Method and apparatus for performing an open wedge, high tibial osteotomy

• US 20090287217A1
• Filed: 05/04/2009
• Published: 11/19/2009
• Est. Priority Date: 01/31/2005
• Status: Active Grant

• Current Assignee: Arthrex Incorporated
• Original Assignee: Arthrex Incorporated
• Inventors: Schneider, Robert, Burns, Ralph E., Novak, Vincent P., Ammann, Kelly
• Granted Patent: US 8,702,715 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 17/152 for removing a wedge-shaped piece of bone
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1732 for bone breaking devices
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 17/68 Internal fixation devices , including fasteners and spinal fixators, even if a part thereof projects from the skin bone staples A61B17/0642
• CPC Class Codes: A61B 17/8095 Wedge osteotomy devices
• CPC Class Codes: A61B 2017/1602 Mills
• CPC Class Codes: A61B 90/03 Automatic limiting or abutting means, e.g. for safety

Abstract

Apparatus for performing an open wedge, high tibial osteotomy, the apparatus comprising:

• • cutting apparatus for forming an osteotomy cut in the tibia, the cutting apparatus comprising:
    • targeting apparatus for identifying a cutting plane through the tibia and a boundary line for terminating a cut made along the cutting plane, wherein the boundary line is located within the tibia, parallel to the anterior-posterior slope of the tibia and parallel to the sagittal plane of the patient.

A method for performing an open wedge, high tibial osteotomy, the method comprising:

• • positioning targeting apparatus for identifying a cutting plane through the tibia and a boundary line for terminating a cut made along the cutting plane, wherein the boundary line is located within the tibia, parallel to the anterior-posterior slope of the tibia and parallel to the sagittal plane of the patient;
  • cutting the bone along the cutting plane, with the cut terminating at the boundary line;
  • moving the bone on either-side of the cut apart so as to form the wedge-like opening in the bone; and
  • stabilizing the bone.

Claims

1. Apparatus for performing an open wedge, high tibial osteotomy, the apparatus comprising:

cutting apparatus for forming an osteotomy cut in the tibia, the cutting apparatus comprising;

targeting apparatus for identifying a cutting plane through the tibia and a boundary line for terminating a cut made along the cutting plane, wherein the boundary line is located within the tibia, parallel to the anterior-posterior slope of the tibia and parallel to the sagittal plane of the patient.

2. Apparatus according to claim 1 wherein the targeting apparatus is configured so as to form an oversized hole along the boundary line, whereby to minimize the occurrence of stress risers within the tibia when the bone on either side of the cut is moved apart so as to form the wedge-like opening in the tibia.

3. Apparatus according to claim 1 wherein the targeting apparatus further comprises an apex pin for disposition along the boundary line, wherein the apex pin provides a positive stop at the boundary line for limiting cutting along the cutting plane.

4. Apparatus according to claim 3 wherein the apex pin is sized so as to form an oversized hole along the boundary line, whereby to minimize the occurrence of stress risers within the tibia when the bone on either side of the cut is moved apart so as to form the wedge-like opening in the tibia.

5. Apparatus according to claim 3 wherein the apex pin comprises a flat at the positive stop.

6. Apparatus according to claim 3 wherein the apex pin is necked down at the positive stop.

7. Apparatus according to claim 1 wherein the targeting apparatus is configured so that the cutting approach is in a generally antero-medial direction.

8. Apparatus according to claim 1 wherein the targeting apparatus comprises a slope guide for determining the anterior-posterior slope of the tibia whereby to determine the location of the boundary line.

9. Apparatus according to claim 8 wherein the slope guide comprises an elongated body having a non-circular cross-section.

10. Apparatus according to claim 1 wherein the targeting apparatus comprises an alignment mechanism for determining the coronal plane and hence the sagittal plane, whereby to determine the location of the boundary line.

11. Apparatus according to claim 1 wherein the cutting apparatus comprises a positioning guide and a cutting guide;

wherein the positioning guide is configured for attachment to the tibia so as to establish the cutting plane and the boundary line relative to the tibia; and

wherein the cutting guide is configured for attachment to the positioning guide so as to align a cutting slot with the cutting plane.

12. Apparatus according to claim 11 wherein the cutting guide is configured so that the cutting approach is in a generally antero-medial direction.

