Auxiliary instruments for acromioclavicular joint separation surgery

Abstract

The present invention provides an auxiliary instrument (2) for acromioclavicular joint separation surgery, comprising: a handle (201) having a first end (222) and a second end (221); an arm (202) having a first end (223) attached to the first end of the handle (201) and having a spoon (203) at a second end (224); a drill guide (204) connected to the second end (221) of the handle (201), the drill guide (204) including a central through hole (205) having a longitudinal axis (405) passing through the spoon (203) and two auxiliary through holes (206) having longitudinal axes (406) passing through the spoon (203); a central drill bushing (207) suitable for insertion into the central through hole (205); and two auxiliary drill bushings suitable for insertion into the two auxiliary through holes (206).

Description

[Technical Field]

[0001] The present invention relates to the field of surgical instruments. The present invention relates to a device for guiding a surgical procedure for the reconstruction of the trapeziocoracoclavicular ligament, or for the reconstruction of both the trapeziocoracoclavicular and conoclavicular ligaments. [Background technology]

[0002] Acromioclavicular joint dislocation is a dislocation of the acromioclavicular joint, which connects the clavicle and acromion. This dislocation accounts for 40% of shoulder injuries in athletes. This dislocation typically involves damage to the ligaments located between the clavicle and the coracoid process. These ligaments are the trapeziocoracoclavicular ligament and the conocoracoclavicular ligament. When ligament damage reaches a certain severity, surgical treatment is performed, but complications can occur. As taught in U.S. Patent No. 5,629,949, among others, a procedure known as coracoclavicular ligament reconstruction involves adding one or more artificial ligaments between the clavicle and the coracoid process. These procedures often involve drilling a tunnel through the clavicle and sometimes through the coracoid process. To facilitate this surgery and limit the associated risks, instruments designed to guide the drilling are shown, particularly in U.S. Patent No. 5,629,949. Such instruments aid in the performance of coracoclavicular trapezoid ligament reconstruction surgery by reducing the risk of intraoperative complications. In fact, the use of instruments for this procedure makes it possible to protect the so-called sensitive areas, where nerves and arteries are densely packed, in particular by means of an instrument that is temporarily inserted into the patient's body during the procedure and placed along the axis along which the drilling is performed, this part serving to block the drill bit used for drilling before it reaches the sensitive area during drilling.

[0003] However, reconstruction of the trapeziocoracoclavicular ligament has the disadvantage of being anatomically insufficient. In fact, by reconstructing only the trapeziocoracoclavicular ligament, the connection between the clavicle and the coracoid process is established in a way that is different from the natural connection formed by both coracoclavicular ligaments (trapeziocoracoclavicular ligament and conocoracoracoclavicular ligament). This difference may result in residual discomfort and pain for the patient. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] French Patent Invention No. 2692470 [Patent Document 2] U.S. Patent No. 9,072,510 Summary of the Invention [Problem to be solved by the invention]

[0005] The present invention aims to overcome the above-mentioned drawbacks by proposing an auxiliary instrument for acromioclavicular separation surgery. [Means for solving the problem]

[0006] To this end, the auxiliary device according to the present invention allows for the reconstruction of the trapeziocoracoclavicular and conocoracoclavicular ligaments while protecting the nerve- and artery-dense area of ​​the patient's shoulder.

[0007] The assistive device of the present invention comprises: - an arc-shaped handle having two ends, referred to as a first end and a second end; - an elongated arm attached at a first end to the first end of the handle and having a spoon-shaped portion at a second end, referred to as a spoon; a drilling guide coupled to the second end of the handle, a central through hole having a longitudinal axis passing through the spoon; two auxiliary through holes disposed on diametrically opposite sides of the central through hole, each of the two auxiliary through holes having a longitudinal axis passing through the spoon, forming a pair of auxiliary through holes; a drilling guide having - a so-called central drill bushing, suitable for insertion into the central through-hole; - two auxiliary drill bushings, suitable for insertion into the two auxiliary through holes; Equipped with.

[0008] The handle is used to operate the assistive device.

[0009] The central drill bushing, in the form of a hollow tube, allows the insertion of a cannulated drill bit, also called a drill bit suite.

[0010] Cannulated drill bits, also called hollow drill bits or hollow drills, are designed for drilling holes in bone.

