U.S. patent number 3,927,423 [Application Number 05/477,260] was granted by the patent office on 1975-12-23 for patellar implant and method.
Invention is credited to Alfred B. Swanson.
United States Patent |
3,927,423 |
Swanson |
December 23, 1975 |
Patellar implant and method
Abstract
A patellar implant replaces the damaged underlying cartilage of
the patella. The implant, formed of silicone rubber, is contoured
to fit into a depression formed in the resected posterior surface
of the patella. The contact surface of the implant within the
formed depression is covered with Dacron velour. Sutures are
embedded in the Dacron within the implant. The sutures are pulled
through four drill holes through the Patella to the anterior
surface and tied in place. A smooth silicone surface is presented
to the patellofemoral joint.
Inventors: |
Swanson; Alfred B. (Grand
Rapids, MI) |
Family
ID: |
23895195 |
Appl.
No.: |
05/477,260 |
Filed: |
June 7, 1974 |
Current U.S.
Class: |
623/20.2 |
Current CPC
Class: |
A61F
2/3877 (20130101) |
Current International
Class: |
A61F
2/38 (20060101); A61F 001/24 () |
Field of
Search: |
;3/1,1.9-1.911
;128/92C,92R |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
"Patella Prosthesis" by D. C. McKeever, The Journal of Bone &
Joint Surgery, Vol. 37-A, No. 5, October 1955, pp. 1074-1084. .
"The Silicones as Tools in Biological Engineering" by Silas Braley,
Medical Electronics & Biological Engineering, Vol. 3, No. 2,
April 1965, pp. 127-136..
|
Primary Examiner: Frinks; Ronald L.
Attorney, Agent or Firm: Price, Heneveld, Huizenga &
Cooper
Claims
The embodiments of the invention in which an exclusive property or
privilege is claimed are defined as follows:
1. A surgically implantable prosthesis for replacing the underlying
cartilage on the posterior surface of the patella, the posterior
surface of the patella having a recess provided therein, said
prosthesis comprising: a body of flexible inert material, said body
having a first compound articular surface corresponding generally
to that of the posterior surface of a normal patella for gliding
engagement with the femoral condyles; a second surface of said body
opposite saaid first surface being adapted for positioning in the
recess formed in the posterior surface of the patella; and means
for securing said body in the recess.
2. A surgically implantable prosthesis for replacing the underlying
cartilage on the posterior surface of the patella, the posterior
surface of the patella having a recess provided therein, said
prosthesis comprising: a body of flexible inert material, said body
having a first surface forming a compound articular surface for
gliding engagement with the femoral condyles; a second surface of
said body opposite said first surface being adapted for positioning
in the recess formed in the posterior surface of the patella; and
means for securing said body in the recess, said securing means
including said second surface having a layer of inert fabric
secured thereon, said fabric adapted to form an interface between
said body and a bottom wall of the recess; and suture means in and
extending from said fabric, the patella having openings formed
therethrough from the bottom wall of said recess to the anterior
surface thereof to receive said suture means to secure said body in
said recess to thereby position said first surface to form a
prosthetic posterior surface on the patella.
3. The prosthesis of claim 2 wherein said securing means further
includes a layer of acrylic cement on said fabric layer and adapted
to contact the bottom wall of the recess.
4. The prosthesis of claim 2 wherein said fabric layer is Dacron
velour.
5. The prosthesis of claim 4 wherein said fabric layer is Dacron
velour.
6. The prosthesis of claim 3 wherein said acrylic cement is methyl
methacrylate.
7. A surgically implantable prosthesis for replacing the underlying
cartilage on the posterior surface of the patella, the posterior
surface of the patella having a recess provided therein, said
prosthesis comprising: a body of flexible inert material, said body
having a first surface forming a compound articular surface for
gliding engagement with the femoral condyles, a vertical ridge
dividing said compound articular surface into an outer larger
portion for gliding engagement with the external condyle and an
inner smaller portion for gliding engagement with the internal
condyle, said outer and inner portions corresponding generally in
configuration to the external and internal facets respectively of
the patella in which the prosthesis is implanted; a second surface
of said body opposite said first surface being adapted for
positioning in the recess formed in the posterior surface of the
patella; and means for securing said body in the recess.
8. The prosthesis of claim 7 wherein the recess formed in the
posterior surface of the patella is generally symmetrical in
configuration, said second surface of said body being generally
symmetrical for mating engagement with the recess and wherein said
body can be positioned in said recess to accommodate the condyles
of either the left or right femur.
