U.S. patent application number 17/132474 was filed with the patent office on 2021-06-17 for device and method for allografting.
This patent application is currently assigned to The Curators of the University of Missouri. The applicant listed for this patent is James L. Cook, Ferris M. Pfeiffer, James P. Stannard. Invention is credited to James L. Cook, Ferris M. Pfeiffer, James P. Stannard.
Application Number | 20210177435 17/132474 |
Document ID | / |
Family ID | 1000005429806 |
Filed Date | 2021-06-17 |
United States Patent
Application |
20210177435 |
Kind Code |
A1 |
Pfeiffer; Ferris M. ; et
al. |
June 17, 2021 |
DEVICE AND METHOD FOR ALLOGRAFTING
Abstract
In one embodiment, a cutting guide is disclosed for use in a
surgical procedure to removed damaged tissue from a patient and
form a recipient site configured and dimensioned to receive a donor
graft. The cutting guide includes a first aim that abuts a section
of the damaged tissue to be removed, and a second arm including a
hole and a slot that receives a cutting implement, the first arm
and the slot defining a distance therebetween corresponding to a
desired dimension of the recipient site. In another embodiment, a
cutting guide is disclosed for use in forming a donor graft from
donor tissue. The cutting guide includes a body that receives the
donor tissue, and a shaping member that is rotatably secured to the
body. The shaping member includes at least one vane that shapes the
donor tissue so as to form the donor graft.
Inventors: |
Pfeiffer; Ferris M.;
(Columbia, MO) ; Cook; James L.; (Columbia,
MO) ; Stannard; James P.; (Columbia, MO) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Pfeiffer; Ferris M.
Cook; James L.
Stannard; James P. |
Columbia
Columbia
Columbia |
MO
MO
MO |
US
US
US |
|
|
Assignee: |
The Curators of the University of
Missouri
Columbia
MO
|
Family ID: |
1000005429806 |
Appl. No.: |
17/132474 |
Filed: |
December 23, 2020 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
15124647 |
Sep 8, 2016 |
10905437 |
|
|
PCT/US2015/020168 |
Mar 12, 2015 |
|
|
|
17132474 |
|
|
|
|
61967257 |
Mar 13, 2014 |
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/157 20130101;
A61B 17/56 20130101; A61F 2/4644 20130101 |
International
Class: |
A61B 17/15 20060101
A61B017/15; A61B 17/56 20060101 A61B017/56; A61F 2/46 20060101
A61F002/46 |
Claims
1. A cutting guide for use in a surgical procedure to remove
damaged tissue from a patient and form a recipient site configured
and dimensioned to receive a donor graft, the cutting guide
comprising: a first arm configured and dimensioned for abutment
with a section of the damaged tissue to be removed; and a second
arm connected to the first arm, the second arm including at least
one slot configured and dimensioned to receive a first cutting
implement, and at least one hole, the first arm and the at least
one slot defining a distance therebetween corresponding to a
desired dimension of the recipient site.
2. The cutting guide of claim 1, wherein the first arm and the
second arm subtend an angle approximately equal to 90.degree..
3. The cutting guide of claim 1, wherein the at least one hole
includes a first hole positioned adjacent an end of the at least
one slot, the first hole defining a periphery and being configured
and dimensioned to receive a second cutting implement.
4. The cutting guide of claim 3, wherein a portion of the periphery
defined by the first hole is positioned below the at least one
slot.
5. The cutting guide of claim 4, wherein a portion of the periphery
defined by the first hole is positioned above the at least one
slot.
6. The cutting guide of claim 5, wherein the at least one slot and
the first hole are oriented such that a central axis defined by the
at least one slot bisects the first hole.
7. The cutting guide of claim 3, wherein the at least one hole
further includes a second hole configured and dimensioned to
receive a fixation member to secure the cutting guide in relation
to the damaged tissue.
8. The cutting guide of claim 1, wherein the at least one slot is
linear in configuration.
9. The cutting guide of claim 1, wherein the at least one slot
includes a first slot and a second slot, the first arm and the
first slot defining a first distance therebetween, and the first
arm and the second slot defining a second distance therebetween
greater than the first distance.
10.-50. (canceled)
Description
RELATED APPLICATION
[0001] This application claims the benefit of, and priority to,
U.S. Provisional Patent Application Ser. No. 61/967,257, entitled
"Device and Method for Tibial Plateau Allografting," filed Mar. 13,
2014, the entire content of which is hereby incorporated by
reference.
BACKGROUND
1. Field
[0002] The present disclosure relates to apparatus, systems, and
methods for use in tissue grafting procedures, e.g., allografting
procedures. For example, the present disclosure relates to
apparatus, methods, and systems for use in tibial plateau
allografting procedures.
2. Discussion
[0003] Few options are available for long term treatment of tibial
plateau articular cartilage and/or meniscal injuries, e.g., in
young patients, which due to trauma or degeneration, render the
joint painful, insufficient, and beyond the ability of native
tissue repair techniques. Current standard of care allograft and/or
autograft cartilage transplantation techniques are sometimes
inappropriate or unable to address tibial plateau cartilage
defects, e.g., due to limitations of surgical exposure and current
grafting techniques. Additionally, meniscus positioning and
attachment to the tibia limits surgical options without disruption
of the meniscus. Moreover, during meniscal transplantation, it is
often difficult to establish an effective meniscus-bone interface
with properties sufficient to withstand physiological loading due
to the complex biologic and biomechanical nature of the
interface.