[0011] In the context of this arthroscopic procedure to treat acromioclavicular joint dislocation, the practitioner can choose to either reconstruct the trapeziocoracoclavicular ligament, known as a coracoid tunnel reconstruction, or reconstruct both the trapeziocoracoclavicular and conoclavicular ligaments, known as a lacing procedure. The lacing procedure has the advantage of restoring the connection between the clavicle and the coracoid process in a manner that approximates the natural connection provided by the ligaments between these two bones. As a result, the lacing procedure is more anatomically accurate than a coracoid tunnel reconstruction.

[0012] Coracoid foramen reconstruction requires a single drilling through the clavicle and coracoid process along a single axis. Lacing procedures require two drillings through the clavicle, one along each of the two axes, without penetrating the coracoid process.

[0013] During coracoid tunnel reconstruction, the surgeon first makes two incisions on the patient's body: one above the clavicle and one below the coracoid process.

[0014] The practitioner inserts the central drill bushing into the central through-hole of the drill guide. The practitioner then inserts the central drill bushing through the first incision until it is firmly positioned on the clavicle.

[0015] The practitioner then inserts the spoon through the second incision until it is firmly positioned under the coracoid. Using a cannulated drill bit guided by a central drill bushing, the practitioner can then drill through the clavicle and then the coracoid until they reach the spoon.

[0016] The longitudinal axis of the central hole in the drill guide, and therefore the longitudinal axis of the central drill bushing, allows the cannulated drill bit to reach the scoop after drilling the clavicle and then the coracoid.

[0017] During a lacing procedure, similar to a coracoid reconstruction, the surgeon makes two incisions in the patient's body: one above the collarbone and one below the coracoid process on the front of the shoulder or on the outside of the shoulder just above the humerus.

[0018] The practitioner inserts the central drill bushing into the central through hole of the drill guide and each auxiliary drill bushing into the auxiliary through hole.

[0019] Next, the practitioner inserts the central drill bushing through the first incision until it is firmly positioned over the clavicle, and then inserts the spoon attached to the second end of the arm into the second incision until it is firmly positioned under the coracoid.

[0020] The practitioner then drills using a cannulated drill bit guided by the central drill bushing. The cannulated drill bit passes through the clavicle and then through the coracoid surface until it reaches the first cortical layer. The first cortical layer is defined as the superficial layer of bone. The auxiliary instrument is then held in place relative to the clavicle and coracoid process. The practitioner then drills the clavicle twice using two cannulated drill bits, each guided by an auxiliary drill bushing. Each cannulated drill bit passes through the clavicle and then along both sides of the coracoid before finally reaching the spoon.

[0021] The auxiliary tool according to the invention therefore makes it possible to carry out the necessary drilling operations, whether in the case of a coracoid canal reconstruction or a lacing procedure, while limiting the risks incurred by the patient.

[0022] In fact, the drill bushing is suitable to be inserted into the through-hole along its longitudinal axis passing through the spoon of the drilling guide, making it possible to guide the cannula drill bit during the drilling required for these operations, while protecting the patient's areas of high nerve and arterial density thanks to the spoon.

[0023] In certain embodiments, the invention may further include one or more of the following features, taken individually or in any technically possible combination:

[0024] According to one embodiment, the drilling guide comprises a plurality of pairs of auxiliary through holes, and for each pair of auxiliary through holes, the two auxiliary through holes are arranged diametrically opposite to the central hole and each have a longitudinal axis passing through the spoon.

[0025] During the lacing procedure, the practitioner can adapt the procedure to the changes in the shape and position of the coracoid muscle depending on the patient. In fact, by having several pairs of auxiliary holes, it is possible to select auxiliary holes adapted to bypass the coracoid during the two drilling steps, i.e., to avoid penetrating the coracoid before the cannula drill bit reaches the spoon.

[0026] According to one embodiment, the arms are curved towards the handle. The curved arms advantageously allow for a so-called lateral approach. The term "approach" refers to the area of ​​the patient's body where the incision is made at the start of the procedure.

[0027] Coracoid foramen reconstruction and lacing procedures can be performed using the so-called anterior approach, which means that the incision for inserting the spoon and arm is made at the shoulder on the front side of the patient's body. However, this approach is more risky for the patient because this area of ​​the patient's body contains major arteries.

