafts to surgical sites.

[0005] 2. Related technical descriptions

[0006] Many common surgical procedures involve the repair and reconstruction of torn or damaged soft tissue. For example, in common arthroscopic surgery, a replacement graft ligament is fixed to the site of a now-damaged original ligament. Repairing and reconstructing torn or damaged soft tissue is a common surgical procedure. For example, a replacement graft ligament may be fixed to the site of the original ligament. This procedure typically involves drilling bone tunnels in the adjacent bone at the site of the original ligament and fixing the graft ligament within these bone tunnels. In many applications, such as in the knee joint, this type of surgery can be performed arthroscopically. Graft ligaments can be autologous, allogeneic, xenografts, or completely synthetic. For example, common types of anterior cruciate ligament (ACL) grafts include bone-patellar tendon-bone or soft tissue grafts (such as the semitendinosus and gracilis tendons), which can be autologous or allogeneic, both of which are obtained using techniques well known to those skilled in the art.

[0007] Graft ligaments can be secured within a bone tunnel in several ways. The most important factor is their ability to withstand pull-out forces before complete healing. For example, it is known to use interfacial screws inserted parallel to the tunnel axis to press the ends of the graft ligament against the wall of the bone tunnel to secure the graft ligament and promote inward tissue growth.

[0008] Suspension-type graft fixation devices have been developed to secure graft ligaments within bone tunnels. One such device is described in U.S. Patent No. 8,852,250 (Lombardo et al.), entitled Graft Fixation Implant, which is incorporated herein by reference. The suspension-type graft fixation device operates by being laterally positioned through the opening of the bone tunnel and typically in the form of an elongated anchoring member that suspends a graft holding collar from a fixation point on the surface of the bone to which the graft is attached (in this case, the femur). The elongated member has an axis and a pair of suture receiving holes symmetrically located on opposite sides of the center of the elongated member along this axis. In ACL surgery, the elongated member (commonly referred to as a buckle) is adapted to be laterally positioned through the exit of the bone tunnel in the lateral cortex of the femur, thereby allowing a support collar, typically made of suture material, to be suspended from the buckle and extended from the suture receiving holes of the buckle into the bone tunnel. The suture collar supports one end of the graft ligament passing through the collar.

[0009] As used herein, the term "suture" can refer to any type of filamentous material capable of providing the collar support and frictional resistance required for the device described herein, such as biocompatible or bioabsorbable filaments, ribbons, strips, woven or nonwoven materials. In arthroscopic procedures such as ACL reconstruction, the elongated anchoring member is initially aligned with the axis of the bone tunnel and pulled through the tunnel to its exit at the distal end of the lateral femur. In order for this suspension graft fixation device to support the graft ligament and be properly laterally positioned at the exit of the bone tunnel, the suture collar and the bone tunnel must be long enough for the elongated member to "flip" from an axially aligned orientation to a lateral orientation as it exits the bone tunnel.

[0010] Because the support collar of such suspension devices typically has a fixed length, graft fixation requires the preparation of graft ligaments of a predetermined length. Furthermore, since conventional suspension graft fixation devices have a fixed collar length, they are manufactured in various sizes (e.g., the XO series manufactured by ConMed Corporation, Largo, Fla.). For implants, the collar length varies in 5mm increments within a range of 15mm to 60mm to accommodate various graft and tunnel lengths that may be encountered during surgery. Fixed graft lengths, as well as variations in tunnel and collar lengths, make traditional suspension ligament fixation difficult.

[0011] Recently, suspension devices have been manufactured with adjustable collar lengths. See, for example, U.S. Patent Application 2010 / 0256677 (Albertorio et al.), entitled Integrated Adjustable Button-Suture-Graft Construct with Two Fixation Devices, published October 7, 2010. It has been found that the adjustability of the collar length of suspension graft fixation devices can be achieved in a much less complex manner than described in the aforementioned publications.

