the ancillary instrument set 1 in accordance with the present invention as shown in fig1 comprises a lockable handle 2 to which are attached , on one side , a set of guide tubes 3 mounted on an extension 4 which is joined to the handle using a socket 5 with a locking screw 6 , and on the other side an aiming block 7 with parallel drill tulles 8 in a plane perpendicular to the plan defined by the axes of the handle 2 and the extension 4 and , additionally a drill tube 9 in the same plane but perpendicular to the first tubes 8 . the aiming block 7 is set on one end of a mounting arm 10 the end other of which has a square fitting 11 that is inserted in the far end 202 of the handle 2 in such a way that the mounting arm 10 has no degree of freedom with respect to the handle 2 . the square fitting 11 of the mounting arm 10 that is inserted into the socket 202 of the handle 2 is locked by a longitudinal ram 12 operated by a knurled knob 121 that is attached to a threaded shaft 122 . by rotating the knob 121 , the longitudinal ram is brought to bear on the upper face of the square fitting 11 of the mounting arm 10 with the result that the arm 10 is locked on the inside of the handle 2 . in accordance with the embodiment of the instrument set that is especially suited to ligament reconstruction by arthrotomy , the whole of the guide tube unit 3 as in fig1 a comprises two parallel bent tubes 301 , 302 the upper ends of which are welded on either side of the extension 4 . each bent tube 301 - 302 has a distal end 303 - 304 which will , after introduction through the intercondylar fossa , bear on the posterior surface of the upper end of the tibia to provide a stop for the drill 89 which drills the tibial insertion channels . preferably , the other ends of the bent tubes 301 - 302 are bevelled laterally to provide a wider exit 305 from the intercondylar fossa to facilitate the extraction of the metallic loop used to draw the ligament . it will be seen that the distal ends 303 and 304 of the guide tubes 3 are also bevelled 306 to be absolutely certain of trapping the ends 131 of the wire guide tubes 13 inserted in the drill tubes 82 and 84 ( fig1 b ) of the aiming block 7 . the ends 131 of the wire guide tubes 13 are bullet shaped , formed by swaging , which ensures that the wire guide tubes 13 engage the guide tubes 3 satisfactorily . finally , a pin 14 can be inserted through a radial hole 15 in the mounting arm 10 supporting the aiming block 7 in order to immobilize the ancillary instrument set on the tibia while the surgeon is operating , as will be described hereinafter . in accordance with one of the features of the present invention , the mounting arm 10 supporting the aiming block 7 can be removed from the handle 2 as shown in fig1 by the arrows f2 , simply by unscrewing the knurled knob 121 in the direction of arrow f1 . removing the mounting arm 10 in this way in the direction of f2 allows the aiming block 7 to be moved to the left of fig1 sliding off the wire guide tubes 13 which must remain in place in the tibial insertion tubes , as will be described hereinafter . in the same way , the aiming block 7 can be removed from the mounting arm 10 by unscrewing the screw 70 . it is then possible to rotate the aiming block 7 by 90 ° bringing the drill channel 9 ( fig1 b ) in line with the bent tubes 3 . when this is done , it is necessary to replace the set of guide tubes 3 in fig1 a which are intended for reconstruction by arthrotomy , by an assembly with a single guide tube attached to an extension of the same type as heretofore described . this single guide tube 3 will , of course , be in the median plane of the instrument set , that is exactly in line with the central tube of the aiming block , which may be the specific drill tube 9 . it should be remembered in this context that the specific drill tube 9 which has replaced the central drill tube 83 by rotation about the mounting arm 10 is particularly useful for autogenous ligament reconstruction . in fact , natural tendons or ligaments intended for posterior cruciate knee ligament reconstruction are usually of a size requiring a drill tube that is approximately twice the section . it should be noted that the embodiment of the instrument set fitted with a single guide tube intended for reconstruction using an arthroscope has been intentionally omitted from fig1 : as the diagram is simpler , it can easily be derived from the instrument shown . two examples of the typical use of the ancillary instrument set in accordance with the present invention are now given , one for ligament reconstruction under open surgery / and the other for ligament reconstruction using an arthroscope . the first example of use of the ancillary instrument set in accordance with the present invention shows , with reference to fig1 , 7 and 8 , the main stages of ligament reconstruction under open surgery . the two aforementioned guide tubes 3 are inserted through the intercondylar fossa 16 to bear against the posterior surface of the upper end of the tibia 17 ( fig2 ). it can be seen that as the guide tubes 301 , 302 are perfectly cylindrical they cause considerably less damage to the capsule and ligament structures of the posterior surface of the tibia 17 than the spatula fitted to the aforementioned known ancillary instrument . moreover , it is particularly useful that each guide tube 301 , 302 helps to open up a tubular path through the nerve - free parts of the implantation zone for the internal posterior or external posterior ligament which will settle down more readily in the tubular path as it is itself approximately circular with a resultant improvement in acceptance of the prosthetic by the fibroblasts . using