[0028] When using a lateral approach, an incision is made to insert the spoon and arm at the shoulder on the side of the patient's body. This includes an area of ​​the patient's body that is devoid of major arteries. However, using this approach, the humerus of the patient's arm prevents direct access to the coracoid process. The curvature of the arm toward the handle allows for an upper bypass of the humerus to reach the coracoid process, making this lateral approach possible, thereby reducing risk to the patient.

[0029] According to one embodiment, the central drill bushing is provided at one end with a Jacob's rasp, referred to as the free end, oriented towards said spoon.

[0030] A Jacob's rasp is a long, thin, curved, claw-like piece designed to scrape or scrape bone.

[0031] During reconstruction of the coracoid tunnel or lacing procedure, the central drill bushing is pressed against the clavicle with its free end and the Jacob's rasp catches on the edge of the clavicle, thus ensuring better stabilization of the auxiliary instrument during drilling.

[0032] According to one embodiment, the handle is adjustable. Patients have variations in the size and position of their clavicles, coracoids, and humeri. A handle that is adjustable, particularly in length, allows the distance between the drilling guide and the arm to be adjusted to accommodate these variations when using the auxiliary tool. The handle is designed so that the center of its arc is located on the spoon, so that the longitudinal axes of the central through-hole of the drilling guide and the auxiliary through-holes always pass through the spoon, regardless of the adjustment of the handle.

[0033] According to one embodiment, the arm includes a through channel extending between the first end of the arm and the spoon.

[0034] The through channel is advantageous for passing a nitinol wire loop, referred to as a nitinol loop.

[0035] During the lacing procedure, before the procedure begins, a nitinol loop is inserted into the through-channel of the arm, with one end of the nitinol loop positioned inside the spoon, while the other end, referred to as the free end, is held outside the through-channel at the first end of the arm.

[0036] After forming two drill holes (referred to as auxiliary drill holes) in the clavicle using the auxiliary drill bushing and reaching the cannula drill bit into the spoon, the practitioner inserts a surgical wire into each of the two cannula drill bits placed in the auxiliary drill bushing. The surgical wire has two ends (referred to as a first end and a second end). Each surgical wire is inserted until the second end protrudes from the opening of the cannula drill bit in the spoon, while holding the first end outside the patient's body. The practitioner then pulls the free end of the nitinol loop. As the nitinol loop is pulled, its end within the spoon encircles the second end of the surgical wire protruding from the cannula drill bit. The practitioner then withdraws the arm and spoon from the patient's body, thus pulling the second end of the surgical wire outside the patient's body through the nitinol loop. Following these steps, the practitioner prepares two surgical wires. Each of these ends is external to the patient through the first incision and the second incision. Each surgical wire passes through the patient's clavicle. The surgeon uses these surgical wires to implant an artificial ligament. The artificial ligament may, for example, consist of a first wire connecting an implant called a clavicle button, which is placed on the clavicle, to one of two auxiliary drill holes, and a coracoid button, which is placed under the coracoid, to the other auxiliary drill hole. In practice, the surgeon can more easily attach different implants to the wires outside the patient's body.

[0037] Thus, an arm with a through channel extending between its first end and the spoon advantageously allows the practitioner to more easily position the components of the artificial ligament using nitinol loops and surgical wires.

[0038] According to one embodiment, the auxiliary tool also includes at least one cannulated drill bit intended to be inserted into the central drill bushing or the auxiliary drill bushing. The cannulated drill bit is in the form of a hollow tube into which one or more surgical wires or nitinol loops can be inserted. The at least one cannulated drill bit included in the auxiliary tool has a shape and diameter specifically designed to fit the drill bushing used.

[0039] According to one embodiment, at least one cannulated drill bit has a groove representing a predetermined drilling depth. The groove may be, for example, a circular groove formed on the outer periphery of the cannulated drill bit. Alternatively, the groove may be a longitudinal groove formed on the longitudinal outer side of the cannulated drill bit. The longitudinal groove has a length extending between two ends. When drilling to a predetermined depth, for example, during a lacing procedure, the practitioner can determine that the first cortical layer of the coracoid bone has been reached when, in the case of a circular groove, the circular groove becomes visible just above one end of a central drill bushing located on the side of the drill guide. The practitioner can also determine that the first cortical layer of the coracoid bone has been reached when, in the case of a longitudinal groove, one end of the longitudinal groove aligns with the end of the central drill bushing located on the side of the drill guide. The at least one cannulated drill bit having the groove is preferably used in conjunction with a central drill bushing.