[0004] As such, a need remains for apparatus, systems, and methods
that aid in the graft implantation process, and have sufficient
healing and functional performance to be utilized in a wide range
of patients with joint pathology.
SUMMARY
[0005] In one aspect of the present disclosure, an allograft tibial
plateau implant system is described, as well as corresponding
methods of use, that utilize a tongue-and-groove interlocking
mechanism. More specifically, the disclosed system and methods
create and use an allograft tibial plateau implant with a bulging
outward-curved ledge (tongue member) that is received by an implant
recipient site prepared with a matching inward-curved
groove/channel (groove member). This "tongue-and-groove"
interlocking system and method may be utilized in a wide range of
patients with joint pathology to enhance healing and functional
performance.
[0006] In another aspect of the present disclosure, a recipient
site cutting guide for preparing a recipient site in tissue is
described. The recipient site cutting guide comprises a
height-determination (H-G) arm and a blade arm with a cutting slot,
one or more guide holes, and one or more fixation holes. In one
embodiment, the height-determination (H-G) arm and the blade arm
are arranged so as to define an "L" shape. The configurations,
dimensions, and orientations of the cutting slot, the guide
hole(s), and the fixation hole(s) may be altered or varied such
that the recipient site may be created according to any desired
specifications, e.g., such that the recipient site and the
groove/channel define a particular length, height, and/or
width.
[0007] In certain embodiments, the cutting slot may be configured
as an elongate cavity running horizontally, e.g., more than
half-way, across the blade arm in parallel relation to the
height-determination (H-G) arm.
[0008] In certain embodiments, the guide hole(s) may be located
near an end of the cutting slot, and a bottom curve/edge of the
guide hole(s) may be set lower than the cutting slot.
[0009] In certain embodiments, the fixation hole(s) may be located
below the cutting slot (on an opposite side of the
height-determination (H-G) arm).
[0010] During use of the recipient site cutting guide, the
height-determination (H-G) arm is placed on a surface of a
patient's articular cartilage such that the distance between the
height-determination (H-G) arm and the cutting slot on the blade
arm determines the height of recipient site to receive a harvested
allograft implant.
[0011] Multiple cutting guides defining varying distances between
the height-determination (H-G) arm and the cutting slot may be
employed to create recipient sites of varying heights to
accommodate different grafting requirements.
[0012] In another aspect of the present disclosure, a method of
preparing a recipient site, e.g., a patient's tibial plateau, for
receipt of an allograft is disclosed (which may comprise bone and
articular cartilage), with or without attached meniscus. The method
includes: i) selecting a recipient site cutting guide with a
desired distance being defined between a height-determination (H-G)
arm and a cutting slot, ii) placing the height-determination (H-G)
arm on a surface of the patient's articular cartilage, iii)
securing the recipient site cutting guide by temporary fixation
methods via one or more fixation holes; iv) making a shelf locating
cut from anterior to posterior in a central aspect of the recipient
bone; and v) cutting along the cutting slot to detach a portion of
the recipient bone to be removed.
[0013] In another aspect of the invention, a method for preparing
an allograft recipient site, e.g., a patient's tibial plateua, is
described. The method includes: i) selecting a recipient site
cutting guide comprising a H-G arm and a blade arm, which further
comprises a cutting slot, one or more guide holes with a slot or
other such opening, and one or more fixation holes, so that the
height between the H-G arm and the cutting slot is compatible with
the allograft to be implanted, ii) placing the H-G arm of the
cutting guide on a surface of the patient's articular cartilage,
iii) securing the cutting guide by temporary fixation methods via
the fixation hole(s), iv) creating a channel from anterior to
posterior by drilling (or forming a channel) through the guide
hole(s), and v) removing a portion of the native tibial plateau by
cutting along the cutting slot.
[0014] In another aspect of the present disclosure, a donor cutting
guide is disclosed that is used to create an allograft implant
(which may comprise bone and articular cartilage), with or without
an attached meniscus, having a desired thickness and a bulging
outward-curved ledge (tongue member) that is configured and
dimensioned for positioning within the groove/channel (groove
member) created at the recipient site through use of the recipient
site cutting guide.
[0015] In another aspect of the disclosure, a cutting guide is
disclosed for use in a surgical procedure to removed damaged tissue
from a patient and form a recipient site configured and dimensioned
to receive a donor graft. The cutting guide includes a first arm
configured and dimensioned for abutment with a section of the
damages tissue to be removed, and a second aim connected to the
first arm.
[0016] The second arm includes at least one slot that is configured
and dimensioned to receive a first cutting implement, as well as at
least one hole. The first arm and the at least one slot define a
distance therebetween corresponding to a desired dimension of the
recipient site, e.g., the height of the recipient site.
[0017] In certain embodiments, the first arm and the second arm may
subtend an angle approximately equal to 90.degree..
[0018] The at least one hole includes a first hole that is
configured and dimensioned to receive a second cutting implement.
The first hole defines a periphery, and is positioned adjacent an
end of the at least one slot.
[0019] In certain embodiments, a portion of the periphery defined
by the first hole may be positioned below the at least one slot.
Additionally, or alternatively, a portion of the periphery defined
by the first hole may be positioned above the at least one
slot.
