Patient Selectable Joint Arthroplasty Devices and Surgical Tools

• US 20070198022A1
• Filed: 02/06/2007
• Published: 08/23/2007
• Est. Priority Date: 05/25/2001
• Status: Active Grant

• Current Assignee: Conformis Incorporated
• Original Assignee: Conformis Incorporated
• Inventors: Lang, Philipp, Steines, Daniel, Vargas-Voracek, Rene, Fitz, Wolfgang, Bojarski, Raymond, Burdulis, Albert
• Granted Patent: US 8,066,708 B2
• Time in Patent Office: Days
• US Class Current: 606/88
• 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 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1677 for the patella
• CPC Class Codes: A61B 17/1682 for the foot or ankle
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1739 specially adapted for particular parts of the body
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 17/1767 for the patella
• CPC Class Codes: A61B 2017/568 produced with shape and dimensions specific for an individual patient
• 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 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 5/4523 : Tendons
• CPC Class Codes: A61B 5/4528 : Joints A61B5/4533, A61B5/4538 take precedence
• CPC Class Codes: A61B 5/4533 : Ligaments
• CPC Class Codes: A61F 2/30756 : Cartilage endoprostheses A61F2/3603 takes precedence
• 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 2/38 : for elbows or knees
• CPC Class Codes: B33Y 80/00 : Products made by additive manufacturing
• CPC Class Codes: G06F 30/00 : Computer-aided design [CAD]
• CPC Class Codes: G06F 30/10 : Geometric CAD
• CPC Class Codes: Y10T 29/49 : Method of mechanical manufacture

Abstract

Disclosed herein are methods, compositions and tools for repairing articular surfaces repair materials and for repairing an articular surface. The articular surface repairs are customizable or highly selectable by patient and geared toward providing optimal fit and function. The surgical tools are designed to be customizable or highly selectable by patient to increase the speed, accuracy and simplicity of performing total or partial arthroplasty.

Claims

1. A system for joint arthroplasty, the system comprising:

a first template, the first template including;

at least one surface for engaging a first surface of a joint, the surface being a mirror image of portions or all of the first surface; and

at least one guide for directing movement of a surgical instrument; and

a linkage for cross-referencing at least one surgical tool relative to said guide and relative to one of an anatomical and a biomechanical axis.

2. The system according to claim 1, wherein the surgical tool is a second template, the second template including at least one guide for directing movement of a surgical instrument.

3. The system according to claim 2, wherein the second template includes a surface that is a mirror image of a second surface of the joint.

4. The system according to claim 3, wherein the second joint surface opposes the first joint surface.

6. The system according to claim 1, wherein the shape and/or position of the at least one guide of the first template is based, at least in part, on one or more axis related to said joint.

7. The system according to claim 1, wherein the linkage is an attachment mechanism.

8. The system according to claim 1, wherein the attachment mechanism causes the first template to directly contact the at least one surgical tool.

9. The system according to claim 1, wherein the attachment mechanism attaches the first template and the at least one surgical tool such that the first template and the at least one surgical tool do not directly contact each other.

10. The system according to claim 1, wherein the linkage allows for rotation relative to one of an anatomical and a biomechanical axis.

11. The system according to claim 1, wherein the first template includes a removably attached block, the block including the at least one guide of the first template.

5. The system according to clam 2, wherein the at least one guide of the second template directs the surgical instrument in at least one of a cut, a milling, and a drilling oriented in a predefined location relative to said first template and adapted in shape, size or orientation to an implant shape.

12. A system for joint arthroplasty, the system comprising:

a first template, the first template including;

at least one surface for engaging a first surface of a joint, the surface being a mirror image of portions or all of the first surface; and

at least one guide for directing movement of a surgical instrument; and

a linkage for cross-referencing at least one surgical tool on a second surface of the joint opposing the first surface.

