Ladder-shaped support for use in medical clamping devices

Abstract

This disclosure relates to a ladder-like strut (3) for application to a medical clamping device for clamping at least one biomimetic structure in the surgical treatment of a patient. The ladder-like strut (3) extends in a longitudinal direction (l) and is foldable at least in the longitudinal direction (l) when applied to a biomimetic structure together with the medical clamping device. The ladder-like strut (3) includes at least two openings (33) each suitable for receiving at least one loop-shaped filament for clamping a biomimetic structure to the ladder-like strut. The openings (33) are positioned posterior to each other in the longitudinal direction (l) of the ladder-like strut (3) and are separated from each other by a first crossbeam (10a) and a second crossbeam (10b) by spokes (9) extending transversely between them. The first crossbeam (10a) and the second crossbeam (10b) extend in a longitudinal direction and laterally separate the at least two openings (33).

Description

Technical Field

[0001] The present disclosure relates to a ligament clamp device for clamping a first ligament and a second ligament to each other as set forth in the preamble of the appended claims. The present disclosure further relates to a ladder strut for clamping in a medical clamp device for clamping at least one anatomical structure in surgical treatment of a patient.

Background Art

[0002] A ligament is a piece of fibrous tissue that connects two parts of the body, particularly bone to bone. Ligaments are often damaged (such as detached, lacerated, or ruptured) as a result of an injury or accident. A damaged human ligament can impede the correct movement of the joint and cause pain. Damaged ligaments can be replaced or repaired by various procedures, the choice of which may depend on the specific ligament to be restored and the extent of the damage. When a ligament is damaged, reconstructive surgery may be required because the ligament does not regenerate on its own.

[0003] One example of a ligament that is prone to damage as a result of injury, excessive exertion, aging, and / or accident is the anterior cruciate ligament (ACL). Damage to the ACL can cause the knee joint to become unstable, as well as lead to arthritis and considerable pain. ACL repair typically involves the use of a ligament graft replacement procedure, which usually involves drilling a bone tunnel upward through the tibia and into the femur. A ligament graft, which may be an artificial ligament or an autograft such as a tendon, is then passed through the tibial portion of the tunnel (sometimes referred to as the "tibial tunnel"), across the interior of the joint and upward into the femoral portion of the tunnel (sometimes referred to as the "femoral tunnel"). One end of the ligament graft can then be anchored in the femoral tunnel and the other end of the graft anchored in the tibial tunnel, these being the sites where the native ligament attaches.

[0004] Another ligament that is prone to damage and may require replacement is the posterior cruciate ligament (PCL). Furthermore, repairing other tendons or ligaments, such as the Achilles tendon, requires an attempt to reattach the torn fragments of the existing tendon or ligament back together. This can be difficult to achieve if the ends of the tendon or ligament are weak due to the tear. Sutures can potentially tear the tendon at the repair site.

[0005] Various techniques have been developed for creating grafts and joining two ligaments together, such as two grafts. Many conventional methods involve attaching fixation devices such as ACL TightRope® or buttons to the ends of the graft. Many current methods involve suturing the graft with sutures in complex suture patterns. For example, conventional suturing methods include the (simple or lock) whipstitch method. Other existing graft preparation methods include, for example, the baseball stitch, Roman sandal stitch, Krakow knot, and Prusik knot.

[0006] Suturing techniques have several drawbacks. For example, piercing the graft can result in damage to the graft. Also, under load, it can lead to undesirable excessive stretching of the graft. This can reduce the quality of the graft and increase the risk of complications during ligament reconstruction. Furthermore, grafts created using well-known suturing techniques can be prone to tearing. In addition, conventional graft creation approaches, such as the whip stitch method mentioned above, can be time-consuming and labor-intensive, potentially occupying a significant portion of the reconstruction surgery time. Suturing the graft can be complicated, and using such methods to create the graft may cause the entire reconstruction procedure to be put on hold, potentially contributing to increased surgical costs. Moreover, the surgeon or other healthcare professional performing the suturing bears the risk of needle-stick injuries that can lead to infection.

[0007] More broadly, conventional techniques for connecting two ligaments fail to reliably and permanently connect them, and in particular, to maintain tension over extended periods. For example, in many conventional techniques, the gradual movement of the connected ligaments relative to each other can reduce the tension initially applied to them. Furthermore, many techniques known in the prior art, such as clamping mechanisms, can lead to ligament damage. Ultimately, many well-known techniques are inefficient because they are difficult and time-consuming for surgeons to perform.

[0008] Therefore, improved techniques are needed for creating grafts and clamping ligaments together. [Overview of the Initiative] [Means for solving the problem]

[0009] Therefore, the object of this disclosure is to improve the level of skill relating to the preparation of grafts and clamping ligaments together. In particular, the object is to provide a ligament clamping device for clamping two ligaments together, which minimizes damage to the clamped ligaments. Preferably, it avoids ligament penetration. Furthermore, at least some variations of the device are intended to securely and permanently connect the clamped ligaments together. Furthermore, at least some variations of the device are intended to reduce the loss of tension acting on the clamped ligaments over time. Furthermore, at least some variations of the device are intended to be biocompatible and easy and quick for surgeons to operate. Furthermore, at least some variations of the device are intended to be widely applicable to a variety of clinical applications, such as ligaments with different shapes and / or geometric shapes.

[0010] According to this disclosure, these objectives are addressed by the features of the independent claims. Further advantageous embodiments arise from the dependent claims and the specification. This disclosure relates in a first embodiment to a ligament clamping device for laterally clamping at least one longitudinally extending first ligament. The ligament clamping device includes a longitudinally extending band. The band is positioned posterior to each other in the longitudinal direction and includes at least two openings extending transversely from a first side of the band to a second opposite side with respect 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 that are sizing adjustable between an open and a closed state for (i) receiving the first ligament in an open state and (ii) laterally clamping the first ligament in a closed state.

[0011] By clamping the first ligament laterally in a closed state, it becomes unnecessary to pass the filament (which may be suture thread) through the ligament (which could damage the filament and impair its mechanical stability, such as tensile strength). For example, this ligament clamping device may be used to attach a filament (such as suture thread) to the end of a graft ligament (for example, to apply tension to the graft ligament as part of ALC reconstruction) without the need to pass the filament (such as suture thread) through the ligament. Thus, more broadly, the ligament clamping device can be used to securely and permanently attach a filament (such as medical suture thread) to at least one ligament, among other applications.

[0012] Depending on the application, the device may be used in conjunction with two or more ligaments. For example, in some modifications, the ligament clamping device is for clamping a first ligament laterally to a second ligament extending longitudinally. In these modifications, at least one adjustable first loop and at least one adjustable second loop are typically arranged to (i) receive the first and second ligaments parallel to each other in an open state, and (ii) clamp the first and second ligaments laterally to each other in a closed state. These embodiments make it possible, for example, to fix two or more ligaments to each other. The ligaments may be fixed against movement in one or more directions. For example, by clamping the first and second ligaments laterally to each other, in a closed state, the two ligaments are typically fixed against longitudinal displacement relative to each other. Therefore, for example, tension applied longitudinally to the first ligament will be transmitted to the second ligament when it is closed.

[0013] Therefore, a further advantage of the ligament clamping device of this disclosure is that it can clamp two or more ligaments together. For example, two or more ligaments can be substantially fixed together without the need to penetrate or damage the ligaments. Thus, the biological function of the ligaments is not interfered with or restricted.

[0014] Depending on the application, various ligaments may be selected. The properties of the first ligament and any further optional ligaments are understood not to be limited at first glance to a specific selected biological structure. Rather, typically, elongated, soft, and compressible structures can be selected as ligaments. Typically, but not always, ligaments are biological structures. For example, at least one of the one or more ligaments may be connective tissue, such as connective tissue that connects bone to other bones, or connective tissue that connects bone to muscle (i.e., tendon). Alternatively, or in combination, at least one of the one or more ligaments may be a graft, such as an allograft, xenograft, or autograft. For example, an autograft may be a tendon, which may be used, for example, to replace a damaged natural ligament. An autograft may be, for example, a hamstring tendon, but other tendons such as the patellar tendon can also be used. In some modifications, the ligament graft is obtained from a donor ("allograft").

