Angled pilot hole entry for orthopedic guides

Abstract

The device may include a cutting instrument configured to cut a patient's bone with one or more cutting mechanisms. The device may include a guide configured for attachment to the bone, the guide may define an aperture having a guide hole portion and a pilot hole portion, the pilot hole portion configured to initially receive a portion of the bone cutting instrument, and an axis of the pilot hole portion oriented at an acute angle relative to an axis of the guide hole portion.

Description

[Technical Field]

[0001] (Priority Claim) This application claims the benefit of U.S. Provisional Patent Application No. 63 / 416,101, filed October 14, 2022, and U.S. Provisional Patent Application No. 63 / 426,609, filed November 18, 2022. The benefit of these priority claims made in this application and these U.S. provisional patent applications are incorporated herein by reference in their entireties.

[0002] SUMMARY The present disclosure relates to orthopedic systems, methods, and apparatus, including guides for directing cutting devices during arthroplasty procedures. [Background technology]

[0003] In the human body, tissues may require repair. Such tissues include bones, muscles, tendons, ligaments, and cartilage. Forced twisting, trauma, or rotation of the knee, shoulder (or other joint) may tear or damage tissue. Disease may also require replacing the bones of a joint with one or more prosthetic components. Thus, surgical repair of tissue may be necessary in a variety of circumstances.

[0004] Such replacement may require reaming or other cutting and preparation of the bone. Such repairs may include guides to facilitate the cutting / preparation of the bone. Various guide assemblies have been developed to direct bone cutting instruments, and these guide assemblies are generally effective for their intended purposes. However, improved guides to facilitate the cutting / preparation of the bone would be desirable.

[0005] In a healthy shoulder, the proximal humerus is approximately spherical and articulates within a socket defined by the scapula, called the glenoid, to form the shoulder joint. Conventional implant systems for total shoulder replacement due to disease or trauma, i.e., total shoulder arthroplasty, generally replicate the natural anatomy of the shoulder and typically include a humeral component with a stem that fits within the humeral canal and an articular head that articulates within the socket of the glenoid component, which is implanted within the glenoid of the scapula.

[0006] Various types of shoulder implant systems are known, including conventional or reverse shoulder replacements, revision shoulder replacements, and partial (hemi) shoulder replacements. Summary of the Invention [Means for solving the problem]

[0007] The present disclosure provides orthopedic systems including bone-cutting devices, drivers, guides, and other components. The disclosed systems, apparatus, and methods can be used for a variety of purposes, including joint repair and bone repair following trauma. [Effects of the Invention]

[0008] The inventors have recognized that certain aspects of a joint replacement procedure, such as guiding a reamer into the glenoid during a shoulder replacement procedure, can be overly complicated and time-consuming. This occurs because the patient's soft tissue obstructs the reamer's approach to the guide. Specifically, the guide bore of the guide is undesirably angled relative to the soft tissue. As a result, the surgeon must manipulate the soft tissue and insert the reamer against it to obtain the desired orientation for entry into the guide bore. Such manipulation can be undesirable when greater exposure is required, for example, in the case of a posterior glenoid augmentation scenario, as the process can be time-consuming and can result in unnecessary trauma to the soft tissue.

[0009] The inventors have recognized a guide with a pilot hole that is angled relative to the guide hole. Such an angled pilot hole allows the surgeon to have a more desirable approach for reamer entry into the guide, thereby avoiding or reducing soft tissue manipulation. The angled pilot hole can save time, reduce surgical complexity, and reduce trauma to the soft tissue.

[0010] Further advantages have been recognized by the inventors, including the use of the guide concept with an angled pilot hole relative to the guide hole for other procedures, such as during trauma procedures to wrap sutures or cables around or within bone. Using angled pilot holes as disclosed herein can avoid stretching adjacent soft tissue. As an example, if a drill with a cannula device (or a reamer with a post) were used in conjunction with the angled pilot hole technique discussed herein (for subsequent introduction of secondary sutures or cables through the cannula), the approach angle could be significantly increased, avoiding excessive stretching of surrounding soft tissue during the procedure. The disclosed guides can have the bottom / sides of the pilot hole shaped (e.g., with one or more surfaces having a radius of curvature) to facilitate reorientation of cutting instruments from the pilot hole into the guide hole. Again, this configuration can save time and reduce surgical effort. Further possible advantages include the ability to configure the guide to have elliptical, oval, or compound curve shaped holes on the proximal surface of the guide to improve the angle of entry and / or more fully facilitate coupling of the guide to the inserter / removal tool.

[0011] The above discussion is intended to provide an overview of the subject matter of this patent application. The above discussion is not intended to provide an exclusive or exhaustive description of the invention. The following description is included to provide further information regarding this patent application.

[0012] To better illustrate the devices, systems, and methods disclosed herein, a non-limiting list of embodiments and techniques is provided herein.

[0013] Embodiment 1 The technology described herein relates to a system for performing an orthopedic surgical procedure, the system optionally including a cutting instrument configured to cut a patient's bone using one or more cutting mechanisms, and a guide configured to attach to the bone, the guide defining an aperture having a guide hole portion and a pilot hole portion, the pilot hole portion configured to initially receive a portion of the bone cutting instrument, the axis of the pilot hole portion being oriented at an acute angle relative to the axis of the guide hole portion.

