U.S. patent application number 15/219443 was filed with the patent office on 2017-12-28 for reconstructive joint tunnel drilling locator.
This patent application is currently assigned to Smith & Nephew, Inc.. The applicant listed for this patent is Smith & Nephew, Inc.. Invention is credited to Graham Smith.
Application Number | 20170367715 15/219443 |
Document ID | / |
Family ID | 45937682 |
Filed Date | 2017-12-28 |
United States Patent
Application |
20170367715 |
Kind Code |
A9 |
Smith; Graham |
December 28, 2017 |
RECONSTRUCTIVE JOINT TUNNEL DRILLING LOCATOR
Abstract
An acromioclavicular joint guide for forming multiple drill
tunnels spaced apart by a predetermined distance employs two drill
guides in a pivoting arrangement allowing one drill guide to pivot
around the axis of the other. The drill guides are each disposed in
a respective sleeve of a pivot block for insertion toward the
surgical member along nonintersecting axes defined by the sleeve.
An elongated arm attaches to the pivot block at a proximate end and
has a aimer point at a distal end, in which the arm may extend
around the surgical member via an inverted portion or bend such
that that aimer point is on the insertion axis of the primary drill
guide. In this manner the aimer point locates an exit of the hole
from the insertion point defined by the primary drill guide, and
the pivotal drill guide defines a second tunnel at the
predetermined distance.
Inventors: |
Smith; Graham; (Newburyport,
MA) |
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Applicant: |
Name |
City |
State |
Country |
Type |
Smith & Nephew, Inc. |
Memphis |
TN |
US |
|
|
Assignee: |
Smith & Nephew, Inc.
Memphis
TN
|
Prior
Publication: |
|
Document Identifier |
Publication Date |
|
US 20160331387 A1 |
November 17, 2016 |
|
|
Family ID: |
45937682 |
Appl. No.: |
15/219443 |
Filed: |
July 26, 2016 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
13076766 |
Mar 31, 2011 |
9468449 |
|
|
15219443 |
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60419054 |
Oct 16, 2002 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2017/00407
20130101; A61B 17/1778 20161101; A61B 17/1739 20130101; A61B
17/1714 20130101; A61F 2/08 20130101 |
International
Class: |
A61B 17/17 20060101
A61B017/17; A61F 2/08 20060101 A61F002/08 |
Claims
1. A method for locating insertion sites for surgical joint repair
of a surgical joint member comprising: providing a surgical aiming
devices for compressing a surgical member between a primary
insertion member and an aimer point for disposing an insertion wire
along an primary insertion axis defined by the insertion member,
the aimer point coupled to the insertion member by an inverted,
elongated arm; disposing the aimer point at a target location on
the surgical member coaxial with the primary insertion member;
locating a primary insertion point by disposing the primary
insertion member on an opposed side of the surgical member;
advancing the primary insertion member to the surgical site via a
pivot block having a primary sleeve, the primary sleeve defining a
primary insertion axis through a primary aperture in the pivot
block, the primary insertion member slideably engaging the primary
sleeve for ratcheting movement along the primary insertion axis;
locating a second insertion point by rotating the pivot block
around the primary insertion axis, the pivot block further
comprising: a secondary sleeve in the pivot block, the second
sleeve defining a secondary insertion axis through a pivoting
aperture in the pivot block, the secondary sleeve in pivotal
communication with the primary sleeve via the pivot block; and a
pivoting insertion member, the secondary sleeve receptive to the
pivoting insertion member for ratcheting movement along the
secondary insertion axis, the pivot block maintaining a
predetermined distance between the primary and secondary sleeves
and orienting the primary insertion axis and secondary insertion
axis on nonintersecting paths; advancing the second insertion
member to contact a second insertion site on the surgical member;
and compressing the surgical member by ratcheting at least one of
the first and second insertion members to compress the surgical
member between the insertion members and the aimer point.
2. The method of claim 1 wherein the aimer point is disposed at a
distal end of an elongated arm having a proximate end extending
from the pivot block away from the primary axis, and a distal end
extending toward the primary axis, the proximate end and distal
ends coupled by a bend, the distal end terminating in the aimer
point on the primary insertion axis disposed on an intersecting
path with the primary insertion member.
3. The method of claim 2 where in the primary insertion member is
configured for directing a drilling wire into a primary insertion
location of a surgical site.
4. The method of claim 2 wherein the secondary sleeve is adaptive
to pivot around the primary insertion axis for pivotally disposing
the pivoting insertion member around the primary insertion axis at
the predetermined distance for locating the second insertion
point.
