Guide and instrument for improving accuracy of glenoid implant placement

Abstract

It is an object of the present invention to provide a patient-specific glenoid guide.SOLUTION: A patient-specific glenoid guide is described. The glenoid guide has a body. The body has an outer surface and an inner surface. The inner surface has a patient conforming portion. The patient-matched portion is configured as an inverted surface of the glenoid region of the scapula of the individual patient. The guide may have a positioning feature disposed on or through the body, a K-wire guide passage extending through the body from a K-wire inlet disposed on the lateral surface to a K-wire outlet disposed on the patient-matching portion of the medial surface, and a peripheral passage extending through the body from a drill inlet disposed on the lateral surface to a drill outlet disposed on the patient-matching portion of the medial surface, or peripheral members extending radially outward from an outer periphery of the body and each having a contact member.SELECTED DRAWING: Figure 42B

Description

[Technical Field]

[0001] [Incorporation by reference to priority application] Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet filed with this application are hereby incorporated by reference under 37 CFR §1.57.

[0002] SUMMARY The present disclosure relates to patient-specific shoulder devices and methods. [Background technology]

[0003] Shoulder arthroplasty is a significant medical innovation. The procedure may involve replacing or repairing one or both articular surfaces of the humerus and glenoid cavity to restore shoulder function, relieve shoulder pain, and improve the patient's quality of life by reducing shoulder pain.

[0004] Various instruments are used to assist the surgeon in preparing the bones of the shoulder joint during a shoulder arthroplasty procedure. These instruments can include guide wires, guide pins, and cutting blocks that can guide reamers and bone saws to remove portions of bone to match the standard bone interface. In some cases, several guides are required to produce a good surgical outcome for the patient.

[0005] Patient-specific techniques are beginning to be applied to arthroplasty. Such techniques may involve obtaining imaging of the joint. From that imaging, instruments custom-made for the individual patient may be created. While this may be an advancement, patient-specific instruments may not reduce the number of instruments or the complexity of the procedure. [Prior art documents] [Patent documents]

[0006] [Patent Document 1] U.S. Patent Application Serial No. 14 / 794,544 Summary of the Invention [Problem to be solved by the invention]

[0007] There is a need for improved surgical instruments that can improve the placement of glenoid joint implants. There is a need for improved surgical guides that can assist in orienting glenoid joint implants. There is a need for improved surgical guides that can assist in forming channels for screws and other anchors for glenoid joint implants. There is a need for surgical guides with improved stability, and for guides that can be placed in the glenoid without interfering with, interacting with, potentially being obstructed by, or interfering with the position or movement of tissue retractors and other surgical instruments. There is a need for patient-specific surgical guides that can provide any or all of these and other improved characteristics. There is a need for combining the functions of multiple guides into a single guide to improve patient fit as well as reduce the complexity of instrumentation for shoulder arthroplasty. [Means for solving the problem]

[0008] In one embodiment, a patient-specific glenoid guide is provided. The glenoid guide has a body, a positioning feature, a K-wire guide passage, and a plurality of peripheral passages. The body has a lateral surface and a medial surface. The medial surface has a patient-matched portion. The patient-matched portion is configured as an inverted surface of the glenoid region of an individual patient's scapula. The positioning feature is disposed on or through the body. The positioning feature is configured to reference a guide pin to position the body relative to the glenoid. The K-wire guide passage extends through the body from a K-wire inlet disposed on the lateral surface to a K-wire outlet disposed on the patient-matched portion on the medial surface. The peripheral passage extends through the body from a drill inlet disposed on the lateral surface to a drill outlet disposed on the patient-matched portion on the medial surface. The peripheral passage can be used to prepare the bone for an anchor, which may be a screw, peg, or other implant connector.

[0009] In another embodiment, a patient-specific anchor trajectory guide is provided. The anchor trajectory guide includes a body, a locating feature, and a plurality of peripheral screw openings. The body has a lateral surface and a medial surface. The medial surface has a patient-matched portion configured as an inverted surface of the glenoid articulation area. The locating feature is disposed on or through the body. The locating feature is configured to reference a guide pin to locate the body relative to the glenoid. The peripheral screw openings extend through the body from an inlet located on the lateral surface to an outlet located on the patient-matched portion on the medial surface. The peripheral screw openings are positioned and oriented to provide good acquisition in the shoulder bones around the glenoid for a specific patient.

[0010] In another embodiment, a method is provided that can be used to prepare a glenoid for an implant. In the method, a patient's glenoid is exposed. A body of a glenoid guide is advanced toward the glenoid until a first side of the guide contacts the articular surface of the glenoid. A patient-matched surface on the first side of the guide is positioned in contact with a portion of the articular surface of the glenoid where the patient-matched surface is configured as an inverted portion. The method can involve aligning the guide with the glenoid in rotation and / or translation. A drill is advanced along a planned trajectory defined by a bone preparation channel defined through the body of the glenoid guide. The planned trajectory extends along an axis centered at the drill entry point and the drill exit point, which is positioned at the patient-matched surface. The drill entry point can be positioned on a second side of the body. A screw channel is formed in the scapula along the axis. An implant component is secured to the scapula by advancing a screw through the implant and into the screw channel.

[0011] In another embodiment, a patient-specific glenoid guide is provided, comprising a body, a guide passage, and a plurality of peripheral screw passages. The body has a lateral surface and a medial surface. The medial surface has a patient-matched portion. The patient-matched portion is configured as an inverted surface of the glenoid portion of the individual patient's scapula. The guide passage can be a K-wire guide passage. The K-wire guide passage extends through the body from a K-wire inlet located on the lateral surface to a K-wire outlet located on the patient-matched portion on the medial surface. The peripheral screw passage extends through the body from a drill inlet located on the lateral surface to a drill outlet located on the patient-matched portion on the medial surface.

[0012] In some embodiments, a patient-specific glenoid guide is provided, comprising a body, a plurality of perimeter members, and a passage. The body has an outer surface and an inner surface. The inner surface of the body has a patient-matching portion configured as an inverted surface of the glenoid region of the individual patient's scapula. The plurality of perimeter members extend radially outward from the outer perimeter of the body. Each of the plurality of perimeter members has a contact member. In some implementations, the contact member has a patient-specific portion and a non-contoured portion. The passage extends through the body from a passage inlet disposed on the outer surface to a passage outlet disposed on the inner surface. The passage can be configured to directly or indirectly receive a guide pin or drill. In some embodiments, a patient-specific glenoid guide is provided, comprising a body, a locating feature, and a passage. The body has an outer surface and an inner surface. The inner surface of the body has a patient-matching portion configured as an inverted surface of the glenoid region of the individual patient's scapula. The locating feature is disposed on or through the body and configured to reference the guide pin to locate the body relative to the glenoid region. The positioning feature can extend radially outward from the body. In some implementations, the positioning feature comprises a sealed passageway extending through the body from an inlet located on the outer surface to an outlet located on the inner surface.

[0013] In some embodiments, a method is provided. The method may include exposing a patient's glenoid and removing soft tissue from the surface of the glenoid. The body of any of the aforementioned glenoid guides may be advanced toward the glenoid. When positioned, a contact member of each of the plurality of perimeter members contacts a rim of the glenoid. For example, the contact member may be adapted to the patient to fit the rim. A drill may be advanced along a planned trajectory defined by an axis of a bone preparation channel defined through the body of the glenoid guide. An anchor channel may be formed in the scapula along the axis. An implant component may be secured to the scapula by advancing an implant or bone screw into the anchor channel.

[0014] Any feature, structure, or step disclosed herein may be substituted or combined with any other feature, structure, or step disclosed herein, or may be omitted. Moreover, for purposes of summarizing this disclosure, certain aspects, advantages, and features of the invention are described herein. It is understood that not necessarily any or all such advantages may be achieved in accordance with any particular embodiment of the invention disclosed herein. No aspect of this disclosure is required or essential.

[0015] These and other features, aspects, and advantages are described below with reference to the drawings, which are intended for illustrative purposes and should not be construed as limiting the scope of the embodiments. Furthermore, various features of different disclosed embodiments may be combined to form additional embodiments, which are part of this disclosure. In the drawings, like reference numerals refer consistently to corresponding features throughout like embodiments. Below is a brief description of each of the drawings. [Brief explanation of the drawings]

[0016] [Figure 1] This is a diagram of the glenohumeral shoulder joint. [Figure 2] 1A-1C are views of an embodiment of a reverse glenoid assembly. [Figure 3] FIG. 1 is a perspective view of a patient-specific glenoid guide adapted to provide positive rotational position control and applied to a patient's glenoid. [Figure 4] FIG. 4 is a perspective view of the glenoid guide shown in FIG. 3 separated from the scapula. [Figure 5] FIG. 4 is a lateral view of the glenoid guide shown in FIG. 3. [Figure 6] FIG. 4 is a side view of the medial side of the glenoid guide shown in FIG. 3. [Figure 7] 7 is a cross-sectional view of the guide of FIG. 3 taken at the cutting plane 7-7 shown in FIG. 5. [Figure 8] 8 is a cross-sectional view of the guide of FIG. 3 taken at the cutting plane 8-8 shown in FIG. 5. [Figure 9] FIG. 4 is a side view of the front portion of the guide of FIG. 3. [Figure 10] FIG. 4 is a side view of the rear portion of the guide of FIG. 3. [Figure 11] FIG. 4 is a side view of the upper side of the guide of FIG. 3. [Figure 12] FIG. 4 is a side view of the underside of the guide of FIG. 3. [Figure 13] FIG. 10 is a perspective view of another embodiment of a patient-specific glenoid guide. [Figure 14] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 15] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 16] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 17] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 18] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 19] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 20] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 21] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 22] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 23] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 24] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 25] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 26] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 27] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 28] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 29]10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 30] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 31] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 32] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 33] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 34] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 35] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 36] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 37] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 38] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 39A] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 39B] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 40A] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 40B] 10A-10C are views of another embodiment of a patient-specific glenoid guide. [Figure 41A] 1A-1C are diagrams of a modular embodiment of a patient-specific glenoid guide. [Figure 41B] 1A-1C are diagrams of a modular embodiment of a patient-specific glenoid guide. [Figure 42A] 1A-1C are diagrams of a method of preparing the glenoid cavity using a patient-specific glenoid guide. [Figure 42B] 1A-1C are diagrams of a method of preparing the glenoid cavity using a patient-specific glenoid guide. [Figure 42C] 1A-1C are diagrams of a method of preparing the glenoid cavity using a patient-specific glenoid guide. [Figure 42D]1A-1C are diagrams of a method of preparing the glenoid cavity using a patient-specific glenoid guide. [Figure 42E] 1A-1C are diagrams of a method of preparing the glenoid cavity using a patient-specific glenoid guide. [Figure 42F] 1A-1C are diagrams of a method of preparing the glenoid cavity using a patient-specific glenoid guide. [Figure 42G] 1A-1C are diagrams of a method of preparing the glenoid cavity using a patient-specific glenoid guide. DETAILED DESCRIPTION OF THE INVENTION

[0017] This application is directed to devices and methods for shoulder arthroplasty that are, in some cases, patient-specific. Section I details the shoulder anatomy and glenoid implant anchoring assemblies. Section II details various patient-matched glenoid guide components that streamline and increase the accuracy of the glenoid implant preparation procedure. Section III details methods of using the patient-matched glenoid guide components.

[0018] I. Shoulder Anatomy and Glenoid Implant Assembly FIG. 1 shows the skeletal components of the glenohumeral joint 8. In shoulder arthroplasty surgery, the joint 8 is accessed through an incision made in the tissue above the joint 8. The head 10 of the humerus 12 may be separated from the scapula 14 to provide access to the glenoid fossa 18. A glenoid implant can repair or replace the articular surface of the glenoid fossa 18. The articular surfaces of the humerus 12 and the glenoid fossa 18 may be reversed in some cases, providing the humerus 12 with a concave glenoid member and the glenoid fossa 18 with a convex glenoid member, called a glenosphere. In some cases, the glenoid surface is worn away and is therefore strengthened to compensate for this wear.

[0019] Regardless of whether or not there is significant wear, the glenoid cavity 18 is prepared to accommodate the glenoid implant. Better results result from the glenoid implant being properly oriented in the glenoid cavity. Such preparation may include reaming the glenoid cavity 18 and then attaching the glenoid implant to the reamed surface. Glenoid cavity preparation and reaming, and implant placement, can be accomplished with a series of guide instruments, which may be generic or patient-specific.