13. A system for joint arthroplasty, the system comprising:

a first template, the first template including;

at least one first template surface for engaging a first surface of a joint, the first template surface being a mirror image of portions or all of the first surface; and

at least one guide for directing movement of a surgical instrument;

a second template, the second template including;

at least one second template surface for engaging a second surface of a joint, the second template being a mirror image of portions or all of the second surface; and

at least one guide for directing movement of a surgical instrument; and

a linkage for cross-referencing the first template and the second template.

14. A system for joint arthroplasty, the system comprising:

a first template, the first template including;

at least one surface for engaging a first surface of a joint, the surface being a mirror image of portions or all of the first surface; and

at least one guide for directing movement of a surgical instrument; and

a linkage for cross-referencing at least one surgical tool, wherein the linkage allows for rotation relative to one of an anatomical and a biomechanical axis.

15. A method of joint arthroplasty, the method comprising:

positioning at least one contact surface of a first template onto a first surface of a joint;

cross-referencing a second template to the first template to align position of the second template on a second surface of the joint, the second template including at least one guide; and

directing movement of the surgical instrument using the at least one guide of the second template relative to said guide and relative to one of an anatomical and a biomechanical axis.

16. The method according to claim 15, wherein the at least one contact surface of the first template is substantially a mirror image of the first surface.

17. The method according to claim 16, further comprising:

obtaining electronic image data of the joint;

determining a shape of the at least one contact surface of the first template based, at least in part, on electronic image data.

18. The method according to claim 15, further comprising:

prior to directing movement of the surgical instrument, postioning at least one contact surface of the second template to the second joint surface.

19. The method according to claim 17, wherein the at least one contact surface of the second template is substantially a mirror image of the second surface.

20. The method according to claim 18, further comprising:

obtaining electronic image data of the joint;

determining a shape of the at least one contact surface of the second template based, at least in part, on electronic image data.

21. The method according to claim 15, wherein cross-referencing the second template to the first template includes:

attaching the second template to the first template.

22. The method according to claim 21, wherein attaching the second template to the first template includes performing intraoperative adjustments.

23. The method according to claim 21, wherein the second template is attached to the first template via a pin, and wherein performing intraoperative adjustments includes rotating the second template around the pin.

24. The method according to claim 15 further comprising performing an intraoperative adjustment on the position of the second template on the second surface of the joint, wherein performing the intraoperative adjustment includes using one of spacers, ratchets, and telescoping devices.

25. The method according to claim 15, further comprising performing an intraoperative adjustment on the position of the second template on the second surface of the joint, wherein performing the intraoperative adjustment includes adjusting for at least one of joint flexion, joint extension, joint abduction, and joint rotation.

26. The method according to claim 15, wherein directing movement of the surgical instrument using the at least one guide of the second template includes making one or more cuts or drill holes, the method further comprising implanting a joint prosthesis as a function of the one or more cuts or drill holes.

27. The method according to claim 15, wherein the first template includes at least one guide, the method further comprising:

directing movement of a surgical instrument using the at least one guide of the first template.

28. The method according to claim 27, wherein directing movement of the surgical instrument using the at least one guide of the first template includes making one or more cuts or drill holes, the method further comprising implanting a joint prosthesis as a function of the one or more cuts or drill holes.

29. The method according to claim 15, wherein directing movement of the surgical instrument using the at least one guide of the second template includes making at least one of a cut, a drill hole, and a reaming, the method further comprising implanting a joint prosthesis.

30. The method according to claim 15, wherein the first surface of the joint is a femoral surface, and the second surface of the joint is a tibial surface.

31. The method according to claim 15, further comprising:

obtaining electronic image data of a joint;

determining the at least one of a biomechanical axis and an anatomical axis of the joint based, at least in part, on the electronic image data; and

wherein the shape and/or position of the guide of the second template is based, at least in part, on the at least one of the biomechanical axis and the anatomical axis.

32. The method according to claim 31 wherein the electronic image data is obtained by at least one of pre-operatively, intraoperatively, optically, an MRI, a CT, and a spiral CT.