[0015] The strip includes at least two openings. For example, the strip may include 2 to 20 openings. In some modifications, the strip includes at least three openings, for example, 3 to 12 openings. At least two, preferably all, of the openings extend transversely with respect to the longitudinal direction from a first side of the strip to the opposite second side. Thus, the openings are typically through holes extending transversely through the strip. In some modifications, the openings may be string holes.

[0016] Depending on the application, the openings may be arranged and oriented in various ways. For example, in some modifications, at least two of the openings may be centrally located with respect to the central axis of the strip, but eccentric arrangement is also possible. For example, at least some of the openings may be eccentrically located with respect to the central axis of the strip, which may, for example, cause a twist in the strip when it is closed compared to when it is open.

[0017] At least two openings extend from a first side to a second side. Depending on the application, the first and second sides may be arranged parallel to each other. In some modifications, the central axis of each opening is parallel to the central axis of each other opening. The strip may also have a helical configuration, with the first and second sides extending helically around the strip. In this modification, for example, the openings, which are arranged rearward relative to each other in the longitudinal direction, may be in various orientations.

[0018] Depending on the application, the loops may be arranged in various configurations. In some modifications, at least some, or all, of the loops are located on the same side of the band. In some modifications, at least one filament forms at least one adjustable loop on opposing sides of the band such that, in the closed state, the first and second ligaments are located on opposite sides of the band. These modifications can be used, for example, to clamp two or more ligaments together. The lateral clamp applied to each ligament may be maximized by optionally placing the clamping device between two or more ligaments. Furthermore, depending on the surface properties of the band, the relative fixation of the two ligaments can also be enhanced by friction between the clamping device and each ligament. In some modifications, the loops include a first group of one or more loops and a second group of one or more loops, where the first group of one or more loops is located on a first side and the second group of one or more loops is located on a second side. The first group of one or more loops may optionally define a first passage for the first ligament. Depending on the application, a second group of one or more loops may optionally define a second passage for a second ligament.

[0019] Each loop is formed by a filament. Typically, at least one filament may have a certain length, allowing the filament to form multiple loops. Each loop is formed by a portion of the filament. For example, adjacent portions of a filament may each form a loop. Each filament portion may form one or more loops independently of other filament portions. For example, each filament portion may form one, two, or three, preferably one or two loops, independently of other filament portions.

[0020] In some modifications, it may be considered that at least some filament portions do not form loops, or that each loop has an opening with substantially no area. For example, in some modifications, at least a portion of the filament is positioned adjacent to the strip between at least two openings. In some modifications, at least a portion of the filament may be in contact with the strip between at least two openings. Depending on the application, these modifications may be applied to open and / or closed states. For example, in some modifications, at least a portion of the filament is positioned adjacent to the strip between at least two openings in the open state. Alternatively, or in combination, at least a portion of the filament may be positioned adjacent to the strip between at least two openings in the closed state.

[0021] Depending on the application, the loops may be positioned on different sides of the strip. For example, in some modifications, for each loop, the filament portion forming each loop enters and exits the same or different openings on the same or opposite side of the strip. The following examples show one or more of these combinations, which may be chosen and combined as desired.

[0022] As a first example, for at least one loop, the filament portions forming each loop may enter and exit the same opening on the same side of the strip (e.g., a first side). This can result in, for example, loops extending from a single opening toward the first side.

[0023] Alternatively, or in combination, as a second example, for at least one loop, the filament portions forming each loop may enter and exit through different openings on the same side of the strip. For example, each filament portion may exit from the first opening toward the first side and enter from the first side into a subsequent, for example, adjacent opening, so that a loop is located on the first side.

[0024] Alternatively, or in combination, as a third example, for at least one loop, the filament portions forming each loop may enter and exit through the same openings on opposing sides of the strip. For example, each filament portion may exit the first opening, pass around the strip from the first side to the second side, and then re-enter the same first opening to form a loop extending to the first and second sides.

[0025] In addition, or alternatively, as a fourth example, for at least one loop, the filament portions forming each loop may enter and exit through different openings on opposite sides of the strip. For example, each filament portion may exit through a first opening, pass around the strip from the first side to the second side, and then enter through a different second opening (for example, located longitudinally adjacent to the first opening) to form a loop.

[0026] The four explanatory examples above may be combined with each other at will. Therefore, it is possible to combine one, two, three, or all four explanatory examples with each other. The shape and arrangement of the loop are determined by various factors including, in addition to the opening through which each filament portion enters and exits, the manner in which each filament portion is guided. Depending on these or other factors, the loops may have various three-dimensional contours. For example, when viewed from the lateral direction, some loops may be substantially flat, and other loops may have an extension along the longitudinal direction. A loop that is substantially flat from this viewpoint can be achieved, for example, by passing each filament portion out of and back into the same opening. In contrast, a loop having a longitudinal extension can be achieved, for example, by passing each filament portion out of a first opening and into a different second opening. For example, each loop may be helical. In some variants, at least one loop has an axial extension. Alternatively or in combination, at least one loop has substantially no axial extension.

[0027] In some modifications, the loops may be located on both sides of the band, or at least some loops may extend across both sides. For example, in some modifications, at least one loop may be folded or bent across the opposite side. In some modifications, for at least one loop, the filamentary portions forming each loop enter and exit the same or different openings on the first side of the band and extend circumferentially around the band to the second side of the band. In other words, the entry and exit portions of the filamentary portions forming each loop may be located on the first side, and the loop-forming intermediate portions of the filamentary portions located between the entry and exit portions may be located on the second side. The second side of the band is typically located on the opposite side of the first side of the band. Depending on the application and implementation, the modifications described in this paragraph, for example, may be used to cause twisting of the band and / or one or more ligaments in a closed state. For example, if at least one loop extends circumferentially around a band piece from a first side to a second side, and a ligament passes through the loop, each filament and / or portion of the band piece may be rotated or twisted by changing the clamping device from an open to a closed state (which may be associated with tightening the loop). This may be used in several variations to allow mutual twisting or mutual wrapping, thereby strengthening the interconnection between the band piece and the ligament, and optionally between two ligaments. For example, mutual twisting or mutual wrapping may reduce the tendency of displacement along the longitudinal direction, thereby improving the overall longitudinal tensile strength in the assembled or closed state.

[0028] Depending on the application example, the loops may be in various orientations. For example, at least some of the loops may be oriented longitudinally in the open state. In some variants, in the open state, at least some of the loops overlap each other when viewed in the longitudinal direction. In some variants, in the open state, the loops face their respective loop openings in the longitudinal direction. Using these variants, for example, a ligament may be easily passed through each loop or a plurality of loops. In some variants, all loops face their respective openings in the same direction in the open state.

[0029] Depending on the application example, the clamping device may include one or a plurality of filaments. When the clamping device includes two or more filaments, they may be similar to each other (for example, in terms of material, tensile strength, diameter, etc.) or may be different from each other. For example, different filaments may fulfill different functions. As an example, in a certain variant, the clamping device comprises one main filament, which may optionally be referred to as a "clamping filament", which may primarily serve the purpose of clamping at least one ligament. Depending on the application example, the clamping device may comprise a further filament, which may optimally be referred to as an "auxiliary tension filament". The "auxiliary tension filament" may, for example, serve the purpose of applying a counterforce during clamping. For example, a first tensile force may be applied to the clamping filament in a first direction, and a second tensile force may be applied to the auxiliary tension filament in a second direction opposite to the first direction. This may be done, for example, to clamp one filament or a plurality of filaments, that is, to change at least one loop from an open state to a closed state.

[0030] In some variations, the auxiliary tension filament may be attached in a manner that withstands tension, for example, to the distal portion of the band. For example, the auxiliary tension filament may be attached to the distal end of the band in a manner that withstands tension. The auxiliary tension filament may be tied to the band at the distal portion of the band (preferably using a tension-resistant knot). The auxiliary tension filament may also pass through an opening in the band located at the distal portion of the band. In this latter example, both ends of the auxiliary tension filament may be pulled, for example, to apply tension to the distal portion of the band. In further examples, the auxiliary tension filament may be attached to the opening in the band by a lark's head knot.

[0031] 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.

[0032] Depending on the application, one or more filaments may pass through one or more openings in various patterns. For example, a particular filament may sequentially pass through openings that are positioned behind each other in the longitudinal direction. A particular filament may first pass through the openings in a first longitudinal direction and then return in the opposite longitudinal direction. When returning, the filament may or may not pass through the openings. One advantage of having the filament return in the opposite direction is that tension can be applied by pulling both ends of each filament.

