Methods and apparatus for assisting cartilage diagnostic and therapeutic procedures

• US 10,028,722 B2
• Filed: 09/24/2008
• Issued: 07/24/2018
• Est. Priority Date: 09/25/2007
• Status: Active Grant

• Current Assignee: L'universite Joseph Fourier, Perception Raisonnement Action en Medecine, Hospital For Special Surgery (The NewYork-Presbyterian Healthcare System, Inc.)
• Original Assignee: L'universite Joseph Fourier, Perception Raisonnement Action en Medecine, Hospital For Special Surgery (The NewYork-Presbyterian Healthcare System, Inc.)
• Inventors: Moreau-Gaudry, Alexandre Marie, Cinquin, Philippe, Plaskos, Christopher, Granchi, Carinne, Adler, Ronald S.
• Primary Examiner(s): Akar, Serkan
• Assistant Examiner(s): Negarestan, Farshad
• Application Number:
  US12/679,808
• Publication Number:
  US 20100256504A1
• Time in Patent Office: 3,590 Days
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/2068 using pointers, e.g. pointers having reference marks for determining coordinates of body points
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 5/0066 Optical coherence imaging
• CPC Class Codes: A61B 5/064 using markers A61B5/062 takes precedence
• CPC Class Codes: A61B 5/1075 for measuring dimensions by non-invasive methods, e.g. for determining thickness of tissue layer A61B8/0858 takes precedence
• CPC Class Codes: A61B 5/1127 using markers
• CPC Class Codes: A61B 5/4504 Bones A61B5/4547 takes precedence
• CPC Class Codes: A61B 5/4514 Cartilage
• CPC Class Codes: A61B 5/4528 Joints A61B5/4533, A61B5/4538 take precedence
• CPC Class Codes: A61B 5/6852 Catheters
• CPC Class Codes: A61B 6/502 for diagnosis of breast, i.e. mammography
• CPC Class Codes: A61B 6/5247 combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound
• CPC Class Codes: A61B 8/08 Detecting organic movements or changes, e.g. tumours, cysts, swellings A61B8/02 - A61B8/06 take precedence
• CPC Class Codes: A61B 8/12 in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 8/4245 involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient
• CPC Class Codes: A61B 8/462 characterised by constructional features of the display
• CPC Class Codes: A61B 8/5238 for combining image data of patient, e.g. merging several images from different acquisition modes into one image for image registration algorithms G06T7/30
• CPC Class Codes: G09B 23/28 for medicine

Abstract

In one embodiment of the present invention, a method is provided for assisting cartilage diagnostic and therapeutic procedures and includes the steps of acquiring 3D osteocartilaginous parameters by using multimodal 3D tracked devices; incorporating these parameters into a volumic anatomic osteocartilaginous model from which a bone tracking virtual real-time environment is built; three-dimensionally computing an osteocartilaginous quality score from this multiparametric 3D osteocartilaginous model; providing real-time navigation in this 3D virtual environment in order to make ongoing therapeutic assessments and adjustments; and updating steps 1 to 3 according to the performed therapy. It will be appreciated that the above steps are compatible with arthroscopic procedures involving cartilage.

Claims

1. A computer-assisted orthopedic surgery system for performing joint preservation and assisting cartilage diagnostic and therapeutic procedures comprising:

a cartilage data acquisition tool for acquiring cartilage data;

a computer system configured to implement a three-dimensional osteo-cartilaginous computer model, the computer system having;

a memory storing a computer program that, when executed, causes the computer system to

extract at least two parameters from the acquired cartilage data that is indicative of a quality of the cartilage,

incorporate the at least two parameters into the three-dimensional osteo-cartilaginous computer model,

compute a synthetic cartilage quality score, wherein the synthetic cartilage quality score is a function of the at least two parameters, and

a surgical treatment tool operably coupled to the computer system, the surgical treatment tool being configured for performing the joint preservation and assisting cartilage diagnostic and therapeutic procedures, the surgical treatment tool further configured to be navigated based on the three-dimensional osteo-cartilaginous computer model,

wherein the computer system is configured to continuously update the three-dimensional osteo-cartilaginous computer model in real-time during the joint preservation and assisting cartilage diagnostic and therapeutic procedures based on the computed synthetic cartilage quality score, and further configured to display the synthetic cartilage quality score.

2. The computer-assisted orthopedic surgery system of claim 1, wherein the three-dimensional osteo-cartilaginous computer model comprises a model that includes cartilage data and bone data, including the morphology of cartilage, cartilage layers, bone and subchondral bone surfaces.