[0020] 2 illustrates a reverse shoulder glenoid assembly 19. The glenoid assembly 19 includes a base plate 20 that may be secured to the glenoid by one or more central anchors and one or more peripheral anchors 24. In the case of a reverse shoulder arthroplasty, the base plate 20 may be secured to a glenosphere as previously described. The glenosphere may be coupled to a concave humeral component that is anchored to the upper arm of the shoulder joint to provide articular motion.

[0021] II. Patient-matched multifunctional glenoid guide 3-41B illustrate various glenoid guides that serve multiple functions in connection with a patient-matched or patient-specific glenoid preparation procedure.

[0022] A. Patient-matched glenoid guide with glenoid-sized guide body 3-12 illustrate a first embodiment of a patient-specific glenoid guide 100 including a positioning feature configured to rotationally position the guide 100. The guide 100 is configured to provide multiple functions, as discussed further below. The functions may include one or more of rotationally positioning the patient-specific glenoid guide 100 at the positioning feature 108, guiding a central guide pin 160, such as a K-wire, through the K-wire guide channel 112 into the glenoid fossa 54, and guiding anchor channel preparation in the scapula 52 through the peripheral channel 116. As a result, the guide 100 combines the functionality of multiple guides into a single guide, which may reduce the number of surgical instruments required, improve guide performance, or in some cases provide both of these benefits.

[0023] The patient-specific glenoid guide 100 has a body 104, which in the illustrated embodiment is generally disc-shaped. The body 104 has a periphery 144 that is convex in overall configuration when viewed from the outside, as shown in FIG. 5 . The body 104 generally conforms to the size of the glenoid cavity 54 of the scapula 52. As a result, the body 104 is sized to fit through an incision made to expose the shoulder, specifically the glenoid cavity 54. The body 104 may be sized smaller than the glenoid cavity 54 and may have a more complex periphery shape to expose a portion of the glenoid cavity 54, as discussed further below. The body 104 has a first side 120 and a second side 124 separated from the first side 120 by the periphery 144. The first side 120 may be referred to herein as the medial side because the first side 120 is closest to the patient's medial plane when the body 104 is placed against the glenoid cavity 54. The second side 124 is sometimes referred to as the outer side because when the body 104 is placed against the glenoid fossa 54, the second side 124 is on the outer side of the glenoid fossa 54 and is on the outer side of the first side 120.

[0024] As discussed below, positioning features 108 are provided at or within the periphery 144 of body 104 to assist the surgeon in positioning body 104 when patient-specific glenoid guide 100 is inserted through an incision into glenoid 54. Positioning features 108 may extend between first side 120 and second side 124, for example, from an end at first side 120 to an end at second side 124.

[0025] The K-wire guide passage 112 can be formed generally in the center or central region of the body 104 and can extend, for example, from the second side 124 to the first side 120 or between the first side 120 and the second side 124. The K-wire guide passage 112 can extend at any angle relative to the second side 124 of the body 104. The K-wire guide passage 112 can be perpendicular to the second side 124. The K-wire guide passage 112 can receive a K-wire or other central guide pin 160 at an entrance formed in the second side 124 of the body 104. The central guide pin 160 can be further advanced into the glenoid fossa 54 through an exit of the K-wire guide passage 112. The central guide pin 160 can be further advanced to a depth sufficient to allow a subsequent procedure to be performed thereon, as discussed further below.

[0026] The peripheral passages 116 are disposed around the body 104. The peripheral passages 116 may be disposed between the K-wire guide passages 112 and the periphery 144 of the body 104. In one embodiment, the peripheral passages 116 may comprise four passages with inlets at the second side 124. The inlets of the peripheral passages 116 may be arranged in a generally cross-shaped pattern, with a bore inlet positioned in each of two perpendicular planes. The planes intersecting the bore inlets may extend vertically (relative to the orientation of the glenoid in an upright patient, or as shown as cross section 7-7 in FIG. 5 ), horizontally (relative to the orientation of the glenoid in an upright patient, or as shown as cross section 8-8 in FIG. 5 ), or perpendicular to the second side 124 of the body 104. The peripheral passages 116 may be used to form peripheral screw passages in the glenoid fossa 54 using a passage-forming instrument, such as a drill, as discussed further below. The peripheral channel 116 is sometimes referred to herein as a bone preparation channel.

[0027] The peripheral channels 116 are preferably matched to the patient in at least one respect. In this context, the peripheral channels 116 may be matched to the patient in terms of orientation through the body 104 with reference to the scapula 52 to provide good anchor placement. Referring to FIG. 2 , the peripheral anchors 24 secure the base plate 20 to the glenoid cavity 54, which is a thin, approximately plate-like bony structure. As a result, if the orientation of the peripheral anchors 24 is not carefully controlled, they may move their ends away from the base plate 20, penetrate the wall of the scapula 52, and engage the soft tissue adjacent to the scapula, or may not reach the cortical bone where the anchors can more firmly engage the bone.

[0028] 5-6 show additional details of the patient-specific glenoid guide 100. The locating feature 108 can be seen positioned on the upper portion 200 of the body 104. The locating feature 108 can be seen to have the configuration of an open channel 148 in this embodiment. The locating feature 108 can be a concave channel. The locating feature 108 can be semicircular in one embodiment, for example, bounded by a 180-degree arc. The locating feature 108 can extend from a first end at the first side 120 (see FIG. 6) to a second end at the second side 124 (see FIG. 5). When open, the locating feature 108 can receive a peripheral pin 162 (shown in FIG. 3) in more than one orientation. For example, the peripheral pin 162 can be slid along the locating feature 108 of the glenoid guide 100 in the glenoid fossa 54 from lateral to medial, with the locating feature 108 entering the second end at the second side 124 first. The pin 162 can be advanced through the incision and transitioned toward the glenoid guide 100 after both the guide and pin have been advanced into the glenoid fossa 54. The locating feature 108 may also be used to make bovie marks on the surface of the scapula 52, for example, in the superior region of the glenoid fossa 54, to facilitate further surgical steps following use of the guide 100. The pin 162 or bovie marks can then be used to orient the implant, such as in reverse, if it is an implant, as discussed later in connection with FIGS. 42A-42G.

[0029] FIG. 5 shows that the perimeter 144 is continuously convex from one side of the locating feature 108 (to the right of the cross section in FIG. 5 ) to the opposite side of the locating feature 108 (to the left of the cross section in FIG. 5 ). The continuously convex shape can be circular in one embodiment, or can be elliptical with a major axis between the upper portion 200 and the lower portion 210 of the body 104 and a minor axis between the front portion 204 and the rear portion 212. FIG. 5 shows that some of the peripheral passages 116 can be aligned with one another. For example, as previously discussed, two of the peripheral passages 116 can be positioned at cross section 7-7 and two of the peripheral passages 116 can be positioned at cross section 8-8. In one embodiment, each of the peripheral passages 116 is positioned at a non-perpendicular orientation relative to the second side 124. The peripheral passages 116 in the top portion 200 and the rear portion 212 are angled to such an extent that their portions on the first side 120 of the body 104 are not visible from the second side 124. The peripheral passages 116 in the front portion 204 and the bottom portion 210 are angled to a lesser extent such that their portions on the first side 120 of the body 104 are not visible from the second side 124. The orientation of the peripheral passages 116 is discussed in more detail below.

[0030] FIG. 6 shows the first side 120 of the body 104 in more detail. The first side 120 includes a patient-matching portion 140. The first side 120 also includes an uncontoured portion 141 disposed between the patient-matching portion 140 and a periphery 144. The uncontoured portion 141 can correspond to the portion of the glenoid 54 that is most likely to wear. The uncontoured portion 141 can correspond to the portion of the glenoid 54 that is not suitable for patient-matched connection to the patient-specific glenoid guide 100. The interface between the patient-matching portion 140 and the uncontoured portion 141 can facilitate at least initial rotational positioning or fixation in some embodiments. Also, in some cases, the glenoid guide 100 can be formed as part of a surgical plan in which the glenoid is reamed. For example, reaming around an area of ​​osteophytes can remove the osteophytes. The reaming step can leave the glenoid largely intact while creating one or more flat or planar areas in the glenoid 54. The uncontoured portion 141 can conform to a flat or planar region of the glenoid fossa 54. The K-wire guide passage 112 can be positioned perpendicular to the second side 124 and can emerge onto the first side 120 in a central region or even at the center of the first side 120. One or more of the K-wire guide passage 112 and the peripheral passage 116 can be located in the patient-matching portion 140 of the first side 120. In some variations, one or more of the K-wire guide passage 112 and the peripheral passage 116 can be located in the uncontoured portion 141. In some variations, one or more of the K-wire guide passage 112 and the peripheral passage 116 can be located at the boundary between the patient-matching portion 140 and the uncontoured portion 141.

[0031] 7 and 8 show further details of one embodiment of the patient-specific glenoid guide 100 and the peripheral passage 116 in the K-wire guide passage 112. The peripheral passage 116 may include a first passage 218 in the superior portion 200 of the guide, a second passage 227 in the anterior portion 204, a third passage 235 in the inferior portion 210, and a fourth passage 243 disposed in the posterior portion 208 of the body 104. The K-wire guide passage 112 extends from the drill inlet 180 to the drill outlet 184 to prepare a path for the K-wire. The K-wire guide passage 112 extends along an axis 198. The axis 198 is centered at the drill inlet 180, the drill outlet 184, and the passage therebetween. The axis 198 can be disposed at any suitable angle, but is generally disposed perpendicular to the second side 124.

[0032] In one embodiment, the peripheral passages 116 are oriented non-perpendicular to the second side 124. In other embodiments, at least one of the peripheral passages 116 is perpendicular to the second side 124. Any of the peripheral passages 116 may be positioned at an angle different from that shown in view of the patient-specific glenoid guide 100 being matched to the patient. The angle of the peripheral passages 116 may be selected according to the patient's needs to provide improved bony fixation and positioning in the scapula 52. FIG. 7 shows that a first passage 218 of the peripheral passages 116 may be provided in the upper portion 200 of the patient-specific glenoid guide 100. The first passage 218 may extend through the body 104 from a first passage inlet 220 to a first passage outlet 224. The first passage 218 may extend along a first passage axis 226 positioned through the first passage 218. The first passage axis 226 may be positioned at any angle, but as shown, is oriented away from the axis 198. In some embodiments, the first passageway axis 226 is oriented such that the anchor recess formed through the body 104 has a medial end at the scapula 52 that is farther away from the passageway formed along the axis 198 than the entrance at the glenoid fossa 54 of the recess so formed. This arrangement results in at least the anchors positioned along the recess formed along the first passageway axis 226 being flared or diverging from a vertical axis, such as the axis 198 or a similar axis.

[0033] The third passageway 235 may be disposed in the same plane as the first passageway 218 or on a single side with the first passageway 218. The third passageway 235 may include a third passageway inlet 236 and a third passageway outlet 240. The third passageway 235 may extend along a third passageway axis 242 disposed between the third passageway inlet 236 and the third passageway outlet 240. The third passageway axis 242 may be centered at one or both of the third passageway inlet 236 and the third passageway outlet 240. The third passageway axis 242 may be centered at the passageway between the third passageway inlet 236 and the third passageway outlet 240. The third passageway 235 may be disposed such that the third passageway axis 242 is oriented away from the axis 198 at the first side 120 of the body 104. The orientation of the third passageway axis 242 and the first passageway axis 226 causes the anchors disposed in recesses formed along these axes to diverge from one another, or to flare at the scapula 52. Such anchors are disposed in a common vertical plane.

[0034] The second passageway 227 and the fourth passageway 243 of the body 104 may lie in a common plane, such as the front-to-back plane shown in FIG. 5 . The second passageway 227 may include a second passageway inlet 228 and a second passageway outlet 232. The passageway between the second passageway inlet 228 and the second passageway outlet 232 may extend along and be centered at a second passageway axis 234. The fourth passageway 243 may be disposed between a fourth passageway inlet 244 and a fourth passageway outlet 248 and may be centered at a fourth passageway axis 250 extending through the fourth passageway inlet 244 and the fourth passageway outlet 248. The second passageway axis 234 and the fourth passageway axis 250 may be angled away from the axis 198 at the first side 120 of the body 104. Second passageway axis 234 and fourth passageway axis 250 may be angled away from one another on first side 120 of body 104. The orientation of second passageway 227 and fourth passageway 243 causes anchors advanced along passageways formed along second passageway axis 234 and fourth passageway axis 250 to diverge medially in the bone. Such anchors may have a flared configuration as supported by axes 198, 226, 234, 242, 250 in FIGS. 7-8 , depending on the specific patient anatomy.