[0012] Sometimes, surgeons may encounter situations where a bone tunnel of sufficient length cannot be created to accommodate a ligament graft suitable for suspension fixation. A predetermined length of graft ligament is required to engage a predetermined portion of the bone tunnel for proper healing. For example, so-called short-tunnel ACL reconstruction may present with a relatively small (narrow) femur, making it impossible to create a sufficiently long bone tunnel. This, in turn, means that the suspension anchoring member cannot be adequately advanced and flipped out of the tunnel, resulting in insufficient contact between the graft and the tunnel wall. Nevertheless, in such cases, surgeons can still perform suspension repairs using adjustable collars.

[0013] In cases where soft tissue is pulled into bone tunnels, such as in ACL reconstruction, adjustable loops are needed to simplify procedures and maximize the bone-soft tissue interface.

[0014] The disclaimer regarding the relevant technical section states: With respect to the specific patents / publications / applications / products described above in the relevant technical section or elsewhere in this disclosure, these discussions should not be construed as an admission that the patents / publications / products in question are prior art for patent law purposes. For example, some or all of the patents / publications / products in question may not be early enough in time, may not reflect topics developed sufficiently early in time, and / or may not be sufficient to achieve an equivalent prior art for patent law purposes. With respect to the specific patents / publications / applications / products described above in the relevant technical section and / or discussed throughout the application, their descriptions / disclosures are incorporated herein by reference in their entirety. Summary of the Invention

[0015] Embodiments of the present invention recognize that conventional suspension graft fixation devices have potential problems and / or disadvantages (as discussed herein and above). Various embodiments of the present invention may be advantageous because they can address or reduce one or more of the potential problems and / or disadvantages discussed herein.

[0016] This disclosure relates to apparatus and methods for securing soft tissue grafts to a surgical site. One object of the invention is to produce a suspended graft ligament repair system suitable for short tunnel repairs.

[0017] Another object of the present invention is to produce a suspended graft fixation device adapted to lock the size and position of the graft support collar after it has been set to the desired length.

[0018] Another object of the present invention is to automatically lock the graft support collar by pulling it in one direction relative to the anchoring member, and to adjust the size by changing the length of the graft support collar by pulling it in the opposite direction.

[0019] Another object of the present invention is to correct cases of excessive tension in the graft or cases where the graft is pushed too far into the bone tunnel.

[0020] In one aspect, a suspended graft fixation device is provided for securing a replacement graft ligament in a bone tunnel. The suspended graft fixation device includes an elongated anchoring member having a top surface and a bottom surface, and adjacent first and second suture receiving holes extending from its top surface to its bottom surface. A graft support collar element is attached to the anchoring member and is formed of a suture having a first branch and a second branch. The suture passes through the first and second suture receiving holes, such that a first collar and a second collar are formed within the suture. The first and second collars extend from the bottom surface, while the first and second branches extend from the top surface. A joint is formed in the second branch extending from the top surface, and the first branch extends through the joint.

[0021] According to another aspect, a suspended graft fixation device includes an elongated anchoring member having a top surface and a bottom surface extending between a first end and a second end. A plurality of holes extend from the top surface of the elongated anchoring member to the bottom surface. At least two of the plurality of holes are adjacent to a first suture receiving hole and a second suture receiving hole. The device also includes a graft support collar element attached to the anchoring member. This graft support collar element is formed of a suture having a first branch and a second branch. The suture passes through the first and second suture receiving holes, such that a first collar and a second collar are formed in the suture, the first and second collars extending from the bottom surface of the elongated anchoring member, while the first and second branches extend from the top surface. A joint is formed in the second suture branch extending from the top surface of the elongated anchoring member, and the first branch extends through the joint. Tensing the first collar pulls the first branch through the joint, elongating the first collar, while tensing the second collar pulls the joint through the first suture receiving hole.

