Guide Device

Abstract

A guide device (1) guides a drill (14) that opens a second foramen in which a first foramen was formed. The guide device (1) comprises: a long protection part (2) that is inserted into the first foramen and that demarcates, in the first foramen, a passage extending in the longitudinal direction of the first foramen and through which a suture passes; a guide part (3) that has a guide hole defining a guide axis (G) and that guides, along the guide axis (G), a drill (14) penetrating the guide hole; and an arm part (4) connecting the protection part (2) and the guide part (3). The guide axis (G) is disposed to a twisting position with respect to the protection part (2) and passes through a position in which the drill (14) guided along the guide axis (G) does not interfere with the suture passing through the passage.

Description

[Technical Field]

[0001] The present invention relates to a guide device, and more particularly to a guide device for guiding a bone drill. [Background technology]

[0002] The pull-out method has been commonly used as a repair technique for medial meniscus posterior root tears (MMPRT). As shown in Figure 5, the pull-out method involves pulling the torn end of the posterior root (PR) of the medial meniscus (MM) anteriorly with a suture 10, reducing and fusing the torn end to the posterior root attachment C of the articular surface B. In the pull-out method, a bone tunnel H1 is created from the anterior surface of the tibia A to the posterior root attachment C, and the suture 10, which is placed across the torn end, is pulled anteriorly through the bone tunnel H1 and fixed to the anterior surface of the tibia A.

[0003] Meanwhile, a guide device that guides a drill that drills holes in bone is known (see, for example, Patent Document 1). The guide device of Patent Document 1 is used when simultaneously performing anterior cruciate ligament reconstruction and high tibial osteotomy (HTO), and guides multiple drills so that the bone holes for anterior cruciate ligament reconstruction and the bone holes for high tibial osteotomy do not interfere with each other. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] Japanese Patent Application Laid-Open No. 2012-165977 Summary of the Invention [Problem to be solved by the invention]

[0005] As shown in Figure 5, if a patient has osteoarthritis in addition to MMPRT, the pull-out method and HTO may be performed simultaneously. HTO is a method of correcting the tibia A by osteotomizing the tibia A from the medial side and enlarging the osteotomy D. To fix the corrected tibia A, a bone plate 11 placed on the medial surface of the tibia A is fixed to the tibia A with screws 12a, 12b, 12c, ..., 12h on the proximal and distal sides of the osteotomy D.

[0006] In this case, the proximal and anterior screw 12a is often positioned to pass near the suture 10. Therefore, the surgeon must accurately determine the position of the bone hole H2 for the screw 12a relative to the bone hole H1 through which the suture 10 passes, and carefully drill the bone hole H2 so that the drill does not interfere with the suture 10. This type of work places a heavy burden on the surgeon.

[0007] The present invention has been made in consideration of the above-mentioned circumstances, and aims to provide a guide device that can easily drill a second bone hole near a first bone hole through which the suture passes, while preventing interference between the drill and the suture. [Means for solving the problem]

[0008] One aspect of the present invention is a guide device for guiding a drill to drill a second bone hole in a bone in which a first bone hole has been formed, the guide device comprising: a long protective portion that is inserted into the first bone hole, extends longitudinally of the first bone hole, and defines a passage within the first bone hole through which a suture can pass; a guide portion having a guide hole that defines a guide axis and guides the drill that passes through the guide hole along the guide axis; and an arm portion that connects the protective portion and the guide portion, wherein the guide axis is positioned in a twisted position relative to the protective portion, and the drill guided along the guide axis passes through a position that does not interfere with the protective portion and the passage. [Effects of the Invention]

[0009] According to the present invention, it is possible to easily drill a second bone hole near a first bone hole through which the suture thread passes, while preventing interference of the drill with the suture thread. [Brief explanation of the drawings]

