Elbow rotation center guide

Abstract

Disclosed are surgical constructs, assemblies, and methods for the repair and reconstruction of the elbow. The rotation center guide has specific dimensions configured to be fixed to either the lateral or medial side of the elbow. At one end, the guide is provided with multiple full concentric through-holes (circles of different diameters) having bisectors at 90-degree intervals to identify the rotation center on the lateral and medial epicondyles. At the other end, the guide is provided with a linear pattern of through-holes or openings located around the centerline of the guide. The linear pattern of through-holes identifies the attachment point on the ulnar tubercle. The through-holes in the concentric and linear patterns of the guide are sized to receive instruments such as K-wires, guides, and / or drill guides. One or more spikes or points are provided at the bottom of the guide for stabilization during use.

Description

Technical Field

[0001] The present disclosure relates to the field of surgery, and more particularly to a guide for determining the center of rotation of the elbow joint and related surgical repair methods.

Summary of the Invention

[0002] The center of rotation guide is in the form of a cube having specific dimensions configured to be fixed to either the outside or the inside of the elbow. At one end, the guide is provided with a plurality of complete concentric through-holes (circles of different diameters) having bisectors at approximately 90-degree intervals for specifying the center of rotation on the outer or inner epicondyle. At the other end, the guide is provided with a linear pattern of through-holes or openings located around the centerline of the guide. The linear pattern of through-holes specifies the attachment points on the ulna.

[0003] The concentric and linear pattern through-holes of the guide are sized to receive instruments such as K-wires, guides, and / or drills. One or more bone engagement structures (spikes or points) may be provided on one of the surfaces of the guide for stabilization during use.

[0004] <00000!15>A surgical method is also disclosed. In one embodiment, collateral ligament repair or reconstruction is performed using a guide configured to accurately specify the center of rotation of the outer and / or inner epicondyle for repair / reconstruction of the medial / lateral collateral ligament around the elbow.

Brief Description of the Drawings

[0005] [Figure 1] Figure 1 shows a perspective view of the center of rotation guide. [Figure 2] Figure 2 is a top view of the guide of Figure 1. [Figure 3] Figure 3 is a side view of the guide of Figure 1. [Figure 4] Figure 4 is a front view of the guide of Figure 1. [Figure 5]Figure 5 shows a perspective view of another rotation center guide. [Figure 6] Figure 6 is a top view of the guide in Figure 5. [Figure 7] Figure 7 is a side view of the guide in Figure 5. [Figure 8] Figure 8 is a front view of the guide shown in Figure 5. [Figure 9] Figure 9 shows a top view of another rotation center guide. [Figure 10] Figure 10 shows the subsequent steps of reconstructive surgery with a rotational center guide. [Figure 11] Figure 11 shows the subsequent steps of reconstructive surgery with a rotational center guide. [Figure 12] Figure 12 shows the subsequent steps of reconstructive surgery with a rotational center guide. [Modes for carrying out the invention]

[0006] This disclosure provides surgical constructs, assemblies, kits, and methods for locating, determining, and marking the center of rotation of the elbow joint (i.e., the center of rotation of the lateral and / or medial epicondyles) for elbow repair and reconstruction, such as ulnar collateral ligament (UCL) repair or lateral ulnar collateral ligament (LUCL) repair.

[0007] The surgical guide of this disclosure enables the locating of the center of rotation in a rapid, simple, and efficient manner. The surgical guide eliminates the need for the current use of radiographic or fluoroscopic images, or the use of computed tomography (CT), which currently assists surgeons in locating the center of rotation. Radiographic, fluoroscopic, and CT are time-consuming, cumbersome, and expose both the provider and the patient to radiation, while still averaging approximately 1.1 mm of extension across the entire range of motion of the elbow joint. Fluoroscopy is also associated with substantial rotational errors and significant discrepancies among surgeons.

[0008] As detailed below, the surgical guide of this disclosure helps surgeons locate the center of rotation through the following three checks. 1. Use the outer edge of the capitellum joint surface of the humerus and the equidistant center point from the said edge (for the lateral collateral ligament). 2. Use the confluence point of the radial head bisectors measured at various angles such as 0 degrees, 45 degrees, and 90 degrees, and 3. Use a drill hole pattern that, when combined with one or more K-wires, allows for determination of whether an equiangular position is found when the elbow is placed through its range of motion.