[0014] Embodiment 2 The technology described herein relates to a system in which the guide optionally has one or more redirection surfaces that form apertures, the one or more redirection surfaces configured to reposition a cutting instrument received within the guide hole portion.

[0015] Embodiment 3 The technology described herein optionally relates to a system in which the one or more redirection surfaces form one or more of the sides and bottom of the pilot hole portion, and the one or more redirection surfaces include a radius of curvature.

[0016] Embodiment 4 The technology described herein relates to a system where, optionally, the cutting instrument includes a peg distal to one or more cutting mechanisms, the peg being a portion of the bone cutting instrument initially received by the pilot hole portion, the peg having a blunt tip configured to engage with one or more redirection surfaces.

[0017] Embodiment 5 The techniques described herein optionally include a cutting instrument that is rotatable within the pilot hole portion of the aperture, and rotation of the cutting instrument causes the pegs received within the guide hole portion to contact one or more reorientation surfaces to reposition the pegs.

[0018] EMBODIMENT 6 The technology described herein relates to systems where, optionally, one or more redirection surfaces form a partial spherical shape.

[0019] EMBODIMENT 7 The technology described herein relates to a system in which the guide optionally includes a proximal surface, the aperture communicates with the proximal surface at an opening, and the cross section of the opening is one of an elliptical, an oval, or a compound curve shape.

[0020] EMBODIMENT 8 The technology described herein relates to a system that optionally further includes an instrument configured to insert and / or remove a guide, the guide including a groove configured to be engaged by a prong of the instrument, and the instrument including a protrusion configured to insert into the aperture and engage with a side of the aperture.

[0021] EMBODIMENT 9 The technology described herein relates to systems in which the guide bore portion optionally includes a through bore extending into communication with the distal face of the guide.

[0022] EMBODIMENT 10 The technology described herein relates to a guide for orienting a bone cutting device to cut bone during an orthopaedic surgical procedure, the guide including a distal surface optionally having one or more pegs configured for attachment to bone, and a body defining an aperture having a guide hole portion and a pilot hole portion, the pilot hole portion having an axis oriented at an acute angle relative to the axis of the guide hole portion.

[0023] EMBODIMENT 11 The technology described herein relates to a guide, wherein the guide optionally has one or more redirection surfaces that form an aperture, the one or more redirection surfaces forming one or more of the sides and bottom of the pilot hole portion, and the one or more redirection surfaces including a radius of curvature.

[0024] EMBODIMENT 12 The technology described herein optionally relates to guides in which one or more redirecting surfaces form a partial spherical shape.

[0025] EMBODIMENT 13 The technology described herein further optionally relates to a guide including a proximal surface of the guide, the aperture communicating with the proximal surface at an opening, and a cross section of the opening along the proximal surface being one of an elliptical, an oval, or a compound curve shaped cross section.

[0026] EMBODIMENT 14 The technology described herein relates to guides in which the guide bore portion optionally includes a through bore extending to communicate with the distal face.

[0027] EMBODIMENT 15 The technology described herein relates to a method of cutting bone during an orthopaedic surgical procedure, the method optionally including attaching a guide to the bone, providing a cutting instrument configured to cut the patient's bone using one or more cutting mechanisms, initially inserting a portion of the cutting instrument into a pilot hole portion of an aperture of the guide, reorienting the cutting instrument with a portion inserted within the pilot hole portion so that the portion is received within the guide hole portion of the aperture, and actuating the cutting instrument to cut the bone when guided by the guide hole portion of the aperture.

[0028] EMBODIMENT 16 The techniques described herein optionally relate to methods where reorienting a cutting instrument, a portion of which has been inserted within a pilot hole portion, so that a portion is received within a guide hole portion of the aperture includes contacting one or more surfaces forming the aperture to reposition the cutting instrument received within the guide hole portion.

[0029] EMBODIMENT 17 The technology described herein optionally relates to methods where the surfaces form one or more of the sides and bottom of the pilot hole portion, and the one or more surfaces include a radius of curvature.

[0030] EMBODIMENT 18 The techniques described herein relate to methods that optionally further include rotating a cutting instrument having a portion inserted within the pilot hole portion to contact one or more surfaces to reposition a portion of the cutting instrument received within the guide hole portion.

[0031] EMBODIMENT 19 The techniques described herein relate to methods where, optionally, one or more surfaces form a partial spherical shape.

[0032] EMBODIMENT 20 The techniques described herein relate to methods in which initially inserting a portion of a cutting instrument into a pilot hole portion of an aperture in a guide optionally includes passing the cutting instrument through an opening in a proximal face of the guide, the cross section of the opening being one of an elliptical, an oval, or a compound curve shape.

[0033] Embodiment 21 is any one or combination of the above-described techniques, devices, systems, and methods, including any one or combination of the features disclosed herein.

