Bone plug insertion device

Abstract

The bone plug insertion instrument 1 for inserting a bone plug 70 into a target bone tunnel includes an elongated housing 10 and a elongated plunger 40. The elongated housing 10 has a first central axis and includes an insertion section 11 having at least a portion tubular and a handling section. The elongated plunger 40 includes an actuating section 42 and a bone plug driving section having a bone plug engaging end surface 43 having an engaging area of ​​20% to 80% of the inner cross-sectional area. The insertion section 11 has an inner cross-sectional area at least partially surrounded by the bone engaging end surface substantially perpendicular to the first central axis. The elongated plunger 40 moves relative to the elongated housing 10 between a first position and a second position.

Description

[Technical Field]

[0001] The present invention relates to a bone plug insertion instrument for introducing a bone plug into a targeted bone tunnel in a distal femur. The present invention also relates to a method of operating the bone plug insertion instrument. [Background technology]

[0002] In orthopedic surgery around the knee, soft tissue grafts are often retrieved from a donor site and transplanted to a target site. An example of a surgical intervention process for such a transplant is the anterior cruciate ligament (ACL) reconstruction process, in which autologous tissues such as tendons and ligaments are used. An example of an ACL reconstruction is a reconstruction using a quadriceps tendon and patella bone plug. This arthroscopic surgery involves the following steps:

[0003] <Step 1. Quadriceps tendon graft and reinforcement> A central quadriceps tendon graft approximately 5 cm long and a proximal patellar bone plug approximately 2 cm long are harvested. This graft serves as a replacement for the ruptured anterior cruciate ligament. The tendon portion of the graft is reinforced with sutures. These sutures allow the surgeon to secure the graft to the tibia with proper tension, as described in more detail below.

[0004] A hollow drill is often used to harvest a bone plug from the patella. Because the hollow drill has a thin wall, it can extract an intact bone plug that is slightly smaller in diameter than the hole or tunnel created by the drill. These bone plugs typically have an outer diameter of 8–12 mm and a length of 10–25 mm. Specifically, when using a hollow drill to extract a bone plug from the patella, the bone plug is extracted from the upper side of the patella, resulting in a bone plug with a bone periphery. After drilling to a depth of, for example, 20 mm, the tip of the bone plug is cut off using a chisel.

[0005] <Step 2: Tibial tunnel creation> The tunnel is drilled from the anterior and proximal tibia toward the location where the ACL originally attached to the tibia. A hollow drill is preferably used to retrieve a bone plug that can be placed back into the tibial tunnel later in the procedure. The tibial tunnel is formed as a through-hole with a diameter of approximately 10 mm.

[0006] <Step 3: Femoral Tunnel Preparation> A guidewire is passed through the femur to determine the anatomical orientation of the femoral tunnel. The guidewire is inserted through the bone and exits on the anterolateral side of the leg. The guidewire has an eyelet that will be used to thread sutures across the femur in a later step. A cannulated drill is used to overdrill the guidewire and create the tunnel. Alternatively, a punching tool can be used to create the femoral tunnel. The femoral tunnel resembles a blind hole, approximately 8-10 mm in diameter and 20-25 mm in length.

[0007] <Step 4: Graft placement / ACL reconstruction> The patellar bone plug containing the quadriceps tendon retrieved in step 1 is press-fit into the femoral tunnel. This press-fit fixation holds the bone plug in place during the healing period. The bone plug will fuse with the surrounding femur.

[0008] To achieve press-fit fixation, the tip of the cylindrical graft, or bone plug, is often conical using cutting pliers or a bone plug compression tool. The conical tip, which extends approximately one-third of the length of the bone plug, facilitates insertion of the bone plug into the femoral tunnel. Typically, the shaped tip has a circumference smaller than the entrance circumference of the femoral tunnel. To further facilitate insertion, the next step involves drilling a bore in the bone plug and looping a suture strand through the bore. This suture is then looped through the eyelet of the previously placed femoral guidewire and pulled through the femur, pulling the patient's muscle and skin toward the anterior-lateral side of the leg. This suture is then used to draw the bone plug into the femoral tunnel. Furthermore, the suture helps align the bone plug with the femoral tunnel. Pulling the suture and tapping the bone plug with a plunger and mallet secures the bone plug in place.