[0010] [Figure 1A] 1 is a plan view of a guide device according to an embodiment of the present invention. [Figure 1B] FIG. 1B is a rear view of the guide device of FIG. 1A. [Figure 1C] FIG. 10 is a front view of the protective part inserted into the bone hole for the pull-out method. [Figure 1D] 1B is a side view of the protective portion of the guide device of FIG. 1A. [Figure 1E] FIG. 10 is a rear view of the protective part inserted into the bone hole for the pull-out method. [Figure 2A] FIG. 1B is an exploded perspective view of the guide device of FIG. 1A. [Figure 2B] FIG. 1B is an assembled perspective view of the guide device of FIG. 1A. [Figure 3] FIG. 2 is a side view of the guide device as seen along the guide shaft. [Figure 4A] 10A to 10C are diagrams illustrating a method of using the guide device. [Figure 4B] 10A to 10C are diagrams illustrating a method of using the guide device. [Figure 4C] 10A to 10C are diagrams illustrating a method of using the guide device. [Figure 4D] 10A to 10C are diagrams illustrating a method of using the guide device. [Figure 5] FIG. 1 is a diagram illustrating the pull-out method and HTO. DETAILED DESCRIPTION OF THE INVENTION

[0011] A guide device 1 according to one embodiment of the present invention will be described below with reference to the drawings. As shown in Fig. 5, the guide device 1 according to this embodiment is used in a surgery in which the pull-out method and high tibial osteotomy (HTO) are performed simultaneously. A first bone hole H1 for the pull-out method and a second bone hole H2 for the HTO are both formed in the proximal epiphysis of the tibia A. The guide device 1 is used to guide a drill that drills the bone hole H2 in the proximal epiphysis where the bone hole H1 has been formed.

[0012] Before describing the guide device 1, the pull-out method and HTO will be described. The pull-out technique is one of the repair procedures for medial meniscus posterior root tears (MMPRT). In the pull-out technique, a bone tunnel H1 is formed from the anterior surface of the tibia A to the posterior root attachment C of the articular surface B. A suture 10 is placed across the torn end of the posterior root (PR) of the medial meniscus (MM), pulled through the bone tunnel H1 to the anterior side of the tibia A, and fixed to the anterior surface of the tibia A while being pulled in the anterior-medial direction of the tibia A. In Figure 5, LM is the lateral meniscus, and the left, right, front, and back sides of the drawing correspond to the medial, lateral, anterior, and posterior sides of the tibia A, respectively.

[0013] HTO uses a bone plate 11, bone screws 12a to 12h (hereinafter collectively referred to as bone screws 12), and a drill sleeve 13 (see FIGS. 4B and 4C). The bone plate 11 is a roughly T-shaped plate-like member and has a plurality of screw holes 11a to 11h that penetrate the bone plate 11 in the thickness direction. The screw holes 11a to 11h are threaded holes to which male screws (not shown) provided on the head of the screw 12 and the tip of the drill sleeve 13 are connected.

[0014] The drill sleeve 13 is a cylindrical member that guides the drill. By connecting the tip of the drill sleeve 13 to the screw holes 11a to 11h, the drill sleeve 13 is fixed to the bone plate 11 so that the drill sleeve 13 and the screw holes 11a to 11h are coaxial.

[0015] In HTO, the tibia A is osteotomized from the medial side, and artificial or autologous bone is inserted into the enlarged wedge-shaped osteotomy portion D. Next, if necessary, the bone plate 11 is temporarily fixed to the medial surface of the tibia A with a wire or the like, and multiple bone holes H2 are formed in the tibia A with a drill via the drill sleeves 13 fixed in the screw holes 11a to 11h. Next, the screws 12 are screwed into the bone holes H2 until their heads connect with the screw holes 11a to 11h, thereby fixing the bone plate 11 to the tibia A.

[0016] In order to firmly fix the bone plate 11 to the proximal end of the tibia A, it is preferable that the D screw 12d adjacent to the proximal osteotomy surface E is positioned so as not to interfere with the osteotomy surface E, and for this purpose, it is preferable that the most proximal and most anterior A screw 12a passes near the bone hole H1 for the pull-out method. The guide device 1 of this embodiment is particularly used to form a bone hole H2 for the A screw 12a and to screw the A screw 12a into the bone hole H2 while preventing interference between the drill and the suture 10 of the A screw 12a.