[0020] In certain embodiments, the at least one slot and the first
hole may be oriented such that a central axis defined by the at
least one slot bisects the first hole.
[0021] In certain embodiments, the at least one hole may further
include a second hole that is configured and dimensioned to receive
a fixation member to secure the cutting guide in relation to the
damaged tissue.
[0022] In certain embodiments, the at least one slot may be linear
in configuration.
[0023] In certain embodiments, the at least one slot may include a
first slot and a second slot. In such embodiments, the first arm
and the first slot define a first distance therebetween, and the
first arm and the second slot define a second distance therebetween
greater than the first distance.
[0024] In another aspect of the disclosure, a surgical cutting
guide is disclosed for use in forming a donor graft from donor
tissue. The cutting guide includes a body defining a channel
extending along a first axis that is configured and dimensioned to
receive the donor tissue, and a shaping member that is secured to
the body such that the shaping member is rotatable in relation to
the body about a second axis.
[0025] The body of the cutting guide defines an upper shelf and a
lower shelf positioned on opposite sides of the shaping member.
[0026] The shaping member includes at least one vane having a
linear portion and a non-linear portion, and extends into the
channel such that as the donor tissue is advanced through the
channel, the at least one vane shapes the donor tissue so as to
form the donor graft.
[0027] In certain embodiments, the shaping member may be secured to
the body of the cutting guide such that the second axis is
transverse, e.g., orthogonal, in relation to the first axis.
[0028] The linear portion and the non-linear portion of the at
least one vane are configured and dimensioned such that the donor
graft defines a planar section and a tongue member positioned
adjacent the planar section such that the tongue member extends
outwardly in relation to the planar section.
[0029] In certain embodiments, the non-linear portion of the at
least one vane may define at least one recess.
[0030] The cutting guide further includes a sled movable in
relation to the body of the cutting guide to facilitate movement of
the donor tissue through the channel.
[0031] In certain embodiments, the sled may include a textured
surface to increase friction between the sled and the donor tissue
during movement of the donor tissue through the channel.
[0032] In another aspect of the disclosure, a surgical system is
disclosed for use in: (i) forming a donor graft from donor tissue;
and (ii) removing damaged tissue from a patient to form a recipient
site configured and dimensioned to receive the donor graft. The
system includes a first cutting guide configured and dimensioned to
form the donor graft from the donor tissue, and a second cutting
guide configured and dimensioned to facilitate formation of the
recipient site.
[0033] The first cutting guide includes a body defining a channel
that is configured and dimensioned to receive the donor tissue, and
a shaping member that is secured to the body such that the shaping
member is rotatable in relation to the body.
[0034] The shaping member includes at least one vane having a
linear portion and a non-linear portion, and extends into the
channel whereby as the donor tissue is advanced through the
channel, the at least one vane shapes the donor tissue to form the
donor graft to include a planar section and a tongue member that
extends outwardly in relation to the planar section.
[0035] The second cutting guide includes a first aim that is
configured and dimensioned for abutment with a section of the
damaged tissue to be removed, and a second arm that is connected to
the first arm. The second arm includes at least one slot that is
configured and dimensioned to receive a first cutting implement so
as to define a planar surface at the recipient tissue corresponding
in configuration and dimensions to the planar section of the donor
graft. The second arm also includes at least one hole that is
configured and dimensioned to receive a second cutting implement so
as to define a channel at the recipient site configured and
dimensioned to receive the tongue member of the donor graft such
that the recipient site receives the donor graft in an interlocking
fashion.
[0036] In certain embodiments, the first arm and the second arm may
subtend an angle of approximately 90.degree..
[0037] The at least one hole includes a first hole defining a
periphery that is positioned adjacent an end of the at least one
slot.
[0038] In certain embodiments, a portion of the periphery defined
by the first hole is positioned below the at least one slot.
[0039] In certain embodiments, the at least one hole includes a
second hole configured and dimensioned to receive a fixation member
to secure the second cutting guide in relation to the damaged
tissue.
[0040] The channel defined by the body of the first cutting guide
extends along a first axis, and the shaping member is rotatable in
relation to the body of the first cutting guide about a second
axis. In certain embodiments, the shaping member may be secured to
the body of the first cutting guide such that the second axis is
transverse, e.g., orthogonal, in relation to the first axis.
[0041] The linear portion of the at least one vane is configured
and dimensioned to shape the planar section of the donor graft, and
the non-linear portion of the at least one vane is configured and
dimensioned to shape the tongue member of the donor graft.
[0042] In certain embodiments, the non-linear portion of the at
least one vane may define at least one recess.
[0043] In certain embodiments, the at least one recess may be
curvate in configuration.
[0044] In another aspect of the disclosure, a method of performing
a surgical procedure is disclosed that includes inserting donor
tissue into a donor cutting guide, which may include bone and
cartilage, as well as an attached meniscus, and advancing the donor
tissue into contact with a shaping member rotatably secured to a
body of the donor cutting guide such that a vane of the shaping
member shapes the donor tissue into a donor graft including a
planar section and a tongue member that extends outwardly in
relation to the planar section.
[0045] In certain embodiments, the method may further include
harvesting the donor tissue from a donor site.
[0046] In certain embodiments, harvesting the donor tissue may
include harvesting the donor tissue with an attached meniscus.
