Title:
ARTIFICIAL TENDON
United States Patent 3797047
Abstract:
A tendon of artificial materials which are tolerated by the organism and of which the ends, which can be stitched, show good properties of adhesion to the tissues whilst the middle portion remains non-adherent. The artificial tendon, which is inextensible and is of a length which can be adjusted according to the needs of the surgeon, comprises a suturable textile strip which is such as to permit fibroblastic infiltration and which is sheathed at its longitudinal central portion in a flexible tube which is non-adherent to tissue.
US Patent References:
Plastic prosthetic tendon
Bodell - April 1965 - 3176316
ARTIFICIAL TENDON
Hausner - May 1970 - 3513484
/3613120.html
McFarland - October 1971 - 3613120
SUBDERMAL TENDON IMPLANT
Bader - May 1971 - 3577837
Plastic prosthetic tendon
Bodell - April 1965 - 3176316
ARTIFICIAL TENDON
Hausner - May 1970 - 3513484
/3613120.html
McFarland - October 1971 - 3613120
SUBDERMAL TENDON IMPLANT
Bader - May 1971 - 3577837
Application Number:
05/248692
Publication Date:
03/19/1974
Filing Date:
04/28/1972
View Patent Images:
Export Citation:
Assignee:
Rhone-Poulenc S.A. (Paris, FR)
Primary Class:
Other Classes:
128/DIG.021
International Classes:
A61F2/08; A61F1/24
Field of Search:
3/1 128/334R,DIG.21
Primary Examiner:
Gaudet, Richard A.
Assistant Examiner:
Frinks, Ronald L.
Attorney, Agent or Firm:
Cushman, Darby & Cushman
Claims:
I claim
1. An artificial tendon consisting of a longitudinally inextensible textile strip which has a uniform porosity along its length and which has suturable end portions at each end thereof, said end portions permitting fibroblastic infiltration, and a longitudinally central portion between said end portions; and a flexible tube of a material which will not adhere to tissues sheathing said longitudinally central portion leaving said end portions exposed.
2. A tendon as claimed in claim 1, wherein said longitudinally central portion is impregnated with adhesive.
3. An artificial tendon consisting of a longitudinally inextensible textile strip having suturable end portions at each end thereof, said end portions permitting fibroblastic infiltration, and a longitudinally central portion between said end portions; a flexible tube of a material which will not adhere to tissues sheathing said longitudinal central portion leaving said end portions exposed; and two longitudinal side edges to said strip, at least the sheathed portion of said strip being wound up on itself widthwise starting from said two side edges.
4. An artificial tendon consisting of a longitudinally inextensible textile strip having suturable end portions at each end thereof, said end portions permitting fibroblastic infiltration, and a longitudinally central portion between said end portions; and a flexible tube of a material which will not adhere to tissues sheathing said longitudinal central portion leaving said end portions exposed, said textile strip being independently slidable with respect to said sheathing tube.
5. An artificial tendon consisting of a longitudinally inextensible textile strip having suturable end portions at each end thereof, said end portions permitting fibroblastic infiltration, and a longitudinally central portion between said end portions; a flexible tube of a material which will not adhere to tissues sheathing said longitidinal central portion leaving said end portions exposed; and an area of localized gluing adjacent only to the longitudinal centre of the interior of the tube with the end portions being free of gluing, the textile strip being adhered to said tube by said localized gluing.
6. An artificial tendon consisting of a longitudinally inextensible textile strip having suturable end portions at each end thereof, said end portions permitting fibroblastic infiltration, and a longitudinally central portion between said end portions; a flexible tube of a material which will not adhere to tissues sheathing said longitudinal central portion leaving said end portions exposed; and an area of localized gluing adjacent only to the ends of the interior of said tube with the central portion between said ends being free of gluing, the textile strip being adhered to said tube by said localized gluing.
