SYSTEM AND METHOD FOR INTEROSSEOUS LIGAMENT RECONSTRUCTION

• US 20190099192A1
• Filed: 10/02/2017
• Published: 04/04/2019
• Est. Priority Date: 10/02/2017
• Status: Active Grant

• Current Assignee: Robin Kamal
• Original Assignee: Robin Kamal
• Inventors: Kamal, Robin
• Granted Patent: US 10,639,050 B2
• Time in Patent Office: Days
• CPC Class Codes: A61B 17/1782 for the hand or wrist
• CPC Class Codes: A61B 17/7291 for small bones, e.g. in the foot, ankle, hand or wrist
• CPC Class Codes: A61F 2/0811 Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2/28 Bones joints A61F2/30

Abstract

A method for interosseous ligament reconstruction (e.g., of a scapholunate or lunotriquetral ligament) includes drilling holes through both of the bones to allow for a graft to be placed on the volar and dorsal aspects of the bones, replicating the normal anatomic structure of the interosseous ligament, while requiring only an incision on the dorsal side of the wrist. The method includes using a drill guide that directs the drill to place a drill hole from dorsal to volar (front to back) in the bone, while making sure the drilled hole is within the joint on the volar side. The drill guide includes a hollow guide tube to advance a drill through, the hollow tube movably coupled to a shaft of the drill guide with a distal end that generally aligns with the distal end of the hollow tube. The shaft can have a sharp end that the drill will meet if passed through the drill guide, the sharp end of the drill guide being either hollow or solid, and can serve to release part of the wrist capsule (volar extrinsic carpal ligaments) from the bone in order to keep the drill hole within the wrist joint (and not outside of the joint).

Claims

1. A drill guide for use in interosseous ligament reconstruction of a wrist, comprising:

a monolithic shaft having a proximal portion that extends along a central axis the shaft and a curved distal portion that extends to a distal end that includes a pointed lateral edge defined by an acute angle between a distal edge of the distal end and a circumferential side surface of the distal end and a medial edge defined by an obtuse angle between the distal edge of the distal end and the circumferential side surface of the distal end, the distal edge defined by a plane that extends substantially perpendicular to the central axis of the shaft; and

a monolithic hollow tube extending along a central axis from a proximal end to a distal end and having a bore configured to receive a drill bit therethrough, the hollow tube laterally spaced apart from the shaft, the distal end of the hollow tube axially spaced from the distal end of the shaft to define an adjustable opening therebetween configured to receive a human wrist therein, the hollow tube being movably coupled relative to the shaft and selectively movable by a user to adjust the size of the opening about the user'"'"'s wrist such that the distal end of the hollow tube contacts a dorsal side of a wrist bone and the distal edge of the shaft is positionable proximal a volar side of the wrist bone,

wherein the pointed lateral edge of the distal end of the shaft is actuatable by a user to release ligaments from the volar side of the wrist bone to allow the drill bit to be extended through the hollow tube and through the wrist bone to the distal edge of the shaft while avoiding ligaments and nerves on the volar side of the wrist.

2. The drill guide of claim 1, wherein the shaft is hollow along its entire length, and wherein the distal edge of the shaft defines an opening in the distal end of the shaft configured to receive the drill bit therein.

3. The drill guide of claim 1, wherein one or both of the distal end of the shaft and distal end of the hollow tube are made of a radiopaque material.

4. The drill guide of claim 3, wherein a remainder of the shaft and hollow tube are made of a radiolucent material.

5. The drill guide of claim 1, wherein the plane is substantially perpendicular to the central axis of the hollow tube.

6. The drill guide of claim 2, wherein the shaft is configured to receive a suture therethrough to direct the suture through one or more holes formed in the wrist bone.

7. The drill guide of claim 1, further comprising a handle coupled to a proximal end of the shaft.

8. A method for interosseous ligament reconstruction of a wrist, comprising:

making an incision on a dorsal side of the wrist;

securing a drill guide about the wrist so that a distal end of a hollow tube is adjacent the dorsal side of a wrist bone and so that a distal edge of a shaft is proximal a volar side of the wrist bone;

extending a drill bit through the hollow tube and the wrist bone to the distal edge of the shaft to drill a hole through the wrist bone;

repositioning the drill guide about the wrist so that the distal end of the hollow tube is adjacent the dorsal side of an adjacent wrist bone and so that the distal edge of the shaft is proximal a volar side of the adjacent wrist bone;

extending the drill bit through the hollow tube and the adjacent wrist bone to the distal edge of the shaft to drill a hole through the adjacent wrist bone;

passing a graft material through the hole in the wrist bone from the dorsal side to the volar side, then through the hole in the adjacent wrist bone from the volar side to the dorsal side;

bringing the wrist bone and adjacent wrist bone together into their normal anatomic position;

fixing the ends of the graft material to create a closed circle or loop of the graft; and

closing the incision on the dorsal side of the wrist.

9. The method of claim 8, wherein securing includes confirming the position of the drill guide under fluoroscopy.

10. The method of claim 8, wherein securing includes movably adjusting the hollow tube relative to the shaft so that the distal end of the hollow tube is locked against the dorsal side of the wrist bone and the distal edge of the shaft is locked proximal the volar side of the wrist bone.

11. The method of claim 8, wherein securing includes releasing a wrist capsule from a volar wrist bone so that the hole is drilled within the wrist joint and avoids ligaments and nerves on the volar side of the wrist.

12. The method of claim 8, wherein drilling includes extending the drill bit through the bone until the end of the drill bit contacts the distal end of the shaft.

13. The method of claim 8, wherein drilling includes extending the drill bit under fluoroscopy to confirm a trajectory of the drill bit.

14. The method of claim 8, wherein the graft material is chosen from a group consisting of an autograft, an allograft, a xenograft, and a synthetic material.

15. The method of claim 8, wherein passing includes passing the graft material through a bore of the shaft, out the distal end of the shaft and through the wrist bone from the volar side to the dorsal side.

16. The method of claim 8, wherein bringing includes pulling two ends of the graft material together to bring the wrist bone and adjacent wrist bone together.

17. The method of claim 8, wherein prior to extending the drill bit through the hollow tube, a sleeve is extended through the hollow tube and a wire is extended through the sleeve and at least partially into bone to confirm the path of the drill bit based upon the orientation of the wire.

18. The method of claim 17, wherein the drill bit is cannulated and the drill bit is extended over the wire and into the bone.