3. The computer-assisted orthopedic surgery system of claim 1, wherein one of the at least two parameters is a shape of a border of a cartilage defect, a depth of the defect, a volume of the defect, a theoretical thickness which is measured as a height of the remaining healthy cartilage surface, a texture or surface characterization of the cartilage, roughness of the cartilage, or pathological vascularization, a biomechanical property, an area ratio, or a detection of flaws in the cartilage.

4. The computer-assisted orthopedic surgery system of claim 1, wherein the computer program comprises software that when executed quantifies at least one of the following parameters selected from the group consisting of cartilage surface texture or roughness, a distance between the cartilage surface and the underlying subchondral bone, bio-material properties of the cartilage, and cartilage subsurface ultra-structural and biochemical properties.

5. The computer-assisted orthopedic surgery system of claim 1, wherein the three-dimensional osteo-cartilaginous computer model is obtained using an imaging device and is stored and registered to a patient using data acquired at a time of examination or surgery.

6. The computer-assisted orthopedic surgery system of claim 1, wherein the three-dimensional osteo-cartilaginous computer model is an image-free deformable model that is registered to a patient using deformation techniques including bone morphing techniques resulting in the three-dimensional osteo-cartilaginous model being created at a time of surgery.

7. The computer-assisted orthopedic surgery system of claim 1, wherein the three-dimensional osteo-cartilaginous computer model is a 3D deformable double-layer model of a bone having an outer cartilage surface and an inner cartilage surface and an external bone surface and the acquired cartilage data includes images of the cartilage, wherein the images of the cartilage are segmented such that the outer cartilage surface and the inner cartilage surface are identified, with positions of these segments being known in a bone coordinate system.

8. The computer-assisted orthopedic surgery system of claim 1, wherein the computer system is further configured to visually display the extracted parameters on the three-dimensional osteo-cartilaginous computer model in real-time as the parameters are extracted.

9. The computer-assisted orthopedic surgery system of claim 8, wherein the computer system is further configured to display the extracted parameters utilizing a technique selected from the group consisting of:

using color maps, using transparency, and using image fusion techniques where at least two different types of images or data sets are overlapped in a multimodal environment.

10. The computer-assisted orthopedic surgery system of claim 8, further configured to highlight on the three-dimensional osteo-cartilaginous computer model regions where data has been acquired to assist and guide a surgeon in acquiring cartilage data.

11. The computer-assisted orthopedic surgery system of claim 1, wherein the synthetic cartilage quality score is based on two or more acquired parameters:

a thickness of the cartilage, a depth or size of an observed cartilage defect, and a computed surface cartilage grade.

12. The computer-assisted orthopedic surgery system of claim 1, wherein the three-dimensional osteo-cartilaginous computer model is continuously updated in real-time as cartilage data is acquired with the cartilage data acquisition tool, as the parameters are extracted, as the parameters are incorporated into the three-dimensional osteo-cartilaginous computer model, and as the surgical treatment tool is navigated.

13. The computer-assisted orthopedic surgery system of claim 1, wherein the cartilage data acquisition tool comprises a three-dimensional tracked ultrasound probe and one of the at least two parameters comprises a surface roughness of the cartilage.

14. The computer-assisted orthopedic surgery system of claim 1, wherein the cartilage data acquisition tool comprises a three-dimensional tracked ultrasound probe and one of the at least two parameters comprises a thickness of the cartilage.

15. The computer-assisted orthopedic surgery system of claim 1, wherein the cartilage data acquisition tool comprises a three-dimensional tracked calibrated endoarticular optical coherence tomography probe and one of the at least two parameters comprises a surface roughness of the cartilage.

16. The computer-assisted orthopedic surgery system of claim 1, wherein the cartilage data acquisition tool comprises a three-dimensional tracked endoarticular infrared probe and one of the at least two parameters is acquired by emitting infrared light, receiving reflected infrared light, computing an averaged spectroscopic signal, analyzing peaks of the signal and expressing health of the cartilage based on a ratio of a (detected signal peak) (cm⁻

1) to 1338 cm<sup>−

1</sup>.

17. The computer-assisted orthopedic surgery system of claim 1, wherein the cartilage data acquisition tool comprises a three dimensional tracked endoarticular fluorescent imaging system and the at least two parameters are acquired by introducing marked molecules into a target cartilage area of a patient and detecting the marked molecules with an arthroscopic unit that includes at least one intra-articular illumination device capable of emitting light at an adapted frequency and at least one intra-articular detector capable of detecting reflected fluorescence light.