[0033] Depending on the application, a different opening may be selected as the first opening through which a particular filament passes. For example, a particular filament may first pass through an intermediate opening located in or near the middle of the band, or it may first pass through a proximal or distal opening of the band. In some modifications, the first filament first passes through a proximal opening located closer to the proximal end of the band than other openings in the longitudinal direction. This can be beneficial, for example, to utilize the entire length of the band. For example, when one end of each ligament is pulled, the loop formed by the ligament is tightened, thereby clamping one or more filaments. When the filament first passes through the proximal opening, the tension associated with pulling the ligament acts on or near the proximal end of the band, which can prevent undesirable or uncontrollable folding of the device. Instead, by applying tension to or near the proximal end of the band, the longitudinal elongation of the band is initially maintained until the band is crushed or compressed in a controlled manner by the final tightening of the loop.

[0034] In some modifications, after passing through the proximal opening, the first filament passes through at least one further opening, and finally through the distal opening of the strip, which is located closer to the distal end of the strip than the other openings in the longitudinal direction of the strip. Using these modifications, for example, the tension associated with pulling the filament may be distributed uniformly over 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.

[0035] Depending on the application, the loops may be separated from each other in a closed state (e.g., not in direct contact with each other), or one or more loops may overlap each other. For example, one or more loops may be in direct contact with each other in a closed state. In some modifications, the first filament may be in contact with itself and / or another filament to form a filament cross. The first filament may be in contact with itself and / or another filament in a closed state to form a filament cross. One or more By using the filament crossing, for example, the lateral clamping force at a specific location may be increased. Alternatively, the filament crossing may increase friction, thereby minimizing relative displacement along the longitudinal direction.

[0036] Depending on the application, the strip may have a variety of mechanical properties. In some modifications, 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 the distance between at least two openings in the longitudinal direction is reduced when at least one adjustable loop is moved from an open to a closed position. Thus, the strip may be designed to be compressible in the open position.

[0037] Alternatively, or in combination, the strip may be designed to be compressible transversely perpendicular to the longitudinal direction when at least one adjustable loop is moved from an open to a closed position. For example, the strip may be designed to be compressible transversely perpendicular to the longitudinal direction and perpendicular to the first side surface.

[0038] One advantage of the compressible strip is that, depending on the application, it can reduce the risk of tearing or abrasion by reducing the pressure or tension acting on the opening by the filament. For example, when changing a clamping device from an open to a closed state by pulling at least one filament through two adjacent openings, the filament may gradually exert increasing force on the mutually facing sides of the adjacent openings. By making the strip compressible, this force can be reduced. Alternatively, the compressibility may be used to increase friction between the strip and at least one filament. Furthermore, in some modifications, the compressibility may allow for the formation of lateral projections (e.g., bulges) on the strip when it is closed. These projections may extend laterally, for example, and may be used to prevent, for example, the filament from being displaced longitudinally. For example, a bulge formed by the compression of the strip can effectively act as an obstacle for the adjacent filament.

[0039] The strip may also have other advantageous mechanical properties. For example, the strip may have elasticity, such as longitudinal elasticity. In addition, or in combination, the strip may have transverse elasticity perpendicular to the longitudinal direction, such as transverse elasticity perpendicular to the longitudinal direction and perpendicular to the first side surface.

[0040] Depending on the application, the strip may also be incompressible in at least one direction. For example, in some modifications, the strip may be incompressible in the longitudinal direction, e.g., incompressible when open. Alternatively, or in combination, the strip may be incompressible in the transverse direction perpendicular to the longitudinal direction, e.g., incompressible in the transverse direction perpendicular to the longitudinal direction and parallel to the first side surface. 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 not be elastic in the transverse direction perpendicular to the longitudinal direction, e.g., inelastic in the transverse direction perpendicular to the longitudinal direction and perpendicular to the first side surface.

[0041] In some modifications, the strip may have one or more compressible portions and one or more incompressible portions, as outlined above. Similarly, in combination or alternatively, in some modifications, the strip may have one or more elastic portions and one or more inelastic portions, as outlined above.

[0042] In some modifications, the strip is positioned to be flexible in the longitudinal direction when closed. In addition, or in combination, the strip may be positioned to be flexible in a transverse direction perpendicular to the longitudinal direction, for example, in a transverse direction perpendicular to the longitudinal direction and perpendicular to the first side surface.

[0043] Depending on the application, the band may have various shapes and geometric forms. For example, in some modifications, the band may be ladder-shaped. The band may be made of various materials, for example, a flexible material. In some modifications, the band is made of an absorbable material. These modifications may be used to improve, for example, biocompatibility and integration within the body. For example, using an absorbable material may allow two or more ligaments clamped together to adhere over time, thereby enhancing the healing process.

[0044] Depending on the application, the openings of the strip may have various shapes and geometric forms. In some modifications, at least one, preferably all, of the openings are elliptical in the longitudinal direction. In other words, the longitudinal diameter of the opening may be larger than the diameter perpendicular to the longitudinal direction. In some modifications, the opening is elliptical in a cross section parallel to the longitudinal direction and parallel to the first transverse outer surface, and this ellipse has two pointed vertices positioned opposite each other and facing adjacent fusion portions.

[0045] The opening extends transversely in the longitudinal direction from a first side to a second side on the opposite side. Along this extension, the opening may have various cross-sectional shapes. For example, in at least some of the openings, the cross-section of the opening may taper from the first side toward the central portion of the opening, and then widen again from the central portion toward the second side. The taper and widening may be symmetrical or asymmetrical. In some modifications, at least some of the openings are substantially cylindrical.

[0046] In some variations, at least some, preferably all, of the openings are formed to a size that allows up to five, preferably up to three, sutures to be passed through a single opening when it is open.

[0047] Depending on the application, various types of filaments with different properties may be used. The one or more filaments used are typically understood to have sufficient tensile strength to clamp at least one ligament. In some modifications, sutures, such as medical sutures, may be used as filaments. Various materials are possible. Typically, the filaments are made from materials with a low coefficient of friction. In some modifications, the filaments are made from materials with a coefficient of friction similar to that of at least one filament. These modifications may allow for easy transitions from an open to a closed state, for example. For example, using a low-friction filament allows it to move smoothly through one or more holes, thereby smoothly tightening each of the one or more loops.

[0048] In some variations, at least one filament is formed integrally with the strip. For example, at least one filament may extend from 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. For example, if the strip is a woven fabric, the filament may also be a woven fabric, optionally forming a single braid together with the strip. Typically, the diameter or cross-section of the filament is smaller than the cross-sectional diameter of the strip.

[0049] Depending on the application, the filaments may or may not be permanently attached to the band. For example, at least one of the at least one filaments may be permanently attached to the band. For example, at least one of the at least one filaments may be tied to the band. Alternatively, at least one filament may be attached to the band in a manner that can withstand tension. For example, the filament may be tied to the band (preferably using a knot that can withstand tension), or the filament may be passed through the opening of the band in a first longitudinal direction and then returned in the same longitudinal direction. In the latter example, tension may be transmitted to the band by pulling both ends of each suture, for example. In a further example, the filament may be attached to the opening of the band by a lark's head knot.

[0050] Depending on the application, the ligament clamping device may optionally further include application aids that can be used, for example, to facilitate the use of the clamping device. For example, the application aids may be used to stabilize the loops and facilitate passing one or more ligaments through one or more loops. This can be particularly advantageous in facilitating procedures performed by surgeons, possibly in minimally invasive surgery. In some modifications, the ligament clamping device includes at least one removable application aid that forms an open space within at least one loop suitable for receiving at least one ligament when applied. For example, the application aid may include a first tube that forms an open space (optionally, a first passage for the first ligament described above) within at least one loop suitable for receiving a first ligament when applied. For example, in some modifications, the first tube may pass through a first group of one or more loops. Optionally, the application aid may further include a second tube that forms an open space (optionally, which may be a second passage for the second ligament described above) within at least one further loop suitable for receiving the second ligament when applied. For example, in some modifications, the second tube may pass through a second group of one or more loops.

[0051] The application aid may be positioned to hold one or more loops in place. For example, the application aid may pass through one or more loops to substantially prevent twisting, rotation, or swirling of each of the one or more loops. In some modifications, the application aid is positioned such that, when open, its outer contour contacts the inner circumference of the loop. This can minimize undesirable or uncontrollable movement of the loop.