[0035] The orientation of the second passageway 227 and the fourth passageway 243 results in the distal or free ends of the anchors being directed toward the anterior and posterior walls of the scapula 52. The surgical plan can stipulate that such distal ends do not penetrate the walls of the scapula 52. The plan can be performed such that the distal ends are at or within the cortical bone layer.

[0036] FIGS. 9-12 illustrate the thickness of the guide 100. The thickness of the guide can be configured to position a lateral plane that matches the pre-arthritic state of the glenoid. For example, the body 104 can be configured so that when the first side 120 contacts the glenoid 54, the second side 124 of the body 104 is positioned in a pre-operatively determined lateral pre-arthritic position. The contour of the first side 120 as viewed from the perspective of FIGS. 9-12 can be what fills the gap between the second side 124 and the surface of the glenoid 54 with little or no reaming or other alteration in an arthritic state. The side with more of the patient-matching portion 140 visible will have a smaller thickness from the first side 120 to the second side 124 than the portion with less or no visible patient-matching portion 140, since the bone has been less worn from the pre-arthritic state. In another embodiment, the position of the second side 124 is less interesting than the orientation of the axis 198. The patient-specific glenoid guide 100 provides correction of the ante / retroversion and superior / inferior tilt of the glenoid from an arthritic condition. The correction can return the glenoid 54 to a pre-arthritic state or provide other corrections to improve shoulder joint kinematics. In the illustrated embodiment, the patient-specific glenoid guide 100 is configured to position the stem 198 by making the body 104 thicker posteriorly and superiorly. This rotates the stem 198 anteriorly and inferiorly relative to the eroded or arthritic surface of the glenoid.

[0037] The use of the patient-specific glenoid guide 100 is discussed in more detail below in Section III.

[0038] 13-17 show additional embodiments of patient-specific glenoid guides that may generally cover the surface of the glenoid fossa 54 or may cover at least the portion of the glenoid where an inverted shoulder baseplate or other glenoid implant will be positioned.

[0039] The patient-specific glenoid guide 300 is similar to the patient-specific glenoid guide 100 except as otherwise described below. The patient-specific glenoid guide 300, in one embodiment, includes a perimeter 304 that is continuously convex. In that regard, the perimeter 304 may be circular, oval, or other shape, but is devoid of any protrusions, recesses, or peripheral guiding structures or members. The patient-specific glenoid guide 300 has multiple functions. For example, the first side 120 is matched to the patient, as previously discussed. As such, the first side 120 can position the patient-specific glenoid guide 300 in the glenoid fossa 54 in a repeatable, predictable, preoperatively planned manner. The body 302 has a sufficient thickness between the first side 120 and the second side 124 to allow a surgeon to directly grasp the perimeter 304 to manipulate and position the patient-specific glenoid guide 300. The patient-specific glenoid guide 300 also has a K-wire guide channel 112 and a peripheral channel 116, which may have any of the configurations described above in connection with the patient-specific glenoid guide 100. Thus, use of the patient-specific glenoid guide 300 with guide pins and instruments to prepare the glenoid 54 is similar to use of the patient-specific glenoid guide 100. However, the patient-specific glenoid guide 300 may be deployed without reference to the rotational alignment of the base plate 20. The patient-specific glenoid guide 300 may be advantageous if the shape of the first side 120 and the corresponding side of the base plate 20 are rotationally very distinct, so that the surgeon can easily find the correct rotational position by feel.

[0040] 14-17 show a patient-specific glenoid guide 400 that is similar to guides 100, 300 except as noted below as different.

[0041] The patient-specific glenoid guide 400 includes a guide channel 412 formed in its body 402 that is adapted to receive a pin guide 416. The pin guide 416 may be a non-patient-specific guide for advancing the central guide pin 160 into the glenoid fossa 54. The pin guide 416 may include a docking feature 420, such as a tapered distal portion or surface. An internal bore 424 may extend through the pin guide 416 from a first end adjacent the docking feature 420 to a second end opposite the first end. The internal bore 424 may be sized to slidably receive the central guide pin 160.

[0042] 16 and 17 show the guide passage 412 in more detail in one embodiment. The pin guide 416 includes a guide entrance 438 and a guide seat 442. The guide entrance 438 is configured to slidably receive the docking feature 420 of the pin guide 416. The passage between the guide entrance 438 and the guide seat 442 may be tapered so that the alignment of the docking feature 420 with the passage in the guide passage 412 can provide a temporary connection, such as an interference fit. The guide passage 412 also includes a wire exit 446 through which the central guide pin 160, or a K-wire or similar elongated guide material, can be advanced through the body 402 and glenoid cavity 54 and into the scapula 52. In one method, the central guide pin 160 is placed through the pin guide 416. The pin guide 416 can be removed, leaving the central guide pin 160 in place. Removing the pin guide 416 provides greater clearance for drilling the peripheral passage in the scapula 52, while the central guide pin 160 provides stability to the patient-specific glenoid guide 400 so that the peripheral passage can be quickly and accurately formed.

[0043] 16 and 17 illustrate that at least one, and in some cases all, of the outlets of the first passageway 218A, second passageway 227A, third passageway 235A, and fourth passageway 243A can be positioned on the patient-matching portion of the first side 120. The passageways 218A, 227A, 235A, and 243A can be configured to receive a drill guide, which can be a tubular body similar to the pin guide 416. The passageways 218A, 227A, 235A, and 243A can be configured for this purpose by having a larger dimension and / or being tapered to match a tapered docking feature or to mate with a tubular body in some other manner. The wire outlet 446 of the guide passageway 412 can be positioned on the patient-matching portion of the first side 120. The patient-matching surface can be conformed to the glenoid 54 without reaming or preparing the glenoid 54 to preserve bone volume. Thus, the patient-specific glenoid guide 400 provides multiple functions all on the first side 120 that contacts the glenoid fossa 54. The patient-specific glenoid guide 400 is advantageous in that it extends the guide channel 412 with a pin guide 416. The pin guide 416, by virtue of one or more areas of ridges on the lateral surface, can act as a handle to hold the patient-specific glenoid guide 400 in place while simultaneously allowing the surgeon to insert a central guide pin 160 or other guide material from outside the incision and surrounding area of ​​retracted tissue into the opening to the lumen 424. This can help provide a less invasive procedure, for example, requiring less tissue retraction.

[0044] The method of use of the patient-specific glenoid guide 400 is described in more detail below in Section III.

[0045] B. Patient-matched glenoid guide for improved glenoid visibility 18-21 show a patient-specific glenoid guide 100 similar to the glenoid guide 100, but with improved visibility to the surface of the glenoid 54. The improved visibility to the surface of the glenoid 54 may allow the surgeon to confirm the positioning of the guide or provide other visual cues to the surgeon as to whether the guide is properly seated against the glenoid surface, thereby facilitating the surgical procedure.

[0046] FIG. 18 illustrates a scapula 52 having a patient-specific glenoid guide 500 configured for enhanced visibility positioned thereon. The patient-specific glenoid guide 500 includes a recess 524 that locally reduces the profile of the periphery 520 of the guide to expose the glenoid fossa 54 within the recess 524. The patient-specific glenoid guide 500 may include more than one recess 524, for example, four recesses spaced about the periphery 520. The recesses may be spaced 90 degrees from each other, but may be unevenly spaced in some cases. FIG. 19 illustrates one embodiment of a cloverleaf-shaped body 504 that provides enhanced access to and / or visibility to four regions of the glenoid fossa 54 around the periphery 520 of the patient-specific glenoid guide 500. The patient-specific glenoid guide 500 may include K-wire guide channels 112 and peripheral channels 116, one, more than one, or all of which may have exits on the patient-matching surface at the first side 120 of the body 504. FIG. 20 shows the first side 120 in more detail, with the K-wire guide channels 112 and three of the four peripheral channels 116 of the patient-specific glenoid guide 500 being completely surrounded by the patient-matching portion 140 of the patient-specific glenoid guide 500. One of the peripheral channels 116 is bounded in part by the patient-matching portion 540 and in part by an uncontoured portion 544.

[0047] FIG. 21 illustrates another embodiment of a patient-specific glenoid guide 550 that is similar to patient-specific glenoid guide 500. Patient-specific glenoid guide 550 may have any or all of the features of patient-specific glenoid guide 500. Patient-specific glenoid guide 550 also has a body 554 with a periphery 560 configured for improved visibility and handling. Periphery 560 includes a recess 564 that provides improved visibility as discussed above in connection with recess 524. Recess 564 also includes a flat surface 568 extending between first side 120 and second side 124. Flat surface 568 provides sufficient clearance for a surgeon's fingers to grasp patient-specific glenoid guide 550 between the four outer leaflets of periphery 560 that form the cloverleaf shape of body 554. Thus, patient-specific glenoid guide 550 has an improved configuration for being grasped by a surgeon.

[0048] Guides 500, 550 reflect the recognition that sufficient guiding stability can be achieved by further reducing the contact area between first side 120 of body 504, body 554, and the surface of glenoid 54. For example, the contact area of ​​first side 120 of patient-specific glenoid guide 100 can be reduced by up to 10% due to the presence of recess 524 or recess 564, compared to patient-specific glenoid guide 100, without compromising the accuracy of placement of patient-specific glenoid guide 500, 550. The contact area of ​​first side 120 of patient-specific glenoid guide 100 can be reduced by between 10% and 20% due to the presence of recess 524 or recess 564, compared to patient-specific glenoid guide 100, without compromising the accuracy of placement of patient-specific glenoid guide 500, 550. The contact area of ​​first side 120 of patient-specific glenoid guide 100 can be reduced by between 20% and 30% by the presence of recess 524 or recess 564 compared to patient-specific glenoid guide 100 without compromising the accuracy of placement of patient-specific glenoid guide 500, patient-specific glenoid guide 550. Greater reductions in contact area can be provided while still maintaining various hole outlets in patient-matched portion 540 to provide a multi-functional guide of the type disclosed herein.

[0049] The method of use of the patient-specific glenoid guides 500, 550 is described in more detail below in Section III.

[0050] C. Patient-matched glenoid guide with sealed rotational positioning features 23-27 show a patient-specific glenoid guide 600 that is similar to the patient-specific glenoid guide 550 except as otherwise noted below. The glenoid guide 600 is configured to allow for enhanced visualization of the glenoid 54, such as by including one or more recesses 564 as discussed above. The patient-specific glenoid guide 600 may also include one or more flat surfaces 568.

[0051] The patient-specific glenoid guide 600 has a cloverleaf shaped body 604 as previously discussed. The patient-specific glenoid guide 600 may also have a positioning feature 608 coupled to the periphery 560 of the body 604. The positioning feature 608 may be located on any portion of the periphery 560. In the illustrated embodiment, the positioning feature 608 may be located on the upper portion 200 of the body 604. In other embodiments, the positioning feature 608 is located on the anterior portion, lower portion, or posterior portion. In other embodiments, the positioning feature 608 is located between the upper and anterior portions of the body 604.

[0052] In one embodiment, the locating feature 608 comprises a perimeter member 612 extending from the perimeter 560. In one form, the perimeter member 612 comprises a patient conforming contact member 620, a portion of which may be disposed on the first side 120 of the body 604. The perimeter member 612 may comprise an elongate member 624 having a first end coupled to the perimeter 560 and a second end coupled to the patient conforming contact member 620. The patient conforming contact member 620 may comprise a sealed passageway 616 disposed between a passageway entrance 628 on the first side 120 and a passageway exit 632 on the second side 124. The sealed passageway 616 may be sized to allow a perimeter pin 162 to pass therethrough to provide a reference location for the base plate 20 or another glenoid implant.

[0053] 26 shows that the patient-specific contact member 620 may have a cantilevered configuration coupled to the body 604 at or adjacent the second side 124 and extending to a free end at or adjacent the first side 120. This reduces the material required to form the locating feature 608. The elongated member 624 preferably has a rectangular configuration in cross-section with a longer dimension in a direction between the first side 120 and the second side 124 than in a direction transverse to that direction. This configuration can help maintain the rigidity of the patient-specific glenoid guide 600 when torque is applied about the superior-inferior axis. This rigidity assists the ability of the patient-specific glenoid guide 600 to control rotation of the body 604 relative to the glenoid fossa 54.

