Ancillary instrument for acromioclavicular disjunction surgery
Patent Information
- Authority / Receiving Office
- AU · AU
- Patent Type
- Applications
- Current Assignee / Owner
- VIMS VIDEO INTERVENTIONNELLE MEDICALE SCI
- Filing Date
- 2023-12-06
- Publication Date
- 2026-07-30
AI Technical Summary
Existing surgical procedures for acromioclavicular disjunction, such as coracoclavicular ligament reconstruction, often result in anatomically inadequate reconstructions of the trapezoid coracoclavicular ligament, leading to discomfort or residual pain for the patient.
An ancillary instrument for acromioclavicular disjunction surgery that allows for the reconstruction of both the trapezoid and conoid coracoclavicular ligaments, using a handle, arm, and drilling guide with central and auxiliary drill bushings to guide cannulated drill bits, protecting sensitive areas and enabling anatomically accurate reconstructions.
The instrument facilitates anatomically accurate ligament reconstruction, reducing the risk of complications by guiding drill bits to avoid sensitive areas and ensuring proper placement of artificial ligaments, thereby minimizing patient discomfort.
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Abstract
Description
Technical field of the invention The invention relates to the field of surgical instruments. The invention relates to an apparatus for guiding a surgical procedure for the reconstruction of a trapezoid coracoclavicular ligament or a surgical procedure for the reconstruction of both a trapezoid coracoclavicular ligament and a conoid coracoclavicular ligament. Prior Art Acromioclavicular disjunction is a dislocation of the acromioclavicular joint which connects the clavicle to the acromion. This dislocation accounts for 40% of shoulder injuries in athletes. This dislocation typically involves damage to the ligaments positioned between the clavicle and the coracoid process. These are the trapezoid coracoclavicular ligament and the conoid coracoclavicular ligament. When the ligament injuries reach a certain severity, surgical procedures are performed, though they often present complications. As taught in particular by FR patent 2 692 470, such procedures, known as coracoclavicular ligament reconstruction surgeries, involve adding one or more artificial ligaments between the clavicle and the coracoid process. They often involve drilling tunnels in the clavicle and sometimes in the coracoid process. In order to facilitate this surgery and limit the associated risks, an instrument designed to guide the drilling is illustrated in particular in patent US patent 9,072,510. Such an instrument assists in performing coracoclavicular trapezoid ligament reconstruction surgery by limiting the risks of complications during surgery. Indeed, the use of an instrument for this surgery notably enables to protect so-referred to as sensitive areas, dense with nerves and arteries by means of an instrument temporarily inserted into the patient's body during the operation and positioned along the axis in which the drilling is performed. This piece serves to block the drill bit used for drilling before it reaches a sensitive area during the drilling. However, the reconstruction of the coracoclavicular trapezoid ligament has the drawback of being anatomically inadequate. Indeed, by reconstructing only the trapezoid coracoclavicular ligament, the connection between the clavicle and the coracoid process is established in a manner different from the natural connection created by both coracoclavicular ligaments (the trapezoid coracoclavicular ligament and the conoid coracoclavicular ligament). This difference may lead to discomfort or residual pain for the patient. Disclosure of the invention The present invention aims to overcome the aforementioned drawbacks by proposing an ancillary instrument for acromioclavicular disjunction surgery. To this end, the ancillary instrument according to the invention enables the reconstruction of the trapezoid coracoclavicular and conoid coracoclavicular ligaments, while protecting the areas of the patient’s shoulder that are dense with nerves and arteries. The ancillary instrument of the present invention comprises: - a handle, in the shape of a circular arc, having two ends, referred to as the first and second ends, - an arm, longitudinal in shape, attached at a first end to the first end of the handle and equipped, at a second end, with a spoon-shaped part, referred to as the spoon, - a drilling guide, connected to the second end of the handle, having: o a central through-hole, the longitudinal axis of which passes through said spoon, o two auxiliary through-holes, arranged diametrically opposite with respect to the