[0009] The next step is to pull the quadriceps tendon graft into the joint space and secure it in the tibial tunnel. Tibial fixation is typically achieved using suture screws or interference screws. Suture screws are placed on the anterior side of the tibia and secured by wrapping sutures around the screw. Interference screws are large, absorbable screws placed next to the ligaments and tendons in the tibial tunnel, tightly clamping the tendons between the screw and the tunnel wall.

[0010] The success of the procedure is highly dependent on the primary stability of the patellar bone plug within the femoral tunnel during the healing and union phases.

[0011] Currently, as mentioned above, bone plugs can be placed in place by pulling on the sutures and tapping the plug with a plunger and mallet. To perform this procedure, sutures must be threaded across the femur, muscle, and skin using a guide wire. This procedure involves temporary incisions in the bone, muscle, and skin, making it a time-consuming step.

[0012] To eliminate this trauma and reduce the number of surgical steps and time, an improved instrument for inserting a bone plug is needed that does not require both pushing (impacting) and pulling the bone plug when inserting it. Summary of the Invention [Problem to be solved by the invention]

[0013] It is an object of the present invention to overcome at least some of the problems associated with soft tissue graft fixation techniques, for example, in anterior cruciate ligament surgery. More specifically, it is an object of the present invention to provide a medical instrument for inserting a bone plug that allows for accurate and reproducible insertion of the bone plug without the need to apply tension to the sutures that are passed through the patient's bone, muscle, and skin. [Means for solving the problem]

[0014] According to a first aspect of the present invention, there is provided a bone plug insertion tool as set forth in claim 1.

[0015] The proposed novel bone plug insertion instrument has the advantage of being efficiently used during surgical interventions to insert bone plugs into target holes in the femoral condyles, for example, at the site of the original attachment of a now-torn and removed ACL. More specifically, the bone plug insertion instrument allows practitioners to insert bone plugs in a controlled and reproducible manner through a small anteromedial portal into the knee joint, a location commonly used for these arthroscopic reconstructive interventions. This allows for standardized procedures and reproducible, predictable results. Furthermore, it reduces surgical time and eliminates commonly performed surgical steps.

[0016] Eliminating this combined "push and pull" process eliminates the need to thread a guide wire through the entire leg, puncture a bone plug to thread a suture, pull the suture through the leg, and then remove the suture, as well as the need for an expensive guide wire with eyelets.

[0017] The bone plug can be harvested using a hollow drill, and the bone plug can be freely set in the circumferential direction. As a result, the harvested bone plug usually has a cylindrical shape.

[0018] According to a second aspect of the present invention, there is provided a kit comprising a bone plug insertion instrument and a bone plug grafting instrument.

[0019] According to a third aspect of the present invention 、 A method of operating a bone plug insertion instrument is provided.

[0020] Other aspects of the invention are set out in the detailed description and dependent claims attached hereto. [Brief explanation of the drawings]