[0034] The above and other features and advantages of the present disclosure, as well as the manner in which they are achieved, will become more apparent, and the disclosure itself will be better understood, by referring to the following description of the embodiments in connection with the accompanying drawings. [Brief explanation of the drawings]

[0035] [Figure 1] FIG. 1 is an exploded perspective view of a system for a total shoulder replacement procedure including a driving tool, a cutting instrument, and a guide, according to an embodiment of the present application. [Figure 2] 2 is a cross-sectional view of the cutting instrument and guide of FIG. 1, illustrating an approach of the cutting instrument at an angle relative to the guide hole portion, made possible by the pilot hole portion of an aperture according to an embodiment of the present application. [Figure 3A] 3A is an enlarged cross-sectional view of various sized guides of FIGS. 1 and 2 showing a portion of the pilot hole and guide hole portions of the apertures according to an embodiment of the present application. [Figure 3B] FIG. 3B is an enlarged cross-sectional view of various sized guides of FIGS. 1 and 2 showing a portion of the pilot hole and guide hole portions of the apertures according to an embodiment of the present application. [Figure 3C] 3C is an enlarged cross-sectional view of various sized guides of FIGS. 1 and 2 showing a portion of the pilot hole and guide hole portions of the apertures according to an embodiment of the present application. [Figure 4] FIG. 4 illustrates various views of the guide of FIGS. 1-3C according to another embodiment of the present application. [Figure 4A] 4A-4C are diagrams illustrating various views of the guide of FIGS. 1-3C according to another embodiment of the present application. [Figure 4B] 4B shows various views of the guide of FIGS. 1-3C according to another embodiment of the present application. [Figure 4C] 4A-4C are diagrams illustrating various views of the guide of FIGS. 1-3C according to another embodiment of the present application. [Figure 5]FIG. 5 is a perspective view of a proximal face of another embodiment of a guide having an oval opening in the proximal face for an aperture, according to an embodiment of the present application. [Figure 6] FIG. 6 is a perspective view of a proximal face of another embodiment of a guide having an oval opening in the proximal face for an aperture, according to an embodiment of the present application. [Figure 7] FIG. 7 is a cross-sectional view of a cutting device and a guide having an oval or elliptical opening as in FIG. 5 or 6, showing the approach of the cutting device at a predetermined angle relative to the guide hole portion, made possible by the pilot hole portion of the aperture according to an embodiment of the present application. [Figure 8A] 8A is a perspective view and a cross-sectional view of the guide of FIG. 5 or FIG. 6 engaged by an insertion and / or removal tool according to an embodiment of the present application. [Figure 8B] 8B is a perspective view and a cross-sectional view of the guide of FIG. 5 or FIG. 6 being engaged by an insertion and / or removal tool according to an embodiment of the present application. [Figure 8C] FIG. 8C is a cross-sectional view of another embodiment of a guide being engaged by another embodiment of an insertion and / or removal tool according to an embodiment of the present application. [Figure 9] FIG. 9 illustrates a process in which the cutting instrument of FIGS. 1 and 2 is first inserted into the pilot hole portion of the aperture of the guide and then reoriented via rotational torque for further insertion into the guide hole portion of the aperture according to an embodiment of the present application. [Figure 10] FIG. 10 illustrates a process in which a drill, another embodiment of a cutting instrument, is first inserted into the pilot hole portion of the aperture of the guide and then reoriented via rotational torque for further insertion into the guide hole portion of the aperture according to an embodiment of the present application. DETAILED DESCRIPTION OF THE INVENTION

[0036] Corresponding reference numerals indicate corresponding parts throughout the several views. The exemplifications presented herein illustrate embodiments of the disclosure, and such exemplifications should not be construed as limiting the scope of the disclosure in any way.

[0037] In describing the embodiments of the disclosure that are to be described in connection with the drawings, which are illustrated, specific terminology will be used for the sake of clarity. However, the disclosure is not limited to the specific terms or descriptions used herein, and it is to be understood that each specific term includes all technical equivalents.

[0038] The present disclosure relates to devices, systems, and methods that may be used during joint replacement and other orthopedic procedures that utilize guides to direct / guide bone cutting instruments. The illustrative examples relate to devices and systems used in total shoulder replacement or revision shoulder replacement procedures. However, it is contemplated that these methods, devices, and systems may also be used for other joints and / or during other procedures, such as orthopedic bone stabilization following trauma. Thus, the concepts of the present application are not limited by the examples provided herein. Similarly, the term "bone" as used herein is not limited to the glenoid but may include any applicable bone of the body.

[0039] FIG. 1 shows a system 100 that may include a guide 102, a cutting device 104, and a driving tool 106.

[0040] The driving tool 106 may include a reamer driver or other driving device well known to those skilled in the art. Examples of such devices can be found in U.S. Pat. Nos. 10,687,831 and 10,945,862, the entire disclosures of each of which are incorporated by reference in their entirety. The driving tool 106 may include a shaft 108 and a head 110. The head 110 may be configured, for example, as a gear, hex, or other type of coupling device. As such, the head 110 may have teeth or other features with flat, curved, or angled surfaces, or the like. As shown in FIG. 1 , the head 110 may be configured to mate / engage with and drive a corresponding female component of the cutting instrument 104. Through coupling via the mating component, rotation of the driving tool 106 is transmitted from the driving tool 106 to the cutting instrument 104.