1. An artificial tendon consisting of a longitudinally inextensible textile strip which has a uniform porosity along its length and which has suturable end portions at each end thereof, said end portions permitting fibroblastic infiltration, and a longitudinally central portion between said end portions; and a flexible tube of a material which will not adhere to tissues sheathing said longitudinally central portion leaving said end portions exposed.
2. A tendon as claimed in claim 1, wherein said longitudinally central portion is impregnated with adhesive.
3. An artificial tendon consisting of a longitudinally inextensible textile strip having suturable end portions at each end thereof, said end portions permitting fibroblastic infiltration, and a longitudinally central portion between said end portions; a flexible tube of a material which will not adhere to tissues sheathing said longitudinal central portion leaving said end portions exposed; and two longitudinal side edges to said strip, at least the sheathed portion of said strip being wound up on itself widthwise starting from said two side edges.
4. An artificial tendon consisting of a longitudinally inextensible textile strip having suturable end portions at each end thereof, said end portions permitting fibroblastic infiltration, and a longitudinally central portion between said end portions; and a flexible tube of a material which will not adhere to tissues sheathing said longitudinal central portion leaving said end portions exposed, said textile strip being independently slidable with respect to said sheathing tube.
5. An artificial tendon consisting of a longitudinally inextensible textile strip having suturable end portions at each end thereof, said end portions permitting fibroblastic infiltration, and a longitudinally central portion between said end portions; a flexible tube of a material which will not adhere to tissues sheathing said longitidinal central portion leaving said end portions exposed; and an area of localized gluing adjacent only to the longitudinal centre of the interior of the tube with the end portions being free of gluing, the textile strip being adhered to said tube by said localized gluing.
6. An artificial tendon consisting of a longitudinally inextensible textile strip having suturable end portions at each end thereof, said end portions permitting fibroblastic infiltration, and a longitudinally central portion between said end portions; a flexible tube of a material which will not adhere to tissues sheathing said longitudinal central portion leaving said end portions exposed; and an area of localized gluing adjacent only to the ends of the interior of said tube with the central portion between said ends being free of gluing, the textile strip being adhered to said tube by said localized gluing.
Description:
The present invention relates to an artificial tendon.
It is already known in autografting to use the small palmar tendon to make up for the absence of a more useful tendon. However, adhesions occur between the replacement tendon and the surrounding tissues, with a consequent reduction in the mobility of the limb which it controls.
In order to avoid these adhesions, it has been proposed to fix temporarily, between the bone and the muscle, a false tendon of silicone elastomer, until a pseudocystic membranaceous sheath forms. The elastomer is then removed, the replacement tendon is slid into the sheath and its extremities are fixed according to the usual technique.
Although this practice has the value of avoiding the adhesions, it necessitates two surgical operations between which the functioning of the articulation must be reduced by the maximum extent.
According to the present invention there is provided artificial tendon comprising a longitudinally inextensible textile strip with suturable ends which are such as to permit fibroblastic infiltration and a longitudinally central portion which is sheathed by a flexible tube of a material which will not adhere to tissues. Preferably, the textile strip is wound up on itself starting from its two side edges. This forms a double cord joined by the last turn of each coil. Usually, the two coils are on the same face of the common turn (G-shaped coils in contrast to the S-shape produced by forming one coil on each of the opposite faces of the strip).
A strip with a double coil has the advantage of giving a relatively flat tensile element in which the stresses are well balanced.
The cohesion of the strip can be improved by impregnating the sheathed portion by means of an adhesive which is compatible with the living tissues and especially by means of silicone elastomer, but it is usually preferred to leave it all its porosity over its entire length; it is then possible immediately to adjust the tendon to any desired length even in the operating theatre by laying bare an additional portion of the strip and, if necessary, by reducing the length of the strip itself. Such a procedure can be carried out if a series of tendons of graded lengths between the normal limits for a specific use is not available.
For the same reason, the textile strip is usually freely slidable inside its sheath, or is fixed therein only by localized gluing, for example, in the middle part. It can also be glued at the two ends of the sheath or even over its entire length.
