Ligament clamping device

Abstract

The present disclosure relates to a ligament clamping device (1) for laterally clamping at least a first ligament (21) extending in a longitudinal direction. The ligament clamping device comprises: a) a strip (3) extending in the longitudinal direction and comprising at least two openings (33) arranged one after the other in the longitudinal direction and extending transversely from a first lateral side (31) of the strip (3) to an opposite second lateral side (32) with respect to the longitudinal direction. The ligament clamping device further comprises at least one filament (4) passing through the at least two openings, thereby forming at least one first loop and at least one second loop (51, 52, 53, 54, 55) adjustable in size between an open state and a closed state for: i) receiving the first ligament (21) in the open state; and ii) clamping the first ligament (21) in the lateral direction in the closed state.

Description

Technical Field

[0001] This disclosure relates to a ligament clamping device for clamping a first ligament and a second ligament together, according to the preamble of a patent claim. Background Technology

[0002] Ligaments are fibrous tissues that connect two parts of the body to each other (specifically, one bone to another). Ligaments are frequently damaged as a result of injury or accidents (e.g., separation, tearing, or rupture). Damaged ligaments can impede proper joint movement and cause significant pain. Damaged ligaments can be replaced or repaired using various procedures, the choice of which depends on the specific ligament being treated and the extent of the injury. Surgical reconstruction may be necessary when ligaments are damaged because they may not regenerate on their own.

[0003] An example of a ligament that is frequently damaged as a result of injury, overuse, aging, and / or accidents is the anterior cruciate ligament (ACL). An injured ACL can cause knee instability, arthritis, and severe pain. ACL repair typically involves a ligament graft replacement procedure, which usually involves drilling a bone tunnel through the tibia and upwards into the femur. A ligament graft (which can be an artificial ligament or a harvested graft, such as a tendon) is then passed through the tibial portion of the tunnel spanning the inside of the joint (sometimes called the "tibial tunnel") and upwards into the femoral portion of the tunnel (sometimes called the "femoral tunnel"). One end of the ligament graft is then secured to the femoral tunnel at the site of the natural ligament attachment, and the other end is secured to the tibial tunnel.

[0004] Another ligament that is frequently injured and may require replacement is the posterior cruciate ligament (PCL).

[0005] Furthermore, repairs of other tendons or ligaments, such as the Achilles tendon, require attempting to reattach the torn pieces of the existing tendon or ligament back together. This can be difficult when the ends of the tendon or ligament are weakened due to a tear. Sutures may be used to tear the tendon at the repair site.

[0006] Different techniques have been developed for graft preparation and for connecting two ligaments (e.g., two grafts) together.

[0007] Many existing techniques involve attaching fixation devices such as ACL TightRope® or buttons to the end of the graft. Most current techniques involve threading sutures through the graft in fine suture patterns. For example, conventional suturing techniques include whip sutures (simple or locking). Other existing graft preparation techniques include, for example, baseball sutures, Roman sandal sutures, Krackow knots, and Prusik knots.

[0008] These suturing techniques have a number of drawbacks. For example, they can cause trauma to the graft as a result of puncture. They can also cause undesirable overstretching of the graft when a load is applied. This can impair the quality of the graft and increase the risk of complications during ligament reconstruction procedures. Furthermore, grafts prepared using known suturing techniques may be prone to tearing. In addition, conventional methods for graft preparation (such as the whip suture technique described above) can be laborious and time-consuming, and can take up a significant portion of the reconstructive surgery. Placing the sutures on the graft can be cumbersome, and the entire reconstructive procedure may be delayed when such techniques are used to prepare the graft, which can increase surgical costs. Additionally, surgeons or other medical personnel who suture the grafts are at risk of needlestick injuries, which can lead to potential infections.

[0009] More broadly, existing techniques for connecting two ligaments fail to establish a strong and secure connection between them, and in particular, fail to maintain the tension applied to the ligaments over time. For example, in many techniques used in the prior art, the two or more ligaments connected to each other gradually move relative to one another, which can, for example, lead to a reduction in the initial tension applied to the two ligaments. Furthermore, many techniques known from the prior art result in ligament injury, for example, as a consequence of clamping mechanisms. Finally, many known techniques are difficult and time-consuming to perform for surgeons, thus reducing efficiency.

[0010] Therefore, there is a need for improved techniques for preparing grafts and for clamping ligaments together. Summary of the Invention

[0011] Therefore, the purpose of this disclosure is to advance the prior art in graft preparation and in clamping ligaments together. In particular, the purpose is to provide a ligament clamping device for clamping two ligaments together, which minimizes damage to the clamped ligaments. Preferably, ligament puncture will be avoided. An additional purpose of at least some variations of the device is to establish a strong and stable connection between the clamped ligaments. Another purpose of at least some variations of the device is to reduce the loss of tension acting on the clamped ligaments over time. An additional purpose of at least some variations of the device is that it is biocompatible and easy and quick to operate for surgeons. An additional purpose of at least some variations of the device is that it is widely applicable to different clinical applications, such as ligaments of different shapes and / or geometries.

[0012] According to this disclosure, these objectives are achieved by the features of the independent claims. Further advantageous embodiments are derived from the dependent claims and from the description.

[0013] This disclosure relates, in a first aspect, to a ligament clamping device for laterally clamping at least a first ligament extending in a longitudinal direction. The ligament clamping device includes a strip extending in the longitudinal direction. The strip includes at least two openings arranged front-to-back in the longitudinal direction and extending laterally from a first lateral side of the strip to an opposite second lateral side relative to the longitudinal direction. The ligament clamping device further includes at least one filament passing through the at least two openings, thereby forming at least one first loop and at least one second loop whose dimensions are adjustable between an open and a closed state for i) receiving the first ligament in the open state and ii) clamping the first ligament in the lateral direction in the closed state.

[0014] By clamping the first ligament laterally in the closed state, it is unnecessary to pierce the ligament with a filament (which may be, for example, a suture). Piercing the ligament would damage the filament and weaken its mechanical stability, such as its tension strength. For example, the ligament clamping device of the present invention can be used to attach a filament (such as a suture) to the end of a grafted ligament (e.g., to apply tension to the grafted ligament as part of ACL reconstruction) without piercing the ligament. Therefore, more broadly, among other applications, the ligament clamping device can be used to securely and firmly attach a filament (such as a medical suture) to at least one ligament.