[0041] 1, the cutting instrument 104 may be a reamer 112. However, other types of cutting instruments are contemplated, such as broaches, drills, cannulated drills, needles, osteotomes, rongeurs, bone cutters, punches, etc. The reamer 112 may include a body 114 having a coupling mechanism 116, one or more cutting mechanisms 118, and pegs 120.

[0042] The coupling mechanism 116 may be a portion of the body 114 proximal to the body 114. The coupling mechanism 116 may be a female or male mechanism configured to receive or otherwise couple with the head 110 for rotation of the cutting instrument 104. The body 114 may be generally cylindrical in structure and may be constructed from a metal, a polymer, a ceramic, or any combination thereof.

[0043] One or more cutting mechanisms 118 can be coupled to and extend outwardly around the body 114. The one or more cutting mechanisms 118 (e.g., blades, barbs, tines, sharps, etc.) can have a structure well known to those skilled in the art and can be configured to cut and remove tissue (including soft tissue and bone) of a patient. In the example of FIG. 1 , the one or more cutting mechanisms 118 can be configured (sized and shaped) to cut and remove a glenoid of the shoulder.

[0044] The peg 120 can extend distally from the body 114 and can be positioned distal to the one or more cutting features 118. As such, the peg 120 can be located on the opposite side of the body 114 from the coupling feature 116. The peg 120 can be configured as a boss or other feature to aid in the guided coupling of the cutting instrument 104 and the guide 102. In other words, the peg 120 can be used in conjunction with an aperture in the guide 102 to guide the insertion of the cutting instrument 104 into bone or soft tissue.

[0045] As shown in FIG. 1 , the peg 120 can have a blunt tip 122. However, other tip geometries (e.g., conical, frustoconical, hemispherical, sharp, etc.) are contemplated, as will be familiar to those skilled in the art. The peg 120 can be appropriately sized to be inserted into and captured within an aperture 124 of the guide 102, as further described herein. The aperture 124 is shown in FIG. 2 as a through-hole, extending from the proximal to the distal side of the guide 102. However, other configurations for the aperture 124 are contemplated, such as a blind hole with a bottom, or a through-hole extending into or out of the guide 102. The guide 102 can be constructed from a metal, polymer, ceramic, or any combination thereof. The shape of the guide 102 and other features of the guide are further discussed with reference to FIGS. 2 through 4C.

[0046] 2 illustrates the cutting instrument 104 having an angle of approach toward the aperture 124 of the guide 102. This angle avoids or minimizes stretching / manipulation-like effects on the soft tissue 126 of the shoulder joint 125. Such an approach angle for the cutting instrument 104 may allow a portion of the cutting instrument 104 to be initially inserted into the aperture 124 at a predetermined angle / slant (e.g., the peg 120 may be inserted partially downward into the aperture 124) to avoid the soft tissue 126 of the shoulder joint 125. Insertion of the cutting instrument 104 into the aperture 124 is indicated by arrow A in FIG. 2.

[0047] The angle / tilt (sometimes referred to herein as the attack angle, approach angle, entry angle, or insertion angle) of the cutting instrument 104 and peg 120 of FIG. 2 can be determined by the angle θ of the pilot hole portion 128 of the guide 102, as shown in the enlarged cross-sectional views of FIGS. 3A-3C. Specifically, the angle θ can be measured from the axis A1 of the pilot hole portion 128 of the aperture 124 relative to the axis A2 of the guide hole portion 130 of the aperture 124. FIGS. 3A-3C show three different standard sizes for the guide 102: large ( FIG. 3A ), medium ( FIG. 3B ), and small ( FIG. 3C ). However, additional sizes, shapes, and orientations of the guide 102 and guide features, including the pilot hole portion 128 and guide hole portion 130, are also contemplated.

[0048] 3A-3C illustrate the angle θ measured from the axis A1 of the pilot hole portion 128 of the aperture 124 relative to the axis A2 of the guide hole portion 130. The angle θ may be an acute angle, for example, between 45 degrees and 10 degrees inclusive. However, other angles are contemplated, including oblique angles measured by the angle θ.

[0049] The aperture 124 can have an opening 132 at a proximal side 134 of the guide 102. The pilot hole portion 128 and the guide hole portion 130 can be in communication with each other, which allows for redirection of the cutting instrument 104 (FIGS. 1 and 2), as discussed further herein. The pilot hole portion 128 can extend from one side of the axis A2 of the guide hole portion 130 to a second side thereof. The pilot hole portion 128 can be defined, in part, by one or more surfaces 136 (sometimes referred to herein as one or more redirection surfaces) at a distal end and on the distal side. The one or more surfaces 136 can be radially disposed relative to a side of the axis A2 of the guide hole portion 130. Optionally, the one or more surfaces 136 can be curved (e.g., can have one or more radii of curvature 138). The curvature can provide the one or more surfaces 136 with a partial spherical or another type of shape. However, in some embodiments, such as the large guide 102 of FIG. 3A, one or more surfaces 136 may be otherwise shaped to have flat (non-curved) regions 137. Regions 137 may be oriented perpendicular to the oval walls or at an angle to the oval walls (as shown in FIG. 3A).