[0022] In another aspect, a method for suspending and securing a replacement graft ligament in a bone tunnel is provided. The method includes the following steps: (i) providing an elongated anchoring member having a top surface and a bottom surface, and adjacent first and second suture receiving holes extending from its top surface to the bottom surface; (ii) providing a suture having a first branch and a second branch, and a central interlocking portion therebetween; (iii) passing the first branch from the top surface through the first suture receiving hole to the bottom surface, and then passing the first branch from the bottom surface through the second suture receiving hole to the top surface, thereby forming a first loop in the first branch; (iv) passing the second branch from the top surface through the second suture receiving hole to the bottom surface, and then passing the second branch from the bottom surface through the first suture receiving hole to the top surface, thereby forming a second loop in the second branch; (v) forming a joint in the second branch extending from the top surface of the first suture receiving hole; and (vi) passing the first branch through the joint in the second branch.

[0023] It should be understood that all combinations of the foregoing concepts and other concepts discussed in more detail below (provided that such concepts do not contradict each other) are considered part of the inventive subject matter disclosed herein. Specifically, all combinations of the claimed subject matter appearing at the end of this disclosure are considered part of the inventive subject matter disclosed herein. It should also be understood that terms expressly used herein that may also appear in any disclosure incorporated by reference shall be given the meaning most consistent with the specific concepts disclosed herein.

[0024] These and other aspects of the invention will become apparent and will be elucidated with reference to the embodiments described below. Attached Figure Description

[0025] One or more aspects of the invention are specifically pointed out and clearly claimed as examples in the claims at the conclusion of the specification. The foregoing and other objects, features, and advantages of the invention will become apparent from the following description taken in conjunction with the accompanying drawings, wherein:

[0026] Figure 1 This is a perspective view of a suspension fixing device according to one implementation scheme;

[0027] Figure 2 This is a top perspective view of the anchoring component of a suspension fixing device according to one embodiment;

[0028] Figure 3 This is a cross-sectional side view of a suspension fixing device according to one implementation scheme;

[0029] Figure 4 This is a close-up perspective view of a suspension fixing device according to one implementation scheme; and

[0030] Figure 5 This is a top view schematic diagram of a suspension fixing device according to one implementation scheme;

[0031] Figure 6 This is a side view schematic diagram of a suspension fixation device in a bone tunnel according to one implementation scheme;

[0032] Figure 7 This is a side view schematic diagram of a suspension fixation device in a first configuration according to one embodiment, the suspension fixation device being attached to the graft and extending from the distal end of the bone tunnel; and

[0033] Figure 8 This is a side view schematic diagram of a second configuration of a suspension fixation device according to one embodiment, the suspension fixation device being attached to the graft and extending from the distal end of the bone tunnel. Detailed Implementation

[0034] The invention, along with certain features, advantages, and details thereof, is explained more fully below with reference to the non-limiting examples shown in the accompanying drawings. Descriptions of well-known structures have been omitted to avoid unnecessarily obscuring the invention in detail. However, it should be understood that the detailed descriptions and specific non-limiting examples, while indicating aspects of the invention, are given by way of illustration only and not by way of limitation. Various substitutions, modifications, additions, and / or arrangements within the spirit and / or scope of the basic concept of the invention will be apparent to those skilled in the art based on this disclosure.

[0035] Now refer to the accompanying drawings, in which similar reference numerals always refer to similar parts. Figure 1 A side perspective view of a suspension graft fixation device 100 according to one embodiment is shown. The device 100 includes an elongated anchoring member 102 and a suture 104 of a given length. In the depicted embodiment, the suture 104 is in the form of a strand of filament made of a high-strength filamentous material such as ultra-high molecular weight polyethylene. The anchoring member 102 may be made of a metal such as implantable titanium or any other suitable bioresorbable or biocompatible material (as would be understood by one of ordinary skill in the art in conjunction with viewing this disclosure). In the embodiment, the length of the anchoring member 102 may range from 12 mm to 20 mm.