33. The method according to claim 15, wherein the first template includes a thickness based, at least in part, on at least one of a thickness of an implant to be attached to the first surface of the joint and a desired space between two opposing surfaces of the joint.

34. A method of joint arthroplasty, the method comprising:

positioning at least one contact surface of a first template onto a first surface of a joint;

cross-referencing a second template to the first template to align position of the second template on a second surface of the joint, the second surface opposing the first surface, the second template including at least one guide; and

directing movement of the surgical instrument using the at least one guide of the second template.

35. A method of joint arthroplasty, the method comprising:

positioning at least one contact surface of a first template onto a first surface of a joint, wherein the at least one contact surface of the first template is substantially a mirror image of the first surface.

cross-referencing a second template to the first template to align position of the second template onto a second surface of the joint, the at least one contact surface of the second template substantially a mirror image of the second surface of the joint, the second template including at least one guide; and

directing movement of the surgical instrument using the at least one guide of the second template.

36. A method of joint arthroplasty, the method comprising:

positioning at least one contact surface of a first template onto a first surface of a joint;

cross-referencing a second template to the first template to align position of the second template on a second surface of the joint, the second template including at least one guide, wherein cross-referencing allows rotation of the second template relative to one of a biomechanical and an anatomical axis; and

directing movement of the surgical instrument using the at least one guide of the second template.

37. A method of joint arthroplasty, the method comprising:

obtaining electronic image data of a joint;

determining width space of the joint based, at least in part, on the electronic image data; and

providing a template that includes at least one guide for directing movement of a surgical instrument, wherein at least one of the shape and position of the guide is based, at least in part, on the width space of the joint.

38. The method according to claim 37, wherein the template includes at least one surface for engaging a surface of a joint, the surface being a mirror image of portions or all of the surface.

39. The method according to claim 37, wherein obtaining electronic image data includes at least one of a CT scan, MRI scan, optical scan, and a ultrasound imaging.

40. The method according to claim 37, wherein obtaining electronic image data includes:

obtaining image data of at least one of a medial space, a lateral space, anterior space, and posterior space of the joint.

41. The method according to claim 40, further comprising comparing at least two of the lateral space, anterior space, and posterior space of the joint.

42. The method according to claim 37, wherein obtaining image data is performed in one of two dimensions and three dimensions.

43. The method according to claim 37, wherein determining width of the joint includes measuring the distance from the subchondral bone plate of one articular surface to the subchondral bone plate of the opposing articular surface.

44. The method according to claim 37, wherein determining width of the joint includes measuring the distance from the subchondral bone plate of one articular surface to the subchondral bone plate of the opposing articular surface.

45. The method according to claim 37, wherein obtaining the image data of the joint is performed in at least one of joint flexion, joint extension, and joint rotation.

46. The method according to claim 37, wherein at least one of the shape and position of the guide is further based, at least in part, on the anatomical or biomechanical axis alignment of the joint.

47. A method of joint arthroplasty, the method comprising:

obtaining electronic image data of a joint;

determining cartilage loss associated with the joint based, at least in part, on the electronic image data;

providing a template that includes at least one guide for directing movement of a surgical instrument so as to correct an axis alignment of the joint, wherein at least one of the shape and position of the guide is based, at least in part, on the cartilage loss.

48. The method according to claim 47, further comprising measuring at least one axis associated with the joint.

49. The method according to claim 47, wherein measuring includes at least on of a standing x-ray, a weight bearing x-ray, a CT scout scan, a MRI localizer scan, a CT scan, and a MRI scan.

50. The method according to claim 47, wherein obtaining image data includes one of spiral CT, spiral CT orthography, MRI, optical imaging, optical coherence tomography, and ultrasound.

51. The method according to claim 47, wherein the template includes at least one contact surface for engaging a surface of the joint, the contact surface being a mirror image of portions or all of the joint surface.

