Methods for determining meniscal size and shape and for devising treatment

• US 8,932,363 B2
• Filed: 11/07/2003
• Issued: 01/13/2015
• Est. Priority Date: 11/07/2002
• Status: Active Grant

• Current Assignee: Conformis Incorporated
• Original Assignee: Conformis Incorporated
• Inventors: Tsougarakis, Konstantinos, Steines, Daniel, Vissa, Bhaskar Rao, Lang, Philipp, Linder, Barry J.
• Primary Examiner(s): Cumberledge, Jerry
• Application Number:
  US10/704,208
• Publication Number:
  US 20040147927A1
• Time in Patent Office: 4,085 Days
• Field of Search: 623 1711- 1716, 606/53, 606/60
• US Class Current: 623/20.14
• 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 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 5/4514 Cartilage
• CPC Class Codes: A61B 5/4528 Joints A61B5/4533, A61B5/4538 take precedence
• 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 2/32 for the hip
• CPC Class Codes: A61F 2/34 Acetabular cups
• CPC Class Codes: A61F 2/36 Femoral heads ; Femoral endoprostheses
• CPC Class Codes: A61F 2/38 for elbows or knees
• CPC Class Codes: A61F 2/3804 for elbows
• CPC Class Codes: A61F 2/40 for shoulders
• CPC Class Codes: A61F 2/4202 for ankles
• CPC Class Codes: A61F 2/4241 for hands, e.g. fingers
• CPC Class Codes: A61F 2/4261 for wrists
• CPC Class Codes: A61F 2/44 for the spine, e.g. vertebrae, spinal discs
• CPC Class Codes: A61F 2002/30133 kidney-shaped or bean-shaped
• CPC Class Codes: A61F 2002/30894 inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30943 using mathematical models
• CPC Class Codes: A61F 2002/30948 : using computerized tomography, i.e. CT scans
• CPC Class Codes: A61F 2002/30952 : using CAD-CAM techniques or NC-techniques
• CPC Class Codes: A61F 2230/0015 : Kidney-shaped, e.g. bean-shaped
• CPC Class Codes: G06T 7/0012 : Biomedical image inspection
• CPC Class Codes: Y10S 623/911 : Bone

Abstract

The present invention relates to methods for determining meniscal size and shape for use in designing therapies for the treatment of various joint diseases. The invention uses an image of a joint that is processed for analysis. Analysis can include, for example, generating a thickness map, a cartilage curve, or a point cloud. This information is used to determine the extent of the cartilage defect or damage and to design an appropriate therapy, including, for example, an implant. Adjustments to the designed therapy are made to account for the materials used.

Claims

1. A method of selecting an implant having an inner surface for attachment to a bone of a patient'"'"'s knee joint and an outer surface for providing an articular surface, the method comprising:

obtaining electronic image data of the knee joint;

generating a three dimensional representation of the knee joint;

deriving, from the three dimensional representation, a shape of articular tissue including cartilage of the knee joint;

determining one or more dimensions of a femoral condyle of the knee joint based on the three dimensional representation;

selecting the implant from a library of implants based on the one or more dimensions of the femoral condyle; and

adjusting one or more dimensions of the selected implant to achieve an optimal fit with the patient'"'"'s knee joint.

2. The method of claim 1, further including determining one or more dimensions of a tibial plateau of the knee joint based on the three-dimensional representation.

3. The method of claim 2, wherein the one or more dimensions of a tibial plateau are selected from the group consisting of an anterior-posterior length of the medial tibial plateau, an anterior-posterior length of the lateral tibial plateau, a medio-lateral width of the medial tibial plateau, a medio-lateral width of the lateral tibial plateau, and a distance from the tibial spine to an edge of the tibial plateau.

4. The method of claim 2, wherein the one or more dimensions of a tibial plateau are selected from the group consisting of an anterior-posterior length of the tibial plateau and a medio-lateral width of the tibial plateau.

5. The method of claim 2, wherein the one or more dimensions of a tibial plateau are selected from an anterior-posterior length of the medial tibial plateau, an anterior-posterior length of the lateral tibial plateau and a medio-lateral width of the tibial plateau.

6. The method of claim 1, including determining one or more dimensions of a medial condyle of the knee joint.

7. The method of claim 1, including determining one or more dimensions of a lateral condyle of the knee joint.

8. The method of claim 1, wherein the one or more dimensions of a femoral condyle are selected from the group consisting of an antero-posterior length of the medial femoral condyle, an antero-posterior length of the lateral femoral condyle, a medio-lateral width of the medial femoral condyle, a medio-lateral width of the lateral femoral condyle, an anterior-posterior distance of the femur, a superior-inferior distance of the femur, a medio-lateral distance of the femur, a distance from the trochlea to an edge of the femur;

and a width of the intercondylar notch.

9. The method of claim 1, wherein the one or more dimensions of a femoral condyle include at least two or more medio-lateral widths of a medial and/or a lateral femoral condyle.

10. The method of claim 1, wherein the one or more dimensions of a femoral condyle include at least two or more composite medio-lateral widths of the joint from a medial to a lateral femoral condyle.

11. The method of claim 1, further comprising:

deriving, from the three dimensional representation, a shape of articular tissue surrounding or adjacent articular tissue of the knee joint, wherein determining the one or more dimensions of a femoral condyle is further based, at least in part, on the derived shape of the surrounding or adjacent articular tissue.