[0050] The one or more surfaces 136 may be distal and / or lateral termination points for the pilot hole portion 128. As such, the one or more surfaces 136 may be configured to act as an initial stop for the peg 120 (FIGS. 1 and 2) upon partial entry. Additionally, the one or more surfaces 136 may be shaped with one or more radii of curvature 138 (or other shapes) to redirect / reorient the peg 120 upon contact within the distal portion 140 of the guide hole portion 130. Such redirection / reorientation may change the position of the cutting instrument 104 (FIGS. 1 and 2), as discussed and shown further herein.

[0051] The guide hole portion 130 can extend along the axis A2 throughout its entire length. The length (depth) of the guide hole portion 130 can be greater than that of the pilot hole portion 128. The pilot hole portion 128 can have a depth sufficient for only partial entry of, for example, the peg 120 ( FIGS. 1 and 2 ). In contrast, the depth of the guide hole portion 130 can be sufficient to receive substantially the entire peg 120. Furthermore, the purpose of the guide hole portion 130 is to provide a desired orientation and / or depth for the cutting instrument 104 to contact and cut tissue, such as bone. In other words, the configuration of the guide hole portion 130 allows the cutting instrument 104 ( FIGS. 1 and 2 ) to contact the glenoid in a desired orientation and remove the glenoid to a desired depth so that an implant can subsequently be added to the glenoid. In contrast, the configuration of the pilot hole portion 128 is different from the guide hole portion 130 and can be used only to advance the cutting instrument 104 (FIGS. 1 and 2) in a manner that avoids or minimizes contact with soft tissue, as shown in FIG. 2.

[0052] The depth of the pilot hole portion 128, measured from the opening 132 to the one or more surfaces 136, may vary, for example, from 0.20 inches to 0.45 inches. However, other depths are contemplated, including those for other surgical applications. The radius of the distal portion 140 may be, for example, from 0.025 inches to 0.10 inches. However, other sizes for the distal portion 140 are contemplated, including those for other surgical applications. The size of the opening 132 may vary, as discussed further herein. Optionally, the radius of the opening 132 may be from 0.05 inches to 0.30 inches.

[0053] Figures 4-4C show various views of guide 102. As shown in Figures 4-4B, guide 102 can include aperture 124 with pilot hole portion 128 and guide hole portion 130, opening 132, and proximal side 134. Figure 4B also shows one or more surfaces 136 within aperture 124.

[0054] The proximal side 134 can be defined in part by a protrusion 142 having an aperture 124. The proximal side 134 can have a proximal face 144. The protrusion 142 can extend from a body 146 of the guide 102. As shown in Figures 4-4B, the opening 132 can have a compound curvature at the proximal face 144 and the proximal side 134. A chamfer can be provided on the guide 102 that leads into the aperture 124.

[0055] 4 and 4C , the body 146 can extend to a distal side 148 opposite the proximal side 134. The distal side 148 can include one or more pegs 150 for securing the guide 102 in place. As shown in FIG. 4C , the guide hole portion 130, and in particular its distal portion 140, can extend through the body 146 to the distal side 148. Thus, the guide hole portion 130 can include a through-hole extending from the proximal side 134, completely through the guide 102, and to the distal side 148. As mentioned above, the guide hole portion 130 need not be a through-hole according to further embodiments.

[0056] Figure 5 shows a guide 102A having a different configuration than the guide 102 of Figures 1-4C. In particular, the guide 102A can have an opening 132A to the aperture 124 at the proximal surface 144. This opening 132A has an elliptical shape rather than the compound curved shape previously shown.

[0057] Similarly, Figure 6 shows a guide 102B that has a slightly different configuration than the guide 102 of Figures 1-4C. In particular, the guide 102B can have an opening 132B in the proximal face 144 to the aperture 124. This opening 132B has an oval or slot shape rather than the compound curve shape previously shown.

[0058] 7 illustrates the benefit of the oval or elliptical shape of the openings 132A or 132B in that the cutting instrument 104 can have a more extreme approach angle toward the aperture 124 of the guide 102. This more extreme angle is compared to the angled approach in the embodiment of FIG. 2. This more extreme approach angle can further avoid or minimize effects such as stretching of the soft tissue 126 of the shoulder joint 125.

[0059] 8A and 8B show guide 102B having opening 132B in proximal surface 144, where aperture 124 can be configured to receive post 200 or other appropriately configured portion of insertion / removal tool 202. Insertion / removal tool 202 can be a forceps or other appropriate surgical instrument. Protrusion 142 (FIG. 8B) on proximal side 134 of guide 102B can further include groove 204 (FIG. 8B) and lip 206 (FIG. 8B). Groove 204 (FIG. 8B) and lip 206 (FIG. 8B) can be configured to be engaged by second portion 208 of insertion / removal tool 202, such as a tine, prong, jaw, or the like.

