METHODS AND APPARATUS FOR ASSISTING CARTILAGE DIAGNOSTIC AND THERAPEUTIC PROCEDURES

• US 20100256504A1
• Filed: 09/24/2008
• Published: 10/07/2010
• 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: Perception Raisonnement Action en Medecine
• Inventors: Adler, Ronald S., Moreau-Gaudry, Alexandre Marie, Cinquin, Philippe, Plaskos, Christopher, Granchi, Carinne
• Granted Patent: US 10,028,722 B2
• Time in Patent Office: Days
• US Class Current: 600/476
• 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 method of diagnosing and treating articular cartilage diseases by means of a surgical procedure comprising the steps of:

providing a three-dimensional (3D) osteo-cartilaginous model;

acquiring cartilage data with at least one tracked tool;

extracting at least one parameter from the acquired cartilage data that is indicative of the health of the cartilage;

incorporating the at least one parameter into the three-dimensional osteo-cartilaginous model;

navigating acquisition and treatment tools and instruments with respect to the three-dimensional osteo-cartilaginous model; and

updating the three-dimensional osteo-cartilaginous model during the surgical procedure.

2. The method of claim 1, wherein the three-dimensional osteo-cartilaginous model comprises a model that includes cartilage data and bone data, including the morphology (geometry) of cartilage, cartilage layers, bone and subchondral bone surfaces.

3. The method of claim 1, wherein the at least one morphological parameter selected from the group consisting of:

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, pathological vascularization, or the at least one parameter is a biomechanical property, an area ratio, or a detection of flaws in the cartilage.

4. The method of claim 1, further including the step of quantifying at least one of the following parameters:

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 method of claim 1, wherein the step of providing a three-dimensional (3D) osteo-cartilaginous model includes generating a rigid model that 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 method of claim 1, wherein the step of providing a three-dimensional (3D) osteo-cartilaginous model includes generating a deformable model that is registered to the patient using deformation techniques including bone morphing techniques resulting in the 3D model being created at the time of surgery.

7. The method of claim 1, wherein the step of providing a three-dimensional (3D) osteo-cartilaginous model includes the step of generating 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 step of acquiring data includes the step of acquiring images of the cartilage using one or more tracked tool, wherein the acquired cartilage images are segmented such that the external cartilage surface and the internal cartilage surface are identified, with positions of these segments being known in a bone coordinate system.

8. The method of claim 1, further including the steps of:

visually displaying the extracted parameter on the 3D model in real time as the parameter is extracted.

9. The method of claim 8, wherein the step of displaying the extracted parameter utilizes 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 method of claim 8, further including the step of highlighting on the 3D model regions where sufficient data has been acquired and regions where an insufficient amount of data has been acquired to assist and guide the surgeon in acquiring cartilage data.

11. The method of claim 1, further including the step of:

computing and displaying a synthetic cartilage quality score that is based on the at least one acquired parameter.

12. The method of claim 11, wherein the step of computing the score comprises taking into account two or more acquired parameters such that the computed score is based on the two or more acquired parameters.

13. The method of claim 12, wherein the computed score is based on a thickness of the cartilage and a depth or size of an observed cartilage defect and a surface cartilage grade is computed.

14. The method of claim 1, wherein the model is continuously updated in real time as cartilage data is acquired with the tracked tool, as the parameter is extracted, as the parameter is incorporated into a 3D model, and as acquisition and treatment tools are navigated.

15. The method of claim 1, wherein the tool comprises a three-dimensional tracked ultrasound probe and the at least one parameter comprises a surface roughness of the cartilage.

16. The method of claim 1, wherein the tool comprises a three-dimensional tracked ultrasound probe and the at least one parameter comprises a thickness of the cartilage.

17. The method of claim 1, wherein the tool comprises a three-dimensional tracked calibrated endoarticular optical coherence tomography probe and the at least one parameter comprises a surface roughness of the cartilage.

18. The method of claim 1, wherein the tool comprises a three-dimensional tracked endoarticular infrared probe and the at least one parameter is acquired by emitting infrared light, receiving reflected infrared light, computing an averaged spectroscopic signal, analyzing peaks of the signal and expressing the health of the cartilage based on a ratio defined by (detected signal peak) (cm⁻

1) and 1338 cm<sup>−

1</sup>.

19. The method of claim 1, wherein the tool comprises a three dimensional tracked endoarticular fluorescent imaging system and the at least one parameter is acquired by introducing marked molecules (cytokines) into a target cartilage area of the patient and detecting the cytokines 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, wherein the degree of reflected fluorescence light based on the number of detected marked molecules is indicative of the health of the target cartilage area.

20. The method of claim 1, including the step of mapping the at least one parameter onto the 3D model in real time as the surgery proceeds to assist the surgeon in deciding a course of action.

21. The method of claim 1, wherein the at least one tracked tool is selected from the group consisting of:

a 3D tracked pointer, a 3D tracked arthroscope, a 3D tracked calibrated endoarticular optical coherence tomography probe, a 3D tracked endoarticular infrared probe, a tracked endoarticular interferometric non-destructive laser imaging system, a 3D tracked endoarticular fluorescent imaging system.

22. A method of diagnosing and treating articular cartilage diseases comprising the steps of:

providing a tracked endoarticular interferometric non-destructive laser imaging system including a source of coherent or partially coherent light, a radiation receiving apparatus, a device for applying stress to cartilage tissue and a computer system in communication therewith,

radiating a surface of cartilage tissue with the light from the source;

receiving and recording at the radiation receiving apparatus light that has been reflected by the cartilage surface, the apparatus recording a reflected light pattern;

applying a load to the cartilage tissue to determine the cartilage stiffness and to cause the cartilage tissue to deform resulting in a different reflected light pattern being recorded at the radiation receiving apparatus; and

analyzing the different recorded reflected light patterns using the computer to generate cartilage data that is conveyed to a surgeon to assist diagnosing and treating the articular cartilage disease.

23. The method of claim 22, wherein the cartilage data comprises an image of potential flaws inside the cartilage tissue.

24. The method of claim 22, further including the step of:

displaying the cartilage data on a three-dimensional osteo-cartilaginous model.

25. A system for computer-assisted orthopedic surgery and configured for performing joint preserving and cartilage restoration procedures comprising:

a means for providing a three-dimensional (3D) osteo-cartilaginous model;

at least one tracked tool that is configured to acquire cartilage data;

a computer system that is configured to;

(a) extract at least one morphological parameter from the acquired cartilage data, the at least one parameter being indicative of a quality (health) of the cartilage, (b) incorporate the at least one parameter into the 3D model; and

at least one acquisition and treatment instrument that is operably coupled to the computer system and which is navigated based on the 3D model;

wherein the computer system continuously updates the 3D model in real-time as the procedure progresses.

26. The system of claim 25, wherein the three-dimensional osteo-cartilaginous model comprises a model that includes cartilage data and bone data, including the morphology (geometry) of cartilage, cartilage layers, bone and subchondral bone surfaces.

27. The system of claim 25, wherein the at least one morphological parameter selected from the group consisting of:

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, pathological vascularization, or the at least one parameter is a biomechanical property, an area ratio, or a detection of flaws in the cartilage.

28. The system of claim 25, wherein the computer includes software that is configured to quantify at least one of the following parameters:

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.