Targeter for meniscus root repair

Abstract

The invention relates to a targeting device that allows the drilling of precisely located tunnels for performing a two-tunnel technique for refixing a torn root of the posterior horn of the medial or lateral meniscus. The targeting device according to the invention comprises a supporting structure (1 ), an arm (2), a first guide (3) and a second guide (4), wherein the arm (2) is attached by its one end to the supporting structure (1 ) and at its other end the arm (2) comprises a hook (5) terminated by a tip (6), wherein the first guide (3) and the second guide (4) have a cylindrical shape and comprise a cavity passing through the given guide (3,4) along its entire length, wherein the supporting structure (1 ) comprises a first locking mechanism for locking the first guide (3) and a second locking mechanism for locking the second guide (4), wherein the longitudinal axis (7) of the first guide and the longitudinal axis (8) of the second guide belong to the same plane, are oriented centripetally, and their intersection lies in the given plane behind the tip (6) in the direction from the supporting structure (1 ).

Description

[0001] Targeting device for meniscus root repair

[0002] Field of the Invention

[0003] The invention relates to a targeting device that allows the drilling of precisely located tunnels for performing a two-tunnel technique for refixing a tom root of the posterior horn of the medial or lateral meniscus.

[0004] Background of the Invention

[0005] Targeting devices are used in orthopaedics for precise targeting of planned bone tunnels and play a key role in the precise placement of fixation elements during meniscus root refixation. These specialised instruments help the surgeon to precisely determine the placement and set the correct angle of bone tunnels for the insertion of fixation materials such as anchors or fibres. There are different types of targeting devices, which vary according to the specific fixation technique and the type of fixation material used.

[0006] A well-known state of the art is, for example, the solution described in document EP2548522 B1 , where the targeting device comprises a supporting structure, an arm ending in a tip and a one guide with a cavity for guiding the drill. The design of this targeting device allows the targeting device to be fastened to the bone with a tip and one guide, i.e. only two contact points, which allows for a large number of unwanted movements of the targeting device during surgery, and the instrument must therefore be constantly held in place. Furthermore, the locking mechanism of the disclosed instrument does not allow for easy operation, for example, with one hand.

[0007] Prior art solutions of the targeting devices do not allow for easy drilling of bone tunnels during meniscus root surgery without an excessive need to manipulate during surgery and constant holding in place by the surgeon. Current solutions also do not allow for good visibility or directly obstruct the view of the operated area. It is therefore desirable to develop a targeting device that can be easily and fully connected to the bone, so that the surgeon has his hands free for other tasks during the surgery, wherein it simultaneously allows good visibility of the fastening of the tip of the targeting device and the outlet of the drilled tunnels.

[0008] Summary of the Invention

[0009] The targeting device for meniscus root repair according to the invention eliminates the above-mentioned disadvantages. This targeting device comprises a supporting structure, an arm, a first guide and a second guide, wherein the arm is attached by its one end to the supporting structure and at its other end the arm comprises a hook terminated by a tip, wherein the supporting structure comprises a first opening through which the first guide passes, and a second opening, which is situated further from the arm than the first opening, and through which the second guide passes, wherein the first guide and the second guide have a cylindrical shape and comprise a cavity passing through the entire length of the guide, wherein the supporting structure comprises a first locking mechanism for locking the first guide and a second locking mechanism for locking the second guide. The longitudinal axis of the first guide and the longitudinal axis of the second guide belong to the same plane, are oriented centripetally towards approximately the tip, and their intersection lies in the given plane behind the tip in the direction from the supporting structure.

[0010] The targeting device for meniscus root repair according to the present invention is indicated for use within meniscus root repair for precise targeting of planned bone tunnels for performing a two-tunnel technique for refixing a tom root of the posterior horn of the medial or lateral meniscus.

[0011] The specific design of the presented targeting device allows securing to the bone at 3 different sites: with a tip and two guides, wherein this three-point fixation ensures a firm fastening to the bone without the need to hold the instrument in place in any way, and thus the surgeon has more capacity for other tasks during the surgery. Among the main advantages of the targeting device according to the present invention also include the creation of precisely located bone tunnels during meniscus root repair. The precise localization of the tunnels ensures repair in the anatomical position, which is a necessary condition for minimizing the risk of failure. Ease of use shortens surgery time, and the small diameter of the drilled tunnels reduces the invasiveness of the procedure, which reduces the risk of mechanical or infectious complications.

