Surgery – Instruments – Orthopedic instrumentation
Reexamination Certificate
2000-04-28
2002-04-23
Reip, David O. (Department: 3731)
Surgery
Instruments
Orthopedic instrumentation
C606S096000, C606S099000, C623S020180
Reexamination Certificate
active
06375658
ABSTRACT:
TECHNICAL FIELD
This invention relates to repairing cartilage, for example, articular cartilage on the patella and tibia.
BACKGROUND
Articular cartilage that is damaged (e.g., torn or excessively worn) may be repaired in a variety of ways. For example, the damaged cartilage may be shaved or scraped from the bone surface, thereby causing bleeding which stimulates the growth of fibrocartilage. Similarly, small holes may be drilled in the bone to promote bleeding and fibrocartilage growth. Alternatively, an allograft (e.g., cartilage grown in vitro from cartilage tissue removed from the patient) may be implanted by attaching a periosteum membrane (harvested, e.g., from the patient's tibia) to the bone surface and injecting the allograft beneath the membrane. The periosteum provides a healthy environment which promotes further cartilage cell growth.
SUMMARY
In one general aspect, a set of surgical instruments for repairing a cartilage surface on a posterior surface of the patella includes a first instrument and a second instrument. The first instrument includes a channel defining a longitudinal axis that extends from the channel to intersect an anterior surface of the patella. The second instrument is mountable to the first instrument and includes a surface that is configured to be placed against a posterior surface of the patella. The longitudinal axis of the channel is at an angle to the surface of the second instrument when the second instrument is mounted in the first instrument.
Embodiments of the set of surgical instruments may include one or more of the following features. For example, the angle may be between approximately 80° and 100°. The angle also may be at approximately 90°. The set of surgical instruments may further include a guide wire configured to be inserted into the channel in the first instrument and to drill a passage from an anterior opening on the anterior surface of the patella to a posterior opening on the posterior surface of the patella. The longitudinal axis of the passage through the patella is at an angle to the posterior surface of the patella at the posterior opening. The angle may be between approximately 80° and 100°. The angle also may be at approximately 90°. The set of surgical instruments may still further include a drill that can be passed over the guide wire and into the anterior opening. The drill is operable to enlarge the passage in the patella, from the anterior opening to the posterior opening.
The set of surgical instruments may still further include a delivery instrument to deliver a cartilage graft into the passage in the patella. The delivery instrument has an interior channel passage that extends between an open distal end and an open proximal end, and a flange at the distal end. The flange can be inserted into the anterior opening to deliver the cartilage graft through the interior channel into the passage in the patella. The delivery instrument may include a window formed in a wall. The window is open to the interior channel such that the cartilage graft can be observed through the window during delivery through the interior channel.
The set of surgical instruments may still further include an insertion instrument that is insertable into the interior channel of the delivery instrument to advance the cartilage graft from the delivery instrument through the anterior opening in the patella into the passage in the patella.
The first instrument may be a director handle that includes the channel and a slot that receives the second instrument. The second instrument may be a guide that includes a foot that is flush with a posterior surface of the patella when the foot is pressed against the patella. The foot may include a lower surface and a generally flat upper surface opposite the lower surface, with the foot configured to be pressed against the posterior surface of the patella. The generally flat upper surface may include a central channel passing between an opening in the upper surface and an opening in the lower surface. The central channel may have a diameter that is reduced from the upper surface to the lower surface. A longitudinal axis of the central channel may be perpendicular to the generally flat upper surface of the foot. The distal foot may be pivotably attached to the guide.
The set of surgical instruments may further include a tube having an interior channel. The tube may be configured to be inserted into the channel of the director handle and to receive a guide wire in the interior channel for drilling a hole in the patella.
The set of surgical instruments may further include a drill having an interior channel. The interior channel is designed to be inserted over a guide wire to enlarge a hole drilled by the guide wire in the patella.
The set of surgical instruments may further include an offset tool that includes a handle, a probe, and a guide. The handle has a distal end and the probe is attached to the distal end and extends perpendicularly from a face of the handle. The guide is attached to the distal end of the handle, offset from the probe, and has an inner shaft with a longitudinal axis that is substantially parallel to the probe. The longitudinal axis of the guide is offset from a longitudinal axis of the probe by approximately 0.1 to 0.3 inches. The longitudinal axis of the guide may be more particularly offset from the longitudinal axis of the probe by approximately 0.18 inches.
The set of surgical instruments may further include a chisel, a chisel guard, and a tamp. The chisel has a tip and a longitudinal shaft passing through the tip. The chisel guard has a shaft and a flanged end. The chisel guard can be placed around the chisel by inserting the chisel into the chisel guard's shaft. The tamp is designed to be inserted into the longitudinal shaft of the chisel.
The set of surgical instruments may further include a tapered bone plug compressor. The compressor includes a longitudinal shaft passing between a first opening and a second opening, and the diameter of the shaft increases from the second opening to the first opening.
In another embodiment of the set of surgical instruments, the first instrument may be a guide tube and the second instrument may be a clamp body. The guide tube includes the channel and a window that allows visual inspection of the channel. The clamp body includes an upper arm and a lower arm connected by an extension. The upper arm includes a channel having a longitudinal axis and in which the guide tube is inserted. The lower arm includes a foot having a channel aligned with the longitudinal axis of the channel of the guide tube and of the channel of the upper arm.
The upper arm and the lower arm may be connected to the extension at right angles. The upper arm may be connected to the extension such that the upper arm and the lower arm are parallel. The guide tube may be threadably received in the channel in the upper arm.
The foot may have a flat upper surface that is configured to contact a bony surface. The foot may have a flat upper surface that is perpendicular to the longitudinal channel of the guide tube. The foot may be mounted to the lower arm in a fixed relationship or a pivotal relationship. The foot also may be in the form of a ring having a channel through it.
The set of surgical instruments may further include a drill guide, having a longitudinal channel, which is designed to be inserted into the channel in the guide tube. The set of surgical instruments may still further include a guide wire that is insertable into the longitudinal channel of the drill guide.
In another general aspect, a surgical method of repairing an articular cartilage surface on a posterior surface of the patella includes placing a first instrument through a first incision so that the first instrument is adjacent to an anterior surface of the patella, placing a second instrument through a second incision so that the second instrument is located between the posterior surface of the patella and the femoral head, drilling a passage from the anterior surface of the patella to the posterior sur
Ferragamo Michael
Hangody Lazlo
Karparti Zoltan
Torrie Paul Alexander
Reip David O.
Smith & Nephew Inc.
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