[0052] 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 a ligament located at least partially inside the application aid. For example, in the process of guiding a ligament through the application aid, it may be difficult to pass the ligament through the application guide manually. Therefore, longitudinally extending slits may allow, for example, a surgeon to pass a surgical instrument through the slit to guide the ligament through the application aid. In some modifications, the width of one or more slits is at least 2 mm, preferably at least 4 mm. Depending on the application and the material of the application aid, one or more slits may be used to allow a controlled degree of lateral compression of the application aid.

[0053] Alternatively, or in combination, if the application guide includes at least two parts, these two parts may be configured to be openly connected to each other (e.g., by clipping them together). For example, in some modifications, the application guide includes 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 be openly connected to each other. This may provide further stabilization and further reduce the risk of unintended displacement of the loop. In some modifications, the shoulder of the first tube may be clipped to the second tube.

[0054] Alternatively, or in combination, the application aid may include grooves for receiving one or more filaments. For example, one or more filaments may be received in the grooves when open. This can prevent, for example, undesirable or uncontrollable movement of the loop. It can also make it easier to introduce the clamping device into the body and simplify the procedure required of the surgeon. In some modifications, at least some of the loops extend spirally around the application aid.

[0055] In further modifications, the ligament clamping device may include at least one clip for securing one or more loops. For example, a clip may be used to hold together, for example, all loops arranged on the first side. The clip may be, for example, a paper clip. The clip is typically removed before passing the filament through one or more loops.

[0056] In a second aspect, this disclosure relates to a ligament clamp assembly comprising at least two ligament clamp devices according to any embodiment described herein. The at least two ligament clamp devices may be arranged to define an internal space for (i) receiving a first ligament in an open state and (ii) clamping the first ligament between the first and second clamp devices in a closed state. The internal space is understood to be located between the at least two ligament clamp devices. In other words, the at least two ligament clamp devices may be laterally separated to define the internal space.

[0057] Depending on the application, at least two ligament clamping devices of the assembly may share at least one filament. In some modifications, 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 modifications, at least one loop extends from the first clamping device to the second clamping device. In some modifications, at least one filament alternately passes through the openings of different clamping devices, for example, the openings of the first clamping device and the openings of the second clamping device. For example, the filament may first pass through the opening of the first clamping device, then through the opening of the second clamping device, and then again through the opening of the first clamping device.

[0058] This disclosure relates, in a third aspect, to a ladder-like support for application to a medical clamping device for clamping at least one biological structure. The ladder-like support may, for example, in some modifications, be used for application to a ligament clamping device according to either an embodiment of the first or second aspect of this disclosure. In other words, the medical clamping device for clamping at least one biological structure may, in some modifications, be a ligament clamping device for laterally clamping at least one longitudinally extending ligament. Depending on the application, the band disclosed herein may, in some modifications, include or consist of a ladder-like support according to any of the modifications disclosed herein.

[0059] The ladder-like support extends longitudinally and is foldable at least longitudinally. For example, when applied to a biological structure in conjunction with a medical clamping device, the ladder-like support may be foldable at least longitudinally. The ladder-like support may also be foldable laterally.

[0060] The ladder-like support includes at least two openings, each suitable for receiving at least one loop-shaped filament for clamping a biological structure to the ladder-like support. The openings may be, for example, string holes.

[0061] The openings are positioned aft of each other in the longitudinal direction of the ladder-like support. In a typical embodiment, the openings are positioned aft of each other in the longitudinal direction and separated from each other by a first distance by spokes extending transversely between the first and second transverse beams. Each spoke is understood to be located in the space between two adjacent openings in the transverse direction. Furthermore, the ladder shape of the ladder-like support is understood to be at least in part due to the presence of the first transverse beam, the second transverse beam, and one or more spokes extending between the first and second transverse beams.

[0062] The first and second transverse beams extend longitudinally and laterally divide at least two openings. Typically, as further detailed above, the opening extends longitudinally from a first side of the ladder support to the opposite second side of the ladder support. The first crossbeam, the second crossbeam, and one or more spokes are typically positioned between the first and second sides.

[0063] Ladder struts can be used in a variety of applications. For example, in some modifications, ladder struts are suitable for use in medical clamping devices for clamping at least one bio-structure in the surgical treatment of a patient. Ladder struts can also be used in other clamping applications. Depending on the application, the bio-structure to be clamped may be a ligament. In some modifications, ladder struts are configured to fix and tension one or more bio-structures in the patient's body. Ladder struts may optionally be used in combination with one or more filaments, such as sutures. For example, in some modifications, at least one filament passes through at least one of the openings of the ladder strut. Alternatively, or in combination, at least one filament may be fixed to the ladder strut, for example, by tying it.

[0064] Depending on the application, the spokes and beams may have various cross-sections. For example, in some modifications, the spokes may be elliptical in the transverse and / or longitudinal directions. Alternatively, or in combination, the first and / or second beams may be elliptical with respect to the transverse direction. Specifically, the cross-section of the spokes may be elliptical in the transverse and longitudinal directions, and the cross-sections of the first and second beams may be elliptical with respect to the transverse direction. One advantage of having an elliptical cross-section is that it can result in favorable sliding properties. For example, ligaments or filaments in contact with the ladder-like struts may pass more smoothly along the surface of the struts. In some modifications, the outer contours of the spokes, and / or the outer contours of the first and / or the outer contours of the second beams may not have substantially distinct edges. This may allow ligaments or filaments to slide more easily.

[0065] Depending on the application, the ladder-like supports may have various cross-sections. For example, in some modifications, the cross-section of the spokes is H-shaped. Alternatively, or in combination, the cross-sections of the first and second transverse beams may be T-shaped or I-shaped. The expressions “H-shaped,” “T-shaped,” and “I-shaped” refer to the Latin letters “H,” “T,” and “I,” respectively. The letter “I” is the uppercase letter “i.” For example, in some modifications, an “I-shaped” may be substantially straight. In some modifications, an H-shape includes two substantially straight lines that extend parallel to each other and are separated from each other by a transverse bar passing between them. The transverse bar is typically substantially perpendicular to the two substantially straight lines and is typically positioned substantially centered relative to the two substantially straight lines. In some variations, the T-shape may include a substantially straight first line and a substantially straight second line extending perpendicularly to the first line from its center. For example, the second line may be shorter than the first line.

[0066] Depending on the application, the spokes, the first crossbar, and the second crossbar may be separate parts, or they may be integrally molded, i.e., made from a single part. Furthermore, various geometries are possible, particularly for the transition between the spokes and the first and second crossbars. For example, in some modifications, the spokes and the first and second crossbars transition smoothly from one another without forming a distinct edge. One advantage of these modifications is that they facilitate the smooth sliding of ligaments or filaments along the surface of the ladder struts. A further advantage may be that they reduce the risk of ligaments or filaments getting stuck or caught in specific parts of the ladder struts (which could increase the risk of tearing). A distinct edge could be, for example, a structure on the outer surface with a length of at least 2 mm, e.g., at least 5 mm. Surface roughness, especially uniformly distributed surface roughness, is typically understood not to constitute a distinct edge.

[0067] Depending on the application, the spokes and / or crossbeams may have a variety of physical structures. For example, in some modifications, at least one spoke may be at least partially hollow. Alternatively, or in combination, at least one crossbeam, preferably the first and second crossbeams, may be at least partially hollow. Specifically, in some modifications, at least one spoke and at least one crossbeam of the ladder support are at least partially hollow. One example of being at least partially hollow is being completely hollow. Therefore, for example, at least one spoke and at least one crossbeam of the ladder support may be completely hollow. In some modifications, the first crossbeam and / or the second crossbeam have a tubular cross-section.

[0068] The ladder-like supports may be made from a variety of materials. Depending on the application, various manufacturing methods may be used. In some variations, the ladder-like supports are made by weaving. They can also be made by injection molding. In yet another variation, the ladder-like supports are made by 3D printing.

[0069] Depending on the application, the ladder-like support may be a braid, for example, made from multiple woven filaments. In some modifications, the ladder-like support includes multiple filaments extending longitudinally. In the spoke region, the multiple filaments may form a tubular braid. In addition, or alternatively, in the opening region, the multiple filaments may form two longitudinally extending tubular braids to define a first and second crossbeam in each region of the ladder-like support. Depending on the application, a tunnel extending from the first end of the ladder-like support to the second end may be defined by the tubular braid in the spoke region and the tubular braid in the opening region.