[0017] Next, the guide device 1 of this embodiment will be described. As shown in Figures 1A to 2B, the guide device 1 includes a protective portion 2 for protecting the suture 10 in the bone hole H1 from the drill and screw 12, a guide portion 3 for guiding the drill along the guide axis G, and an arm portion 4 connecting the protective portion 2 and the guide portion 3.

[0018] The protection unit 2, the guide unit 3, and the arm unit 4 are configured as separate members, and the protection unit 2 and the guide unit 3 are removably attached to the arm unit 4. Figures 1A, 1B, and 2B show the guide device 1 in an assembled state, and Figure 2A shows the guide device 1 in a disassembled state.

[0019] The guide device 1 has an up-down direction, a left-right direction, and an anterior-posterior direction that are perpendicular to one another. The up-down direction, left-right direction, and an anterior-posterior direction of the guide device 1 roughly correspond to the longitudinal direction, left-right direction, and an anterior-posterior direction of the tibia A, respectively. That is, the upper side, lower side, left side, right side, anterior side, and posterior side of the guide device 1 roughly correspond to the proximal side, distal side, left side, right side, anterior side, and posterior side of the tibia A, respectively. FIG. 1A is a plan view of the guide device 1 as seen from above, and FIG. 1B is a rear view of the guide device 1 as seen from the rear side.

[0020] The guide device 1 shown in Figures 1A to 2B is for use with the tibia A of the left leg, and the left and right sides of the guide device 1 correspond to the outer and inner sides of the tibia A of the left leg, respectively. In the following description, the left and right sides of the guide device 1 are also referred to as the outer and inner sides, respectively. The guide device 1 for use with the tibia A of the right leg has a structure obtained by flipping the guide device 1 shown in Figures 1A to 2B left and right.

[0021] The protection part 2 is a long member that extends in the front-rear direction and is inserted into the bone hole H1 for the pull-out method. The base end (front end) of the protection part 2 is provided with a connection part 2a (see FIG. 2A) that is connected to the arm part 4. As shown in Fig. 1C, the protective part 2 defines a passage P in the bone hole H1 that extends in the longitudinal direction of the bone hole H1 and through which the suture 10 passes. Fig. 1C is a front view of the protective part 2 inserted into the bone hole H1.

[0022] Specifically, the protective part 2 has a straight groove-like channel 2b extending in the longitudinal direction of the protective part 2 over the entire length of the protective part 2. The channel 2b is formed on the upper side of the protective part 2 and receives the suture 10 from above. The passage P is defined between the inner surface of the channel 2b and the inner surface of the proximal side of the bone hole H1 and is disposed on the proximal side within the bone hole H1.

[0023] The guide portion 3 has a cylindrical guide hole 3a that defines a guide axis G, and guides a drill that penetrates the guide hole 3a along the guide axis G. Specifically, the guide unit 3 has a guide block 31 with a guide hole 3a and a fixing knob 32 for fixing and releasing the guide block 31 to the arm unit 4. The guide block 31 has a male screw 3c that protrudes from the outer surface of a block-shaped main body 3b and passes vertically through a slot 4c (described later) of the arm unit 4. The guide hole 3a passes through the main body 3b in a direction perpendicular to the male screw 3c. The fixing knob 32 has a female screw 3d that connects with the male screw 3c.

[0024] The inner diameter of the guide hole 3a is approximately equal to the outer diameter of the drill sleeve 13, and the inner diameter of the drill sleeve 13 is approximately equal to the outer diameter of the drill. Therefore, the drill sleeve 13 that passes through the guide hole 3a and the drill that passes through the drill sleeve 13 are arranged coaxially or approximately coaxially with the guide axis G, which is the central axis of the guide hole 3a, and the drill that advances through the drill sleeve 13 is guided along the guide axis G. The drill sleeve 13 may be provided as part of the guide device 1 together with the protective part 2, the guide part 3, and the arm part 4.