[0012] The targeting device is intended as an instrument serving for precise targeting of other instruments, especially drills, to create clearly defined structures during surgery.

[0013] Thanks to the above-described arrangement of the first and second guides, the outlets of the drilled bone tunnels are sufficiently distant from each other and leave enough bone structure between them. The structural stability of the bone at the site of the tunnels is thus only minimally compromised. This is specifically achieved by the fact that the intersections of the longitudinal axes of the first and second guides lie behind the tip in the direction from the supporting structure, as the tip is captured in the area of the exit of the drilled tunnels. In this way, the presented targeting device ensures the creation of the tunnels in such a way that their geometry respects the architecture of the bone and achieves maximum fixation strength of the knee structures within the performed surgery. The targeting device allows the surgery to be performed without implants or other auxiliary structures, as the preserved bone structure represents a sufficient means for fastening the fibres during the surgery.

[0014] Preferably, the first guide comprises at least 3 notches along its outer wall and the second guide comprises at least 3 notches along its outer wall, wherein the first locking mechanism comprises a resiliently mounted latch oriented towards the longitudinal axis of the first guide, and the second locking mechanism comprises a resiliently mounted latch oriented towards the longitudinal axis of the second guide. Preferably, the second guide comprises a greater number of notches than the first guide. This method of locking ensures a firm fastening of the targeting device to the bone with easy operation at the same time.

[0015] Preferably, the first guide and the second guide, at their end closer to the tip, comprise teeth along at least part of the circumference of the outlet of the cavity passing through the entire length of the guide. Thanks to the teeth, the guides are even more firmly fastened to the bone.

[0016] The axes of the first guide and the second guide together form an angle of 2° to 20°, preferably 2° to 10°, more preferably 3° to 5°. Description of the Drawings

[0017] The summary of the invention is further explained by examples of embodiments, which are described with reference to the accompanying drawings, where:

[0018] Fig. 1 shows a targeting device for meniscus root repair according to the first exemplary embodiment of the invention with drills inserted into the first and second guides in a spatial representation,

[0019] Fig. 2 shows the targeting device for meniscus root repair according to the first exemplary embodiment with drills inserted into the first and second guides, shown in profile,

[0020] Fig. 3 shows the targeting device for meniscus root repair according to the first exemplary embodiment of the invention with drills inserted into the first and second guides, shown from below,

[0021] Fig. 4 shows the first and second guides according to first exemplary embodiment,

[0022] Fig.5 shows the targeting device for meniscus root repair according to the first exemplary embodiment of the invention with the longitudinal axes of the first and second guides shown, in a spatial representation,

[0023] Fig.6 shows the targeting device for meniscus root repair according to the first exemplary embodiment of the invention hooked into the insertion site during surgery,

[0024] Fig. 7 shows the targeting device for meniscus root repair according to the first exemplary embodiment of the invention hooked into the insertion site and fastened by means of the first and second guides during the surgery and with the drill shown.

[0025] Exemplary Embodiments of the Invention

[0026] The invention will be further explained by examples of embodiments with reference to the respective drawings. The targeting device for meniscus root repair according to the first exemplary embodiment of the invention is shown in Fig. 1 to 7, wherein it comprises the supporting structure 1_, the arm 2, the first guide 3, and the second guide 4. The arm 2 is firmly attached by its one end to the supporting structure 1. and at its other end the arm 2 comprises the hook 5 terminated by the tip 6, wherein the supporting structure 1_ comprises the first opening through which the first guide 3 passes, and the second opening which is situated further from the arm 2 than the first opening and through which the second guide 4 passes, wherein the first guide 3 and the second guide 4 have a cylindrical shape and comprise the cavity passing through the entire length of the guide 3,4, wherein the supporting structure 1. comprises the first locking mechanism for locking the first guide 3 and the second locking mechanism for locking the second guide 4.

[0027] The first guide 3 is mounted in the first opening slidably movably in the direction of the longitudinal axis 7 of the first guide and rotatably movably about the longitudinal axis 7 of the first guide. The second guide 4 is mounted in the second opening slidably movably in the direction of the longitudinal axis 8 of the second guide and rotatably movably about the longitudinal axis 8 of the second guide.