[0040] According to one embodiment, at least one cannulated drill bit includes a stopper configured to rest on the drill bushing to be used. The cannulated drill bit generally has a substantially uniform diameter along its entire length. The stopper is a locally increased portion of the drill bit's outer diameter that prevents the drill bit from being inserted into the drill bushing beyond the stopper, thereby preventing the drill bit from drilling deeper than a predetermined depth.

[0041] According to one embodiment, for example, the spoon can have through-holes in its thickness to accommodate the end of a cannula drill bit guided by an auxiliary drill bushing. These through-holes in the spoon can facilitate the retrieval of a surgical wire inserted into the cannula drill bit during a lacing procedure thanks to a nitinol loop in the spoon. In this case, the spoon no longer prevents the cannula drill bit from reaching the nerve- and artery-dense area below the patient's coracoid process. A cannula drill bit with a stopper configured to rest on the drill bushing used prevents the cannula drill bit from reaching this nerve- and artery-dense area. This at least one cannula drill bit with a stopper is preferably used in conjunction with an auxiliary drill bushing. [Brief explanation of the drawings]

[0042] The invention will be better understood by reading the following description, given by way of non-limiting example, and by referring to the figures, in which:

[0043] [Figure 1] Figure 1 shows a schematic diagram of the reconstruction of the coracoid foramen. [Figure 2] FIG. 2 shows a schematic diagram of the lacing procedure. [Figure 3] FIG. 3 shows a schematic diagram of an embodiment of an assistive device according to the invention. [Figure 4] FIG. 4 shows a schematic diagram of an embodiment of a cannulated drill bit. [Figure 5] FIG. 5 shows a schematic diagram of an example of an auxiliary device used during a lacing procedure. [Figure 6] FIG. 6 shows a schematic diagram of an exemplary embodiment of an implant used during a coracoid tunnel reconstruction or lacing procedure. [Figure 7] FIG. 7 shows a schematic diagram of an exemplary embodiment of the arm and spoon of the assistive device. [Figure 8] FIG. 8 shows a schematic diagram of an exemplary embodiment of the spoon of the assistive device.

[0044] In these figures, the same reference numbers from one figure to another indicate the same or similar elements. For clarity, elements shown are not necessarily to scale unless otherwise indicated. DETAILED DESCRIPTION OF THE INVENTION

[0045] FIG. 1 shows a patient's shoulder 1. Also shown are the clavicle 101, coracoid process (hereafter referred to as the coracoid bone 102), acromion 103, humerus 104, and scapula 105. FIG. 1 also illustrates a schematic diagram of a trapezoid coracoclavicular ligament reconstruction, also known as a coracoclavicular tunnel reconstruction. Coracoclavicular tunnel reconstruction involves the placement of an artificial ligament consisting of a stretched wire 106 between an implant called a clavicle button 107 placed on the clavicle and an implant called a coracoid button 108 placed on the underside of the coracoid bone. Coracoclavicular tunnel reconstruction requires drilling of the clavicle 101 and the coracoid bone 102. The drilling of the clavicle 101 and the coracoid bone 102 must be performed along the same axis to allow for proper placement of the wire 106.

[0046] Figure 2 shows a schematic diagram of the reconstruction of the trapezoid and conoclavicular ligaments, known as the lacing procedure. The lacing procedure requires two drill holes in the clavicle 101 to place an artificial ligament consisting of two wires 106, but no drill holes in the coracoid 102. Two clavicle buttons 107 are placed on the clavicle, and one coracoid button 108 is placed below the clavicle. A wire 106 is stretched between each clavicle button 107 and the coracoid button 108. During the lacing procedure, the two wires 106 pass through the clavicle but not through the coracoid. The drill holes in the clavicle 101 must be made along an axis that passes under the coracoid to allow for proper positioning of the wires 106. Placing the wires 106 on either side of the coracoid process allows for a more anatomically appropriate lacing procedure than reconstruction of the coracoid foramen. "More anatomically appropriate" means that the artificial ligament connects various bones in a manner that more closely resembles the way natural ligaments connect these same bones.

[0047] 3 shows a schematic representation of an exemplary embodiment of an auxiliary device 2 according to the invention, which can be advantageously used both for the reconstruction of the coracoid foramen and for lacing procedures.

[0048] The assistive device 2 has an arc-shaped handle 201.