[0021] [Figure 1A] 1 is a perspective view of an exemplary bone plug grafting device. [Figure 1B] FIG. 1 shows an example of a bone plug with a tendon graft attached. [Figure 2A] FIG. 1 is a perspective view of an example bone plug insertion tool and a bone plug with a tendon attached. [Figure 2B] FIG. 1 is a perspective view of an example bone plug insertion tool and a bone plug with a tendon attached. [Figure 3A] FIG. 1 shows the first component of the bone plug insertion tool, the elongated housing. [Figure 3B] FIG. 1 shows the first component of the bone plug insertion tool, the elongated housing. [Figure 3C] FIG. 1 shows the first component of the bone plug insertion tool, the elongated housing. [Figure 4A] FIG. 10 shows the second component of the bone plug insertion tool, the elongated plunger. [Figure 4B] FIG. 10 shows the second component of the bone plug insertion tool, the elongated plunger. [Figure 5A] 10A to 10C are diagrams showing the operating procedure of the bone plug insertion instrument. [Figure 5B] 10A to 10C are diagrams showing the operating procedure of the bone plug insertion instrument. [Figure 5C] 10A to 10C are diagrams showing the operating procedure of the bone plug insertion instrument. [Figure 5D] 10A to 10C are diagrams showing the operating procedure of the bone plug insertion instrument. [Figure 5E] 10A to 10C are diagrams showing the operating procedure of the bone plug insertion instrument. [Figure 5F] 10A to 10C are diagrams showing the operating procedure of the bone plug insertion instrument. [Figure 5G] 10A to 10C are diagrams showing the operating procedure of the bone plug insertion instrument. [Figure 5H] 10A to 10C are diagrams showing the operating procedure of the bone plug insertion instrument. [Figure 6A] 13A-13C show an alternative variation of the bone plug insertion tool. [Figure 6B] 13A-13C show an alternative variation of the bone plug insertion tool. [Figure 6C] 13A-13C show an alternative variation of the bone plug insertion tool. [Figure 6D] 13A-13C show an alternative variation of the bone plug insertion tool. [Figure 6E] 13A-13C show an alternative variation of the bone plug insertion tool. [Figure 6F] 13A-13C show an alternative variation of the bone plug insertion tool. [Figure 6G] 13A-13C show an alternative variation of the bone plug insertion tool. DETAILED DESCRIPTION OF THE INVENTION

[0022] Next, an embodiment of the present invention will be described in detail with reference to the accompanying drawings. The embodiment describes a bone plug insertion instrument configured to insert a cylindrical bone plug into a target femoral bone tunnel, but the present invention is not limited to this configuration. The present invention is equally applicable to bone plugs of different shapes. Identical or corresponding functional and structural elements appearing in different drawings are given the same reference numerals. When the term "contact" is used, this means that a first object is configured to directly or indirectly contact a second object. Similarly, when the term "engage" is used, this means that a first object is configured to directly or indirectly contact a second object. Furthermore, in this specification, there is no particular difference in meaning between these two words unless the context makes it clear, implicitly or explicitly, that the first object is engaged with a second object.

[0023] FIG. 1A shows an exemplary bone plug insertion or removal instrument 60. FIG. 1B shows a bone plug 70 with a tendon 71 attached thereto. The grafting instrument 60 is sized and shaped like a thin-walled, i.e., hollow, tube, thus defining a longitudinally extending bore or cavity. A first end 61 of the grafting instrument 60 is configured to be coupled to a surgical drill, while an opposite end 62 includes a cutting edge 63 or surface, in this example, in the form of a serrated cutting surface or cutting teeth. The tubular grafting instrument 60 defines a first inner diameter ID1 and is intended for grafting a first size bone plug having a first outer diameter OD1 and a length L1. The grafting instrument 60 can be used to graft the bone plug 70 with the tendon 71 attached thereto. The length L1 may be between 10 mm and 25 mm, more specifically, between 18 mm and 22 mm. The first outer diameter OD1 may be less than 12 mm, or less than 10 mm, and more specifically, between 8 mm and 12 mm. In this example, the bone plug 70 has a generally cylindrical shape. As shown in FIG. 1A, the grafting instrument 60 is a hollow drill element configured to be attached to a surgical drill machine. The grafting instrument 60 is advanced into the target bone while rotating. The retrieved bone plug 70 is received in the hollow portion of the grafting instrument 60. Specifically, when using a hollow drill to retrieve a bone plug from the patella, the bone plug is retrieved from the upper side of the patella and is flush with the outer peripheral surface of the bone. After drilling to a depth of, for example, 20 mm, the tip of the bone plug is cut off using a chisel. The separated bone plug and tendon are then placed inside the grafting instrument 60.

