Surgical tools and joint kinematic reconstruction techniques

Abstract

The present disclosure relates to surgical instruments and methods. The surgical instrument (22) may include a handle (24), a first rod (26) extending from the handle, and a second rod (28) extending from the handle. At least one of the first rod and the second rod is rotatable between a folded position and an expanded position. The first rod and the second rod may be closer together in the folded position than in the expanded position.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims priority to U.S. application No. 15 / 973,470, filed May 7, 2018. Technical Field

[0003] The present disclosure relates to surgical tools and various surgical techniques for improving the arthrokinematics of unstable joints. Background Art

[0004] Normal joint kinematics are achieved by the balanced soft tissue surrounding the articulating bones of a joint. Joint instability can occur if there is significant disruption of the articulating bones or surrounding soft tissue. Joint instability can also occur within a replaced joint after arthroplasty. The resulting joint instability can lead to pain, dysfunction, accelerated bone loss, soft tissue tears, and premature arthritis. Summary of the Invention

[0005] The present disclosure relates to surgical tools and techniques. The surgical tools may include a handle and one or more rods extending from the handle. The surgical tools can be positioned between a folded position and an expanded position. These techniques can be used to reconstruct and / or improve the arthrokinematics of any joint in the human musculoskeletal system.

[0006] A surgical tool according to an exemplary aspect of the present disclosure may include, inter alia, a handle, a first rod extending from the handle, and a second rod extending from the handle. At least one of the first rod and the second rod is rotatable between a folded position and an extended position. The first rod and the second rod may be closer together in the folded position than in the extended position.

[0007] A surgical tool according to an exemplary aspect of the present disclosure may include a handle having a first opening, a second opening, and a third opening. A first rod may extend from the handle and be received in the first opening. A second rod may be selectively received in the second opening and the third opening.

[0008] A surgical method of attaching a graft to a joint according to another exemplary aspect of the present disclosure may include, inter alia, rolling the graft on a surgical tool outside the joint space. The surgical tool may be inserted through a portal along with the rolled graft. The graft may be unfolded within the joint space by the surgical tool.

[0009] The embodiments, examples and alternatives of the preceding paragraphs, claims or following description and drawings, including any of their various aspects or corresponding individual features, may be obtained independently or in any combination. Features described in conjunction with one embodiment are applicable to all embodiments, unless these features are incompatible.

[0010] The various features and advantages of the present disclosure will become apparent to those skilled in the art from the following detailed description.The drawings that accompany the detailed description can be briefly described as follows. BRIEF DESCRIPTION OF THE DRAWINGS

[0011] Figure 1 The joints of the human musculoskeletal system are shown.

[0012] Figure 2 Example surgical tools are shown.

[0013] Figure 3 Shown Figure 2 Examples of surgical tools.

[0014] Figure 4 Shown Figures 2 to 3 Examples of surgical tools.

[0015] Figure 5 Shown Figures 2 to 4 Examples of surgical tools.

[0016] Figure 6 Another example surgical tool is shown.

[0017] Figure 7 Shown Figure 6 Example of the face of a surgical tool handle.

[0018] Figure 8 Shown in folded position Figures 6 and 7 Examples of surgical tools.

[0019] Figure 9 Another example surgical tool is shown.

[0020] Figure 10 Shown in folded position Figure 9 Examples of surgical tools.

[0021] Figure 11 The retrieval and passage of multiple sutures through the graft is schematically shown.

[0022] Figure 12 The arrangement of the implant in an example surgical tool is schematically shown in a deployed position.

[0023] Figure 13 Schematically shows the Figure 10 Example surgical tools for placement of implants.

[0024] Figure 14 Schematic diagram showing the delivery of a graft into a joint space, wherein the graft and Figure 10 The surgical tool is in the deployed position. DETAILED DESCRIPTION

[0025] Figure 1 A joint 10 of the human musculoskeletal system is shown. Joint 10 can be any joint of the human musculoskeletal system. In one embodiment, joint 10 is the glenohumeral joint of the shoulder. Joint 10 includes multiple bones, including a scapula 12 and a humerus 16. Some of these bones articulate relative to each other. For example, joint 10 includes a ball-and-socket joint formed between a head 18 of humerus 16 and a glenoid 14, which is a cup-shaped depression in scapula 12 that is configured to receive head 18.

