Shield Guide Assembly

Abstract

The present disclosure relates to a shield guide assembly and method for restoring joint function. The shield guide assembly disclosed herein includes a shield dimensioned to prevent access therethrough onto an adjacent bone surface area during formation of one or more features along a surgical site.

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This disclosure claims priority to U.S. Patent Application No. 17 / 214,067, filed March 26, 2021. [Background technology]

[0002] The present disclosure relates to orthopaedic surgical procedures, and more particularly, to a shield guide assembly for repairing a joint.

[0003] Many bones in the human musculoskeletal system contain articular surfaces. The articular surfaces work together to facilitate different types and degrees of joint movement. The articular surfaces can wear down or suffer bone loss over time due to repeated use or wear, or can fracture as a result of traumatic impact. These types of bone defects can cause joint instability and pain. Some techniques may utilize artificial joints to repair the articular surfaces. Tissue may be removed from the bone prior to placement of the artificial joint. Tissue may be reattached to the bone using one or more fasteners located adjacent to the artificial joint. Summary of the Invention

[0004] SUMMARY The present disclosure relates to a shield guide assembly for orthopaedic surgical procedures. The shield guide assembly may be used to at least partially block access to a localized surface area of ​​a bone during surgical site preparation.

[0005] A shield guide assembly for an orthopaedic surgical procedure according to exemplary aspects of the present disclosure may include, inter alia, a base configured to be removably secured to an implant, an elongated guide arm extending from the base along an arm axis, and a shield translatable along the arm axis to set a position of the shield relative to the base. The shield may include a shield body that establishes a shield perimeter. The shield body may be dimensioned to prevent access therethrough onto an adjacent bone surface area associated with a projection of the shield perimeter.

[0006] A shield guide assembly for an orthopaedic surgical procedure according to an exemplary aspect of the present disclosure may include, inter alia, a base configured to be removably secured to an implant, a guide arm extending from the base, and a shield movable relative to the guide arm. The shield includes a shield body that may be dimensioned to prevent access therethrough such that a projection of the circumference of the shield body may silhouette the circumference of the implant.

[0007] A kit for an orthopaedic surgical procedure according to exemplary aspects of the present disclosure may include, inter alia, an implant including an implant body configured to be at least partially received in a bone and a shield guide assembly. The shield guide assembly may include a base configured to be removably secured to the implant, a guide arm extending from the base, and a shield translatable along a length of the guide arm to set a position of the shield relative to the implant. The shield may include a shield body that establishes a shield perimeter. The shield body may be dimensioned to prevent access therethrough onto an adjacent bone surface region of a bone associated with a projection of the shield perimeter.

[0008] A method of installing an orthopedic implant according to exemplary aspects of the present disclosure may include, inter alia, positioning the implant in a bone and securing a shield guide assembly to the implant. The shield guide assembly may include a base, a guide arm extending from the base, and a shield secured to the guide arm. The securing step may include mounting the base to the implant. The method may include moving the shield along the guide arm to set a position of the shield relative to the implant. The shield body may be dimensioned to prevent access through the shield body onto a bone surface area of ​​the bone associated with a projection of the shield perimeter from the set position. The method may include forming at least one opening in the bone surface area and in the bone adjacent to the shield. [Brief description of the drawings]

[0009] [Figure 1] 1 is a perspective view of an exemplary shield guide assembly including a base, a guide arm, and a shield. [Diagram 2] FIG. 2 is a plan view of the shield guide assembly of FIG. 1. [Diagram 3] 3 is a cross-sectional view of the shield guide assembly taken along line 3-3 of FIG. 2. [Figure 3A] FIG. 1 illustrates an exemplary shield profile. [Figure 4] 4 is a cross-sectional view of the shield guide assembly taken along line 4-4 of FIG. 2. [Diagram 5] FIG. 2 is a bottom view of the shield guide assembly of FIG. 1. [Figure 5A] FIG. 13 illustrates a shield in a first position relative to a guide arm. [Figure 5B] FIG. 13 illustrates the shield in a second position relative to the guide arm. [Figure 6] FIG. 6 shows the shield perimeter of the shield guide of FIG. 5 relative to the local bone surface area and implant perimeter. [Figure 7] FIG. 13 shows the shield perimeter of another shield guide relative to the implant perimeter. [Figure 8] 1A-1D are perspective and exploded views of an exemplary implant. [Figure 9] 1A-1D are perspective and exploded views of an exemplary implant. [Figure 10] 1A-1D illustrate an exemplary method of installing an orthopedic implant system at a surgical site. [Figure 11] FIG. 2 shows the resected bone. [Figure 12] FIG. 12 shows an implant positioned along the resected bone of FIG. 11. [Figure 13] 1A-1C illustrate an exemplary shield guide assembly positioned relative to a surgical site. [Figure 14]1A-1C illustrate an exemplary shield guide assembly positioned relative to a surgical site. [Figure 15] FIG. 13 shows the implant of FIG. 12 positioned at a surgical site. [Figure 16] FIG. 1 shows tissue attached to a surgical site. [Figure 17] FIG. 13 illustrates a fastener positioned within the opening. [Figure 18] FIG. 17 is a completed view of the tissue repair installed in FIG. 16. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0010] The present disclosure relates to a shield guide assembly that may be utilized in orthopedic procedures to restore function of a joint. The shield guide assembly described herein may be utilized during placement of a shoulder prosthesis in anatomic and reverse type procedures to restore function of a shoulder with advanced cartilage disease. View of the portion of the prosthesis may be obscured due to placement on the bone. The shield guide assembly and techniques disclosed herein may be utilized to block access to the portion of the bone surrounding the prosthesis, thereby reducing the possibility of contact from instruments and other devices that may be utilized for reattachment of any tissue that stabilizes the joint, such as soft tissues including tendons, ligaments, and joint capsules, as well as other tissues that may result in improved healing. The tissues may include one or more rotator cuff tendons, including the supraspinatus tendon, infraspinatus tendon, teres minor tendon, and / or subscapularis tendon. For example, a surgeon may position the shield guide assembly relative to the prosthesis when preparing to reattach the subscapularis tendon or other rotator cuff tendons to the bone to reduce the possibility of inadvertently contacting the prosthesis and forming a hole.