[0024] 2A and 2B show an exemplary bone plug insertion instrument 1 and its individual components. The bone plug insertion instrument 1 includes an elongated housing 10 or body element and an elongated plunger 40. Also shown in these figures is a bone plug 70 with an attached tendon 71. In FIG. 2A, the bone plug 70 is engaged or received in the bone plug insertion instrument 1, while FIG. 2B shows the bone plug 70 ejected or expelled from the bone plug insertion instrument 1.

[0025] 3A to 3C illustrate the elongated housing 10 in more detail. As shown in FIG. 3C, the elongated housing 10 comprises an at least partially tube-shaped insertion portion 11, a middle portion 25, and a handling portion 12. The insertion portion 11 is a hollow element sized and shaped to hold a bone plug 70 with an attached tendon 71. The handling portion 12 allows a user to manipulate the bone plug insertion tool 1, and the middle portion 25 separates the handling portion 12 from the insertion portion so that the bone plug can be placed in an arthroscopic procedure. In this example, the middle portion is formed as a partial tube, such as a half-tube, i.e., a tube with one or more open or exposed surfaces along its length. The partial tube allows the bone plug 70 to be loaded into the insertion portion 11. Furthermore, in this example, the handling portion 12 is formed as an elongated grip 27.

[0026] 3A, the insertion portion 11 is substantially rotationally symmetric and has an inner periphery IC1 or imaginary inner periphery IVC1 that is approximately the same size as the first outer diameter OD1 of the bone plug 70. The inner periphery IC1 or imaginary inner periphery IVC1 defines a cross-sectional area CSA that is perpendicular or approximately perpendicular to the longitudinal axis A1 of the bone plug insertion instrument 1.

[0027] It should be noted that the term "circumference" is used herein to describe the boundary of a curved geometric figure or object. More specifically, the term "inner circumference" may be used to describe the circular inner boundary of a tube. In this example, the tube is cylindrical, but "circumference" is not limited to a circular boundary, but defines a general distance inside an object, such as an inner perimeter, boundary, border, or perimeter. For example, according to one example, "circumference" may also refer to the boundary of an element having an elliptical shape. Other shapes, such as polygons, irregular shapes, etc., also have (average) inner boundaries that form a perimeter.

[0028] The cross-section CSA is at least partially defined or at least partially bounded by a bone-engaging end surface 13 (or bone-contacting end surface) or target bone-contacting end surface or first contact surface. Alternatively, if the bone-engaging end surface 13 is not a closed surface, it is optionally defined or bounded by an imaginary extension of the bone-engaging end surface (the imaginary extension would close an unclosed bone-engaging end surface). The bone-engaging end surface 13 forms the tip 31 or distal end of the bone plug insertion instrument 1 and is configured to be pressed against the bone surrounding the target femoral tunnel 80 (see FIG. 5D ) (in this example, the lateral inner side of the intercondylar notch of the femur). The elongated housing 10 further includes or defines a first central axis A1 that coincides with the longitudinal axis of the insertion instrument 1. In this example, the bone-engaging end surface 13 forms an acute angle α with the first central axis A1 and has a generally planar shape. Alternatively, the bone-engaging end surface 13 may be disposed perpendicular to the first central axis A1, as depicted in FIG. 6G.

[0029] As shown in FIG. 3A , the insert 11 defines a clearance or opening, more specifically, a soft-tissue graft clearance 15, that intersects with the bone-engaging end surface 13. This clearance 15 provides a passageway for the tendon 71 of the graft to pass through when the bone plug 70 is inserted into the femoral bone tunnel 80. The clearance 15 has a size and shape that prevents damage to the tendon 71 when the bone plug 70 is pushed forward from the elongated housing 10, as will be described in more detail below. Thus, the insert 11 can be understood as a tube or cylinder having a slot that penetrates the outer wall of the tubular member in the longitudinal direction.