[0009] The use of guides eliminates the need for fluoroscopy, radiography, and CT scans, accelerates procedure time, eliminates radiation exposure, improves surgical precision, and enhances elbow isometricity in collateral ligament repair / reconstruction. The use of guides also eliminates the need to find the true axis of rotation (and the subsequent second surgery for the use and removal of the corresponding axial guide) commonly used in current elbow stabilization systems.

[0010] As detailed below, the rotation center guide may consist of a solid metal body in the shape of a typical cube, having a length of approximately 1.9 to 2.25 inches, a width of approximately 0.8 to 1.2 inches, and a height of approximately 0.06 to 0.12 inches. One end of the guide has a semicircular configuration and is provided with two or more concentric through-holes or circles that pinpoint the rotation center. The other end of the guide has a generally rectangular shape and is provided with multiple through-holes or openings. The multiple through-holes or openings can form a linear pattern located around the centerline of the guide. The linear pattern of through-holes or openings helps to identify the attachment point on the ulnar tubercle. One or more bone engagement structures (spikes or points) may be provided on one of the surfaces of the guide (bottom of the guide) for stabilization during use.

[0011] Concentric through-holes and multiple linear through-holes or openings are configured and sized to engage with one or more instruments and / or devices (such as K-wires, drills, etc.) and to allow the easy passage of fixation devices (such as screws, suture button structures, suture anchors, etc.) and flexible members (such as flexible strands like sutures and / or suture tapes) associated with fixation devices used in elbow reconstruction (such as graft fixation).

[0012] Methods for determining the center of rotation of the elbow and methods for elbow reconstruction surgery are also disclosed. Exemplary methods include, in particular, the steps of (i) positioning a center of rotation guide on the medial or lateral side of the elbow, and (ii) fixing surgical instruments to the guide. The method may further include the steps of identifying the center of rotation of the elbow, engaging a plurality of bone engagement structures (spikes or points) located at the bottom of the guide with one or more bone surfaces / edges of the bone, and drilling a bone in the elbow. The method may further include the steps of attaching a graft to one or more elbow bones, and fixing the graft with one or more fixation devices.

[0013] Referring here to the drawings, where similar elements are indicated by the same reference numbers, Figures 1–9 show various illustrations of exemplary rotational center guides 100, 200, 300 (guides 100, 200, 300, elbow guides 100, 200, 300, structures 100, 200, 300, surgical structures 100, 200, 300, fixtures 100, 200, 300). Figures 10–12 show steps of an exemplary method of reconstructive surgery with rotational center guides.

[0014] The rotation center guide 100 in Figures 1 to 4 comprises a body 10 having an overall substantially cubic shape, i.e., a three-dimensional solid body having about six sides or faces (sides) positioned at angles of about 90 degrees to each other. In exemplary embodiments, the body 10 of the guide 100 is a cubic block having length L, width W, and height H. The length L may be about 1.9 to about 2.25 inches, the width W may be about 0.8 to about 1.2 inches (0.9 inches), and the height H may be about 0.060 to 0.120 inches, which is the dimension that allows the guide to be housed in an elbow, as will be detailed below. In exemplary embodiments, the rotation center guide 100 may be configured to have a length of about 1.98 inches and a width of about 0.9 inches.

[0015] As shown in Figure 1, one end of the guide 100, for example, end 11, has a semicircular configuration and is provided with two or more concentric through-holes or circles that locate / indicate the center of rotation C. In exemplary embodiments only, end 11 is provided with three concentric through-holes 22, 33, 44 or circles 22, 33, 44 that pinpoint the center of rotation C. The other end of the guide 100, for example, end 13, is substantially rectangular and is provided with a plurality of through-holes 55 or openings 55. The plurality of through-holes 55 or openings 55 can form a linear pattern located around the centerline 12 of the guide 100. The linear pattern of through-holes 55 or openings 55 helps to locate the attachment point on the ulnar tubercle. One or more bone engagement structures 77a, 77b (spikes 77a, 77b or points 77a, 77b) may be provided on one of the surfaces of the guide (for example, on the bottom surface 10b of the guide 100, as shown in Figure 4) for stabilization during use. The spikes or points may have similar or different configurations and / or dimensions.