5. The method of claim 4 further comprising directing a drilling
wire at a secondary insertion location at the predetermined
distance from the primary insertion location to dispose the second
sleeve in alignment with the second insertion point.
6. The method of claim 1 wherein locating the primary insertion
member further comprises disposing, via a slot in the pivot block
for receiving the proximate end of the elongated arm, the aimer
point to the opposed side of the surgical member, wherein the
proximate end has an arcuate contour adapted for slideable movement
along the slot in the pivot block, the aimer point maintaining
alignment on the primary insertion axis through a range of the
slideable movement.
7. The method of claim 1 wherein advancing the primary insertion
member includes advancing such that the primary insertion member is
disposed via the fixed aperture and travels an intersecting path
with the aimer point, the aimer point configured for compressing a
surgical member between the primary insertion member and the aimer
point for fixing the primary insertion member on a path toward the
aimer point for surgical entry defined by the primary insertion
axis.
Description
CROSS REFERENCE TO RELATED APPLICATION
[0001] This application is a divisional of U.S. patent application
Ser. No. 13/076,766 filed Mar. 31, 2011 entitled RECONSTRUCTIVE
JOINT TUNNEL DRILLING LOCATOR, the contents of which are
incorporated by reference herein in their entirety for all
purposes.
BACKGROUND
[0002] Reconstructive bone and ligament surgery often involves
drilling bone tunnel into skeletal members to attach connective
elements such as ligament and tendon grafts, as well as various
artificial replacements and/or attachments for articulated joints.
In particular, reconstructive surgery of the shoulder joint often
involves reduction and drilling of the
Acromioclavicular/Coracoclavicular (AC/CC) joint. Such drilling is
typically facilitated by a guide for disposing an insertion wire or
drilling member to an insertion location on a surgical member.
Careful placement and subsequent drilling ensures maximum joint
mobility from the resulting reconstruction.
SUMMARY
[0003] Reconstructive surgery for flexible joints such as arm and
leg joints often involves surgical attachments that are subject to
substantial force due to the pivotal movement these joints provide.
Connective tissue or a suitable replacement attaches to a surgical
member such as an arm or leg bone. Reconstructive surgery involving
functional, structural fixation to bone members often involves
drilling into a structurally sound area of the corresponding bone.
Typically this involves drilling tunnels into the bone for
providing a passage or attachment of a ligament. In the case of an
acromioclavicular (shoulder) joint repair, the proposed approach
employs a reconstructive joint tunnel drilling locator, or
acromioclavicular joint guide, to facilitate compression of a joint
and drilling of two holes for repairs and/or rebuilding of the
acromioclavicular (AC) and/or coracoclavicular (CC) joint. When the
AC/CC joint is ruptured, particular repair techniques require a
graft to be passed under the coracoid and form a sling whose ends
are anchored in the clavicle. Further, it is desirable to install a
suture anchor in the coracoid tied to the clavicle to take the load
off the graft during initial healing.
[0004] The guide includes two ratcheting sleeves, a central sleeve
and a second sleeve pivoting around the axis of the first to allow
a second hole to be drilled offset from the first at a known or
predetermined distance. The guide includes an aimer arm to provide
a target for the first hole and allow compression of the joint, or
surgical member being drilled. The sleeves each define an insertion
member such as a drill guide for advancement to the entry location
of the respective drilling sites. The aimer arm is disposable at an
opposed side of a joint from the drilling sites, and is securable
for positioning the insertion members for a guidewire or other
drilling member. The first member is fixable at a primary location
for drilling, and the second member is positionable by rotating the
second insertion member about the axis defined by the first
insertion member to locate a second drilling site at the
predetermined distance and optimal location from the primary
location, for drilling a substantially parallel (non-intersecting)
tunnel, thus obviating the need for separate right and left or
other permutations of a drilling guide.
[0005] Configurations herein are based, in part, on the observation
that repairs and/or rebuilding of the acromioclavicular (AC) and/or
coracoclavicular (CC) joint may require a graft to be passed under
the coracoid and form a sling whose ends are anchored in the
clavicle. Further, it is desirable to install a suture anchor in
the coracoid tied to the clavicle to take the load off the graft
during initial healing. Unfortunately, conventional approaches
suffer from the shortcoming that the available guides provide for
placement of only a single hole and further require a right and
left guide depending on the operative side.
[0006] Configuration herein substantially overcome the above
described shortcomings by providing a reconstructive joint tunnel
locator in the form of an acromioclavicular joint guide for
drilling two holes (tunnels) spaced apart by a predetermined
distance, and by orienting the drill guides in a pivoting
arrangement allowing one drill guide to pivot around the axis of
the other at a predetermined distance for locating the second drill
hole at the predetermined distance on either the right or left side
of a surgical patient.