[0030] As shown in FIG. 3B , to hold or clamp the bone plug 70 (and tendon), the insert 11 includes a first slot 16 (a U-shaped slot in this example) that forms a first compliant structure 19, such as a leaf spring 23, for holding or clamping the bone plug 70. The first compliant structure 19 thus forms a first elastic structure. In this example, the first slot 16 is located on the side opposite to the side where the clearance 15 is located. In its rest state, the leaf spring is bent inward (i.e., toward the center of the housing), thus pressing the bone plug 70 against the inner wall of the tubular insert 11 and thus preventing undesired premature release of the bone plug 70.

[0031] 3B, the handling portion 12 has an inwardly directed (i.e., toward the first central axis A1 in this example) rotation-inhibiting protrusion 24. As described below, this protrusion 24 is configured to engage with an elongated channel, groove, or track 45 of the elongated plunger 40. The track 45 of the elongated plunger 40 is configured to receive the rotation-inhibiting protrusion 24 with substantially no play, thereby allowing the elongated plunger 40 to move only in translation parallel to the first central axis A1 relative to the elongated housing 10.

[0032] As will be described later, the bone plug insertion tool 1 is most often oriented obliquely, i.e., upward, during surgery. After the bone plug 70 is placed in the elongated tube (i.e., the insertion portion 11), the operator or surgeon holds the handling portion 12 with one hand. The other hand can then hold a mallet or small hammer and strike the elongated plunger. To prevent the plunger 40 from coming off the elongated housing 10, the elongated housing 10 includes a friction mechanism 29 (which can also be understood as a compliance structure) that suppresses unwanted movement of the plunger 40 relative to the housing 10, as shown in FIG. 3B . In this example, the friction mechanism 29 is formed as an inwardly bent second leaf spring 34. Alternatively, the elongated plunger 40 may include the friction mechanism. The elongated housing 10 includes a first stop surface 14 to limit the amount of translation of the elongated plunger 40 relative to the elongated housing 10. This stop surface 14 is configured to engage a second stop surface 44 of the elongated plunger 40 as will be described in more detail below.

[0033] 4A-4B show the elongated plunger or pusher in more detail. In this example, the elongated plunger 40 is configured to move relative to the elongated housing 10 between at least a first position and a second position. In the second position, the elongated plunger 40 is configured to eject or remove the bone plug 70 from the insertion tool 1. This movement, in this example, is a sliding movement. The elongated plunger 40 can then return to the first position for reuse. The elongated plunger 40 includes a bone plug driving portion 41 having a bone plug contacting or engaging end face (or second contact surface) 43. At the opposite end (i.e., proximal end), the elongated plunger 40 includes an actuating portion 42. The actuating portion terminates in an impaction end 46 comprising an impaction surface. The elongated plunger constitutes or defines a second central axis A2 along the length of the elongated plunger. The bone plug driver 41 is sized and shaped to at least partially fit (axially) within the tubular insert 11. In this embodiment, the bone plug driver 41 has a substantially crescent-shaped cross section, sized and shaped to partially overlap the cross section CSA. More specifically, according to this embodiment, the cross section of the bone plug driver 41 perpendicular to the second central axis A2 is sized and shaped to be 10% to 90% of the cross section CSA of the bone-engaging end surface 13, which defines the ACL attachment location or virtual attachment location. In other words, the surface or contact area of ​​the bone plug engaging end surface 43 is 10% to 90% of the cross section CSA. However, if the surface or contact area of ​​the bone plug engaging end surface 43 is 20% to 80% of the cross section CSA, a good result is likely to be obtained. As shown in FIG. 2A, a tendon 71 is attached to one end of the bone plug 70. This attachment or attachment area of ​​the tendon 71 is the majority of the end of the bone plug. As will be described later, when the bone plug is inserted, a striking force is applied to this attachment area by the bone plug driver 41. Ideally, most of this force should be transmitted directly to the bone to prevent damage to the tendon attachment.Damage to the tendon attachment can adversely affect the overall strength of the tendon. If the bone plug engaging end surface 43 is too small, excessive pressure will be applied to the bone plug 70 and tendon 71, resulting in bone crushing, tendon crushing, or end surface slippage. On the other hand, if the bone plug engaging end surface 43 is too large, a large portion of the tendon 71 attachment will be crushed, increasing the risk of fiber damage and subsequent tendon rupture. In this embodiment, the bone plug engaging end surface 43 includes grooves 49 or a textured or roughened surface to increase friction between the bone plug 70 and the bone plug engaging end surface 43. This improves the grip of the bone plug 70 in the targeted impaction area. As shown in FIG. 4B, the elongated plunger 40 further includes an elongated recess 52 on its bottom side. The advantage of this recess 52 is that it avoids interference with the first compliant structure 19 (FIG. 3B). This means that the first compliant structure 19 does not get in the way when inserting the elongated plunger 40.