[0026] The joint capsule 20 typically covers the joint 10 and is surrounded and reinforced by various muscles, tendons, and ligaments that are responsible for holding together the adjacent bones of the joint 10. If there is significant damage to the articulating bones (e.g., the humerus 16 and glenoid 14), the joint capsule 20, or other surrounding muscles, tendons, and / or ligaments, the joint 10 may become unstable. In one embodiment, the joint 10 may become unstable in response to a massive, irreparable rotator cuff tear.

[0027] The present disclosure describes arthroscopic reconstruction techniques for reconstructing an unstable joint, such as in response to a massive, irreparable rotator cuff tear or other injury. Although arthroscopic reconstruction of the shoulder joint is described throughout this disclosure as an example arthroscopic reconstruction technique, this disclosure is not intended to be limited to shoulder joint reconstruction. In other words, the various techniques described herein can be used to reconstruct and / or improve the arthroscopic kinematics of any joint of the human musculoskeletal system.

[0028] Figure 2 An exemplary surgical tool 22 is shown that may be used in a surgical procedure such as a kinematic reconstruction technique. The surgical tool 22 includes a handle 24 and a first shaft 26 and a second shaft 28 extending from the handle 24. The exemplary shaft 26 is received in an opening 30 in the handle 24 and may include a slot 32 extending to a distal end 34 thereof for receiving a graft (not shown). The shaft 28 is received in an opening 36 in the handle spaced apart from the opening 30. The shaft 28 may include a slot 38 extending to a distal end 40 thereof for receiving a graft. In another embodiment, the slots 32, 38 do not extend to the distal end. Although the slots 32, 38 are used to receive a graft in this example, in some examples, the graft may be received in the same manner as in the example. Figures 9 and 10 Other attachment members, including those shown, may also be used to attach the graft to the rods 26 , 28 .

[0029] Figure 3An example surgical tool 22 is shown having a rod 28 extending along and rotatable within an axis A1 that extends through an opening 36 in a handle 24. The rod 28 may include a knob 42 near a proximal portion 44 thereof that is opposite a distal end 40 of the handle 24. The knob 42 may be manipulated to provide rotational input to the rod 28. In the example surgical tool 22, the rod 26 is fixed; however, in other examples, both rods 26, 28 may be rotatable. One or both of the rods 26, 28 may be rotated to fold a graft received in the rods 26, 28 prior to shuttling the graft to a graft site, such as within a joint space, as discussed further below. The surgical tool 22 may be used to fold a graft for ease of insertion through an opening, an example of an opening being an arthroscopic portal, such as a cannula, during an arthroscopic procedure.

[0030] The rod 28 may include an offset portion 46 that is offset from the main portion 48, such that a central axis A2 extending through the offset portion 46 is spaced apart from the axis A1 by a distance D1. The offset portion 46 may be distal to the main portion 48. However, other offset configurations are contemplated within the scope of the present disclosure. In one example, the main portion 48 is rotatable about the axis A1 and includes a portion 48A received in the handle 24 and a portion 48B extending distally from the handle 24. The example rod 26 does not have an offset; however, in other examples, both rods 26 and 28 may have an offset. The rod 26 extends along a central axis A3. In some examples, two or more of the axes A1, A2, and A3 may be substantially parallel, and in the example shown, the axes A1, A2, and A3 are substantially parallel.

[0031] Figure 4 A graft 49 is shown being received by the first shaft 26 and the second shaft 28 of the surgical tool 22. The surgical tool 22 and the graft 49 are shown in an expanded position. In one example, in the expanded position, the offset portion 46 of the shaft 28 is at its maximum distance D2 from the first shaft 26, maximizing coverage of the graft 49 by the shafts 26, 28. In some examples, the expanded position of the graft 49 mimics the desired implantation position of the graft during surgery. Utilizing one or more offsets allows the distance D2 to be greater than without the offsets, thereby providing greater control and stability when weaving and deploying the graft 49 during surgery.