52. A method for joint arthroplasty, the method comprising:

obtaining electronic image data of a joint;

determining a plurality of measurements based, at least in part, on the image data, the measurements selected from at least one of an axis associated with the joint and a plane associated with the joint; and

providing a template that includes at least one guide for directing movement of a surgical instrument, wherein at least one of the shape and position of the guide is based, at least in part, on the plurality of measurements.

53. The method according to claim 52, wherein obtaining image data of the joint includes at least one of an x-ray, a standing x-ray, a CT scan, an MRI scan, CT scout scans, MRI localizer scans.

54. The method according to claim 52, wherein the plurality of measurements include one of a plurality of axis, a plurality of planes, and a combination of an axis and a plane.

55. The method according to claim 52, wherein the template includes at least one contact surface for engaging a surface of a joint, the contact surface being a mirror image of portions or all of the joint surface.

56. A surgical tool comprising:

a template including;

a surface for engaging a joint surface, the surface being a mirror image of a portion or all of the joint surface; and

two or more guides for directing movement of a surgical instrument, wherein the shape and/or position of at least one of the guides is based, at least in part, on at least one axis related to said joint.

57. The surgical tool according to claim 56, wherein the template further includes a block removably attached to the surface, the block including the two or more guides.

58. The surgical tool according to claim 56, wherein the two or more guides include at least one guide for a cut, a milling, and a drilling.

59. The surgical tool according to claim 56, further comprising a second surgical tool attached to the template, the second tool including at least one guide aperture for guiding a surgical instrument.

60. The surgical tool according to claim 59, wherein the at least one guide of the second surgical tool guides a surgical instrument to make cuts that are at least one of parallel, non-parallel, perpendicular, and non-perpendicular to cuts guided by the first template.

61. A method of joint arthroplasty, the method comprising:

performing an extended scan of a joint to obtain electronic image data that includes the joint and at least 15 cm or greater beyond the joint;

determining at least one of an anatomical and a biomechanical axis associated with the joint based, at least in part, on the electronic image data;

providing a template that includes at least one guide for directing movement of a surgical instrument, wherein at least one of the shape and position of the guide is based, at least in part, on the at least one of the anatomical and the biomechanical axis.

62. The method according to claim 61, wherein the joint is a knee joint, and performing the extended scan of a joint to obtain electronic image data includes obtaining electronic image data at least one of 15 cm, 20 cm, and 25 cm beyond the tibiofemoral joint space.

63. A method of joint arthroplasty, the method comprising:

performing an imaging scan acquisition that obtains electronic image data through more than one joint;

determining at least one of an anatomical axis and a biomechanical axis associated with the joint based, at least in part, on the electronic image data; and

providing a template that includes at least one guide for directing movement of a surgical instrument, wherein at least one of the shape and position of the guide is based, at least in part, on the at least one of the anatomical and the biomechanical axis.

64. The method according to claim 63, wherein performing an imaging acquisition includes performing at least one of a CT, MRI, Ian x-ray, and a two-plane x-ray, wherein the CT and the MRI includes at least one of slice, spiral, and volume acquisition.

65. The method according to claim 63, wherein the guide directs the movement of a surgical instrument to correct one of a varus deformity and a valgus deformity.

66. A method of joint arthroplasty, the method comprising:

obtaining a first image of a joint in a first plane, wherein the first image generates a first image volume;

obtaining a second image of a joint in a second plane, wherein the second image generates a second image data volume;

combining the first and second image data volumes to form a resultant image data volume, wherein the resultant image data volume is substantially isotropic.

providing a template based on the resultant image data volume, the template including;

at least one surface for engaging a first surface of a joint, the surface being a mirror image of portions or all of the first surface; and

at least one guide for directing movement of a surgical instrument.

67. The method of joint arthroplasty according to claim 66, wherein obtaining the first image and the second image includes one of spiral CT, volumetric CT, and an MRI scan.