The sheath is a flexible tube of a material which is tolerated by the organism, preferably of medical quality silicone elastomer. As its principal use is to avoid the adhesion of the textile strip to the surrounding tissues, the thickness of its wall is usually made as small as possible. The diameters of the sheath are chosen so that it shows a radial extension of 0 to 10 percent (preferably 1 to 5percent) once it has been adjusted on the tensile element. The sheath can optionally be reinforced by an extensible textile tube such as a tubular knitted fabric.
The sheath, its reinforcement or the strip can contain radio-opaque fillers, which allow the post-operative inspection of the prosthesis.
The following examples illustrate the invention and the use to which it can be put.
EXAMPLE 1
An artificial tendon may be formed as follows: sheath of a medical quality silicone elastomer tube, internal and external diameters respectively of 0.2 and 0.3 cm when in a relaxed non-tensioned state, length 21 cm, tensile element formed of a tape of ladderproof knitted fabric of polyester fibre (glycol polyterephthalate), 55 meshes per cm of width, 10 meshes per cm of length, 3 cm wide and 20 cm long. The tape is wound up on itself starting from its two edges (1.5 to 2 turns on each side). It is impregnated with water and stretched by 3 cm. It is dried in an oven at 140° C for 15 minutes. This tape is inserted in the sheath, and this gives a 23 cm tendon (including the two 1 cm extremities which can be stitched), with an almost elliptical middle cross-section (3/3.5 mm axes). The whole can be sterilised by the usual means, especially in an oven.
A tendon according to the invention is illustrated in the single FIGURE of the accompanying drawing which illustrates, in perspective, a tensile element 1 opened out at 1b, wound up on itself again at 1a and received within a tubular sheath 2.
The putting into place can be carried out as follows; the near end of the tape can be opened out, buried and stitched in the muscle. The distal end can be opened out and firmly fixed to the bone by one of the usual techniques such as an intraosseous or sub-periosteal tunnel. If a sufficient portion of the natural tendon is still in existence, the following technique may be used; a sufficient length of tape is bared and divided longitudinally into two strands (a part of the middle portion being removed, if appropriate). Transverse holes are pierced in the tendon and the two strands are laced through them, for example, by crossing the strands in each hole.
This portion of the tendon is then surrounded with a piece of crimped polyester velvet, coated with silicone elastomer on its outer face and which is glued along its free edge. A sheath is thus formed which will fix itself to the tendon by fibroblastic infiltration and will resist post-operative adhesions. The end of this sheath is glued in the same way to the sheath of the prosthesis, preferably with a silicone glue which can be vulcanized by moisture.
If necessary, the length of the tendon can be adjusted before it is put into place by removing the excess length of sheath and, if required, of tape.
EXAMPLE 2
A tendon may be prepared as in Example 1, but with 5 cm reserved at each end as elements which can be stitched. At the time of insertion into the sheath, the portion of tape to be sheathed is impregnated with medical quality silicone elastomer which can be self-vulcanized. The tendon produced is a little less flexible and resists the penetration of serum under the sheath.
It is already known in autografting to use the small palmar tendon to make up for the absence of a more useful tendon. However, adhesions occur between the replacement tendon and the surrounding tissues, with a consequent reduction in the mobility of the limb which it controls.
In order to avoid these adhesions, it has been proposed to fix temporarily, between the bone and the muscle, a false tendon of silicone elastomer, until a pseudocystic membranaceous sheath forms. The elastomer is then removed, the replacement tendon is slid into the sheath and its extremities are fixed according to the usual technique.
Although this practice has the value of avoiding the adhesions, it necessitates two surgical operations between which the functioning of the articulation must be reduced by the maximum extent.
According to the present invention there is provided artificial tendon comprising a longitudinally inextensible textile strip with suturable ends which are such as to permit fibroblastic infiltration and a longitudinally central portion which is sheathed by a flexible tube of a material which will not adhere to tissues. Preferably, the textile strip is wound up on itself starting from its two side edges. This forms a double cord joined by the last turn of each coil. Usually, the two coils are on the same face of the common turn (G-shaped coils in contrast to the S-shape produced by forming one coil on each of the opposite faces of the strip).