[0007] In an example configuration discussed further below, the
acromioclavicular joint guide includes a tunnel locating device for
compressing a surgical member between an insertion member and an
aimer point to permit an operator, such as a surgeon, to dispose an
insertion wire along an axis defined by the insertion member. The
device includes a plurality of insertion members including a
primary insertion member and moveable, or pivoting, insertion
members, such that the pivoting insertion members are disposed at a
predetermined distance around a primary insertion axis defined by
the primary insertion member.
[0008] In the example arrangement, two tunnels are employed
corresponding to a primary insertion member and a pivoting, or
secondary insertion member. A pivot block has a plurality of
apertures forming sleeves in the pivot block for accommodating each
of the insertion members, such that each of the sleeves defines an
insertion axis for a respective insertion member of the plurality
of the insertion members. The insertion members are each disposed
in a respective sleeve of the pivot block for insertion toward the
surgical member along nonintersecting axes defined by the sleeve,
such that the insertion members following generally parallel paths
into the surgical member (i.e. bone). An elongated arm attaches to
the pivot block at a proximate portion or end and has a aimer point
at a distal portion or end, in which the elongated arm may extend
around the surgical member via an inverted portion or bend such
that the aimer point is on the insertion axis of the primary
insertion member. In this manner, the aimer point locates an exit
of the hole from the insertion point defined by the primary
insertion member, and the pivoting insertion member defines a
second tunnel located at the predetermined distance from the
primary tunnel.
BRIEF DESCRIPTION OF THE DRAWINGS
[0009] The foregoing and other objects, features and advantages of
the invention will be apparent from the following description of
the particular embodiments of the invention, as illustrated in the
accompanying drawings in which the reference characters refer to
the same parts throughout the different views. The drawings are not
necessarily to scale, emphasis instead being placed upon
illustrating the principles of the invention.
[0010] FIG. 1 shows a perspective view of the tunnel drilling
locator;
[0011] FIGS. 2-3 show a flowchart of tunnel locating using the
tunnel drilling locator of FIG. 1 for use with an insertion
wire;
[0012] FIG. 4 shows a perspective downward view of the tunnel
drilling locator of FIG. 1;
[0013] FIG. 5 shows a perspective upward view of the tunnel
drilling locator of FIG. 1; and
[0014] FIG. 6 shows a top perspective angle view of the tunnel
drilling locator.
DETAILED DESCRIPTION
[0015] Disclosed below is an example configuration and deployment
of the AC/CC tunnel drilling locator. The tunnel drilling locator
operates as a guide for facilitating tunnel placement by an
operator of the guide, typically a surgeon. A surgical member such
as a patient bone structure is employed as an example in
reconstructive procedure of an AC/CC joint. Other surgical members
involving other joints may also benefit from application of the
disclosed guide. The example below depicts a particular
configuration and usage of the guide; other arrangements and
usages, such as those involving additional tunnels, may be apparent
to those of skill in the art.
[0016] FIG. 1 shows a perspective view of the tunnel drilling
locator 100. Referring to FIG. 1, the tunnel drilling locator 100
includes a primary insertion member 110 and a secondary insertion
member 120 disposed in sleeves 112, 122 (respectively) through
apertures 114, 124 in pivot block 130. The apertures 114, 124 form
sleeves 112, 122 for insertion of the insertion members 110, 120
and adapted for ratcheting movement through the sleeves 112, 122
via ratcheting teeth 116, 126 in the insertion members 110, 120.
Each of the insertion members 110, 120 is adapted for ratcheting
movement along a primary insertion axis 150 and a secondary
insertion axis 152, respectively. An engaging tip 154, 156 on each
insertion member 110, 120 (also referred to as a "bullet") fixes
the insertion member 110, 120 to surgical members upon sufficient
insertion and compression, discussed further below. A knob 118, 128
on each of the insertion members permits insertion force and
rotational force for disengaging the teeth and releasing the
ratchet.
[0017] An elongated arm 140 attaches the pivot block 130 for
permitting rotational communication around the primary insertion
axis 150, allowing the secondary (moveable, or pivoting) insertion
member 120 to rotate or pivot around the primary insertion axis 110
at a predetermined distance 160 determined by the sleeves 112, 122
in the pivot block 130, as shown by arrows 132. The pivot block 130
therefore allows the moveable insertion member to pivot around the
primary insertion member 110 to accommodate right or left shoulder
positioning while maintaining the fixed distance 160 between the
insertion members 110, 120 for optimal drilling placement of
tunnels. In a particular configuration, also shown in greater
details in FIG. 4, the pivot block 130 may be adapted to slide off
the proximate end 142' of the arm for reverse installation on the
opposed side 142'' of the proximate end 142 at the tip 147 for
pivoting from the opposed side 142''.