68. A method for joint arthroplasty, the method comprising:

performing a first cut on a joint to create a first cut joint surface, wherein performing the first cut includes;

positioning at least one contact surface of a first template onto a first surface of a joint, the at least one contact surface being a mirror image of the first surface of the joint, the first template including a guide for directing movement of a surgical instrument to perform the first cut; and

cross-referencing the first cut to perform a second cut associated with an opposing surface of the joint.

69. The method according to claim 68, wherein cross-referencing the first cut to make the second cut includes:

attaching a second template to the first template so as to assist positioning at least one contact surface of the second template onto a second surface of the joint, the second template including a guide for directing movement of a surgical instrument to perform the second cut.

70. The method according to claim 69, the second template including at least one contact surface being a mirror image of the second surface of the joint.

71. The method according to claim 68, wherein cross-referencing the first cut to make the second cut includes:

positioning at least one contact surface of a third template onto at least a portion of the first cut surface; and

attaching a second template to the third template so as to position at least one contact surface of the second template onto a second surface of the joint, the second template including a guide for directing movement of a surgical instrument to perform the second cut.

72. The method according to claim 71, wherein the at least one contact surface of the third templateis a mirror image of the first cut surface.

73. The method according to claim 68, wherein the first cut is a horizontal femoral cut, and the second cut is a vertical femoral cut.

74. The method according to claim 68, wherein the first cut is a femoral cut and the second cut is a tibial cut.

75. The method according to claim 68, wherein the first cut is a femoral cut, and the second cut is a patellar cut.

76. The method according to claim 68, wherein the first cut is an acetabular reaming and the second cut is a femoral cut.

77. A method for joint arthroplasty, the method comprising:

positioning at least one contact surface of a template onto a surface of a joint, the at least one contact surface being a mirror image of at least a portion of the surface of the joint, the template including a guide for directing movement of a surgical instrument; and

stabilizing the first template onto the first surface.

78. The method according to claim 77, further comprising:

obtaining electronic image data of the joint; and

determining a shape of the at least one contact surface of the first template based, at least in part, on electronic image data.

79. The method according to claim 77, wherein stabilizing includes using one of k-wires, a screw, an anchor, and a drill bit left in place on the joint.

80. The method according to claim 77, wherein stabilizing includes positioning the contact surface on at least one or more concavities and convexities on the joint.

81. The method according to claim 77, wherein stabilizing includes positioning the contact surface on at least one concavity and at least convexity on the joint.

82. The method according to claim 77, wherein stabilizing includes positioning the contact surface, at least partially, on an arthritic portion of the joint.

83. The method according to claim 77, wherein stabilizing includes positioning the contact surface, at least partially, on an interface between a normal and an arthritic portion of the joint.

84. The method according to claim 77, wherein stabilizing includes positioning the contact surface, at least partially, against an anatomic feature.

85. The method according to claim 84, wherein the anatomic feature is one of a trochlea, an intercondylar notch, a medial condyle and a lateral condyle, a medial trochlea and a lateral trochlea, a medial tibial plateau and a lateral tibial plateau, a fovea capities, an acetabular fossa, a tri-radiate cartilage, an acetabular wall, and an acetabular rim.

86. The method according to claim 77, wherein positioning the contact surface on the surface of the joint includes positioning the contact surface on, at least partially, a normal portion of the joint.

87. The method according to claim 77, further comprising:

determining the position of the guide on the template based, at least in part, on ligament balancing and/or to optimize at least one of flexion and extension gap.

88. The method according to claim 77, further comprising:

adjusting the position of the guide relative to the joint intraoperatively.

89. The method according to claim 88, wherein adjusting the position of the guide includes at least one of a spacer, a ratchet device, and a pin that allows rotation.

90. A method for joint arthroplasty, the method comprising:

positioning at least one contact surface of a template onto a surface of a joint, such that the contact surface, at least partially, rests on, and is a mirror image of, an interface between an arthritic and a normal portion of the joint surface, the template including a guide for directing movement of a surgical instrument;

making a surgical intervention on the joint with the surgical instrument based, at least in part, on the guide.