central through-hole, each of the two auxiliary through-holes having a longitudinal axis passing through said spoon, the two auxiliary through-holes forming a pair of auxiliary through-holes, - a so-called central drill bushing, suitable for being inserted into the central through-hole, - two so-called auxiliary drill bushings suitable for being inserted into the two auxiliary through-holes, The handle is used to manipulate the ancillary instrument. The central drill bushing in the shape of a hollow tube, into which a cannulated drill bit, also referred to as a drill bit suite, may be inserted. A cannulated drill bit refers to a hollow drill bit or a drill in the shape of a hollow tube, designed for drilling bones. In the context of an arthroscopic procedure to treat this acromioclavicular disjunction, a practitioner may choose between reconstructing the trapezoid coracoclavicular ligament, known as the coracoid tunnel reconstruction, or reconstructing both the trapezoid and conoid coracoclavicular ligaments, referred to as the lacing procedure. The lacing procedure has the advantage of restoring a connection between the clavicle and the coracoid process that is closer to the natural connection provided by the ligaments between these two bones. As a result, this lacing procedure is more anatomically accurate than the coracoid tunnel reconstruction. Coracoid tunnel reconstruction requires a single drilling of the clavicle and the coracoid process along a single axis. The lacing procedure requires two drillings in the clavicle, each following two respective axes that pass beneath the coracoid process without penetrating it. During a coracoid tunnel reconstruction, the practitioner first makes two incisions on the patient's body: a first incision above the clavicle and a second incision below the coracoid process, also referred to as the coracoid. The practitioner inserts the central drill bushing into the central through-hole of the drilling guide. Then, the practitioner inserts the central drill bushing through the first incision until it is placed securely on the clavicle. The practitioner then inserts the spoon through the second incision until it is placed securely beneath the coracoid. The practitioner may then use a cannulated drill bit, guided by the central drill bushing, to drill the clavicle and then the coracoid until it reaches the spoon. The longitudinal axis of the central hole in the drilling guide, and, therefore, of the central drill bushing, allows the cannulated drill bit to reach the scoop after drilling through the clavicle and then the coracoid. During a lacing procedure, similarly to a coracoid canal reconstruction, the practitioner makes two incisions on the patient's body, the first one above the clavicle and a second one either on the front of the shoulder below the coracoid, on the lateral side of the shoulder just above the humerus. The practitioner inserts the central drill bushing into the central through-hole of the drilling guide and each auxiliary drill bushing into an auxiliary through-hole. Then, the practitioner inserts the central drill bushing through the first incision, until it is placed securely on the clavicle. The practitioner then inserts the spoon, attached to the second end of the arm, into the second incision, until the spoon is placed securely below the coracoid. The practitioner may then drill using a cannulated drill bit, guided by the central drill bushing, through the clavicle and then the surface of the coracoid until reaching the first cortical layer. The first cortical layer is defined as the superficial layer of a bone. The ancillary instrument is thus held in position relative to the clavicle and the coracoid. The practitioner then drills through the clavicle twice with two cannulated drill bits, each guided by an auxiliary drill bushing. The two cannulated drill bits, respectively guided by each auxiliary drill bushing, pass through the clavicle, then run along both sides of the coracoid before finally reaching the spoon. The ancillary instrument according to the invention thus makes it possible to perform the necessary drilling operations, either for reconstruction of the coracoid canal or for lacing surgery, while limiting the risks incurred by the patient. Indeed, the drill bushings, suitable for being inserted into the through-holes along longitudinal axes passing through the spoon of the drilling guide, make it possible to guide cannulated drill bits during the drilling required for these operations, while protecting the patient's nerve- and arterial-dense area thanks to the spoon. In certain particular embodiments, the invention may further comprise one or more of the following features, taken