[0015] Depending on the application, the device can also be used in conjunction with two or more ligaments. For example, in some variations, the ligament clamping device is a ligament clamping device for laterally clamping a first ligament to a second ligament extending in the longitudinal direction. In these variations, at least one first adjustable ring and at least one second adjustable ring are typically arranged to i) receive the first and second ligaments parallel to each other in the open state; and ii) clamp the first and second ligaments to each other in the lateral direction in the closed state. These embodiments allow, for example, the fixation of two or more ligaments relative to each other. The ligaments can be fixed relative to one or more directions of movement. For example, by clamping the first and second ligaments to each other in the lateral direction in the closed state, the two ligaments are typically fixed with respect to displacement in the longitudinal direction relative to each other. Thus, for example, the tension applied to the first ligament in the longitudinal direction will be transmitted to the second ligament in the closed state.

[0016] Therefore, another advantage of the ligament clamping device disclosed herein is that it allows two or more ligaments to be clamped together. As an example, two or more ligaments can be substantially fixed relative to each other without puncturing the ligaments or otherwise causing damage to them. Thus, the biological function of the ligaments is not impaired or otherwise limited.

[0017] Depending on the application, different ligaments may be selected. It is understood that the nature of the first and optional additional ligaments is not ostensibly limited to certain selected biological structures. Rather, generally, slender, flexible, and compressible structures may be selected as ligaments. Typically, but not necessarily, ligaments are biological structures. For example, at least one of one or more ligaments may be connective tissue, such as connective tissue connecting bone to other bones, or connective tissue connecting bone to muscles (i.e., tendons). Alternatively or in combination, at least one of one or more ligaments may be a graft, such as an allogeneic graft, xenograft, or autologous graft. For example, an autologous graft may be a tendon, which may be used, for example, to replace a damaged natural ligament. An autologous graft may be, for example, the hamstring tendon, although other tendons, such as the patellar tendon, may also be used. In some variations, the ligament graft is obtained from a donor (“allogeneic graft”).

[0018] The strip includes at least two openings. For example, the strip may include from 2 to 20 openings. In some variations, the strip includes at least three openings, such as from 3 to 12 openings. At least two (preferably all) of the openings extend laterally from a first side of the strip to an opposite second side relative to the longitudinal direction. Thus, the openings are typically through-holes extending laterally through the strip. In some variations, the openings may be eyelets.

[0019] Depending on the application, the openings can have different arrangements and orientations. For example, in some variations, at least two of the openings can be arranged centered relative to the central axis of the strip, although an eccentric arrangement is also possible. For example, at least some of the openings can be arranged eccentrically relative to the central axis of the strip, which can be used, for example, to cause the strip to be twisted in the closed state compared to the open state.

[0020] At least two openings extend from a first lateral side to a second lateral side. Depending on the application, the first and second lateral sides may be arranged parallel to each other. In some variations, the central axis of each opening is parallel to the central axis of each of the other openings. It is also possible that the strip has a helical construction, wherein the first and second lateral sides each extend helically around the strip. In this variation, for example, the openings arranged one behind the other in the longitudinal direction may have different orientations.

[0021] Depending on the application, the rings can be arranged differently. In some variations, at least some rings, or alternatively all rings, are arranged on the same lateral side of the strip. In some variations, at least one filament forms at least one adjustable ring on two opposite lateral sides of the strip, such that in the closed state, the first ligament and the second ligament are arranged on opposite sides of the strip. These variations can be used, for example, to clamp two or more ligaments together. Optionally arranging the clamping device between two or more ligaments can maximize the lateral clamping applied to each ligament. Furthermore, depending on the surface characteristics of the strip, friction between the clamping device and each ligament can also enhance the relative fixation of the two ligaments relative to each other. In some variations, the rings comprise a first set of one or more rings and a second set of one or more rings, wherein the first set of one or more rings is arranged on a first lateral side, and the second set of one or more rings is arranged on a second lateral side. The first set of one or more rings may optionally define a first passage for the first ligament. Depending on the application, the second set of one or more rings may optionally define a second passage for the second ligament.

[0022] Each loop is formed by a filament. Typically, at least one filament has a length that allows the filament to form multiple loops. Each loop is formed by a segment of the filament. For example, adjacent segments of the filament can each form their own loop. Each segment of the filament can form one or more loops independently of other segments of the filament. For example, each segment of the filament can form one, two, or three loops, preferably one or two loops, independently of other segments of the filament.

[0023] In some variations, at least some filament segments do not form loops, or the corresponding loops can be considered to have openings with substantially no area. For example, in some variations, at least one segment of the filament is arranged adjacent to the strip between at least two openings. In some variations, at least one segment of the filament may contact the strip between at least two openings. Depending on the application, these variations may be applicable to open and / or closed states. Thus, for example, in some variations, in the open state, at least one segment of the filament is arranged adjacent to the strip between at least two openings. Alternatively or in combination, in the closed state, at least one segment of the filament may be arranged adjacent to the strip between at least two openings.

[0024] Depending on the application, the loops can be arranged on different lateral sides of the strip. For example, in some variations, for each loop, the filament segment forming the corresponding loop leaves and enters the same or different openings on the same or opposite lateral sides of the strip. The following examples (one or more of which may optionally be combined with each other) illustrate this: - In the first example, for at least one ring, the filament segments forming the corresponding ring may exit and enter the same opening on the same lateral side of the strip (e.g., on the first lateral side). This can, for example, result in a ring extending from a single opening toward the first lateral side.

[0025] - Alternatively or in combination, for the second example, for at least one ring, the filament segments forming the respective rings may exit and enter different openings on the same lateral side of the strip. For example, the respective filament segments may exit from the first opening toward the first lateral side and may enter from the first lateral side into subsequent (e.g., adjacently arranged) openings, which would create a ring arranged on the first lateral side.

[0026] - Alternatively or in combination, for the third example, for at least one ring, the filament segment forming the corresponding ring may exit and enter the same opening on opposite lateral sides of the strip. For example, the corresponding filament segment may exit from the first opening, then pass around the strip from the first lateral side to the second lateral side, and then re-enter the same first opening, thereby forming a ring extending on the first and second lateral sides.

[0027] - Additionally or alternatively, for the fourth example, for at least one ring, the filament segment forming the respective ring may exit and enter different openings on opposite lateral sides of the strip. For example, the respective filament segment may exit from a first opening, then pass around the strip from the first lateral side to a second lateral side, and then enter another second opening that is different from the first opening (e.g., arranged adjacent to the first opening in the longitudinal direction), thereby forming a ring.