9. The method of rebuilding the damaged underlying cartilage on the
posterior surface of a patella comprising the steps of:
exposing the posterior surface of the patella;
resecting the posterior surface and forming a recess in the
resected posterior surface;
providing a body of flexible inert material having a compound
articular first surface formed thereon corresponding generally to
the external and internal articular facets of a normal patella and
having an opposite surface adapted for mating engagement with said
recess;
securing said body in said recess; and
replacing the patella with said body secured therein such that said
compound articular surface is positioned for gliding engagement
with the femoral condyles.
10. The method of rebuilding the patella as defined in claim 9
wherein said body of flexible material is provided with suture
means extending from said opposite surface, and wherein said
securing step includes placing a layer of adhesive between said
opposite surface and said recess and suturing said body to said
patella.
11. The method of rebuilding the patella as defined in claim 10
wherein said step of forming a recess in said posterior surface
includes the further step of forming at least two openings through
aid patella from the bottom wall of said recess to the anterior
surface thereof to receive said suturing means.
12. The method of rebuilding the patella as defined in claim 11 and
further including the step of tying said suturing means at the
anterior surface of the patella.
Description
BACKGROUND OF THE INVENTION
The present invention relates to surgically implantable prosthetic
devices for replacing the posterior surface of the patella. More
particularly, the invention relates to a patellar implant and a
method for surgically installing the same which is particularly
useful where it is desired to avoid patellectomy.
The replacement of damaged or diseased joints in the human body has
been known for some time. If the device used to replace the natural
joint structures was to be movable in a manner similar to the
natural joint, it was once necessary to provide a multiple part
structure of rigid clinically inert material. Generally, metals
such as stainless steel alloys were used for this purpose. Such
rigid structures, however, were subject to breakage and were
difficult to implant and hold in place once implanted. The rigidity
of the appliance can cause undue pressure on the underlying
cartilage and bone. Furthermore, while some metals are considered
to be clinically inert, some risk of deterioration of the device
with time continues to exist.
One prior art patellar implant, for example, utilized a Vitallium
cap pinned in position over the cartilage covered posterior surface
of the patella for gliding movement upon the femoral condyles.
Unfortunately, however, such devices are difficult to fix to the
patella and eventually will work loose. Since the material is hard,
there is also a certain amount of inherent abrasion against the
adjacent bone surfaces and cartilage eventually causing the implant
to hang up and cease to function properly.
SUMMARY OF THE INVENTION
The present invention overcomes the difficulties encountered in the
prior art and provides a prosthetic implant for replacing the
posterior surface of the patella. The implant is formed as a body
of flexible inert material and replaces the underlying cartilage of
the patella. The implant is particularly adapted for use in cases
of chondromalacia when the femoral portion of the patellofemoral
joint is reasonably smooth. One side of the implant is contoured or
shaped to fit into a recess formed in the resected posterior
surface of the patella. The opposite side, forms a new posterior
surface for the patella and has a compound articular surface for
gliding engagement with the femoral condyles.
The many objects and advantages of the present invention will
become readily apparent to those skilled in the art from a
consideration of the following detailed description of the
preferred embodiment of the implant and method for installing same
when read in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a vertical cross section of a knee joint;
FIG. 2 is a front view of the knee joint with the patella rotated
to expose its posterior surface;
FIG. 3 is a fragmentary view illustrating the resected posterior
surface of the patella, the support ligaments and the like having
been removed for clarity;
FIG. 4 is a cross-sectional view taken along plane IV--IV of the
patella shown in FIG. 3;
FIG. 5 is a top plan view of the patellar implant of the
invention;
FIG. 6 is a bottom view of the patellar implant shown in FIG.
5;
FIG. 7 is a cross-sectional view of the patellar implant taken
along the plane VII--VII of FIG. 5; and
FIG. 8 is a cross-sectional view illustrating the implant of FIG. 7
installed in the resected portion of the patella of FIG. 4.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring to the drawings, a human knee joint and the patella are
illustrated in simplified diagramatic form while the implant of the
invention is illustrated in detail in FIGS. 5-8. With specific
reference to FIGS. 1-4, a simplified anatomical illustration will
be briefly described to aid in a better understanding of the
structure and installation of the patellar implant. Basically, the
knee joint shown in FIGS. 1 and 2 provides a connection between the
upper end of the tibia bone 10 and the lower end of the femur bone
12. The lower end of femur bone 12 is formed with a pair of
generally rounded surfaces 14 and 16 known as the femoral condyles.
The inner condyle of the femur is generally identified by the
numeral 14 while the outer or external condyle is identified by the
numeral 16.