individually or in any technically possible combination. According to one embodiment, the drilling guide comprises several pairs of auxiliary through-holes and, for each pair of auxiliary through-holes, the two auxiliary through-holes are arranged diametrically opposite with respect to the central hole, and each have a longitudinal axis passing through said spoon. During a lacing procedure, the practitioner may adapt the operation to the variations in shape 5 and location of the coracoid muscle depending on the patient. Indeed, by having several pairs of auxiliary through-holes, they will be able to choose the pair of auxiliary through-holes adapted to bypassing the coracoid during the two drillings. That is to say, in such a way that the cannulated drill bits do not penetrate the coracoid before reaching the spoon. According to one embodiment, the arm features a curvature oriented toward the handle. Said arm featuring a curvature advantageously allows for the use of what is known as a lateral approach. The term "approach" refers to the area of the patient's body on which the incisions are made at the beginning of the procedure. The coracoid tunnel reconstruction and lacing procedure may be performed using what is known as an anterior approach, meaning the incision to insert the spoon and arm is made at the shoulder on the front side of the patient's body. However, this area of the patient's body contains a major artery, making this approach riskier for the patient. When using the lateral approach, the incision to insert the spoon and arm is made at the shoulder on the lateral side of the patient's body. This involves an area of the patient's body without major arteries. However, using this approach, the humerus of the patient's arm prevents straight access to the coracoid. The arm's curvature, oriented toward the handle, allows for the superior bypass of the humerus to reach the coracoid, thus allowing for this lateral approach, which poses less risk to the patient. According to one embodiment, the central drill bushing comprises a Jacob's rasp at one end, referred to as the free end, oriented toward said spoon. A Jacob's rasp is an elongated piece curved like a claw, designed for scraping or rasping bones. During the reconstruction of the coracoid tunnel or a lacing procedure, the central drill bushing is pressed against the clavicle at the free end, and the Jacob's rasp hooks onto the edge of the clavicle, thus ensuring better stabilization of the ancillary instrument during drilling. According to one embodiment, the handle is adjustable. Patients exhibit variations in the dimensions and positions of their clavicle, coracoid, and humerus. The adjustable handle, particularly in terms of length, allows the distance between the drilling guide and the arm to be adjusted to accommodate these different variations when using the ancillary instrument. The handle is designed so that the center of the circular arc is located at the spoon, ensuring that the longitudinal axes of the central and auxiliary through-holes of the drilling guide always pass through the spoon, regardless of the handle's adjustment. According to one embodiment, the arm features a through-channel extending between the first end of the arm and the spoon. The through-channel advantageously allows for the passage of a Nitinol wire loop, referred to as a Nitinol loop. During a lacing procedure, before the start of the operation begins, a Nitinol loop is inserted into the through-channel of the arm. One end of this Nitinol loop is placed inside the spoon, while the other end, referred to as the free end, is kept outside the through-channel at the first end of the arm. After making the two drill holes, referred to as auxiliary drill holes, of the clavicle using the auxiliary drill bushings and after the cannulated drill bits have reached the spoon, the practitioner inserts a surgical wire into each of the two cannulated drill bits placed in the auxiliary drill bushings. The surgical wire has two ends referred to as first and second ends. Each surgical wire is inserted until their second end protrudes from the opening of the cannulated drill bit at the spoon while keeping their first end outside the patient. The practitioner then pulls on the free end of the Nitinol loop. When the Nitinol loop is pulled, its end placed in the spoon encloses the second end of the surgical wires protruding from the cannulated drill bits. The practitioner then withdraws the arm and the spoon from the patient's body, thus pulling the second end of the surgical wires outside the patient's body thanks to the Nitinol loop. Following these steps, the practitioner has two surgical wires, each end of which is