A strip with a double coil has the advantage of giving a relatively flat tensile element in which the stresses are well balanced.
The cohesion of the strip can be improved by impregnating the sheathed portion by means of an adhesive which is compatible with the living tissues and especially by means of silicone elastomer, but it is usually preferred to leave it all its porosity over its entire length; it is then possible immediately to adjust the tendon to any desired length even in the operating theatre by laying bare an additional portion of the strip and, if necessary, by reducing the length of the strip itself. Such a procedure can be carried out if a series of tendons of graded lengths between the normal limits for a specific use is not available.
For the same reason, the textile strip is usually freely slidable inside its sheath, or is fixed therein only by localized gluing, for example, in the middle part. It can also be glued at the two ends of the sheath or even over its entire length.
The sheath is a flexible tube of a material which is tolerated by the organism, preferably of medical quality silicone elastomer. As its principal use is to avoid the adhesion of the textile strip to the surrounding tissues, the thickness of its wall is usually made as small as possible. The diameters of the sheath are chosen so that it shows a radial extension of 0 to 10 percent (preferably 1 to 5percent) once it has been adjusted on the tensile element. The sheath can optionally be reinforced by an extensible textile tube such as a tubular knitted fabric.
The sheath, its reinforcement or the strip can contain radio-opaque fillers, which allow the post-operative inspection of the prosthesis.
The following examples illustrate the invention and the use to which it can be put.
EXAMPLE 1
An artificial tendon may be formed as follows: sheath of a medical quality silicone elastomer tube, internal and external diameters respectively of 0.2 and 0.3 cm when in a relaxed non-tensioned state, length 21 cm, tensile element formed of a tape of ladderproof knitted fabric of polyester fibre (glycol polyterephthalate), 55 meshes per cm of width, 10 meshes per cm of length, 3 cm wide and 20 cm long. The tape is wound up on itself starting from its two edges (1.5 to 2 turns on each side). It is impregnated with water and stretched by 3 cm. It is dried in an oven at 140° C for 15 minutes. This tape is inserted in the sheath, and this gives a 23 cm tendon (including the two 1 cm extremities which can be stitched), with an almost elliptical middle cross-section (3/3.5 mm axes). The whole can be sterilised by the usual means, especially in an oven.
A tendon according to the invention is illustrated in the single FIGURE of the accompanying drawing which illustrates, in perspective, a tensile element 1 opened out at 1b, wound up on itself again at 1a and received within a tubular sheath 2.
The putting into place can be carried out as follows; the near end of the tape can be opened out, buried and stitched in the muscle. The distal end can be opened out and firmly fixed to the bone by one of the usual techniques such as an intraosseous or sub-periosteal tunnel. If a sufficient portion of the natural tendon is still in existence, the following technique may be used; a sufficient length of tape is bared and divided longitudinally into two strands (a part of the middle portion being removed, if appropriate). Transverse holes are pierced in the tendon and the two strands are laced through them, for example, by crossing the strands in each hole.
This portion of the tendon is then surrounded with a piece of crimped polyester velvet, coated with silicone elastomer on its outer face and which is glued along its free edge. A sheath is thus formed which will fix itself to the tendon by fibroblastic infiltration and will resist post-operative adhesions. The end of this sheath is glued in the same way to the sheath of the prosthesis, preferably with a silicone glue which can be vulcanized by moisture.
If necessary, the length of the tendon can be adjusted before it is put into place by removing the excess length of sheath and, if required, of tape.
EXAMPLE 2
A tendon may be prepared as in Example 1, but with 5 cm reserved at each end as elements which can be stitched. At the time of insertion into the sheath, the portion of tape to be sheathed is impregnated with medical quality silicone elastomer which can be self-vulcanized. The tendon produced is a little less flexible and resists the penetration of serum under the sheath.