Quadriceps Graft Suspension Construct to Prevent Suture Pull-Through
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Solution Overview
Problem
Existing methods for attaching a quadricep tendon graft to bone constructs in ACL reconstruction surgery are prone to catastrophic failure due to sutures pulling through the graft tissue, necessitating complex reinforcement steps that prolong surgical preparation time.
Innovation Solution
A suture construct using a flat braid of fibers with swaged needles and a button loop assembly, which is whipstitched to the graft, providing a strong and efficient attachment method.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If a reinforcement element is used to prevent suture pull-through, then the reliability of graft attachment is improved, but the device complexity and surgical preparation time increase
Solution Approach 1:
The reinforcement element is integrated with the suspension construct to form a unified structure. The flat braid reinforcement is positioned between the graft and button, with tails that are swaged to the suspension suture, merging multiple functions (reinforcement, suspension, and attachment) into a single integrated construct rather than separate components
Solution Approach 2:
The construct uses a composite structure combining different materials: the flat braid reinforcement (likely synthetic fibers), the graft tissue (biological material), the button (synthetic or metal), and the suture materials. This composite approach leverages the strengths of each material to prevent pull-through while maintaining overall construct integrity
2Strength
If a reinforcement element with multiple needle passes is used to strongly affix the construct, then the strength of attachment is improved, but the surgical preparation time increases
Solution Approach 1:
The reinforcement element is pre-assembled with the suspension construct before surgery, with the flat braid positioned and tails prepared for swaging. This preliminary preparation allows the reinforcement to be integrated into the graft-tunnel-construct assembly as a single unit during surgery, eliminating the need for multiple separate needle passes and strong affixing steps during the surgical procedure
3Device complexity
If the suture is engaged directly to the graft tissue, then the device simplicity is improved, but the reliability of attachment deteriorates due to suture pull-through
Solution Approach 1:
The flat braid reinforcement element serves as an intermediary between the suture and the graft tissue. Instead of the suture directly engaging the graft (which risks pull-through), the reinforcement is positioned between them, distributing the load across a broader area of the graft and providing a more secure attachment point for the suture tails
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
The construct ensures a secure attachment of the graft to bone, preventing suture pull-through and reducing surgical preparation time by simplifying the attachment process.
Implementation Method 1
a needle is swaged onto the ends of the first tails, joining them together
Implementation Method 2
the needle and first tails are used to whipstitch the reinforcement to the graft
Data Source
AI summary
A quadricep graft suspension construct, having a button loop, including a generally rectangular button, defining four apertures, including an innermost pair of apertures; and a suture loop looping through the innermost pair of apertures. The construct also has a graft holding assembly, including a reinforcement of first fibers braided with two second fibers, and wherein the first fibers have a first and second lengthwise end and the second fibers continue separately, extending from the first lengthwise end to form a pair of first tails and from the second lengthwise end to form a pair of second tails and wherein the first tails are jointly swaged to a needle. And wherein the graft holding assembly is affixed to the suture loop at a position opposed to the button at least in part by the second tails being joined together about the suture loop and further includes a packaging holding the needle.