[0060] 8A and 8B, engagement surface 210, which forms part of aperture 124, may be abutted by post 200 during insertion and / or removal of guide 102B, in addition to engagement of groove 204 (FIG. 8B) and lip 206 (FIG. 8B) by second portion 208. The oval or elliptical shape of opening 132B may further facilitate engagement of engagement surface 210 by post 200.

[0061] As shown in FIG. 8C , engagement between the post 200 and the aperture 124 may be achieved by a spherical protuberance 250 (or other similar distal male feature, e.g., a rounded rectangular, chamfered cylindrical, or rounded square shape) on the end of the post 200. The protuberance 250 may be located on the interior of the post 200 of the insertion / removal tool 202. Having such a feature on the interior of the guide 102B, which interfaces with the second portion 208, allows for a more medialized approach of the insertion / removal tool 202, thereby better avoiding soft tissue that may obstruct the second portion 208 engaging the groove 204. A similar spherical recess 252 (or other similar female recess feature, e.g., a rounded rectangular, chamfered cylindrical, or rounded square shape) on the interior of the aperture 124 (to receive the spherical protuberance on the end of the post 200) would also facilitate this approach. The engagement of this spherical protuberance 250 (or similar male feature as described) within the associated spherical recess 252 (or similar female feature as described) will further improve the grip of the forceps on the guide for extraction. Note that the insertion / removal tool 202 may, in some embodiments, have a female feature, while the guide 102B may have a corresponding male feature within the aperture 124.

[0062] 9 illustrates a surgical method 300 in which the peg 120 of the cutting instrument 104 is first partially inserted into the pilot hole portion 128 of the aperture 124 of the guide 102 in step 302, then the peg 120 and instrument 104 are reoriented in step 304, and then the peg 120 is further inserted into the guide hole portion 130 of the aperture 124 in step 306. This method 300 may be facilitated by the shape of one or more surfaces 136 (having a radius of curvature 138) and / or may be further assisted by, for example, the shape of the tip of the peg 120. Additionally, method 300 contemplates that reorientation of the cutting instrument 104 from the position in step 302 to the position in step 304 may be facilitated by rotating the cutting instrument 104 (as indicated by arrow R). Such rotation can be performed manually or by powered (driven) rotation of cutting equipment 104, for example, using a reamer (FIG. 1).

[0063] More specifically, step 302 depicts the peg 120 with the tip contacting one or more surfaces 136 after initial partial insertion of the peg 120 into the pilot hole portion 128. Rotation of the cutting instrument 104 can continue until the reoriented position shown, up to step 304. Such a reoriented position can allow further insertion of the peg 120 into the guide hole portion 130, toward the distal side 148 of the guide 102. The final position of step 306 depicts further insertion of the cutting instrument 104, with the peg 120 positioned adjacent the distal side 148.

[0064] Figure 10 illustrates a surgical method 400 similar to method 300 of Figure 9. The method 400 is performed using a guide 402, for example, a guide for trauma surgery or other orthopedic repair. As such, the guide 402 may differ in shape from the guides previously shown and discussed herein. However, the guide 402 may include an aperture 124 having a configuration similar to that previously described, including a pilot hole portion and a guide hole portion.

[0065] As shown in FIG. 10a, a drill bit 404 of a drill 406 is utilized. The drill bit 404 (e.g., a cutting instrument) of the drill 406 is first partially inserted into the pilot hole portion 128 of the aperture 124 of the guide 402 in step 408, then reoriented in step 410, and then further inserted into the guide hole portion 130 of the aperture 124 in step 412. This method 400 may be facilitated by the shape of one or more surfaces 136 (having a radius of curvature 138) and may be further assisted, for example, by the shape of the tip of the drill bit 404. Furthermore, the method 400 contemplates that reorienting the drill bit 404 from the position of step 408 to the position of step 410 may be facilitated by rotating the drill bit 404 (as indicated by arrow R). Such rotation may be performed by hand or by powered rotation of the drill bit 404, for example, by manipulation of the drill 406.

[0066] As an example, the guide 402 can also be used in other orthopedic fields. In one embodiment, the guide 402 can wrap sutures or cables around or within bone while avoiding stretching of adjacent tissue. The drill 406 (or a reamer with a post) can have a cannula arrangement, which can be used to later introduce secondary sutures or cables through the cannula. Such a configuration would use a similar approach to the method 400 of FIG. 10 . The guide 402 can allow the drill bit 404 or other cutting instrument to traverse or penetrate the long bone. The approach angle of the drill bit 404 (or other cutting instrument) can be increased (as discussed in the glenoid example of FIGS. 1-8 ). This can avoid overstretching of the surrounding soft tissue during the procedure. The drill bit 404 may be inserted into the guide 402 and contact a spherical or beveled / angled surface and / or feature located on the end / side of the pilot hole portion 128 (the embodiment shown in FIG. 10 ). Finally, the drill bit 404 is reoriented and exits the side of the guide 402 (shown in step 412). After the drill bit exits the guide 402, a cable or suture may be threaded through the cannulated device within the guide 402 and / or drill bit 404 to reach around or penetrate a long bone with the aid of the guide 402. In this manner, a greater approach angle may be achieved to suture or cable fixate the bone / tissue around corners, avoiding trauma to adjacent tissue by overstretching during the procedure. This may have numerous applications, including allowing cannulated instruments for threading minimally invasive sutures or cables to reach into or around bone.