[0047] Inserting the donor tissue into the donor cutting guide
includes positioning the donor tissue within a channel defined by
the body of the donor cutting guide, and more specifically, on a
lower shelf defined by the body of the donor cutting guide.
[0048] The disclosed method further includes advancing the donor
tissue beyond the shaping member such that the donor tissue is
positioned on an upper shelf defined by the body of the donor
cutting guide after shaping into the donor graft.
[0049] Advancing the donor tissue includes repositioning a sled in
contact with the donor tissue to thereby reposition the donor
tissue.
[0050] Advancing the donor tissue into contact with the shaping
member includes shaping a first portion of the donor tissue with a
linear portion of the vane to thereby form the planar section of
the donor graft, and shaping a second portion of the donor tissue
with a non-linear portion of the vane to thereby form the tongue
member of the donor graft.
[0051] In certain embodiments, shaping the second portion of the
donor tissue may include shaping the donor tissue with a recess
defined by the vane.
[0052] In certain embodiments, shaping the donor tissue with the
recess may include contacting the donor tissue with an arcuate
surface defined by the recess.
[0053] The method further includes removing damaged tissue from a
patient to faun a recipient site configured and dimensioned to
receive the donor graft in an interlocking fashion.
[0054] Forming the recipient site includes positioning a first arm
of a recipient cutting guide in abutment with a section of the
damaged tissue to be removed, and a second arm of the recipient
cutting guide in abutment with a section of tissue that will not be
removed.
[0055] In certain embodiments, forming the recipient site may
further include securing the recipient cutting guide in relation to
the damaged tissue, e.g., via attachment of a fixation member to
the tissue that will not be removed through a hole in the recipient
cutting guide.
[0056] Forming the recipient site further includes forming a
channel configured and dimensioned to receive the tongue member of
the donor graft, e.g., by passing a cutting implement through a
hole in the recipient cutting guide.
[0057] Forming the recipient site further includes making a cut
that intersects the channel so as to form a planar surface at the
recipient site configured and dimensioned for engagement with the
planar section of the donor graft, i.e., by passing a cutting
implement through a slot extending through the second aim of the
recipient cutting guide.
[0058] The method further includes positioning the donor graft such
that the donor graft interlocks with the recipient site, e.g., such
that the tongue member of the donor graft is positioned within the
channel at the recipient site.
[0059] In certain embodiments, the method may further include
securing the donor graft to the recipient site.
[0060] Other objects, features, and advantages of various
illustrative embodiments of the present disclosure will become
apparent with reference to the accompanying drawings, and the
detailed description that follows.
BRIEF DESCRIPTION OF THE DRAWINGS
[0061] Various embodiments of the present disclosure are described
herein with reference to the figures, wherein:
[0062] FIG. 1 is a front, elevational view illustrating a recipient
cutting guide according to the principles of the present disclosure
useful in the removal of damaged tissue, e.g., bone and cartilage,
and the formation of a recipient site configured and dimensioned to
receive a donor graft;
[0063] FIG. 2 is a side, elevational view of the presently
disclosed recipient cutting guide;
[0064] FIG. 3 is a side, elevational view of a donor graft
following the removal of damaged tissue and formation of the
recipient site;
[0065] FIG. 4 is a top, perspective view of the recipient site;
[0066] FIG. 5 is a side, elevational view illustrating placement of
the donor graft at the recipient site;
[0067] FIG. 6 is a top, perspective view illustrating placement of
the donor graft at the recipient site;
[0068] FIG. 7 is a side, elevational view of the presently
disclosed recipient cutting guide;
[0069] FIG. 8 is a front, elevational view of the presently
disclosed recipient cutting guide;
[0070] FIGS. 9 and 10 are top, perspective views of the presently
disclosed recipient cutting guide;
[0071] FIGS. 11 and 12 are bottom, perspective views of the
presently disclosed recipient cutting guide;
[0072] FIG. 13 is a side, elevational view of an alternate
embodiment of the presently disclosed recipient cutting guide;
[0073] FIG. 14 is a top, perspective view of the recipient cutting
guide shown in FIG. 13;
[0074] FIG. 15 is a top, perspective view of a donor cutting guide
useful in forming the donor graft shown in FIG. 3 from donor
tissue;
[0075] FIG. 16 is an end view of the presently disclosed donor
cutting guide and the donor tissue;
[0076] FIG. 17 is a longitudinal, cross-sectional view of the
presently disclosed donor cutting guide and the donor tissue;
[0077] FIG. 18 is a partial, end view of the presently disclosed
donor cutting guide;
[0078] FIG. 19 is a side, elevational view illustrating a shaping
member of the presently disclosed donor cutting guide; and
[0079] FIG. 20 is a partial, end view illustrating a sled of the
presently disclosed donor cutting guide together with the donor
tissue.
DETAILED DESCRIPTION
[0080] In the following detailed description, reference is made to
the accompanying drawings, which depict non-limiting, illustrative
embodiments of the present disclosure. Throughout the present
disclosure, the term "tissue" should be understood as including
many forms of biological structural material, including, but not
limited to, bone and cartilage. Additionally, the term "damaged
tissue" should be understood to encompass any negatively affected
tissue, including, but not limited to inflamed tissue, scarred
tissue, and joint pathology. Additionally, the terms "height,"
"width," "thickness," "above," "below," "closer," "further," and
any variation(s) thereof used herein are relative in character, and
are intended to be interpreted in accordance with the perspective
shown in the corresponding figure(s).