[0018] The elongated arm 140 includes a proximate end 142 and a
distal end 144 coupled by a bend 146. The bend 146 allows the
proximate end 142 to extend around the surgical member and inverts
the arm 140 such that that distal end 144 terminates in an
insertion point 148, referring to the flat area proximal and
perpendicular to the tip. aligned with the insertion axis 150 such
that the primary insertion member 110, when disposed through the
sleeve 112 via ratcheting teeth 126, compresses the surgical
members between the aimer point 148 and the engaging tip 154 of the
primary insertion member 110 for defining a point of insertion for
an insertion wire or other drilling tool. Subsequent to fixing the
primary insertion point, the pivoting insertion member 120 may
pivot for defining a secondary insertion point allowing optimal
hole position in a surgical member, (e.g. a clavicle of a surgical
patient) defined by advancement of the moveable insertion member
120 at the predetermined distance 160 on the surgical member to
dispose the engaging tip 156 of the pivoting insertion member
120.
[0019] FIGS. 2-3 show a flowchart of tunnel locating using the
tunnel drilling locator 100. One particular use of the drill guide
devices is for an acromioclavicular joint report for drilling two
holes (tunnels) spaced apart by a predetermined distance. The
method for locating insertion sites for surgical joint repair of a
surgical joint member such as the
acromioclavicular/coracoclavicular joint as performed by an
operator (surgeon) includes, at step 200, providing a surgical
aiming device 100 for compressing a surgical member between primary
insertion member 110 and an aimer point 148. The insertion member
110 is typically a drill guide or other elongated structure having
a bore for delivering an insertion wire. The aimer point 148
locates an exit point for disposing an insertion wire 170 (FIG. 4)
along the primary insertion axis 150 defined by the insertion
member 110, such that the aimer point 148 is coupled to the primary
insertion member 110 by an inverted, elongated arm 140 coupling the
aimer point 148 to the insertion members 110, 120 around opposed
sides of a surgical member.
[0020] The operator disposes the aimer point 148 at a target
location on the surgical member coaxial with the primary insertion
member 110, as depicted at step 201. The aimer point 148 is
disposed at a distal end of an elongated arm 140 having a proximate
end 142 extending from the pivot block 130 away from the primary
axis 150, and a distal end 144 extending toward the primary axis
150, the proximate end 142 and distal end coupled by a bend 146, in
which the distal end 144 terminates in the aimer point 148 which is
located on the primary insertion axis 150 disposed on an
intersecting path with the primary insertion member 110, as
disclosed at step 202.
[0021] The operator locates a primary insertion point by disposing
the primary insertion member 110 and engaging tip 154 on an opposed
side of the surgical member, as depicted at step 203. Once the
aimer point 148 is located (set) at the drilling terminus and
affixed by the pointed end, the primary insertion member 110 allows
the operator to locate the start of the tunnel for drilling. The
primary insertion member is configured for directing the drilling
wire 170 into a primary insertion location of a surgical site, as
shown at step 204. Locating the primary insertion member 110 may
also include disposing, via a slot 180 in the pivot block 130 for
receiving the proximate end 142 of the elongated arm 140, the aimer
point 140 on the opposed side of the surgical member, as depicted
at step 205, to change the angle of the distal end 144. The
proximate end 142 has an arcuate contour adapted for slideable
movement along the slot 180 in the pivot block 130, while the aimer
point 148 maintains alignment on the primary insertion axis 150
through a range of the slideable movement. Such slideable movement
allows optimal placement of the insertion member 150 and the aimer
point 148 on opposed sides of the surgical member.
[0022] The operator begins advancing the primary insertion member
110 to the surgical site via the pivot block 130 having a primary
sleeve 112, such that the primary sleeve 112 defines the primary
insertion axis 150 through a primary aperture 114 in the pivot
block 130, as disclosed at step 206. The primary insertion member
150 slideably engages the primary sleeve 112 for ratcheting
movement along the primary insertion axis 150 via ratcheting teeth
126 on the primary insertion member 110. Advancing the primary
insertion member 110 includes advancing such that the primary
insertion member 110 is disposed via the fixed (non-pivoting)
aperture 114 and travels an intersecting path with the aimer point
148, in which the aimer point 148 is configured for compressing a
surgical member between the primary insertion member 110 and the
aimer point 148 for fixing the primary insertion member 110 on a
path toward the aimer point 148 for surgical entry defined by the
primary insertion axis 150, as depicted at step 207.
