WO2025083238A1

WO2025083238A1 - Ladder-shaped column for application in a medical clamping device

Info

Publication number: WO2025083238A1
Application number: PCT/EP2024/079551
Authority: WO
Inventors: Philippe GÉDET; Michelle Stutz
Original assignee: 41medical AG
Current assignee: 41medical AG
Priority date: 2023-10-20
Filing date: 2024-10-18
Publication date: 2025-04-24
Anticipated expiration: 2026-04-20

Abstract

The present disclosure relates to a ladder-shaped column (3) for application in a medical clamping device for clamping of at least one biological structure in a surgical treatment of a patient. The ladder-shaped column (3) extends in a longitudinal direction (l) and is collapsible at least in said longitudinal direction (l) when 5 applied along with the medical clamping device to the biological structure. The ladder-shaped column (3) comprises at least two openings (33), each suitable to receive at least one loop-shaped filament for clamping the biological structure with respect to the ladder-shaped column. The openings (33) are arranged in the longitudinal direction (l) of the ladder-shaped column (3) behind each other and 10 spaced a first distance apart from each other by a spoke (9) extending in transversal direction between a first lateral spar (10a) and a second lateral spar (10b). The first lateral spar (10a) and said second lateral spar (10b) extend in the longitudinal direction and delimit the at last two openings (33) in the lateral direction.

Description

Ladder-shaped column for application in a medical clamping device

FIELD OF THE DISCLOSURE

The present disclosure relates to a ligament clamping device for clamping together a first ligament and a second ligament according to the preamble of patent claims. The disclosure further relates to a ladder-shaped column for clamping in a medical clamping device for clamping of at least one biological structure in a surgical treatment of a patient.

BACKGROUND OF THE DISCLOSURE

A ligament is a piece of fibrous tissue which connects two body parts to each other, particularly one bone to another bone. Ligaments are frequently damaged (e.g., detached, torn or ruptured) as the result of injury or accident. A damaged ligament can impede proper motion of a joint and cause significant pain. A damaged ligament can be replaced or repaired using various procedures, a choice of which can depend on a particular ligament to be restored and on the extent of the damage. When ligaments are damaged, surgical reconstruction can be necessary, as the ligaments may not regenerate on their own.

An example of a ligament that is frequently damaged as a result of injury, overexertion, aging and/or accident is the anterior cruciate ligament (ACL). A damaged ACL can cause instability of the knee joint, arthritis, and substantial pain. ACL repair typically includes the use of a ligament graft replacement procedure which usually involves drilling a bone tunnel through the tibia and up into the femur. Then a ligament graft, which may be an artificial ligament or harvested graft, such as a tendon, is passed through a tibial portion of the tunnel (sometimes referred to as "the tibial tunnel") across the interior of the joint, and up into a femoral portion of a tunnel (sometimes referred to as "the femoral tunnel"). One end of the ligament graft can then be secured in the femoral tunnel and another end of the graft is secured in the tibial tunnel, at the sites where the natural ligament attaches.

Another ligament that is often damaged and may need to be replaced is a posterior cruciate ligament (PCL).

Furthermore, repairs of other tendons or ligaments, such as the Achilles tendon, require trying to reattach the torn pieces of the existing tendon or ligament back together. This can be difficult to accomplish when the tendon or ligament ends are weaker because of the tear. The stitches can rip through the tendon at the repair site.

Different techniques have been developed for graft preparation and for connecting two ligaments, e.g. two grafts, together.

Many techniques from the prior art involve attaching a fixation device such as an ACL TightRope® or button to the end of a graft. Current techniques mostly involve stitching sutures in elaborate stitching patterns through the graft. For example, conventional stitching techniques include whip-stitching (simple or locking) technique. Other existing graft preparation techniques include, for example, baseball stitching, roman sandal suture techniques, Krackow and Prusik knots. The stitching techniques have a range of drawbacks. For example, they may cause trauma to the graft as a result of piercing through the graft. They may also lead to undesirable excessive elongation of the graft when a load is applied thereto. This can compromise the quality of the graft and create a risk of complications during the ligament reconstruction procedure. Furthermore, the grafts prepared with the known stitching techniques may be prone to tearing. Furthermore, the conventional approaches to graft preparation, such as the whip-stitching technique described above, can be labor- and time-consuming and may take up a large portion of time during a reconstruction surgery. Placing a suture on the graft can be cumbersome and, when a graft is prepared using such techniques, the entire reconstruction procedure may be put on hold, which can contribute to increased costs of the surgery. In addition, the surgeon or other medical personnel sewing the stitches bears a risk of a needle-stick injury which can lead to potential infections.

More broadly, the prior art techniques for connecting two ligaments are unable to establish a secure and fixed connection between the two ligaments and especially to maintain over time a tension applied to the ligaments. For example, in many techniques used in the prior art, the two or more ligaments connected to each other gradually move relative to each other, which may for example lead to a reduction in a tensile force that was originally applied to the two ligaments. Further, many techniques known from the prior art lead to damage of the ligaments, e.g. as a result of a clamping mechanism. Finally, many known techniques are difficult and lengthy to perform for a surgeon, thus reducing efficiency. Accordingly, there is a need for improved techniques for preparing grafts and for clamping ligaments together.

SUMMARY OF THE DISCLOSURE

It is therefore an object of the present disclosure to advance the state of the art with respect to graft preparation and with respect to clamping ligaments together. In particular, it is an object to provide a ligament clamping device for clamping two ligaments together which minimizes damage to the ligaments being clamped together. Preferably, piercing through the ligaments would be avoided. It is a further object of at least some variants of the device to establish a secure and firm connection between the ligaments being clamped together. It is a further object of at least some variants of the device to reduce a loss occurring over time in a tensile force acting on the ligaments being clamped together. It is a further object of at least some variants of the device to be biocompatible and to be easy and fast to operate for a surgeon. It is a further object of at least some variants of the device to be broadly applicable for different clinical applications, for example for ligaments of different shape and/or geometry.

According to the present disclosure, these objects are addressed by the features of the independent claim. Further advantageous embodiments follow from the dependent claims and from the description.

The present disclosure relates in a first aspect to a ligament clamping device for laterally clamping at least a first ligament extending in a longitudinal direction. The ligament clamping device comprises a strip extending in the longitudinal direction. The strip comprises at least two openings arranged in longitudinal direction behind each other and extending with respect to the longitudinal direction transversally from a first lateral side to an opposite second lateral side of the strip. The ligament clamping device further comprises at least one filament which passes through at least two openings, thereby forming at least one first and at least one second in their size between an open state and a closed state adjustable loop for i) receiving in the open state the first ligament and ii) clamping in the closed stated the first ligament in the lateral direction.

By clamping the first ligament in the closed state in the lateral direction, it is not necessary to pierce through the filament (which may e.g. be a suture) through the ligament, which would cause harm to the filament and may impede mechanical stability of the filament, for example tensile strength. For example, the present ligament clamping device may be used to attach a filament (such as a suture) to an end of a graft ligament (e.g. in order to apply a tension force to the graft ligament as part of ACL reconstruction), without the need to pierce the filament through the ligament. Thus, more broadly, the ligament clamping device may, among other applications, be used to fixedly and securely attach a filament (such as a medical suture) to at least one ligament.

Depending on the application, the device may also be used in connection with two or more ligaments. For example, in some variants, the ligament clamping device is a ligament clamping device for laterally clamping the first ligament to a second ligament extending in the longitudinal direction. In these variants, the at least one first and at least one second adjustable loop are typically arranged for i) receiving in the open state the first ligament and the second ligament in parallel to each other; and ii) clamping in the closed state the first ligament and the second ligament in the lateral direction to each other. These embodiments allow for example to fixate two or more ligaments relative to each other. The ligaments may be fixated with respect to one or more directions of motions. For example, by clamping the first ligament and the second ligament in the lateral direction to each other, in the closed state, the two ligaments are typically fixated with respect to displacement in the longitudinal direction relative to each other. Thus, for example, a tensile force being applied on the first ligament in the longitudinal direction would be transferred to the second ligament in the closed state.

Thus, a further advantage of the ligament clamping device of the present disclosure is that it allows clamping two or more ligaments together. As an example, the two or more ligaments may essentially be fixated relative to each other, without the need to pierce through or otherwise cause harm to the ligament. Thus, the biological functions of the ligaments are not hampered or otherwise limited.