91. A template comprising:

at least one contact surface for positioning onto a surface of a joint, the contact surface at least partially being a mirror image of an interface between an arthritic and a normal portion of the joint surface,

a guide for directing movement of a surgical instrument.

92. A method for joint arthroplasty, the method comprising:

positioning at least one contact surface of a template onto a surface of a joint, such that the contact surface, at least partially, rests on, and is a mirror image of, an arthritic portion of the joint surface, the template including a guide for directing movement of a surgical instrument;

making a surgical intervention on the joint with the surgical instrument based, at least in part, on the guide.

93. A template comprising:

at least one contact surface for positioning onto a surface of a joint, the contact surface at least partially being a mirror image of a normal portion of the joint surface,

a guide for directing movement of a surgical instrument.

94. A method for joint arthroplasty, the method comprising:

performing a phantom scan of one of a MRI and CT instrument;

performing, using the one of the an MRI and CT instrument, a scan on a joint;

determining a shape of the at least one contact surface of the first template based, at least in part, on the phantom scan and the scan of the joint, the at least one contact surface being a mirror image of at least a portion of the surface of the joint, the template including a guide for directing movement of a surgical instrument.

95. The method according to claim 94, wherein the phantom scan is performed prior to the scan of the joint, the method further comprising adjusting the one of the MRI and the CT instrument.

96. The method according to claim 94, wherein the phantom scan is performed after performing the scan of the joint, wherein the scan of the joint is optimized based on the phantom scan.

97. A method for joint arthroplasty, the method comprising:

determining a desired femoral component rotation for one of a uni-compartmental or total knee replacement;

providing a template that includes at least one guide for directing movement of at least one of a surgical instrument, attached linkage, and tool, wherein at least one of the shape and position of the guide is based, at least in part, on the desired femoral component rotation.

98. The method according to claim 97, wherein determining the desired femoral component rotation includes measuring one or more anatomic axis and/or planes relevant to femoral component rotation.

99. The method according to claim 97, wherein the one or more anatomic axis and/or planes is at least one of the transepicondylar axis, the Whiteside line, and the posterior condylar axis.

100. The method according to claim 97, wherein the guide directs a femoral cut, the method further comprising rotating the template so that the femoral cut is parallel to a tibial cut with substantially equal tension medially and laterally applied from medial and lateral ligaments and soft tissue.

101. A method for joint arthroplasty, the method comprising:

determining a desired tibial component rotation for one of a uni-compartmental or total knee replacement;

providing a tibial template that includes at least one guide for directing movement of at least one of a surgical instrument, attached linkage, and tool, wherein at least one of the shape and position of the guide is based, at least in part, on the desired tibial component rotation.

102. The method according to claim 101, wherein determining the desired tibial component rotation includes measuring one or more anatomic axis and/or planes relevant to tibial component rotation.

103. The method according to claim 102, wherein the one or more anatomic axis and/or planes is at least one of an anteroposterior axis of the tibia, and the meidal one-third of the tibial tuberosity.

104. The method according to claim 101, wherein the guide directs a femoral cut, the method further comprising rotating the template so that the femoral cut is parallel to a tibial cut with substantially equal tension medially and laterally applied from medial and lateral ligaments and soft tissue.

105. A method of hip arthroplasty, the method comprising:

determining leg length discrepancy;

obtaining electronic image data of the hip joint;

providing a template that includes at least one guide for directing movement of at least one of a surgical instrument, attached linkage, and tool, the template including at least one contact surface that is a mirror image of the femoral neck, wherein at least one of the shape and position of the template and/or guide is based, at least in part, on the electronic image data.

106. The method according to claim 105, wherein determining leg length discrepancy includes at least one of a standing x-ray of the leg, a CT scout scan, a CT, and MRI.