[0025] The arm 4 has a linear first portion 41 to which the protective portion 2 is attached in the front-to-rear direction, and an arc-shaped or approximately arc-shaped second portion 42 to which the guide portion 3 is attached. The first portion 41 is a portion positioned on the anterior side of the tibia A, and the second portion 42 is a portion positioned from the anterior side to the medial side of the tibia A. The first part 41 is rod-shaped or column-shaped extending in the front-rear direction, and a connecting part 4a (see FIG. 2A) that is detachable from the connecting part 2a of the protective part 2 is provided at the tip (rear end) of the first part 41. In one configuration example, the connecting parts 2a and 4a are formed by a combination of a recess and a protrusion that fit together.

[0026] In order to prevent the protective part 2 and the first part 41 from rotating relative to each other around the longitudinal axis of the first part 41, the cross sections of the recessed part 2a and the protruding part 4a are preferably non-circular. In Fig. 2A, the cross sections of the recessed part 2a and the protruding part 4a are approximately semicircular. The connecting parts 2a and 4a may have any other shape as long as they can connect the protective part 2 and the first part 41 to each other so as not to rotate relative to each other.

[0027] A groove-shaped channel 4b is provided on the outer surface of the upper side of the first portion 41, extending in the longitudinal direction of the first portion 41 over the entire length of the first portion 41. When the protective portion 2 is connected in series to the tip (rear end) of the first portion 41 by the connecting portions 2a and 4a, the channel 4b is continuous with the channel 2b, and the channels 2b and 4b extend in a straight line from the tip (rear end) of the protective portion 2 to the base end (front end) of the first portion 41.

[0028] The second part 42 is in the shape of a strip extending inward and rearward in an arc-like or approximately arc-like shape from the first part 41, and the outer end of the second part 42 is fixed to the first part 41. Therefore, the guide part 3 attached to the second part 42 is disposed on the inner side of the protective part 2 attached to the first part 41. The second part 42 has an arc-like or approximately arc-like slot 4c that extends in the extension direction of the second part 42 and penetrates the second part 42 in the thickness direction (up and down direction).

[0029] The male screw 3c that passes through the slot 4c is movable within the slot 4c in the extension direction of the slot 4c and is rotatable around a rotation axis I that is the central axis of the male screw 3c and extends in the vertical direction. The fixed knob 32 is connected to the tip of the male screw 3c that protrudes from the slot 4c.

[0030] By tightening the fixing knob 32, the guide part 3 is fixed to the second part 42. On the other hand, loosening the fixing knob 32 releases the fixation of the guide unit 3 to the second portion 42, and the guide unit 3 is supported by the second portion 42 so as to be movable along the extension direction of the slot 4c and rotatable about the rotation axis I. With the fixing knob 32 loosened, the user can change the attachment position of the guide unit 3 relative to the second portion 42 and the rotation angle of the guide unit 3 about the rotation axis I, thereby adjusting the position and angle of the guide axis G. FIG. 1A shows a preferred position and angle of the guide axis G. When the guide device 1 is in use, the guide axis G is positioned so as to intersect with the protective unit 2 in a plan view viewed in the vertical direction.

[0031] FIG. 3 shows the guide device 1 as viewed from the outside or rear side along the guide axis G. As shown in FIGS. 1B and 3, the protective portion 2 and the guide axis G each extend parallel or substantially parallel to a plane F defined by the arc-shaped second portion 42 and perpendicular to the vertical direction. The guide axis G is positioned at a skew angle relative to the protective portion 2 and passes below the protective portion 2. The vertical distance from the guide axis G to the outer surface of the lower side of the protective portion 2 is greater than the radii of the drill 14 and the screw 12a. Therefore, regardless of the mounting position and rotation angle of the guide portion 3 relative to the second portion 42, the drill 14 guided along the guide axis G passes below the protective portion 2 without interfering with the protective portion 2 and the passage P. Similarly, a screw 12a having an outer diameter substantially equal to that of the drill 14 and screwed into the bone hole H2 formed by the drill 14 also passes below the protective portion 2 without interfering with the protective portion 2 and the passage P.