Depending on the application, different ligaments may be chosen. It is understood that the nature of the first and optional further ligaments is not prima facie limited to certain selected biological structures. Rather, in general, an elongate, soft and compressible structure may be chosen as ligament. Typically, but not necessarily, the ligament is a biological structure. For example, at least one of the one or more ligaments may be a connective tissue, e.g. a connective tissue connecting bones to other bones, or a connective tissue connecting bones to muscles (i.e. tendon). Alternatively or in combination, at least one of the one or more ligaments may be a graft, for example, an allograft, a xenograft or an autograft. For example, the autograft could be a tendon, which may e.g. be used to replace a damaged natural ligament. The autograft may for example be a hamstring tendon, though other tendons can be used as well, such as a patellar tendon. In some variants, the ligament graft is obtained from a donor ("allograft").

The strip comprises at least two openings. For example, the strip may comprise from 2 to 20 openings. In some variants, the strip comprises at least three openings, for example from 3 to 12 openings. At least two, preferably all, of the openings extend with respect to the longitudinal direction transversally from the first lateral side to the opposite second lateral side of the strip. Thus, the openings are typically through-holes, extending transversally through the strip. The openings may in some variants be eyelets.

Depending on the application, the openings may have different arrangements and orientations. For example, in some variants, at least two of the openings may be arranged centrally with respect to a central axis of the strip, although eccentric arrangements are also possible. For example, at least some openings may be arranged eccentric with respect to the central axis of the strip, which may for example be used to impart the strip to be twisted in the closed state compared to the open state.

At least two openings extend from the first lateral side to the second lateral side. Depending on the application, the first lateral side and the second lateral side may be arranged parallel to each other. In some variants, a central axis of each opening is parallel to the central axis of each other opening. It is also possible that the strip has a helical configuration, with the first lateral side and the second lateral side each extending helically around the strip. In this variant, for example, the openings arranged in the longitudinal direction behind each other may have different orientations.

Depending on the application, the loops may have different arrangements. In some variants, at least some loops, or alternatively all loops, are arranged on the same lateral side of the strip. In some variants, the at least one filament forms on both opposite lateral sides of the strip at least one adjustable loop such that in the closed state the first ligament and the second ligament are arranged on opposite sides of the strip. These variants may for example be used to clamp two or more ligaments together. Having the clamping device optionally being arranged between the two more ligaments may be used to maximize the lateral clamping applied to each of the ligaments. Further, depending on the surface properties of the strip, friction between the clamping device and each ligament may also enhance the relative fixation of the two ligaments with respect to each other. In some variants, the loops comprise a first group of one or more loops and a second group of one or more loops, wherein the first group of one or more loops are arranged on the first lateral side and the second group of one or more loops are arranged on the second lateral side. The first group of one or more loops may optionally define a first passage for the first ligament. Depending on the application, optionally, the second group of one or more loops may define a second passage for the second ligament.

Each loop is formed by a filament. Typically, the at least one filament has a certain length, which may allow a filament to form a plurality of loops. Each loop is formed by a filament segment. For example, adjacent filament segments of filament may each form a respective loop. Each filament segment may independently of the other filament segments form one or more loops. For example, each filament segment may independently of the other filament segments form one, two or three loops, preferably one or two loops.

In some variants, at least some filament segments do not form a loop, or the respective loop may be considered to have an opening with essentially no area. For example, in some variants, at least one segment of a filament is arranged adjacent to the strip between at least two openings. In some variants, the at least one segment of a filament may contact the strip between the at least two openings. Depending on the application, these variants may apply to the open state and/or to the closed state. Thus, for example, in some variants, at least one segment of a filament is arranged adjacent to the strip between at least two openings in the open state. Alternatively or in combination, at least one segment of a filament may be arranged adjacent to the strip between at least two openings in the closed state.

Depending on the application, the loops may be arranged on different lateral sides of the strip. For example, in some variants, for each loop, a filament segment forming the respective loop exits and enters the same or a different opening on the same or on opposite lateral sides of the strip. The following example, of which one or more examples may optionally be combined with each other, illustrate this:

For a first example, for at least one loop, a filament segment forming the respective loop may exit and enter the same opening on the same lateral side of the strip, e.g. on the first lateral side. This may for example lead to a loop extending out from a single opening towards a first lateral side.

- Alternatively or in combination, for a second example, for at least one loop, a filament segment forming the respective loop may exit and enter a different opening on the same lateral side lateral side of the strip. For example, the respective filament segment may exit from a first opening towards the first lateral side and may enter into a subsequent, for example adjacently arranged, opening from the first lateral side, which would result in a loop arranged on the first lateral side.

- Alternatively or in combination, for a third example, for at least one loop, a filament segment forming the respective loop may exit and enter the same opening on opposite lateral sides of the strip. For example, the respective filament segment may exit from a first opening, then be passed around the strip from the first lateral side to the second lateral side, and then enter into the same first opening again, thereby forming a loop extending on the first lateral side and on the second lateral side.

- Additionally or alternatively, for a fourth example, for at least one loop, a filament segment forming the respective loop may exit and enter a different opening on opposite lateral sides of the strip. For example, the respective filament segment may exit from a first opening, then be passed around the strip from the first lateral side to the second lateral side, and then enter into another, second opening different from the first opening (e.g. arranged in the longitudinal direction adjacent to the first opening), thereby forming the loop.

Each of the four illustrative examples listed above may optionally be combined with each other. Thus, it is possible to combine one, two, three or even all four illustrative examples with each other.

The shape and arrangement of the loops depends on various factors, including on the opening through which the respective filament segment enters and exits, as well as how the respective filament segment is guided. Depending on these and other factors, the loops may have different three-dimensional contours. For example, when viewed from a lateral perspective, some loops may be essentially flat, and other loops may have an extension along the longitudinal direction. A loop being essentially flat from this perspective may for example be achieved by having the respective filament segment exiting from and entering into the same opening. By contrast, a loop having an extension in the longitudinal direction may for example be achieved by having the respective filament segment exiting from a first opening and entering into a different second opening. For example, the respective loop may have a helical shape. In some variants, at least one loop has an extension in the axial direction. Alternatively or in combination, at least one loop has essentially no extension in the axial direction.

In some variants, the loops may be arranged on either lateral side of the strip, or at least some loops extend across both lateral sides. For example, in some variants, at least one loop is flapped or folded across to an opposite lateral side. In some variants, for at least one loop a filament segment forming the respective loop exits and enters the same or a different opening on a first lateral side of the strip and extends circumferentially around the strip to a second lateral side of the strip. In other words, an entry and an exit section of the filament segment forming the respective loop may be arranged on the first lateral side and an intermediate loop-forming section of the filament segment arranged between the entry section and the exit section is arranged on the second lateral side. The second lateral side of the strip is typically arranged opposite the first lateral side of the strip. Depending on the application and realization, the variants described in this paragraph may for example be used to effect a twisting of the strip and/or of the ligament or ligaments in the closed state. For example, when at least one loop extends circumferentially around the strip from a first lateral side to a second lateral side, and a ligament is passed through that loop, then upon transforming the clamping device from the open state to the closed state (which may be associated with constriction of that loop), the respective filament and/or a segment of the strip may be caused to rotate or twist. This may in some variants be used to enable an intertwisting or intertwining, and may enhance the interconnection between the strip and the ligament and optionally between two ligaments. For example, the intertwisting or intertwining may decrease the propensity towards displacement along the longitudinal direction, and thereby enhance the overall tensile strength in longitudinal direction in an assembled or closed state.

Depending on the application, the loops may have different orientations. For example, at least some of the loops may in the open state face in the longitudinal direction. In some variants, in the open state at least some of the loops overlap with each other when viewed in the longitudinal direction. In some variants, in the open state the loops face with their respective loop openings in the longitudinal direction. These variants may for example be used to facilitate passing a ligament through the respective loop or loops. In some variants, all loops face with their respective opening in the open state in the same direction.

Depending on the application, the clamping device may comprise one or more filaments. If the clamping device comprises two or more filaments, these may be similar to each other (e.g. with respect to material, tensile strength, diameter, etc.), or they may be different from each other. For example, different filaments may fulfil different functions. As an example, in one variant, the clamping device comprises one principal filament, which may optionally be labelled “clamping filament”, which may primarily serve the purpose of clamping the at least one ligament. Depending on the application, the clamping device may comprise a further filament, which may optimally be labelled “auxiliary tensioning filament”. The “auxiliary tensioning filament” may for example serve the purpose of applying a counter-force during clamping. As an example, a first pull-force may be applied in a first direction on the clamping filament and a second pull-force may be applied in a second direction opposite the first direction on the auxiliary tensioning filament. This may for example be done to clamp the filament or filaments, i.e. to transform at least one loop from the open state into the closed state.

In some variants, the auxiliary tensioning filament may for example be connected in a tensile-resistant manner to a distal section of the strip. For example, the auxiliary tensioning filament may be connected in tensile-resistant matter to a distal end of the strip. The auxiliary tensioning filament may e.g. be knotted to the strip (preferably using a tensile-resistant knot) in the distal section of the strip. It is also possible for the auxiliary tensioning filament to pass through an opening of the strip arranged in the distal section of the strip. In this latter example, the two ends of the auxiliary tensioning filament may for example be pulled in order to exert a tensile force on the distal section of the strip. In a further example, the auxiliary tensioning filament may be connected to an opening of the strip by a cow hitch.