[0049] The handle 201 has two ends: a first end 222 to which the arm 202 is attached, and a second end 221 to which the drilling guide 204 is attached.

[0050] The arm 202 has an elongated shape. It extends between two ends. The first end 223 of the arm is attached to the first end 222 of the handle. The second end 224 of the arm 202 is provided with a part called the spoon 203. The spoon 203 is, for example, a metal part, and its shape allows it to fit the shape of the coracoid 102 in order to press against the coracoid 102 from below.

[0051] The handle 201 is designed so that the center of the arc is located on the spoon.

[0052] In the preferred embodiment shown in Figure 3, the handle 201 is adjustable, thus allowing the distance between the arm 202 and the drilling guide 204 to be adjusted to accommodate different morphologies of the patient's shoulder 1.

[0053] In one embodiment, the handle 201 has a slot that is also arc-shaped and through which the guide element slides. A locking means 220 holds the guide element in place within the handle.

[0054] When adjusting the handle 201, once the length between the arm 202 and the drilling guide 204 has been adjusted to suit the patient's morphology, the practitioner can lock the handle using the locking means 220.

[0055] In a preferred embodiment, as shown in Figure 3, arm 202 has a curved portion with the curvature directed towards handle 201. This shape of arm 202 is advantageous when a lateral approach is used to insert the assistive device into the patient's body, as it allows bypassing humerus 104 to reach the coracoid process with spoon 203. A lateral approach is defined as an incision made on the lateral aspect of the patient's shoulder 1 to insert the spoon and arm into the patient's body.

[0056] In another embodiment, the arm 202 does not have a curve. In this case, the auxiliary instrument can be inserted into the patient using an anterior approach. The anterior approach is defined as an incision made to insert the spoon and arm into the patient from the front of the patient's shoulder. This allows access to the coracoid 102 without having to bypass the humerus 104.

[0057] The drilling guide 204 has a central through-hole 205, the longitudinal axis 405 of which passes through the spoon 203. The 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 receive and guide the cannulated drill bit 301, also referred to as drill bit. The central through-hole 205, with its longitudinal axis 405 passing through the spoon, ensures that the cannulated drill bit guided by the central drill bushing will necessarily emerge into the spoon 203.

[0058] The drill guide 204 comprises through holes, referred to as auxiliary through holes 206. Each auxiliary through hole 206 is arranged along a longitudinal axis 406 passing through the spoon 203. The auxiliary through holes 206 of the drill guide 204 are intended to receive an auxiliary drill bushing 208. The cannulated drill bit 301 is intended to be inserted into the auxiliary drill bushing 208. The auxiliary through holes 206 and the auxiliary drill bushings are advantageously intended for a lacing procedure, as will be explained later. Only two auxiliary through holes 206 and two auxiliary drill bushings are used for a lacing procedure.

[0059] The auxiliary through holes 206 of the drilling guide 204 are arranged in pairs diametrically opposed to each other around the central through hole 205 .

[0060] In one embodiment (not shown), the drilling guide 204 includes a pair of auxiliary through holes 206. The pair of auxiliary through holes and the central through hole are aligned.

[0061] In another embodiment, the drill guide 204 includes multiple pairs of auxiliary through-holes, which allows the practitioner to accommodate the patient's condition during the lacing procedure by selecting a pair of auxiliary through-holes that allows the procedure to be performed without drilling the coracoid.

[0062] In the preferred, but non-limiting example of Figure 3, the drill guide comprises eight auxiliary through holes. In a preferred embodiment, as shown in Figure 3, the central drill bushing 207 comprises a Jacob's rasp 209 at one free end oriented toward the spoon 203. A Jacob's rasp is a generally metal component having an elongated, curved shape substantially similar to that of a claw. The Jacob's rasp 209 advantageously increases the stability of the auxiliary instrument by hooking onto the edge of the clavicle 101 before the drilling is performed.

[0063] 4 schematically illustrates two exemplary embodiments of a cannulated drill bit 301. The cannulated drill bit 301, also known as a cannula, is an elongated piece in the shape of a hollow tube designed for implantation into a patient's body and drilling into bone. The cannulated drill bit 301 is hollow so that it can accommodate a surgical wire or a nitinol loop.