[0036] Briefly switch to Figure 2This is a top perspective view of the anchoring member 102 of a suspension fixing device 100 according to one embodiment. The anchoring member 102 extends along a central longitudinal yy-axis between its first end 106 and second end 108. The anchoring member 102 also has a pair of central suture receiving holes 110, 112, the size or, in other words, configuration of which is set to receive suture 104 that will form a loop. For example, the diameter of the suture receiving holes 110, 112 can be on the order of 1 mm, while the diameter of the suture 104 can be on the order of 1 mm or USP#5. Figure 5 In one embodiment, the anchoring member 102 has a rectangular geometry. Specifically, as shown in the figure, the length L of the anchoring member 102 is greater than the width w of the anchoring member 102. The rectangular geometry of the anchoring member 102 allows it to pass through narrow bone tunnels.

[0037] Re-reference Figure 2 The anchoring member 102 has a top surface 114 and a bottom surface 116 (e.g., Figures 3 to 4 (Fully shown in the diagram). The bottom surface 116 is sometimes referred to as the proximal surface and is intended to be placed adjacent to the bone tunnel exit. As used herein, the term "proximal" refers to the side of the bone containing the bone tunnel (i.e., extending medially from the surface of the lateral femur in ACL surgery), and the term "distal" refers to the side of the bone against which the transverse anchoring member 102 abuts (i.e., extending laterally from the surface of the lateral femur).

[0038] Still referencing Figure 2 The suture receiving holes 110 and 112 are located on opposite sides of the central bridging portion 118 extending between them. The anchoring member 102 may also optionally have one or more placement holes 120 extending between the top surface 114 and the bottom surface 116. In the depicted embodiment, a placement hole 120 is provided at a first end 106 of the anchoring member 102, and at a second end 108 of the anchoring member 102. The placement holes 120 are sized, or in other words, configured to receive a placement suture 140 (or another filamentous strand) to facilitate placement of the device 100 at the bone tunnel exit. For example, the placement suture 140 is attached to the placement hole 120 and pulled through the bone tunnel, thereby facilitating the orientation of the elongated anchoring member 102 parallel to the bone tunnel axis.

[0039] like Figure 1As shown, the suspension anchorage 100 is designed to work with the anchoring member 102 in conjunction with filamentous strands 104 adapted to follow a tortuous path through the suture receiving holes 110, 112 of the anchoring member 102. In one embodiment, the filamentous strands 104 are sutures of a suitable size and of a single length. As used herein, the term “suture” may be used interchangeably with “filamentous material” and, as stated above, should be understood to refer to any biocompatible or bioabsorbable material strand that, when combined with the anchoring member 102, can function to support a replacement graft in such a manner. As will be understood below, the combination of the filamentous strands 104 with the features of the anchoring member 102 can perform different functions along the path of the suture 104 through the suture receiving holes 110, 112 of the anchoring member 102.

[0040] Now for reference Figure 3 A cross-sectional side view of a suspension fixing device 100 according to one embodiment is provided. For loading... Figure 2 The anchoring member 102 shown allows the filamentary strands 104 to pass through or be wound around the thread receiving holes 110, 112. Specifically, as... Figure 3 As shown, the filament 104 is first folded on itself to form a central bend 122, thereby forming two branches 124, 126 extending from the central bend 122. Each branch 124, 126 has a length of free, unattached ends 128, 130 extending from the central bend 122 to the branch 124, 126.

[0041] Still referencing Figure 3 The first branch 124 passes through the first suture receiving hole 110, and the second branch 126 passes through the second suture receiving hole 112 (along the direction of the first branch 124). Figure 3 (As shown in the downward direction). The first branch 124 and the second branch 126 extend from the top surface 114 of the anchoring member 102 through the seam receiving holes 110, 112 to the bottom surface 116 of the anchoring member 102. Then the second branch 126 extends upward from the bottom surface 116 of the anchoring member 102 through the first seam receiving hole 110 to reach the top surface 114 of the anchoring member 102. Similarly, the first branch 124 extends upward from the bottom surface 116 of the anchoring member 102 through the second seam receiving hole 112 to reach the top surface 114 of the anchoring member 102. Figure 3 As shown, the central curved portion 122 extends on the central bridging portion 118 on the top surface 114 of the anchoring member 102, while two adjustable collars 132, 134 extend from the seam receiving holes 110, 112 through the bottom surface 116 of the anchoring member 102, as... Figure 1 As shown.