[0032] The graft 49 may comprise an allograft or an autologous graft. In one embodiment, the graft 49 is an acellular dermal extracellular matrix. is a type of implant 49 that is suitable for use in performing the exemplary joint kinematic reconstruction technique.

[0033] Figure 5 The implant 49 is shown received in the folded position in the first and second rods 26, 28 of the surgical tool 22. The knob 42 can be rotated in the direction R to rotate the rods 28 from the deployed position to the folded position. In the folded position, the biasing portion 46 is wider than it is in the folded position. Figure 4 In the expanded position shown, the graft 49 and the rods 26, 28 are closer to the first rod 26. In one example, the knob 42 may include one or more protrusions 47, and the handle 24 may include one or more protrusions 51, which are configured to engage with the protrusion 47 at the rotation limit, which can be set to any rotation angle. In the collapsed position, the graft 49 and the rods 26, 28 can be shuttled through an opening having a diameter or width less than the distance D2 ( Figure 4 ).

[0034] Figure 6 Another exemplary surgical tool 122 is shown. Surgical tool 122 is similar to surgical tool 22, except that it includes a third opening 150 in handle 124 for receiving a second shaft 128. First shaft 126 can be fixed and received in opening 130 of handle 124; in other examples, first shaft 126 can rotate within opening 130. Second shaft 128 can be received in opening 136 as shown, or it can be removed from opening 136 and then inserted into third opening 150. The positioning of second shaft 128 can be adjusted by providing openings 136 and 150, each of which can receive second shaft 128. In some examples, this adjustability is based on a desired spread distance D3 between offset portion 146 and first shaft 126, which is the maximum width between offset portion 146 and first shaft 126 in the expanded position. The actual spread distance D3 can be set to any desired size to accommodate implants of varying sizes. In some examples, the first shaft 126 further includes an offset portion, and the distance D3 is the maximum width between the offset portion of the first shaft 126 and the offset portion of the second shaft 128 in the deployed position.

[0035] Adjustability may additionally or alternatively be based on a desired spread distance D4 between the main portion 148 and the first shaft 126. The spread distance D4 is the maximum width between the main portion 148 of the first shaft 126 and the second shaft 128.

[0036] However, in other examples, the first rod 126 may alternatively be biased, or both the first rod 126 and the second rod 128 may be biased. In another example, the non-biased rod of the rods 126, 128 is a removable and interchangeable rod.

[0037] Figure 7 An end view of the distal end face 152 of the handle 124 is shown. Figure 7 , first rod 126 and second rod 128 are removed. The center of opening 130 and the center of opening 136 are separated by a distance D5. The center of opening 130 and the center of opening 150 are separated by a distance D6. The center of opening 136 and the center of opening 150 are separated by a distance D7. In one example, distance D5 is different from distance D6. In one example, openings 130, 136, and 150 are substantially linearly aligned; however, a nonlinear arrangement of openings 130, 136, and 150 may alternatively be utilized. Furthermore, while three openings are shown in this example, more than three openings may be used in other examples.

[0038] Figure 8 An example surgical tool 122 is shown in a folded position. As shown, in one example, a portion of the biasing portion 146 can be rotated beyond the first shaft 126 in the folded position. In other examples, the biasing portion 146 does not rotate beyond the first shaft 126 in the folded position, or is rotated to be substantially aligned with the first shaft 126. Thus, the adjustability of the surgical tool 122 can additionally or alternatively be based on a desired deployed distance D8 between the shafts 126, 128 when positioned in the folded position. In the example shown where the biasing portion 146 is rotated beyond the first shaft 126 in the folded position, the distance D8 is the maximum width of the main portion 148 of the shaft 128 and the biasing portion 146. The distance D8 can be selected based on, among other factors, the size of the arthroscopic portal to be used.

[0039] Figure 9 An example surgical tool 222 is shown in a deployed position. In this example, rod 226 is rotatable about axis A3, and rod 228 is rotatable about axis A1. In some examples, both rods 226, 228 are rotatable between 0-90 degrees. In other examples, one of rods 226, 228 may be fixed. In this example, rod 226 includes an offset portion 245, and rod 228 includes an offset portion 246. In other examples, only one of rods 226, 228 includes an offset portion. Rod 226 includes a suture slot 232, which may be positioned at offset portion 245. Rod 228 includes a suture slot 238, which may be positioned at offset portion 246. In this example, each rod 226, 228 includes two suture slots 232, 238, although more or fewer suture slots may be used. Suture slots 232, 238 are configured to receive one or more suture strands, suture tape, any other suture-like product or any thread-like material that can be attached to the graft. In one example, suture is attached at the four corners of the graft, and suture is received in slits 232, 238.