[0016] The concentric through-holes 22, 33, 44 and the plurality of linear through-holes 55 or openings 55 are configured and sized to enable the easy passage of one or more surgical instruments or devices (such as K-wires, pins, drills, etc.), fixation devices (such as screws, suture button structures, suture anchors, etc.) associated with fixation devices used in elbow reconstruction (such as graft fixation), and flexible members (such as flexible strands like sutures and / or suture tapes), as detailed below.

[0017] The concentric through-holes 22, 3, 44 extend from the first surface or side 10a of the body 10 to the second opposite surface or side 10b of the body 10. The concentric through-holes 22, 33, 44 are configured to enable engagement and passage with one or more instruments, such as a drill or any cutting instrument, during a bone perforation procedure. The concentric through-holes 22, 33, 44 include a plurality of bisectors 20 at approximately 90-degree intervals to identify the center of rotation C on the outer and / or inner epicondyles.

[0018] The concentric through-holes 22, 33, 44 can be end-opened holes (such as cylindrical and extending in the long-axis direction) to receive one or more instruments (such as a drill guide and / or a drill) substantially parallel to each other and during use. The concentric through-holes 22, 33, 44 may be configured to have chamfered edges. The concentric through-holes 22, 33, 44 may be configured to be symmetrically arranged with respect to the center C of the cube. At least one or all of the concentric through-holes 22, 33, 44 may be configured to have internal threads for receiving one or more instruments. The concentric through-holes 22, 33, 44 are provided as circles for overlaying on the capitulum of the humerus. The central hole 22 is large enough to fit a pin for a fixation device (such as a suture anchor like the Arthrex SwiveLock® anchor).

[0019] The plurality of through-holes 55 or openings 55 identify the attachment points on the ulnar tubercle. In an exemplary embodiment, six through-holes 55 are provided symmetrically with respect to each other and along the longitudinal axis 12. The linear 6X hole pattern identifies the attachment points on the lateral ulnar collateral ligament (for LUCL repair / reconstruction) or the ulnar hook (for UCL repair / reconstruction). When used with a K-wire, the elbow can be checked through its range of motion before drilling the bone holes for the fixation device (such as a suture anchor). The parallel lines 15 are provided on each side of the through-hole 55 and along the body 10 with dimensions centered on the size of the radial head, and the open slots are on the opposite side. In use, the center of the radial head points to the center of rotation C at different elbow flexion angles. Using a marking pen, the surgeon draws a plurality of lines on the capitellum at different elbow ROM angles, and the point bisected by those lines corresponds to the center of rotation C.

[0020] One or more bone engagement structures 77a, 77b (spikes 77a, 77b, barbs 77a, 77b, points 77a, 77b) may be provided on one of the surfaces of the guide (e.g., on the bottom surface 10b of the guide 100 as shown in FIG. 4) for stabilization during use. In one embodiment, two spikes or barbs 77a, 77b are provided on the lower side 10b of the guide 100 at approximately 0.254 inches from the center C. The two spikes may have similar or different dimensions and / or configurations. The two spikes can be formed of the same or different material as one of the bodies 10 and can be formed integrally with or separately from the body 10. In one embodiment, the proximal barb 77b has a length smaller than the length of the distal barb 77a. In one embodiment, the proximal barb 77b has a length of approximately 5 mm and the distal barb 77a has a length of approximately 9 mm.

[0021] Guide 100 can be manufactured from metal, metal alloy, nonmetal, plastic, or a combination thereof. Guide 100 may be a metal guide manufactured by 3D printing, injection molding, or machining. Guide 100 may be formed from stainless steel, may be disposable, or may be reusable. Guide 100 is a simple construct that allows for precise and convenient positioning on the anterior surface of the bone to be transplanted / repaired / reconstructed (e.g., the lateral or medial side of the elbow).

[0022] Here, we refer to Figures 5-8, which show another exemplary embodiment. The rotation center guide 200 is substantially similar to the rotation center guide 100 described above in that it also provides a body 110 having three concentric through holes 122, 133, and 144 that pinpoint the rotation center C. The end 113 of the guide 200 is provided with four through holes 155 or openings 155 that form a linear pattern around the center line of the guide 200. The dimensions of the bone engagement structures 177a, 177b (spikes or points 177a, 177b) are also smaller than those of the guide 100.