[0032] Next, a method of using the guide device 1 will be described with reference to Figures 4A to 4D. Note that in Figures 4A to 4D, the osteotomy portion D is not shown. As shown in FIG. 4A, the protection part 2 is inserted into the bone hole H1 through which the suture 10 passes, and the suture 10 is accommodated in the channel 2b arranged on the proximal side within the bone hole H1.

[0033] 4B, the arm 4 to which the guide part 3 is attached is attached to the protective part 2 to assemble the guide device 1, and the drill sleeve 13 passing through the guide hole 3a is connected to the screw hole 11a to fix the drill sleeve 13 to the bone plate 11. Next, with the fixing knob 32 loosened, the position and angle of the bone plate 11 relative to the tibia A is adjusted, and the fixing knob 32 is tightened to fix the guide part 3 to the arm part 4. Additionally, the suture 10 passing through the channels 2b and 4b is pulled forward to hold the suture 10 in a taut state.

[0034] Next, as shown in Figure 4C, bone holes H2 are drilled at the positions of the screw holes 11a to 11h, and screws 12 are inserted into the screw holes 11b to 11h other than the screw hole 11a to fix the bone plate 11 to the tibia A. Specifically, drill sleeves 13 are connected to the screw holes 11a to 11h, and multiple bone holes H2 are drilled in the tibia A through the drill sleeves 13, and the screws 12 are screwed into the bone holes H2 through the screw holes 11b to 11h. At this time, the drill inserted into the drill sleeve 13 in the screw hole 11a is guided along the guide axis G to drill the bone holes H2 along the guide axis G.

[0035] If the distance between the screw hole 11a and the screw hole 11b adjacent to the screw hole 11a is narrow, the guide block 31 may interfere with the drill sleeve 13 connected to the screw hole 11b. To prevent this interference, the guide block 31 may be configured to be inclined with respect to the male thread 3c, and the guide block 31 fixed to the second portion 42 may be configured to be inclined outward.

[0036] 4D, the arm portion 4 is separated from the protective portion 2, and the arm portion 4 and the guide portion 3 are removed, leaving the protective portion 2 in the bone hole H1 on the tibia A. Then, using the screwdriver 15, the screw 12 is screwed into the bone hole H2 via the screw hole 11a.

[0037] In this case, according to this embodiment, the guide shaft G is disposed in a position skewed with respect to the protector 2 and the passage P within the bone hole H1, and a distance is ensured between the guide shaft G and the passage P such that the drill guided along the guide shaft G does not interfere with the protector 2 or the passage P. Therefore, the surgeon can easily determine the position of the bone hole H2 so that the drill does not interfere with the suture 10 within the bone hole H1. Then, by simply advancing the drill following the guidance of the guide portion 3 and the drill sleeve 13, the surgeon can easily drill the bone hole H2 near the bone hole H1 through which the suture 10 passes, while preventing the drill from interfering with the suture 10. Furthermore, the surgeon can easily insert a screw 12a, which has an outer diameter approximately equal to that of the drill, into the bone hole H2 without interfering with the suture 10.

[0038] Furthermore, because the channel 2b opens on the side opposite the guide axis G, the protective portion 2 is interposed between the suture 10 placed in the passage P and the drill and screw 12a guided along the guide axis G. This makes it possible to more reliably prevent the drill and screw 12a from interfering with the suture 10.

[0039] Furthermore, because the shape and dimensions of the tibia A vary from patient to patient, the placement of the bone plate 11 on the tibia A varies from patient to patient, and therefore the position and inclination of the screw holes 11a vary from patient to patient. According to this embodiment, the guide unit 3 supported by the arm unit 4 is movable between the anterior and medial sides of the tibia A and is rotatable around the rotation axis I extending in the longitudinal direction of the tibia A. Therefore, the drill sleeve 13 passing through the guide hole 3a can be easily fixed to the screw hole 11a optimally positioned according to the shape of the tibia A of each individual patient, and the guide device 1 can be applied to tibias A of various shapes.