Depending on the application, the ligament clamping device may comprise one or more filaments forming loops. For example, the at least one first loop and the at least one second loop may optionally be formed by the same filament or two different filaments.

Depending on the application, the filament or filaments may pass through one or more openings in different patterns. For example, a given filament may pass successively through openings arranged in the longitudinal direction behind each other. It is possible for a given filament to first pass through openings in a first longitudinal direction, and then to return in the opposite longitudinal direction. On returning, the filament may or may not pass through openings. One advantage of having a filament return in the opposite direction is that this enables application of a tensile force by pulling both ends of the respective filament.

Depending on the application, different openings may be chosen as the first opening through which a given filament passes. For example, a given filament may first pass through an intermediate opening arranged for example in or near the middle of the strip, or it may first pass through a proximal or distal opening of the strip. In some variants, the first filament first passes through a proximal opening arranged in the longitudinal direction closer to a proximal end of the strip than the other openings. This may for example be beneficial to use an entire length of the strip. For example, when pulling an end of the respective ligament, the loops formed by said ligament are constricted, thereby causing the filament or filaments to be clamped. When the filament first passes through the proximal opening, then a tensile force associated with pulling of the ligament acts on or near the proximal end of the strip, which may prevent undesired or uncontrolled folding up of the device. Instead, by having the tensile force acting on or near the proximal end of the strip, a longitudinal extension of the strip is initially maintained, until eventually increasing constriction of the loops causes the strip to collapse or otherwise be compressed in a controlled fashion.

In some variants, after passing through the proximal opening, the first filament then passes through at least one further opening and finally through a distal opening of the strip arranged in the longitudinal direction closer to a distal end of the strip than the other openings. These variants may for example be used to evenly distribute a tensile force associated with pulling of the filament throughout the length of the strip. Furthermore, if the first and last opening though which the filament passes are the proximal and distal opening, respectively, uncontrolled folding up of the strip is minimized.

Depending on the application, the loops may in the closed state be interspaced from each other (for example not being in direct contact with each other), or one or more loops may overlap with each other. For example, one or more loops may be in direct contact with each other in the closed state. In some variants, the first filament contacts itself and/or another filament to form a filament crossing. The first filament may for example contact itself and/or another filament in the closed state to form the filament crossing. Having one or more filament crossings may for example be used to enhance a clamping lateral clamping force at a specific position. Filament crossings may also increase friction and thereby minimize relative displacement along the longitudinal direction.

Depending on the application, the strip may have different mechanical properties. In some variants, the strip is compressible, preferably compressible at least in the longitudinal direction. For example, the strip may be designed compressible in the longitudinal direction such that when the at least one adjustable loop is brought from the open state to the closed state, the distance between the at least two openings in longitudinal direction is reduced. Thus, the strip may be designed compressible in the open state.

Alternatively or in combination, the strip may be designed compressible in a lateral direction orthogonal to the longitudinal direction when the at least one adjustable loop is brought from the open to the closed state. For example, the strip may be designed compressible in a lateral direction orthogonal to the longitudinal direction and orthogonal to the first lateral side.

One advantage of the strip being compressible is that, depending on the application, a pressure or tension acting by the filament on the opening or openings may be reduced, thereby reducing the risk of tear or wear. For example, when the clamping device is transferred from the open state to the closed state by pulling at least one filament which passes through two adjacent openings, the filament may exert an increasingly strong force on those sides of the adjacent openings which face each other. This force may be reduced by enabling the strip to be compressible. The compressibility may also be used to increase friction between the strip and at least one filament. Further, the compressibility may in some variants allow formation of lateral protrusions (e.g. bulges) of the strip in the closed state. These protrusions may for example extend in the lateral direction, and may thereby for example be used to prevent displacement of the filament in the longitudinal direction. As an example, a bulge formed from compression of the strip may effectively act as a roadblock for an adjacent filament.

The strip may also have other advantageous mechanical properties. For example, the strip may be elastic, for example elastic in the longitudinal direction. Additionally or in combination, the strip may be elastic in a lateral direction orthogonal to the longitudinal direction, for example elastic in a lateral direction orthogonal to the longitudinal direction and orthogonal to the first lateral side.

Depending on the application, the strip may also be incompressible in at least one direction. For example, the strip may in some variants be incompressible in the longitudinal direction, for example incompressible in the open state. Alternatively or in combination, the strip may be incompressible in a lateral direction orthogonal to the longitudinal direction, for example incompressible in a lateral direction orthogonal to the longitudinal direction and parallel to the first lateral side. 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 be inelastic in a lateral direction orthogonal to the longitudinal direction, for example inelastic in a lateral direction orthogonal to the longitudinal direction and orthogonal to the first lateral side. It is understood that the strip may in some variants have one or more sections which are compressible, as outlined above, and one or more other sections which are incompressible. Similarly, in combination or alternatively, the strip may in some variants have one or more sections which are elastic, as outlined above, and one or more other sections which are inelastic.

In some variants, the strip is in the closed state arranged flexible in longitudinal direction. Additionally or alternatively, the strip may in the closed state be arranged flexible in a lateral direction orthogonal to the longitudinal direction, for example in a lateral direction orthogonal to the longitudinal direction and orthogonal to the first lateral side.

Depending on the application, the strip may have different shapes and geometry. For example, in some variants, the strip may be ladder-shaped. The strip may be made for different materials, for example, it may be made of a flexible material. In some variants, the strip is made from a resorbable material. These variants may for example be used to improve biological compatibility and integration in the body. For example, then using a resorbable material, the two or more ligaments clamped together may be allowed to grow together over time, thereby enhancing the healing process.

Depending on the application, the openings of the strip may have different shapes and geometries. In some variants, at least one of the openings, preferably all openings, is oval in the longitudinal direction. In other words, a diameter of the opening in the longitudinal direction may be larger than a diameter orthogonal to the longitudinal direction. In some variants, the openings have in a cross-section parallel to the longitudinal direction and parallel to the first lateral outer surface an elliptical shape with two oppositely arranged edged vertexes each pointing towards an adjacent merged section.

The openings extend with respect to the longitudinal direction transversally from the first lateral side to the opposite second lateral side. Along this extension, the openings may have different cross-sectional profiles. For example, for at least some of the openings, a cross-section of the opening may taper from the first lateral side towards a central section of the opening, and then widen again from the central section of the opening towards the second lateral side. The tapering and widening may be symmetrical or unsymmetrical. In some variants, at least some of the openings are essentially cylindrical.

In some variants, at least some of the openings, preferably all openings, are sized to allow in the open state up to five, preferably up to three sutures to be passed through a single opening.

Depending on the application, different types of filaments having different properties may be used. It is understood that the filament or filaments used typically have sufficient tensile strength to allow clamping of the at least one ligament. In some variants, a suture may be used as filament, for example a medical suture. Different materials may be envisaged. Typically, the filament is made from a material having a surface with a low friction coefficient. In some variants, the filament is made from a material having a surface with a friction coefficient similar to a friction coefficient of the at least one filament. These variants may for example be used to allow facile transformation from the open state into the closed state. For example, when a low-friction filament is used, it may smoothly glide through one or more holes, which allows smooth constriction of the one or more respective loops.

In some variants, at least one filament is formed integral with the strip. For example, at least one filament may extend from a proximal or distal end of the strip. Typically, a diameter of the filament extending from the strip is smaller than a diameter of the strip. As an example, when the strip is a braided textile, the filament may be a braided textile as well, optionally forming together with the strip a single braid. Typically, a diameter or cross-sectional surface of the filament is smaller than a diameter of cross-sectional surface of the strip.

Depending on the application, the filament may or may not be fixedly connected with the strip. For example, at least one of the at least one filament may be fixedly connected to the strip. For example, at least one of the at least one filament may be knotted to the strip. It is also possible that at least one filament is connected to the strip in a tensile resistant manner. For example the filament may be knotted to the strip (preferably using a tensile resistant knot) or the filament may be passed through an opening of the strip from a first longitudinal direction and then be returned in the same longitudinal direction. In the latter example, for example, pulling both ends of the respective suture would allow transferring a tensile force to the strip. In a further example, the filament may be connected to an opening of the strip by a cow hitch.