[0023] Figure 9 shows a rotation center guide 300, which is substantially similar to the guides 100 and 200 described above, in that it also provides a body 210 having three concentric through-holes 222, 233, and 244 that pinpoint the rotation center C. However, the guide 300 comprises three layers, each having three through-holes 255 equidistant in a concentric circle from the rotation center hole 222 (COR hole). These holes 255 are provided for at least two reasons: if a surgeon wishes to fabricate a biliary construct, the surgeon can use these holes so that there is one hole in the COR and two holes in the ulna to fabricate a V-shaped construct. This distance needs to be measured to correspond to the average distance from the COR to the approximate level of the proximal articular surface of the radial head. These holes 255 can also be used to help verify that the COR is accurate. The surgeon can mark the holes with a marking pen and place the elbow into the ROM, and the surgeon should see the dots passing through the holes through the ROM. The V-shaped structure can be subjected to tension with one leg bent at approximately 30 degrees and the other at approximately 60 degrees.

[0024] The rotational center guides 100, 200, and 300 detailed above can be manufactured from metal, metal alloy, nonmetal, plastic, or a combination thereof. The rotational center guides 100, 200, and 300 may be metal guides produced by 3D printing, injection molding, or machining. The rotational center guides 100, 200, and 300 may be formed from stainless steel. The rotational center guides 100, 200, and 300 may be disposable. The rotational center guides 100, 200, and 300 may be reusable. The guides 100, 200, and 300 are simple constructs that allow for accurate and convenient positioning on the anterior surface of the bone to be implanted (e.g., the lateral or medial side of the elbow). The guides 100, 200, and 300 may also be contoured because the lateral epicondyle and supinator crest of the ulna are not in the same plane.

[0025] Guides 100, 200, and 300 are applicable to a variety of open procedures, particularly those involving the repair and reconstruction of the ulnar collateral ligament (UCL) and lateral ulnar collateral ligament (LUCL). While guides 100, 200, and 300 have been described above with reference to specific embodiments having a linear pattern of six or four through-holes, it will be understood that this disclosure is not limited to these specific embodiments only. Accordingly, this disclosure also envisions guides having three, four, five, six, and even more inline through-holes (of similar or different diameters) for precisely identifying attachment to the ulnar tubercle and checking isometricity.

[0026] For example, a guide with additional holes at its end (in addition to the 6X linear pattern) provides two additional holes at the end of the guide, and in one of the two additional holes, the surgeon can position another bone drilling hole in the supinator crest of the ulna. The surgeon can leave the guidewire at the center of rotation (COR) of the humerus, then drill one of the last two holes, then pass the elbow through the range of motion (ROM), and easily check in real time for isometricity to see if the drilled hole coincides with the hole in the center of rotation guide.

[0027] Referring here to Figures 10-12, which illustrate a method of elbow repair using the guides 100, 200, and 300 of this disclosure, more specifically, an elbow UCL (Figure 12) with an InternalBrace® (trademark) (internal) repair 101. Figure 10 shows an exemplary guide 200 of Figure 5 positioned on the elbow. Concentric through-holes 122, 133, and 144 are provided as a circle for overlapping the capitellum of the humerus 80. A linear through-hole 155 identifies an attachment point on the ulnar tubercle 90.

[0028] Figure 11 shows an exemplary surgical assembly with a guide 200 and associated driver 70. Depending on the intended use and surgical needs, the guide 200 may be configured to be provided on both the lateral and medial ulna. The central hole 122 is large enough to accommodate a pin and / or driver 70 for a fixation device 66 (e.g., a suture anchor 66 such as an Arthrex SwiveLock® anchor 66).

[0029] Figure 12 shows an elbow UCL repair using an exemplary guide 200 positioned on the capitellum 80 of the humerus and the tubercle 90 of the ulna. The positioning on the capitellum 80 of the humerus and the tubercle 90, and the determination of the center of rotation C, are performed by the surgeon using the center of rotation guides (guides 100, 200, 300, etc.). The outer edge of the articular surface of the capitellum 80 of the humerus is aligned with the semicircular edges of the bodies 10, 110, 210 of the guides 100, 200, 300, and the equidistant center points from the edges. Using the confluence of the bisectors of the radial head measured at various degrees such as 0, 45, and 90 degrees, the surgeon determines the center of rotation C (and can, for example, mark it with a marking pen).

