ACL Reconstruction System with Single Tunnel and Bundle Segmentation
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Solution Overview
Problem
Current ACL reconstruction techniques face challenges such as improper bone tunnel placement, increased surgical complexity, notch impingement, and difficulty in revision surgeries due to the double bundle procedure, which affects the stability and kinematics of the knee joint.
Innovation Solution
A novel ACL reconstruction system that uses a single graft separated into bundles for anatomically correct tunnel placement, employing cortical fixation and aperture fixation to mimic the natural ACL bundles, while also providing osteoconductivity for bony ingrowth and the potential for delivering therapeutic agents to enhance tendon-bone healing.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If double bundle ACL reconstruction is performed with separate femoral and tibial tunnels, then anatomical accuracy and knee stability are improved, but surgical complexity and difficulty of revision increase
Solution Approach 1:
The patent combines the femoral and tibial bone tunnels into a single trans-tibial tunnel that passes through the tibia and exits at the femoral attachment site. This merging of two separate tunnels into one reduces surgical complexity while maintaining the ability to create separate ACL bundle pathways, thereby resolving the contradiction between anatomical accuracy and surgical complexity.
Solution Approach 2:
Within the single trans-tibial tunnel, the patent segments the graft into two distinct bundles (anteromedial and posterolateral) that are routed separately to their respective femoral attachment sites. This segmentation allows reconstruction of both ACL functional bundles through a simplified single-tunnel approach, maintaining knee stability while reducing surgical complexity.
2Strength
If traditional cortical fixation devices are used, then pullout strength is improved, but osteoconductivity and tendon-bone healing are reduced
Solution Approach 1:
The fixation device combines cortical bone engagement features (for pullout strength) with porous or textured surfaces that promote osteoconductivity and bony ingrowth. This composite design integrates both mechanical strength and biological healing properties into a single fixation system, resolving the contradiction between pullout strength and tendon-bone healing.
3Ease of operation
If interference screw fixation is used, then ease of operation is improved, but long-term stability and bony ingrowth are reduced
Solution Approach 1:
The fixation device incorporates porous structures that allow bony ingrowth over time, providing long-term stability. The porous design maintains ease of insertion similar to interference screws while adding the beneficial property of osteoconductivity for enhanced long-term fixation reliability.
4Manufacturing precision
If separate femoral tunnel drilling is performed, then anatomic placement is improved, but risk of notch impingement increases
Solution Approach 1:
The patent uses the intercondylar notch space as an intermediary pathway, routing both ACL bundles through this central location before distributing them to their respective femoral attachments. This intermediary approach allows precise anatomic placement while using the natural notch geometry to protect against impingement of the grafts.
Data Source
AI summary
Systems for single tunnel, double bundle anterior cruciate ligament reconstruction include implant constructs and instruments. The implant constructs provide a combination of cortical fixation and bone tunnel aperture fixation. The implant constructs separate a graft into distinct bundles. The instruments are used to prepare shaped bone tunnels to receive the implant constructs and graft bundles. The instruments are also used to exercise and insert the ligament graft constructs. Methods for reconstructing the antero-medial and postero-lateral bundles of the anterior cruciate ligament may rely on a single femoral tunnel, single or double tibial tunnels, and one or more ligament grafts.