[0034] As previously described, the elongated plunger 40 includes an elongated track 45 sized and shaped to receive the rotation-inhibiting protrusion 24. The elongated track 45 is parallel or substantially parallel to the second central axis A2. Engagement of the protrusion 24 with the elongated track 45 prevents rotation of the elongated plunger 40 about the second central axis A2. Additionally, the elongated plunger 40 includes a second stop surface 44 that engages with the first stop surface 14 to limit the maximum insertion depth of the elongated plunger 40 within the housing 10.

[0035] 5A to 5H are diagrams illustrating a method of operating the bone plug insertion tool 1, detailing further examples of components of the bone plug insertion tool 1 and their interactions.

[0036] The elongated plunger 40 is configured to move relative to the elongated housing 10 between a first position and a second position, in which the bone plug insertion tool 1 forms an open configuration, and in the second position, the bone plug insertion tool 1 forms a substantially closed configuration.

[0037] 5A and 5B show a first position, in which the elongated housing 10 and the elongated plunger 40 are longitudinally or longitudinally shifted relative to one another by a distance X (first distance) that allows the bone plug 70 to be positioned in the space 30 within the tubular insert 11 between the bone-engaging end face 13 and the bone plug-engaging end face 43. Distance X is measured here as the distance between the bone-engaging end face 13 and the bone plug-engaging end face 43, for example, along an imaginary line parallel to the first or second central axis.

[0038] Figure 5C shows the bone plug engaging end surface 43 engaging the bone plug trailing end 74 (Figure 5B). Distance X is smaller than in Figure 5A. In this state, the bone plug leading end 73 protrudes beyond the bone engaging end surface 13.

[0039] 5D shows the bone plug insertion instrument 1, including the bone plug 70 and tendon 71, aligned with the target femoral tunnel 80. In an exemplary scenario, the bone plug insertion instrument 1 is introduced into the knee joint via the so-called antero-medial portal.

[0040] FIG. 5E shows the bone engaging end face 13 engaged with the target bone and the bone plug tip 73 engaged or partially inserted within the femoral bone tunnel 80.

[0041] 5F and 5G (without target bone) show that the bone plug 70 is driven from the insertion tool 1 into the femoral tunnel 80 by applying a force or impact to the actuating portion 42. The elongated plunger 40 has reached the second position in this illustration.

[0042] In the second position, the bone plug insertion instrument 1 forms a substantially closed configuration, where the space 30 ( FIG. 5A ) is reduced so that the end surface 13 and the bone plug engagement end surface 43 overlap or are adjacent to each other. In other words, the distance X (second distance) is reduced to zero or nearly zero. In this example, the distance X in the second position is less than 1 cm, more specifically less than 0.5 cm, e.g., substantially 0 cm. Note that this distance can even become negative. This occurs when the bone plug engagement end surface 43 moves beyond the bone engagement end surface 13. In this example, the elongated housing 10 forms a first stop seat 14, and the elongated plunger 40 forms a second stop seat 44. In the second position, the first and second stop seats 14, 44 engage or are adjacent to each other. In other words, the first and second stop seats 14, 44 are in contact with each other or are stationary relative to each other. The first stop seat 14 and the second stop seat 44 prevent the bone plug 70 from being impacted and penetrating too far into the target bone tunnel 80 .