Depending on the application, the ligament clamping device may optionally further comprise an application aid, which may for example be used to facilitate use of the clamping device. As an example, the application aid may be used to stabilize the loops and may facilitate passing the one or more ligaments through the one or more loops. This may be particularly advantageous to facilitate the manual maneuvers to be performed by a surgeon, potentially in a minimally invasive surgery. In some variants, the ligament clamping device comprises at least one removable application aid forming an open space in at least one loop suitable for receiving at least one ligament during application. For example, the application aid may comprise a first tube forming an open space (which may optionally be the first passage for the first ligament mentioned above) in at least one loop suitable for receiving the first ligament during application. For example, the first tube may in some variants pass through the first group of one or more loops. Optionally, the application aid may further comprise a second tube forming an open space (which may optionally be the second passage for the second ligament mentioned above) in at least one further loop suitable for receiving the second ligament during application. For example, the second tube may in some variants pass through the second group of more or more loops.

The application aid may be arranged such that it holds one or more loops in place. For example, the application aid may pass through one or more loops such that twisting or turning or swiveling of the respective one or more loops is essentially prevented. In some variants, the application aid is arranged such that in the open state an outer contour of the application aid contacts an inner circumference of the loop. Thereby, undesired or uncontrolled movement of the loop may be minimized. Depending on the application, the application aid may comprise one or more longitudinally extending slits. For example, the one or more longitudinally extending slits may grant access to a ligament arranged at least partially inside the application aid. For example, during the process of guiding a ligament through an application aid, it may be manually difficult to pass the ligament through the application guide. As such, longitudinally extending slits may allow e.g. a surgeon to pass e.g. surgical instruments through the slit in order to pass the ligament through the application aid. In some variants, the one or more slits have a width of at least 2 mm, preferably at least 4 mm. Depending on the application and on the material of which the application aid is made, the slit or slits may also be used to allow a controlled degree of lateral compression of the application aid.

Alternatively or in combination, if the application guide comprises at least two parts, these two parts may be configured to be releasably connected to each other (e.g. by being clipped together). For example, in some variants, the application guide comprises a first tube and a second tube, which may optionally each have at least one longitudinally extending slit. The first tube and second tube may each be releasably connectable to each other. This may contribute to further stabilization and further reduce the risk of inadvertent displacement of the loops. In some variants, a shoulder of the first tube may be clipped to the second tube.

Alternatively or in combination, the application aid may comprise grooves for receiving the filament or filaments. As an example, in the open state, the filament or filaments may be received by the grooves. This may for example prevent undesired or uncontrolled movement of the loops. It may also facilitate introducing the clamping device into the body and facilitate the manual maneuvers required by the surgeon. In some variants, at least some of the loops extend around the application aid in a helical fashion.

In a further variant, the ligament clamping device may comprise at least one clip for fixating one or more loops. For example, a clip may be used to hold for example all loops arranged on the first lateral side together. The clip may for example be a paperclip. It is typically removed before passing the filament through the loop or loops.

The present disclosure relates in a second aspect to a ligament clamping assembly comprising at least two ligament clamping devices according to any of the embodiments described herein. The at least two ligament clamping devices may be arranged such that they define an interspace for i) receiving in the open state the first ligament; and ii) for clamping in the closed state the first ligament between the first clamping device and the second clamping device. It is understood that the interspace is arranged between the at least two ligament clamping devices. In other words, the at least two ligament clamping devices may be laterally interspaced to define the interspace.

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

The disclosure relates in a third aspect to a ladder-shaped column for application in a medical clamping device for clamping of at least one biological structure. The ladder-shaped column may for example in some variants be used for application in a ligament clamping device according to any of the embodiments of the first or second aspect of the disclosure. In other words, the medical clamping device for clamping of at least one biological structure may in some variants be a ligament clamping device for laterally clamping at least a first ligament extending in a longitudinal direction. Depending on the application, the strip disclosed herein may in some variants comprise or consist of a ladder-shaped column according to any of the variants disclosed herein.

The ladder-shaped column extends in a longitudinal direction and is collapsible at least in the longitudinal direction. For example, the ladder-shaped column may be collapsible at least in the longitudinal direction when applied along with the medical clamping device to the biological structure. The ladder-shaped column may additionally be collapsible in a lateral direction.

The ladder-shaped column comprises at least two openings, each suitable to receive at least one loop-shaped filament for clamping the biological structure with respect to the ladder-shaped column. The openings may for example be eyelets. The openings are arranged in the longitudinal direction of the ladder-shaped column behind each other. In a typical embodiment, the openings are arranged in the longitudinal direction behind each other and spaced a first distance apart from each other by a spoke extending in transversal direction between a first lateral spar and a second lateral spar. It is understood that each spoke interspaces in the lateral direction two adjacent openings. It is further understood that the ladder-shape of the ladder-shaped column is at least partially due to the presence of a first lateral spar, a second lateral spar and one or more spokes, extending between the first lateral spar and the second lateral spar.

The first lateral spar and the second lateral spar extend in the longitudinal direction and delimit the at least two openings in the lateral direction.

Typically, as explained in further detail above, the openings extend with respect to the longitudinal direction from a first lateral side of the ladder-shaped column to an opposite second lateral side of the ladder-shaped column. The first lateral spar, the second lateral spar and the one or more spokes are typically arranged between the first lateral side and the second lateral side.

The ladder-shaped column may be used for various applications. For example, in some variants, the ladder-shaped column is suitable for application in a medical clamping device for clamping of at least one biological structure in a surgical treatment of a patient. The ladder-shaped column may also be used in other clamping applications. Depending on the application, the biological structure to be clamped may be a ligament. In some variants, the ladder-shaped column is configured for fixating and tensioning one or more biological structures inside the body of a patient. The ladder-shaped column may optionally be used in conjunction with one or more filaments, such as sutures. For example, in some variants, at least one filament passes through at least one of the openings of the laddershaped column. Alternatively or in combination, at least one filament may be fixated, e.g. knotted, to the ladder-shaped column.

Depending on the application, the spoke and the spar may have different crosssections. For example, in some variants, the spoke is oval shaped in lateral direction and/or in longitudinal direction. Alternatively or in combination, the first lateral spar and/or the second lateral spar may be oval shaped with respect to the transversal direction. As a specific example, it is possible that the cross-section of the spoke is oval shaped in lateral and in longitudinal direction and that the cross-section of the first lateral spar and of the second lateral spar is oval shaped with respect to the transversal direction. One advantage of having an oval cross-section is that it may contribute to advantageous gliding properties, for example, it may facilitate a ligament or filament in contact with the ladder-shaped column to pass smoothly along a surface of the column. In some variants, an outer contour of the spoke and/or an outer contour of the first lateral spar and/or an outer contour of the second lateral spar may be essentially free of distinct edges. Thus, gliding of a ligament or filament may be facilitated.

Depending on the application, the ladder-shaped column may have different cross-sections. For example, in some variants, the cross-section of the spoke is H-shaped. Alternatively or in combination, the cross-section of the first lateral spar and the second lateral spar may be T-shaped or l-shaped. The expressions “H-shaped”, “T-shaped” and “l-shaped” refer to the letters “H” respectively “T” respectively “I” in the Latin alphabet. The letter “I” is the capital letter of the letter

“i". For example, the “l-shape” may in some variants be an essentially straight line. The H-shape may in some variants comprise two essentially straight lines extending in parallel to each other and being interspaced from each other by a cross-bar extending between the two lines. The cross-bar is typically essentially orthogonal with respect to the two essentially straight lines and is typically arranged essentially centrally with respect to the two essentially straight lines. The T-shape may in some variants comprise an essentially straight first line and an essentially straight second line extending from a center of the first line orthogonally with respect to the first line. The second line may for example be shorter than the first line.

Depending on the application, the spoke, the first lateral spar and the second lateral spar may be separate pieces or they may be integrally formed, i.e. made of a single piece. Furthermore, different geometries may be envisioned in particular for a transition between the spoke and the first and the second lateral spar. For example, in some variants, the spoke and the first and the second lateral spar are smoothly transitioning into each other without forming distinct edges. One advantage of these variants is that they facilitate smooth gliding of a ligament or filament along a surface of the ladder-shaped column. A further advantage may be that the risk of a ligament or filament being caught or stuck in a particular portion of the ladder-shaped column, which would increase the risk of tear, may be reduced. A distinct edge may for example be a structure on an outer surface and having a length of at least 2 mm, such as at least 5 mm. It is understood that for example that a surface roughness, in particular an evenly distributed surface roughness, typically does not qualify as a distinct edge. Depending on the application, the spoke and/or the lateral spars may have different physical structures. For example, in some variants, at least one spoke may be at least partially hollow. Alternatively or in combination, at least one lateral spar, preferably the first and the second lateral spar, is at least partially hollow. As a specific example, in some variants, at least one spoke and at least one lateral spar of the ladder-shaped column are at least partially hollow. One example of at least partially hollow is entirely hollow. Thus, for example, at least one spoke and at least one lateral spar of the ladder-shaped column may be entirely hollow. In some variants, the first lateral spar and/or the second lateral spar have a tubular cross-section.