[0067] Additionally, a cutting instrument, such as a cannulated drill / reamer post, can be introduced non-rotatably into pilot hole portion 128, and then torque applied to the cutting instrument shaft can help drive the cutting instrument tip downward into guide hole portion 130. Using centrifugal force generated by rotation (e.g., powered rotation from drill 406), it is contemplated that the cutting instrument (e.g., drill bit 404) can be rotated against one or more surfaces 136 of pilot hole portion 128 in guide 402. As previously mentioned, an opening having an oval or elliptical shape can also allow the user to approach the guide at a greater angle. Customized approach angles can also be created for the patient's involved bone. The twisting / rotating / centrifugal drop (from pilot hole portion 128 into guide hole portion 130) can allow the cutting instrument tip and pilot hole end design to be optimized within a range of tip geometry parameters (e.g., tip surface finish, different raw material behavior, different tip geometries: trocar tip, cone with pointed tip, cone with rounded tip, flat tip with no edge blend, and / or flat tip with different radius blend) and guide geometry parameters (e.g., angled or spherical pilot hole bottom, different raw material behavior, different pilot hole bottom geometries, e.g., spherical or beveled / angled bottom). The above optimization principles can also be applied to the glenoid embodiments of FIGS. 1 through 8.

[0068] The term "proximal" refers to the general orientation of the side and / or surface when a guide is implanted within bone or when a cutting instrument is utilized to cut tissue. Thus, "proximal" refers to a direction or position generally toward or toward the patient's head, and "distal" refers to the opposite direction of proximal, i.e., a direction away from the patient's head. As used herein, the terms "anterior" and "posterior" should be given their commonly understood anatomical interpretations. Thus, "posterior" refers to a position or direction generally toward the back of the patient. Similarly, "anterior" refers to a position or direction generally toward the front of the patient. Thus, "posterior" refers to the opposite direction from "anterior." Similarly, the terms "medial" and "lateral" should be given their commonly understood anatomical interpretations. "Medial" means the more inwardly facing portion of a guide or device (as in the implanted orientation), and "lateral" means the outer or outwardly facing portion. "Medial" means in the opposite direction from "lateral."

[0069] As will be readily apparent to those skilled in the art, various other changes can be made in the details, materials, and arrangements of parts and method steps described and illustrated to explain the nature of the inventive subject matter without departing from the spirit and scope of the inventive subject matter as expressed in the appended claims. For example, the order of method steps or method steps can be varied from that described above as preferred by those skilled in the art.

[0070] Of course, the various independent claims, embodiments, and features shown herein may be combined in ways other than those described above and / or in the original claims. For example, any feature from the embodiments may be shared with other of the described embodiments, and / or features from a particular dependent claim may be shared with another dependent or independent claim in combinations understood by those skilled in the art.

[0071] The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention may be practiced. These embodiments are also referred to herein as "embodiments." Such embodiments may include elements in addition to those shown or described. However, the inventors also contemplate embodiments in which only the elements shown or described are provided. Furthermore, the inventors also contemplate embodiments using combinations or substitutions of the illustrated and described elements (or one or more aspects thereof) with respect to the specific embodiment (or one or more aspects thereof) shown or described, or with respect to other embodiments (or one or more aspects thereof).

[0072] In the event of inconsistent usage between this document and any document so incorporated by reference, the usage in this document shall control. The terms "including" and "in which" are used in this document as the plain English equivalents of the terms "comprising" and "wherein," respectively. Also, in the claims below, the terms "including" and "comprising" are open-ended, i.e., systems, devices, articles, compositions, formulations, or processes that include elements in addition to those recited after such terms in a claim are still deemed to be within the scope of that claim.

[0073] The terms "a" or "an," as common in patent documents, are used to include one or more than one, independent of any other instance or use of "at least one" or "one or more." In this document, the term "or" means a non-exclusive or, whereby "A or B" is used to include "A but not B," "B but not A," and "A and B," unless otherwise specified. In this document, the terms "including" and "in which" are used as plain English equivalents of the terms "comprising" and "wherein," respectively. Also, in the claims below, the terms "including" and "comprising" are open-ended, i.e., systems, devices, articles, compositions, formulations, or processes that include elements in addition to those listed after such terms in a claim are still considered to be within the scope of that claim. Moreover, in the following claims, the terms "first," "second," and "third," etc., are used merely as labels and do not impose numerical requirements on their objects.