[0054] The sealed passage 616 advantageously allows for precise placement of the peripheral pin 162 through the sealed passage 616 in the patient-specific glenoid guide 600. The peripheral pin 162 can be advanced through the passage from outside the incision to the second (or outer) side of the sealed passage 616 and out from the first (or inner) side into the adjacent glenoid cavity 54 or scapula 52. The sealed nature of the sealed passage 616 allows for greater control over the specific location of the peripheral pin 162 than would be possible with an open passage.

[0055] 28 and 29 illustrate a patient-specific glenoid guide 650 that is similar in some respects to the patient-specific glenoid guide 300 and similar in other respects to the patient-specific glenoid guide 600. The descriptions of these other embodiments are considered supplemental to the description of the patient-specific glenoid guide 650. The patient-specific glenoid guide 650 includes a body 654 configured to generally cover the glenoid fossa 54, or a portion thereof, that receives a glenoid implant. The body 654 may be continuously convex around at least a portion of its periphery 304. The body 654 may be circular or may have an elongated configuration, such as an oval. A peripheral member 612 may be coupled to a portion of the periphery 304, such as an upper portion. The body 604 may be symmetrical except for the presence of the peripheral member 612. The patient-specific glenoid guide 650 offers the advantage of being easily attached to a peripheral pin 162 (or similar structure) by virtue of a sealed passage 616 formed through the peripheral member 612. This attachment can be external to the incision providing access to the patient, which can facilitate a small incision. The configuration of the periphery 304 provides protection to the glenoid 54 by covering most or all of the portion of the glenoid 54 that is engaged by the implant.

[0056] The method of use of the patient-specific glenoid guides 600, 650 is described in more detail below in Section III.

[0057] D. Patient-matched glenoid guide with peripheral extension for improved stability 31-41B show embodiments of glenoid guides having overhangs or other projections extending from a portion configured to overlap the glenoid fossa 54 at locations on the periphery or outside of the glenoid fossa 54. FIG.

[0058] 31-35 illustrate a patient-specific glenoid guide 700 that is similar in some ways to the patient-specific glenoid guide 550 of FIG. 21 and the patient-specific glenoid guide 600 of FIG. 22, and their descriptions are considered supplemental to the description of the patient-specific glenoid guide 700. The patient-specific glenoid guide 700 has a plurality of positioning perimeter members extending away from its body 704. The perimeter members may include a perimeter member 708 and a perimeter member 732. The perimeter member 708 may be a first perimeter member, and the perimeter member 732 may be a second perimeter member. The perimeter member 732 may be offset from the perimeter member 708 by 90 degrees. In some embodiments, the perimeter members 708 and 732 are offset by other amounts, such as between 10 and 80 degrees, between 20 and 70 degrees, between 30 and 50 degrees, or about 45 degrees. There may be more than two perimeter members, such as three, four, or five or more such members.

[0059] The perimeter member 708 may include a patient-matching portion, such as a surface 716 configured as an inverted portion of the surface of the scapula. The surface 716 may be configured as an inverted portion of the surface of the scapula that is spaced from the articular surface of the glenoid. The surface 716 may be formed as part of a contact member 724. The contact member 724 may be comprised of an elongated member 720 having a first end coupled to the perimeter of the glenoid guide 700 and a second end coupled to a patient-matching contact member. The patient-matching contact member may be a cylindrical portion coupled to the second end of the elongated member 720 and extending medially toward the first side 120 to contact the glenoid fossa 54.

[0060] The perimeter member 732 may have a configuration similar to the perimeter member 708. The perimeter member 732 may have an elongate member 740 coupled at a first end to the perimeter 560 of the body 704 and coupled at a second end to a contact member 744. The contact member 744 may have a surface 716 that conforms to the bone adjacent the outside of the perimeter of the glenoid fossa 54 with the patient.

[0061] The perimeter member 708 may be configured to mate with a portion of the scapula 52 below the glenoid cavity 54. The perimeter member 732 may be configured to mate with a portion of the scapula 52 behind the glenoid cavity 54. Other combinations of anatomy for mating with the perimeter member 708 and the perimeter member 732 may be provided, such as any pair of surfaces of the scapula 52 offset by 90 degrees in the illustrated embodiment, or other offsets as discussed above.

[0062] 36-38 show patient-specific glenoid guide 800, which is similar to patient-specific glenoid guide 100, patient-specific glenoid guide 300, and patient-specific glenoid guide 650. Descriptions of these guides may supplement the description of patient-specific glenoid guide 800 to provide various further variations and descriptions.

[0063] The patient-specific glenoid guide 800 includes a body 804 and a plurality of peripheral members. A first peripheral member 806 is disposed on the body 804. The first peripheral member 806 may be configured to conform to bone in the region of the glenoid or periphery of the glenoid 54, or in the region of the scapula 52 on the surface of the glenoid 54. The first peripheral member 806 may include an elongated member 808 and a transverse portion 810. The transverse portion 810 extends transversely relative to the elongated member 808. The transverse portion 810 includes a contact portion that may be conformed to the patient. The body 804, in one embodiment, includes a patient-conforming portion 140 and a non-contoured portion 141 on a first side 120. The transverse portion 810 may also include a patient-conforming portion 140 and a non-contoured portion 141 on a first side, as shown in FIG. 38 . A lateral portion 810 of the first perimeter member 806 may be spaced from the perimeter 144 of the body 804 by an elongate member 808 .

[0064] The patient-specific glenoid guide 800 may include a second perimeter member 814 spaced apart from the first perimeter member 806. The second perimeter member 814 may include a structure similar to that of the first perimeter member 806. The spacing between the first perimeter member 806 and the second perimeter member 814 may be selected by the surgeon based on an analysis of the patient's bone at, around, or outside the glenoid fossa 54. The spacing can have the second perimeter member 814 positioned in the anterior portion of the guide, as shown, but the second perimeter member 814 can also be in a posterior region of the guide.

[0065] The patient-specific glenoid guide 800 may include one or more perimeter members comprising bone-contacting members extending directly from the perimeter 144 of the body 804. The patient-specific glenoid guide 800 may include a third perimeter member 816 and a fourth perimeter member 820. The third perimeter member 816 and the fourth perimeter member 820 may each include a convex protrusion disposed at the perimeter 144 of the patient-specific glenoid guide 800. The third perimeter member 816 and the fourth perimeter member 820 may each include a semicircular perimeter. The semicircular perimeter of the third perimeter member 816 may begin and end at the perimeter 144. The semicircular perimeter of the fourth perimeter member 820 may begin and end at the perimeter 144. The presence or absence of elongated members 808 may be determined by how close the perimeter 144 is to the edge or rim of the glenoid fossa 54. An elongated member 808 may be added, for example, to span the gap between the periphery 144 and the location of the rim of the glenoid fossa 54. If the periphery 144 is configured to mostly overlap or cover the rim of the glenoid fossa 54 or other feature of the scapula 52, the elongated member 808 may be omitted.

[0066] In the illustrated embodiment, all of the peripheral members are between the upper and lower positions on the anterior side of the body 804. In other embodiments, one or more of the peripheral members of the body 804 are on the posterior side of the glenoid guide 800.

[0067] 39A-39B and 40A-40B illustrate patient-specific glenoid guides 900, 1000 that are similar to previously described glenoid guides and may include any of the features of previously described glenoid guides. The descriptions of the previously described guides can be supplemented with descriptions of the patient-specific glenoid guides 900, 1000 to provide various additional variations and descriptions. The glenoid guides 900, 1000 provide a single guide for guide pin placement, rotational alignment and proper seating of the baseplate 20, and visualization of at least a portion of the seated portion of the baseplate 20. Providing these features in the glenoid guides 900, 1000 allows the clinician to assess any corrections that may be required, such as rotation, inclination, or medialization. The use of a single guide to perform these functions eliminates the need for additional guides and instruments, which streamlines the surgical technique and reduces overall surgical costs.

[0068] As shown in FIGS. 39A-39B , the patient-specific glenoid guide 900 includes a body 904 and a plurality of perimeter members 906. The body 904 has a patient-matching portion 140 and / or a non-contoured portion 141 on a first side 120 to provide the enlarged body 904. The outer perimeter 144 of the body 904 may correspond to the size and shape of the perimeter of the baseplate 20 or another glenoid implant. For some patients, the body 904 may be enlarged such that a first portion of the body 904 has a greater thickness than a second portion of the body 904. The body 904 allows a clinician to visualize the amount of correction provided to the glenoid by the glenoid implant. Because the first side 120 includes the patient-matching portion 140, a clinician can properly position and orient the glenoid guide 900 in the glenoid in a repeatable, predictable, preoperatively planned manner, as described in detail below in Section III, and assess the seating of the implanted baseplate 20 or other glenoid implant before preparing the bone for fixation. After the glenoid guide 900 is properly seated, a guide pin can be placed as described below. In alternative embodiments, a portion of the first side 120 may include a non-patient-matching portion if the body 904 exceeds the size or shape of the perimeter of the baseplate 20 or another glenoid implant. For example, the non-patient-matching portion may overhang the bone. In another embodiment, at least a portion of the body 904, including the first side 120, may be separably attached to multiple perimeter members 906 or the remainder of the glenoid guide 900 to form a modular guide. In some embodiments, the body 904 may be separably attached to the surround 906 with a mechanical connection, such as, for example, a friction fit, a snap fit, a threaded connection, or other technique.

[0069] The body 904 includes a passageway 912 formed therein that is adapted to receive a guide pin and / or pin guide. The guide pin provides cannulation of the anchor hole. The passageway 912 extends from a passageway inlet located on the lateral or second side 124 of the glenoid guide 900 to a passageway outlet located on the medial or first side 120 of the glenoid guide 900. The passageway 912 may be centered within the body 904. The passageway 912 controls the position and axis of the guide pin and may be patient-matched. For example, the orientation of the passageway 912 may be provided according to a surgical plan such that the patient-matched portion 140 is in a preselected orientation when properly seated in, on, or around the glenoid.

[0070] The body 904 may also include one or more open spaces 914 extending from the first side 120 to the second side 124 of the body 904 to provide visualization of the underlying bone. Reducing the amount of material in the body 904 can also reduce manufacturing costs. The open spaces 914 may include the peripheral passage 116 for preparation for an anchor passage, as described above, and / or the open spaces 914 may be different from the peripheral passage 116, e.g., be much larger than the peripheral passage 116, to provide visibility with the surgeon's naked eye. The open spaces 914 are positioned radially between the passage 912 and the outer periphery 144 of the body 904. In the illustrated embodiment, multiple open spaces 914 are provided between spokes extending between the annular member defining the guide passage 912 and the remainder of the body. The open spaces 914 may be positioned closer to the inner periphery disposed around the passage 912 than the outer periphery 144. While multiple open spaces, such as three, may be provided, more or fewer open spaces may be provided in other embodiments. In the illustrated embodiment, three symmetrically positioned spaces 914 are provided. Three symmetrically positioned spaces may be provided. Four, five, or six symmetrically or asymmetrically positioned spaces may be provided. In other embodiments, a single space 914 may be provided if such a space, when so configured, provides sufficient visibility of the glenoid surface in use of the glenoid guide 900.

[0071] The patient-specific glenoid guide 900 may have a positioning feature 916 at or extending from the perimeter 144 of the body 904. The positioning feature 916 may be located anywhere on the perimeter 144. In the illustrated embodiment, the positioning feature 916 may be located between the posterior portion and an upper portion, e.g., a generally superior portion, of the glenoid guide 900. In other embodiments, the positioning feature 916 is located on the anterior, inferior, posterior portion of the glenoid guide 900, or anywhere in between.

[0072] The locating feature 916 may comprise a peripheral member 906 extending from the periphery 144. The locating feature 916 may comprise a passageway 918, such as a sealed passageway, sized to create an implant rotational alignment mark or a locating device, such as a peripheral pin. The locating feature 916 may allow a pin to pass through the locating feature 916 at a peripheral location on the guide 900 to provide a reference location for proper rotational positioning of the base plate 20 or another glenoid implant. Also, in some embodiments, a pin placed through the locating feature may rotationally hold the guide 900 in place in the glenoid during use of the guide.

[0073] As previously discussed, the patient-specific guide includes multiple perimeter members 906. One or more of the perimeter members 906 may include a patient-matching portion 140 configured to match the perimeter or portion of the glenoid. The multiple perimeter members 906 may have different shapes and / or extend at different lengths from the body 904. This allows different perimeter members 906 to rest on the perimeter of the glenoid while positioning the passageway 912 anywhere on the glenoid surface, for example, lower as appropriate for the individual patient.