[0011] A shield guide assembly for an orthopaedic surgical procedure according to exemplary aspects of the present disclosure may include, inter alia, a base configured to be removably secured to an implant, an elongated guide arm extending from the base along an arm axis, and a shield translatable along the arm axis to set a position of the shield relative to the base. The shield may include a shield body that establishes a shield perimeter. The shield body may be dimensioned to prevent access therethrough onto an adjacent bone surface area associated with a projection of the shield perimeter.

[0012] In a further embodiment, the shield body may include at least one slot configured to slidably receive a portion of the guide arm along the arm axis.

[0013] In a further embodiment, the length of the guide arm may have a T-shaped cross-section.

[0014] In a further embodiment, the at least one slot may be a row of interconnected T-shaped slots corresponding to respective radial positions of the shield relative to the arm axis, and a length of the guide arm may be insertable into each of the T-shaped slots to set respective radial positions of the shield.

[0015] In a further embodiment, the shield body excludes any openings between the row of slots and the shield perimeter.

[0016] In a further embodiment, the base may include a recess configured to at least partially receive an end portion of the implant.

[0017] In a further embodiment, the base may be rotatable about the implant axis of the implant to vary the circumferential position of the shield relative to the implant axis.

[0018] In a further embodiment, the shield may be sized to abut adjacent bone surface areas in the deployed position.

[0019] In a further embodiment, the adjacent bone surface area may be associated with the humerus.

[0020] A shield guide assembly for an orthopaedic surgical procedure according to an exemplary aspect of the present disclosure may include, inter alia, a base configured to be removably secured to an implant, a guide arm extending from the base, and a shield movable relative to the guide arm. The shield includes a shield body that may be dimensioned to prevent access therethrough such that a projection of the circumference of the shield body may silhouette the circumference of the implant.

[0021] In a further embodiment, the base may be rotatable about the implant axis of the implant to vary the circumferential position of the shield relative to the implant axis of the implant.

[0022] In a further embodiment, for substantially all positions along the periphery of the implant below the bottom of the base relative to the implant axis, the periphery of the shield may be offset outwardly from the periphery of the implant by a maximum distance of 1 millimeter or less.

[0023] In a further embodiment, the shield may be movable relative to the guide arm to change the radial position of the shield relative to the implant axis.

[0024] In a further embodiment, the shield body may be dimensioned to prevent access through the shield onto the adjacent bone surface area associated with the humerus.

[0025] A kit for an orthopaedic surgical procedure according to exemplary aspects of the present disclosure may include, inter alia, an implant including an implant body configured to be at least partially received in a bone and a shield guide assembly. The shield guide assembly may include a base configured to be removably secured to the implant, a guide arm extending from the base, and a shield translatable along a length of the guide arm to set a position of the shield relative to the implant. The shield may include a shield body that establishes a shield perimeter. The shield body may be dimensioned to prevent access therethrough onto an adjacent bone surface region of a bone associated with a projection of the shield perimeter.

[0026] In a further embodiment, the shield perimeter may define a shield width that is greater than an implant width of a portion of the implant configured to be received in bone.

[0027] In a further embodiment, the implant body may extend along an implant axis between a first end portion and a second end portion, the base may be configured to be secured to the first end portion, and the shield may be rotatable about the implant axis to vary a circumferential position of the shield relative to the implant body in the installed position.

[0028] In a further embodiment, the implant may include a trunnion configured to be secured to the implant body and an articulating head configured to be secured to the implant body. The trunnion may be configured to engage a resected surface along the humerus. The articulating head may include an articulating surface dimensioned to mate with the glenoid or an opposing articular surface associated with the glenoid implant.

[0029] In a further embodiment, the multiple threads may extend around a circumference of the implant body, and the multiple threads may be dimensioned to secure the implant body to bone.

[0030] A method of installing an orthopedic implant according to exemplary aspects of the present disclosure may include, inter alia, positioning the implant in a bone and securing a shield guide assembly to the implant. The shield guide assembly may include a base, a guide arm extending from the base, and a shield secured to the guide arm. The securing step may include mounting the base to the implant. The method may include moving the shield along the guide arm to set a position of the shield relative to the implant. The shield body may be dimensioned to prevent access through the shield body onto a bone surface area of ​​the bone associated with a projection of the shield perimeter from the set position. The method may include forming at least one opening in the bone surface area and in the bone adjacent to the shield.