[0081] The present disclosure relates to apparatus, systems, and
methods adapted for use in grafting procedures, e.g., tibial
plateau allografting (with or without attached meniscus), and
provides numerous benefits over known apparatus, systems, and
methods. For example, the apparatus, systems, and methods disclosed
allow for maintenance of the meniscus/bone junction, and facilitate
transplantation of healthy cartilage and a healthy meniscus as a
unit, as opposed to being transplanted separately. Moreover, the
apparatus disclosed herein minimize the amount of native tissue
that is removed to form the recipient site, while still allowing
for appropriate fixation of the donor graft.
[0082] With reference now to FIGS. 1-12, a cutting guide 10 is
illustrated for use during a surgical procedure in the preparation
of a recipient site 5 (FIGS. 3-6) in tissue 2, e.g., a patient's
tibial plateau, to receive a donor graft 1, e.g., a tibial plateau
allograft, and the removal of damaged tissue.
[0083] The recipient site cutting guide 10 may include, e.g., be
formed from, any material suitable for use in surgical practice,
e.g., plastics, polymers, aluminum, stainless steel, titanium, and
combinations thereof, and includes a generally horizontal first
arm, e.g., a height-determination (H-G) arm, identified by the
reference character 20, and a generally vertical second aim, e.g.,
a blade aim, identified by the reference character 30. In the
illustrated embodiment, the arms 20, 30 are integrally, e.g.,
monolithically, formed. In alternate embodiments, however, other
suitable methods of attachment may be employed to connect the arms
20, 30, e.g., one or more connectors or fasteners may be employed,
or the arms 20, 30 may be welded together.
[0084] The arms 20, 30 are connected such that the cutting guide 10
defines a generally "L-shaped" configuration, e.g., such that the
arms 20, 30 subtend a fixed angle .alpha. (FIG. 7) of approximately
90.degree., e.g., 60.degree.-120.degree.. In alternate embodiments,
however, if necessary or desirable, the configuration of the
cutting guide 10 may be varied to alter the angle .alpha.. For
example, the arms 20, 30 may be arranged such that the angle
.alpha. lies outside the range of 60.degree.-120.degree. dependent
upon the requirements of a particular surgical procedure.
Additionally, it is envisioned that the arms 20, 30 may movably
connected to one another such that the angle .alpha. may be
adjusted by the user on an as-needed basis, e.g., during the course
of a surgical procedure.
[0085] The second arm 30 includes a cutting slot 40, one or more
guide holes, 50, and one or more fixation holes 60. Although
illustrated as including a single cutting slot 40, a single guide
hole 50, and a pair of fixation holes 60 in the embodiment
illustrated in FIGS. 7-12, the number of cutting slots 40, guide
holes 50, and fixation holes 60 may be varied in alternate
embodiments of the cutting guide 10 without departing from the
scope of the present disclosure.
[0086] The cutting slot 40 extends horizontally across the second
arm 30, and is configured and dimensioned to receive a cutting
implement, e.g., a sagittal saw (not shown). In the illustrated
embodiment, the cutting slot 40 and the first arm 20 are shown as
extending in parallel relation, i.e., along non-intersecting axes.
In alternate embodiments, however, the cutting slot 40 and the
first arm 20 may be arranged so as to extend along intersecting
axes. Additionally, while the cutting slot 40 is illustrated as
being linear in configuration in the embodiment shown in FIGS.
7-12, in alternate embodiments, the cutting slot 40 may be
non-linear in configuration. For example, the cutting slot 40 may
include one or more arcuate and/or linear segments or sections.
[0087] The first arm 20 and the cutting slot 40 define a distance D
(FIG. 7) therebetween that determines the vertical height
(thickness) of the recipient site 5 (FIGS. 3-6), as discussed in
further detail below. In general, the distance D will lie within
the range of approximately 2 cm to approximately 20 cm (.+-.25%).
In most surgical applications, however, a distance D of
approximately 6 cm to approximately 10 cm is standard.
[0088] The guide hole 50 is located adjacent an end of the cutting
slot 40, and defines a periphery P (FIG. 8). Although illustrated
as being separated from the cutting slot 40, i.e., such that there
is not communication between the guide hole 50 and the cutting slot
40, in alternate embodiments, the guide hole 50 and the cutting
slot 40 may intersect. Additionally, while illustrated as circular
in configuration in FIGS. 7-12, the guide hole 50 may define
alternate configurations in other embodiments of the cutting guide
10, e.g., the guide hole 50 may be elliptical, ovoid, rectangular,
etc.
[0089] As seen in FIG. 8, for example, the guide hole 50 and the
cutting slot 40 are oriented such that an upper portion of the
periphery P of the guide hole 50 is located above the cutting slot
40 (closer to the first arm 20), and a lower portion of the
periphery P of the guide hole 50 is located below the cutting slot
40 (further from the first arm 20). For example, it is envisioned
that a central axis X.sub.CS (FIG. 8) of the cutting slot 40 may
bisect the guide hole 50.