[0074] At least a first perimeter member 906a is provided on the body 904 at a location that aligns with the posterior portion of the glenoid when the guide is placed against the scapula. The first perimeter member 906a may be configured to conform to a posterior perimeter or portion of the glenoid. The first perimeter member 906a may include an elongated member 908 and a lateral portion 910 (also referred to herein as a patient-matching contact member) extending transversely or perpendicularly to the elongated member 908. The lateral portion 910 may have a cylindrical configuration or portion. A first side of the lateral portion 910 may have a patient-matching portion 140 and a non-contoured portion 141 on the first side, as shown in FIG. 39B . The patient-matching portion 140 of the lateral portion 910 facilitates proper rotational positioning of the glenoid guide 900, and thereby the base plate 20. A lateral portion 910 of the first perimeter member 906a may be spaced from the perimeter 144 of the body 904 by an elongate member 908. This spacing allows the clinician to visualize the portion of the glenoid cavity that will underlie the final seated portion of the baseplate 20 when the baseplate is implanted.

[0075] The patient-specific glenoid guide 900 may include at least a second peripheral member 906b spaced apart from a first peripheral member 906a. The second peripheral member 906b may have a structure similar to that of the first peripheral member 906a. The spacing between the first peripheral member 906a and the second peripheral member 906b may be selected by the surgeon based on an analysis of the patient's bone at, around, or outside the glenoid. This analysis may be performed preoperatively by reviewing a CT scan, MRI, or other output from an imaging device. The spacing may allow the second peripheral member 906b to be positioned at the anterior portion, the superior portion, or between the superior and anterior portions of the guide 900.

[0076] The patient-specific glenoid guide 900 may also include at least one perimeter member 906 disposed at the perimeter 144 of the body 904. For example, the patient-specific glenoid guide 900 may include a third perimeter member 906c and a fourth perimeter member 906d. The third perimeter member 906c and the fourth perimeter member 906d may each include a convex protrusion disposed at the perimeter 144 of the patient-specific glenoid guide 900. The third perimeter member 906c and the fourth perimeter member 906d may each include a circular or semicircular perimeter. The semicircular perimeters of the third perimeter member 906c and the fourth perimeter member 906d may begin and end at the perimeter 144. The third perimeter member 906c and / or the fourth perimeter member 906d may be positioned at the anterior portion of the patient-specific glenoid guide 900, between the upper and lower portions. A circular or semicircular perimeter member can be positioned in any of the positions shown in FIGS. 39A-39B , including, for example, the rear position of perimeter member 906. The presence or absence of elongated member 908 can be determined by how close perimeter 144 is to the rim or rim of the glenoid cavity. Elongated member 908 can be added, for example, to span the gap between perimeter 144 and the location of the glenoid cavity rim. If perimeter 144 is configured to nearly overlap or cover the glenoid cavity rim or other feature of the scapula, elongated member 908 can be omitted. In some cases, perimeter 144 is configured to nearly overlap or cover the glenoid cavity rim, and elongated member 908 is provided so that contact between guide 900 and the scapula can be spaced outside the glenoid cavity rim.

[0077] When the periphery 906 is properly seated on the rim or other portion of the glenoid or scapula, the first side 120 of the body 904 may be spaced apart, e.g., evenly spaced from the glenoid surface, e.g., by about 1.0 mm or less. In this configuration, the patient-matching portion 140 of the first side 120 may not be needed to provide guide alignment. In some implementations, the glenoid is not reamed before using the guide 900, but cartilage or labrum may be removed from the glenoid surface before advancing the implant, as described in more detail below in Section III. Excessively soft tissue may prevent the glenoid implant from properly seating. The patient-matching portion 140 of the body 904 may be used to assess whether additional soft tissue may need to be removed. For example, if the patient-matching portion 140 of the body 904 contacts the glenoid surface when the periphery 906 is properly seated on the rim or other portion of the glenoid, additional soft tissue may need to be removed. Sufficient soft tissue may have been removed if the patient-matched portion 140 of the body 904 is spaced, e.g., evenly spaced, from the glenoid surface when the peripheral member 906 is properly seated against the rim or other portion of the glenoid. After the patient-specific guide 900 is properly positioned, the guide 900 may be used to place guide pins through the passageways 912 and / or to mark the rotational alignment of the implant or to place peripheral pins through the locating features 916.

[0078] 40A-40B show a patient-specific glenoid guide 1000. The patient-specific glenoid guide 1000 comprises a body 1004 and a plurality of perimeter members 1006. The body 1004 has a patient-matching portion 140 and / or a non-contoured portion 141 on a first side 120 to provide the enlarged body 1004. The outer perimeter 144 of the body 1004 may correspond to the size and shape of the perimeter of the baseplate 20 or another glenoid implant. For some patients, the body 1004 may be enlarged such that a first portion of the body 1004 has a greater thickness than a second portion of the body 1004. The body 1004 allows a clinician to visualize the amount of correction provided to the glenoid by the glenoid implant. Because the first side 120 includes the patient-matching portion 140, a clinician can properly position and orient the glenoid guide 1000 in the glenoid in a repeatable, predictable, preoperatively planned manner, as described in detail below in Section III, and assess the seating of the implanted base plate 20 or other glenoid implant before preparing the bone for fixation. After the glenoid guide 1000 is properly seated, guide pins can be drilled as described below. In alternative embodiments, a portion of the first side 120 may include a non-patient-matching portion if the body 1004 exceeds the perimeter size or shape of the base plate 20 or other glenoid implant. For example, the non-patient-matching portion may overhang the bone. In another embodiment, at least a portion of the body 1004, including the first side 120, may be separably attached to multiple perimeter members 1006 or the remainder of the glenoid guide 1000 to form a modular guide. In some embodiments, the body 1004 may be separably attached to the surround 1006 with a mechanical connection, such as, for example, a friction fit, a snap fit, a threaded connection, or other technique.

[0079] The body 1004 includes a passageway 1012 formed therein that may be adapted to receive an instrument for preparing the glenoid or a bushing for receiving a guide pin to control the position and axis of the guide pin or guide wire. The passageway 1012 extends from a passageway inlet located on the lateral or second side 124 of the glenoid guide 1000 to a passageway outlet located on the medial or first side 120 of the glenoid guide 1000. The passageway 1012 may be centrally positioned within the body 1004.

[0080] The passageway 1012 can be sized to directly receive a drill, for example, without the use of a pin guide, to create an anchor passageway for a central fixation element. The passageway 1012 includes a central cannula that acts as a drill stop for the drill. In the embodiment depicted in FIGS. 40A and 40B , the cannula includes a ring-shaped member 1030 that is retained within the inner periphery 142 of the body 1004. The ring-shaped member 1030 has an inner periphery 1034 with a diameter that roughly matches the size of the anchor peg of the base plate 20. Thus, the inner periphery 1034 can be large enough to receive a bit or other hole-forming tool to guide it into the glenoid when the guide 1000 is properly seated. The location of the ring-shaped member 1030 on the inner periphery 142 of the body 1004 can be determined individually for each patient. For example, the ring member 1030 may be closer to the rear edge of the perimeter 142 of the body 1004 if the position of the peg would be offset from the centered position. The ring member 1030 may in some cases be closer to the front of the perimeter 142 of the body 1004. The ring member 1030 may in some cases be closer to the top surface of the perimeter 142 of the body 1004. The ring member 1030 may in some cases be closer to the bottom surface of the perimeter 142 of the body 1004. The ring member 1030 may be supported in any suitable manner. In the illustrated embodiment, a plurality of spokes are provided between the body 1004 and the ring member 1030 to support the ring member. The height of the central cannula 1030 may be matched to the patient to control the position of the drill, e.g., the depth to which a bit or other tool may be advanced. For example, the outer or inner position of the spokes 1036 or the ring member 1030 may be set in a patient-specific manner to control the depth of the bit or tool forming the hole. The spokes 1036 and / or the annular member 1030 may be recessed a distance from the second side 124 of the body 1004. Thus, the drill can only be advanced until it contacts the outside of the spokes 1036 or the annular member 1030.While the spokes 1036 or annular member 1030 may be recessed, in some cases these structures may extend in a direction opposite to the recessed direction, e.g., protruding or extending outward from the second side 124 to further limit the extent of the depth of any holes formed through the passages 1012 or otherwise through the guide 1000. After the guide 1000 is properly seated, a central anchor hole and / or implant rotational alignment markings may be drilled. The drilling depth may be controlled as previously discussed in a patient-specific manner by the configuration of the guide 1000 (or any of the other guides disclosed herein as modified with recessed or protruding drill stops to provide such control). The guide 1000 can directly accept a drill, as previously described, although a bushing may be provided in the passage 1012 for a guide pin if cannulated drilling is preferred.

[0081] The body 1004 may also include one or more open spaces 1014 extending from the first side 120 to the second side 124 of the body 1004 to provide visualization of the underlying bone. Reducing the amount of material in the body 1004 may also reduce manufacturing costs. The open spaces 1014 may include the peripheral passages 116 for preparation for anchor passage as described above and / or the open spaces 1014 may only provide visualization, as opposed to the peripheral passages 116. The open spaces 1014 are positioned radially between the passages 1012 and the outer periphery 144 of the body 1004.

[0082] The patient-specific glenoid guide 1000 may have a positioning feature 1016 at or extending from the periphery 144 of the body 1004. The positioning feature 1016 may be located in any portion of the periphery 144. In the illustrated embodiment, the positioning feature 1016 may be located on the upper portion of the body 1004 or between the anterior and upper portions of the body 1004. In other embodiments, the positioning feature 1016 is located on the posterior portion, the lower portion, or the anterior portion.

[0083] The locating feature 1016 may comprise a peripheral member 1006 extending from the periphery 144. The locating feature 1016 may comprise a passageway, such as a sealed passageway 1018, sized to create a locating device, such as an implant rotational alignment mark, or allow a peripheral pin to pass through to provide a reference location for proper rotational positioning of the base plate 20 or another glenoid implant.

[0084] As previously discussed, the patient-specific guide includes a plurality of perimeter members 1006. One or more of the perimeter members 1006 may include a patient-matching portion 140 configured to match the periphery or portion of the glenoid. The plurality of perimeter members 1006 may have different shapes and / or extend at different lengths from the body 1004.

[0085] At least a first peripheral member 1006a is provided at a posterior position of the body 1004 when implanted. The first peripheral member 1006a may be configured to conform to a posterior periphery or portion of the glenoid cavity. The first peripheral member 1006a may include an elongated member 1008 and a lateral portion 1010 (also referred to herein as a patient-matching contact member) extending transversely or perpendicularly to the elongated member 1008. The lateral portion 1010 may have a cylindrical portion. The lateral portion 1010 may include a patient-matching portion 140 and / or a non-contoured portion 141 on a first side, as shown in FIG. 40B . The patient-matching portion 140 of the lateral portion 1010 facilitates proper rotational positioning of the glenoid guide 1000, and thereby the base plate 20. A lateral portion 1010 of the first perimeter member 1006a may be spaced from the perimeter 144 of the body 1004 by an elongate member 1008. The spacing allows the clinician to visualize the final installed portion of the base plate 20.

[0086] The patient-specific glenoid guide 1000 may include at least a second peripheral member 1006b spaced apart from a first peripheral member 1006a. The second peripheral member 1006b may have a structure similar to that of the first peripheral member 1006a. The spacing between the first peripheral member 1006a and the second peripheral member 1006b may be selected by the surgeon based on an analysis of the patient's bone at, around, or outside the glenoid. The spacing may allow the second peripheral member 1006b to be positioned at the anterior portion of the guide 1000 as shown, or between the upper and anterior portions.

[0087] The patient-specific glenoid guide 1000 may also include at least one perimeter member 1006 disposed at the perimeter 144 of the body 1004. For example, the patient-specific glenoid guide 1000 may include a third perimeter member 1006c and a fourth perimeter member 1006d. The third perimeter member 1006c and the fourth perimeter member 1006d may each include a convex protrusion disposed at the perimeter 144 of the patient-specific glenoid guide 1000. The third perimeter member 1006c and the fourth perimeter member 1006d may each include a semicircular perimeter. The semicircular perimeters of the third perimeter member 1006c and the fourth perimeter member 1006d may begin and end at the perimeter 144. The third perimeter member 1006c and / or the fourth perimeter member 1006d may be positioned at the anterior portion of the patient-specific glenoid guide 1000, between the upper and lower portions. The presence or absence of elongated member 1008 may be determined by how close perimeter 144 is to the edge or rim of the glenoid. Elongated member 1008 may be added, for example, to span the gap between perimeter 144 and the location of the glenoid rim. If perimeter 144 is configured to mostly overlap or cover the glenoid rim or other feature of the scapula, elongated member 1008 may be omitted.