outside the patient at the first incision, and each end outside the patient at the second incision. Each surgical wire passes through the patient's clavicle. The practitioner may then use these surgical wires to implant an artificial ligament which may consist, for example, of a first wire connecting an implant, referred to as a clavicle button, intended to be placed on the clavicle at one of the two auxiliary drill holes to an implant referred to as coracoid button intended 7 to be placed beneath the coracoid, and a second wire connecting a second clavicle button intended to be placed on the clavicle at the other auxiliary drill hole to the coracoid button. Indeed, the different implants may be more easily attached to the wires by the practitioner outside the patient's body. Thus, the arm featuring a through-channel extending between its first end and the spoon advantageously allows the practitioner to more easily position the components of an artificial ligament using a Nitinol loop and surgical wires. According to one embodiment, the ancillary instrument also includes at least one cannulated drill bit intended to be inserted into a central or auxiliary drill bushing. A cannulated drill bit is in the shape of a hollow tube into which one or more surgical wires, or a Nitinol loop, may be inserted. The at least one cannulated drill bit included in the ancillary instrument has a shape and diameter specifically designed to match the drill bushing used. According to one embodiment, the at least one cannulated drill bit has a groove representing a predetermined drilling depth. The groove may, for example, be a circular groove made on an outer circumferential surface of the cannulated drill bit. The groove may also be a longitudinal groove made on the outer longitudinal surface of the cannulated drill bit. This longitudinal groove has a length extending between two ends. When drilling to a predetermined depth, for example, during a lacing procedure, the practitioner may be able to determine that the first cortical layer of the coracoid has been reached when, in the case of a circular groove, said circular groove becomes visible just above one end of the central drill bushing, located on the side of the drilling guide. The practitioner may also be able to determine that the first cortical layer of the coracoid has been reached when, in the case of a longitudinal groove, one end of said longitudinal groove aligns with the end of the central drill bushing located on the side of the drilling guide. This at least one cannulated drill bit having a groove will preferably be used in conjunction with the central drill bushing. According to one embodiment, the at least one cannulated drill bit features a stop configured to bear on the drill bushing used. A cannulated drill bit generally has a substantially uniform 8 diameter along its entire length. A stop is defined as a local increase in the drill bit's outer diameter that prevents the drill bit from being inserted beyond this stop into a drill bushing. This prevents the drill bit from drilling deeper than a predetermined depth. According to one embodiment, for example, the spoon may have through-holes in its thickness, intended to accommodate the ends of cannulated drill bits guided by the auxiliary drill bushings. These through-holes in the spoon may, during a lacing procedure, facilitate the retrieval, thanks to the Nitinol loop in the spoon, of surgical wires inserted into the cannulated drill bits. In this case, the spoon no longer prevents the cannulated drill bits from reaching the patient's nerve- and arterial-dense area beneath the coracoid. A cannulated drill bit having a stop configured to rest on the drill bushing used will prevent the cannulated drill bit from reaching this nerve- and arterial-dense area. This at least one cannulated drill bit having a stop will preferably be used with the auxiliary drill bushings. Presentation of the figures The invention will be better understood upon reading the following description, given by way of non-limiting example, and with reference to the figures: [Fig. 1] a schematic representation of a reconstruction of the coracoid tunnel, [Fig. 2] a schematic representation of a lacing procedure, [Fig. 3] a schematic representation of an example embodiment of the ancillary instrument according to the invention, [Fig. 4] a schematic representation of example embodiments of cannulated drill bits, [Fig. 5] a schematic representation of the example embodiment of the ancillary instrument used during a lacing procedure, [Fig. 6] a schematic representation of an example embodiment of implants used in a coracoid tunnel reconstruction or in a lacing procedure, [Fig. 7] a