[0028] Each of the four illustrative examples listed above can be optionally combined with one another. Therefore, it is possible to combine one, two, three, or even all four illustrative examples with one another.

[0029] The shape and arrangement of the rings depend on various factors, including the openings through which the corresponding filament segments enter and exit, and how the corresponding filament segments are guided. Depending on these and other factors, the rings can have different three-dimensional profiles. For example, when viewed from a side view, some rings can be substantially flat, and others can have an extension along the longitudinal direction. A substantially flat ring, viewed from this perspective, can be achieved, for example, by having the corresponding filament segments exit and enter the same opening. In contrast, a ring with an extension in the longitudinal direction can be achieved, for example, by having the corresponding filament segments exit from a first opening and enter different second openings. For example, the corresponding ring can have a helical shape. In some variations, at least one ring has an extension in the axial direction. Alternatively or in combination, at least one ring substantially does not have an extension in the axial direction.

[0030] In some variations, loops may be arranged on either side of the strip, or at least some loops may extend across both sides. For example, in some variations, at least one loop is folded or turned to the opposite side. In some variations, for at least one loop, the filamentary segment forming the corresponding loop exits and enters the same or different openings on the first side of the strip, and extends circumferentially around the strip to the second side of the strip. In other words, the entry and exit segments of the filamentary segment forming the corresponding loop may be arranged on the first side, and the intermediate loop-forming segment of the filamentary segment arranged between the entry and exit segments is arranged on the second side. The second side of the strip is typically arranged opposite to the first side of the strip. Depending on the application and implementation, the variations described in this paragraph may, for example, be used to achieve torsion of the strip and / or one or more ligaments in a closed state. For example, when at least one loop extends circumferentially around the strip from a first side to a second side and the ligament passes through the loop, then switching the clamping device from an open state to a closed state (which may be associated with the contraction of the loop) can cause rotation or twisting of the corresponding filaments and / or strip segments. In some variations, this can be used to achieve twisting or interlacing, and can enhance the interconnection between the strip and the ligament, and optionally between two ligaments. For example, twisting or interlacing can reduce the tendency to shift in the longitudinal direction, and thereby enhance the overall tension in the longitudinal direction in the assembled or closed state.

[0031] Depending on the application, the rings may have different orientations. For example, at least some of the rings may face the longitudinal direction in the open state. In some variations, in the open state, at least some of the rings overlap each other when viewed in the longitudinal direction. In some variations, in the open state, the rings face the longitudinal direction with their respective ring openings. These variations may be used, for example, to facilitate the passage of ligaments through one or more corresponding rings. In some variations, in the open state, all the rings face the same direction with their respective openings.

[0032] Depending on the application, the clamping device may include one or more filaments. If the clamping device includes two or more filaments, these filaments may be similar to each other (e.g., in terms of material, tension strength, diameter, etc.) or they may be different from each other. For example, different filaments may perform different functions. As an example, in one variation, the clamping device includes a main filament, which may optionally be labeled as a "clamping filament," primarily for the purpose of clamping at least one ligament. Depending on the application, the clamping device may include additional filaments, which may be best labeled as "auxiliary tensioning filaments." The "auxiliary tensioning filaments" may be used, for example, for the purpose of applying a reaction force during clamping. As an example, a first tension may be applied to the clamping filament in a first direction, and a second tension may be applied to the auxiliary tensioning filament in a second direction opposite to the first direction. This may accomplish, for example, to clamp one or more filaments, i.e., to change at least one loop from an open state to a closed state.

[0033] In some variations, the auxiliary tension filament may be attached to the distal segment of the strip, for example, in a tension-resistant manner. For instance, the auxiliary tension filament may be attached to the distal end of the strip in a tension-resistant manner. The auxiliary tension filament may be knotted to the strip in the distal segment (preferably using a tension-resistant knot). It is also possible for the auxiliary tension filament to pass through an opening in the strip arranged in the distal segment. In this latter example, both ends of the auxiliary tension filament may be pulled, for example, to apply tension to the distal segment of the strip. In another example, the auxiliary tension filament may be attached to the opening of the strip via a double knot.

[0034] Depending on the application, the ligament clamping device may include one or more filaments forming loops. For example, at least one first loop and at least one second loop may optionally be formed from the same filament or two different filaments.

[0035] Depending on the application, one or more filaments can pass through one or more openings in different patterns. For example, a given filament can pass through openings arranged one after another in the longitudinal direction. It is possible that a given filament first passes through an opening in a first longitudinal direction and then returns in the opposite longitudinal direction. On the return, the filament may or may not pass through the opening. One advantage of having the filaments return in opposite directions is that this makes it possible to apply tension by pulling on both ends of the respective filaments.

[0036] Depending on the application, different openings can be selected as the first opening through which a given filament passes. For example, a given filament may first pass through an intermediate opening, such as one located in or near the middle of the strip, or it may first pass through a proximal or distal opening of the strip. In some variations, the first filament passes through a proximal opening, which is arranged longitudinally closer to the proximal end of the strip than the other openings. This can, for example, be advantageous for using the entire length of the strip. For example, when the end of the corresponding ligament is pulled, the loop formed by the ligament contracts, thereby causing one or more filaments to be clamped. When the filament passes through the proximal opening first, the tension associated with the pulling of the ligament acts on or near the proximal end of the strip, which prevents undesirable or uncontrolled folding of the device. Conversely, by applying tension on or near the proximal end of the strip, the longitudinal extension of the strip is initially maintained until the eventual, progressive contraction of the loop causes the strip to collapse in a controlled manner or otherwise be compressed.

[0037] In some variations, after passing through the proximal opening, the first filament then passes through at least one additional opening and finally through the distal opening of the strip, which is arranged longitudinally closer to the distal end of the strip than the other openings. These variations can, for example, be used to uniformly distribute the tension associated with the pulling of the filament along the entire length of the strip. Furthermore, if the first and last openings through which the filament passes are the proximal and distal openings, respectively, uncontrolled folding of the strip is minimized.

[0038] Depending on the application, the rings may be spaced apart in the closed state (e.g., not in direct contact with each other), or one or more rings may overlap each other. For example, one or more rings may be in direct contact with each other in the closed state. In some variations, a first filament contacts itself and / or another filament to form a filament cross. The first filament may, for example, contact itself and / or another filament in the closed state to form a filament cross. Having one or more filament crosses can, for example, be used to enhance lateral clamping forces at a specific location. Fiber crosses can also increase friction and thereby minimize relative displacement along the longitudinal direction.