[0040] Each suture slot 232, 238 can include an elongated portion 270 extending along its corresponding rod 226, 228 and an entry portion 272 extending transverse to the elongated portion 270 and to the outer surface of the corresponding rod 226, 228. In some examples, the suture is received in the rod 226, 228 through the entry portion 272 and is secured in the elongated portion 270.

[0041] Figure 10 An example surgical tool 222 is shown in a collapsed position. Rods 226, 228 are rotated so that the offset portions 245 and 246 are closer to each other than when they are in the deployed position.

[0042] The example surgical tools 22 / 122 / 222 can be used in joint kinematic reconstruction techniques. For example, these techniques can include upper joint capsule reconstruction. In other examples, the example surgical tools 22 / 122 / 222 can be used in any technique in which a graft can be positioned against bone.

[0043] like Figure 11 As shown, the surgeon can start the example joint kinematics reconstruction technique 300 by selecting the desired position in which various sutures 354 are fixed in the joint space 356. The fixing position of the suture 354 can be selected based on the surgeon's preference and is selected to best restore the joint kinematics of the repaired joint. The suture 354 can include a single suture strand, multiple suture strands, a suture tape, any other suture-like product or any linear material. The suture 354 can be fixed inside the joint space 356 using various suture anchors 358. The hole 360 ​​can optionally be pre-formed for receiving the suture anchor 358, such as in some examples using a drill, a punch and / or other tools (not shown).

[0044] Any number of suture anchors 358 may be secured within the joint space 356 for attaching the sutures 354, and the present disclosure is not limited to the specific number of suture anchors shown in this embodiment. The actual number of suture anchors 358 used is procedure-specific and can be quantified as the minimum number of suture anchors necessary to achieve graft fixation to one or more bones of the unstable joint.

[0045] Graft 349 can be used to reconstruct an unstable joint. Holes 362 can be bored through graft 349 at intervals corresponding to the spacing of holes 360. Holes 362 are oriented and configured to receive sutures 354 attached to implanted suture anchors 358. Holes 362 allow sutures 354 to slide relative to graft 349 as graft 349 is shuttled, pulled, manipulated, or otherwise maneuvered into position within joint space 356.

[0046] like Figure 11As shown, the graft 349 is first aligned and oriented at a location outside or outside the joint space 356 in a manner that simulates its implantation location. The sutures 354 already secured inside the joint space 356 can then be retrieved from each implanted suture anchor 358, pulled outward through the cannula 364, and then inserted through the graft 349 while the graft 349 is located outside the joint space 356. Each hole 362 of the graft 349 is configured to accommodate one or more sutures 354. One of ordinary skill in the art will be able to locate the various arthroscopic portals required for performing arthroscopic surgery. In another embodiment, the sutures 354 are retrieved from the joint space 356 one by one (i.e., sequentially), passed through the appropriate holes 362 of the graft 349, and then tightened before additional sutures 354 are shuttled through the cannula 364. In other embodiments, one or more sutures 354 can be passed through the graft 349 after the graft 349 has been shuttled into the joint space 356.

[0047] Figure 12 The surgical tool 322 is shown receiving the implant 349 outside the sleeve 364 relative to the joint space 356. The surgical tool 322 is in the deployed position and receives the implant 349 in its simulated implant position. In the example shown, the rods 326, 328 are arranged inside the opening 362 relative to the implant 349. In another example, the rods 326, 328 can be arranged outside the opening 362 relative to the implant 349. Figures 9 and 10 In some examples, at this location, sutures 354 passing through graft 349 are received in suture openings in rods 326, 328. Figures 6 to 8 In the illustrated embodiment, in some examples, one of the first rod 326 and the second rod 328 may be adjustable within an opening in the handle 324 based on a desired spacing of the rods 326 , 328 for the size of the implant 349 or the joint 356 .