[0040] Furthermore, according to this embodiment, the guide portion 3 is positioned inside the protective portion 2, and the guide axis G intersects with the protective portion 2 when viewed in a plan view in the vertical direction, thereby realizing the placement of the bone hole H1 and screw 12a that allows stable fixation of both the tibia A and the medial meniscus MM.

[0041] In other words, since a heavy load is applied to the posterior portion of the tibia A and the tibia A is particularly hard in the posterior portion, it is preferable that the bone plate 11 be fixed with the screw 12c in the posterior portion of the tibia A in order to firmly and stably fix the tibia A with the bone plate 11. On the other hand, with the pull-out method, a so-called "cheese cut" may occur near the opening of the bone tunnel H1 on the articular surface B. This occurs when the suture 10 or the like bites too hard into the bone, potentially causing the suture 10 to loosen and reducing the fixation strength of the medial meniscus MM. To prevent this, it is preferable that the angle θ (see FIG. 5) between the bone tunnel H1 and the medial meniscus MM is not too steep (not too small). For example, if the bone tunnel H1 is drilled in the posterior portion of the tibia A or between the screws 12a and 12b or 12b and 12c, the angle θ becomes too steep, making the cheese cut more likely to occur.

[0042] According to this embodiment, the bone hole H2 for the A screw 12a can be formed so that the opening O1 of the bone hole H1 on the anterior surface of the tibia A is positioned anterior to the most anterior A screw 12a, and so that the bone hole H1 passes near the A screw 12a without interfering with the A screw 12a. This makes it possible to position the bone plate 11 at a position toward the rear of the medial surface so that the screw 12c passes through the posterior portion of the tibia A, and to form the bone hole H1 on the anterior surface of the tibia A so that the angle θ is gentle, thereby achieving both strong and stable internal fixation of the tibia A by the bone plate 11 and strong and stable fixation of the medial meniscus MM by the pull-out method.

[0043] In this embodiment, as shown in FIG. 1D, the protective part 2 may have a thick first portion 21 on the base end side (front side) and a thin second portion 22 on the tip end side (rear side). The first portion 21 is generally columnar. The second portion 22 is thinner than the first portion 21 in the vertical direction, and the lower surface of the second portion 22 is offset from the lower surface of the first portion 21 toward the opposite side of the guide axis G (i.e., toward the upper side). Therefore, as shown in FIG. 1E, when at least the tip of the first portion 21 and the second portion 22 are inserted into the bone hole H1, the second portion 22 is disposed on the proximal side within the bone hole H1, and a space is secured on the distal side of the second portion 22.

[0044] With this configuration, the guide shaft G can be brought close to the channel 2b to a position where the upper portion of the bone hole H2 interferes with the lower portion of the bone hole H1, while preventing the drill and screw 12a guided along the guide shaft G from interfering with the suture 10.

[0045] In the above embodiment, each of the protective part 2 and the guide part 3 is detachable from the arm part 4, but alternatively, at least one of the protective part 2 and the guide part 3 may be formed as a single member with the arm part 4. For example, if the positional relationship between bone holes H1 and H2 is predetermined and there is no need to adjust the position and rotation angle of guide portion 3 during surgery, guide portion 3 and arm portion 4 may be formed from a single member. In this case, slot 4c and locking knob 32 are not required.

[0046] The protector 2 and the arm 4 may be formed from a single member. In this case, when connecting the head of the A screw 12a to the A screw hole 11a, the protector 2 is rotated around the longitudinal axis of the protector 2 within the bone hole H1 to move the arm 4, guide 3, and drill sleeve 13 to positions that do not interfere with the screwing of the screw 12a. At this time, the channel 2b may be formed coaxially with the longitudinal axis of the protector 2 to prevent the passage P from rotating within the bone hole H2 as the protector 2 rotates.