18. The computer-assisted orthopedic surgery system of claim 1, wherein the computer system is further configured to map the at least two parameters onto the three-dimensional osteo-cartilaginous model in real-time as a surgery proceeds to assist a surgeon in deciding a course of action.

19. The computer-assisted orthopedic surgery system of claim 1, wherein the cartilage data acquisition tool is selected from the group consisting of:

a tracked pointer, a tracked arthroscope, a tracked calibrated endoarticular optical coherence tomography probe, a tracked endoarticular infrared probe, a tracked endoarticular interferometric non-destructive laser imaging system, and a tracked endoarticular fluorescent imaging system.

20. A system for a computer-assisted orthopedic surgery for performing joint preservation and assisting cartilage diagnostic and therapeutic procedures, the system comprising:

a cartilage data acquisition tool for acquiring cartilage data;

a computer system configured to implement a computer generated three-dimensional osteo-cartilaginous computer model having a cartilage quality data map, the computer system having;

a memory storing a computer program that, when executed, causes the computer system to

extract at least one morphological parameter from the acquired cartilage data, the at least one parameter being indicative of a quality of the cartilage,

incorporate the at least one parameter into the three-dimensional osteo-cartilaginous computer model

compute a synthetic cartilage quality score based on the at least one morphological parameter and a secondary parameter indicative of the quality of the cartilage, and

at least one surgical treatment instrument that is operably coupled to the computer system, the at least one surgical treatment tool being configured for performing the joint preservation and assisting cartilage diagnostic and therapeutic procedures, the at least one surgical treatment tool further configured to be navigated based on the three-dimensional osteo-cartilaginous computer model,

wherein the computer system is configured to continuously update the cartilage quality data map of the three-dimensional osteo-cartilaginous computer model in real-time during the joint preservation and assisting cartilage diagnostic and therapeutic procedures based on the computed synthetic cartilage quality score, and further configured to display the synthetic cartilage quality score.

21. The system of claim 20, wherein the three-dimensional osteocartilaginous computer model comprises a model that includes cartilage data and bone data, including the morphology of cartilage, cartilage layers, and bone and subchondral bone surfaces.

22. The system of claim 20, wherein the at least one morphological parameter is selected from the group consisting of:

a shape of a border of a cartilage defect, a depth of the cartilage defect, a volume of the cartilage defect, a theoretical thickness which is measured as a height of a remaining healthy cartilage surface, a texture or surface characterization of the cartilage, roughness of the cartilage, and pathological vascularization, a biomechanical property, an area ratio, or a detection of flaws in the cartilage.

23. The system of claim 20, wherein the computer program comprises software that when executed quantifies at least one of the following morphological parameters selected from the group consisting of cartilage surface texture or roughness, a distance between a cartilage surface and underlying subchondral bone, bio-material properties of the cartilage, and cartilage subsurface ultra-structural and biochemical properties.

24. The system of claim 20, wherein the secondary parameter is extracted from a preoperative image.

25. The system of claim 24, wherein the preoperative image is an MRI.

26. The system of claim 20, wherein the secondary parameter is extracted from intraoperatively acquired cartilage data.

27. A computer-assisted orthopedic surgery system for performing joint preservation and assisting cartilage diagnostic and therapeutic procedures, the system comprising:

a position measuring system;

a tool tracked by the position measuring system and configured to acquire cartilage and bone data;

a computer configured to display a three-dimensional osteo-cartilaginous model having a cartilage quality data map, the computer having a memory storing a computer program that, when executed, causes the computer to

extract at least two parameters from the acquired cartilage data that is indicative of a quality of the cartilage,

incorporate the at least two parameters from the acquired cartilage data and bone data into the three-dimensional osteo-cartilaginous model,

compute a synthetic cartilage quality score that is a function of the at least two parameters, and

a surgical treatment tool tracked by the position measuring system and operably coupled to the computer, the surgical treatment tool being configured for performing the joint preservation and assisting cartilage diagnostic and therapeutic procedures, the surgical treatment tool further configured to be navigated based on the three-dimensional osteo-cartilaginous computer model,

wherein the computer system is configured to continuously deform the three-dimensional osteo-cartilaginous computer model in real-time during the joint preservation and assisting cartilage diagnostic and therapeutic procedures based on the acquired cartilage and bone data and the computed synthetic cartilage quality score, and further configured to display the synthetic cartilage quality score.