The ladder-shaped column may be made of different materials. Depending on the application, different manufacturing techniques may be used. In some variants, the ladder-shaped column is made by braiding. It is also possible that the laddershaped column may be made by injection molding. In still another variant, the ladder-shaped column is made by 3D-printing.

Depending on the application, the ladder-shaped column may be a braid and may for example be made of a plurality of braided filaments. In some variants, the ladder-shaped column comprises a plurality of filaments extending in the longitudinal direction. In the region of the spokes, the plurality of filaments may form a tubular braid. Additionally or alternatively, in the region of the openings, the plurality of filaments may form two tubular braids extending in the longitudinal direction, thereby defining in the respective region of the ladder-shaped column the first lateral spar and the second lateral spar. Depending on the application, a tunnel extending from a first end of the ladder-shaped column to a second end of the ladder-shaped column may be defined by the tubular braids in the region of the spokes and by the tubular braids in the region of the openings.

Different braiding patterns and techniques may be used. For example, in some variants, a composition of the filaments forming the first lateral spar and a composition of the filaments forming the second lateral spar may differ for each opening. For example, a first group of filaments may form the first lateral spar and a second group of filaments may form the second lateral spar for each region comprising an opening. It is also possible that the filaments forming the first lateral spar and the filaments forming the second lateral spar are selected independently for each region comprising an opening. Depending on the application, each filament may form in each central section and in each bifurcation section a helix. The helix may have different twist directions. For example, each filament may maintain a helical twist direction from a first end of the ladder-shaped column to a second end of the ladder-shaped column. The braid-forming filaments may have different arrangements with respect to each other. In some variants, each filament extends from a first end of the ladder-shaped column to a second end of the ladder-shaped column. Depending on the application, from a first end of each filament, each successive segment of the filament progressively approaches the second end of the strip. Thus, for example, it is possible that no filament is guided in a reverse direction.

Depending on the application, the tubular braid has in each central section a pick count in a range from 40 ppi to 120 ppi, preferably from 60 ppi to 100 ppi. In other words, the ladder-shaped column may in the regions of the spokes comprise a tubular braid with a pick count in a range from 40 ppi to 120 ppi, preferably from

60 ppi to 100 ppi.

Alternatively or in combination, the tubular braids in each bifurcation section may each have a pick count in a range from 20 ppi to 90 ppi, preferably from 40 ppi to 70 ppi. In other words, the ladder-shaped column may in the regions of the openings comprise a tubular braid with a pick count in a range from 20 ppi to 90 ppi, preferably from 40 ppi to 70 ppi.

In some variants, each filament has a linear density from 20 dtex to 880 dtex, preferably from 55 dtex to 440 dtex, even more preferably from 80 dtex to 250 dtex. Alternatively or in combination, the ladder-shaped column may comprise from 8 to 32 filaments, preferably 16 filaments.

Depending on the application, the tubular braids formed in the regions of the spokes may be twill braids. Alternatively or in combination, the tubular braids formed in the regions of the openings may be twill braids. In some variants, the filaments are braided in a two-over-and-two-under fashion or in a one-over-and- one-under fashion. It is understood that in a two-over-and-two-under braid, each filament successively passes over two strands of an opposite direction and then in turn passes under the next two strands of the opposite direction. Similarly, in a one-over-and-one-under braid, each filament successively passes over one strand of an opposite direction and then in turn passes under the one next strand of the opposite direction. Depending on the application, the ladder-shaped column may consist of a two-over-and-two-under braid or it may consist of a one- over-one-under braid. It is also possible that the ladder-shaped column may comprise a one-over-and-one-under braid in some regions and a two-over-and-two- under in further regions.

In some variants, in each central section a ratio between the number of filaments and a circumference of the tubular braid of the respective central section is in a range from 4 filaments/mm to 13 filaments/mm. In other words, in each region comprising a spoke, a ratio between the number of filaments and a circumference of the tubular braid of that region may be in a range from 4 filaments/mm to 13 filaments/mm.

In some variants, in each bifurcation section a ratio between the number of filaments and a circumference of the tubular braid of the respective bifurcation section is in a range from 4 filaments/mm to 13 filaments/mm. For example, for each first lateral leg and for each second lateral leg the ratio between the number of filaments and a circumference of the tubular braid of the respective lateral leg may be in a range from 4 filaments/mm to 13 filaments/mm. In other words, in each of the regions of the openings, a ratio between the number of filaments and a circumference of the tubular braid of the respective region may be in a range from 4 filaments/mm to 13 filaments/mm.

Depending on the application, the ladder-shaped column may have different shapes or different outer contours. For example, in some variants, the lateral spars are undulated in longitudinal direction. For example, the lateral spars may be uniformly undulated in longitudinal direction or they may be undulated in opposite direction. In some variants, a lateral extent of the ladder-shaped column may be greater in the region of the openings than in the region of the spokes. It is also possible that the lateral extent of the ladder-shaped column may be essentially the same in the region of the openings than in the region of the spokes. In some variants, the lateral extent of the ladder-shaped column is greater in the region of the openings than in the region of the spokes by at least 5%, preferably by at least 10%, more preferably by at least 20%, relative to the lateral extent in the region of the spokes.

The number of spokes may vary depending on the application. In some variants, the ladder-shaped column comprises a spoke at the beginning and/or at the end.

The openings are spaced a first distance apart from each other by the spoke. Depending on the application, the distance between two adjacent openings may differ. For example, in some variants, a distance in the longitudinal direction between the center of two adjacent openings is in the range of 2 mm to 30 mm, preferably of 3.5 mm to 20 mm. The indicated distance ranges were found to be advantageous for clamping applications. For example, depending on the application, distances exceeding 30 mm or 20 mm may in some variants impair the structural integrity or stability, especially when clamping forces are applied. Conversely, the indicated ranges may in some variants contribute to a controlled degree of lateral compression.

In some variants, the ladder-shaped column may be described to comprise a plurality of central sections and a plurality of at least two bifurcation sections each arranged in the longitudinal direction between two adjacent central sections. Each bifurcation section comprises an opening. The bifurcation sections correspond to the regions of the openings and the central sections correspond to the regions of the spokes. A central section extends between two adjacent openings. In some variants, a ratio between a length in the longitudinal direction of each central section and a length in the longitudinal direction of each adjacent bifurcation section is in a range from 6:1 to 1 :3. For example, the ratio between the length in the longitudinal direction of each central section and the length in the longitudinal direction of each adjacent bifurcation section may be in a range from 3:1 to 1 :1 .5. In other words, a ratio between a length in the longitudinal direction of each spoke and a length in longitudinal direction of each adjacent opening may be in a range from 6:1 to 1 :3, preferably in a range from 3:1 to 1 :1 .5.

Depending on the application, the openings may have different shapes and/or geometries. For example, in some variants, each opening has a perimeter from 1 .5 mm to 40 mm, preferably from 2 mm to 15 mm. The perimeter may for example refer to a minimum perimeter. For example, the perimeter may differ along a longitudinal cross-section parallel to the first lateral side. Thus, the indicated perimeter ranges may for example relate to a central longitudinal cross-section arranged between the first lateral side and the second lateral side.

In some variants, the ladder-shaped column has a circumference in the region of the spokes in a range from 2 mm to 25 mm, preferably from 3 mm to 12 mm. Alternatively or in combination, in some variants, the first lateral spar and the second lateral spar each independently have a circumference in the region of the openings in a range from 0.8 mm to 15 mm, preferably from 1 .2 mm to 7 mm. In some variants, each opening has in a longitudinal cross-section an elliptical shape, e.g. with two vertices arranged opposite of each other in the longitudinal direction. Depending on the application, one vertex or both vertices of at least one opening may be edged. The longitudinal cross-section referred to in this paragraph is a cross-section parallel to the longitudinal direction. It may for example be parallel to the first lateral face.

Depending on the application, the ladder-shaped column may be described to have, in each region comprising an opening, a first lateral leg and an opposite second lateral leg delimiting in a lateral direction the respective opening. In some variants, an inner contour of each first leg and an inner contour of each second leg is rounded in a cross-section orthogonal to the longitudinal direction.

Depending on the application, the ladder-shaped column may comprise one or more spokes. Typically, the spokes extend parallel to each other. The laddershaped column may in some variants comprise at least two, preferably at least five, spokes.

Depending on the application, the number and density of openings may be different. For example, in some variants, the ladder-shaped column may have an opening density in the longitudinal direction of at least one opening per 30 mm. Depending on the application, the openings may be distributed evenly or unevenly along the longitudinal direction. It is also possible that a majority or all openings are arranged in only one of two or more longitudinal segments of the laddershaped column. In some variants, in at least one longitudinal segment of the lad- der-shaped column comprising at least three openings, the ladder-shaped column has an opening density in the longitudinal direction of at least one opening per 30 mm.