[0074] The above description is intended to be illustrative, not limiting. For example, the above examples (or one or more aspects thereof) can be used in combination with each other. Other embodiments may be employed by those skilled in the art upon review of the above description. The Abstract is provided to comply with U.S.C. § 1.72(b) to enable the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Furthermore, the grouping of various features in the above Detailed Description serves to simplify the disclosure. This should not be construed as intending that a non-claimed feature is essential to any claim. Rather, subject matter lies in less than all features of a particular disclosed embodiment. Accordingly, the claims are herein incorporated into the Detailed Description as examples or embodiments. Each claim stands on its own as a separate embodiment, and such embodiments can be combined with each other in various combinations or permutations. The scope of the present invention should be determined by reference to the appended claims, along with the full range of equivalents to which such claims are entitled.

Claims

1. 1. A system for performing an orthopedic surgical procedure, the system comprising: a cutting instrument configured to cut bone of a patient using one or more cutting mechanisms; a guide configured to be attached to the bone; Including, the guide defines an aperture having a guide hole portion and a pilot hole portion, the pilot hole portion configured to initially receive a portion of the bone cutting instrument, and an axis of the pilot hole portion oriented at an acute angle relative to an axis of the guide hole portion; A system for performing an orthopedic surgical procedure.

2. The system of claim 1 , wherein the guide has one or more redirection surfaces that define the aperture, the one or more redirection surfaces configured to reposition the cutting instrument received within the guide hole portion.

3. The system of claim 2 , wherein the one or more redirection surfaces form one or more of a side and a bottom of the pilot hole portion, and the one or more redirection surfaces include a radius of curvature.

4. 4. The system of claim 3, wherein the cutting instrument includes one or more pegs distal to the cutting mechanism, the pegs being a portion of the bone cutting instrument initially received by the pilot hole portion, the pegs having blunt tips configured to engage one or more of the redirection surfaces.

5. 5. The system of claim 4, wherein the cutting device is rotatable within the pilot hole portion of the aperture, and rotation of the cutting device causes the peg to contact one or more of the reorientation surfaces to reposition the peg received within the guide hole portion.

6. The system of claim 3 , wherein one or more of the redirection surfaces form a partial spherical shape.

7. 7. The system of claim 1, wherein the guide includes a proximal surface, the aperture communicates with the proximal surface at an opening, and a cross section of the opening is one of an elliptical, an oval, or a compound curve shape.

8. 8. The system of claim 1, further comprising an instrument configured to insert and / or remove the guide, the guide including a groove configured to be engaged by a prong of the instrument, and the instrument including a protrusion configured to be inserted into the aperture and engage with a side of the aperture.

9. The system of claim 1 , wherein the guide bore portion includes a through bore extending in communication with a distal surface of the guide.

10. 1. A guide for orienting a bone cutting device to cut bone during an orthopaedic surgical procedure, said guide comprising: a distal surface having one or more pegs configured to attach to the bone; a body defining an aperture having a guide hole portion and a pilot hole portion; Including, the pilot hole portion has an axis oriented at an acute angle to the axis of the guide hole portion; A guide for orienting bone cutting devices.

11. 11. The guide of claim 10, wherein the guide has one or more redirection surfaces that form the aperture, the one or more redirection surfaces forming one or more of a side and a bottom of the pilot hole portion, and the one or more redirection surfaces including a radius of curvature.

12. The guide of claim 11 , wherein one or more of the redirecting surfaces form a partial spherical shape.

13. 13. The guide of claim 10, further comprising a proximal surface of the guide, the aperture communicating with the proximal surface at an opening, and a cross-section of the opening along the proximal surface being one of an elliptical, an oval, or a compound curve shaped cross-section.

14. The guide of claim 10 , wherein the guide bore portion includes a through bore extending in communication with the distal surface.

15. 1. A method of cutting bone during an orthopedic surgical procedure, comprising: The method comprises: attaching a guide to the bone; providing a cutting instrument configured to cut bone of a patient using one or more cutting mechanisms; initially inserting a portion of the cutting instrument into a pilot hole portion of an aperture in the guide; reorienting the cutting instrument with the portion inserted within the pilot hole portion so that the portion is received within the guide hole portion of the aperture; activating the cutting instrument to cut the bone when guided by the guide hole portion of the aperture; 1. A method for cutting bone during an orthopedic surgical procedure, comprising:

16. 16. The method of claim 15, wherein reorienting the cutting instrument, a portion of which has been inserted within the pilot hole portion, so that the portion is received within the guide hole portion of the aperture comprises contacting one or more surfaces forming the aperture to reposition the cutting instrument received within the guide hole portion.

17. The method of claim 16 , wherein the surfaces form one or more of a side and a bottom of the pilot hole portion, and one or more of the surfaces includes a radius of curvature.

18. 18. The method of claim 17, further comprising rotating the cutting device with the portion inserted within the pilot hole portion to contact one or more of the surfaces to reposition the portion of the cutting device received within the guide hole portion.

19. The method of claim 17 , wherein one or more of the surfaces form a partial spherical shape.

20. 20. The method of any one of claims 15 to 19, wherein initially inserting the portion of the cutting instrument into the pilot hole portion of the aperture of the guide includes passing the cutting instrument through an opening in a proximal face of the guide, the cross section of the opening being one of an elliptical, an oval, or a compound curve shape.

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