[0030] The linear pattern of through-holes 55, 155, and 255 is positioned on the supinator crest of the ulnar tubercle (for LUCL repair) or the coronoid process of the ulna (for UCL repair). Using one of the through-holes in the linear pattern of through-holes 55, 155, and 255, the surgeon determines the attachment point on the ulnar tubercle (coronoid process of the ulna for UCL repair) (i.e., the surgeon introduces the K-wire into one or any of the through-holes 55, 155, and 255 to determine the ideal attachment point). When combined with one or more K-wires, the surgeon can determine whether an isometric position has been found when the elbow is placed through its range of motion.

[0031] An anchor drill guide is inserted into holes 22, 122, and 222 on the capitellum of the humerus 80. A socket is drilled into the supinator crest to position the fixation device. An exemplary suture anchor 66, such as an Arthrex SwiveLock® anchor loaded with suture tape 88 (e.g., FiberTape® suture tape 88), is inserted into the ulna until the anchor is flush with the bone. Natural ligaments may be repaired to the supinator crest of the ulnar tubercle using flexible strands 87 (e.g., sutures 87).

[0032] The drill guide is positioned on the medial epicondyle (determined center of rotation C), and the socket is drilled into the bone for the placement of another fixation device 66, such as another suture anchor 66 (e.g., an Arthrex SwiveLock® anchor 66). The tail end of the suture tape 88 is loaded onto the suture anchor 66, and the loaded anchor is inserted into a cavity in the bone and fixed in place.

[0033] In particular, various fastening devices in the form of screws, buttons, suture button structures, anchors, soft suture anchors (such as knotted and knotless suture anchors), and plates can be used with the rotation center guides 100, 200, and 300.

[0034] The fastening device 66 may be made of one or more parts, or it may be provided as an integrated device. In one exemplary embodiment, the fastening device 66 is a Corkscrew® anchor. In one exemplary embodiment, the fastening device 66 is a knotless suture anchor such as a two-piece Arthrex PushLock® anchor disclosed in U.S. Patent No. 7,329,272, or an Arthrex SwiveLock® anchor disclosed in U.S. Patents No. 8,012,174 and U.S. Patent No. 9,005,246, all of which are fully incorporated herein by reference. The exemplary knotless fastening device 66 may consist of an anchor body (or screw) and a hole.

[0035] The fixing device 66 may also be in the form of a soft anchor (soft suture anchor or fully sutured soft knotless anchor) comprising a soft anchor sleeve (sheath or tubular member) having two open ends, with at least one flexible connector extending through the soft anchor sleeve (sheath), and upper limbs each extending from the open ends of the sheath. The flexible connector may extend through the sleeve in similar or different directions and / or orientations and / or positions. Details of exemplary soft suture anchors having a soft anchor sleeve (sheath or tubular member) and a flexible shuttle strand are described, for example, in U.S. Patent Application No. 10,849,734, “Methods of Tissue Repairs,” filed 1 December 2020, the disclosure of which is incorporated herein by reference in its entirety.

[0036] The flexible strands 87, 88 may be formed from any flexible material, such as sutures or tapes, or a combination of sutures and tapes. The sutures may be in the form of any known suture construct, such as multifilaments, braided sutures, knitted sutures, woven sutures, elastic sutures, or may consist of ultra-high molecular weight polyethylene (UHMWPE) fibers or FiberWire® sutures (disclosed in U.S. Patent No. 6,716,234, the disclosure of which is incorporated herein by reference in its entirety). The tapes may be formed from suture tapes, such as Arthrex FiberTape®, which is a braided, rectangular cross-section high-strength suture tape, such as the one disclosed in U.S. Patent No. 7,892,256, the disclosure of which is thus incorporated herein by reference in its entirety.

[0037] The flexible strands 87, 88 may be connectors in the form of any elongated members, fibers, or materials, or combinations thereof. The flexible strands 87, 88 may include a single filament or fiber, or may include multiple continuous filaments, segments, or regions of filaments having different configurations (e.g., different dimensions and / or different compositions). Each region / segment of filaments may be homogeneous (i.e., formed from the same material) or a combination of homogeneous and heterogeneous (i.e., formed from multiple materials). Exemplary materials include sutures, silk, cotton, nylon, polypropylene, polyethylene, ultra-high molecular weight polyethylene (UHMWPE), polyethylene terephthalate (PET), and polyester, as well as copolymers thereof, or combinations thereof.