[0039] Depending on the application, the strip may have different mechanical properties. In some variations, the strip is compressible, preferably at least in the longitudinal direction. For example, the strip may be designed to be compressible in the longitudinal direction such that when at least one adjustable ring changes from an open state to a closed state, the distance in the longitudinal direction between at least two openings decreases. Therefore, the strip may be designed to be compressible in the open state.

[0040] Alternatively or in combination, the strip may be designed to be compressible in a lateral direction orthogonal to the longitudinal direction when at least one adjustable ring changes from an open state to a closed state. For example, the strip may be designed to be compressible in a lateral direction orthogonal to the longitudinal direction and orthogonal to a first lateral side.

[0041] One advantage of a compressible strip is that, depending on the application, the pressure or tension exerted by the filaments on one or more openings can be reduced, thereby decreasing the risk of tearing or abrasion. For example, when a clamping device is switched from an open to a closed state by pulling at least one filament through two adjacent openings, the filaments can exert increasingly stronger forces on the sides of the adjacent openings facing each other. This force can be reduced by making the strip compressible. Compressibility can also be used to increase friction between the strip and at least one filament. Furthermore, in some variations, compressibility can allow lateral protrusions (e.g., bumps) to form on the strip in the closed state. These protrusions can extend, for example, in the lateral direction and can thus be used, for example, to prevent displacement of the filaments in the longitudinal direction. As an example, the bumps formed by the compression of the strip can effectively act as barriers for adjacent filaments.

[0042] The strip may also have other advantageous mechanical properties. For example, the strip may be elastic, such as being elastic in the longitudinal direction. Additionally or in combination, the strip may be elastic in a lateral direction orthogonal to the longitudinal direction, such as being elastic in a lateral direction orthogonal to both the longitudinal direction and the first lateral side.

[0043] Depending on the application, the strip may also be incompressible in at least one direction. For example, in some variations, the strip may be incompressible in the longitudinal direction, such as in the open state. Alternatively or in combination, the strip may be incompressible in a lateral direction orthogonal to the longitudinal direction, such as in a lateral direction orthogonal to the longitudinal direction and parallel to the first lateral side. Alternatively or in combination, the strip may be inelastic in at least one direction. For example, the strip may be inelastic in the longitudinal direction. Alternatively or in combination, the strip may be inelastic in a lateral direction orthogonal to the longitudinal direction, such as in a lateral direction orthogonal to the longitudinal direction and perpendicular to the first lateral side.

[0044] It is understood that in some variations, the strip may have one or more compressible segments as outlined above, and one or more incompressible segments. Similarly, in combination or alternatively, in some variations, the strip may have one or more elastic segments and one or more inelastic segments as outlined above.

[0045] In some variations, the strip is arranged to be flexible in the longitudinal direction when closed. Additionally or alternatively, the strip may be arranged to be flexible in a lateral direction orthogonal to the longitudinal direction (e.g., in a lateral direction orthogonal to the longitudinal direction and orthogonal to the first lateral side) when closed.

[0046] Depending on the application, the strip can have different shapes and geometries. For example, in some variations, the strip can be trapezoidal. The strip can be made of different materials; for example, it can be made of a flexible material. In some variations, the strip is made of a reabsorbable material. These variations can be used, for example, to improve biocompatibility and integration within the body. For example, by then using a reabsorbable material, two or more ligaments clamped together can be allowed to grow together over time, thereby enhancing the healing process.

[0047] Depending on the application, the openings of the strip can have different shapes and geometries. In some variations, at least one (preferably all) of the openings is oval in the longitudinal direction. In other words, the diameter of the opening in the longitudinal direction can be larger than the diameter orthogonal to the longitudinal direction. In some variations, the opening has an elliptical shape in a cross-section parallel to the longitudinal direction and parallel to the first lateral outer surface, the elliptical shape having two oppositely arranged vertices with edges, each pointing towards an adjacent merging segment.

[0048] The opening extends laterally from a first lateral side to an opposite second lateral side relative to the longitudinal direction. Along this extension, the opening may have different cross-sectional profiles. For example, for at least some of the openings, the cross-section of the opening may taper from the first lateral side toward the center segment of the opening, and then widen again from the center segment toward the second lateral side. The taper and widening may be symmetrical or asymmetrical. In some variations, at least some of the openings are substantially cylindrical.

[0049] In some variations, at least some (preferably all) of the openings are sized to allow up to five, preferably up to three, sutures to pass through a single opening when it is open.

[0050] Depending on the application, different types of filaments with different properties can be used. It is understood that the one or more filaments used typically have sufficient tensile strength to allow clamping of at least one ligament. In some variations, sutures can be used as filaments, such as medical sutures. Different materials are conceivable. Typically, filaments are made of materials having a low coefficient of friction on their surfaces. In some variations, filaments are made of materials having a coefficient of friction similar to that of at least one filament. These variations can, for example, allow for easy transitions from an open to a closed state. For example, when using low-friction filaments, they can smoothly glide through one or more holes, allowing for the smooth contraction of one or more corresponding loops.

[0051] In some variations, at least one filament is integrally formed with the strip. For example, at least one filament may extend from either the proximal or distal end of the strip. Typically, the diameter of the filament extending from the strip is smaller than the diameter of the strip. As an example, when the strip is a woven fabric, the filament may also be a woven fabric, optionally forming a single weave together with the strip. Typically, the diameter of the cross-sectional surface of the filament is smaller than the diameter of the cross-sectional surface of the strip.

[0052] Depending on the application, the filaments may or may not be fixedly connected to the strip. For example, at least one of the at least one filament may be fixedly connected to the strip. For example, at least one of the at least one filament may be knotted to the strip. It is also possible that at least one filament is connected to the strip in a tension-resistant manner. For example, the filament may be knotted to the strip (preferably using a tension-resistant knot), or the filament may pass through an opening in the strip in a first longitudinal direction and then return in the same longitudinal direction. In the latter example, for example, pulling the two ends of the respective suture will allow tension to be transferred to the strip. In another example, the filament may be connected to an opening in the strip via a double knot.