[0043] FIG. 5H shows the bone and tendon graft implanted after the bone plug insertion tool 1 has been removed.

[0044] 6A to 6G show variations of a particular embodiment of the bone plug insertion instrument. Fig. 6A shows a variation in which the handling portion 12 comprises a handle 28, which is angled relative to the first central axis A1. Depending on the operator's preference, the angled handle 28 may be considered more ergonomic for holding the instrument 1.

[0045] 6B shows a variation in which the bone-engaging end face 13 is provided with at least one spike 20a, 20b that can be driven into the target bone to stabilize the instrument 1.

[0046] 6C shows a variation in which the bone-engaging end surface 13 is non-planar and has a hollow shape. In other words, the bone-engaging end surface 13 has a concave or substantially concave profile. Such a surface shape may provide better engagement with the target bone.

[0047] 6D shows a variation in which the bone plug driver 41 has pointy protrusions 50 or pyramids 51 and a rough or textured contact surface. Such a configuration increases the grip of the bone plug 70 on the impact area. The rough surface may have a sandpaper-like structure.

[0048] FIG. 6E shows a modification in which the bone plug driver 41 has a C-shaped or U-shaped cross section.

[0049] FIG. 6F shows a modified example in which the bone plug driver 41 has a semicircular cross section.

[0050] FIG. 6G shows a variation designed to better hold the bone plug 70 before ejecting it from the bone plug insertion instrument 1. In this example, the elongated housing 10 defines a second slot 21 that intersects or reaches the bone-engaging end surface 13. Thus, the second slot 21 extends a predetermined distance from the bone-engaging end surface 13 toward the opposite end of the bone plug insertion instrument 1, parallel or substantially parallel to the first central axis A1 in this example. This slot 21 divides the insertion portion 11 into a first tubular portion 17 and a second tubular portion 18 and provides a certain elasticity between these portions, thereby forming a second compliant structure 22, which can be understood as a second elastic structure. In this case, the inner circumference IC1 or imaginary inner circumference IVC1 of the insertion portion 11 is equal to or smaller than the first outer diameter OD1 of the bone plug. Thanks to the elasticity provided by the second compliant structure, a frictional force can be applied to the bone plug 70 to prevent undesired release of the bone plug 70 from the insertion instrument 1.

[0051] While the invention has been illustrated and described in detail in the drawings and foregoing description, such illustration and description is to be considered exemplary or illustrative and not restrictive, and the invention is not limited to the disclosed embodiments. Other embodiments and variations can be understood and effected by those skilled in the art in practicing the claimed invention, from a study of the drawings, the disclosure, and the appended claims. Further embodiments can be obtained by combining any of the above teachings.

[0052] In the claims, the word "comprising" does not exclude other elements or steps, and the absence of the noun "plurality" does not exclude a plurality. The mere fact that different features are recited in mutually different dependent claims does not indicate that a combination of these features cannot be used to advantage. Any reference signs in the claims should not be interpreted as limiting the scope of the invention.

Claims

1. A bone plug insertion instrument for inserting a bone plug into a target bone tunnel, the bone plug insertion instrument comprising: an elongated housing having a first central axis; and an elongated plunger; The elongated housing includes: an insertion portion at least a portion of which is formed in a tubular shape; a handling unit; The long plunger is An actuating section; a bone plug drive unit having a bone plug contact end surface that comes into contact with the bone plug; Equipped with the insert defines an inner cross-sectional area at least partially bounded by a bone-contacting end surface, the inner cross-sectional area being substantially perpendicular to the first central axis; the bone plug contact end surface has a contact area of ​​10% to 90% of the inner cross-sectional area; the elongated plunger is configured to move relative to the elongated housing between a first position and a second position; In the first position, the bone contacting end surface and the bone plug contacting end surface are spaced apart by a first distance, and the bone plug is received in a space between the bone contacting end surface and the bone plug contacting end surface; In the second position, a second distance between the bone contacting end surface and the bone plug contacting end surface is smaller than the first distance, and the bone plug contacting end surface is adjacent to the bone contacting end surface; The bone plug insertion tool includes an insertion portion having a soft tissue graft clearance extending from the bone contacting end surface toward the handling portion, allowing soft tissue structures to pass through the soft tissue graft clearance.