[0070] Various braiding patterns and techniques may be used. For example, in some modifications, the configuration of the filaments forming the first crossbeam and the configuration of the filaments forming the second crossbeam may differ for each opening. For example, for each region containing an opening, the first group of filaments may form the first crossbeam, and the second group of filaments may form the second crossbeam. Alternatively, the filaments forming the first crossbeam and the filaments forming the second crossbeam may be selected independently for each region containing an opening. Depending on the application, each filament may form a helix at each central portion and each branching portion. The helix may have various twisting directions. For example, each filament may maintain a helical twisting direction from the first end of the ladder-like support to the second end of the ladder-like support. Each filament forming the braid may be arranged differently relative to one another. In some modifications, each filament extends from the first end of the ladder-like support to the second end of the ladder-like support. Depending on the application, each continuous portion of the filament gradually approaches the second end of the strip from the first end of each filament. Therefore, for example, the filament can be prevented from being guided in the reverse direction.

[0071] Depending on the application, the tubular braid may have a pick count in each central portion ranging from 40 ppi to 120 ppi, preferably from 60 ppi to 100 ppi. In other words, the ladder-like support may include tubular braids in the spoke region with a pick count ranging from 40 ppi to 120 ppi, preferably from 60 ppi to 100 ppi.

[0072] Alternatively, or in combination, each tubular braid may have a number of threads driven in at each branching section ranging from 20 ppi to 90 ppi, preferably from 40 ppi to 70 ppi. In other words, the ladder-like support may include tubular braids with a number of threads driven in ranging from 20 ppi to 90 ppi, preferably from 40 ppi to 70 ppi, in the area of ​​the opening.

[0073] In some variations, the linear density of each filament is 20 dtex to 880 dtex, preferably 55 dtex to 440 dtex, more preferably 80 dtex to 250 dtex. Alternatively, or in combination, the ladder-like support may include 8 to 32 filaments, preferably 16 filaments.

[0074] Depending on the application, the tubular braid formed in the spoke area may be a twill braid. Alternatively, or in combination, the tubular braid formed in the opening area may be a twill braid. In some modifications, the filaments are braided so that two are on top and two are on the bottom, or one is on top and one is on the bottom. In a two-on-top, two-on-bottom braid, each filament is understood to pass sequentially over two threads in the opposite direction and then under the next two threads in the opposite direction. Similarly, in a one-on-top, one-on-bottom braid, each filament passes sequentially over one thread in the opposite direction and then under the next thread in the opposite direction. Depending on the application, the ladder-like support may consist of a two-on-top, two-on-bottom braid, or a one-on-top, one-on-bottom braid. Furthermore, the ladder-like supports may include braids in which one braid is on top and one on the bottom in some areas, and braids in which two braids are on top and two on the bottom in other areas.

[0075] In some variations, the ratio of the number of filaments in each central section to the circumference of the tubular braid in each central section ranges from 4 filaments / mm to 13 filaments / mm. In other words, in each region containing spokes, the ratio of the number of filaments to the circumference of the tubular braid in that region may also range from 4 filaments / mm to 13 filaments / mm.

[0076] In some variations, the ratio of the number of filaments to the circumference of the tubular braid at each branching point ranges from 4 filaments / mm to 13 filaments / mm. For example, for each first transverse leg and each second transverse leg, the ratio of the number of filaments to the circumference of the tubular braid at each transverse leg may range from 4 filaments / mm to 13 filaments / mm. In other words, in each region containing an opening, the ratio of the number of filaments to the circumference of the tubular braid in each region may range from 4 filaments / mm to 13 filaments / mm.

[0077] Depending on the application, the ladder-like supports may have various shapes or various outer contours. For example, in some modifications, the crossbeams may undulate in the longitudinal direction. For example, the crossbeams may undulate uniformly in the longitudinal direction or in the opposite direction. In some modifications, the lateral extension of the ladder-like supports may be greater than the area of ​​the spokes in the opening region. Alternatively, the lateral extension of the ladder-like supports may be substantially the same as the area of ​​the spokes in the opening region. In some modifications, the lateral extension of the ladder-like supports in the opening region is at least 5%, preferably at least 10%, more preferably at least 20%, greater than the lateral extension in the area of ​​the spokes in the opening region.

[0078] The number of spokes may be varied depending on the application. In some variations, the ladder-like supports include spokes at the start and / or end points. The openings are separated from each other by a first distance by spokes. Depending on the application, the distance between two adjacent openings may vary. For example, in some modifications, the longitudinal distance between the centers of two adjacent openings is in the range of 2 mm to 30 mm, preferably 3.5 mm to 20 mm. This presented distance range has been found to be advantageous in clamping applications. For example, in some applications, distances exceeding 30 mm or 20 mm may impair structural integrity or stability in some modifications, especially when clamping forces are applied. Conversely, the presented range can result in a controlled degree of lateral compression in some modifications.

[0079] In some variations, the ladder-like support may be described as comprising a plurality of central sections and a plurality of at least two branched sections arranged longitudinally between two adjacent central sections. Each branched section includes an opening. The branched section corresponds to the area of ​​the opening, and the central sections correspond to the area of ​​the spokes. The central sections extend between two adjacent openings. In some variations, the ratio of the longitudinal length of each central section to the longitudinal length of each adjacent branched section ranges from 6:1 to 1:3. For example, the ratio of the longitudinal length of each central section to the longitudinal length of each adjacent branched section ranges from 3:1 to 1:1.5. In other words, the ratio of the longitudinal length of each spoke to the longitudinal length of each adjacent opening may range from 6:1 to 1:3, preferably from 3:1 to 1:1.5.

[0080] Depending on the application, the openings may have various shapes and / or geometric shapes. For example, in some modifications, the perimeter of each opening is 1.5 mm to 40 mm, preferably 2 mm to 15 mm. Perimeter may refer to, for example, the minimum perimeter. For example, the perimeter may differ along a longitudinal section parallel to the first side surface. Thus, this presented perimeter range may, for example, relate to a central longitudinal section located between the first side surface and the second side surface.

[0081] In some modifications, the circumference of the spoke region of the ladder support is in the range of 2 mm to 25 mm, preferably 3 mm to 12 mm. Alternatively, or in combination, in some modifications, the circumference of the opening region of the first and second crossbeams is independently in the range of 0.8 mm to 15 mm, preferably 1.2 mm to 7 mm.

[0082] In some modifications, each opening is elliptical in its longitudinal cross-section, for example, having two vertices that are opposite each other in the longitudinal direction. Depending on the application, one or both vertices of at least one opening may be pointed. The longitudinal cross-section referred to in this paragraph is a cross-section parallel to the longitudinal direction. The longitudinal cross-section may be parallel to the first side surface, for example.

[0083] Depending on the application, the ladder-like support may be described as including a first transverse leg and a second transverse leg on the opposite side, each region containing an opening, that laterally divides each opening. In some modifications, the inner contours of each first leg and each second leg are rounded in a cross section perpendicular to the longitudinal direction.

[0084] Depending on the application, the ladder support may include one or more spokes. Typically, the spokes extend parallel to each other. In some modifications, the ladder support may include at least two, preferably at least five, spokes.

[0085] Depending on the application, the number and density of openings may vary. For example, in some modifications, the opening density in the longitudinal direction of the ladder support may be at least one opening per 30 mm. Depending on the application, the openings may be distributed uniformly or unevenly in the longitudinal direction. Also, most or all of the openings may be located in only one of two or more longitudinal sections of the ladder support. In some modifications, in at least one longitudinal section of the ladder support containing at least three openings, the opening density in the longitudinal direction of the ladder support is at least one opening per 30 mm.

[0086] Depending on the application, the ladder-like support may have various cross-sections. For example, in some modifications, in a cross-section perpendicular to the longitudinal direction, the opening is located within an opening portion positioned laterally between a first peripheral portion and a second peripheral portion. The first and second peripheral portions may each have a lateral extension of, for example, 10% to 300% of the lateral extension of the opening portion. Depending on the application, the opening portion and / or central portion may have a substantially planar outer surface.

[0087] It is understood that the exact shape or outline of a ladder support may be affected, at least partially, by physical deformation of the ladder support, depending on the geometry and shape it has and the material from which it is made. Therefore, the geometry, shape, or outline disclosed herein preferably relates to a relaxed state, i.e., a state in which no external force is applied to the ladder support.

