Extracapsular surgical procedure and surgical referencing instrument therefor

• US 20060052795A1
• Filed: 09/06/2005
• Published: 03/09/2006
• Est. Priority Date: 09/03/2003
• Status: Active Grant

• Current Assignee: Ralph Richard White
• Original Assignee: Ralph Richard White
• Inventors: White, Ralph Richard
• Granted Patent: US 7,905,924 B2
• Time in Patent Office: Days
• US Class Current: 606/102
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/1714 for applying tendons or ligaments implements for applying tendons or ligaments A61F2/0805
• CPC Class Codes: A61B 2017/0458 Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0464 for soft tissue
• CPC Class Codes: A61B 2017/0619 thermoplastic, e.g. for bonding, welding, fusing or cutting the suture by melting it
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/067 for measuring angles
• CPC Class Codes: A61B 90/06 Measuring instruments not otherwise provided for
• CPC Class Codes: Y10S 623/914 Bone

Abstract

A method and device for finding isometric points in the joints of mammals for use in surgical repair of a joint. Isometric points are first identified in radiographic or other two dimensional images and then located in the actual joint. A method for repairing a cruciate ligament-deficient canine stifle employing the method and device for finding isometric points is described. A method and apparatus for locating the axis of rotation of a joint is also described.

Claims

1. A method of determining isometric relationships in an articulated mammalian joint, comprising:

(a) identifying a reference point on an image of one bone in said joint and an isometric point on an image of a second bone in said joint which appears isometric to said reference point in at least two images of the joint, said two images respectively showing said joint in flexed and extended positions;

(b) providing a measuring and positioning device having a body and two locating portions associated with said body, at least one of which is capable of movement relative to the other;

(c) identifying said reference point on said one bone in said mammalian joint;

(d) holding a first one of said locating portions at said reference point on said mammalian joint; and

(e) concurrently identifying said isometric point on said second bone in said mammalian joint by holding a second one of said locating portions adjacent to said second bone in said mammalian joint while moving said mammalian joint to each of said flexed and extended positions.

2. The method of claim 1 including the step of positioning said two locating portions at a distance from each other corresponding to a distance measured between said reference point and said isometric point in said images.

3. The method of claim 1 wherein each said locating portion has a marking element associated therewith.

4. The method of claim 3 further comprising the step of marking said reference point on said first bone with one said marking element.

5. The method of claim 4 further comprising the step of marking the isometric point on said second bone with the other said marking element.

6. The method of claim 3 wherein said marking elements are substantially perpendicular to said body.

7. The method of claim 1 wherein said mammalian joint is a non-human mammalian joint.

8. The method of claim 1 wherein said mammalian joint is a canine stifle joint.

9. The method of claim 1 wherein said images are radiographic images.

10. The method of claim 1 wherein said measuring and positioning device comprises two arms connected by at least one pivot joint.

11. The method of claim 1 wherein each said locating portion includes a receptacle capable of holding one of said marking elements.

12. The method of claim 11 wherein said marking elements are wires.

13. A device for locating a pair of isometric points in a mammalian joint, comprising:

(a) two arms interconnected with each other, and each said arm having a distal end;

(b) each of said distal ends having a locating portion associated therewith, and said arms being movable with respect to each other so as to adjust a separation distance between said locating portions; and

(c) a fastener associated with at least one of said arms and arranged to hold said locating portions at a selected said separation distance from each other.

14. The device of claim 13 wherein each said locating portion has a marking element associated therewith.

15. The device of claim 14 wherein said marking element is capable of being temporarily affixed to an isometric point.

16. The device of claim 14 wherein said marking elements are substantially perpendicular to said arms.

17. The device of claim 13 wherein said mammalian joint is a non-human mammalian joint.

18. The device of claim 13 wherein said mammalian joint is a canine stifle joint.

19. The device of claim 13 wherein said locating portions include respective receptacles each capable of holding a respective marking element.

20. The device of claim 14 wherein said marking elements are wires.

21. The device of claim 13 further comprising a scale associated with said arms and providing an indication of said separation distance between said locating portions.

26. The device of claim 13 wherein said locating portions include respective receptacles each capable of holding a respective marking element.

