Methods and compositions for articular repair

• US 20030216669A1
• Filed: 11/27/2002
• Published: 11/20/2003
• Est. Priority Date: 05/25/2001
• Status: Active Grant

• Current Assignee: Conformis Incorporated
• Original Assignee: Imaging Therapeutics, Inc. (Conformis Incorporated)
• Inventors: Lang, Philipp, Steines, Daniel, Tsougarakis, Konstantinos, Timsari, Bijan, Berez, Aaron
• Granted Patent: US 7,468,075 B2
• Time in Patent Office: Days
• US Class Current: 600/587
• CPC Class Codes: A61B 17/15 Guides therefor arrangements for guiding straight saw blades in general B23D51/025
• CPC Class Codes: A61B 17/154 for preparing bone for knee prosthesis
• CPC Class Codes: A61B 17/155 Cutting femur
• CPC Class Codes: A61B 17/157 Cutting tibia
• CPC Class Codes: A61B 17/158 Cutting patella
• CPC Class Codes: A61B 17/16 Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans arthroscopic bone cutters A61B17/320016; dental implant drills potentially for other surgical use A61C8/0089; bone grinders A61F2/4644, A22C17/06; A61B17/1662 takes precedence over all other subgroups except A61B17/17
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1668 for the upper femur A61B17/164 takes precedence
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1739 specially adapted for particular parts of the body
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 17/7098 wherein the implant is permeable or has openings, e.g. fenestrated screw hollow surgical screws A61B17/864
• CPC Class Codes: A61B 17/8805 for introducing fluid filler into bone or extracting it A61B17/7097, A61B17/8833 take precedence
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/108 Computer aided selection or customisation of medical implants or cutting guides
• CPC Class Codes: A61B 2034/256 having a database of accessory information, e.g. including context sensitive help or scientific articles
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• 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 5/4504 : 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 6/508 : for non-human patients
• CPC Class Codes: A61F 2/30756 : Cartilage endoprostheses A61F2/3603 takes precedence
• CPC Class Codes: A61F 2/30767 : Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/30771 : applied in original prostheses, e.g. holes or grooves
• CPC Class Codes: A61F 2/30942 : for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
• CPC Class Codes: A61F 2/36 : Femoral heads ; Femoral endoprostheses
• CPC Class Codes: A61F 2/3859 : Femoral components
• CPC Class Codes: A61F 2/4657 : Measuring instruments used for implanting artificial joints for surgical instruments A61B90/06
• CPC Class Codes: A61F 2002/30062 : (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/30677 : Means for introducing or releasing pharmaceutical products, e.g. antibiotics, into the body
• CPC Class Codes: A61F 2002/30787 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30841 : Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
• CPC Class Codes: A61F 2002/30894 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/3092 : having an open-celled or open-pored structure
• CPC Class Codes: A61F 2002/30948 : using computerized tomography, i.e. CT scans
• CPC Class Codes: A61F 2002/30957 : using a positive or a negative model, e.g. moulds
• CPC Class Codes: A61F 2002/30962 : using stereolithography
• CPC Class Codes: A61F 2002/3097 : using laser
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2210/0004 : bioabsorbable
• CPC Class Codes: A61F 2310/00011 : Metals or alloys
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00029 : Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
• CPC Class Codes: A61F 2310/00047 : Aluminium or Al-based alloys
• CPC Class Codes: A61F 2310/00065 : Manganese or Mn-based alloys
• CPC Class Codes: A61F 2310/00071 : Nickel or Ni-based alloys
• CPC Class Codes: A61F 2310/00077 : Copper or Cu-based alloys
• CPC Class Codes: A61F 2310/00083 : Zinc or Zn-based alloys
• CPC Class Codes: A61F 2310/00107 : Palladium or Pd-based alloys
• CPC Class Codes: A61F 2310/00113 : Silver or Ag-based alloys
• CPC Class Codes: A61F 2310/00119 : Tin or Sn-based alloys
• CPC Class Codes: A61F 2310/00131 : Tantalum or Ta-based alloys
• CPC Class Codes: A61F 2310/00143 : Iridium or Ir-based alloys
• CPC Class Codes: A61F 2310/00149 : Platinum or Pt-based alloys
• CPC Class Codes: A61F 2310/00155 : Gold or Au-based alloys
• CPC Class Codes: A61F 2310/00293 : containing a phosphorus-containing compound, e.g. apatite
• CPC Class Codes: A61F 2310/00383 : Gelatin
• CPC Class Codes: A61F 2310/00395 : Coating or prosthesis-covering structure made of metals or of alloys
• CPC Class Codes: A61F 2310/00592 : Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
• CPC Class Codes: B23Q 17/00 : Arrangements for observing, indicating or measuring on machine tools for automatic control or regulation of feed movement, cutting velocity or position of tool or work B23Q15/00
• CPC Class Codes: B33Y 80/00 : Products made by additive manufacturing
• CPC Class Codes: Y10T 29/49 : Method of mechanical manufacture
• CPC Class Codes: Y10T 29/49764 : with testing or indicating
• CPC Class Codes: Y10T 29/49778 : with aligning, guiding, or instruction

Abstract

Disclosed herein are methods and compositions for producing articular repair materials and for repairing an articular surface. In particular, methods for providing articular repair systems. Also provided are articular surface repair systems designed to replace a selected area cartilage, for example, and surgical tools for repairing articular surfaces.