13. Apparatus according to claim 11 wherein the cutting apparatus comprises a drill guide for forming at least one keyhole in the tibia adjacent to the cutting plane.

14. Apparatus according to claim 13 wherein the cutting apparatus is configured so that the at least one keyhole overlays the cutting plane.

15. Apparatus according to claim 1 wherein the apparatus further comprises a jack for opening the cut made along the cutting plane so as to form a wedge-like opening within the bone.

16. Apparatus according to claim 15 wherein the targeting apparatus further comprises an apex pin for disposition along the boundary line, and further wherein the jack is configured for mounting on the apex pin.

17. Apparatus according to claim 1 wherein the apparatus further comprises a wedge-shaped implant for disposition in a wedge-shaped opening created in the tibia when the cut made along the cutting plane is opened.

18. Apparatus according to claim 17 wherein the wedge-shaped implant comprises a plurality of components.

19. Apparatus according to claim 17 wherein the wedge-shaped implant comprises a U-shaped construction when viewed from the top.

20. Apparatus according to claim 17 wherein the wedge-shaped implant includes at least one key for disposition in a keyway disposed within the tibia.

21. A method for performing an open wedge, high tibial osteotomy, the method comprising:

positioning targeting apparatus for identifying a cutting plane through the tibia and a boundary line for terminating a cut made along the cutting plane, wherein the boundary line is located within the tibia, parallel to the anterior-posterior slope of the tibia and parallel to the sagittal plane of the patient;

cutting the bone along the cutting plane, with the cut terminating at the boundary line;

moving the bone on either side of the cut apart so as to form the wedge-like opening in the bone; and

stabilizing the bone.

22. A method according to claim 21 wherein a jack is used to move the bone apart.

23. A method according to claim 21 wherein a wedge-shaped implant is inserted into the wedge-shaped opening in the bone so as to stabilize the bone.

24. Apparatus for performing an open wedge, high tibial osteotomy, the apparatus comprising:

a wedge-shaped implant for disposition in a wedge-shaped opening created in the tibia, wherein the wedge-shaped implant comprises at least one key for disposition in a keyhole formed in the tibia adjacent to the wedge-shaped opening created in the tibia.

25. Apparatus according to claim 24 wherein the wedge-shaped implant comprises at least two separate components.

26. Apparatus according to claim 24 wherein the wedge-shaped implant comprises three separate components.

27. Apparatus according to claim 26 wherein the wedge-shaped implant comprises:

a base component;

a posterior component; and

an anterior component.

28. Apparatus according to claim 27 wherein the base comprises the at least one key.

29-34. -34. (canceled)

35. Apparatus for performing an open wedge, high tibial osteotomy, the apparatus comprising:

cutting apparatus for forming an osteotomy cut in the tibia, the cutting apparatus comprising;

targeting apparatus for identifying a cutting plane through the tibia and a boundary line for terminating a cut made along the cutting plane, wherein the boundary line is located within the tibia, parallel to the anterior-posterior slope of the tibia and at a selected angle to the sagittal plane of the patient.

36. Apparatus according to claim 35 wherein the selected angle is established by translating the boundary line a selected degree in a counter-clockwise fashion so as to produce a change in the anterior-posterior slope and a change in the lateral-medial slope.

37. Apparatus according to claim 35 wherein the selected angle is established by translating the boundary line a selected degree in a clockwise fashion so as to produce a change in the anterior-posterior slope and a change in the lateral-medial slope.

38. A method for performing an open wedge, high tibial osteotomy, the method comprising:

positioning targeting apparatus for identifying a cutting plane through the tibia and a boundary line for terminating a cut made along the cutting plane, wherein the boundary line is located within the tibia, parallel to the anterior-posterior slope of the tibia and at a selected angle to the sagittal plane of the patient;

cutting the bone along the cutting plane, with the cut terminating at the boundary line;

moving the bone on either side of the cut apart so as to form the wedge-like opening in the bone; and

stabilizing the bone.

39. A method according to claim 38 wherein the selected angle is established by translating the boundary line a selected degree in a counter-clockwise fashion so as to produce a change in the anterior-posterior slope and a change in the lateral-medial slope.

40. A method according to claim 38 wherein the selected angle is established by translating the boundary line a selected degree in a clockwise fashion so as to produce a change in the anterior-posterior slope and a change in the lateral-medial slope.