[0031] In a further embodiment, the tissue may be soft tissue and the method may include positioning a fastener in the at least one aperture to secure the soft tissue to the bone.

[0032] In a further embodiment, the bone may be the humerus, the fastener may be a suture anchor, and the soft tissue may include the subscapularis tendon.

[0033] In a further embodiment, the bone may be a humerus. The method may include resecting the humerus along the humeral head to establish a resection surface, and then embedding at least a portion of the implant into the resection surface.

[0034] In a further embodiment, the method may include rotating the shield about an implant axis of the implant to set a circumferential position of the shield relative to the implant axis. The moving step may occur such that the shield abuts the bone along the bone surface area at the set position. The forming step may occur after the rotating and moving steps.

[0035] In a further embodiment, the bone may be a humerus. The method may include resecting the humerus along the humeral head to establish a resection surface, and then embedding at least a portion of the implant into the resection surface.

[0036] In a further embodiment, the implant may include an implant body, a trunnion configured to be secured to the implant body, and an articulating head. The articulating head may include an articulating surface dimensioned to mate with the glenoid or an opposing articular surface associated with the glenoid implant. Positioning the implant may include moving the trunnion into engagement along the resection surface.

[0037] In a further embodiment, the plurality of threads may extend around a circumference of the implant body. The step of positioning the implant may include rotating the implant body about an implant axis to fixedly attach the implant body to the bone. The method may include fixing the articulating head to the trunnion to trap an end portion of the implant body between the trunnion and the articulating head.

[0038] 1-6 illustrate an exemplary shield guide assembly 20. The assembly 20 may be utilized for a variety of surgical procedures, such as orthopedic procedures to restore function to a joint. The assembly 20 may be utilized in repairing the articular surface along the humerus in anatomical and reverse shoulder replacement procedures. The assembly 20 may be utilized during attachment of soft tissue, including tendons, ligaments, and joint capsules, at a surgical site, such as reattachment of the subscapularis tendon or other rotator cuff tendons to bone following implantation of a prosthetic joint at the humerus. The surgeon may position the assembly 20 to obstruct a path to the portion of the bone surrounding the implant during preparation of the surgical site, thereby reducing the possibility of contact from instruments and other devices, such as guide pins and fasteners, that may be utilized in the attachment of the tissue. Although the assemblies disclosed herein primarily refer to shoulder reconstruction, the disclosed assemblies may also be utilized to restore function elsewhere in the patient, such as the knee and hip joints.

[0039] With reference to FIG. 1 , assembly 20 includes a base 22, an elongated guide arm 24, and a shield 26 carried by and secured to guide arm 24. Base 22 is configured to be removably secured to an implant 28 (shown in phantom in FIG. 3 for illustrative purposes). Assembly 20 may be utilized with implants of various shapes and sizes. The geometry of implant 28 in FIG. 3 is exemplary and not intended to be limiting. Shield 26 is translatable along the length of guide arm 24 to set the position of shield 26 relative to base 22 and implant 28.

[0040] With continued reference to FIG. 1 , and with reference to FIGS. 2 and 3 , the base 22 may have a generally dome-shaped geometry for mating with the implant 28 ( FIG. 3 ). The base 22 may extend along a base axis BA. The assembly 20 may include a handle 30 extending outwardly from the base 22, such as along the base axis BA, as shown in FIG. 3 . The handle 30 may be dimensioned to be manipulated by a surgeon to place the assembly 20 in a desired position and / or orientation along a surgical site. The handle 30 may have a generally cylindrical geometry. The handle 30 may be integrally formed with the base 22 or may be a separate, distinct component mechanically attached to the base 22 with one or more fasteners.

[0041] The base 22 may include a recess 32 configured to at least partially receive a first end portion 34 of the implant 28 to secure the base 22 to the implant 28, as shown in FIG. 3. The base 22 may define one or more openings 31 (e.g., windows) for viewing the first end portion 34 of the implant 28, which may aid in positioning the assembly 20. The implant 28 may include an implant body 33 extending along an implant axis IA between a first end portion 34 and a second end portion 35. The base axis BA may be collinear with or otherwise substantially parallel to the implant axis IA of the implant 28 in the installed position, as shown in FIG. 3. In other implementations, the base 22 may be dimensioned such that the base axis BA is transverse to the implant axis IA. For purposes of this disclosure, the terms "about," "approximately," and "substantially" mean within ±10% of the stated value or relationship, unless otherwise indicated. The recess 32 may be dimensioned to have a geometric shape that complements the perimeter of the first end portion 34 of the implant 28.

[0042] In the installed position, the base 22 may be rotatable in a direction R1 about the implant axis IA to vary the circumferential position of the shield 26 relative to the implant axis IA of the implant 28 and the implant body 33. In other implementations, the recess 32 is dimensioned to establish an interference fit with the periphery of the implant body 33 to limit or otherwise oppose relative rotation.