Depending on the application, the ladder-shaped column may have different cross-sections. For example, in some variants, in a cross-section orthogonal to the longitudinal direction the openings are arranged in an opening segment arranged in lateral direction between a first peripheral segment and a second peripheral segment. The first peripheral segment and the second peripheral segment may for example each have a lateral extension from 10% to 300% relative to a lateral extension of the opening segment. Depending on the application, the opening segment and/or the central sections may have an essentially planar outer surface.

It is understood that, depending on which geometry and shape the ladder-shaped column has and depending on which material it is made of, the exact shape or outer contour of the ladder-shaped column may at least partially be influenced by physical deformation of the ladder-shaped column. Thus, any geometries, shapes or contours disclosed herein may preferably relate to a relaxed state, i.e. a state in which no external force has been applied to the ladder-shaped column.

It is to be understood that both the foregoing general description and the following detailed description present embodiments, and are intended to provide an overview or framework for understanding the nature and character of the disclosure. The accompanying drawings are included to provide a further understanding, and are incorporated into and constitute a part of this specification. The drawings illustrate various embodiments, and together with the description serve to explain the principles and operation of the concepts disclosed.

BRIEF DESCRIPTION OF THE DRAWINGS The disclosure described herein will be more fully understood from the detailed description given herein below and the accompanying drawings which should not be considered limiting to the disclosure described in the appended claims. The drawings are showing:

Fig. 1 shows an embodiment of the ligament clamping device; Fig. 2 shows a further embodiment of the ligament clamping device;

Fig. 3 shows a further embodiment of the ligament clamping device, including an application aid;

Fig. 4 shows a cerclage application of an embodiment of the ligament clamping device; Fig. 5 shows a further embodiment of the ligament clamping device and a cerclage application for treatment of periprosthetic fractures;

Fig. 6 shows an application of a variant of the ligament clamping device for spinal stabilization; Fig. 7 shows a further embodiment of the ligament clamping device comprising an auxiliary tensioning filament;

Fig. 8 shows an embodiment of a ladder-shaped column for application for application in a medical clamping device;

Fig. 9 illustrates different cross-sections of the ladder-shaped column shown in fig. 8;

Fig. 10 shows a further embodiment of a ladder-shaped column for application in a medical clamping device.

DESCRIPTION OF THE EMBODIMENTS

Reference will now be made in detail to certain embodiments, examples of which are illustrated in the accompanying drawings, in which some, but not all features are shown. Indeed, embodiments disclosed herein may be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will satisfy applicable legal requirements. Whenever possible, like reference numbers will be used to refer to like components or parts.

Figure 1 shows an embodiment of the ligament clamping device 1. It comprises a strip 3 and two filaments 41 , 42. In the illustrated embodiment, both filaments 41 , 42 are medical sutures. The strip 3 extends along a longitudinal direction (corresponding to the x-axis) and comprises a plurality of openings 33, which are arranged in the longitudinal direction behind each other. In the illustrated embodiment, the openings 33 are eyelets and extend from a first lateral side 31 (corresponding to positive values on the y-axis) to a second lateral side 32 (corresponding to negative values on the y-axis) arranged opposite the first lateral side 31 .

The two filaments 41 , 42 both pass through the openings 33 to form a plurality of loops 51 , 52, 53, 54, 55. More specifically, in the illustrated embodiment, a first group of loops (including loops 51 , 52, 53) is formed which extend laterally from the first lateral side 31 , and a second group of loops (including loops 54, 55) is formed which extend laterally from the second lateral side 32. The first group of loops 51 , 52, 53 form a first passage for receiving in the open state and clamping in the closed state a first ligament 21 . Likewise, the second group of loops 54, 55 form a second passage for receiving in the open state and clamping in the closed state a second ligament 22. In the illustrated embodiment, the first ligament 21 is passed through all loops arranged on its respective lateral side, namely the first lateral side 31 , and the second ligament 22 is passed through all loops arranged on its respective lateral side, namely the second lateral side 32. It is understood that this is not necessarily required.

In the present disclosure, in general, the one or more filaments may be passed through the openings of the strip in numerous different ways. For example, in the variant shown in fig. 1 , the filament 41 may successively pass through openings arranged in the longitudinal direction consecutively behind each other. The same applies to the second filament 42. It is however also possible to pass the filament or filaments through non-consecutively arranged openings of the strip (not shown). Alternatively or in combination, at least some openings may also be skipped (not shown).

In the embodiment illustrated in Fig. 1 , all loops are arranged fully on either lateral side of the strip. In other words, for each of the loops 51 , 52, 53, 54, 55, a respective filament segment forming the respective loop enters and exits the same or a different opening 33 from the same lateral side. Thus, for example, the loops belonging to the first group of loops 51 , 52, 53 are all fully arranged on the first lateral side 31 , while the loops belonging to the second group of loops are all fully arranged on the second lateral side 32. In other words, in the illustrated variant, each filament segment forming a loop belonging to the first group of loops 51 , 52, 53 exits an eyelet and enters again into the same or a different eyelet from the same lateral side, namely the first lateral side 31. Similarly, in the illustrated variant, each filament segment forming a loop belonging to the second group of loops 54, 55 exits and enters again into the same or a different eyelet from the same lateral side, namely in this case the second lateral side 32. Thus, each loop enters into an eyelet from the same lateral face as the lateral face into which it exits an eyelet.

It is understood that the since both oppositely arranged groups of loops share at least one filament (in the illustrated variant they even share two filaments), the two groups of loops are not independent of each other. Rather, the loops arranged on either lateral side are nevertheless constricted in concert.

The ligament clamping device 1 is illustrated in Fig. 1 in an open state. To transform the clamping device 1 from the open state into a closed state, both opposite ends of each of the filaments 41 and 42 may be pulled. This will lead to the respective loops being formed from the first filament 41 and from the second filament 42 being increasingly constricted, thereby laterally clamping the first filament 21 and the second ligament 22. In principle, it is conceivable that the ends of one of the filament, e.g. 41 , are pulled first and that the ends of the second filament, e.g. 42, are pulled only later, once the loops formed from the first filament 41 are at least partially, or maybe even fully, constricted. For example, it may be advantageous to first fixate the two ligaments 21 , 22 partially using the first filament 41 , before increasing the fixation using the second filament 42. It is also conceivable that a first ligament may be fixated first using a first filament and that a second ligament may be fixated later using a second filament (not illustrated). In some variants, it may also be advantageous to pull the ends of both filaments 41 and 42 at the same time in order to constrict the respective loops in an even and permanent fashion. Depending on the application, this may for example contribute to an even distribution of clamping pressure along the filament or filaments, which may minimize biological damage.

In the illustrated embodiments, the two ends of the first filament 41 are positioned on opposite ends of the strip in the longitudinal direction. This also applies to the two ends of the second filament 42, which are also positioned on opposite ends of the strip. Additionally, both filaments 41 , 42 are each first passed through a proximal eyelet 33p and last passed through a distal eyelet 33d of the strip (where the distal and proximal eyelets are arranged opposite each other in the longitudinal direction and may also be labelled as outermost eyelets) . This arrangement contributes to an even distribution of clamping force along the length of the strip 3. Specifically, since the outward loops (i.e. those loops nearest the proximal end or the distal end of the strip) are initially constricted more strongly than the subsequent loops, the constriction of the loops - and thereby the clamping force - is applied consecutively from the outer periphery towards a central portion of the clamping device 1.

Furthermore, by passing the filaments 41 , 42 each first and last through a proximal respectively distal eyelet, during tensioning of the filaments 41 , 42, an elongation of the strip is maintained. Specifically, for example, when pulling both ends of filaments 41 , a force acting in the distal direction (i.e. in the direction of positive values on the x-axis) is applied on the distal eyelet 33d and a force acting in the proximal direction (i.e. in the direction of negative values on the x-axis) is applied on the proximal eyelet 33p. These opposite forces acting on the proximal section respectively the distal section of the strip ensure that the strip 3 is not significantly compressed yet when beginning to pull the two ends of filament 41 . Instead, the tensile force is primarily translated into constriction of the loops, thereby laterally clamping the first ligament 21 and the second ligament 22, respectively. As the ends are pulled further and further and the loops are increasingly constricted and start to contact and clamp the first ligament 21 and second ligament 22 increasingly strongly, eventually, the pull force is increasingly translated into a compression of the strip 3 in the longitudinal direction (not illustrated).