[0042] A joint 136 is formed in the second branch 126 through the free, unattached ends 128, 130 extending from the top surface 114 of the anchoring member 102, as shown in the figure. Figure 3 As shown. A first branch 124 passes through a connector 136, forming a sheath around the first branch 124. In the depicted embodiment, the connector 136 is adjacent to and above (away from) the central bend 122. With the filamentous strands 104 wound through suture receiving holes 110, 112 to form adjustable collars 132, 134 extending from the bottom surface 116 of the anchoring member 102 and a connector 136 extending from the top surface 114 of the anchoring member 102, the device 100 can be used to adjustably apply and release tension to the graft at the bone tunnel exit.

[0043] Although the suture path of the embodiment of device 100 is as follows Figure 3 As shown, however, alternative embodiments are feasible. Therefore, although the suture path through the anchoring member 102 results in the device 100 including a graft support element in the form of two adjustable collars 132, 134, different collar configurations are possible. For example, the adjustable collars 132, 134 may be formed from a single length of suture 104 (or other filamentous material), but in alternative embodiments, the adjustable collars 132, 134 may be formed from multiple individual lengths of suture 104, which together form the adjustable collars 132, 134.

[0044] Now go to Figures 6 to 8 This shows a side view schematic of the device 100 in various configurations during deployment. First, Figure 1 The device 100 shown is attached to the graft 148. Figures 7 to 8 In one implementation, graft 148 ( Figures 7 to 8 It is attached to the second ring 134, and a suture 140 is placed through the placement hole 120 of the anchoring member 102. The suture 140 is inserted through the proximal end 144 of the bone tunnel 142 and pulled toward the distal end 146 of the bone tunnel 142. Figure 6 A side view schematic diagram of a device 100 in a bone tunnel 142 according to one embodiment is shown. As shown, the placement suture 140 is pulled or otherwise tensioned toward the distal end 146 of the bone tunnel 142. In the depicted embodiment, the placement suture 140 is pulled through the bone tunnel 142 so that the elongated anchoring member 102 is oriented substantially parallel to the bone tunnel axis.

[0045] Now for reference Figure 7 The diagram shows a side view of a device 100 in a first configuration, attached to a graft 148 and extending from the distal end 146 of a bone tunnel 142. Figure 7As shown, the suture 140 is pulled until the anchoring member 102 leaves the distal end 146 of the bone tunnel 142, and the graft 148 remains within the bone tunnel 142. When the graft 148 is secured using the device 100, the two adjustable collars 132, 134 (also...) Figure 1 (As shown in the diagram) for different purposes. The first collar 132 formed by the first branch 124 is used to adjust the lengths of the two adjustable collars 132, 134. The second collar 134 formed by the second branch 126 and attached to the graft 148 is used to lock the device 100 in place, thereby locking the graft 148 in place relative to the bone tunnel outlet (i.e., the distal end 146 of the bone tunnel 142).