[0028] The longitudinal axis 7 of the first guide, the longitudinal axis 8 of the second guide, and the tip 6 belong to the same plane, are oriented centripetally towards approximately the tip 6, and their intersection lies in the given plane behind the tip 6 in the direction from the supporting structure 1_, as can be seen in Fig. 3. The longitudinal axes 7,8 of the first and second guides together form an angle of 4° and are directed approximately towards tip 6. In Figs. 1 , 2, 3, and 5, it can be seen that the longitudinal axis 7 of the first guide runs almost immediately next to tip 6, and the longitudinal axis

[0029] 8 of the second guide is further offset from the tip 6 behind the longitudinal axis 7 of the first guide.

[0030] The first guide 3 comprises 50 notches 9 along its outer wall, and the second guide 4 comprises 80 notches 9 along its outer wall, see Fig. 4. These sets of notches

[0031] 9 can also be referred to as ratchets. The notches 9 are oriented perpendicular to the longitudinal axis 7,8 of the given guide and are distributed along the same length of the guide 3,4 for both guides 3,4, so that in the case of the second guide 4, the notches 9 have a higher density (has more notches 9 per unit length). The notches 9 are placed only on one side of the guides 3,4, wherein the other sides of the guides 3,4 across the longitudinal axis 7,8 of the given guide are smooth without notches 9. The notches 9 gradually connect at their ends to the smooth second wall of the guide 3,4 so that a smooth transition of the latch from the notches 9 to the smooth wall of the guide 3,4 is ensured when the guide 3,4 is rotated.

[0032] The first locking mechanism comprises a resiliently mounted latch, placed in the area of the first opening, oriented towards the notches 9 of the first guide, and the second locking mechanism comprises a resiliently mounted latch, placed in the area of the second opening, oriented towards the notches 9 of the second guide. The latches are not visible in the accompanying drawings, they are placed inside the supporting structure 1. and pass through the wall of the first and second openings in the supporting structure 1_, where they abut the passing guides 3,4.

[0033] The first guide 3 and the second guide 4, at their end closer to the tip 6, comprise teeth 10 forming a gearing around the entire circumference of the outlet of the cavity passing through the entire length of the guide 3,4. At their opposite end, the guides 3,4 comprise a plate-shaped handle.

[0034] The design of the targeting device according to the first exemplary embodiment is made of stainless steel.

[0035] In alternative exemplary embodiments of the invention, the locking mechanisms may be provided, for example, as tightening threads for tightening around the guide 3,4 and locking it, or as a screw abutting the given guide 3,4 at the site of the opening in the supporting structure 1.. However, such solutions are difficult to manipulate because they are more complex in design and / or cannot be locked and released with one hand.

[0036] In an alternative embodiment, the guides comprise fewer notches 9, whose placement is calculated so as to lock the given guide 3,4 at the required site relative to the bone. However, more notches 9 allow the targeting device to be fastened in many more ways, wherein it is not necessary to calculate the exact placement of the notches 9. In another exemplary embodiment, each guide may have 3 notches 9, 10 notches 9, 20 notches 9, or even 50 notches 9, for example. Preferably, it applies that the second guide 4 has more notches 9, or has a greater density of notches 9 (has more notches 9 per unit length), wherein more preferably, the first guide 3 has 30 notches and the second guide has 10 more notches 9, in another embodiment, the first guide 3 has 60 notches 9 and the second guide 4 has 30 more notches 9. Similarly, guides 3,4 may also have more than the above-mentioned number of notches 9, thereby allowing even more precise and firmer fastening without exerting excessive pressure on the bone.

[0037] The surgical procedure for meniscus root repair using the targeting device according to the first exemplary embodiment will be described here.

[0038] The patient is operated on in the standard position for knee arthroscopy, i.e. , lying on their back with the thigh secured in a holder. The knee is flexed to 90° and hangs freely over the edge of the folded table. During surgery, the knee can be positioned into extension. The surgery is performed through standard anteromedial and anterolateral ports. For good access to the posterior horn, it is important to place the anteromedial port as low as possible above the anterior horn of the medial meniscus and as close parapatellar as possible. In exceptional cases, it may be necessary to create a posteromedial port for meniscus suturing. For manipulation of the posterior horn, it may sometimes be appropriate to create an accessory anteromedial or anterolateral port.