12. The method of claim 11, further comprising determining one or more dimensions of a tibial plateau of the knee joint.

13. The method of claim 12, wherein the one or more dimensions of a tibial plateau is selected from the group consisting of an anterior-posterior length of the medial tibial plateau, an anterior-posterior length of the lateral tibial plateau, a medio-lateral width of the medial tibial plateau, a medio-lateral width of the lateral tibial plateau, and a distance from the tibial spine to an edge of the tibial plateau.

14. The method of claim 12, wherein the one or more dimensions of a tibial plateau include an anterior-posterior length of the medial tibial plateau, an anterior-posterior length of the lateral tibial plateau and a medio-lateral width of the tibial plateau.

15. The method of claim 1, further comprising:

deriving, from the three dimensional representation, a shape of articular tissue surrounding or adjacent diseased articular cartilage of the knee joint, wherein determining the one or more dimensions of a femoral condyle is derived, at least in part, based on subchondral bone underlying the cartilage or surrounding or adjacent articular tissue.

16. The method of claim 1, wherein the image data is obtained by one or more imaging techniques selected from the group consisting of MRI, CT, laser, ultrasound, digital tomosynthesis, optical coherence tomography, optical imaging and combinations thereof.

17. The method of claim 1, wherein the image data is obtained non-invasively.

18. A method of selecting an implant having an inner surface for attachment to a bone of a patient'"'"'s knee joint and an outer surface for providing an articular surface, the method comprising:

obtaining electronic image data of the knee joint;

generating a three dimensional representation of the knee joint;

deriving, from the electronic image data, a shape of articular tissue including cartilage of the knee joint;

determining, based at least in part on the three dimensional representation, one or more medio-lateral dimensions of a femoral condyle of the knee joint;

selecting the implant from a library of implants based on the one or more medio-lateral dimensions of the femoral condyle; and

adjusting one or more dimensions of the selected implant to achieve an optimal fit with the patient'"'"'s knee joint.

19. The method of claim 18, wherein the one or more medio-lateral dimensions of a femoral condyle include at least two or more medio-lateral widths of a medial and/or a lateral femoral condyle.

20. The method of claim 18, wherein the one or more dimensions of a femoral condyle include at least two or more composite medio-lateral widths of the joint from a medial to a lateral femoral condyle.

21. The method of claim 18, further including determining one or more dimensions of a femoral condyle selected from the group consisting of an antero-posterior length of the medial femoral condyle, an antero-posterior length of the lateral femoral condyle, a medio-lateral width of the medial femoral condyle, a medio-lateral width of the lateral femoral condyle, an anterior-posterior distance of the femur, a superior-inferior distance of the femur, a medio-lateral distance of the femur, a distance from the trochlea to an edge of the femur;

and a width of the intercondylar notch.

22. A method of selecting a tibial implant having an inner surface for attachment to a bone of a patient'"'"'s knee joint and an outer surface for providing an articular surface, the method comprising:

obtaining electronic image data of the knee joint;

generating a three dimensional representation of the knee joint;

deriving, from the three dimensional representation, a shape of articular tissue including cartilage of the knee joint;

determining one or more dimensions of a tibial plateau of the knee joint based on the three-dimensional representation;

selecting the implant from a library of implants based on the one or more dimensions of the tibial plateau; and

adjusting one or more dimensions of the selected implant to achieve an optimal fit with the patient'"'"'s knee joint.

23. The method of claim 22, further comprising determining one or more dimensions of a femoral condyle of the knee joint based on the three dimensional representation.

24. The method of claim 23, wherein the one or more dimensions of a femoral condyle include one or more medio-lateral dimensions of a medial and/or a lateral condyle.

25. The method of claim 23, wherein the one or more dimensions of a femoral condyle include at least two or more medio-lateral widths of a medial and/or a lateral femoral condyle.

26. The method of claim 23, wherein the one or more dimensions of a femoral condyle include at least two or more composite mediolateral widths of the joint from a medial to a lateral femoral condyle.

27. The method of claim 22, comprising determining one or more dimensions of a medial and/or a lateral condyle of the knee joint based on the three dimensional representation.

28. The method of claim 27, wherein the one or more dimensions of a femoral condyle is selected from the group consisting of an antero-posterior length of the medial femoral condyle, an antero-posterior length of the lateral femoral condyle, a medio-lateral width of the medial femoral condyle, a medio-lateral width of the lateral femoral condyle, an anterior-posterior distance of the femur, a superior-inferior distance of the femur, a medio-lateral distance of the femur, a distance from the trochlea to an edge of the femur;

and a width of the intercondylar notch.

29. The method of claim 22, wherein the one or more dimensions of a tibial plateau include an anterior-posterior length of the medial tibial plateau, an anterior-posterior length of the lateral tibial plateau and a medio-lateral width of the tibial plateau.

30. The method of claim 22, wherein the one or more dimensions of a tibial plateau is selected from the group consisting of an anterior-posterior length of the medial tibial plateau, an anterior-posterior length of the lateral tibial plateau, a medio-lateral width of the medial tibial plateau, a medio-lateral width of the lateral tibial plateau, and a distance from the tibial spine to an edge of the tibial plateau.