The tibia 10 and femur 12 are connected by various ligaments and
like connective tissues known to those skilled in the art. The
patella generally designated by the numeral 18 is a sesamoid bone
somewhat triangular in shape (FIGS. 2 and 3) and situated in front
of the knee joint. The outermost or anterior surface 20 (FIGS. 1
and 4) of the patella is slightly convex. The inner or posterior
surface 22 of a normal patella is generally concave and in great
part cartilage covered, forming a compound articular surface for
gliding on the femoral condyles. A slightly marked vertical ridge
24 divides the posterior surface 22 into an external articular
facet 26 for gliding engagement with the outer condyle 16 and an
inner or internal articular facet 28 for gliding engagement with
the inner condyle 14. The lower portion of the patella tapers to a
blunt point 30 which is embedded in the patellar ligament 32 while
the upper portion is held by the quadriceps tendon 34 associated
with the tissues of the femur bone. The bursa 36 is located between
the anterior surface 20 of the patella and the skin.
Referring additionally to FIGS. 5-7, the patella implant designated
by the numeral 40 is generally circular in configuration and has a
top or upper surface 42 which corresponds generally to the
configuration of the posterior surface 22 of patella 18 illustrated
in FIG. 2.
Preferably, the patellar implant 40 of the invention is molded of
flexible elastomeric physiologically inert material. CLEAN ROOM DOW
CORNING Silicone Rubber Compound No. MDX4-4515 available from the
Dow Corning Corporation, Midland, Mich., is one material selected
to meet the requirements of the patellar implant. While the
prosthetic implant is described as being made of silicone rubber
type materials, it will be realized that other flexible, clinically
inert materials having sufficient strength may be used.
The upper surface 42 of implant 40 is molded to include surface
areas generally corresponding to the surfaces found on a normal
patella. These surfaces include a vertical ridge 44 dividing top
surface 42 into an outer, larger curved, surface portion 46
corresponding to the external articular facet 26 and a smaller
inner curved, surface portion 48 corresponding to the internal
articular facet 28. These surfaces 46 and 48 are adapted for
gliding engagement with the outer and inner condyles 16 and 14,
respectively.
To aid in the installation of the implant as will be hereinafter
described, the base or back of the implant 40 is covered with a
thin layer of fabric 50. Preferably, the fabric 50 is a Dacron
velour secured to the back surface in any conventional manner as by
suitable adhesive or if desired may be fixed simultaneously with
molding of the implant.
Two sutures 52 are passed through fabric so as to have their
midportions sandwiched between the fabric and the implant. The
extremities of the sutures hang free for use in the manner to be
described. Preferably, a polyester, clinically inert, suture
material is provided as, for example, Tycron.
Referring additionally to FIGS. 3, 4, and 8, the preparation of the
patella 18 and installation of the implant 40 will be described. By
means of conventional surgical techniques, the posterior surface 22
of patella 18 is exposed by slitting the supporting side tendons
and rotating the patella to expose the posterior surface 22
thereof. The patella is rotated generally about an axis parallel to
the tibia 10 and femur 12. The posterior surface 22 of patella 18
is resected to remove the damaged areas such that a generally flat
surface area 54 remains. A circular relief or depression 56 is
formed in the resected posterior surface of the patella to accept
the implant, the damaged underlying cartilage on the posterior
surface being removed in this process.
Circular depression 56 includes a bottom wall surface 58 and a side
wall surface 60 upstanding therefrom. A series of four generally
equally spaced holes 62 are drilled from bottom wall surface 58
through patella 18 to the anterior surface 20. Openings 62 are
spaced apart to correspond generally to the location of the sutures
52 extending from fabric 50 of implant 40. After formation of the
circular relief 56 and openings 62, the implant 40 is positioned in
recess 56 and secured to bottom wall 58. Implant 40 is secured in
the resected patella by first cementing it in place to provide an
immediate bond, and in addition, by tying the sutures 52 at the
anterior surface as illustrated in FIG. 8. A physical bond between
fabric 50 and bottom wall 58 of the recess can be provided by
cement such as methyl methacrylate which fills in the spaces
between the fabric material conforming to any surface
irregularities of bottom wall 84 and eventually grows to the
surrounding tissues. The upstanding side wall surfaces 60 stabilize
the implant and prevent shifting of the implant with respect to the
posterior surface of the patella.
Since the implant 40 is generally symmetrical in line VII--VII
(FIG. 5), about an axis defined by its position in the resected
portion of the patella can be reversed, permitting the implant to
be used to rebuild the patella of either the left or right knee. A
suitable template is preferably utilized by the surgeon in forming
the resection and locating the position for the drilling of the
suture holes.
After implant 40 is installed and secured in the resected posterior
surface of the patella, it is folded back into position with the
formed surface of the implant in engagement with the condyles.
Normal surgical procedures are followed thereafter to complete the
operation.
Those skilled in the art will, of course, readily appreciate the
many advantages of the present invention. Those so skilled will
also recognize that many modifications may be made, and it is
intended that modifications be covered unless the following claims
by their wording expressly state otherwise.
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