schematic representation of an example embodiment of an arm and a spoon of the ancillary instrument, [Fig. 8] a schematic representation of an example embodiment of a spoon of the ancillary instrument. In these figures, identical references from one figure to another designate identical or similar elements. For reasons of clarity, the elements illustrated are not necessarily to the same scale, unless otherwise indicated. Detailed description of particular embodiments of the invention Fig. 1 shows a shoulder 1 of a patient. A clavicle 101, a coracoid process, hereinafter referred to as the coracoid 102, an acromion 103, a humerus 104, and a scapula 105 are also illustrated. Fig. 1 schematically illustrates a reconstruction of the trapezoid coracoclavicular ligament, also known as a coracoclavicular tunnel reconstruction. A coracoclavicular tunnel reconstruction involves placing an artificial ligament consisting of a wire 106, stretched between an implant, referred to as a clavicle button 107, placed on the clavicle, and an implant, referred to as a coracoid button 108, placed beneath the coracoid. A coracoclavicular tunnel reconstruction requires drilling of the clavicle 101 and the coracoid 102. The drilling of the clavicle 101 and the coracoid 102 must be performed along the same axis to allow for proper placement of the wire 106. Fig. 2 schematically shows a reconstruction of the trapezoid and conoid coracoclavicular ligaments, known as a lacing procedure. The lacing procedure requires two drill holes in the clavicle 101 in order to place an artificial ligament consisting of two wires 106, but no drill hole in the coracoid 102. Two clavicle buttons 107 are placed on the clavicle and one coracoid button 108 is placed beneath the coracoid. A wire 106 is stretched between each clavicle button 107 and the coracoid button 108. During a lacing procedure, the two wires 106 pass through the clavicle but do not pass through the coracoid. The drill holes in the clavicle 101 must be made along axes passing beneath the coracoid in order to allow the proper positioning of the wires 106. The placement of the wires 106 on either side of the coracoid allows the lacing procedure to be more anatomically adequate than the reconstruction of the coracoid tunnel. "More anatomically adequate" means that the artificial ligaments bind the various bones together in a way that more closely resembles how natural ligaments bind these same bones together. Fig. 3 schematically represents an example embodiment of an ancillary instrument 2 according to the invention. The ancillary instrument 2 according to the invention may be advantageously used both for reconstruction of the coracoid tunnel and for lacing procedures. The ancillary instrument 2 comprises a handle 201 in the shape of a circular arc. The handle 201 has two ends: a first end 222 to which an arm 202 is attached, and a second end 221 to which a drilling guide 204 is attached. The arm 202 is longitudinal in shape. It extends between two ends. A first end 223 of the arm is attached to the first end 222 of the handle. A second end 224 of the arm 202 is equipped with a part referred to as a spoon 203. The spoon 203 is a part, for example made of metal, whose shape allows it to adapt to the shape of the coracoid 102 in order to press against it from below. The handle 201 is designed so that a center of the circular arc is located at the spoon. In a preferred embodiment, illustrated in Fig. 3, the handle 201 is adjustable. Thus, the ancillary instrument allows the distance between the arm 202 and the drilling guide 204 to be adjusted to accommodate different morphologies of the patient's shoulder 1. In one embodiment, the handle 201 has a slot into which a guide element slides, also in the shape of a circular arc. A locking means 220 holds the guide element in position in the handle. When adjusting the handle 201, once the length between the arm 202 and the drilling guide 204 is adjusted to the patient's morphology, a practitioner may lock the handle using the locking means 220. In a preferred embodiment, as illustrated in Figure 3, the arm (202) features a curvature with its curve oriented toward the handle (201). This shape of the arm (202) advantageously allows it to bypass the humerus (104) to reach the coracoid process with the spoon (203) when a lateral approach is used for inserting the ancillary instrument into the patient's body. A lateral approach is defined as an incision made to insert the spoon and arm into the patient's body at a lateral aspect of the patient's shoulder 1. In another embodiment, the arm 202 does not have a curvature. In this case, an anterior approach may be used to insert the ancillary instrument