[0038] The rotational center guides 100, 200, and 300 described above may be included in a surgical kit, assembly, or system to simplify the surgeon's work in selecting specific instruments and to support the entire surgical procedure. A surgical kit for open surgical repair of the elbow may consist of one or more guides 100, 200, and 300, and at least one other surgical instrument or device for use with said guides 100, 200, and 300. The surgical kit may also consist of a drilling instrument or equivalent device, as well as a drill or bone-penetrating device. The surgical kit may also consist of a tensioner and / or bone plate and associated instruments. The surgical kit may also consist of fixation devices (such as anchors 66, screws, suture button structures, etc.) and flexible members (such as sutures 87 and suture tapes 88) used with the bone holes, holes, or openings formed by the guides 100, 200, and 300.

[0039] A method for determining the center of rotation of the elbow and a related elbow surgery method are also disclosed. An exemplary method includes, in particular, the steps of (i) positioning the center of rotation guides 100, 200, 300 on the medial or lateral side of the elbow, and (ii) determining the center of rotation of the elbow. The method may further include the steps of fixing the center of rotation guides 100, 200, 300 on the capitellum 80 of the humerus so that the semicircular ends of the guides 100, 200, 300 are aligned with the outer edge of the articular surface of the capitellum 80 of the humerus, engaging a plurality of spikes 77a, 77b or points located at the bottom of the guides 100, 200, 300 with the articular surface of the capitellum 80 of the humerus, fixing a cutting instrument 70 to the guides 100, 200, 300, and drilling the elbow.

[0040] The aforementioned guides 100, 200, and 300 help confirm the isometricity of the repair / internal brace / reconstruction by 1) finding the center of rotation (CoR) on the humerus in three different ways. This is the most effective and reliable way to do this by using the concentric circles on guides 100, 200, and 300 and utilizing the central hole of those concentric circles. This is the most accurate way to find the CoR, and 2) the CoR aligns with where the center of the radial head points at two different angles, where the surgeon bisects (which can be done, for example, at 30 and 90 degrees), so the surgeon can choose to use this option as well as, or instead of, the concentric circle method. Thus, the lines on the guides help frame the radial head, and the surgeon can mark those lines so that where they bisect coincides with the CoR. 3) Multiple inline holes on guides 100, 200, and 300 help confirm isometricity and select a spot on the ulna above the supinator crest. While the drilled hole spot on the ulna is not critical from an isometric standpoint, the surgeon can align it with the radial head-humeral capitellum (RC) joint, partly because if the LUCL is partially attached there and positioned further distally (if the LUCL is attached distally), the graft / InternalBrace™ ligament may rub against the radial head throughout the full range of motion of the elbow. Using multiple holes, after inserting the guidewire concentrically, the surgeon can select one of the multiple inline holes and drill a hole corresponding to the midpoint between the anterior and posterior cortical points on the ulna, aligning with the RC joint. After drilling the hole, the surgeon can pass the elbow through the range of motion of the joint, with the drilled hole in the bone being within 1.1 mm (or less) of the guide hole. Due to the pointed tip on the CoR guide, the surgeon must pull the guide away from the bone to check for isometricity. If the tips are of different lengths and not conventionally visible through the drill hole due to their angle, the surgeon may turn the guide inside out, which will allow for a better view.

[0041] The term “high-strength suture” is defined as any elongated flexible member, the choice of material and size depending on the specific application. For illustrative purposes only and without limitation, the term “suture” as used herein may be a cable, filament, thread, wire, fabric, or any other flexible member suitable for fixing tissues within the body. [Explanation of symbols]

[0042] 10 Main Unit 22 concentric hole 33 Concentric hole 44 Concentric hole 55 Through hole 100 Rotation Center Guide 122 Concentric hole 133 Concentric hole 144 Concentric hole 155 Through hole 200 Rotation Center Guide 222 Concentric holes 233 Concentric holes 244 Concentric hole 255 Through hole 300 Rotation Center Guide

Claims

1. It is a rotation center guide, A cube having length, width, and height, At least one projection, fitted to engage with the surface of the capitellum of the humerus at the elbow, Two or more concentric holes of different diameters, located at one end of the cube, with the one end having a semicircular configuration, A rotation center guide comprising a plurality of linear through holes extending from a first surface of the cube to a second surface of the cube.