[0053] Depending on the application, the ligament clamping device may optionally further include an application aid, which may be used, for example, to facilitate the use of the clamping device. As an example, the application aid may be used to stabilize the rings and facilitate the passage of one or more ligaments through one or more rings. This can be particularly advantageous for facilitating manual manipulation that may be performed by a surgeon in a minimally invasive procedure. In some variations, the ligament clamping device includes at least one removable application aid that forms an open space in at least one ring suitable for receiving at least one ligament during application. For example, the application aid may include a first tube that forms an open space (which may optionally be the first passage for the first ligament mentioned above) in at least one ring suitable for receiving the first ligament during application. For example, in some variations, the first tube may pass through a first set of one or more rings. Optionally, the application aid may further include a second tube that forms an open space (which may optionally be the second passage for the second ligament mentioned above) in at least one additional ring suitable for receiving the second ligament during application. For example, in some variations, the second tube may pass through a second set of one or more rings.

[0054] The application aid can be arranged to hold one or more rings in place. For example, the application aid can pass through one or more rings, thereby substantially preventing torsion, rotation, or return of the corresponding one or more rings. In some variations, the application aid is arranged such that, in the open state, the outer contour of the application aid contacts the inner circumference of the ring. This minimizes unwanted or uncontrolled movement of the ring.

[0055] Depending on the application, the application aid may include one or more longitudinally extending slits. For example, one or more longitudinally extending slits may allow access to ligaments at least partially disposed within the application aid. For example, manually guiding a ligament through an application guide during the process of guiding the ligament through the application aid can be difficult. Accordingly, longitudinally extending slits may allow, for example, a surgeon to pass surgical instruments through the slits to allow the ligament to pass through the application aid. In some variations, the one or more slits have a width of at least 2 mm, preferably at least 4 mm. Depending on the application and the material used to manufacture the application aid, the one or more slits may also be used to allow for controlled lateral compression of the application aid.

[0056] Alternatively or in combination, if the application guide comprises at least two parts, these two parts may be configured to be releasably connected to each other (e.g., by being clamped together). For example, in some variations, the application guide comprises a first tube and a second tube, which may optionally each have at least one longitudinally extending slit. The first tube and the second tube may each be releasably connected to each other. This can help to further stabilize and further reduce the risk of unintentional displacement of the ring. In some variations, the shoulder of the first tube may be clamped to the second tube.

[0057] Alternatively or in combination, the application aid may include grooves for receiving one or more filaments. As an example, in the open state, one or more filaments may be received by the grooves. This can, for example, prevent unintended or uncontrolled movement of the rings. It also facilitates the introduction of clamping devices into the body and allows for manual manipulation as required by the surgeon. In some variations, at least some of the rings extend helically around the application aid.

[0058] In another variation, the ligament clamping device may include at least one clamp for securing one or more loops. For example, the clamp may be used to hold all loops arranged, for example, on a first lateral side, together. The clamp may be, for example, a paperclip. It is typically removed before the filament is passed through one or more loops.

[0059] This disclosure relates in a second aspect to a ligament clamping assembly comprising at least two ligament clamping devices according to any embodiment described herein. The at least two ligament clamping devices may be arranged such that they define a gap for i) receiving a first ligament in an open state; and ii) clamping the first ligament between a first clamping device and a second clamping device in a closed state. It is understood that the gap is arranged between the at least two ligament clamping devices. In other words, the at least two ligament clamping devices may be laterally spaced to define the gap.

[0060] Depending on the application, at least two ligament clamping devices of this component may share at least one filament. In some variations, at least one filament passes through at least one opening of the first clamping device and at least one opening of the second clamping device. In some variations, at least one loop extends from the first clamping device to the second clamping device. In some variations, at least one filament alternately passes through the openings of different clamping devices, for example, alternately passing through the openings of the first and second clamping devices. For example, the filament may first pass through the opening of the first clamping device, then through the opening of the second clamping device, then through the opening of the first clamping device again, and so on.

[0061] It will be understood that both the foregoing general description and the following detailed description present embodiments and are intended to provide an overview or framework for understanding the nature and features of this disclosure. The accompanying drawings are included to provide further understanding and are incorporated in and form a part of this specification. The drawings illustrate various embodiments and, together with the description, serve to explain the principles and operation of the disclosed concepts. Attached Figure Description

[0062] The present disclosure described herein will be more fully understood from the detailed description and accompanying drawings given below, which should not be considered as limiting the present disclosure as described in the appended claims. The drawings show: Figure 1 An embodiment of the ligament clamping device is shown; Figure 2 Another embodiment of the ligament clamping device is shown; Figure 3 Another embodiment of a ligament clamping device including the application of auxiliary tools is shown; Figure 4 illustrates the circumflex application of an embodiment of the ligament clamping device; Figure 5 Further embodiments of cerclage application and ligament clamping devices for treating periprosthetic fractures are shown; Figure 6 This illustrates the application of a variant of the ligament clamping device for spinal stability; Figure 7 Another embodiment is shown, which includes a ligament clamping device that assists in tensioning the filament. Detailed Implementation

[0063] Reference will now be made in detail to certain embodiments, examples of which are illustrated in the accompanying drawings, which show some, but not all, of the features. In fact, the embodiments disclosed herein can be implemented in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will satisfy applicable legal requirements. Wherever possible, similar reference numerals will be used to refer to similar components or parts.

[0064] Figure 1 An embodiment of the ligament clamping device 1 is shown. It includes a strip 3 and two filaments 41, 42. In the illustrated embodiment, both filaments 41, 42 are medical sutures. The strip 3 extends along a longitudinal direction (corresponding to the x-axis) and includes a plurality of openings 33 arranged one in front of the other in the longitudinal direction. In the illustrated embodiment, the openings 33 are eyelets and extend from a first lateral side 31 (corresponding to a positive value on the y-axis) to a second lateral side 32 (corresponding to a negative value on the y-axis) arranged opposite to the first lateral side 31.

[0065] Both filaments 41 and 42 pass through opening 33 to form a plurality of loops 51, 52, 53, 54, and 55. More specifically, in the illustrated embodiment, a first set of loops (including loops 51, 52, and 53) extending laterally from a first side 31 is formed, and a second set of loops (including loops 54 and 55) extending laterally from a second side 32 is formed. The first set of loops 51, 52, and 53 forms a first passage for receiving the first ligament 21 in the open state and clamping the first ligament 21 in the closed state. Similarly, the second set of loops 54 and 55 forms a second passage for receiving the second ligament 22 in the open state and clamping the second ligament 22 in the closed state. In the illustrated embodiment, the first ligament 21 passes through all the loops arranged on its respective lateral side (i.e., the first lateral side 31), and the second ligament 22 passes through all the loops arranged on its respective lateral side (i.e., the second lateral side 32). It is understood that this is not necessarily required.