[0090] With continued reference to FIGS. 7-12, the fixation holes
60 will be discussed. The fixation holes 60 are configured and
dimensioned to removably receive fixation members (not shown),
e.g., pins, screws, nails, or the like, which can be used to secure
the cutting guide 10 to the tissue 2 (FIGS. 3-6), e.g., tibial
bone, in which the recipient site 5 is formed, as discussed in
further detail below. In the illustrated embodiment, the fixation
holes 60 are located below the cutting slot 40. In alternate
embodiments, however, the specific location of the fixation holes
60 may be altered or varied. For example, in one embodiment, it is
envisioned that the fixation holes 60 may be located above the
cutting slot 40, whereas in another embodiment, it is envisioned
that the cutting guide 10 may include one fixation hole 60 located
above the cutting slot 40, and another fixation hole 60 located
below, or in line with, the cutting slot 40.
[0091] Although illustrated as being circular in configuration in
the embodiment of the cutting guide 10 shown in FIGS. 7-12, the
fixation holes 60 may define alternate configurations in other
embodiments of the present disclosure. For example, the fixation
holes 60 may be elliptical, ovoid, rectangular, etc.
[0092] With reference now to FIGS. 1-12, use of the recipient site
cutting guide 10 will be discussed in connection with the removal
of damaged tissue, and formation of the recipient site 5 (FIGS.
3-6) in preparation to receive a donor graft 1.
[0093] Initially, the recipient site cutting guide 10 is selected
according to the requirements of the procedure, e.g., such that the
dimensions defined by the recipient site 5 correspond to those of
the donor graft 1, which may include an attached meniscus 4, as
seen in FIGS. 3, 5, and 6. For example, the recipient site cutting
guide 10 may be selected based upon the distance D (FIG. 7) defined
between the first arm 20 and the cutting slot 40 such that the
recipient site 5 is dimensioned to define a particular height in
correspondence with the height (thickness) of the donor graft 1.
The selected recipient site cutting guide 10 is then positioned
such that the first arm 20 abuts a portion 3.sub.A (FIG. 2) of the
tissue 2 to be removed, i.e., damaged tissue, located above the
cutting slot 40, and the second arm 30 abuts a portion 3.sub.B of
the tissue 2 that will not be removed, located below the cutting
slot 40. The configuration and dimensions of the recipient site
cutting guide 10, e.g., the location and dimensions of the cutting
slot 40, are such that the amount of native tissue 2 removed to
form the recipient site 5 is minimized, while still allowing for
appropriate fixation of the donor graft 1.
[0094] After positioning the recipient site cutting guide 10, the
cutting guide 10 is then secured to the tissue 2 by fixation
members (not shown) inserted through the fixation holes 60.
Alternatively, the user may simply apply pressure to the recipient
site cutting guide 10 to hold the recipient site cutting guide 10
in place.
[0095] Thereafter, a drill bit (not shown), or other such cutting
implement, is inserted into, and advanced through, the guide hole
50 into contact with the tissue 2 to create a channel 6 (FIGS. 3,
4), e.g., from anterior to posterior. A cut is then made along the
cutting slot 40 using a saggital saw (not shown), or other such
cutting implement, until the channel 6 is reached so as to define
an upper surface 7 of the recipient site 5. For example, with
reference to FIGS. 1-6 in particular, due to the linear
configuration of the cutting slot 40 included in the cutting guide
10, the cut made in the tissue 2 results in a planar configuration
at the upper surface 7 of the recipient site 5. In alternate
embodiments, however, i.e., embodiments wherein the cuttings slot
40 is non-linear in configuration, the upper surface 7 of the
recipient site 5 may be formed so as to define a non-planar, or
otherwise irregular configuration.
[0096] After completion of the cut, the cutting implement is
removed from the cutting slot 40, the fixation members (not shown)
can be removed from the fixation holes 60, and the portion 3.sub.A
(FIG. 2) of the tissue 2 to be removed can be separated from the
remainder of the tissue 2, revealing the recipient site 5,
including the aforementioned channel 6 and upper surface 7.
[0097] FIGS. 13 and 14 illustrate an alternate embodiment of the
presently disclosed recipient site cutting guide, which is referred
to generally by the reference character 110. The cutting guide 110
is identical to the cutting guide 10 discussed above in connection
with FIGS. 7-12, for example, hut for any distinctions that are
specifically noted. Accordingly, a discussion of certain features
common to the cutting guides 10, 110 may be omitted in the interest
of brevity.
[0098] To increase versatility of the cutting guide 110, and the
creation of recipient sites 5 (FIGS. 3-6) of various dimensions,
e.g., heights, the cutting guide 110 includes a first arm 120, and
a second arm 130 with a series of cutting slots 140, each of which
is located a different distance from the first arm 120. For
example, in the embodiment illustrated in FIGS. 13 and 14, the
second aim 130 includes cutting slots 140.sub.A, 140.sub.B,
140.sub.C, wherein the first arm 120 is spaced a distance D.sub.A
from the cutting slot 140.sub.A, a distance D.sub.B from the
cutting slot 140.sub.B greater than the distance D.sub.A, and a
distance D.sub.C from the cutting slot 140.sub.C greater than the
distance D.sub.B.
[0099] The method of using the cutting guide 110 is identical to
that of the cutting guide 10, but for the fact that the user has
the ability to choose a specific cutting slot, e.g., one of the
cutting slots 140.sub.A, 140.sub.B, 140.sub.C in the embodiment
shown in FIGS. 13 and 14, based upon the requirements of the
particular procedure. For example, dependent upon the
characteristics of the patient, and/or those of the damaged tissue
to be removed, the user may elect to use one of the cutting slots
140.sub.A, 140.sub.B, 140.sub.C as opposed to another to guide the
cutting implement during formation of the upper surface 7 (FIGS.