this configuration , the surgeon first inserts the guide tubes 301 and 302 through the intercondylar fossa 16 and then proceeds to locate the mounting arm 10 in the distal socket 202 of handle 2 , locking it into position with the knob 121 ( fig1 ). the surgeon then attaches the aiming block 7 to the base of the mounting arm 10 using the screw 70 so that the aiming tubes 82 and 84 are in line with the distal ends 303 , 304 of the guide tubes 301 , 302 . the whole of the instrument set thus arranged within the articulation is immobilized to the bone by introducing the pin 14 into the tibia . the surgeon can then proceed to drill the channels through the bone using the drill tubes 82 and 84 , confident that the drills 89 will strike the ends 303 , 304 of the guide tubes , thus avoiding damage to the surrounding tissue . the drills 89 are then withdrawn and the surgeon can insert the two wire guide tubes 13 within the two channels through the bone until the ends 131 of the wire guide tubes 13 meet the ends 306 of the guide tubes 3 . the surgeon can then pass the metallic loops 18 through the channel thus formed . these can then be recovered at the exit 305 of the guide tubes 3 inside the intercondylar fossa 16 . all that remains to do then is to attach the prosthetic ligament traction points to the ends of these metallic loops 18 so that the posterior cruciate knee ligament can be fitted permanently using the well - known techniques . the second embodiment of the present invention is intended particularly for ligament reconstruction using an arthroscope and will now be described with reference to fig1 and 3 to 8 . the instrument set has only one guide tube 3 . the tube 3 is introduced into the femur - tibia articulation through a small incision made by the surgeon in the anterior surface of the knee in such a way that the distal end 306 of the guide tube 3 fits exactly into the intercondylar fossa 16 of the femur ( fig4 ). when the guide tube 3 is in place , the surgeon fixes the mounting arm 10 in position on the handle 2 of the instrument 1 ( fig5 ). the central drill tube 83 that is provided for this purpose in the center of the aiming block 7 allows the surgeon to locate with precision the incision point on the knee for the first tibial channel that corresponds , for example , to the external posterior cruciate knee ligament . after the drill 89 has been removed , a wire guide tube 13 is inserted as in the aforementioned variant by arthrotomy , in order to create a continuous channel through which the metallic wire 18 can be slid from the tibial entry of the channel , emerging without difficulty from the intercondylar fossa 16 , to exit finally from the articulation by the small incision made for the introduction of the guide tube 3 . the mounting arm 10 of the aiming block 7 is then removed by sliding it along the wire guide tube 13 . the mounting arm 10 is thus removed parallel to the direction of the first insertion channel . one of the lateral drill tubes 81 or 85 provided at the ends of the aiming block 7 is repositioned ( fig6 ). it will be noted that the two openings of the drill tubes 81 and 85 ( fig1 b ) are recessed on the aiming block 7 to provide the surgeon with a guide to avoid confusion between the drill tubes . in this operation , the single guide tube 3 must be moved sideways within the intercondylar fossa 16 so that the plane defined by the mounting arm 10 and the axis of the central drill tube 83 of the aiming block 7 remains parallel to its original position . the surgeon can then drill the second tibial insertion channel using the central drill tube 83 which corresponds , for example , to the internal posterior part of the prosthetic posterior cruciate knee ligament . the drill 89 is then replaced by a second straight wire guide tube 13 , allowing a second sheathed metallic wire 18 to be passed through the new continuous channel thus created . the end loop on this second wire 18 then emerges , like the first loop , through the small incision made for the introduction of the guide tube 3 . finally , the same result is obtained as for the first embodiment as shown in fig7 and 8 . of course , any embodiment of the form of the instrument set in accordance with the present invention which has the same essential characteristics is included within the present invention . for example , there can be variation in the angle between the handle 2 and the extension 4 or the curvature of the guide tubes 3 , provided that their ends 303 , 304 remain coincident with the ends 131 of the wire guide tube 13 . equally , any mechanism , apart from that which has been described , for locking the arm 10 to the handle 2 belongs to the present invention .
ancillary instruments for the reconstruction of a posterior cruciate knee ligament by drilling one or two tibial canals using a surgical operation performed from the front . the instrument set includes a system for protecting the posterior surface of the upper tibia end and an aiming device for guiding at least one drill . the protection system comprises at least one bent tube removably coupled by an extension portion to a locking handle for securing the tube through the intercondylar fossa of the femur on the posterior surface of the upper end of the tibia , so that the distal end of the bent tube serves as the stop to the drill guided by the aiming device and emerging from the tibial bone canal , and the bent tube can form , together with a rectilinear wire feed - through tube disposed in the place of the drill , a continuous canal for guiding a metallic loop used to draw the prosthetic posterior cruciate knee ligament from the anterior surface of the tibia to the femur insertion point .