[0088] The above-mentioned summary 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 incorporated into and form part of this specification for further understanding of this specification. The drawings illustrate various embodiments and, together with the description, illustrate the principles and operation of the disclosed concepts.

[0089] The disclosures described herein will be more fully understood by the detailed description and accompanying drawings set forth below. However, these should not be considered to limit the disclosures set forth in the claims in the appendix. The drawings are shown below. [Brief explanation of the drawing]

[0090] [Figure 1] Figure 1 shows one embodiment of a ligament clamping device. [Figure 2] Figure 2 shows a further embodiment of the ligament clamping device. [Figure 3] Figure 3 shows a further embodiment of the ligament clamping device, including an application aid. [Figure 4] Figure 4A shows an example of Circular application in one embodiment of the ligament clamping device. Figure 4B shows an example of Circular application in one embodiment of the ligament clamping device. Figure 4C shows an example of Circular application in one embodiment of the ligament clamping device. Figure 4D shows an example of Circular application in one embodiment of the ligament clamping device. [Figure 5] Figure 5 shows further embodiments of the ligament clamping device and an example of its application for the treatment of periarthritis of a prosthesis. [Figure 6] Figure 6 shows an example of a modified ligament clamp device for spinal stabilization. [Figure 7] Figure 7 shows a further embodiment of a ligament clamping device including auxiliary tension filaments. [Figure 8] Figure 8 shows one embodiment of a ladder-shaped support for application to a medical clamping device. [Figure 9] Figure 9 shows various cross-sections of the ladder-like support structure shown in Figure 8. [Figure 10] Figure 10 shows a further embodiment of a ladder-like support for application to a medical clamping device. [Modes for carrying out the invention]

[0091] Specific embodiments will now be described in detail. Examples of embodiments are shown in the accompanying drawings, but only some, not all, features are shown. In fact, the embodiments disclosed herein may be carried out in many different forms and should not be construed as being limited to the embodiments described herein. More precisely, these embodiments are provided so that this disclosure may satisfy applicable legal requirements. Wherever possible, the same reference numerals will be used to refer to similar components or parts.

[0092] Figure 1 shows one embodiment of a ligament clamp device 1. The ligament clamp device 1 includes a band 3 and two filaments 41 and 42. In the illustrated embodiment, both filaments 41 and 42 are medical sutures. The band 3 extends along its longitudinal direction (corresponding to the x-axis) and includes a plurality of openings 33 that are positioned posterior to each other in the longitudinal direction. In the illustrated embodiment, the openings 33 are lace holes and extend from a first side surface 31 (corresponding to a positive value on the y-axis) to a second side surface 32 (corresponding to a negative value on the y-axis) located opposite the first side surface 31.

[0093] The two filaments 41 and 42 both pass through the opening 33, forming a plurality of loops 51, 52, 53, 54, and 55. More specifically, in the illustrated embodiment, a first group of loops (including loops 51, 52, and 53) is formed extending laterally from the first side surface 31, and a second group of loops (including loops 54 and 55) is formed extending laterally from the second side surface 32. The first group of loops 51, 52, and 53 form a first passage for receiving the first ligament 21 when open and for clamping the first ligament 21 when closed. Similarly, the second group of loops 54 and 55 form a second passage for receiving the second ligament 22 when open and for clamping the second ligament 22 when closed. In the illustrated embodiment, the first ligament 21 passes through all the loops located on the corresponding side, i.e., the first side 31, and the second ligament 22 passes through all the loops located on the corresponding side, i.e., the second side 32. This is not considered essential.

[0094] In this disclosure, typically, one or more filaments may be passed through openings in the strip in a number of different ways. For example, in the modified example shown in Figure 1, the filament 41 may pass through sequentially openings that are arranged consecutively to each other in the longitudinal direction. The same applies to the second filament 42. However, it is also possible to pass one or more filaments through discontinuously arranged openings (not shown) in the strip. Alternatively, or in combination, at least some openings may be omitted (not shown).

[0095] In the embodiment shown in Figure 1, all loops are arranged entirely on both sides of the strip. In other words, for each of the loops 51, 52, 53, 54, and 55, each filament portion forming each loop enters and exits the same or different openings 33 from the same side. Therefore, for example, all loops belonging to the first loop group 51, 52, and 53 are arranged entirely on the first side 31, and all loops belonging to the second loop group are arranged entirely on the second side 32. In other words, in the illustrated modification, each filament portion forming the loops belonging to the first loop group 51, 52, and 53 exits the string hole and re-enters the same side, i.e., the first side 31, into the same or different string hole. Similarly, in the illustrated modification, each filament portion forming the loops belonging to the second loop group 54 and 55 exits the same side, i.e., the second side 32, and re-enters the same or different string hole. Therefore, each loop enters the string hole from the same side from which it exits.

[0096] Since the two groups of loops, positioned on opposite sides of each other, share at least one filament (and in the illustrated modification, even two filaments), the two groups of loops are not considered independent of each other. Rather, the loops positioned on both sides are tightened simultaneously.

[0097] Figure 1 shows the ligament clamping device 1 in the open state. To change the clamping device 1 from the open state to the closed state, both ends of the filaments 41 and 42 are pulled. This gradually tightens each loop formed by the first filament 41 and the second filament 42, clamping the first filament 21 and the second ligament 22 laterally. In principle, it is conceivable to pull the end of one filament (e.g., 41) first, and then pull the end of the second filament (e.g., 42) after the loop formed by the first filament 41 has been tightened at least partially or completely. For example, it may be advantageous to partially fix the two ligaments 21 and 22 using the first filament 41, and then reinforce the fixation using the second filament 42. It is also conceivable to fix the first ligament first using the first filament, and then fix the second ligament using the second filament (not shown). In some modifications, it may be advantageous to pull both ends of filaments 41 and 42 simultaneously to tighten each loop in a uniform and permanent manner. Depending on the application, this may allow the clamping pressure to be evenly distributed along, for example, one or more filaments, minimizing biological damage.

[0098] In the illustrated embodiment, both ends of the first filament 41 are located at both ends in the longitudinal direction of the strip. This also applies to both ends of the second filament 42, which are similarly located at both ends of the strip. In addition, both filaments 41 and 42 first pass through the proximal string hole 33p of the strip and last pass through the distal string hole 33d of the strip (the distal and proximal string holes are located on opposite sides of each other in the longitudinal direction and are sometimes referred to as the outermost string holes). This arrangement ensures that the clamping force is uniformly distributed along the length of the strip 3. Specifically, the outer loops (i.e., the loops closest to the proximal or distal end of the strip) are tightened more strongly from the beginning than subsequent loops, so that the tightening of the loops and the resulting clamping force are continuously applied from the outer circumference to the center of the clamping device 1.

[0099] Furthermore, by passing the filaments 41 and 42 through the proximal and distal ligament holes at the beginning and end, respectively, the elongation of the band is maintained when tension is applied to the filaments 41 and 42. Specifically, for example, when both ends of the filament 41 are pulled, a force is applied distally (i.e., in the positive direction on the x-axis) to the distal ligament hole 33d, and a force is applied proximally (i.e., in the negative direction on the x-axis) to the proximal ligament hole 33p. These opposing forces acting on the proximal and distal portions of the band ensure that the band 3 is not significantly compressed even when both ends of the filament 41 are first pulled. Rather, the tension is mainly converted into tightening of the loop, thereby clamping the first ligament 21 and the second ligament 22 laterally, respectively. As both ends are pulled more and more, and the loop is gradually tightened, and begins to contact the first ligament 21 and the second ligament 22 and clamp more tightly, the tensile force is eventually gradually converted into compression in the longitudinal direction of the strip 3 (not shown).