3-7) of the recipient site 5.
[0100] In an alternate method of use, it is envisioned that more
than one of the cutting slots 140.sub.A, 140.sub.B, 140.sub.C may
be employed during a surgical procedure. For example, an initial
cut may be made using the cutting slot 140.sub.A, and thereafter,
one ore more additional cuts may be made using the cutting slot
140.sub.B and/or the cutting slot 140.sub.C to allow for the
progressive removal of the tissue and definition of the recipient
site 5, e.g., to reduce patient trauma and/or inflammation at the
recipient site 5.
[0101] With reference now to FIGS. 15-20, a donor implant cutting
guide 200 will be discussed useful in formation of the
aforementioned donor graft 1 (FIGS. 3-6, 15). The cutting guide 200
may include, e.g., be formed from, any material suitable for use in
surgical practice, e.g., plastics, polymers, aluminum, stainless
steel, titanium, and combinations thereof, and includes a body 202,
a shaping member 204, and a movable sled 206.
[0102] The body 202 of the cutting guide 200 defines a channel 208
that is configured and dimensioned to receive donor tissue T, which
may include an attached meniscus 4 (FIGS. 3, 5, 6, 15, 16). The
channel 208 extends along an axis X, and is defined by sidewalls
210, 212, and respective lower and upper shelves 214, 216
positioned on opposite sides of the shaping member 204. The lower
shelf 214 is spaced a first distance D.sub.1 (FIG. 17) from a
bottom wall 218 of the body 202, and the upper shelf 216 is spaced
a second, greater distance D.sub.2 from the bottom wall 218 of the
body 202.
[0103] Although illustrated as extending in parallel relation to
the bottom wall 218 of the body 202 in the embodiment illustrated
in FIGS. 15-20, in alternate embodiments of the cutting guide 200,
the shelf 214 and/or the shelf 216 may extend at an angle to the
bottom wall 218 so as to either assist or resist movement of the
donor tissue T through the channel 208. For example, either or both
of the shelves 214, 216 may be angled toward the shaping member
204, or away from the shaping member 204.
[0104] The shaping member 204 resides within a well 220 defined by
the body 202, and is secured to the body 202 such that the shaping
member 204 is rotatable in relation to the body 202 about a fixed
axis Y (FIG. 15) that extends in transverse relation to the axis X
defined by the channel 208. For example, in the embodiment seen in
FIG. 15, the shaping member 204 is oriented such that the axis Y is
orthogonal in relation to the axis X. In alternate embodiments,
however, the shaping member 204 may be oriented such that the axes
X, Y subtend an angle other than 90.degree., e.g., 45.degree..
[0105] The shaping member 204 may be actuated, i.e., caused to
rotate, by an automated mechanism, e.g., a motor (not shown), or
alternatively, under manual power via the application of force by a
user. For example, the shaping member 204 may be rotated by a crank
(not shown) connected to the shaping member 204.
[0106] The shaping member 204 includes a drum 222, and one or more
vanes 224. While the vanes 224 may include sharpened cutting edges
226 (FIGS. 18, 19), as illustrated in the embodiment seen in FIGS.
15-20, the vanes 224 may be devoid of any sharpened edges in
alternate embodiments of the cutting guide 200. Additionally, while
the shaping member 204 is illustrated as including four (4) vanes
224 in the embodiment of the cutting guide 200 shown in FIGS.
15-20, the number of vanes 224 may be increased or decreased in
alternate embodiments of the cutting guide 200 without departing
from the scope of the present disclosure, e.g., to reduce
manufacturing costs.
[0107] The vanes 224 extend outwardly from the drum 222 into the
channel 208. Specifically, the shaping member 204 is positioned
within the well 220 such that the edges 226 of the vanes 224 align
with the upper shelf 216, i.e., such that the maximum linear
separation realized between the vanes 224 and the bottom wall 218
of the body 202 during rotation of the shaping member 204 is
equivalent to the distance D.sub.2 (FIG. 17) defined between the
upper shelf 216 and the bottom wall 218.
[0108] The vanes 224 are configured and dimensioned to shape the
donor tissue T into the donor graft 1 (FIGS. 3, 5, 6) in
correspondence with the configuration of the recipient site 5
(FIGS. 3-6). For example, in the embodiment of the cutting guide
200 illustrated in FIGS. 15-20, to facilitate shaping of the donor
tissue T in the desired manner, the vanes 224 include a linear
portion 228 (FIG. 19), and a non-linear portion 230 defining one or
more recesses 232. In the specific embodiment shown, the vanes 224
are illustrated as including a single, curvate recess 232 defining
an arcuate surface 234 that extends inwardly, toward the axis Y,
resulting in a generally C-shaped configuration. In alternate
embodiments, however, the recesses 232 may be present in greater
number, and/or may define alternative configurations. For example,
each vane 224 may include a pair of recesses 232 that arc
triangular in configuration.
[0109] Additionally, or alternatively, it is envisioned that the
non-linear portion 230 of the vanes 224 may include one or more
projections (not shown) extending outwardly, away from the axis
Y.