into the patient's body. An anterior approach is defined as an incision made to insert the spoon and arm into the patient's body from a 11 front aspect of the patient's shoulder. This makes it possible to reach the coracoid 102 without having to bypass the humerus 104. The drilling guide 204 has a central through-hole 205, with its longitudinal axis 405 passing through the spoon 203. A central drill bushing 207 is designed to fit into the central through-hole 205. The central drill bushing 207 has the shape of a hollow tube, configured to accommodate and guide a cannulated drill bit 301, also referred to as a drill bit. The central through-hole 205, whose longitudinal axis 405 passes through the spoon, ensures that a cannulated drill bit guided by the central drill bushing inevitably emerges in the spoon 203. The drilling guide 204 comprises through-holes referred to as auxiliary through-holes 206. Each auxiliary through-hole 206 is oriented along a longitudinal axis 406 passing through the spoon 203. The auxiliary through-holes 206 of the drilling guide 204 are intended to accommodate auxiliary drill bushings 208. Cannulated drill bits 301 are intended to be inserted into the auxiliary drill bushings 208. The auxiliary through-holes 206 and the auxiliary drill bushings are advantageously intended for lacing procedures, as will be described later. Only two auxiliary through-holes 206 and two auxiliary drill bushings are used for a lacing procedure. The auxiliary through-holes 206 of the drilling guide 204 are arranged in diametrically opposed pairs around the central through-hole 205. In one embodiment (not illustrated), the drilling guide 204 features a single pair of auxiliary through-holes 206. The two auxiliary through-holes of the pair of auxiliary through-holes and the central through-hole are aligned. In another embodiment, the drilling guide 204 features multiple pairs of auxiliary through-holes. This allows the practitioner, during a lacing procedure, to adapt to the patient's morphology by selecting the pair of auxiliary through-holes that that enable the procedure to be performed without drilling into the coracoid. In the preferred but non-limiting example of Fig. 3, the drilling guide comprises eight auxiliary through-holes. In a preferred embodiment, as illustrated in Fig. 3, the central drill bushing 207 comprises, at 12 one free end, oriented towards the spoon 203, a Jacob's rasp 209. The Jacob's rasp is a part, generally made of metal, with an elongated and curved shape substantially similar to the shape of a claw. This Jacob's rasp 209 advantageously enhances the stability of the ancillary instrument by hooking onto an edge of the clavicle 101 before drilling is performed. Fig. 4 schematically represents two example embodiments of cannulated drill bits 301. A cannulated drill bit 301, also called a cannulated bur, is an elongated part in the shape of a hollow tube designed for implantation in a patient's body and for drilling into bones. The cannulated drill bit 301 is hollow so that it can accommodate surgical wires or a Nitinol loop. In an example embodiment, the cannulated drill bit comprises a groove 302 on a circumferential surface of said cannulated drill bit 301, providing an indication to the practitioner that the cannulated drill bit has reached a desired depth. The practitioner may, for example, determine that the target depth has been reached when the groove 302 is positioned just above one end of the central drill bushing, located on the side of the drilling guide 204. In an example embodiment, the cannulated drill bit 301 comprises a stop 303 on its circumferential surface. This stop is characterized by a localized increase in the external diameter of the cannulated drill bit. This stop is configured to bear on the drill bushing used, thus advantageously preventing the cannulated drill bit 301 from exceeding a predetermined depth. As a result, sensitive areas of the patient's body are protected during drilling. In one embodiment, as illustrated in Fig. 8, the spoon has two through-openings 212 in its thickness. Each of the two openings is positioned at the virtual intersection of the longitudinal axis of an auxiliary through-hole of the drilling guide with the spoon. The drill bits guided by the auxiliary drill bushings pass through both openings in the spoon. In this case, using drill bits with a stop is particularly advantageous for protecting the sensitive area beneath the coracoid. In one embodiment, as illustrated in Fig. 7, the arm 202 has a through-channel 210, extending between the first end 223 of the arm and the spoon 203. The through-channel 210 is advantageously used for lacing procedures, as will be described