[0046] In use, tension is first applied to the first collar 132, which causes the dimensions of the two adjustable collars 132, 134 to increase. In one embodiment, a fastening element 138 (e.g., rope, thread, or other filamentous strand) is attached to the first collar 132, such as... Figure 1 As shown. When the fastener 138 is pulled proximally or otherwise moved away from the connector 136, slack is introduced into the adjustable collars 132, 134, thereby widening the adjustable collars 132, 134. In some cases, when the first collar 132 is tensioned, the connector 136 is pulled toward the second suture receiving hole 112. However, the connector 136 is too large relative to the second suture receiving hole 112 and therefore cannot be pulled through the second suture receiving hole 112 to the bottom surface 116 of the anchoring member 102. Therefore, the additional tension on the first collar 132 pulls the first branch 124 (and the connector 136) proximally toward the second suture receiving hole 112, where, due to its size relative to the second suture receiving hole 112, the first branch 124 is pulled through the connector 136 and the second suture receiving hole 112 to provide additional slack in the adjustable collars 132, 134. Simultaneously, the tension on the two adjustable collars 132 and 134 of the graft 148 causes the anchoring member 102 to rotate. For example... Figures 7 to 8 As shown, the graft 148 (or the filament attached to the graft 148 (not shown)) can be tensioned or otherwise pulled proximally from the proximal end 144 of the bone tunnel 142, which would tension the adjustable collars 132, 134. The tension from the graft 148 causes the anchoring member 102 to move from a first configuration substantially parallel to the bone tunnel axis (zz). Figure 7 Rotate to the second configuration that is substantially perpendicular to the bone tunnel axis (zz). Figure 8When the anchoring member 102 is perpendicular to the bone tunnel 142, the anchoring member 102 is locked in place by bringing the connector 136 against the first suture receiving hole 110. Similarly, the connector 136 is too large relative to the first suture receiving hole 110, so it cannot be pulled through the first suture receiving hole 110 to the bottom surface 116 of the anchoring member 102. Because the connector 136 is formed in the second branch 126, the second branch 126 cannot be pulled through the first suture receiving hole 110 to provide slack; instead, it locks the device 100.

[0047] All definitions defined and used herein should be understood to take precedence over dictionary definitions, definitions in referenced documents, and / or the general meaning of the defined terms.

[0048] Although various embodiments have been described and illustrated herein, those skilled in the art will readily conceive of various other means and / or structures for performing functions and / or obtaining results and / or one or more of the advantages described herein, and each of such variations and / or modifications is considered to be within the scope of the embodiments described herein. More generally, those skilled in the art will readily understand that all parameters, dimensions, materials, and configurations described herein are exemplary, and actual parameters, dimensions, materials, and / or configurations will depend on the specific application of the teachings of the invention for one or more specific applications therein. Those skilled in the art will recognize or be able to determine many equivalent forms of the specific embodiments described herein using only conventional experimentation. Therefore, it should be understood that the foregoing embodiments are given by way of example only, and that embodiments may be practiced in ways other than those specifically described and protected by the claims within the scope of the appended claims and their equivalents. Embodiments of this disclosure relate to each individual feature, system, article of manufacture, material, kit, and / or method described herein. Furthermore, any combination of two or more such features, systems, articles of manufacture, materials, kits, and / or methods is also included within the scope of this disclosure if these features, systems, articles of manufacture, materials, kits, and / or methods are not contradictory.

[0049] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to limit the invention. As used herein, unless the context clearly indicates otherwise, the singular forms “a,” “an,” and “the” are intended to include the plural forms as well. It should also be understood that the terms “comprise” (and any form of “comprise” such as “comprises” and “comprising”), “have” (and any form of “have” such as “has” and “having”), “include” (and any form of “include” such as “includes” and “including”), and “contain” (and any form of “contain” such as “contains” and “containing”) are open-ended copulas. Thus, a method or apparatus that “comprises,” “have,” “includes,” or “contains” one or more steps or elements. Similarly, the elements of a method or apparatus that "comprises," "has," "includes," or "contains" one or more of the features have, but are not limited to, those features. Furthermore, an apparatus or structure constructed in a certain way is constructed at least in that manner, but may also be constructed in ways not listed.

[0050] All means or steps in the following claims, plus corresponding structures, materials, operations, and equivalents of the functional elements, are intended to include any structure, material, or operation for performing the function in combination with other claimed elements as specifically claimed. The invention has been described for purposes of illustration and description, but this description is not exhaustive or intended to limit the invention to the forms disclosed. Many modifications and variations will be apparent to those skilled in the art without departing from the scope and spirit of the invention. The embodiments were chosen and described in order to best explain the principles and practical application of one or more aspects of the invention and to enable others skilled in the art to understand one or more aspects of the invention for various embodiments with various modifications suitable for the particular intended use.