[0110] With reference now to FIGS. 15 and 20 in particular, the
sled 206 will be discussed. During operation of the cutting guide
200, the sled 206 is used to stabilize and move the donor tissue T
through the channel 208 across the lower shelf 214 into contact
with the shaping member 204 and onto the upper shelf 216. To
facilitate movement of the donor tissue T, the sled 206 is
configured and dimensioned to slide in relation to the body 202 of
the cutting guide 200, and may be either fixedly or removably
connected thereto in any manner facilitating movement in this
manner. For example, the sled 206 may rest upon upper surfaces 236,
238 (FIG. 15) defined by the sidewalls 210, 212 of the body 202
such that the sled 206 slides along the upper surfaces 236, 238
during movement.
[0111] In one embodiment, such as the embodiment shown in FIGS. 15
and 20, for example, the sled 206 includes a shoulder 240 that
depends from an underside 242 (FIG. 20) thereof which may be used
to urge the donor tissue T into contact with one of the sidewalls
210, 212 (FIG. 15) during movement of the donor tissue T through
the channel 208 to further stabilize the donor tissue T, e.g.,
during shaping.
[0112] In one embodiment, seen in FIGS. 15 and 20 for example, the
underside 242 of the sled 206 may include a textured surface 244 to
increase friction between the sled 206 and the donor tissue T, and
thus, control over the donor tissue T during movement through the
channel 208. For example, the underside 242 of the sled 206 may
include one or more protrusions 246 configured as detents, teeth,
or the like. Alternatively, the underside 242 of the sled 206 may
be non-textured.
[0113] Additionally, or alternatively, the sled 206 may include
retaining structure (not shown), e.g., one or more pins, clamps,
jaws, or the like, to secure the donor tissue T to the sled
206.
[0114] With reference now to FIGS. 3-6 and 15-20, use of the
cutting guide 200 will be discussed in connection with formation of
the aforementioned donor graft 1.
[0115] Initially, the donor tissue T is harvested from a larger
section of tissue (not shown), e.g., through use of a saggital saw,
scalpel etc., and is fed into the cutting guide 200. If necessary,
the donor tissue T can be shaped or trimmed so as to fit within the
confines of the channel 208 (FIG. 15) defined by the body 202 of
the donor implant cutting guide 200. Specifically, the donor tissue
T is positioned on the lower shelf 214, and is stabilized using the
sled 206, i.e., the donor tissue T is positioned between the lower
shelf 214 and the sled 206. Using the sled 206, the donor tissue T
is advanced into contact with the shaping member 204 whereby the
vanes 224 remove portions of the donor tissue T in accordance with
a pattern determined by the configuration and dimensions thereof.
Specifically, in the illustrated embodiment, the linear portion 228
(FIG. 19) of the vanes 224 shape a section of the donor tissue T so
as to define a planar section 8 (FIG. 3) that corresponds in
configurations and dimensions to the upper surface 7 of the
recipient site 5, while the non-linear portion 230 (FIG. 19) of the
vanes 224 simultaneously shape an adjacent section of the donor
tissue T so as to define a tongue member 9 (FIG. 3). The tongue
member 9 corresponds in configurations and dimensions to the
channel 6 defined by the recipient site 5, and extends transversely
in relation to the length and width of the planar section 8 of the
donor graft 1 such that the tongue member 9 extends outwardly in
relation to the planar section 8.
[0116] As the donor tissue T passes by the shaping member 204, it
is supported by the upper shelf 216. After shaping of the donor
tissue T has been completed, i.e., when the donor graft 1 has been
formed, the donor graft 1 is placed at the recipient site 5 (FIGS.
3-6). Specifically, the planar section 8 of the donor graft 1 is
positioned in abutment with the upper surface 7 of the recipient
site 5, and the tongue member 9 is positioned within the channel 6,
as shown in FIGS. 3, 5 and 6, whereby the donor graft 1 and the
recipient site 5 mate in an interlocking fashion so as to inhibit
movement of the donor graft 1 in relation to the recipient site 5,
e.g., motion in the medial-lateral direction.
[0117] In various embodiments of the present disclosure, the
configurations, dimensions, and orientations of the cutting slot
40, the guide hole 50, and the fixation holes 60 of the cutting
guide 10 (FIGS. 7-12) may be altered or varied, as can the
configuration and dimensions of the vanes 224, the recesses 232,
and the shelves 214, 216 of the cutting guide 200 (FIG. 15), so as
to create a recipient site 5 (FIG. 3) and a donor graft 1 that
interlock in any desired manner.
[0118] With reference again to FIG. 3, following placement of the
donor graft 1, the donor graft 1 can be attached to the recipient
site 5 using either temporary or permanent attachment structures
(not shown), e.g., fixation screws, bone plates, or the like.
[0119] While the present disclosure has been described in
connection with specific embodiments thereof, it will be understood
that the subject matter of the present disclosure is capable of
further modifications. For example, persons skilled in the art will
understand that additional components and features may be added to
any of the embodiments discussed herein above, and that those
elements and features described in connection with any one
embodiment may also be applicable to, or combined with, those of
any other embodiment, without departing from the scope of the
present disclosure.
[0120] The scope of the present disclosure is intended to cover any
variations, uses, and/or adaptations of the presently disclosed
subject matter in accordance with the principles of the present
disclosure, including such departures from the present disclosure
as come within known or customary practice within the art to which
the present disclosure pertains, and as may be applied to the
elements, components, and features set forth herein above.
* * * * *