[0100] Depending on the loop arrangement, gradually applying tensile force may be associated with partial twisting of the band. For example, in the embodiment shown in Figure 1, gradually tightening the loop 51 (formed by the filament 42 passing through the proximal opening 33p and adjacent openings in succession) will cause torsional forces to act on the corresponding portion of the first ligament (not shown) and the band 3 that are tightened by the loop 51. Specifically, since the filament portion forming the loop 52 exits the proximal lacing hole 33p, passes around the first ligament 21 in a circular direction, and then enters the lacing hole adjacent to the proximal lacing hole 33p, gradually tightening the loop 51 will induce a slight clockwise twist (not shown) in the first filament 21 (viewed from the lateral direction from the first side surface 31 to the second side surface 32, i.e., from the direction from positive to negative values ​​on the y-axis) and / or a slight counterclockwise twist (viewed from the same direction) in the band 3. Depending on various factors (particularly the distance between adjacent lace holes through which the filament portions pass, the strength of the band piece 3, the strength of the first ligament, etc.), the first ligament may be primarily rotated, the band piece 3 may be primarily rotated, or both the first ligament and the band piece 3 may be rotated relative to each other. In any of these methods, the first ligament can be effectively fixed using the relative twist of each portion of the band piece 3 with respect to the first ligament, and the first ligament 21 can be fixed to the second ligament 22 in the illustrated modified example where the two ligaments are clamped together.

[0101] Depending on the application, adjacent portions of the ligament may be induced to twist in opposite directions (not shown). For example, a first loop may induce clockwise rotation of a first portion of the ligament, and an adjacent second loop may induce counterclockwise rotation of an adjacent second portion of the same ligament. In some modifications (not shown), for example, this may be used to further strengthen fixation and reduce the tendency of each ligament to displace axially.

[0102] Finally, after all the loops formed by the first filament 41 and the second filament 42 are tightened, a closed state is reached (not shown), in which the band piece 3 is positioned between the first ligament 21 and the second ligament 22.

[0103] Depending on the application, the strip 3 and filaments 41 and 42 may be made from various materials and have various shapes. For example, filaments 41 and 42 may be made from the same material or not. The strip 3 may be made from a woven fabric, for example. Depending on the application, the strip 3 may have a tubular structure, which may be optionally hollow as shown in Figure 1. The strip 3 may form multiple lateral bulges in the region of the opening 33, for example. The opening 33 of the strip 3 may have an elliptical shape, for example.

[0104] Figure 2 shows a further embodiment of the ligament clamping device 1. Similar to the modification shown in Figure 1, this embodiment also includes a clip 3 and two filaments 41 and 42 extending through the opening of the clip 3. The first filament 41 and the second filament 42 each form a number of loops 51, 52, 53, and 54 on both sides of the clip 3. The loops 51 and 52 located on the first side 31 of the band piece form a first group of loops, and the loops 53 and 54 located on the opposite second side 32 of the band piece form a second group of loops. The first ligament 21 passes through the first group of loops, and the second filament 22 passes through the second group 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 band piece 3.

[0105] Figure 3 shows a further embodiment of the ligament clamping device 1, which includes application aids 61, 62 in the form of two tubes 61, 62 passing through loops formed by filaments 41. Specifically, similar to the embodiment shown in Figure 2, a first group of loops 51, 52 is formed on the first side 31 of the band piece 3, and a second group of loops 53, 54 is formed on the opposite second side 32 of the band piece 3. The first application aid tube 61 passes through the first group of loops 51, 52, and the second application aid tube 62 passes through the second group of loops 53, 54.

[0106] Tubes 61 and 62 each have internal cavities for receiving a first ligament and a second ligament, respectively. Tubes 61 and 62 also hold each loop 51, 52, 53, and 54 in place and / or shape, and in particular ensure that they do not rotate. Specifically, the loops are kept open, thereby allowing the user to reliably and easily pass any ligament through all the necessary loops.

[0107] Depending on the application, before inserting the clamping device 1 into the body, loops 51, 52, 53, and 54 may be optionally tightened so that the inner contour of each loop contacts each tube 61, 62. By effectively clamping the tubes 61, 62, undesirable displacement of the tubes 61, 62 may be prevented. For this reason, in the open state, the application aid may be clamped by at least one loop.

[0108] Depending on the application, the filament portion may optionally form one or more loops between exiting the string hole of the strip 3 and re-entering the same or a different string hole. For example, in the illustrated embodiment, the filament portion forming loop 53 forms only one loop, i.e., loop 53. In contrast, the filament portion forming loop 54 forms two loops, including loop 54 and an additional loop.

[0109] Furthermore, as shown in Figure 3, one loop may overlap with another loop, forming a loop intersection. For example, loop 51 is positioned adjacent to another loop and intersects with the aforementioned another loop, forming a loop intersection 5c.

[0110] Figure 4 shows an example of the application of the clamp device 1 with a CircLarge. Specifically, the CircLarge is used to fix the locking device 8 (e.g., a locking plate) to a biological structure 7, which is typically bone. The illustrated embodiment of the clamp device 1 includes application auxiliary tubes 61 and 62, which extend through a first group of loops and a second group of loops located on the opposite side, respectively.

[0111] In the first step (see Figure 4A), the first end of the ligament 21 is passed through the first tube 61, and the second end of the same ligament 21 is passed through the second tube 62 in the opposite direction. The ligament 21 in the illustrated embodiment may be, for example, an autograft, but it may also be made of a synthetic material.

[0112] In the second step (see Figure 4B), both ends of the ligament 21 are exposed to the loops by passing them through the respective auxiliary tubes 61 and 62 and then removing the tubes. Immediately after removing the tubes 61 and 62, the ligament 21 is typically not yet constricted by either loop, so care must be taken to ensure that neither end of the ligament comes loose from one or more loops and is not unintentionally displaced.

[0113] Next, the ends of the suture 41 are pulled to tighten the multiple loops. As a result, both ends of the suture are clamped from the side and fixed to each other. As described above, if both ends of the suture 41 are continuously pulled, each part of the ligament 21 may twist relative to the band 3, as shown in Figure 4C. Depending on the application, the twisting may be used to increase the overall tension on the ligament and further tighten the circula.

[0114] Depending on the application, it may be desirable to tie both ends of the suture 41 in the final step (see Figure 4D). This may further secure fixation, in this case the circular suture. Tying minimizes tension loss over time, in particular. Furthermore, tying may prevent loose ends from becoming entangled or interfering with adjacent tissue.

[0115] Figure 5 shows further applications of the Circulage in the treatment of periarthritis of a prosthesis. Similar to Figure 4, the Circulage is used to fix a fixation device 8 (e.g., a fixation plate) to a biological structure 7 (e.g., bone). In the illustrated embodiment, the ligament clamp device 1 includes a first tubular application aid 61 and a second tubular application aid 62, which are used to hold the loops 51, 52 in place and to facilitate passing both ends of the filament 21 through the loops 51, 52.

[0116] Figure 6 shows an example of a modified application of the ligament clamp device 1 in a spinal stabilization situation. Specifically, two adjacent vertebrae are fixed to each other by the ligament clamp device 1 (illustrated in a closed and tensed state). More specifically, a fixation loop is formed to fix the two vertebrae by passing a ligament (e.g., an allograft) through a hole in the spinous process of the superior vertebra and a hole in the spinous process of the adjacent inferior vertebra. Depending on the application, one fixation loop, two fixation loops, or two or more fixation loops may be formed. The two or more fixation loops may, optionally, be formed from the same or different ligaments. This fixation loop should not be confused with a loop formed by at least one filament as disclosed herein. Rather, the fixation loop is tightened to restrict relative movement between two adjacent vertebrae. The fixation loop is maintained in a tightened state by clamping both ends of the ligament to each other using the ligament clamp device 1.

[0117] Figure 7 shows a further embodiment of the ligament clamping device 1. This embodiment includes a band 3 and two filaments 41 and 42. The first filament 41 functions as a clamping filament 41, and the second filament 43 functions as an auxiliary tensioning filament 43. In the illustrated modification, one end of the clamping filament 41 is fixedly connected to the band 3 by a knot. Specifically, the knot is formed by passing the clamping filament 41 through an opening in the band 3, specifically the opening next to the opening labeled reference numeral 33 in Figure 7, and tying it. The opposite end of the clamping filament 41 is a free end and may be pulled to tighten the loops formed from the clamping filament 41 on both sides of the band 3. It is understood that the clamping filament 41 does not necessarily have to be fixedly connected to the band 3. For example, both ends of the clamping filament 41 can be pulled to tighten the loops formed by the clamping filament 41.

[0118] The auxiliary tension filament 43 is positioned so that it can be used to apply a counterforce to the ligament clamping device 1. To achieve this, the auxiliary tension filament 43 may optionally be fixedly attached to the band piece by one of its ends (not shown).