[0043] The guide arm 24 may be cantilevered from the periphery of the base 22. The guide arm 24 may extend from the base 22 along an arm axis AA. The guide arm 24 may be dimensioned such that the arm axis AA is substantially perpendicular to the base axis BA and the shield 26 is substantially parallel to the base axis BA, as shown in FIG. 3. In other implementations, the assembly 20 may be dimensioned such that the shield 26 is substantially non-parallel to the base axis BA and angled relative to the base 22. The shield 26 is translatable in a direction D1 along the arm axis AA to set the position of the shield 26 relative to the base 22. An exemplary position of the shield 26 along the guide arm 24 is illustrated by shields 26-1, 26-2 in FIG. 3 (for illustrative purposes, 26-2 is shown in dashed lines). The periphery of the base 22 may define an axially innermost position of the shield 26 relative to the arm axis AA. Moving shield 26 along guide arm 24 in direction D1 may occur such that shield 26 abuts bone B in a set position (for illustration purposes, bone B is shown in dashed lines in FIG. 2).

[0044] The guide arm 24 may be dimensioned to limit rotation of the shield 26 about the arm axis AA. In other implementations, the shield 26 may be rotatable about the arm axis AA. The guide arm 24 may include a body 36 extending along the arm axis AA and a pair of rails 38 (FIG. 2) on opposing sides of the body 36. The rails 38 may be disposed along the body 36 such that the length of the guide arm 24 has a substantially T-shaped cross-sectional geometry, as shown in FIG. 4. The rails 38 may be dimensioned to extend from the periphery of the base 22 and may be spaced apart from an abutment 40 at a free end of the guide arm 24 to establish a pair of opposing slots 42 (FIG. 3). The abutment 40 may define an axially outermost position of the shield 26 relative to the arm axis AA.

[0045] The shield 26 may include a shield body 44 sized with respect to a predetermined implant geometry to prevent a path or access through the shield body 44 onto adjacent localized bone surface areas, such as during the formation of one or more openings utilized for reattachment of tissue, including any tissue disclosed herein, such as the subscapularis tendon or other rotator cuff tendons, after at least partial implantation of the implant 28 into the bone.

[0046] With continued reference to FIGS. 2-3 and with reference to FIG. 5, the shield body 44 may include a first portion 46 and a second portion 48. The first portion 46 may face toward the free end of the guide arm 24, and the second portion 48 may face toward the base 22. The first portion 46 and the second portion 48 may be integrally formed or may be separate distinct components mechanically attached or otherwise secured to one another. The first portion 46 may have a substantially rectangular geometric shape. The second portion 48 may include a pair of wings 50 sized to extend outwardly of the first portion 46. The first and second portions 46, 48 of the shield body 44 cooperate to establish a shield perimeter 52 (shown in dashed lines for illustrative purposes).

[0047] The shield body 44 may be sized with respect to the geometry of the surgical site. The shield body 44 may have a substantially planar geometry along the second portion 48, as shown in FIG. 3. In other implementations, the shield 26 may be sized to substantially complement or approximate the contour of the adjacent surface of bone B, as shown by shield body 144 in FIG. 3A. Shaping the shield body 144 may reduce the possibility of placing instruments and other devices between the shield body 144 and bone B. In this disclosure, like reference numbers refer to like elements where appropriate, and reference numbers increased by 100 or multiples thereof refer to modified elements that are understood to incorporate the same features and advantages of the corresponding original elements.

[0048] The shield 26 may be movable relative to the guide arm 24 to vary the radial position of the shield 26 relative to the implant axis IA of the implant 28. The shield body 44 may include at least one slot 54 extending through the first and second portions 46, 48. The slot 54 is configured to slidably receive a portion of the guide arm 24 along the arm axis AA, as shown in FIG. 3. The slot 54 may have a variety of geometric shapes, such as a row of interconnected T-shaped slots 57. The T-shaped slots 57 may correspond to respective radial positions of the shield 26 relative to the arm axis AA and / or a set of predetermined implant sizes. For example, the shield body 44 may define four slots 57 corresponding to a set of predetermined implant sizes (e.g., small, medium, large, and extra large). The shield body 44 may be aligned with one of the slots 57 in the guide arm 24, and then the shield 26 may be moved in direction D2 to set the radial position of the shield 26 relative to the arm axis AA, as shown by shields 26-3, 26-4 in Figures 5A-5B. A rail 38 along the length of the guide arm 24 may be insertable into each of the T-shaped slots 57 to set the radial position of the shield 26 relative to the arm axis AA. The shield 26 may be sized such that the shield body 44 precludes any opening between the row of slots 57 and the shield perimeter 52, as shown in Figure 5.

[0049] With continued reference to FIGS. 3 and 5, and with reference to FIG. 6, the shield perimeter 52 may be sized with respect to a predetermined geometry of the implant or set of implants. For example, the implant 28 may establish an implant perimeter 58. The implant perimeter 58 may correspond to a portion of the implant 28 configured to be received in the bone, or may correspond to the entire implant 28, including the portion configured to extend outwardly from the bone. The shield perimeter 52 may be sized such that a projection of the shield perimeter 52 substantially or completely surrounds the implant perimeter 58. The shield 26 may be sized to prevent access through the shield body 44 onto a localized bone surface area 60 associated with the projection of the shield perimeter 52. The bone surface area 60 may be established along an outer contour of the bone B that at least partially receives the implant 28, such as the humeral head. The shield 26 may be sized to abut the bone surface area 60 in the installed position, as shown in FIG. 2 (see also FIG. 3A). The shield perimeter 52, implant perimeter 58, bone surface area 60, and related features are shown in dashed lines in FIG. 6 for illustrative purposes.