[0064] In the exemplary embodiment, the cannulated drill bit includes grooves 302 on the periphery of the cannulated drill bit 301 to provide an indication to the practitioner that the cannulated drill bit has reached the desired depth. The practitioner can determine that the target depth has been reached, for example, when groove 302 is located directly over one end of the central drill bushing located on the side of drill guide 204.

[0065] In the exemplary embodiment, the cannulated drill bit 301 includes a stop 303 on its periphery. This stop is characterized by a localized increase in the outer diameter of the cannulated drill bit. This stop is configured to abut against the drill bushing used and thus advantageously prevents the cannulated drill bit 301 from exceeding a predetermined depth. As a result, sensitive areas of the patient's body are protected during drilling.

[0066] In one embodiment, as shown in Figure 8, the spoon has two through-holes 212 in its thickness direction. The two openings are positioned at the virtual intersections of the spoon and the longitudinal axis of the auxiliary through-hole of the drill guide. The drill bit, guided by the auxiliary drill bushing, passes through both openings in the spoon. In this case, using a drill bit with a stop is particularly advantageous for protecting the sensitive area below the coracoid bone.

[0067] 7, arm 202 has a through channel 210 extending between a first end 223 of the arm and spoon 203. Through channel 210 is advantageously used for lacing procedures, particularly for the passage of a surgical wire or nitinol wire loop, as will be described later. For example, as shown in FIG. 8, a first end of a loop 211 of nitinol wire, referred to as a nitinol loop, protrudes from through channel 210 such that the first end of the nitinol loop is disposed within spoon 203.

[0068] FIG. 6 is a schematic diagram of an implant used in a coracoid tunnel reconstruction surgery or lacing procedure. An implant is understood to mean a component intended to remain permanently in the patient's body after a surgical procedure. A first implant 108, called a coracoid button, is shown in this FIG. 6. The coracoid button has a curved shape that preferably allows it to conform to the shape of the coracoid bone on which it rests. Also shown in FIG. 6 is a second implant 107, called a clavicle button. This clavicle button 107 is designed to be placed on the clavicle 101 during a lacing procedure or coracoid tunnel reconstruction.

[0069] In this embodiment of auxiliary instrument 2 for coracoid foramen reconstruction, the practitioner uses only the central drill bushing, but not the auxiliary drill bushing. The arms 202 of the auxiliary instrument are curved to allow for a lateral approach to the humerus and to bypass the humerus. The practitioner makes two incisions in the patient's shoulder: one above the clavicle 101 and the second in the space between the humerus 104 and the acromion 103. The practitioner then manipulates auxiliary instrument 2 using handle 201 as follows: - Insert the free end of the central drill bushing 207 into the first incision until the free end of the central drill bushing 207 rests on the clavicle 101. - The spoon 203 attached to one end of the arm 202 is then inserted until the spoon 203 is placed under the coracoid bone.

[0070] If the central drill bushing contains a Jacob's rasp, as shown in Figure 5, the Jacob's rasp will catch on the clavicle.

[0071] The practitioner can then perform the drilling necessary to reconstruct the coracoid foramen using the cannula drill bit 301, guided by the central drill bushing 207. The cannula drill bit 301 is used to drill the clavicle 101 and then the coracoid 102. The area of ​​the patient's body below the coracoid 102 is considered a sensitive area due to the concentration of nerves and arteries. During drilling, the spoon 203 advantageously prevents the cannula drill bit 301 from reaching this sensitive area by stopping the tip of the cannula drill bit immediately after the cannula drill bit has drilled.

[0072] As shown in FIG. 5 , in an embodiment of the auxiliary tool 2 for a lacing procedure, the practitioner uses a central drill bushing along with two auxiliary drill bushings. The arms 202 of the auxiliary tool are curved to facilitate lateral approach and bypass of the humerus. The practitioner also makes two incisions in the patient's shoulder: a first incision above the clavicle 101 and a second incision in the space between the humerus 104 and the acromion 103. The practitioner then uses the handle 201 to manipulate the auxiliary tool 2 as follows: The free end of the central drill bushing 207 is inserted into the first incision until it rests on the clavicle 101 . The spoon 203 is inserted until it is placed under the coracoid bone.

[0073] As shown in Figure 5, when the central drill bushing contains a Jacob's rasp, the Jacob's rasp catches on the clavicle.