[0039] The condition to successful diagnosis and treatment of meniscus root lesion is ensuring a good view and access to the posterior horn area. Surgery on the medial meniscus cannot be performed safely without releasing the posteromedial compartment (MCL release). This procedure is best performed using a pink 18G needle inserted percutaneously just behind the posterior edge of the medial collateral ligament, just above the upper edge of the meniscus. In this area, the posterior oblique ligament (POL) is weakened by several obliquely upward -directed punctures, and with simultaneous application of valgus stress, a gradual opening of the medial joint space is observed.

[0040] After verifying the tear, the mobility of the meniscus is checked. If the tear is of an older date and the meniscus is already beginning to extrude, it is usually necessary to sharply release the posterior horn from adhesions to the posterior capsule.

[0041] We then locate the anatomical position of the insertion site (footprint). The medial meniscus is fixed to the tibia approximately 10 mm behind the medial intercondylar eminence. The correct position is always behind the posterior edge of the tibia, on an obliquely downward sloping surface on the dorsal side of the tibia, and in the standard anterior arthroscopic view of the knee, the insertion site must not be visible. For healing, the meniscus must be refixed to a well-cleaned bone bed. The insertion site must be carefully cleared of residual soft tissues from the posterior horn of the meniscus using a curved curette, shaver, and radiofrequency ablation probe, and the bone must be decorticated.

[0042] If the bone bed is prepared and the posterior horn of the meniscus can be repositioned into it without tension, the posterior horn of the meniscus is sutured using one of the preferred techniques. The meniscus is sutured with simple sutures inserted vertically 5-10 mm from the posterior horn at a site where the tissue is already firmer, closer to the base of the meniscus. Alternatively, other meniscus suturing techniques can be used according to the surgeon's preference (e.g., the so-called Luggage-Tag or horizontal mattress suture). It is appropriate to use fibres of different colours, ideally braided fibres of size #2. An antegrade technique (e.g., FirstPass Mini, Knee Scorpion, etc.) or, exceptionally, retrogradely through the posteromedial port using suture needles (Suture Shuttle) can be used. All 4 ends of the fibres emerging from the posterior horn of the meniscus through the anteromedial port are secured with a Pean clamp.

[0043] The targeting device according to the first exemplary embodiment of the invention is then inserted in front of the anteromedial port, see Fig. 6. By slightly tilting the targeting device relative to the longitudinal axis of the tibia, smooth sliding of the arm 2 with the tip 6 into the posterior compartment is ensured. We position the targeting device so that the longitudinal axis of the supporting structure 1. forms an angle of 20°- 40° with the longitudinal axis of the tibia. The exact value of this angle depends on the anatomical proportions and the position of the anteromedial port. The tip 6 is aimed at the front edge of the insertion site and anchored into the bone by gentle traction. The first guide 3 and the second guide 4 are insert through a 1 .5 cm mini-incision into the bone and gradually pushed in - first the first guide 3 (cranial drill sleeve), then the second guide 4 (caudal drill sleeve). The latches of the locking mechanisms, in conjunction with the notches 9 of the respective guide 3,4, ensure firm locking of the targeting device to the bone. The greater density of notches 9 on the second guide 4 then ensures precise abutment of the teeth 10 of the first and second guides 3,4 to the bone, resulting in a connection with the bone that is neither loose nor exerts excessive pressure on the bone.

[0044] In the next phase, under arthroscopic control, two tunnels are drilled with a K- wire or a 2 mm drill, see Fig. 7. The intraarticular exit of the tunnels is at the edges of the insertion site. The cranial tunnel points to the anterior edge and the caudal tunnel to the posterior edge, with the junction of the two tunnels perpendicular to the longitudinal axis of the posterior horn of the meniscus. This position of the tunnels ensures maximum coverage of the insertion site.