107. The method of claim 105, wherein the guide assists a surgical instrument in cutting the femoral neck.

108. A method for joint arthroplasty, the method comprising:

determining a desired femoral component rotation for a hip;

providing a template that includes at least one guide for directing movement of at least one of a surgical instrument, attached linkage, and tool, wherein at least one of the shape and position of the guide is based, at least in part, on the desired femoral component rotation.

109. A method for joint arthroplasty, the method comprising:

determining a desired acetabular component rotation for a hip;

providing an acetabular template that includes at least one guide for directing movement of at least one of a surgical instrument, attached linkage, and tool, wherein at least one of the shape and position of the guide is based, at least in part, on the desired acetabular component rotation.

110. A method for joint arthroplasty, the method comprising:

determining a desired humerus component rotation for a shoulder;

providing a template that includes at least one guide for directing movement of at least one of a surgical instrument, attached linkage, and tool, wherein at least one of the shape and position of the guide is based, at least in part, on the desired humerus component rotation.

111. A method for joint arthroplasty, the method comprising:

providing a template that includes at least one surface for engaging a surface of a joint based, at least in part, on substantially isotropic input data, the surface being a mirror image of portions or all of the joint surface, the template including at least one guide for directing movement of a surgical instrument.

112. The method according to claim 111, wherein said input data is acquired using one of fusion of image planes, substantially isotropic MRI and spiral CT.

113. A method for ligament repair, the method comprising:

obtaining electronic image data of at least one surface associated with a ligament,

creating a first template based, at least in part, on the image data, the template having at least one contact surface that conforms with at least a portion of the surface, the template including at least one guide for directing movement of a surgical instrument involved with the ligament repair.

114. The method according to claim 113, wherein the ligament is an anterior cruciate ligament.

115. The method according to claim 113, wherein the ligament is a posterior cruciate ligament.

116. The method according to claim 113, further comprising determining a tunnel site for a ligament graft.

117. The method according to claim 116, wherein determining the tunnel site includes identifying an origin of the ligament on a first articular surface, and an insertion position onto a second articular surface opposing the first articular surface.

118. The method according to claim 116, wherein determining the tunnel site includes identifying at least one of a bony landmark and a remainder of a ligament based on the image data.

119. The method according to claim 116, wherein the surface is one of adjacent to the tunnel site and a non-weight bearing surface.

120. The method according to claim 113, wherein the first template includes a drill guide aperture, the method further comprising:

positioning the template such that the at least one contact surface contacts the at least a portion of the surface; and

drilling a ligament tunnel, wherein the drilling is guided by the drill guide aperture.

121. The method according to claim 120, wherein at least one of the shape, position and orientation of the drill guide aperture on the first template is based, at least in part, on a distance of the tunnel to adjacent cortical bone.

122. The method according to claim 121, wherein the drill guide aperture includes a stop, such that a desired drill depth is obtained.

123. The method according to claim 113, wherein the image data is obtained preoperatively.

124. The method according to claim 113, wherein the image data is obtained by at least one of a CT scan and an MRI scan.

125. The method according to claim 113, wherein the image data is obtained in at least one of joint flexion, joint extension, joint abduction, joint adduction, and joint rotation.

126. The method according to claim 113, further comprising:

identifying a graft harvest site based on the image data;

using the first template to guide harvesting of at least one of ligament and bone form the graft harvest site.

127. The method according to claim 113, further comprising:

cross-referencing a second template to the first template to align position of the second template on a second surface associated with the ligament, the second template including at least one guide; and

directing movement of the a instrument using the at least one guide of the second template relative to said guide.

128. The method according to claim 127, wherein the first and second surfaces are opposing articular surfaces.

129. The method according to claim 128, wherein the first surface is a femoral surface and the second surface is a tibial surface.

130. The method according to claim 113, wherein the first template includes a tissue retractor.

131. The method according to claim 130, wherein the tissue retractor is one of a flange and an extender.

132. The method according to claim 113, further comprising using the template in at least one of a single bundle and a double bundle ligament reconstruction.