Method for treating joint pain and associated instruments
First Claim
1. A method of subchondrally accessing an area in or adjacent to a bone marrow lesion in a subchondral region of a proximal tibia, the method comprising:
- identifying a bone marrow lesion in a subchondral region of a proximal tibia, the subchondral region occurring under an articular surface of the proximal tibia;
providing a guide instrument positioned adjacent the proximal tibia with a tip of a probe of the guide instrument contacting a location on the articular surface of the proximal tibia and with a first opening in the guide instrument being in receipt of an access tool that is advanceable through the first opening for entry into the proximal tibia, wherein the tip of the probe contacting said location establishes a targeted delivery site in the subchondral region of the proximal tibia, the targeted delivery site spaced a distance from the tip of the probe and located in an area of the subchondral region in or adjacent to the bone marrow lesion; and
advancing the access tool through the first opening and into the proximal tibia, wherein the first opening guides the access tool to the targeted delivery site in a first direction and in a manner that preserves an existing condition of the articular surface of the proximal tibia.
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Abstract
The embodiments provide provides devices, instruments, and associated methods for treating joint pain. A joint is evaluated using magnetic resonance imaging to detect any defects in the subchondral bone. For example, using T2-weighted MRI images, bone marrow lesions or edemas can be identified, and using T1-weighted MRI images, associated regions of sclerotic bone adjacent to the bone marrow lesion can be identified. The treatment method may involve introducing a bone void filler material at the site to address the bone marrow lesion or edema, and/or drilling and inserting an implant to address the sclerotic bone, bone marrow lesion or edema, and insufficiency or stress fractures. An access path is mapped to a location in the subchondral region where the insufficiency fracture resides. The access path attempts to preserve an articular surface of the joint. A reinforcing member that stabilizes the insufficiency fracture is then implanted via the access path.
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Citations
21 Claims
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1. A method of subchondrally accessing an area in or adjacent to a bone marrow lesion in a subchondral region of a proximal tibia, the method comprising:
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identifying a bone marrow lesion in a subchondral region of a proximal tibia, the subchondral region occurring under an articular surface of the proximal tibia; providing a guide instrument positioned adjacent the proximal tibia with a tip of a probe of the guide instrument contacting a location on the articular surface of the proximal tibia and with a first opening in the guide instrument being in receipt of an access tool that is advanceable through the first opening for entry into the proximal tibia, wherein the tip of the probe contacting said location establishes a targeted delivery site in the subchondral region of the proximal tibia, the targeted delivery site spaced a distance from the tip of the probe and located in an area of the subchondral region in or adjacent to the bone marrow lesion; and advancing the access tool through the first opening and into the proximal tibia, wherein the first opening guides the access tool to the targeted delivery site in a first direction and in a manner that preserves an existing condition of the articular surface of the proximal tibia. - View Dependent Claims (2, 3, 4, 5, 6, 7)
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8. An instrument for guiding one or more tools to a subchondral region of a proximal tibia, the proximal tibia having an articular surface, the instrument comprising:
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an upper instrument portion that incorporates a first guide section, the first guide section including a first opening that extends through the upper instrument portion for allowing passage of a first access tool through the upper instrument portion for guiding the first access tool, in a first direction and in a manner that preserves an existing condition of the articular surface of the proximal tibia, to an area in or adjacent to a bone marrow lesion in a subchondral region of a proximal tibia; a reference probe that extends from the upper instrument portion and which includes a leading tip positionable on the articular surface of the proximal tibia; and a lower instrument portion that incorporates a second guide section, the second guide section including a second opening that extends through the lower instrument portion for allowing passage of a second access tool through the lower instrument portion for guiding the second access tool, in a second direction and in a manner that preserves an existing condition of the articular surface of the proximal tibia, to the area in or adjacent to the bone marrow lesion in the subchondral region of the proximal tibia, wherein said second direction is angled acutely relative to said first direction. - View Dependent Claims (9, 10, 11, 12, 13, 14)
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15. A method of subchondrally accessing a targeted delivery site in a subchondral region of a proximal tibia, the method comprising:
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identifying a cartilage defect on an articular surface of the proximal tibia; providing a guide instrument positioned adjacent the proximal tibia with a tip of a probe of the guide instrument contacting the cartilage defect and with a first opening in the guide instrument being in receipt of an access tool that is advanceable through the first opening for entry into the proximal tibia, wherein the tip of the probe contacting the cartilage defect establishes a targeted delivery site in a subchondral region of the proximal tibia, the targeted delivery site spaced a distance from the tip of the probe; and advancing the access tool through the first opening and into the proximal tibia, wherein the first opening guides the access tool to the targeted delivery site in a first direction and in a manner that preserves an existing condition of the articular surface of the proximal tibia. - View Dependent Claims (16, 17, 18, 19, 20, 21)
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Specification