Claims

1. A method of designing an articular implant comprising the steps of

obtaining an image of a joint, wherein the image includes both normal cartilage and diseased cartilage;

reconstructing dimensions of the diseased cartilage surface to correspond to normal cartilage; and

designing the articular implant to match the dimensions of the reconstructed diseased cartilage surface or an area slightly greater than the diseased cartilage surface.

2. The method of claim 1, wherein the image is selected from the group consisting of MRI, CT, ultrasound, digital tomosynthesis, optical coherence tomography and combinations thereof.

3. The method of claim 1, wherein the reconstruction comprises obtaining a parametric surface that follows the contour of the normal cartilage, the parametric surface comprising control points that extend the contour of the normal cartilage to the diseased cartilage.

4. The method of claim 3, wherein the parametric surface comprises a B-spline surface.

5. The method of claim 1, wherein the reconstruction comprises

obtaining a binary image of cartilage by extracting cartilage from the image, wherein diseased cartilage appears as indentations in the binary image;

and

performing a morphological closing operation to determine the shape of an implant to fill the areas of diseased cartilage.

6. The method of claim 5, wherein the morphological closing operation is performed in two or three-dimensions using a structuring element.

7. The method of claim 5, wherein the morphological closing operation comprises a dilation followed by an erosion.

8. A system for evaluating the fit of an articular repair system into a joint, the system comprising,

one or more computing means capable of superimposing a three-dimensional or a two-dimensional cross-sectional image of a joint and an image of an articular repair system to determine the fit of the articular repair system.

9. The system of claim 8, wherein the computing means is capable of merging the images of the joint and the articular repair system into common coordinate system.

10. The system of claim 8, wherein the computing means is capable of rotating or moving the images with respect to each other.

11. The system of claim 8, wherein the images are three-dimensional.

12. The system of claim 11, wherein the images comprise three-dimensional representations of at least one articular structure and of the articular repair system.

13. The system of claim 11, wherein the three-dimensional representations are generated using a parametric surface representation.

14. The system of claim 8, wherein the images comprise one or more cross-sectional 2-D images.

15. The system of claim 14, wherein the 2-D cross-sectional images are reconstructed in multiple planes.

16. The system of claim 8, wherein the computing means is capable of selecting an articular repair system having the best fit.

17. The system of claim 8, wherein the computing means is capable highlighting areas of poor alignment between the articular repair system and the surrounding articular surfaces.

18. A surgical tool for preparing a joint to receive an implant, the tool comprising one or more surfaces or members that conform to the shape of the articular surfaces of the joint.

19. The surgical tool of claim 18, wherein the joint is a knee and the articular surface comprises a femoral condyle or a tibial plateau.

20. The surgical tool of claim 18, wherein the tool comprises lucite or silastic.

21. The surgical tool of claim 18, wherein the tool is re-useable.

22. The surgical tool of claim 21, wherein the tool comprises an array of adjustable, closely spaced pins.

23. The surgical tool of claim 18, further comprising an aperture therein, wherein the dimensions of the aperture are smaller or equal to the dimensions of the implant.

24. The surgical tool of claim 18, further comprising one or more apertures adapted to receive one or more injectables.

25. The surgical tool of claim 24, further comprising one or more curable compositions.

26. The surgical tool of claim 25, wherein the curable compositions are injected through the apertures.

27. A method of evaluating the fit of an articular repair system into a joint, the method comprising

obtaining one or more three-dimensional or two-dimensional cross-sectional images of a joint, wherein the joint includes at least one defect or diseased area;

obtaining one or more images of one or more articular repair systems designed to repair the defect or diseased area; and

evaluating the images to determine the articular repair system that best fits the defect.

28. The method of claim 27, wherein the evaluating comprises superimposing the images to determine the fit of the articular repair system into the joint.

29. The method of claim 27, wherein the images of the joint and the articular repair system are merged into common coordinate system.

30. The method of claim 27, wherein the images are three-dimensional.

31. The method of claim 30, wherein the images comprise three-dimensional representations of at least one articular structure and of the articular repair system.

32. The method of claim 31, wherein the three-dimensional representations are generated using a parametric surface representation.

33. The method of claim 27, wherein the images comprise one or more cross-sectional 2-D images.

34. The method of claim 33, wherein the 2-D cross-sectional images are reconstructed in multiple planes.

35. The method of claim 27, wherein the evaluation is performed by computer.

36. The method of claim 27, wherein the evaluation is performed by manual visual inspection.

37. The method of claim 27, wherein the image of the joint is obtained using a C-arm system.

38. The method of claim 37, wherein the image of the joint is obtained using radiographic contrast.

39. A method of placing an implant into an articular surface having a defect or diseased area, the method comprising the step of imaging the joint using a C-arm system during placement of the implant, thereby accurately placing the implant into a defect or diseased area.