[0066] In this disclosure, generally, one or more filaments can pass through the opening of the strip in a variety of different ways. For example, in Figure 1 In the variant shown, filament 41 may pass sequentially through openings arranged sequentially back-to-back in the longitudinal direction. The same applies to the second filament 42. However, it is also possible to allow one or more filaments to pass through openings (not shown) arranged discontinuously in the strip. Alternatively, or in combination, at least some openings (not shown) may be skipped.

[0067] exist Figure 1 In the illustrated embodiment, all rings are completely arranged on either side of the strip. In other words, for each of rings 51, 52, 53, 54, 55, the corresponding filament segment forming the corresponding ring enters and exits the same or different openings 33 from the same side. Thus, for example, all rings belonging to the first group of rings 51, 52, 53 are completely arranged on the first side 31, while all rings belonging to the second group are completely arranged on the second side 32. In other words, in the illustrated variant, each filament segment forming the rings belonging to the first group of rings 51, 52, 53 exits the eyelet from the same side (i.e., the first side 31) and re-enters the same or different eyelet. Similarly, in the illustrated variant, each filament segment forming the rings belonging to the second group of rings 54, 55 exits from the same side (i.e., the second side 32 in this case) and re-enters the same or different eyelet. Thus, each ring enters the eyelet from the same side as the side it enters from when it exits the eyelet.

[0068] It is understood that, since the two sets of oppositely arranged rings share at least one filament (in the illustrated variant, they even share two filaments), the two sets of rings are not independent of each other. Instead, the rings arranged on either side still contract uniformly.

[0069] Ligament clamping device 1 in Figure 1 The diagram shows the clamping device 1 in the open state. To change the clamping device 1 from the open state to the closed state, the two opposite ends of each of the filaments 41 and 42 can be pulled. This will cause the corresponding loops formed by the first filament 41 and the second filament 42 to contract more and more, thereby laterally clamping the first filament 21 and the second ligament 22. In principle, it is conceivable to pull the end of one of the filaments (e.g., 41) first, and only laterally pull the end of the second filament (e.g., 42) once the loop formed by the first filament 41 has contracted at least partially or even completely. For example, it may be advantageous to first partially fix the two ligaments 21, 22 with the first filament 41 before using the second filament 42 to increase fixation. It is also conceivable that the first ligament can be fixed first with the first filament, and the second ligament can be fixed laterally with the second filament (not shown). In some variations, it may also be advantageous to pull the ends of both filaments 41 and 42 simultaneously so as to contract the corresponding loops in a uniform and permanent manner. Depending on the application, this can, for example, help to distribute clamping pressure evenly along one or more filaments, which can minimize biological damage.

[0070] In the illustrated embodiment, the two ends of the first filament 41 are positioned longitudinally on opposite ends of the strip. This also applies to the two ends of the second filament 42, which are also positioned on opposite ends of the strip. Furthermore, each of the two filaments 41, 42 first passes through the proximal eyelet 33p of the strip and last passes through the distal eyelet 33d of the strip (where the distal and proximal eyelets are arranged opposite to each other in the longitudinal direction and may also be labeled as the outermost eyelets). This arrangement facilitates a uniform distribution of clamping force along the length of the strip 3. Specifically, since the outward loops (i.e., those closest to the proximal or distal end of the strip) initially contract more strongly than the subsequent loops, the contraction of the loops—and thus the clamping force—is continuously applied from the outer periphery toward the central portion of the clamping device 1.

[0071] Furthermore, by having filaments 41 and 42 pass through the proximal and distal eyelets first and last, respectively, the elongation of the strip is maintained during the tensioning of filaments 41 and 42. Specifically, for example, when the two ends of filament 41 are pulled, a force acting in the distal direction (i.e., the positive direction on the x-axis) is applied to the distal eyelet 33d, and a force acting in the proximal direction (i.e., the negative direction on the x-axis) is applied to the proximal eyelet 33p. These opposing forces acting on the proximal and distal segments of the strip ensure that the strip 3 is not significantly compressed when the two ends of filament 41 are initially pulled. Instead, the tension is primarily converted into the contraction of the loops, thereby laterally clamping the first ligament 21 and the second ligament 22, respectively. As the ends are pulled further and the loops contract more and more and begin to contact and clamp the first ligament 21 and the second ligament 22 more and more strongly, eventually, the tension is increasingly converted into compression of the strip 3 in the longitudinal direction (not shown).

[0072] Depending on the arrangement of the rings, increasing application of tension can be associated with partial torsion of the strip. For example, in Figure 1 In the illustrated embodiment, the increasing contraction of the ring 51 (which is formed by filaments 42 continuously passing through the proximal opening 33p and adjacent openings) will cause torsional forces to act on the corresponding segments (not shown) of the first ligament through which the ring 51 contracts and the corresponding segments of the strip 3. Specifically, because the filament segments forming the ring 52 pass circumferentially around the first ligament 21 after leaving the proximal opening 33p and before entering the opening adjacent to the proximal opening 33p, the increasing contraction of the ring 51 in the illustrated embodiment will cause a slight torsion (not shown) of the first filament 21 in a clockwise direction (when viewed in the lateral direction from the first lateral side 31 to the second lateral side 32, i.e., when viewed in the direction from positive to negative values ​​on the y-axis) and / or a slight torsion of the strip 3 in a counterclockwise direction (when viewed from the same direction). Depending on various factors (including the distance between adjacent openings through which the filament segments pass, the strength of strip 3, and the strength of the first ligament), it is possible to influence whether rotation of the first ligament is primarily caused, whether rotation of strip 3 is primarily caused, or whether rotation of both the first ligament and strip 3 is caused relative to each other. In any case, the relative torsion of the segments of strip 3 relative to the first ligament can be used to facilitate effective fixation of the first ligament, and in the illustrated variant in which the two ligaments will be clamped together, it helps to fix the first ligament 21 to the second ligament 22.

[0073] Depending on the application, adjacent segments of the ligament can be induced to twist in opposite directions of rotation (not shown). For example, a first loop can induce rotation of a first segment of the ligament in a clockwise direction, while an adjacent second loop can induce rotation of an adjacent second segment of the same ligament in a counterclockwise direction. In some variations (not shown), this can be used, for example, to further enhance fixation and reduce the tendency for the corresponding ligament to axial displacement.