Claims

1. A suspension graft fixation device for securing a replacement graft ligament in a bone tunnel, comprising: an elongated anchor member comprising a top surface and a bottom surface, and adjacent first and second suture receiving holes extending therefrom the top surface to the bottom surface; a graft support loop element attached to the anchor member, the graft support loop element formed from a suture comprising a first branch and a second branch; wherein the suture passes through the first and second suture receiving holes such that first and second loops are formed on the suture and the first and second loops extend from the bottom surface of the elongated anchor member while the first and second branches extend from the top surface, and a joint is formed in the second branch of the suture extending from the top surface of the elongated anchor member, and wherein the first branch extends through the joint; wherein when tension is applied to the first loop, the first and second loops are caused to increase in size, the first loop formed from the first branch for adjusting the length of the first and second loops, the second loop formed from the second branch and attached to a graft for locking the device in place, thereby locking the graft in place relative to a bone tunnel exit, wherein the joint is oversized relative to the first suture receiving hole and thus cannot be pulled through the first suture receiving hole to the bottom surface of the anchor member.

2. The suspension graft fixation device of claim 1, further comprising a central bite portion extending between the first and second branches, the central bite portion extending on a central bridge portion of the elongated anchor member between the first and second suture receiving holes.

3. The suspension graft fixation device of claim 1, wherein, the first branch extending from the top surface to the bottom surface through the first suture receiving hole and from the bottom surface to the top surface through the second suture receiving hole.

4. The suspension graft fixation device of claim 1, wherein, the second branch extending from the top surface to the bottom surface through the second suture receiving hole and from the bottom surface to the top surface through the first suture receiving hole.

5. The suspension implant of claim 1, wherein, the elongated anchor member is comprised of titanium.

6. A suspension graft fixation device for securing a replacement graft ligament in a bone tunnel, comprising: an elongated anchor member comprising a top surface and a bottom surface extending between a first end and a second end; a plurality of holes extending from the top surface to the bottom surface of the elongated anchor member; wherein at least two of the plurality of holes are adjacent first and second suture receiving holes; the first and second suture receiving holes are formed in the top surface of the elongated anchor member. a graft support loop element attached to the anchor member, the graft support loop element formed from a suture including a first branch and a second branch, wherein the suture passes through the first suture receiving hole and the second suture receiving hole such that a first loop and a second loop are formed on the suture and the first loop and the second loop extend from the bottom surface of the elongated anchor member while the first branch and the second branch extend from the top surface, and a knot is formed in the second branch of the suture that extends from the top surface of the elongated anchor member; wherein the first branch extends through the knot; wherein tensioning the first loop pulls the first branch through the knot, thereby lengthening the first loop; and wherein tensioning the second loop pulls the knot over the first suture receiving hole, the first loop formed from the first branch for adjusting the length of the first loop and the second loop, the second loop formed from the second branch and attached to a graft for locking the device in place, thereby locking the graft in place relative to a bone tunnel exit, wherein the knot is oversized relative to the first suture receiving hole and thus cannot be pulled through the first suture receiving hole to the bottom surface of the anchor member.

7. The suspension graft fixation device of claim 6, further comprising a first placement hole at the first end of the elongate anchor member, the first placement hole extending from the top surface to the bottom surface, wherein, the first placement hole configured to receive a first placement suture therethrough.

8. The suspension graft fixation device of claim 6, further comprising a second placement hole at the second end of the elongate anchor member, the second placement hole extending from the top surface to the bottom surface, wherein, the second placement hole configured to receive a second placement suture therethrough.

9. The suspension graft fixation device of claim 6, further comprising a tether connected to the first loop.

10. The suspension implant of claim 6 wherein, the first branch extends from the top surface to the bottom surface through the first suture receiving hole and from the bottom surface to the top surface through the second suture receiving hole.

11. The suspension implant of claim 6 wherein, the second branch extends from the top surface to the bottom surface through the second suture receiving hole and from the bottom surface to the top surface through the first suture receiving hole.

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