INSTRUMENTS FOR USE IN FEMOROACETABULAR IMPINGEMENT PROCEDURES

• US 20120046526A1
• Filed: 08/15/2011
• Published: 02/23/2012
• Est. Priority Date: 08/21/2010
• Status: Active Grant

• Current Assignee: New York Society For The Ruptured and Crippled Manufacturing The Hospital For Special Surgery
• Original Assignee: New York Society For The Ruptured and Crippled Manufacturing The Hospital For Special Surgery
• Inventors: Lipman, Joseph, Boettner, Friedrich
• Granted Patent: US 9,119,644 B2
• Time in Patent Office: Days
• US Class Current: 600/210
• CPC Class Codes: A41H 31/005 Thread-cutting or seam-ripping tools
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 17/15 Guides therefor arrangements for guiding straight saw blades in general B23D51/025
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1659 Surgical rasps, files, planes, or scrapers
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1746 for the acetabulum
• CPC Class Codes: A61B 17/1796 for holes for sutures or flexible wires
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/00862 elastic or resilient for sutures A61B2017/0618
• CPC Class Codes: A61B 2017/00902 transparent or translucent
• CPC Class Codes: A61B 2017/00907 for light
• CPC Class Codes: A61B 2017/0275 for the hip
• CPC Class Codes: A61B 2017/06019 by means of a suture-receiving lateral eyelet machined in the needle lateral opening for attaching suture to suture anchor A61B2017/0414

Abstract

Improved instruments (tools) and surgical techniques are provided for use in surgical procedures that treat femoroacetabular impingement of both the Cam and Pincer types.

Claims

1. An anchor drill guide for use in a surgical treatment of acetabular (pincer) impingement comprising:

an elongated main body that has a distal end and has a bore formed therein that is open at the distal end, the main body having an inner edge and an outer edge;

a pointed tip portion that is at the distal end of the main body and is formed along the outer edge for stable alignment of the guide on a bone without impeding rotation of the guide;

a rounded tip portion that is formed along the inner edge of the main body at this distal end thereof for retracting the labrum into an inner recess, wherein the pointed tip portion is more distal than the rounded tip portion; and

a contoured tip portion that is joined to inner edge of the main body such that the contoured tip extends outwardly from the inner edge of the main body and distally beyond the sharp tip portion and the inner recess is defined between the main body and the contoured tip portion, the contoured tip portion for resting on cartilage.

2. The anchor drill guide of claim 1, wherein the main body comprises a tubular structure that is open both at the distal end and an opposite proximal end.

3. The anchor drill guide of claim 1, wherein the contoured tip portion is connected to the inner edge of the main body by a curved arm that has a portion that extends in a direction that is parallel to a longitudinal axis of the main body.

4. The anchor drill guide of claim 1, wherein the contoured tip portion has a truncated spherical shape, with a flat surface thereof facing away from the pointed tip portion and a spherical surface facing the pointed tip portion.

5. The anchor drill guide of claim 1, wherein the bore is formed between the rounded tip portion and the pointed tip portion.

6. The anchor drill guide of claim 1, wherein the contoured tip portion has a spherical shape.

7. The anchor drill guide of claim 1, wherein the bore is sized to receive each of a drill bit and a bone anchor.

8. The anchor drill guide of claim 1, wherein a maximum height of the guide as measured from the bottom edge of the main body to a top edge of the contoured tip portion is approximately 8.5 mm.

9. The anchor drill guide of claim 1, wherein an offset distance from the pointed tip portion to a spherical head of the contoured tip portion is about 5.25 mm.

10. A Cam resection guide for evaluating a spherical contour of a bone that has undergone a Cam resection comprising:

a handle having a distal end; and

a tip member that is coupled to the distal end of the handle such that the tip member can both rotate and pivot relative to the handle, the tip member having a spherical shaped bottom surface for evaluating the spherical contour of the bone by being moved therealong.

11. The Cam resection guide of claim 10, wherein the tip member is constructed so that at least a portion of the underlying bone is visible therethrough.

12. The Cam resection guide of claim 11, wherein the tip member is formed of a transparent material.

13. The Cam resection guide of claim 10, wherein the tip member includes at least one through opening formed therein to permit visualization of the underlying bone.

14. The Cam resection guide of claim 13, wherein the tip member includes a first window formed on one side of a spherical joint that couples the tip member to the handle and a pair of second windows formed on an opposite side of the spherical joint.