later, in particular for the passage of surgical wire or a Nitinol wire loop. For example, and as illustrated in Fig. 8, a first end of a loop 211 of Nitinol 13 wire, referred to as a Nitinol loop, protrudes from the through-channel 210 so that the first end of the Nitinol loop is positioned in the spoon 203. Fig. 6 is a schematic representation of implants used in a coracoid tunnel reconstruction operation or in a lacing procedure. An implant is understood to mean a part intended to remain permanently in the body of a patient after a surgical procedure. A first implant 108, referred to as a coracoid button, is illustrated in this Fig. 6. The coracoid button has a curved shape advantageously allowing it to adapt to the shape of the coracoid to be placed in abutment beneath the coracoid. A second implant 107, referred to as a clavicle button, is also illustrated in Fig. 6. This clavicle button 107 is designed to be placed on the clavicle 101 during a lacing procedure or during a reconstruction of the coracoid tunnel. In an example embodiment of the ancillary instrument 2 for the reconstruction of the coracoid tunnel, the practitioner uses only the central drill bushing, while the auxiliary drill bushings are not used. The arm 202 of the ancillary instrument is curved to enable a lateral approach and bypass the humerus. The practitioner makes two incisions on the patient's shoulder: a first incision is made above the clavicle 101 and a second incision is made at the gap between the humerus 104 and the acromion 103. The practitioner then manipulates the ancillary instrument 2 using the handle 201 as follows: - the free end of the central drill bushing 207 is inserted into the first incision until the free end of the central drill bushing 207 is resting on the clavicle 101. - the spoon 203, fitted on one end of the arm 202, is then inserted until the spoon 203 is resting beneath the coracoid. When the central drill bushing includes a Jacob's rasp, the Jacob's rasp hooks onto the clavicle, as illustrated in Fig. 5. The practitioner may then perform the drilling required for the reconstruction of the coracoid tunnel using a cannulated drill bit 301, guided by the central drill bushing 207. The cannulated drill bit 301 is used to drill the clavicle 101 and then the coracoid 102. The area of the patient's body beneath the coracoid 102 is considered a sensitive area, as it contains a high concentration of nerves and arteries. During drilling, the spoon 103 advantageously prevents the cannulated drill bit 301 from reaching this sensitive area by stopping the tip of the cannulated drill bit just after the coracoid has been perforated. In an example embodiment of the ancillary instrument 2 in a lacing procedure, as illustrated in Fig. 5, the practitioner uses the central drill bushing along with two auxiliary drill bushings. The arm 202 of the ancillary instrument is curved to facilitate a lateral approach and bypass the humerus. The practitioner also makes two incisions on the patient's shoulder: a first incision above the clavicle 101 and a second incision at the gap between the humerus 104 and the acromion 103. The practitioner then manipulates the ancillary instrument 2 using the handle 201 as follows: - the free end of the central drill bushing 207 is inserted into the first incision until the free end of the central drill bushing 207 rests on the clavicle 101. - the spoon 203 its then inserted until it rests beneath the coracoid. When the central drill bushing includes a Jacob's rasp, the Jacob's rasp hooks onto the clavicle, as illustrated in Fig. 5. A cannulated drill bit is then inserted into the central drill bushing 207 to drill through the clavicle 101 and reach the first cortical layer of the coracoid 102. The term first cortical layer refers to the superficial layer of a bone. This drilling of the clavicle guided by the central drill bushing is generally not used to insert an artificial ligament during a lacing procedure. However, it does ensure that the ancillary instrument 2 is held in position during the auxiliary drilling operations which are guided by the auxiliary drill bushings. Two cannulated drill bits 301 are inserted into two auxiliary drill bushings 208 and allow the clavicle 101 to be drilled in two locations. The auxiliary drill bushings have been previously positioned in two auxiliary through-holes diametrically opposite with respect to the central through-hole, based on the patient's morphology, so as not to drill the coracoid with the cannulated drill bits. As illustrated in Fig. 5, in a non-limiting manner, the cannulated drill bit inserted into the central drill bushing 207 features a groove 302. This groove advantageously serves as an indicator to the practitioner that the first cortical layer of the coracoid has been reached. Also illustrated in Fig. 5, in a non-limiting manner, the cannulated drill bits inserted into the auxiliary drill bushings include a stop 303. This stop 303 is particularly beneficial in protecting the sensitive area beneath the coracoid. 