Depending on the arrangement of the loops, the increasing application of pullforce may be associated with a partial twisting of the strip. For example, in the embodiment illustrated in fig. 1 , increasing constriction of loop 51 (which is formed by filament 42 passing consecutively through proximal opening 33p and the adjacent opening) will lead to a torsional force acting on the respective section of the first ligament that is constricted by loop 51 (not shown) as well as on the respective section of the strip 3. Specifically, because the filament segment forming loop 52, after exiting from proximal eyelet 33p, passes circumferentially around the first ligament 21 before entering into the eyelet adjacent to proximal eyelet 33p, increasing constriction of loop 51 will in the illustrated embodiment induce slight torsion (not shown) of the first filament 21 in a clockwise direction (when viewed in a lateral direction from the first lateral side 31 to the second lateral side 32, i.e. when viewed in the direction from positive values to negative values on the y-axis) and/or slight torsion of the strip 3 in a counter-clockwise direction (when viewed from the same direction). Depending on various factors (including the distance between the adjacent eyelets through which the filament segment passes, the strength of the strip 3 and the strength of the first ligament, among others), it is possible to influence whether the first ligament is primarily caused to rotate, whether the strip 3 is primarily caused to rotate, or whether the first ligament and the strip 3 are both caused to rotate relative to each other. Either way, the relative torsion of segments of the strip 3 with respect to the first ligament may be used to contribute to effective fixation of the first ligament and, in the illustrated variant in which two ligaments are to be clamped together, fixation of the first ligament 21 to the second ligament 22.

Depending on the application, adjacent sections of a ligament may be induced to be twisted in opposite directions of rotation (not illustrated). For example, a first loop may induce rotation of a first section of a ligament to rotate in a clockwise direction, whereas an adjacent second loop may induce rotation of an adjacent second section of the same ligament in an anti -clockwise direction. This may for example in some variants (not illustrated) be used to further enhance fixation and reduce the propensity of the respective ligament to axial displacement.

Eventually, after constriction of all loops formed by the first filament 41 and by the second filament 42, the closed state is reached (not illustrated), in which the strip 3 is arranged between the first ligament 21 and the second ligament 22.

Depending on the application, the strip 3 and the filaments 41 and 42 may be made of different materials and may have different shapes. For example, the filaments 41 and 42 may or may not be made of the same material. The strip 3 may for example be made of a textile, such as a braided textile. Depending on the application, the strip 3 may for example have a tubular structure, which may optionally be hollow, as illustrated in figure 1. The strip 3 may for example form a plurality of lateral bulges in the region of the openings 33. The openings 33 of the strip 3 may for example have an ellipsoid shape.

Figure 2 shows a further embodiment of the ligament clamping device 1 . Similar to the variant shown in figure 1 , it also comprises a clip 3 and two filaments 41 and 42 which extend through openings in clip 3. The first filament 41 and the second filament 42 each form a plurality of loops 51 , 52, 53, 54 on either lateral side of the clip 3. The loops 51 , 52 arranged on a first lateral side 31 of the strip form a first group of loops and the loops 53, 54 arranged on a second, opposite lateral side 32 of the strip form a second group of loops. A first ligament 21 passes through the first group of loops and, in parallel to the first ligament 21 , a second filament 22 passes through the second group of loops. The first ligament 21 and the second ligament 22 both extend in parallel to a longitudinal direction of the strip 3.

Figure 3 shows a further embodiment of the ligament clamping device 1 , which comprises an application aid 61 , 62 in the form of two tubes 61 , 62 passing through the loops formed by filament 41. Specifically, similar to the embodiment shown in Fig. 2, a first group of loops 51 , 52 arranged on a first lateral side 31 of strip 3 is formed and a second group of loops 53, 54 arranged on an opposite second lateral side 32 of strip 3 is formed. A first application aid tube 61 passes through the first group of loops 51 , 52 and a second application aid tube 62 passes through the second group of loops 53, 54.

The tubes 61 , 62 have an inner cavity for each receiving a first ligament respectively a second ligament. The tubes 61 , 62 also ensure that the respective loops 51 , 52, 53, 54 are held in a certain position and/or shape and that, in particular, they are prevented from rotating. Specifically, the loops are maintained in an open orientation, which enables a user to pass a given ligament securely and easily through all required loops.

Depending on the application, the loops 51 , 52, 53, 54 may optionally be constricted before insertion of the clamping device 1 into the body, such that an inner contour of each loop contacts the respective tube 61 , 62. By effectively clamping the tubes 61 , 62, undesired displacement of the tubes 61 , 62 may be prevented. As such, in the open state, the application aid may be clamped by at least one loop. Depending on the application, a filament segment may optionally form one or more loops between exiting from an eyelet of the strip 3 and entering again into the same or a different eyelet. For example, in the illustrated embodiment, the filament segment forming loop 53 forms only a single loop, namely loop 53. By contrast, the filament segment forming loop 54 forms two loops, including loop 54 and a further loop.

Furthermore, as illustrated in fig. 3, a loop may overlap with a further loop to form a loop crossing. For example, loop 51 is arranged adjacent a further loop and crossed said further loop to form a loop crossing 5c.

Figure 4 illustrates a cerclage application of the clamping device 1. Specifically, the cerclage is used to fixate a locking device 8 (e.g. a locking plate) to a biological structure 7, which is typically a bone. The illustrated embodiment of the clamping device 1 comprises application aid tubes 61 and 62, which respectively extend through a first group of loops and an oppositely arranged second group of loops.

In a first step (cf. Fig. 4A), a first end of a ligament 21 is passed through a first tube 61 , while a second end of the same ligament 21 is passed in opposite direction through a second tube 62. The ligament 21 in the illustrated embodiment may for example be an autograft, but can also be a synthetic material.

In a second step (cf. Fig. 4B), after both ends of the ligament 21 have been passed through the respective application aid tubes 61 and 62, the tubes are removed, thereby exposing the opposite ends of the ligament to the loops. Directly after removal of the tubes 61 , 62, the ligament 21 is typically not yet constricted by any of the loops, so care should be taken to avoid inadvertent displacement of either end of the ligament out of the loop or loops.

Subsequently, both ends of the suture 41 are pulled, causing the plurality of loops to be constricted. As a result of this, both ends of the suture are clamped laterally and thereby fixated relative to each other.

As explained above, continued pulling on the opposite ends of the suture 41 may lead to twisting of sections of the ligament 21 with respect to the strip 3, as illustrated in Fig. 4C. Depending on the application, the twisting may be used to increase an overall tensile force on the ligament and to further constrict the cerclage.

Depending on the application, it may be desirable to knot the opposite ends of the suture 41 together in a final step (cf. Fig. 4D). This may further secure the fixation, in this case the cerclage. The knot may in particular minimize loss of tensile force over time. The knot may further be used to prevent the loose ends from entangling or otherwise interfering with adjacent tissue.

Figure 5 illustrates a further application in the area of cerclage for treatment of periprosthetic fractures. Similar to figure 4, the cerclage is used to clamp a fixation device 8 (e.g. a fixation plate) to a biological structure 7 (e.g. a bone). In the illustrated embodiment, the ligament clamping device 1 comprises a first tubular application aid 61 and a second tubular application aid 62 which are used to hold loops 51 , 52 in place and facilitate passing the two opposite ends of a filament 21 through the loops 51 , 52.

Figure 6 shows an application of a variant of the ligament clamping device 1 in the context of spinal stabilization. Specifically, two adjacent vertebrae are fixated relative to other through the ligament clamping device 1 , which is illustrated in a closed and tensioned state. More specifically, a ligament (e.g. an allograft) is passed through a hole in the spinous process of an upper vertebra and through a hole in the spinous process of an adjacent lower vertebra, thereby forming a fixation loop for fixating the two vertebrae. Depending on the application, one fixation loop or two fixation loops or even more than two fixation loops may be formed. The two or more fixation loops may optionally be formed from the same or a different ligament. It is understood that this fixation loop is not to be confused with the loops formed by the at least one filament as disclosed herein. Instead, the fixation loop is constricted in order to limit relative movement between the two adjacent vertebrae. The fixation loop is maintained in a constricted state by clamping two opposite ends of the ligament together using a ligament clamping device 1 .

Figure 7 shows a further embodiment of a ligament clamping device 1 . It comprises a strip 3 and two filaments 41 , 42. A first filament 41 functions as clamping filament 41 , while a second filament 43 functions as auxiliary tensioning filament 43. In the illustrated variant, one end of the clamping filament 41 is fixedly connected to the strip 3 through a knot. Specifically, the knot was formed by knotting the clamping filament 41 through an opening of the strip 3, specifically, through the opening next to the opening labelled with reference number 33 in fig. 7. An opposite end of the clamping filament 41 is free and may be pulled in order to constrict the plurality of loops formed from clamping filament 41 on both lateral sides of the strip 3. It is understood that the clamping filament 41 need not necessarily be fixedly connected to the strip 3. For example, it is also possible for both ends of the clamping filament 41 to be pulled in order to constrict the loops formed by the clamping filament 41 .