[0088] When the peripheral member 1006 is properly seated on the rim or other portion of the glenoid, the first side 120 of the body 1004 may be spaced apart, e.g., uniformly spaced from the glenoid surface, e.g., by about 1.0 mm or less. In this configuration, the patient-matching portion 140 of the first side 120 may not be needed to provide guide alignment. In some implementations, the glenoid is not reamed before using the guide 1000, but, as described in more detail below in Section III, cartilage or labrum may be removed from the glenoid surface before advancing the implant. Excessively soft tissue may prevent the glenoid implant from properly seating. The patient-matching portion 140 of the body 1004 may be used to assess whether additional soft tissue may need to be removed. For example, if the patient-matching portion 140 of the body 1004 contacts the glenoid surface when the peripheral member 1006 is properly seated on the rim or other portion of the glenoid, additional soft tissue may need to be removed. When the peripheral member 1006 is properly seated against the rim or other portion of the glenoid, sufficient soft tissue may have been removed if the patient-matched portion 140 of the body 1004 is spaced, e.g., evenly spaced, from the glenoid surface. After the patient-specific guide 1000 is properly positioned, the guide 1000 may be used to place guide pins through the passageways 1012 and / or to mark the rotational alignment of the implant or to place peripheral pins through the locating features 1016.

[0089] 40A , the glenoid guide 1000 includes a receiver 1032 extending from the body 1004. The receiver 1032 may extend from the second side 124 of the body 1004 at the outer periphery. The receiver 1032 is configured to receive a handle that may be used to stabilize the glenoid guide 1000 without the use of a guide pin.

[0090] As previously mentioned, any of the glenoid guides described herein may be modular. As an exemplary embodiment, FIGS. 41A-41B show a modular guide 1100 including a body 1104 and a separate peripheral portion 1103. The peripheral portion 1103 may include any combination of peripheral members 1106, as previously described in connection with the other guides. The body 1104 may be removably attached to the peripheral portion 1103 by a mechanical connection, such as a friction fit, a snap fit, a threaded connection, or other techniques. The body 1104 may be designed to avoid interfering with the peripheral members 1106. For example, at least a portion of the entire outer peripheral portion 144 may be disposed radially inward of the lateral portion 1110 of the peripheral member 1106. As shown in FIG. 41A, the body 1104 may include an outer peripheral portion 144 configured to receive one or more of the peripheral members 1106. The body 1104 includes several recesses or cutouts 1105 structured to receive corresponding peripheral members 1106, e.g., lateral portions 1110 of the peripheral member 1106. The cutouts 1105 may have a concave shape or any other shape suitable for receiving the lateral portions 1110. As used herein, a cutout can refer to an area where an otherwise continuous perimeter 144 is interrupted, e.g., a transition from convex to concave, and does not necessarily imply that the recesses are created by removing portions of the body 1104 after the body 1104 is formed. The body 1104 can receive all of the peripheral members 1106 or only a subset of the peripheral members 1106; for example, the body 1104 can only receive lateral portions 1110 in the posterior or anterior regions of the guide 1100. In the illustrated embodiment, the body 1104 receives the peripheral member 1106 at a lower location (the member at 6 o'clock in FIG. 41B ) and at a forward location (the member at 3 o'clock in FIG. 41B ). In many, but not all, cases, the body 1104 is configured to receive the peripheral member 1106 configured to contact a lower portion of the periphery of the glenoid cavity of a particular patient.

[0091] As shown in FIG. 41B , the body 1104 can include one or more slots 1107 for receiving a corresponding elongated member 1108 of the peripheral member 1106. The one or more slots 1107 are disposed on the second side 1124 of the body 1104 and extend partway through the thickness of the body 1104. The slots 1107 can extend radially from the outer periphery 144 of the body 1104 to the inner periphery 142 of the body 1104. The body 1104 can receive the elongated member 1108 in one of the slots 1107 without receiving the lateral portion 1110 of the same peripheral member 1106, for example, in a portion of the guide 1100 configured to match the superior surface of the glenoid. The slots 1107 provide rotational alignment of the body 1104 with the peripheral member 1103.

[0092] In use, one or both of the body 1104 and the peripheral portion 1103 can be patient-specific. The body 1104 and the peripheral portion 1103 can be assembled together, and the assembled guide can be used as described herein.

[0093] The method of use of the patient-specific glenoid guides 700, 800, 900, 1000, 1100 is described in more detail below in Section III.

[0094] III. Methods for preparing the glenoid cavity using a patient-matched multifunctional glenoid guide A method of use of the patient-specific glenoid guide 100 will be discussed with reference to Figures 42A-42G. Use of the other guides is generally similar to use of the patient-specific glenoid guide 100, except as discussed differently herein.

[0095] 42A illustrates desired or target locations 1204, 1208, 1212, 1216, respectively, of the body 104, positioning feature 108, K-wire guide channel 112, and / or peripheral channel 116 of the patient-specific glenoid guide 100. Target location 1204 may comprise an area of ​​the glenoid that will receive and / or support a patient-specific glenoid guide, such as the patient-specific glenoid guide 100. In one embodiment, the size and shape of target location 1204 can match the peripheral size and shape of a baseplate 20 or another glenoid implant. Target location 1208 can correspond to a target location for a rotational control or positioning feature. Target location 1212 can correspond to the location of a central anchor for the baseplate 20 or another glenoid implant. Target location 1216 can correspond to a location or position for a peripheral anchor for the baseplate 20 or another implant.

[0096] The target locations 1204, 1208, 1212, and 1216 may be planned preoperatively. Software may be used to select the target location 1204 of the body 104 and the location, size, and / or orientation of the passageway of the component 100 corresponding to the glenoid cavity. These predetermined locations, sizes, and / or orientations may be selected and / or changed by the user. The positioning feature target location 1208, peripheral target location 1216, and central target location 1212 represent predetermined locations in the glenoid cavity corresponding to the passageways and / or features of the patient-specific glenoid guide 100. The positioning feature target location 1208 is positioned, e.g., centered at a location intersected by the axes of the positioning features 108 of the guide 100. The peripheral target location 1216 is positioned, e.g., centered at a location intersected by the axis of the peripheral passageway 116 of the guide 100. A central target location 1212 is located, for example, centered at a location intersected by the axis of the K-wire guide channel 112. The target locations 1204, 1208, 1212, 1216 can be displayed on a user interface of the surgical planning instrument and overlaid on a rendering of the patient's bone taken from imaging data, such as a CT scan. Peripheral target locations 1216 identify where recesses can be formed in the glenoid.

[0097] As a first step, the patient's glenoid is exposed. Cartilage, labrum, and / or bone spurs are optionally removed from the surface and / or rim of the glenoid.

[0098] As shown by the dotted arrow in FIG. 42B , the patient-specific glenoid guide 100 is advanced toward the target position 1204 in the glenoid. The guide 100 is advanced until the first side 120 of the guide 100 contacts the articular surface of the glenoid. The guide 100 can be oriented in the planned orientation before applying the guide 100 to the glenoid. The guide 100 can also be applied to the glenoid and then reoriented to achieve the planned orientation. The patient-specific glenoid guide 100 can be rotated as needed until the surgeon is satisfied that the patient-matched portion 140 is correctly positioned on the anatomy to which it is to be matched. In embodiments with overhanging projections (e.g., glenoid guides 700, 800), positioning and repositioning can include aligning the first side (medial) of the overhanging structure to any anatomy to which the overhanging projection is planned to mate. The guide 100 is rotated and / or translated until the patient-matching surface on the first side 120 of the guide 100 aligns with a portion of the glenoid articular surface that is configured as an inverted portion.

[0099] As shown by the dotted arrow in Figure 42C, the peripheral pin 162 is optionally advanced toward a target location 1208 in the glenoid. The peripheral pin 162 is brought into contact with the glenoid after the patient-specific glenoid guide 100 is positioned against the articular surface of the glenoid. The peripheral pin 162 can be slid into engagement with the locating feature 108 of the guide 100.

[0100] In a first optional method that eliminates the peripheral pin 162, a surgical pen is used to mark the scapula 52, such as a portion of the glenoid 54 or a portion of the scapula adjacent the glenoid, using, for example, the locating feature 108. Alternatively, the patient-specific glenoid guide 300 may be used without marking any location. Optionally, the patient-specific glenoid guide 300 has lines or other landmarks on its periphery 304 that the surgeon can refer to for marking the bone. Other guides without channel-type locating features (e.g., the patient-specific glenoid guides 500, 550, 700, 800, 900, 1000) may include landmarks on their periphery to guide the surgical pen to mark a portion of the scapula 52 to assist in placement of the baseplate 20.

[0101] Use of any of the aforementioned guides with enhanced visibility (e.g., guides 500, 550, 600, 700, 900, 1000) can include visualizing a portion of the glenoid fossa 54 adjacent to the periphery of the guide. The surgical plan can include information about how much of the glenoid fossa 54 should be visible between any portion of the periphery of the guide and a landmark on the scapula 52, such as the periphery of the glenoid fossa 54. When the guide is centered on the periphery of the glenoid fossa 54, an equal-sized articular surface of the glenoid fossa 54 should be visible (and in one method viewed) between the anterior-inferior recess of the guide, the anterior-inferior portion of the periphery of the glenoid fossa 54, the posterior-inferior recess of the guide, and the posterior-inferior portion of the periphery of the glenoid fossa.

[0102] 42D-42E show that the central guide pin 160 is advanced through the K-wire guide channel 112 of the guide 100 and advanced into contact with the glenoid at a central target location 1212 in the glenoid. As shown by the dotted lines in FIG. 42D, the central guide pin 160 is inserted through the K-wire guide channel 112 as the guide 100 is held against the glenoid. Some guides provide structure to support the guide outside of the central region. For example, the patient-specific glenoid guide 700 has overhangs on the peripheral members 708 and 732. These members may be positioned on a planned portion of the scapula 52, for example, at or across the periphery of the glenoid 54. The patient-matching portion 140 may be positioned on a portion of the glenoid fossa 54 that it is configured to match. Similarly, one or all of the first perimeter member 806, second perimeter member 814, third perimeter member 816, and fourth perimeter member 820 may be placed on the scapula 52 at pre-planned locations, while the patient-matching portion 140 of the patient-specific glenoid guide 800 is conformed to the articular surface of the glenoid fossa 54. The optional peripheral pin 162, when used or present, remains in place when the central guide pin 160 is advanced through the K-wire guide channel 112 for subsequent guidance of the baseplate 20, as discussed below. In some variations, the peripheral pin 162 is positioned later, as it may not be needed during the majority of uses of the patient-specific glenoid guide 100. The patient guides 900, 1000 may also comprise multiple peripheral members that may be positioned in the manner described above. However, in some variations, when the perimeter 906, 1006 is properly seated on the rim or other portion of the glenoid or scapula, the first side 120 of the body 904, 1004 can be spaced from the glenoid surface, for example, by about 1.0 mm or less. If the patient-matching portion 140 of the body 904, 1004 contacts the glenoid surface when the perimeter 906, 1006 is properly seated on the rim or other portion of the glenoid, additional soft tissue may need to be removed.When the peripheral member 906, 1006 is properly seated on the rim or other portion of the glenoid cavity, sufficient soft tissue may have been removed if the patient-matching portion 140 of the body 904, 1004 is spaced away from the glenoid cavity surface.

[0103] The patient-specific glenoid guide 400 provides a convenient method for placing the central guide pin 160. In one method, the patient-specific glenoid guide 400 is coupled with a pin guide 416. The patient-specific glenoid guide 400 can be first placed against the glenoid fossa 54, and then the pin guide 416 can be aligned with the guide channel 412 of the patient-specific glenoid guide 400. The docking feature 420 can be positioned in the tapered portion of the guide channel 412 and bear against the guide seat 442. The central guide pin 160 can then be advanced into the open end of the bore 424.

[0104] Instead of placing a central guide pin, the patient-specific glenoid guide can provide a method for drilling the central anchor hole. For example, as described above with respect to Figures 40A and 40B, the guide 1000 can include a central cannula that receives a drill for preparation of the central anchor hole.