15. The Cam resection guide of claim 13, further including a pair of suture attachment holes formed through the tip member to permit sutures to be applied therethrough.

16. The Cam resection guide of claim 10, wherein the tip member can be flexed up to about 50 degrees relative to the handle.

17. The Cam resection guide of claim 10, wherein the tip is disposable and is removably coupled to the handle by a spherical joint.

18. The Cam resection guide of claim 17, wherein the distal end of the handle where the spherical joint is located has a flattened surface to cause a truncation of an outer contour of the spherical joint and permit the guide to be received within a cannula having a diameter of about 8.5 mm.

19. A microfracture pick for use in a microfracture procedure performed on a subchondral bone comprising:

an elongated curved handle having a distal end;

a pointed tip portion formed at the distal end of the handle for facilitating entry into the bone and producing a hole therein, wherein the pointed tip portion has an arcuate contour; and

a rounded buttress tip portion that is offset from the pointed tip portion and is located proximal thereto such that an arcuate shaped inner edge of the pointed tip portion faces the rounded buttress tip portion, the rounded buttress tip for resting on a side of the acetabulum and providing a buttress so that the pointed tip portion is prevented from sliding in a direction of the handle.

20. The microfracture pick of claim 19, wherein the handle has curved portion proximal and adjacent the rounded buttress tip and pointed tip portion to allow the pick to be placed around a contour of a femoral head and aid in positioning the pointed tip portion perpendicular to the bone.

21. The microfracture pick of claim 19, wherein the rounded buttress tip portion comprises a truncated spherical shape tip.

22. The microfracture of claim 19, wherein the offset between the pointed tip portion and the rounded buttress tip determines a depth of penetration and where a microfracture hole is placed in relation to a rim of the acetabulum.

23. The microfracture of claim 19, wherein the handle includes an impaction surface on an outside portion thereof that is angled to help direct an applied force in the direction of the pointed tip portion towards the bone.

24. The microfracture pick of claim 19, wherein the arcuate shaped inner edge of the pointed tip portion extends to the rounded buttress tip.

25. The microfracture pick of 19, wherein the pointed tip portion has a circular contour that orients a sharp distal end of the pointed tip portion more perpendicular to a surface of the bone.

26. An inflatable space holder for placement in a peripheral space formed by a femoral neck and a joint capsule comprising:

a flexible, inflatable body having an outer surface and a tip, wherein the tip includes a pocket for receiving a flexible tool for directing the inflatable body around the femoral neck;

a conduit that is fluidly connected to an interior of the inflatable body; and

an inlet valve that is associated with the conduit for inflation of the inflatable body;

wherein the inflatable body, in a deflated state, the conduit, and the inlet valve are sized to fit through a cannula that has a diameter between about 4.5 mm and 8.5 mm.

27. The inflatable space holder of claim 26, wherein the inflatable body is preshaped to fit around the femoral neck.

28. The inflatable space holder of claim 26, wherein the outer surface of the inflatable body has rough surface structures to make the outer surface rougher, increase friction on the femoral neck and minimize movement of the inflatable body after its insertion, during inflation of the inflatable body and after inflation of the inflatable body.

29. The inflatable space holder of claim 26, wherein the condui comprises tubing.

30. The inflatable space holder of claim 26, wherein the inlet valve is configured to mate with a syringe for inflating the inflatable body with a fluid.

31. A self retaining capsule retractor for maintaining a joint capsule in an open position comprising:

a ring-shaped member having a central opening and a plurality of blade openings formed radially about the central opening; and

a plurality of independently movable retractor blades that can be of different lengths, each blade having a proximal end that is received within one blade opening such that rotation of the blade is prevented, wherein each blade has an angled portion that terminates in a distal end of the blade.

32. The capsule retractor of claim 31, wherein each blade opening has a hexagonal shape and the proximal end of the blade has a complementary hexagonal shape.

33. The capsule retractor of claim 31, wherein there are three blades, each blade being configured to fit into any of the blade openings.

34. The capsule retractor of claim 31, wherein the distal end of the blade includes a plurality of sharp, slightly curved spikes.

35. The capsule retractor of claim 31, wherein the blade comprises a rigid member.

36. The capsule retractor of claim 31, wherein the central opening is sized to receive one or more tools that are directed into a peripheral space formed between a femoral neck and the joint capsule.