[0074] Finally, after the contraction of all the loops formed by the first filament 41 and the second filament 42, a closed state is reached (not shown), wherein the strip 3 is arranged between the first ligament 21 and the second ligament 22.

[0075] Depending on the application, the strip 3 and the filaments 41 and 42 can be made of different materials and can have different shapes. For example, the filaments 41 and 42 can be made of the same material, or they can be made of different materials. The strip 3 can be made of, for example, a fabric (such as a woven fabric). Depending on the application, the strip 3 can have, for example, a tubular structure, which can optionally be hollow, such as... Figure 1 As illustrated in the figure, the strip 3 may, for example, form multiple lateral protrusions in the region of the opening 33. The opening 33 of the strip 3 may, for example, have an ellipsoidal shape.

[0076] Figure 2 Another embodiment of the ligament clamping device 1 is shown. Similar to... Figure 1 The variant shown further includes a clip 3 and two filaments 41 and 42 extending through an opening in the clip 3. The first filament 41 and the second filament 42 each form a plurality of loops 51, 52, 53, and 54 on either side of the clip 3. The loops 51 and 52 arranged on the first side 31 of the strip form a first set of loops, and the loops 53 and 54 arranged on the second opposite side 32 of the strip form a second set of loops. A first ligament 21 passes through the first set of loops, and a second filament 22 passes through the second set of loops parallel to the first ligament 21. Both the first ligament 21 and the second ligament 22 extend parallel to the longitudinal direction of the strip 3.

[0077] Figure 3 Another embodiment of the ligament clamping device 1 is shown, which includes application aids 61, 62 in the form of two tubes 61, 62 passing through a loop formed of filament 41. Specifically, similar to Figure 2 The embodiment shown forms a first set of rings 51, 52 arranged on a first lateral side 31 of the strip 3, and a second set of rings 53, 54 arranged on the opposite second lateral side 32 of the strip 3. A first application auxiliary tube 61 passes through the first set of rings 51, 52, and a second application auxiliary tube 62 passes through the second set of rings 53, 54.

[0078] Tubes 61 and 62 have internal cavities for receiving the first and second ligaments, respectively. Tubes 61 and 62 also ensure that the corresponding rings 51, 52, 53, and 54 are held in a certain position and / or shape, and in particular, they are prevented from rotating. Specifically, the rings are maintained in an open orientation, which allows the user to safely and easily pass a given ligament through all the required rings.

[0079] Depending on the application, rings 51, 52, 53, and 54 may optionally retract before the clamping device 1 is inserted into the body, such that the inner contour of each ring contacts the corresponding tube 61, 62. By effectively clamping the tubes 61, 62, undesirable displacement of the tubes 61, 62 can be prevented. Thus, in the open state, the application of auxiliary tools can be clamped by at least one ring.

[0080] Depending on the application, the filament segments may optionally form one or more loops between exiting and re-entering the same or different apertures of the strip 3. For example, in the illustrated embodiment, the filament segment forming loop 53 forms only a single loop, i.e., loop 53. In contrast, the filament segment forming loop 54 forms two loops, including loop 54 and an additional loop.

[0081] In addition, such as Figure 3 As illustrated, a ring can overlap with another ring to form a ring intersection. For example, ring 51 is arranged adjacent to and intersects with another ring to form a ring intersection 5c.

[0082] Figure 4 illustrates the application of the clamping device 1 in a circumferential clamping configuration. Specifically, the clamping device 8 (e.g., a locking plate) is used to secure the locking device 8 to a biological structure 7, which is typically bone. The illustrated embodiment of the clamping device 1 includes application aid tubes 61 and 62, which extend through a first set of rings and a second set of rings arranged opposite to each other, respectively.

[0083] In the first step (see Figure 4A In the embodiment, the first end of the ligament 21 passes through the first tube 61, while the second end of the same ligament 21 passes through the second tube 62 in the opposite direction. In the illustrated embodiment, the ligament 21 may be, for example, an autologous graft, but may also be a synthetic material.

[0084] In the second step (see Figure 4B In this procedure, after both ends of ligament 21 have passed through the corresponding application auxiliary tubes 61 and 62, the tubes are removed, thereby exposing the opposite ends of the ligament to the ring. Immediately following the removal of tubes 61 and 62, ligament 21 typically has not yet contracted through any ring of the ring, so care should be taken to avoid any end of the ligament unintentionally displacing out of one or more rings.

[0085] Subsequently, pulling on both ends of the suture 41 causes multiple loops to contract. As a result, the two ends of the suture are laterally clamped and thus fixed relative to each other.

[0086] As explained above, continuous pulling at the opposite end of suture 41 can cause a segment of ligament 21 to twist relative to strip 3, such as Figure 4C As illustrated in the diagram. Depending on the application, torsion can be used to increase overall tension on the ligament and further shrink the ligamentous structure.

[0087] Depending on the application, it may be desirable to tie the opposite ends of the suture 41 together in the final step (see [link]). Figure 4D This further ensures fixation, in this case, by circumduction. The knot can particularly minimize the loss of tension over time. The knot can also be used to prevent loose ends from tangling or otherwise interfering with adjacent tissues.

[0088] Figure 5 The illustration shows another application of cerclage in the treatment of periprosthetic fractures. Similar to Figure 4, cerclage is used to clamp a fixation device 8 (e.g., a fixation plate) to a biological structure 7 (e.g., bone). In the illustrated embodiment, the ligament clamping device 1 includes a first tubular application aid 61 and a second tubular application aid 62 for holding the rings 51, 52 in place and facilitating the passage of the two opposite ends of the wire 21 through the rings 51, 52.

[0089] Figure 6 The illustration shows the application of a variant of the ligament clamping device 1 in the context of spinal stabilization. Specifically, two adjacent vertebrae are fixed relative to each other by the ligament clamping device 1, which is illustrated in a closed and tensioned state. More specifically, a ligament (e.g., an allogeneic graft) passes through a foramen in the spinous process of an upper vertebra and through a foramen in the spinous process of an adjacent lower vertebra, thereby forming a fixation ring for fixing the two vertebrae. Depending on the application, one, two, or even more fixation rings may be formed. Two or more fixation rings may optionally be formed from the same or different ligaments. It is understood that this fixation ring will not be confused with a ring formed from at least one filament as disclosed herein. Instead, the fixation ring contracts to restrict relative movement between the two adjacent vertebrae. The fixation ring is maintained in a contracted state by clamping the two opposite ends of the ligament together using the ligament clamping device 1.