[0023] Once the location of the primary tunnel is identified, the
pivot block 130 is employed to identify second tunnel at a
predetermined distance around the primary tunnel. The operator
locates a second insertion point by rotating the pivot block 130
around the primary insertion axis 100, as depicted at step 208. To
locate the tunnel, the pivot block 130 includes a secondary sleeve
122 in the pivot block 130, such that the secondary sleeve 122
defines a secondary insertion axis 152 through the pivoting
aperture 124 in the pivot block 130, in which the secondary sleeve
122 is in pivotal communication with the primary sleeve 112 via the
pivot block 130, as shown at step 209. The secondary sleeve 122 is
adapted to pivot around the primary insertion axis 150 for
pivotally disposing the pivoting insertion member 120 around the
primary insertion axis 150 at the predetermined distance 160 for
locating the second insertion point with engaging tip 156, as
depicted at step 210. The operator disposes the pivoting insertion
member 120, in which the secondary sleeve 122 is receptive to the
pivoting insertion ember 120 for ratcheting movement along the
secondary insertion axis 152, as disclosed at step 211. The pivot
block 130 maintains a predetermined distance 160 between the
primary 112 and secondary sleeves 122 and orients the primary
insertion axis 150 and secondary insertion axis 152 on
nonintersecting paths for forming parallel tunnels, as depicted at
step 211.
[0024] The operator advances the second insertion member 120 to
contact a second insertion site on the surgical member with the
engaging tip 156, as disclosed at step 212, and compresses the
surgical member by ratcheting at least one of the first and second
insertion members 110, 120 to compress the surgical member between
the insertion members and the aimer point 148, as depicted at step
213. As the primary insertion member is typically located first,
the primary insertion member 110 and the aimer point 148 compress
the surgical member uniformly due to axial alignment on the primary
insertion axis 150. The secondary insertion member 120 is then
positioned by rotating, or pivoting of the pivot block 130. Once
both insertion members 110, 120 are fixed, the operator directs a
drilling wire 170 via the primary insertion member 110, and at the
secondary insertion location at the predetermined distance 160 from
the primary insertion location to dispose the second sleeve in
alignment with the second insertion point, as depicted at step
214.
[0025] FIG. 4 shows a perspective downward view of the tunnel
drilling locator for FIG. 1. Referring to FIGS. 1 and 4, an
insertion wire 170, 172 is insertable through the insertion members
110, 120 respectively, for drilling the primary and secondary
tunnels. Pivotal movement 132 of the pivoting insertion member 120
is along a side 142' of the proximate end 142 of the elongated arms
140, or the pivot block 130 may be disposed along the arm to a tip
147 for pivoting along the opposed side 142'' or for removal and
reinstallation of the pivot block 130.
[0026] FIG. 5 shows a perspective upward view of the tunnel
drilling locator of FIG. 1. Referring to FIGS. 1 and 5, a knob 130
secures the pivot block 130 to the proximate end 142 via a threaded
screw or other suitable mechanism. Exit apertures 114' and 124'
defined the exit points of the sleeves 112, 122 corresponding to
apertures 114 and 124, respectively.
[0027] FIG. 6 shows a top perspective angle view of the tunnel
drilling locator. Referring to FIGS. 1, 4 and 6, the pivot block
130 includes a slideable portion 133 and a rotating portion 135.
The slideable portion 133 includes the slot 180 responsive to the
proximate end 142 of the elongated arm 140 for arcuate, sliding
movement thereto. A fixing knob 186 turns a screw for fixing the
pivot block on the arm 140. The rotating portion 135 couples to the
slideable portion 133 by a top bracket 188 and a bottom bracket 190
secured in rotational communication by the primary insertion member
110 passing through hinge apertures 192 in the top and bottom
brackets 188, 190. A guide slot 194 in the bottom bracket 190
defines the pivoting (rotational) movement range 132. In this
manner, the secondary insertion member 120 is permitted pivotal
movement around the primary insertion member 110 while both are
afforded slideable movement along the proximate end 142 relative to
the aimer tip 148.
[0028] While this invention has been particular shown and described
with references to preferred embodiments thereof, it will be
understood by those skilled in the art that various changes in form
and details may be mad therein without departing from the spirit
and scope of the present application as defined by the appended
claims. Such variations are intended to be covered by the scope of
this present application. As such, the foregoing description of
embodiments of the present application is not intended to be
limiting, the full scope rather being conveyed by the appended
claims.
* * * * *