The auxiliary tensioning filament 43 is arranged such that it may be used to apply a counter-force to the ligament clamping device 1 . To this end, the auxiliary tensioning filament 43 may optionally be fixedly connected to the strip with one of its two ends (not illustrated).

The ligament clamping device 1 is illustrated in fig. 7 in an open state. To transform the clamping device 1 into a closed state, the free end of the clamping filament 41 and both ends of the auxiliary tensioning filament 43 may be pulled. Pulling of the free end of clamping filament 41 exerts a tensile force to the left, while pulling of the auxiliary tensioning filament 43 exerts a tensile force to the right. Through these opposite forces, the loops are increasingly constricted, thereby laterally clamping a first ligament (not illustrated) and a second ligament (not illustrated), respectively.

In the illustrated embodiment, the clamping suture 41 passes first through a proximal opening of the strip 3, which is arranged opposite an opposite distal opening through which the auxiliary tensioning filament is passed. This arrangement allows effectively applying the tensile forces on opposite ends of the strip 3 and ensures that the strip 3 is initially maintained in an essentially linear conformation while the loops are constricted. This contributes to an orderly and controlled constriction of the loops, minimizing uncontrolled and undesired motions.

It is understood that the geometry of the strip 3 in fig. 7 primarily serves to illustrate the auxiliary tensile filament 43 and is typically not representative of the actual geometry and shape of the strip 3. Instead, in typical variants, the illustration in fig. 1 is a more accurate depiction of the geometry and shape of the strip 3.

Figure 8 shows an embodiment of a ladder-shaped column for application in a medical clamping device. The ladder-shaped column may for example be a strip 3 as illustrated in figure 8.

The ladder-shaped column comprises a plurality of openings 33 which are interspaced in longitudinal direction I by a plurality of spokes 9. The ladder-shaped column further comprises a first lateral spar 10a and a second lateral spar 10b arranged in lateral direction opposite the first lateral spar 10a. The first later spar 10a and the second lateral spar 10b delimit in lateral direction the openings 33. The spokes 9 delimit the openings 33 in longitudinal direction.

The ladder-shaped column shown in figure 8 has a tubular structure with a hollow core. Thus, a hollow core section of each spoke 9 diverts into a hollow core of the first lateral spar 10a and a hollow core of the second lateral spar 10b. Subsequently, the hollow core of the first lateral spar 10a and the hollow core of the second lateral spar 10b are fused again to form a hollow core of the next adjacent spoke 9. Figure 9 shows an excerpt of the ladder-shaped column shown in figure 8. Specifically, figure 9 illustrates selected cross-sections of the ladder-shaped column. For example, as illustrated in figure 9, the spoke 9 may be oval shaped in a crosssection parallel to the longitudinal direction I, namely in a cross-section lying in the x-y-plane. Specifically, as illustrated in figure 9, both an inner contour and an outer contour of the spoke 9 are oval shaped in the cross -section parallel to the longitudinal direction I.

In the region 12 of the spoke 9, the ladder-shaped column is also oval shaped in a cross-section orthogonal to the longitudinal direction I. Specifically, both an inner contour and an outer contour of the ladder-shaped column are oval shaped in the cross-section orthogonal to the longitudinal direction I.

Furthermore, figure 9 illustrates that the openings 33 of the ladder-shaped column define regions of the openings 11 . In these regions of the openings 1 1 , the illustrated ladder-shaped column also has an oval shape in a cross-section orthogonal to the longitudinal direction. Specifically, both the inner contour and the outer contour of the ladder-shaped column are oval shaped in the cross-section orthogonal to the longitudinal direction.

The variants illustrated in figure 9 also has an outer contour and an inner contour that is essentially devoid of edges. In the illustrated variant, the spokes 9 and the first and second lateral spars 10a, 10b smoothly transition into each other. Furthermore, the illustrated ladder-shaped column has an undulating outer contour. Specifically, in the region of the openings 1 1 , the ladder-shaped column forms bulges protruding outwardly in lateral direction, while in the regions of the spokes 12, the lateral extension of the ladder-shaped column is smaller. When viewed along the longitudinal direction, the outer contour of the first lateral spar 10a and the outer contour of the second lateral spar 10b are undulating or wave-shaped.

Figure 10 illustrates a further embodiment of the ladder-shaped column. In the illustrated variants, the ladder-shaped column is a strip 3. It also comprises a first lateral spar 10a, a second lateral spar 10b and a plurality of spokes 9.

When considering a cross-section orthogonal to the longitudinal direction I, the ladder-shaped column is H-shaped in the regions of the spokes 12. By contrast, the first lateral spar 10a and the second lateral spar 10b are essentially l-shaped in the cross-section orthogonal to the longitudinal direction. Furthermore, in the illustrated embodiment, the ladder-shaped column comprises an opening segment 13 arranged in lateral direction between a first peripheral segment 14a and a second peripheral segment 14b.

LIST OF DESIGNATIONS

I ligament clamping device

21 first ligament

22 second ligament

3 strip

31 first lateral side

32 second lateral side

33 openings

33p proximal opening

33d distal opening

41 , 42 clamping filament

43 auxiliary tensioning filament

51 ,52,53,54,55 loop

5c loop crossing

61 ,62 application aid

7 biological structure

8 fixation device

9 spoke

10a,1 Ob first and second lateral spars

I I region of the openings

12 region of the spokes

13 opening segment

14a, 14b first and second peripheral segment

Claims

PATENT CLAIMS

1 . Ladder-shaped column (3) for application in a medical clamping device for clamping of at least one biological structure in a surgical treatment of a patient, wherein a. said ladder-shaped column (3) extends in a longitudinal direction (I) and is collapsible at least in said longitudinal direction (I) when applied along with the medical clamping device to the biological structure; wherein b. said column (3) comprises at least two openings (33), each suitable to receive at least one loop-shaped filament for clamping the biological structure with respect to the ladder-shaped column (3); c. said openings (33) being arranged in the longitudinal direction of the ladder-shaped column (3) behind each other and spaced a first distance apart from each other by a spoke (9) extending in transversal direction between a first lateral spar (10a) and a second lateral spar (10b); d. said first lateral spar (10a) and said second lateral spar (10b) extending in the longitudinal direction and delimiting the at last two openings (33) in the lateral direction.

2. Ladder-shaped column (3) device according to claim 1 , wherein a. the cross-section of the spoke (9) is oval shaped in lateral and in longitudinal direction (I); and b. the cross-section of first lateral spar (10a) and the second lateral spar (10b) is oval shaped with respect to their transversal direction.

3. Ladder-shaped column (3) according to claim 2, wherein the spoke (9) and the first and the second lateral spar (10a, 10b) are smoothly transitioning into each other without forming distinct edges.

4. Ladder-shaped column (3) according to claim 1 , wherein a. the cross-section of the spoke (9) is H-shaped; b. the cross-section of the first lateral spar (10a) and the second lateral spar (10b) is l-shaped.

5. Ladder-shaped column (3) according to any one of the previous claims, wherein the lateral spars (10a, 10b) are uniformly undulated in longitudinal direction or undulated in opposite direction.

6. Ladder-shaped column (3) according to any one of the previous claims, wherein at least one spoke (9) and/or at least one lateral spar (10a, 10b) of the ladder-shaped column (3) are at least partially hollow.

7. Ladder-shaped column (3) according to any one of the previous claims, wherein the ladder-shaped column (3) is made by braiding and/or injection molding and/or 3D-printing.

8. Ladder-shaped column (3) according to any one of the previous claims, wherein the lateral extent of the ladder-shaped column (3) is greater in the region (11 ) of the openings (33) than in the region (12) of the spokes (9).

9. Ladder-shaped column (3) according to any one of the previous claims, wherein the ladder-shaped column (3) comprises a spoke (9) at the beginning and at the end.

10. Ladder-shaped column (3) according to any one of the previous claims, wherein a distance in the longitudinal direction between the center of two adjacent openings (33) is in the range of 3.5 mm to 20 mm.

11. Ladder-shaped column (3) according to any one of the previous claims, wherein each opening (33) has a perimeter from 1 .5 mm to 40 mm.

12. Ladder-shaped column (3) according to any one of the previous claims, wherein in a cross-section orthogonal to the longitudinal direction the openings are arranged in an opening segment (13) arranged in lateral direction between a first peripheral segment (14a) and a second peripheral segment (14b), wherein the first peripheral segment (14a) and the second peripheral segment (14b) each have a lateral extension from 10% to 300% relative to a lateral extension of the opening segment (13).

3. Ladder-shaped column (3) according to any one of the previous claims, wherein each opening (33) has in a longitudinal cross-section an elliptical shape with two vertices arranged opposite of each other in the longitudinal direction.