[0045] Shuttling loops are inserted through the cavities of the first guide 3 and the second guide 4 into both tunnels so deep that their tips can be seen in the joint. Any monofilament nylon thread with a thickness of USP 1 and a length of at least 70 cm folded in half to form a loop can be used. Alternatively, thin binding wire or a wire loop (e.g., Chia Percpasser, Wire Loop, etc.) can be used. By rotating the first and second guides 3,4 around the respective longitudinal axis 7,8, the notches 9 are released from the latch of the locking mechanisms, thereby releasing the firm connection of the targeting device and the bone. The first and second guides 3,4 are then pulled out of the supporting structure 1_, and then the rest of the targeting device is also removed. If the shuttling loops are pulled into the tunnels when manipulating the targeting device, they can be re-advanced deeper so that their tips are visible in the knee. They are then pulled out through the anteromedial port. The fibres that are dorsally in the meniscus are threaded into the caudal loop that passes through the posterior tunnel, and these fibres are pulled through the posterior tunnel by pulling on the loop. Then, the fibres that are ventrally in the meniscus are threaded into the cranial loop that passes through the anterior tunnel, and these fibres are pulled through the anterior tunnel by pulling on the loop. The knee is then extended and flexed several times while simultaneously pulling on all the fibres to ensure that the meniscus is well seated in the bed.

[0046] The fibres can be knotted in two ways, either over an implant or without using an implant over a bone bridge. When knotting over an implant, a button with four holes is ideally used, wherein the corresponding ends of the fibres from the cranial and caudal tunnels are knotted together. The button is positioned on the junction between the tunnels. When tightening the sutures, it is appropriate to check the compression of the meniscus root into the bed arthroscopically. When knotting without using an implant, the pair of fibres from the caudal tunnel form a so-called post. A sliding suture cannot be used. Onto the tensioned pair of fibres from the caudal tunnel (the so-called post), we tie the fibres from the cranial tunnel using individual knots (e.g., a Revo knot). It is appropriate to use a knot pusher to tighten the sutures. When tightening the knots, it is appropriate to check the compression of the meniscus root into the bone bed arthroscopically. After knotting the fibres, the meniscus root is firmly repaired. With good meniscus mobilization, correct fibre insertion, and good position of the tunnels, we achieve maximum coverage of the insertion site and root repair is anatomical.

[0047] Industrial applicability

[0048] The targeting device according to the presented invention can also be used for other orthopaedic surgeries, especially for fixating torn muscle tissue.

[0049] List of the Reference Signs

[0050] 1 supporting structure

[0051] 2 arm

[0052] 3 first guide

[0053] 4 second guide

[0054] 5 hook

[0055] 6 tip

[0056] 7 longitudinal axis of the first guide

[0057] 8 longitudinal axis of the second guide

[0058] 9 notches

[0059] 10 teeth

Claims

1. PATENT CLAIMS1. A targeting device for meniscus root repair comprising a supporting structure (1 ), an arm (2), a first guide (3) and a second guide (4), wherein the arm (2) is attached by its one end to the supporting structure (1 ) and at its other end the arm (2) comprises a hook (5) terminated by a tip (6), wherein the supporting structure (1 ) comprises a first opening through which the first guide (3) passes, and a second opening, which is situated further from the arm (2) than the first opening and through which the second guide (4) passes, wherein the first guide (3) and the second guide (4) have a cylindrical shape and comprise a cavity passing through the given guide (3,4) along its entire length, wherein the supporting structure (1 ) comprises a first locking mechanism for locking the first guide (3) and a second locking mechanism for locking the second guide (4), characterised in that the longitudinal axis (7) of the first guide and the longitudinal axis (8) of the second guide belong to the same plane, are oriented centripetally, and their intersection lies in the given plane behind the tip (6) in the direction from the supporting structure (1 ).

2. The targeting device for meniscus root repair according to claim 1 , characterised in that the first guide (3) comprises at least 3 notches (9) along its outer wall, and the second guide (4) comprises at least 3 notches (9) along its outer wall, wherein the first locking mechanism comprises a resiliently mounted latch oriented towards the longitudinal axis (7) of the first guide for locking the first guide (3), and the second locking mechanism comprises a resiliently mounted latch oriented towards the longitudinal axis (8) of the second guide for locking the second guide (4).

3. The targeting device for meniscus root repair according to claim 2, characterised in that the second guide (4) comprises a greater number of notches (9) than the first guide (3).

4. The targeting device for meniscus root repair according to claims 1 to 3, characterised in that the first guide (3) and the second guide (4), at their end closer to the tip (6), comprise teeth (10) along at least part of the circumference of the outlet of the cavity passing through the entire length of the given guide (3,4).

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