2. The bone plug insertion tool of claim 1 , wherein the second distance is less than 1 cm or less than 0.5 cm.

3. The bone plug insertion instrument according to claim 1 or 2, wherein the bone contact end surface forms an acute angle with respect to the first central axis.

4. the elongated housing having a first stop surface and the elongated plunger having a second stop surface; 4. The bone plug insertion tool of claim 1, 2 or 3, wherein in said second position, said first and second stop surfaces contact each other.

5. 5. The bone plug insertion instrument according to claim 1, wherein the elongated plunger defines a second central axis, and the cross section of the bone plug contact end surface perpendicular to the second central axis is C-shaped, U-shaped, crescent-shaped, or semicircular.

6. The bone plug insertion instrument according to any one of claims 1 to 5, wherein the bone plug contact end surface comprises a groove, a protrusion, a pyramid, a sandpaper-like structure, or any combination thereof.

7. The bone plug insertion instrument according to any one of claims 1 to 6, wherein the insertion portion has an approximately circular circumferential portion or an approximately circular imaginary circumferential portion on the inside.

8. The bone plug insertion instrument according to any one of claims 1 to 7, wherein the insertion portion has a first slot forming a first compliance structure including a leaf spring configured to compress an accepted bone plug.

9. The bone plug insertion tool of claim 8 , wherein the elongated plunger includes an elongated recess sized and shaped to receive the first compliant structure.

10. The bone plug insertion tool according to any one of claims 1 to 9, further comprising at least one spike protruding from the bone contact end surface.

11. a second slot extending a predetermined distance from the bone-contacting end surface toward the handling portion; The second slot is configured to divide the insertion portion into a first tubular portion and a second tubular portion and to press the bone plug to be inserted, 11. The bone plug insertion instrument according to claim 1, wherein the first and second tubular portions collectively form a second compliance structure.

12. the elongated housing includes a rotation-restricting protrusion and the elongated plunger includes an elongated groove sized and shaped to receive the rotation-restricting protrusion; or the elongated plunger including a rotation-restricting protrusion, and the elongated housing including an elongated groove sized and shaped to receive the rotation-restricting protrusion; 12. The bone plug insertion instrument according to claim 1, wherein the elongated groove extends parallel or approximately parallel to the first central axis.

13. 13. The bone plug insertion tool according to claim 1, wherein the elongated housing includes a middle portion, the interior of which is formed as a partial tube having at least one open side.

14. 14. The bone plug insertion instrument according to claim 1, wherein the handling portion is formed as a long grip.

15. 15. The bone plug insertion instrument according to claim 1, wherein a handle oriented non-parallel to the first central axis is connected to the handling portion.

16. 16. The bone plug insertion instrument according to claim 1, wherein the long plunger has an impaction surface on the side opposite to the bone plug contact end surface.

17. a friction mechanism configured such that the elongated housing presses against a surface of the elongated plunger to inhibit undesired movement of the elongated plunger relative to the elongated housing; or 17. The bone plug insertion instrument according to claim 1, wherein the elongated plunger comprises a friction mechanism configured to press against a surface of the elongated housing to inhibit undesired movement of the elongated plunger relative to the elongated housing.

18. A kit comprising the bone plug insertion tool according to any one of claims 1 to 17, The kit further includes a grafting instrument for retrieving the bone plug from the target site.

Images