[0119] Figure 7 shows the ligament clamping device 1 in the open position. To close the clamping device 1, the free end of the clamping filament 41 and both ends of the auxiliary tension filament 43 are pulled. Pulling the free end of the clamping filament 41 applies tension to the left, and pulling the auxiliary tension filament 43 applies tension to the right. These opposing forces gradually tighten the loop, thereby tightening the first ligament (not shown) and the second ligament (not shown) laterally.

[0120] In the illustrated embodiment, the clamping suture 41 first passes through the proximal opening of the band 3, which is located opposite the distal opening through which the auxiliary tension filament passes. This arrangement allows tension to be effectively applied to both ends of the band 3 and ensures that the band 3 is initially maintained in a substantially straight shape while the loop is being tightened. This ensures that the loop is tightened in a sequential and controlled manner, minimizing uncontrollable and undesirable movement.

[0121] The geometry of the strip 3 shown in Figure 7 is primarily for illustrating the auxiliary tension filament 43 and is understood not to typically represent the actual geometry and shape of the strip 3. Instead, in typical modifications, the explanatory diagram in Figure 1 more accurately depicts the geometry and shape of the strip 3.

[0122] Figure 8 shows one embodiment of a ladder-shaped support for application to a medical clamping device. The ladder-shaped support may be, for example, a strip 3 as shown in Figure 8. The ladder-like support includes a plurality of openings 33 separated longitudinally l by a plurality of spokes 9. The ladder-like support further includes a first transverse beam 10a and a second transverse beam 10b positioned laterally opposite the first transverse beam 10a. The first transverse beam 10a and the second transverse beam 10b divide the openings 33 laterally. The spokes 9 divide the openings 33 longitudinally.

[0123] The ladder-like support shown in Figure 8 is a tubular structure with a hollow core. Therefore, the hollow core portion of each spoke 9 branches into the hollow core of the first transverse beam 10a and the hollow core of the second transverse beam 10b. Subsequently, the hollow core of the first transverse beam 10a and the hollow core of the second transverse beam 10b are fused again to form the hollow core of the adjacent spoke 9.

[0124] Figure 9 shows an excerpt of the ladder-like support shown in Figure 8. Specifically, Figure 9 shows a selective cross-section of the ladder-like support. For example, as shown in Figure 9, the spoke 9 may be elliptical in the cross-section parallel to the longitudinal direction l, i.e., in the cross-section in the xy-plane. Specifically, as shown in Figure 9, both the inner and outer contours of the spoke 9 are elliptical in the cross-section parallel to the longitudinal direction l.

[0125] In the region 12 of spoke 9, the ladder-like support is elliptical even in a cross-section perpendicular to the longitudinal direction l. Specifically, both the inner and outer contours of the ladder-like support are elliptical in a cross-section perpendicular to the longitudinal direction l.

[0126] Furthermore, Figure 9 shows that the opening 33 of the ladder-like support defines the region 11 of the opening. In this region 11 of the opening, the ladder-like support is elliptical even in a cross-section perpendicular to the longitudinal direction. Specifically, both the inner and outer contours of the ladder-like support are elliptical in a cross-section perpendicular to the longitudinal direction.

[0127] The modified form shown in Figure 9 also has an outer contour and a substantially borderless inner contour. In the illustrated modified form, the spokes 9 and the first and second transverse beams 10a and 10b transition smoothly from one another. Furthermore, the illustrated ladder-like supports have an undulating outer contour. Specifically, in the opening region 11, the ladder-like supports form a bulge that projects laterally outward, while in the spoke region 12, the lateral extension of the ladder-like supports is less pronounced. When viewed along the longitudinal direction, the outer contours of the first transverse beam 10a and the second transverse beam 10b are undulating or wavy.

[0128] Figure 10 shows a further embodiment of the ladder support. In the illustrated modification, the ladder support is a strip 3. The strip 3 also includes a first transverse beam 10a, a second transverse beam 10b, and a number of spokes 9.

[0129] Looking at a cross section perpendicular to the longitudinal direction l, the ladder-like support is H-shaped in the region of the spokes 12. In contrast, the first transverse beam 10a and the second transverse beam 10b are substantially I-shaped in a cross section perpendicular to the longitudinal direction. Furthermore, in the illustrated embodiment, the ladder-like support includes an opening 13 positioned laterally between the first peripheral portion 14a and the second peripheral portion 14b. [Explanation of Symbols]

[0130] 1. Ligament clamping device 21. First ligament 22. Second ligament 3 strips 31. First Aspect 32. Second Aspect 33 Aperture 33p Proximal opening 33d Distal opening 41, 42 Clamp filaments 43 Auxiliary Tension Filaments 51, 52, 53, 54, 55 Loop 5c Loop Crossing 61, 62 Applicable assistive devices 7. Biological Structure 8 Fixation device 9 spokes 10a, 10b First and second transverse beams 11. Area of ​​opening 12 spoke area 13 Opening part 14a, 14b First peripheral portion and second peripheral portion

Claims

1. A ladder-like support (3) for application to a medical clamping device for clamping at least one biological structure in the surgical treatment of a patient, a. The ladder-like support (3) extends in the longitudinal direction (l) and is foldable at least in the longitudinal direction (l) when applied to the biological structure together with the medical clamp device. b. The support column (3) includes at least two openings (33) each suitable for receiving at least one loop-shaped filament for clamping the biological structure to the ladder-shaped support column (3), c. The openings (33) are positioned rearward from each other in the longitudinal direction of the ladder-shaped support (3), and are separated from each other by a first distance by spokes (9) extending transversely between the first transverse beam (10a) and the second transverse beam (10b), d. Ladder-shaped support columns (3) the first transverse beam (10a) and the second transverse beam (10b) extend in the longitudinal direction and divide the at least two openings (33) in the lateral direction.

2. A ladder-shaped support (3) device according to claim 1, a. The cross-section of the spoke (9) is elliptical in the lateral and longitudinal directions (l), b. A ladder-shaped support (3) device in which the cross-sections of the first transverse beam (10a) and the second transverse beam (10b) are elliptical with respect to the transverse direction of the transverse beam.

3. The ladder-shaped support (3) according to claim 2, A ladder-like support (3) in which the spokes (9) and the first and second transverse beams (10a, 10b) smoothly transition from one another without forming a distinct edge.

4. The ladder-shaped support (3) according to claim 1, a. The cross-section of the spoke (9) is H-shaped, b. A ladder-shaped support (3) in which the cross-sections of the first transverse beam (10a) and the second transverse beam (10b) are I-shaped.

5. A ladder-shaped support (3) according to any one of claims 1 to 4, The aforementioned crossbeams (10a, 10b) are uniformly undulating in the longitudinal direction or in the opposite direction, forming a ladder-like support (3).

6. A ladder-like support (3) according to any one of claims 1 to 5, A ladder-like support (3) wherein at least one spoke (9) and / or at least one crossbeam (10a, 10b) of the ladder-like support (3) is at least partially hollow.

7. A ladder-like support (3) according to any one of claims 1 to 6, The ladder-like support (3) is made by weaving and / or injection molding and / or 3D printing.

8. A ladder-like support (3) according to any one of claims 1 to 7, A ladder-shaped support (3) wherein the lateral extension of the ladder-shaped support (3) is greater in the region (11) of the opening (33) than in the region (12) of the spoke (9).

9. A ladder-like support (3) according to any one of claims 1 to 8, A ladder-like support (3) with spokes (9) at the starting and ending points.

10. A ladder-like support (3) according to any one of claims 1 to 9, A ladder-like support column wherein the longitudinal distance between the centers of two adjacent openings (33) is in the range of 3.5 mm to 20 mm.

11. A ladder-like support (3) according to any one of claims 1 to 10, Each of the aforementioned openings (33) has a ladder-like support column (3) with a circumference of 1.5 mm to 40 mm.

12. A ladder-like support (3) according to any one of claims 1 to 11, In a cross section perpendicular to the longitudinal direction, the opening is located in the laterally positioned opening portion (13) between the first peripheral portion (14a) and the second peripheral portion (14b), and the first peripheral portion (14a) and the second peripheral portion (14b) each have a laterally extended length of 10% to 300% of the laterally extended length of the opening portion (13), respectively, in a ladder-shaped support (3).

13. A ladder-like support (3) according to any one of claims 1 to 12, Each of the openings (33) is an ellipse with two vertices located opposite each other in the longitudinal direction in a cross-section, and is a ladder-like support (3).

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