[0050] The perimeter 52 of the shield 26 may establish a first width W1. The first width W1 may extend between a pair of side walls of the shield body 44. The perimeter 58 of the implant 28 may establish a second width W2. The shield body 44 may be dimensioned such that the shield width W1 is greater than the implant width W2, at least for a portion of the implant 28 configured to be received in bone, as shown in FIG. 6. The shield 26 may be dimensioned to have a height equal to or greater than the height of the implant body 33, such that the perimeter 52 of the shield 26 extends above and / or below the perimeter 58 of the implant 28 relative to the implant axis IA, as shown in FIG. 3. The shield 26' may be dimensioned to approximate the contour of the implant 28', as shown in FIG. 7. The perimeter 52' ​​of the shield 26' may be dimensioned to substantially follow the perimeter 58' of the implant 28' such that a projection of the perimeter 52' ​​of the shield 26' silhouettes the perimeter 58' of the implant 28' to prevent access through the shield body 44' onto the adjacent localized bone surface area 60'. The first width W1' of the shield 26' may be substantially equal to the second width W2' of the implant 28'. The perimeter 52' ​​of the shield 26' may be offset outwardly from the perimeter 58' of the implant 28' by a maximum distance of 1 millimeter (mm) or less for at least a majority or substantially all locations along the perimeter 58', including at least a location of the perimeter 58' below the bottom 37' of the base 22' relative to the implant axis IA' (see also the bottom 37 of the base 22 in FIG. 3). The disclosed techniques may facilitate more precise positioning of instruments relative to the implant 28' during formation of one or more features in the bone B', which may improve fixation and patient healing.

[0051] 8-9 show an exemplary orthopedic implant 128 that may be utilized with the shield guide assembly 20. The implant 128 may represent a stemless implant sold under the trade name Eclipse System™ and manufactured by Arthrex®, Inc. The assembly 20 and the disclosed implants may be provided to a surgeon as a kit for performing an orthopedic surgical procedure. The kit may include implants of various shapes and sizes. A particular implant may be selected from the kit according to the patient's anatomy. Other implants may be utilized with the teachings disclosed herein, including implants having a stem portion received within an internal cavity of a bone, intramedullary nails, and bone plates.

[0052] The implant 128 may include an implant body 133, a trunnion 172, and an articulating head 174. The implant body 133 may be configured to be at least partially received in bone, such as along a resected surface of the humeral head. The implant body 133 may be a cage screw including one or more threads 171 extending around a circumference of the implant body 133. The threads 171 may be dimensioned to secure the implant body 133 to bone. The implant body 133 may be rotatable about an implant axis IA in a direction R3 (FIG. 9) to secure the implant body 133 to the bone. The implant body 133 may define a hollow cavity 173 and one or more openings 177 in a wall of the implant body 133. The openings 177 may promote bone growth from the surrounding bone into the cavity 173, which may improve healing for the patient.

[0053] The trunnion 172 may be configured to be secured to the implant body 133. The trunnion 172 may be configured to engage a resected surface of a bone, such as a resected surface along the humerus (see, e.g., FIG. 12). The trunnion 172 may include a passageway 176 ( FIG. 9 ) configured to at least partially receive the implant body 133 along the implant axis IA. During assembly, the implant body 133 may move in a direction D3 along the implant axis IA into the passageway 176 until a collar 179 of the implant body 133 abuts a body 181 of the trunnion 172. The trunnion 172 may include one or more protrusions 178 configured to engage a bone surface to secure the implant 128.

[0054] The articulating head 174 may be configured to be secured to the implant body 133. The articulating head 174 may include an articulating surface 175 sized to match an opposing articular surface. The opposing articulating surface may be associated with a glenoid or glenoid implant utilized in an anatomical or reverse shoulder repair procedure. The articulating surface 175 may have a convex shape for an anatomical shoulder procedure or a concave surface for a reverse shoulder procedure, as shown in FIGS. 8-9. The articulating head 174 may move along the implant axis IA in a direction D3 and engage or otherwise be secured to the implant body 133 and / or the body 181 of the trunnion 172.

[0055] FIG. 10 illustrates an exemplary method of installing an orthopedic implant in a flow chart 290. The method 290 may be utilized to perform joint arthroplasty to restore function to a joint, such as a shoulder, having advanced cartilage disease. The method 290 may be utilized with the shield guide assembly 20 and any of the orthopedic implants disclosed herein. The method 290 may be utilized to attach any tissue disclosed herein, including soft tissues such as tendons, ligaments, and joint capsules. The tissue may be one of the patient's rotator cuff tendons, including the supraspinatus tendon, infraspinatus tendon, teres minor tendon, and / or subscapularis tendon. Fewer or additional steps than those listed below may be performed within the scope of the present disclosure, and the order of the steps listed is not intended to limit the present disclosure.