2. The rotation center guide according to claim 1, wherein the at least one projection consists of one or more spikes or points.

3. The rotation center guide according to claim 2, wherein at least one projection consists of two spikes, one of which has a height of about 9 mm and the other of which has a height of about 5 mm.

4. The rotation center guide according to claim 1, wherein the two or more concentric holes are through holes extending from the first surface of the cube to the second surface of the cube, and the two or more concentric holes determine the rotation center of the lateral or medial epicondyle of the elbow.

5. The rotation center guide according to claim 1, wherein the plurality of linear through holes are located at the other end of the cube.

6. The rotation center guide according to claim 1, wherein the plurality of linear through holes are positioned along the longitudinal axis of the cube.

7. The rotation center guide according to claim 1, wherein the plurality of linear through holes identify an attachment point on the ulnar tubercle.

8. The rotation center guide according to claim 1, wherein the length is approximately 1.9 to approximately 2.25 inches, the width is approximately 0.8 to approximately 1.2 inches, and the height is approximately 0.060 to 0.120 inches.

9. The rotation center guide according to claim 1, wherein the length is approximately 1.98 inches and the width is approximately 0.9 inches.

10. The rotation center guide according to claim 1, wherein the plurality of linear through holes form a linear pattern and are positioned symmetrically with respect to the longitudinal axis of the cube.

11. The rotational center guide according to claim 1, wherein the guide is used for repairing or reconstructing the ulnar collateral ligament.

12. The rotational center guide according to claim 1, wherein the guide is used for repairing or reconstructing the lateral ulnar collateral ligament.

13. It is a surgical kit, A rotation center guide comprising a cube, one or more spikes configured to be attached to the surface of the capitellum of the humerus to be bony-drilled, two or more concentric holes of different diameters located at one end of the cube to identify the rotation center of the lateral or medial epicondyle, and a plurality of linear through-holes located at the other end of the cube to identify the attachment point on the ulnar tubercle, A surgical kit comprising at least one surgical instrument.

14. The surgical kit according to claim 13, wherein the at least one surgical instrument is a pin, a guide, a K-wire, a drill, or a cutting instrument.

15. The surgical kit according to claim 13, further comprising at least one fixation device.

16. The surgical kit according to claim 15, wherein the at least one fixing device is a suture anchor.

17. The surgical kit according to claim 13, wherein the rotation center guide is disposable.

18. A method for determining the center of rotation of the lateral or medial epicondyle of the elbow, Positioning the guide on the articular surface of the lateral / medial epicondyle, A method comprising determining the center of rotation of the lateral or medial epicondyle.

19. The method according to claim 18, The guide is fixed on the capitellum of the humerus so that its semicircular end aligns with the outer edge of the articular surface of the capitellum of the humerus. One or more spikes or points located on the bottom of the guide engage with the articular surface of the capitellum of the humerus, The cutting tool is fixed to the guide, A method that further includes drilling a bone in the elbow.

20. The method according to claim 19, further comprising positioning the linear pattern of through holes located on the rectangular end of the guide on the supinator crest or the coronoid process of the ulna.

21. The method according to claim 20, The three concentric lines on the semicircular end of the guide identify the center of rotation on the outer / inner upper condyle, and mark the center of rotation. A method further comprising identifying the attachment point on the supinator crest or the coronoid process of the ulna.

22. A method for repairing the elbow, Position the rotation center guide on the lateral or medial epicondyle of the elbow, Determining the center of rotation, A method comprising performing at least one surgical repair.

23. The method according to claim 22, wherein the at least one surgical repair is repair of the ulnar collateral ligament or repair of the lateral ulnar collateral ligament.

24. The method according to claim 22, wherein the rotation center guide is a cube comprising one or more spikes configured to be attached to the surface of the capitellum of the humerus to be bony drilled, two or more concentric holes of different diameters located at one end of the cube to identify the rotation center of the lateral or medial epicondyle, and a plurality of linear through-holes located at the other end of the cube to identify the attachment point on the ulnar tubercle.

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