5 The Nitinol loop 211 is inserted into the through-channel 210 so that its first end is positioned within the spoon 203, while its other end, referred to as the free end, extends beyond the through-channel at the first end of the arm 202. After completing the auxiliary drillings, the practitioner inserts a surgical wire into each of the cannulated drill bits placed in the auxiliary drill bushings. Each surgical wire has two ends, referred to as the first and second ends. The first end of each 10 surgical wire is held outside the patient's body, above the clavicle. The second end of each surgical wire protrudes from the cannulated drill bit inside the patient's body, at the spoon. The practitioner then pulls on the free end of the Nitinol loop. As the Nitinol loop is pulled, its first end hooks onto the second end of the surgical wires. The practitioner subsequently removes the spoon from the patient’s body. When the spoon is withdrawn from the patient’s body, the Nitinol loop pulls the 15 second end of each surgical wire out of the patient’s body. As a result, the practitioner now has two surgical wires passing through the clavicle 101, with both ends outside the patient’s body. These wires may then be used to position the clavicle buttons 107 at each auxiliary drill hole and to secure the coracoid button 108 beneath the coracoid, at the location previously occupied by the spoon 203. Thanks to the through-channel 210 of the arm 202, the practitioner may easily extract 20 the ends of the surgical wires passing through the patient’s clavicle, thereby facilitating the fixation of implants onto these surgical wires
Claims
1. An ancillary instrument (2) for acromioclavicular disjunction surgery comprising:- a handle (201), in the shape of a circular arc, having two ends, referred to as the first (222) and second (221) ends,- an arm (202), longitudinal in shape, attached at a first end (223) to the first end (222) of the handle (201) and equipped, at a second end (224), with a spoon-shaped part, referred to as the spoon (203),- a drilling guide (204), connected to the second end (221) of the handle (201), having:o a central through-hole (205), the longitudinal axis (405) of which passes through said spoon (203),o two auxiliary through-holes (206), arranged diametrically opposite with respect to the central hole (205), each of the two auxiliary through-holes (206) having a longitudinal axis (406) passing through said spoon (203), the two auxiliary through-holes (206) forming a pair of auxiliary through-holes,- a so-called central drill bushing (207) suitable for being inserted into the central through-hole (205),- two so-called auxiliary drill bushings (208) suitable for being inserted into the two auxiliary through-holes (206).
2. The ancillary instrument (2) according to claim 1, wherein the drilling guide (204) comprises several pairs of auxiliary through-holes (206), and wherein, for each pair of auxiliary through-holes, the two auxiliary through-holes (206) are arranged diametrically opposite with respect to the central hole (205), and each have a longitudinal axis (406) passing through said spoon (203).
3. The ancillary instrument (2) according to one of the preceding claims, wherein the arm (202) has a curvature oriented towards the handle (201).
4. The ancillary instrument (2) according to one of the preceding claims, wherein the central drill bushing (207) comprises a Jacob's rasp tool (209) at one end, referred to as the free end,oriented towards said spoon (203).
5. The ancillary instrument (2) according to one of the preceding claims, wherein the handle (201) is adjustable.
6. The ancillary instrument (2) according to one of the preceding claims, wherein the arm 5 (202) has a through-channel (210) extending between the first end of the arm and the spoon (203).
7. The ancillary instrument (2) according to one of the preceding claims, also comprising at least one cannulated drill bit (301) designed to be inserted into a central (207) or auxiliary (208) drill bushing.
8. The ancillary instrument (2) according to claim 7, wherein the at least one cannulated drill 10 bit (301) has a groove (302) representing a predetermined drilling depth.
9. The ancillary instrument (2) according to claims 7 or 8 wherein the at least one cannulated drill bit (301) has a stop (303) configured to bear on the drill bushing used.