[0047] In the above embodiment, the protective part 2 has a groove-like channel 2b that opens to the outer surface of the protective part 2, but the protective part 2 may have any other shape as long as it can define a passage P for the suture 10 that penetrates longitudinally within the bone hole H1. For example, the protective part 2 may be a cylindrical member, and the channel 2b may be a through-hole that passes through the protective part 2 in the longitudinal direction. Depending on the shape of the channel 2b, the shape of the channel 4b of the first part 41 may also be changed as appropriate. Alternatively, the protective part 2 may not have the channel 2b. For example, the protective part 2 may be a substantially semi-cylindrical member that occupies approximately half of the bone hole H1, or may be a flat member that radially divides the bone hole H1 into two spaces.

[0048] In the above embodiment, the drill sleeve 13 is inserted into the guide hole 3a of the guide portion 3, but the drill sleeve 13 is not necessarily required. For example, instead of using the drill sleeve 13, any means for fixing the guide part 3 to the bone plate 11 at a position where the guide axis G is arranged coaxially with the screw hole 11a may be used. When only a drill is inserted into the guide hole 3a, the inner diameter of the guide hole 3a is designed according to the outer diameter of the drill.

[0049] In the above embodiment, the guide device 1 is used for the pull-out method and HTO, but the use of the guide device 1 is not limited to this. That is, the guide device 1 may be used in any surgical procedure in which a second bone hole is drilled near a first bone hole through which a suture is passed. [Explanation of symbols]

[0050] 1 Guide device 2 Protective part 21 Part 1 22 Part 2 2b channel 3 Guide section 3a Guide hole 4 Arm section 41 Part 1 42 Part 2 10 sutures 14 Drill A tibia F plane G guide shaft H1 First bone tunnel H2 Second bone tunnel I Rotation axis P aisle

Claims

1. A guide device for guiding a drill for drilling a second bone hole in a bone in which a first bone hole has been formed, an elongated protective portion inserted into the first bone tunnel and extending longitudinally of the first bone tunnel to define a passageway for a suture within the first bone tunnel; a guide portion having a guide hole defining a guide axis and guiding the drill passing through the guide hole along the guide axis; an arm portion connecting the protection portion and the guide portion, A guide device in which the guide shaft is arranged in a twisted position relative to the protective part, and the drill guided along the guide shaft passes through a position that does not interfere with the protective part and the passage.

2. the guide device has an up-down direction, a left-right direction, and an anterior-posterior direction, which correspond to the longitudinal direction, the left-right direction, and the anterior-posterior direction of the tibia, respectively; The protection portion extends in the front-rear direction, the guide portion is disposed on a side of the protection portion corresponding to an inner side of the tibia in a left-right direction of the guide device, The guide device according to claim 1 , wherein the guide shaft intersects with the protection portion in a plan view seen in the up-down direction.

3. the protective portion has a channel extending longitudinally of the protective portion over the entire length of the protective portion, the channel being groove-shaped to receive the suture, and defining the passage between the channel and an inner surface of the first bone tunnel; 3. The guide device according to claim 1 or 2, wherein the channel opens onto an outer surface of the guard part opposite the guide shaft.

4. the protection portion, the guide portion, and the arm portion are formed from separate members, the protection portion is removably attached to the arm portion, The guide device according to claim 1 , wherein the guide portion is removably attached to the arm portion.

5. The arm portion is a first portion disposed on the anterior side of the tibia, to which the protection portion is attached in the anterior-posterior direction of the tibia; a second portion extending from the anterior side of the tibia toward the medial side in an arcuate or arcuate shape, to which the guide portion is attached; 5. A guide device according to claim 1, wherein the guide portion is supported on the second portion so as to be movable in the extension direction of the second portion and rotatable around a rotation axis that intersects a plane defined by the second portion.

6. the protective portion has a first portion on a base end side and a second portion on a tip end side, 6. The guide device according to claim 1, wherein the second portion is thinner than the first portion, and an outer surface of the second portion facing the guide shaft is offset in a direction away from the guide shaft relative to an outer surface of the first portion facing the guide shaft.

Images