[0105] A recess may be formed in the glenoid using the patient-specific glenoid guide 100. The central guide pin 160 and optional peripheral pins 162, when present, help stabilize the guide 100 during recess formation. A recess may be formed through the guide 100 extending from a peripheral target location 1216 in the glenoid into the glenoid. For example, as shown by the dotted lines in FIG. 42F , a drill 432 may be coupled with an appropriately sized drill bit that may be advanced through the peripheral passages 116 in the guide 100. The surgeon may advance the drill bit coupled with the drill 432 through at least one peripheral passage 116 of the patient-specific glenoid guide 100 and into the glenoid at the corresponding peripheral target location 1216, thereby creating a recess in the glenoid. The depth and orientation of the recess may be pre-operatively selected and controlled by the length of the drill bit coupled with the drill 432. The planned trajectory of the drill bit is centered on the peripheral target location 1216 and extends along an axis centered on the third passage axis 242 through the third passage entrance 236 (see FIG. 7 ) of the body 104 of the guide 100. The recess may be configured to engage an anchor 24, such as a screw.

[0106] As previously discussed, the third passage 235A of the patient-specific glenoid guide 400 may be mated with a tubular drill guide. The guide may be similar to the pin guide 416, but may be sized and configured for the third passage 235A. One or more of the first passage 218A, second passage 227A, third passage 235A, and fourth passage 243A may be mated with a drill guide prior to forming a recess at the target location 1216.

[0107] Using the patient-specific glenoid guide 100 as a guide, the surgeon can drill recesses 1220 extending from each of the peripheral target locations 1216 into the glenoid fossa 54. When the recesses 1220 are formed, an axis extends through the center of each of the recesses. The axis of each recess 1220 is aligned with the center of the corresponding peripheral passageway 116 of the guide 100. Each recess 1220 formed in the glenoid fossa can be similar or dissimilar to each of the other recesses. One or more of the recesses can extend at a non-perpendicular angle relative to the second side or lateral side 124 of the guide 100. Each recess 1220 can be configured to have a different orientation, e.g., at a different non-perpendicular angle relative to the second side 124 of the guide 100. The recesses 1220 can have a flared axis 1222, as shown in FIG. 42G.

[0108] As shown in FIG. 42G, a peripheral recess 1220 is formed in the glenoid fossa 54 using the guide 100. The guide 100 and optional peripheral pin 162 can be removed from the glenoid fossa. The central guide pin 160 is maintained in contact with the glenoid fossa. The central guide pin 160 guides the base plate 20 into contact with the glenoid fossa. The base plate 20 can be oriented using a rotational alignment feature, such as a special marking on the base plate 20 or another guide. The base plate 20 can have markings 26 on its outer periphery that can be rotated into alignment with the peripheral pin 162, as shown, or can be oriented toward bobby marks formed using the alignment feature 108. The central passage 25 of the base plate 20 slides over the central guide pin 160 as the base plate is advanced into the glenoid fossa. While the central passage is much larger, it could also be smaller in size to closely match the size of the central guide pin 160 while still being slidable. In some cases, a separate instrument may be mated with the larger passageway 25 of the base plate, and the instrument may have an internal cavity sized to slide over the central guide pin 160. In some methods, the passageway formed by the central guide pin 160 may provide a pilot hole for the central anchor of the glenoid assembly 19. The central anchor may be coupled to the glenoid 54 in a step between the step shown in FIG. 37F and the step shown in FIG. 37G. The central anchor may be advanced into the glenoid 54, and the base plate 20 may be coupled to the glenoid 54 in a subsequent step. The coupling between the central anchor and the base plate 20 may facilitate rotational orientation of the base plate 20 to align the indicia 26 with bobby marks or other location features on or coupled to the scapula 52. Further details related to the glenoid assembly 19 are discussed in U.S. Patent Application Publication No. 2009 / 0129994, which is hereby incorporated by reference to supplement the discussion of the glenoid assembly 19 and for all other purposes. As indicated by the dotted arrow in Figure 42G, the surgeon can secure the baseplate 20 to the glenoid cavity using anchors 24, such as screws, in a pre-operatively planned manner.The depth of the peripheral recesses 1220 can be determined using an instrument such as a depth gauge. The anchors 24 can be advanced through the peripheral passages 23 of the base plate 20 and into the peripheral recesses 1220 in the glenoid fossa. The anchors 24 can be advanced through each of the peripheral recesses 1220 in the glenoid fossa 54.

[0109] term Although specific embodiments are described herein, the implants and methods described herein can be used interchangeably with any joint component, as the context may dictate.

[0110] As used herein, relative terms such as "proximal" and "distal" are defined from the perspective of the implant, such that proximal refers to the direction of the articular component and distal refers to the direction of the anchor component, such as the shank of a humeral anchor or screw, or the porous surface or other anchor structure of a shankless anchor, when the implant is assembled.

[0111] Conditional language such as "can," "could," "might," or "may," unless expressly stated otherwise or understood within the context in which it is used, is generally intended to convey that certain embodiments include particular features, elements, and / or steps, but other embodiments do not. Thus, such conditional language is generally intended to mean that the feature, element, and / or step is not required in any way for one or more embodiments.

[0112] Terms such as "comprising," "including," and "having" are synonymous and are used in an open-ended, inclusive manner and do not exclude additional elements, features, acts, operations, etc. Also, the term "or," for example, when used to connect a list of elements, is used in its inclusive sense (not its exclusive sense) to mean one, some, or all of the elements in the list. Also, the articles "a," "an," and "the," as used in this application and the appended claims, unless expressly stated otherwise, shall be construed to mean "one or more" or "at least one."

[0113] Ranges disclosed herein encompass any and all overlaps, subranges, and combinations thereof. Words such as "up to," "at least," "greater than," "less than," and "between" are inclusive of the stated number. Numbers preceded by terms such as "about" or "approximately" are inclusive of the stated number and should be interpreted according to the context (e.g., interpreted as accurately as reasonably possible under the circumstances, e.g., ±5%, ±10%, ±15%, etc.). For example, "about 1" includes "1." Language preceded by terms such as "substantially," "generally," and the like is inclusive of the stated number and should be interpreted according to the context (e.g., interpreted as broadly as reasonably possible under the circumstances). For example, "substantially spherical" includes "spherical." Unless otherwise stated, all measurements are at standard conditions, including temperature and pressure.

[0114] As used herein, phrases referring to "at least one of" a list of items refer to any combination of those items, including single elements. For example, "at least one of A, B, or C" is intended to cover A, B, C, A and B, A and C, B and C, and A, B, and C. Transitive language, such as phrases like "at least one of X, Y, and Z," is generally understood in the context in which it is used to convey that an item, term, etc., can be at least one of X, Y, or Z, unless expressly stated otherwise. Thus, such transitive language is generally not intended to imply that a particular embodiment requires that at least one of X, at least one of Y, and at least one of Z each be present.

[0115] While specific embodiments and examples have been described herein, it should be emphasized that many variations and modifications may be made to the humeral head assembly shown and described in this disclosure, and it is understood that the elements may be differently combined and / or modified to form still further embodiments or acceptable examples. All such modifications and variations are intended to be included herein within the scope of this disclosure. A wide variety of designs and approaches are possible. No feature, structure, or step disclosed herein is essential or essential.

[0116] Some embodiments are described in connection with the accompanying drawings. However, it should be understood that the figures are not drawn to scale. Distances, angles, and the like are merely exemplary and do not necessarily bear a precise relationship to the actual dimensions and arrangement of the devices shown. Components may be added, removed, and / or rearranged. Furthermore, any specific features, aspects, methods, properties, characteristics, qualities, attributes, elements, etc. disclosed herein in connection with various embodiments can be used in all other embodiments described herein. It is also recognized that any method described herein can be performed using any apparatus suitable for performing the proposed steps.

[0117] For purposes of this disclosure, certain aspects, advantages, and novel features have been described herein. It is understood that not all such advantages may be achieved according to any particular embodiment. Thus, for example, those skilled in the art will recognize that the present disclosure may be embodied or carried out in a manner that achieves one advantage or group of advantages as taught herein without necessarily achieving other advantages that may be taught or suggested herein.

[0118] Furthermore, while exemplary embodiments are described herein, it will be understood by those skilled in the art that the scope of the present invention extends beyond the explicitly disclosed embodiments to any and all embodiments having equivalent elements, modifications, omissions, combinations, or subcombinations of specific features and aspects of the invention (e.g., of aspects across various embodiments), adaptations and / or modifications, and equivalent elements, modifications, omissions, combinations, or subcombinations of specific features and aspects of use, as would be understood by those skilled in the art based on this disclosure. Any limitations in the claims shall be interpreted broadly based on the language used in the claims and not limited to the examples described herein or during prosecution of this application, which examples shall be construed as non-exclusive. Furthermore, the acts of the disclosed processes and methods may be altered in any manner, including by reordering acts and / or inserting additional acts and / or re-eliminating acts. Therefore, it is intended that the specification and examples be considered exemplary only, with the true scope and spirit being indicated by the claims and their full scope of equivalents.

[0119] Any methods disclosed herein need not be performed in the order suggested. The methods disclosed herein include specific actions taken by a practitioner, but may also include, either explicitly or implicitly, any third-party command of those actions. For example, an action such as "connecting a glenoid guide with a glenoid rim" includes "commanding the connection of the glenoid guide with the glenoid rim." [Explanation of symbols]

[0120] 8 Glenohumeral joint 10 head 12 Upper Arm 14 Shoulder blade 18 Glenoid fossa 19 Glenoid Assembly 20 base plate 24 Peripheral moorings 25 Center aisle 26 marks 52 Shoulder blade 54 Glenoid fossa 100 Patient-Specific Glenoid Guides 104 Main Unit 108 Positioning Features 112 K-wire guide passage 116 Peripheral Passage 120 First Side 124 Second Side, Outer 140 Patient matching section 141 Uncontoured Area 142 Inner periphery 144 Outer periphery 148 Open passage 160 Center guide pin 162 peripheral pins 180 Drill entrance 184 Drill Exit 198 axes 200 upper part 204 Front part 208 Rear part 210 Lower part 212 Rear part 218, 218A 1st aisle 220 First Passage Entrance 224 First Passage Exit 226 First Passage Axis 227, 227A Second Passage 228 Second Passage Entrance 232 Second Passage Exit 234 Second Passage Axis 235, 235A Third Passage 236 Third Passage Entrance 240 Third Passage Exit 242 Third Passage Axis 243, 243A 4th aisle 244 Fourth Passage Entrance 248 4th Passage Exit 250 Fourth Passage Axis 300 Patient-Specific Glenoid Guides 302 Main Unit Around 304 400 Patient-Specific Glenoid Guides 402 Main Unit 412 Guideway 416 Pin Guide 420 Docking Features 424 Lumen 432 Drill 438 Information Entrance 442 Guide seat 446 Wire Exit 500 Patient-Specific Glenoid Guides 504 Main Unit Around 520 524 recess 540 Patient Matching Unit 550 Patient-Specific Glenoid Guide 554 Main Unit Around 560 564 recess 568 Flat Surface 600 Patient-Specific Glenoid Guide 604 Main Unit 608 Positioning Features 612 Peripheral parts 616 Closed passage 620 Patient-matched contact member 624 Long and thin members 628 Passage entrance 632 Passage exit 650 Patient-Specific Glenoid Guide 654 Main Unit 700 Patient-Specific Glenoid Guide 704 Main Unit 708 Peripheral parts 716 Surface 720 Long and thin members 724 Contact Members 732 Peripheral parts 740 Long and thin members 744 Contact Members 800 Patient-Specific Glenoid Guides 804 Main Unit 806 First peripheral member 808 Long and thin members 810 Horizontal part 814 Second peripheral component 816 Third peripheral component 820 Fourth peripheral component 900 Patient-Specific Glenoid Guide 904 Main Unit 906 Peripheral parts 906a First peripheral member 906b Second peripheral member 906c Third peripheral component 906d Fourth peripheral component 908 Long and thin members 910 Horizontal part 912 Guideway 914 open space 916 Positioning Features 918 Passage 1000 Patient-Specific Glenoid Guides 1103 Peripheral area 1004 Main Unit 1006 Peripheral parts 1006a first peripheral member 1006b Second peripheral member 1006c Third peripheral member 1006d Fourth peripheral member 1008 Long and thin members 1010 Horizontal part 1012 Passage 1014 Open space 1016 Positioning feature 1018 Closed passage 1030 Annular member, central cannula 1032 Receiving Department 1034 Inner periphery 1036 spokes 1100 Module Guide 1103 Peripheral area 1104 Main unit 1105 Cutout 1106 Peripheral parts 1107 Slots 1108 Long and thin members 1110 Horizontal part 1124 Second Side 1204 Target position 1208 Target Position of Positioning Feature 1212 Center target position Target locations around 1216 1220 recess

Claims

1. 1. A patient-specific glenoid guide, comprising: a body having an outer surface and an inner surface, the inner surface including a patient-matching portion configured as an inverted surface of a glenoid portion of an individual patient's scapula; a plurality of peripheral members extending radially outward from an outer periphery of the body, each peripheral member comprising a contact member; a passageway extending through the body from a passageway inlet located on the outer surface to a passageway outlet located on the inner surface; 1. A patient-specific glenoid guide comprising:

2. The patient-specific glenoid guide of claim 1 , further comprising a positioning feature configured to reference a guide pin to position the body relative to the glenoid site.