[0056] 11 with continuing reference to FIG. 10, a surgical site S may be prepared at step 290A. The surgical site S may be a joint, such as the shoulder joint, including a glenoid cavity G and a humerus H (see, e.g., FIG. 15). The surgical site S may be established along a bone B associated with an articular surface of the shoulder joint, such as the humeral head HH of the humerus. To establish a desired shape of the surgical site S, one or more operations may be performed to prepare the surgical site S, such as one or more of reaming, milling and drilling operations.

[0057] Step 290A may include, at step 290B, resecting a portion of bone B to establish a resection plane RS. Step 290B may include cutting a portion of the humerus along the humeral head HH at a resection angle α relative to an axis BB of bone B to establish a resection plane RS. For example, bone B may be resected utilizing one or more cutting instruments and a guide block.

[0058] Step 290A may include forming a bone cavity BC in bone B along resection surface RS. The bone cavity BC may be annular, as shown in FIG. 11. The bone cavity BC may be sized to receive at least a portion of the implant body 233 of the implant 228, as shown in FIG. 12. In other implementations, the core CC may be removed such that the bone cavity BC is substantially hollow. Various techniques may be utilized to form the bone cavity BC, such as forcing an annular coring template into the resection surface RS, or by reaming or drilling.

[0059] 12 with continued reference to FIG. 10, implant 228 may be at least partially positioned in bone B at step 290C. Implant 228 may be a stemless implant. Other implants may be utilized with method 290 and shield guide assembly 20, including implants having an elongated stem receiving a humeral tunnel and any of the implants disclosed herein. Step 290C may include embedding at least a portion of implant body 233 in resection surface RS after resectioning bone B. Trunnion 272 may be moved to engage or otherwise positioned along resection surface RS.

[0060] The implant body 233 may be at least partially positioned in the bone cavity BC, which may occur after positioning the trunnion 272. The implant body 233 may be moved in a direction D3 along the implant axis IA and at least partially into the passageway 276 of the trunnion 272 until the collar 279 of the implant body 233 abuts the body 281 of the trunnion 272. Step 290C may include rotating the implant body 233 in a direction R3 about the implant axis IA to fixedly attach or otherwise secure the implant body 233 to the bone B along the bone cavity BC by the one or more threads 271.

[0061] 13-14, with continued reference to FIG. 10, at step 290D, the shield guide assembly 220 is removably secured to the implant 228 to at least partially block access to the localized bone surface area 260 along the surgical site S (see FIG. 14). The shield guide assembly 220 may include a base 222, a guide arm 224, and a shield 226. Step 290D may include mounting the base 222 to the trunnion 272 or another portion of the implant 228, as shown in FIG. 14. In other implementations, the assembly 220 may be mounted directly to the implant body 233 (FIG. 12). The assembly 220 may be secured to the implant 228 such that the guide arm 224 is cantilevered from the periphery of the base 222.

[0062] At step 290E, the position of the shield 226 may be set relative to the implant 228. Step 290E may include aligning the shield body 244 of the shield 226 with a selected T-shaped slot 257 in the guide arm 224 and then moving the shield 226 in a direction D2 to set a radial position of the shield 226 relative to the arm axis AA of the guide arm 224. Step 290E may include inserting one or more rails 238 of the guide arm 224 into a selected one of the T-shaped slots 257 to set a respective radial position of the shield 226. The rails 238 and slots 257 may be sized to limit relative radial movement of the shield 226 relative to the arm axis AA such that the shield 226 sits on the guide arm 224 at a substantially constant height along the length of the rails 238.

[0063] Step 290E may include rotating shield 226 in direction R1 about implant axis IA to set a circumferential position of shield 226 relative to implant 228 ( FIG. 12 ). Assembly 220 may be dimensioned such that shield 226 is rotatable approximately 360 degrees about base axis BA to block access to bone B surrounding implant 228. In some implementations, assembly 220 may be dimensioned such that shield 226 is rotatable less than 360 degrees about base axis BA, such as approximately 180 degrees or less.

[0064] Step 290E may include moving shield 226 in direction D1 along the length of guide arm 224 to set a position of shield 226 relative to implant 228. Moving shield 226 in direction D1 along guide arm 224 may occur such that shield 226 abuts bone B along bone surface area 260 in the set position, as shown in FIG. 14 (see also FIG. 2). Bone surface area 260 may be associated with a projection of shield perimeter 252 (for illustrative purposes, 252, 260 are each shown in dashed lines in FIGS. 13-14; see also FIG. 6). Shield body 244 may be sized to prevent access through shield body 244 onto bone surface area 260 in the set position.