[0090] Figure 7Another embodiment of the ligament clamping device 1 is shown. It includes a strip 3 and two filaments 41, 42. The first filament 41 serves as a clamping filament 41, while the second filament 43 serves as an auxiliary tensioning filament 43. In the illustrated variant, one end of the clamping filament 41 is securely connected to the strip 3 by a knot. Specifically, this is achieved by passing the clamping filament 41 through an opening in the strip 3 (specifically, through the adjacent...). Figure 7 A knot is formed by tying the opening (marked by reference number 33) in the middle. The opposite ends of the clamping filament 41 are free and can be pulled to contract the multiple loops formed by the clamping filament 41 on both lateral sides of the strip 3. It is understood that the clamping filament 41 does not necessarily need to be fixedly connected to the strip 3. For example, it is also possible to pull both ends of the clamping filament 41 to contract the loops formed by the clamping filament 41.

[0091] The auxiliary tensioning filament 43 is arranged such that it can be used to apply a reaction force to the ligament clamping device 1. For this purpose, the auxiliary tensioning filament 43 may optionally be fixedly connected to a strip (not shown) at one of its two ends.

[0092] Ligament clamping device 1 in Figure 7 The diagram shows the clamping device 1 in the open state. To switch the clamping device 1 to the closed state, the free end of the clamping filament 41 and the two ends of the auxiliary tensioning filament 43 can be pulled. Pulling the free end of the clamping filament 41 applies tension to the left, while pulling the auxiliary tensioning filament 43 applies tension to the right. Through these opposing forces, the ring contracts more and more, thereby laterally clamping the first ligament (not shown) and the second ligament (not shown), respectively.

[0093] In the illustrated embodiment, the clamping suture 41 first passes through the proximal opening of the strip 3, which is arranged opposite to the distal opening through which the auxiliary tensioning filament passes. This arrangement allows for effective application of tension at the opposite ends of the strip 3 and ensures that the strip 3 initially remains in a substantially linear conformation as the loop contracts. This contributes to the orderly and controlled contraction of the loop, thereby minimizing uncontrolled and undesirable movement.

[0094] What I understand is, Figure 7 The geometry of strip 3 in the diagram is primarily used to illustrate the auxiliary tensioning filament 43 and typically does not represent the actual geometry and shape of strip 3. Instead, in typical variations, Figure 1 The illustration in the diagram is a more accurate depiction of the geometry and shape of strip 3.

[0095] Tag list 1. Ligament clamping device 21 First ligament 22 Second ligament 3 strips 31 First lateral side 32 Second lateral side 33 Opening 33p Proximal opening 33d distal opening 41, 42 Clamp the fine wires 43. Assist in tensioning the fine filament Rings 51, 52, 53, 54, and 55 5c ring intersection 61, 62 Apply auxiliary tools 7. Biological Structure 8. Fixing device.

Claims

1. A ligament clamping device (1) for laterally clamping at least a first ligament (21) extending in the longitudinal direction, the ligament clamping device (1) comprising: a. A strip (3) extending in the longitudinal direction and including at least two openings (33) arranged one after the other in the longitudinal direction and extending laterally from a first lateral side (31) of the strip (3) to an opposite second lateral side (32) relative to the longitudinal direction. b. At least one filament (41, 42) passing through at least two openings, thereby forming at least one first loop and at least one second loop (51, 52, 53, 54, 55) whose dimensions are adjustable between an open and closed state, for use in: i. Receiving the first ligament (21) in the open state; and ii. In the closed state, the first ligament (21) is clamped in the lateral direction.

2. The ligament clamping device (1) according to claim 1, wherein the ligament clamping device (1) is used to laterally clamp the first ligament to a second ligament (22) extending in the longitudinal direction, wherein, The at least one first adjustable ring and at least one second adjustable ring are arranged for use with respect to a. The first ligament (21) and the second ligament (22) are received parallel to each other in the open state; and b. In the closed state, the first ligament (21) and the second ligament (22) are clamped together in the lateral direction.

3. The ligament clamping device (1) according to claim 1 or 2, wherein, The at least one filament (41) forms at least one adjustable loop on two opposite lateral sides of the strip (3), such that in the closed state, the first ligament and the second ligament are arranged on opposite sides of the strip (3).

4. The ligament clamping device (1) according to any one of the preceding claims, wherein, The strip (3) is designed to be compressible in the longitudinal direction such that when the at least one adjustable ring changes from the open state to the closed state, the distance between the at least two openings in the longitudinal direction decreases.

5. The ligament clamping device (1) according to any one of the preceding claims, wherein, For each ring, the filamentary segments forming the corresponding ring leave and enter the same or different openings on the same or opposite lateral sides of the strip (3).

6. The ligament clamping device (1) according to any one of the preceding claims, wherein, In the open state, the ring faces the longitudinal direction with its corresponding ring opening.

7. The ligament clamping device (1) according to any one of the preceding claims, wherein, The at least one first ring and the at least one second ring are formed from the same filament or two different filaments.

8. The ligament clamping device (1) according to any one of the preceding claims, wherein, The strip (3) is arranged in the closed state to be flexible in the longitudinal direction.

9. The ligament clamping device (1) according to any one of the preceding claims, wherein, The filament is made of a material with a low coefficient of friction on its surface.

10. The ligament clamping device (1) according to any one of the preceding claims, wherein, The strip (3) is made of reabsorbable material.

11. The ligament clamping device (1) according to any one of the preceding claims, wherein, The ligament clamping device (1) includes at least one removable application aid (61, 62) that forms an open space in at least one ring suitable for receiving at least one ligament during application.

12. The ligament clamping device (1) according to any one of the preceding claims, wherein, At least one ring has an extension in the axial direction, and / or at least one ring substantially does not have an extension in the axial direction.

13. The ligament clamping device (1) according to any one of the preceding claims, wherein, At least one segment of the filament is arranged adjacent to the strip (3) between at least two openings.

14. A ligament clamping assembly comprising at least two ligament clamping devices (1) according to any one of the preceding claims, wherein, The at least two ligament clamping devices (1) are laterally spaced apart, thereby defining a gap for: a. To receive the first ligament in the open state; and b. In the closed state, the first ligament is clamped between the first clamping device and the second clamping device (1).

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