3. The patient-specific glenoid guide of claim 2 , wherein the positioning feature comprises a sealed passageway.

4. 3. The patient-specific glenoid guide of claim 1 or 2, wherein positioning features extend radially outward from the outer periphery of the body.

5. 5. The patient-specific glenoid guide of claim 1, wherein at least one of the plurality of peripheral members comprises an elongate member extending between the body and the contact member.

6. 6. The patient-specific glenoid guide of claim 1, wherein at least one of the plurality of peripheral members comprises a convex protrusion disposed on the outer periphery of the body.

7. 7. The patient-specific glenoid guide of claim 1, wherein at least one of the plurality of perimeter members comprises a semicircular perimeter beginning and ending at the outer perimeter of the body.

8. 8. The patient-specific glenoid guide of claim 1, wherein at least two of said plurality of peripheral members are differently shaped.

9. 9. The patient-specific glenoid guide of claim 1, wherein at least two of the plurality of peripheral members extend at different lengths from the body.

10. 10. The patient-specific glenoid guide of claim 1, wherein the inner surface of the body is configured to be spaced apart from the glenoid site when each contact member contacts a periphery of the glenoid site.

11. 11. The patient-specific glenoid guide of claim 1, further comprising one or more open spaces extending from the lateral surface to the medial surface, the one or more open spaces configured to provide visualization of the glenoid area.

12. 12. The patient-specific glenoid guide of claim 1, further comprising a plurality of peripheral anchor passages extending through the body from drill inlets located on the lateral surface to drill outlets located on the patient-matched portion on the medial surface.

13. 13. The patient-specific glenoid guide of claim 1, wherein the body comprises a receiving portion configured to receive a handle.

14. 14. The patient-specific glenoid guide of claim 13, wherein the passage is positioned in a central region of the body and the receiving portion is positioned radially outward of the passage.

15. 15. A patient-specific glenoid guide according to any one of claims 1 to 14, wherein the passageway comprises a drill stop.

16. 16. The patient-specific glenoid guide of any one of claims 1 to 15, further comprising a bushing configured to receive a guidewire.

17. 17. A patient-specific glenoid guide according to any one of claims 1 to 16, wherein the contact member is adapted to fit the patient.

18. 18. A patient-specific glenoid guide according to any one of claims 1 to 17, wherein the body is connected to the surround by a snap fit.

19. 1. A patient-specific glenoid guide, comprising: a body having an outer surface, an inner surface, and an outer periphery, the inner surface including a patient-matching portion configured as an inverted surface of a glenoid portion of an individual patient's scapula; a positioning feature disposed on or through the body and configured to reference a guide pin to position the body relative to the glenoid cavity; a passageway extending through the body from an inlet disposed on the outer surface to an outlet disposed on the inner surface; 1. A patient-specific glenoid guide comprising:

20. 20. The patient-specific glenoid guide of claim 19, further comprising one or more open spaces extending from the lateral surface to the medial surface, the one or more open spaces configured to provide visualization of the glenoid area.

21. 21. The patient-specific glenoid guide of claim 19 or 20, further comprising a plurality of peripheral anchor passages extending through the body from drill inlets located on the lateral surface to drill outlets located on the patient-matched portion of the medial surface.

22. 22. The patient-specific glenoid guide of any one of claims 19 to 21, further comprising a plurality of perimeter members extending radially outward from the outer periphery of the body, each perimeter member comprising a patient-matching contact member.

23. 23. The patient-specific glenoid guide of claim 22, wherein at least one of said plurality of peripheral members comprises an elongate member extending between said body and said patient-matching contact member.

24. 24. The patient-specific glenoid guide of claim 22 or 23, wherein at least one of the plurality of perimeter members comprises a convex protrusion disposed on the outer perimeter of the body.

25. 25. The patient-specific glenoid guide of any one of claims 19 to 24, wherein the positioning features are on the outer periphery of the body.

26. 26. The patient-specific glenoid guide of any one of claims 19 to 25, wherein the positioning feature comprises a sealed passageway.

27. 27. The patient-specific glenoid guide of any one of claims 19 to 26, wherein the positioning features extend radially outward from the outer periphery of the body.

28. 28. A patient-specific glenoid guide according to any one of claims 19 to 27, wherein the body comprises a receiving portion configured to receive a handle.

29. 30. The patient-specific glenoid guide of claim 28, wherein the passage is positioned in a central region of the body and the receiving portion is positioned radially outward of the passage.

30. 30. A patient-specific glenoid guide according to any one of claims 19 to 29, wherein the passageway comprises a drill stop.

31. exposing a glenoid cavity of a patient; removing soft tissue from the surface of the glenoid cavity; advancing a body of a glenoid guide toward the glenoid, the glenoid guide comprising a body having a patient-matching surface on a first side of the glenoid guide, the glenoid guide further comprising a plurality of peripheral members extending radially outward from an outer periphery of the body; contacting a patient-conforming contact member of each of the plurality of peripheral members against a rim of the glenoid cavity against which the patient-conforming contact member is configured to fit; advancing a drill along a planned trajectory defined by the axis of a bone preparation channel defined through the body of the glenoid guide; forming a tether passageway along the axis at the scapula; securing an implant component to the scapula by advancing an implant or bone screw into the anchor channel; A method comprising:

32. 32. The method of claim 31, further comprising contacting the patient-matching surface with a surface of the glenoid, the patient-matching surface being configured as an inverted portion.

33. 33. The method of claim 32, further comprising the step of removing additional soft tissue after contacting the patient-matching surface with the surface of the glenoid until the first side of the glenoid guide is spaced from the surface of the glenoid.

34. 34. The method of any one of claims 31 to 33, further comprising advancing the drill directly through the bone preparation channel defined through the body.

35. 35. The method of any one of claims 31 to 34, further comprising advancing the drill until it contacts a drill stop disposed on the body of the glenoid guide.

36. 36. The method of any one of claims 31 to 35, further comprising providing a positioning device on or within the scapula to orient the glenoid guide relative to the glenoid.

37. 37. The method of any one of claims 31 to 36, further comprising stabilizing the glenoid guide using a handle.

38. 38. The method of any one of claims 31 to 37, further comprising engaging a bushing with the glenoid guide to provide a guidewire guidance passage for guidewire placement.

39. 1. A patient-specific glenoid guide, comprising: a body having an outer surface and an inner surface, the inner surface including a patient-matching portion configured as an inverted surface of a glenoid portion of an individual patient's scapula; a positioning feature disposed on or through the body and configured to reference a guide pin to position the body relative to the glenoid cavity; a K-wire guide passageway extending through the body from a K-wire inlet located on the outer surface to a K-wire outlet located on the patient mating portion on the inner surface; a plurality of peripheral tether passages extending through the body from drill inlets located on the outer surface to drill outlets located on the patient-matched portion of the inner surface; 1. A patient-specific glenoid guide comprising:

40. 40. The patient-specific glenoid guide of claim 39, wherein the positioning features are located on a superior portion, an anterior portion, and / or anterior-superior portion of the glenoid guide.

41. 41. The patient-specific glenoid guide of claim 39 or 40, wherein the peripheral anchor channel is positioned beneath the positioning feature.

42. 42. The patient-specific glenoid guide of any one of claims 39 to 41, wherein at least two of the plurality of peripheral anchor channels are disposed at diverging or converging angles relative to one another.

43. 43. The patient-specific glenoid guide of any one of claims 39 to 42, wherein the peripheral anchor passages are positioned at positions and orientations corresponding to predetermined peripheral anchor locations and peripheral anchor orientations.

44. 44. The patient-specific glenoid guide of any one of claims 39 to 43, wherein the positioning feature comprises a sealed passage disposed from the exterior to the interior of the patient-specific glenoid guide.

45. 44. The patient-specific glenoid guide of any one of claims 39 to 43, wherein the positioning feature comprises an open passageway recessed into a superior surface of the patient-specific glenoid guide.

46. 46. ​​A patient-specific glenoid guide according to any one of claims 39 to 45, wherein the periphery of the body comprises at least one recessed portion configured to expose a portion of the glenoid when the glenoid guide is applied to the glenoid.

47. 47. The patient-specific glenoid guide of any one of claims 39 to 46, further comprising a peripheral member extending from a periphery of the body, the peripheral member comprising a patient-matching portion having a surface configured as an inverse of a surface of the scapula that is positioned away from the articular surface of the glenoid.

48. 48. The patient-specific glenoid guide of claim 47, wherein the patient-matched portion of the surround is configured as an inverted surface of a portion of the patient's glenoid rim.

49. 49. The patient-specific glenoid guide of claim 47 or 48, wherein the peripheral element is a first peripheral element and the patient-specific glenoid guide further comprises a second peripheral element offset 90 degrees from the first peripheral element.

50. 50. A patient-specific glenoid guide according to any one of claims 47 to 49, wherein the peripheral member comprises convex protrusions disposed about the periphery of the glenoid guide.

51. 51. The patient-specific glenoid guide of any one of claims 47 to 50, wherein the perimeter member comprises a patient-matching contact member and an elongate member having a first end coupled to the perimeter of the glenoid guide and a second end coupled to the patient-matching contact member.

52. 52. The patient-specific glenoid guide of any one of claims 39 to 51, wherein the plurality of peripheral anchor passages comprises two passages arranged along a single plane.

53. 53. The patient-specific glenoid guide of any one of claims 39 to 52, wherein the plurality of peripheral anchor passages comprises an array of anchor passages located in superior, inferior, anterior, and posterior portions of the body.

54. A patient-specific tether trajectory guide, comprising: a body having an outer surface and an inner surface, the inner surface including a patient-matched portion configured as an inverted surface of the glenoid joint; a positioning feature disposed on or through the body and configured to reference a guide pin to position the body relative to the glenoid cavity; a plurality of peripheral tether openings extending through the body from inlets disposed on the outer surface to outlets disposed on the patient-matched portion of the inner surface; Equipped with A patient-specific anchor trajectory guide, where the peripheral anchor openings are positioned and oriented to provide good acquisition in the shoulder bone around the glenoid cavity for a particular patient.

55. exposing a glenoid cavity of a patient; advancing a body of the glenoid guide toward the glenoid until a first side of the glenoid guide contacts the articular surface of the glenoid; contacting a patient-matching surface on the first side of the glenoid guide with a portion of the articular surface of the glenoid, the patient-matching surface being configured as an inverted portion; advancing a drill along a planned trajectory defined by a bone preparation channel defined through the body of the glenoid guide, the planned trajectory extending along an axis centered at a drill entry point and a drill exit point positioned on the patient-matching surface; forming a tether passageway along the axis at the scapula; securing an implant component to the scapula by advancing an anchor through the implant and into the anchor channel; A method comprising:

56. 56. The method of claim 55, further comprising the step of advancing a K-wire through a K-wire guide channel formed through the body, the K-wire guide channel configured to guide positioning of the implant prior to fixation of the implant to the scapula.

57. 57. The method of claim 55 or 56, further comprising providing a positioning device on or within the scapula, and wherein the advancing and / or contacting steps include contacting a positioning feature with the positioning device to orient the glenoid guide relative to the glenoid.

58. 1. A patient-specific glenoid guide, comprising: a body having an outer surface and an inner surface, the inner surface including a patient-matching portion configured as an inverted surface of a glenoid portion of an individual patient's scapula; a bone preparation channel extending through the body from a channel inlet disposed on the outer surface to a channel outlet disposed on the patient-matched portion of the inner surface; a plurality of peripheral tether passages extending through the body from drill inlets located on the outer surface to drill outlets located on the patient-matched portion of the inner surface; 1. A patient-specific glenoid guide comprising:

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