38. The device of claim 13 wherein said receptacles are oriented parallel with each other.

39. The device of claim 13 including a releasable fastener arranged to hold said locating portions selectively at a predetermined distance from each other.

40. The device of claim 13 including a pair of marking elements capable of forming an opening in a bone and being inserted into said opening.

41. The device of claim 13 wherein at least one of said locating portions is carried on a distal end of a first arm connected with said body through a pivot joint.

42. The device of claim 39 wherein said body has a second arm attached thereto.

43. The device of claim 39 wherein said pivot joint defines a pivot axis and said locating portions include respective receptacles that are oriented to hold said marking members parallel with said pivot axis.

22. A device for locating a pair of isometric points in a mammalian joint, comprising:

(a) a body;

(b) a pair of locating portions associated with a said body, at least one of said locating portions being adjustably located with respect to said body; and

(c) a scale capable of providing an indication of a separation distance between said locating portions.

23. The device of claim 22 wherein each said locating portion has a marking element associated therewith.

24. The device of claim 23 wherein each said marking element is capable of being temporarily affixed to an isometric point.

25. The device of claim 23 wherein each said marking element is substantially perpendicular to said arms.

27. A method of locating a pair of isometric points within a mammalian joint, comprising:

(a) obtaining images of said mammalian joint respectively in its flexed and extended positions;

(b) on the images, identifying a first point on a first bone in said joint;

(c) on the images, identifying a second point on a second bone in said joint, said second point being separated from said first point by a distance that is equal when said joint is in full flexion and in full extension; and

(d) thereafter locating within said mammalian joint said first and second points previously identified on said images.

28. The method of claim 27 wherein said joint is a canine stifle joint.

29. The method of claim 28 wherein said first bone is a tibia and said second bone is a femur.

30. The method of claim 27 including the further step of surgically exposing said joint prior to locating said first and second points in said joint.

31. The method of claim 27 wherein said images are radiographic images.

32. The method of claim 27 including the further step of measuring a first distance between said first and second points within said joint when said joint is fully flexed;

measuring a second distance between said first and second points when said joint is fully extended;

thereafter if said first and second distances are unequal adjusting said second point on said femur;

thereafter again measuring said first and second distances; and

repeating said steps of adjusting and measuring until said second point is located where said first and second distances are equal.

33. The method of claim 27 wherein said joint is a canine stifle joint.

34. A method of providing a stabilizing extracapsular surgical repair for an articulating joint between two bones in a mammalian subject, comprising:

(a) obtaining a pair of images, a first image of said pair showing said articulating joint in a fully flexed position and a second image of said pair showing said articulating joint in a fully extended position;

(b) in said images identifying a pair of points between which to provide an extracapsular tension-carrying structure interconnecting said two bones, said pair of points being a reference point on a first one of said two bones and an isometric point on the second one of said two bones, said reference and isometric points being located in said joint so as to be separated by a separation distance that is equal in both of said first and second images;

(c) providing a measuring and locating device having;

(i) a body;

(ii) a pair of locating portions associated with a said body, at least one of said locating portions being adjustably located with respect to said body; and

(iii) a scale capable of providing an indication of a separation distance between said locating portions.

(d) locating said reference point in said first one of said bones in said articulating joint in said subject;

(e) thereafter, locating a trial isometric point on said second one of said bones in said articulating joint in said subject by fastening a first marking element at said reference point and holding a second marking element in said second locating portion of said device at said separation distance with said articulating joint in a first one of a fully extended position and a fully flexed position;

(f) moving said articulating joint to the other one of said fully extended and fully flexed positions and observing whether said reference point and said trial isometric point are then separated by said separation distance; and

adjusting the position of said second locating member with respect to said trial isometric point until an isometric point is located on said second one of said bones of said articulating joint; and

(g) surgically attaching a tension-bearing repair structure to said bones as necessary to provide tension-bearing structure extending between respectively said reference point and said isometric point as thus located in said joint.

35. The method of claim 34 wherein one of said locating portions includes a threaded component adjustably carried in said locating portion.

36. The method of claim 34, when said device includes a releasable fastener selectively holding said locating portions at a predetermined distance from each other.

37. The method of claim 34, including the further step of using said scale and thereby verifying that said separation distance between said reference point and said isometric point is equal when said joint is flexed and when it is extended.