[0065] At step 290F, one or more features may be formed at the surgical site S adjacent to the implant 228 while the assembly 220 is secured to the implant 220. Step 290F may occur after setting the position of the shield 226 at step 290E. The features may include recesses or openings 292 configured to receive respective fasteners, such as suture anchors. The openings 292 and other features may be formed utilizing a variety of techniques, such as drilling, punching, or inserting needles into the bone B. Step 290G may include forming one or more openings 292 in the bone B adjacent to the bone surface area 260 and the shield 226, as shown in FIGS. 13-14. The openings 292 may be formed in the humeral head HH outwardly of the shield perimeter 252 and the bone surface area 260, as shown in FIGS. 14-15. Four openings 292 formed in the humeral head HH are shown for illustrative purposes. However, a different number of apertures 292 may be formed in bone B along the surgical site S, such as only one or two apertures 292, while shield guide assembly 220 is secured to implant 228. Step 290F may include forming one or more apertures 292-1 associated with a first bone surface region 260-1 corresponding to a first circumferential position of shield 226 relative to base axis BA, rotating shield 226 in direction R1 to a second, different radial position in step 290E associated with a second, different bone surface region 260-2, and then forming one or more apertures 292-2 adjacent second bone surface region 260-2 as shown in FIG. 14 (see also FIG. 15). Assembly 220 may be removed from surgical site S after forming features 292.

[0066] With continuing reference to FIG. 10, and with reference to FIG. 15, the articulating head 274 may be seated in the implant body 233 to secure the articulating head 274 to the bone B at step 290H. Step 290H may occur such that an end portion of the implant body 233 is trapped between the trunnion 272 and the articulating head 274 (see also FIG. 8). The articulating head 274 may include an articulating surface 275 dimensioned to mate with an opposing articular surface AS. The articular surface AS may be associated with the glenoid G or the glenoid implant GI. The articulating surface 275 may have a generally convex geometry as illustrated in FIG. 15, or may have a generally concave geometry.

[0067] With continuing reference to FIG. 10 and with reference to FIG. 16, at step 290I, tissue T may be reattached or otherwise secured to bone B along the surgical site S. Tissue T is shown in FIG. 16 with dashed lines for illustrative purposes. Step 290I may include attaching one or more lengths of suture SS to an end portion of tissue T at step 290J. Tissue T may include any tissue disclosed herein, including tendons, ligaments, or joint capsules. Tissue T may be one of the rotator cuff tendons, including the supraspinatus tendon, infraspinatus tendon, teres minor tendon, and / or subscapularis tendon, associated with the patient's humerus H. Step 290I may occur after removing assembly 220 from surgical site S. Step 290A may include peeling or otherwise displacing a portion of tissue T from the humeral head HH to provide access for positioning implant 228. Step 290I may include moving a portion of the tissue T above the articulation head 274 and to a position that substantially approximates an initial position of the tissue T prior to placement of the implant 228.

[0068] Step 290I may include securing tissue T with one or more fasteners 294 affixed or otherwise secured to bone B. Step 290I may include positioning one or more fasteners 294 in respective apertures 292 to secure tissue T to bone B at step 290K. Step 290K may include positioning fasteners 294 in respective apertures 292 to secure tissue T, such as the subscapularis tendon, to the humeral head HH of the humerus. Exemplary fasteners may include anchors comprising a variety of materials, such as polyetheretherketone (PEEK), metallic and biocomposite materials, suture materials, other natural and synthetic materials, and / or one or more sutures.

[0069] The fasteners 294 may be, for example, suture anchors secured to the sutures SS. Step 290K may include at least partially inserting the fasteners 294 into the respective apertures 292 to secure the sutures SS at respective locations along the surgical site S. The fasteners 294 may have a variety of geometries and configurations. For example, the fasteners 294 may have one or more threads or ribs to establish an interference fit with surfaces along the respective apertures 292, as shown in FIG.

[0070] Various techniques may be utilized to secure the tissue T at step 290I. In some implementations, the tissue T may be secured to the bone B utilizing a double row technique, as shown in FIG. 16. Double rows of apertures 292 may be formed along the surgical site S outwardly of the respective bone surface areas 260 associated with the projection of the shield perimeter 252 (see FIGS. 13-15). Fasteners 294 are located in the respective apertures 292 to secure the sutures SS and the tissue T to the bone B along the surgical site S. The sutures SS may be disposed in a generally X-shaped pattern between the double rows of fasteners 294. In other implementations, step 290I may include performing a single row technique, in which a pair of apertures 292 are formed to secure the respective fasteners 294 to secure the tissue to the bone B. FIG. 18 illustrates the completed repair, including the attachment of the tissue T as a result of step 290I, where the tissue T is the subscapularis tendon reattached to the humeral head HH. One or more finishing operations, including encapsulating the surgical site S, may be performed in step 290L.

[0071] The novel shield guide assemblies and methods of the present disclosure may be utilized to block access to portions of bone surrounding an implanted implant, which may reduce the likelihood of the implant contacting or perforating the bone during formation of one or more features proximate the implant. The shield guide assemblies may be positioned circumferentially around the implant and / or at one or more heights to provide versatility in the selection of various implant shapes and to accommodate the patient's respective bone profile. Openings and other features may be formed proximate the implant to provide improved bone scaffolding and fixation of tendons or other tissues.

[0072] Although different non-limiting embodiments are illustrated as having particular components or steps, embodiments of the present disclosure are not limited to those particular combinations. Some of the components or features from any of the non-limiting embodiments can be used in combination with features or components from any of the other non-limiting embodiments.

[0073] It should be understood that like reference numerals identify corresponding or similar elements throughout the several views. Although particular component arrangements are disclosed and illustrated in these exemplary embodiments, it should be further understood that other arrangements can also benefit from the teachings of the present disclosure.