[0074] A cannulated drill bit is then inserted into the central drill bushing 207 to drill through the clavicle 101, reaching the first cortical layer of the coracoid 102. The term "first cortical layer" refers to the superficial layer of bone. This drilling of the clavicle, guided by the central drill bushing, is not generally used to insert an artificial ligament during a lacing procedure. However, it ensures that the auxiliary instrument 2 is held in place during the auxiliary drilling operation, guided by the auxiliary drill bushing.

[0075] Two cannulated drill bits 301 are inserted into two auxiliary drill bushings 208 to allow drilling at two locations on the clavicle 101. The auxiliary drill bushings are pre-positioned in two auxiliary through-holes diametrically opposite the central through-hole based on the patient's condition to avoid drilling the coracoid with the cannulated drill bits.

[0076] As shown in Figure 5, in a non-limiting manner, the cannulated drill bit inserted into the central drill bushing 207 includes 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 shown in Figure 5, in a non-limiting manner, the cannulated drill bit inserted into the auxiliary drill bushing includes a stop 303. This stop 303 is particularly useful for protecting the sensitive area below the coracoid.

[0077] 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 drilling, the practitioner inserts a surgical wire into each of the cannula drill bits positioned within the auxiliary drilling bushing. Each surgical wire has two ends, referred to as the first end and the second end. The first end of each surgical wire is held outside the patient's body above the clavicle. The second end of each surgical wire protrudes from the cannula drill bit inside the patient's body, within the spoon. The practitioner then pulls the free end of the nitinol loop. As the nitinol loop is pulled, its first end hooks onto the second end of the surgical wire. The practitioner then removes the spoon from the patient's body. As the spoon is withdrawn from the patient's body, the nitinol loop withdraws the second end of each surgical wire from the patient's body. As a result, the practitioner has two surgical wires passing through the clavicle 101 with both ends external to the patient's body. These wires can then be used to place clavicle buttons 107 in each auxiliary drill hole and secure the coracoid button 108 below the coracoid bone in the position previously occupied by the spoon 203. Thanks to the through-channels 210 in the arms 202, the practitioner can easily withdraw the ends of the surgical wires that pass through the patient's clavicle, thereby facilitating the securement of the implants to these surgical wires.

Claims

1. An auxiliary instrument (2) for acromioclavicular joint separation surgery, an arc-shaped handle (201) having two ends called a first end (222) and a second end (221); an elongated arm (202) attached at a first end (223) to the first end (222) of the handle (201) and comprising at a second end (224) a spoon-shaped portion called spoon (203); a drilling guide (204) connected to said second end (221) of said handle (201), a central through-hole (205) whose longitudinal axis (405) passes through said spoon (203); two auxiliary through holes (206) arranged diametrically opposite to the central through hole (205), each of the two auxiliary through holes (206) having a longitudinal axis (406) passing through the spoon (203), forming a pair of the auxiliary through holes; the drilling guide (204), a so-called central drill bushing (207) suitable for insertion into said central through-hole (205); - two so-called auxiliary drill bushings (208) suitable for insertion into the two said auxiliary through holes (206); An auxiliary device (2) comprising:

2. 2. The auxiliary tool (2) of claim 1, wherein the drilling guide (204) comprises a plurality of pairs of auxiliary through holes (206), each pair of auxiliary through holes being arranged diametrically opposite the central through hole (205), and each having the longitudinal axis (406) passing through the spoon (203).

3. 3. An aid (2) according to claim 1 or 2, wherein the arm (202) has a curved portion directed towards the handle (201).

4. 4. An auxiliary tool (2) according to any one of claims 1 to 3, wherein the central drill bushing (207) is provided with a Jacob's rasp tool (209) at one end, referred to as the free end, oriented towards the spoon (203).

5. 5. An aid (2) according to any one of claims 1 to 4, wherein the handle (201) is adjustable.

6. 6. An aid (2) according to any one of claims 1 to 5, wherein the arm (202) has a through channel (210) extending between the first end of the arm and the spoon (203).

7. 7. An auxiliary tool (2) according to any one of claims 1 to 6, also comprising at least one cannulated drill bit (301) designed to be inserted into the central drill bushing (207) or the auxiliary drill bushing (208).

8. 8. An auxiliary tool (2) according to claim 7, wherein at least one of the cannulated drill bits (301) has a groove (302) representing a predetermined drilling depth.

9. 9. An auxiliary tool (2) according to claim 7 or claim 8, wherein at least one of the cannulated drill bits (301) has a stop (303) adapted to bear against a drill bushing used.

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