[0048] Figure 13 The surgical tool is shown receiving a graft 349 outside of a sleeve 364 and rotated to a folded position relative to the joint space 356. Rod 328 is rotated so that the surgical tool 322 and the graft 349 are in the folded position. In other examples, both rods 326 and 328 can be rotated, including examples in which one or both of the rods 326 and 328 have offset portions. In the folded position, the rods 326, 328 and the graft 349 can fit through an opening 366 in the sleeve 364 for shuttling the graft 349 to the joint space 356. The graft 349 is thus shuttled through the opening 366 to the joint space 356 in the folded position. In some examples, the surgeon can manually provide additional folding to the end 368 of the graft 349 prior to insertion.

[0049] Figure 14Shown is the graft 349 in joint space 356 after being shuttled to joint space 356.As shown, surgical tool 322 is rotated to the expanded position now, allows graft 349 to be arranged at its implantation position.That is, after rod 326 and 328 and graft 349 are shuttled through sleeve 364, rod 328 is rotated to the expanded position, to expand graft 349, for being arranged at its implantation position.Then, rod 326,328 can be disengaged from graft 349, such as by removing graft 349 or from the suture slot (not shown) in rod 326,328 in some examples suture 354 is removed from the slit (not shown) in rod 326,328.The tensioning of suture 354 can occur before and / or after the disengagement of rod 326,328 for positioning graft 349.Then graft 349 can be fixed to the bone of joint.

[0050] Although different embodiments are shown with specific components, the embodiments of the present disclosure are not limited to those specific combinations. It is possible to use some components or features from any embodiment in combination with features or components from any other embodiment.

[0051] It should be understood that throughout the several drawings, like reference numerals indicate corresponding or similar elements. It should also be understood that although particular component arrangements are disclosed and shown in these exemplary embodiments, other arrangements may also benefit from the teachings of this disclosure.

[0052] The foregoing description should be interpreted as illustrative and should not be interpreted in any limiting sense. It will be understood by those skilled in the art that certain modifications may fall within the scope of this disclosure. For these reasons, the following claims should be studied to determine the true scope and content of this disclosure.

Claims

1. A surgical tool for attaching a graft to a joint and / or for positioning a graft against bone and / or for reconstructing joint kinematics, comprising: handle; a first rod extending from the handle and fixedly received in the opening of the handle; and a second rod extending from the handle, wherein the second rod is rotatable between a folded position and a deployed position, wherein the first rod and the second rod are closer together in the folded position than in the deployed position, wherein the first rod includes a first attachment member configured to attach a graft to the first rod, and the second rod includes a second attachment member configured to attach the graft to the second rod.

2. The surgical tool according to claim 1, wherein The second rod is rotatable about an axis passing through the second rod within the handle and includes a distal portion offset from a proximal portion.

3. The surgical tool according to claim 1, wherein The first and second attachment members are slots configured to receive the implant.

4. The surgical tool according to claim 1, wherein The first attachment member and the second attachment member are suture slots.

5. The surgical tool according to claim 1, wherein Each of the first rod and the second rod is rotatable.

6. The surgical tool according to claim 1, comprising a knob near the proximal end portion of the second rod for rotating the second rod.

7. A surgical tool for attaching a graft to a joint and / or for positioning a graft against bone and / or for reconstructing joint kinematics, comprising: a handle, the handle being provided with a first opening, a second opening, and a third opening; a first rod extending from the handle and fixedly received in the first opening; and a second rod selectively receivable in the second opening and the third opening, Wherein, the first rod includes a first attachment member configured to attach a graft to the first rod, and the second rod includes a second attachment member configured to attach the graft to the second rod.

8. The surgical tool according to claim 7, wherein: The first shaft includes a distal portion offset relative to a proximal portion.

9. The surgical tool according to claim 7, wherein: The second shaft includes a distal portion offset relative to a proximal portion.

10. The surgical tool according to claim 9, wherein The second lever is rotatable within the second opening and the third opening between a folded position and a deployed position.

11. The surgical tool according to claim 7, wherein: The second opening is a first distance from the first opening, the third opening is a second distance from the first opening, and the second distance is different from the first distance.

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