[0074] The foregoing description is illustrative and is not to be construed in any limiting sense. Those of ordinary skill in the art will recognize that certain modifications would be possible within the scope of the present disclosure. [Explanation of symbols]

[0075] 20 Shield guide assembly 20 Assembly 22 Base 24 Guide Arm 26 Shield 28 Implants 30 Handle 31 Opening 32 Recess 33 Implant body 34 First end portion 35 Second end portion 36 Main Unit 37 Bottom 38 Rail 40 Abutment 42 Slots 44 Shield body 46 First Part 48 Second Part 50 Wing 52 Shield perimeter 54 Slots 57 T-shaped slot 58 Peri-implant 60 Bone surface area 128 Orthopedic Implants 133 Implant body 144 Shield body 171 Thread 172 Trunnion 173 Cavity 174 Articulating Head 175 Articular Surface Aisle 176 177 Opening 178 Protrusion 181 Main unit 220 Shield guide assembly 220 Assembly 222 Base 224 Guide Arm 226 Shield 228 Implants 233 Implant body 238 Rail 244 Shield body 252 Shield Surroundings 257 T-shaped slot 260 Bone surface area 271 Thread 272 Trunnion 274 Articulating Head 275 Articular Surface 276 Aisle 281 Main unit 292 Aperture 294 Fasteners

Claims

1. 1. A shield guide assembly for an orthopaedic surgical procedure, comprising: a base configured to be removably secured to the implant; an elongated guide arm extending from the base along an arm axis; a shield axially translatable along the guide arm relative to the arm axis to set a position relative to the base; Equipped with A shield guide assembly, wherein the shield includes a shield body establishing a shield perimeter, and the shield body is dimensioned to prevent access through the shield body onto an adjacent bone surface area within a projection of the shield perimeter.

2. The shield guide assembly of claim 1 , wherein the shield body includes at least one slot configured to slidably receive a portion of the guide arm along the arm axis.

3. The shield guide assembly of claim 2 , wherein the length of the guide arm has a T-shaped cross-section.

4. 4. The shield guide assembly of claim 3, wherein the at least one slot is a row of interconnected T-shaped slots corresponding to different heights of the shield on the guide arm, a length of the guide arm being insertable into each of the T-shaped slots to set a respective height of the shield.

5. The shield guide assembly of claim 4 , wherein the shield body excludes any openings between the row of slots and the shield perimeter.

6. The shield guide assembly of claim 1 , wherein the base includes a recess configured to at least partially receive an end portion of the implant.

7. The shield guide assembly of claim 6 , wherein the base is rotatable about an implant axis to vary a circumferential position of the shield relative to an implant axis of the implant.

8. The shield guide assembly of claim 1 , wherein the shield is dimensioned to abut the adjacent bone surface area in an installed position.

9. The shield guide assembly of claim 1 , wherein the adjacent bone surface area is associated with a humerus.

10. A kit for an orthopedic surgical procedure comprising a shield guide assembly and an implant, the shield guide assembly comprising: a base configured to be removably secured to the implant; A guide arm extending from the base; a shield movable along the guide arm; Equipped with The kit, wherein the shield includes a shield body, the shield body being dimensioned to prevent access therethrough such that a projection of a periphery of the shield body silhouettes a periphery of the implant.

11. The kit of claim 10 , wherein the base is rotatable about an implant axis of the implant to vary a circumferential position of the shield relative to an implant axis of the implant.

12. 12. The kit of claim 11, wherein the perimeter of the shield is offset outwardly from the perimeter of the implant by a maximum distance of 1 millimeter or less for substantially all positions along the perimeter of the implant below the bottom of the base relative to the implant axis.

13. The kit of claim 11 , wherein the shield is movable along an arm axis of the guide arm to vary the distance of the shield from the implant axis.

14. The kit of claim 10 , wherein the shield body is dimensioned to prevent access therethrough onto an adjacent bone surface area associated with the humerus.

15. 1. A kit for an orthopedic surgical procedure comprising: an implant including an implant body configured to be at least partially received in a bone; 1. A shield guide assembly comprising: a base configured to be removably secured to the implant; A guide arm extending from the base; a shield guide assembly comprising: a shield translatable along a length of the guide arm to set a position relative to the implant; Including, The kit, wherein the shield includes a shield body establishing a shield perimeter, and the shield body is dimensioned to prevent access through the shield body onto an adjacent bone surface region of the bone within a projection of the shield perimeter.

16. The kit of claim 15 , wherein the shield perimeter defines a shield width that is greater than an implant width of a portion of the implant configured to be received in bone.

17. 16. The kit of claim 15, wherein the implant body extends along an implant axis between a first end portion and a second end portion, the base is configured to be secured to the first end portion, and the shield is rotatable about the implant axis to vary a circumferential position of the shield relative to the implant body in an installed position.

18. the implant includes a trunnion configured to be secured to the implant body; and an articulation head configured to be secured to the implant body; the trunnion is configured to engage a resection surface along the humerus; The kit of claim 15 , wherein the articulating head includes an articulating surface dimensioned to match an opposing articular surface associated with a glenoid or glenoid implant.

19. 20. The kit of claim 18, wherein a plurality of threads extend around a circumference of the implant body, the plurality of threads being dimensioned to secure the implant body to bone.

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