EP1027001A1 - Procede et instruments de reparation de defauts cartilagineux et osteo-cartilagineux - Google Patents

Procede et instruments de reparation de defauts cartilagineux et osteo-cartilagineux

Info

Publication number
EP1027001A1
EP1027001A1 EP98944954A EP98944954A EP1027001A1 EP 1027001 A1 EP1027001 A1 EP 1027001A1 EP 98944954 A EP98944954 A EP 98944954A EP 98944954 A EP98944954 A EP 98944954A EP 1027001 A1 EP1027001 A1 EP 1027001A1
Authority
EP
European Patent Office
Prior art keywords
cartilage
instrument
instruments
tissue
defect
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP98944954A
Other languages
German (de)
English (en)
Inventor
Roland Peter Jakob
Emanuel Gautier
Christoph Saager
Pierre Mainil-Varlet
Manfred Zech
Werner MÜLLER-GLAUSER
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Zimmer GmbH
Original Assignee
Zimmer GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Zimmer GmbH filed Critical Zimmer GmbH
Publication of EP1027001A1 publication Critical patent/EP1027001A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/1604—Chisels; Rongeurs; Punches; Stamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/90—Identification means for patients or instruments, e.g. tags
    • A61B90/92—Identification means for patients or instruments, e.g. tags coded with colour
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30756—Cartilage endoprostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4618—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of cartilage
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/0233—Pointed or sharp biopsy instruments
    • A61B10/025—Pointed or sharp biopsy instruments for taking bone, bone marrow or cartilage samples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/062—Measuring instruments not otherwise provided for penetration depth
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/3094—Designing or manufacturing processes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30108—Shapes
    • A61F2002/30199—Three-dimensional shapes
    • A61F2002/30224—Three-dimensional shapes cylindrical
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30756—Cartilage endoprostheses
    • A61F2002/30759—Mosaicplasty, i.e. using a plurality of individual cartilage plugs for filling a substantial cartilage defect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/30756—Cartilage endoprostheses
    • A61F2002/30764—Cartilage harvest sites
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4658—Measuring instruments used for implanting artificial joints for measuring dimensions, e.g. length
    • A61F2002/4661—Measuring instruments used for implanting artificial joints for measuring dimensions, e.g. length for measuring thickness
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4662—Measuring instruments used for implanting artificial joints for measuring penetration depth
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063—Three-dimensional shapes
    • A61F2230/0069—Three-dimensional shapes cylindrical

Definitions

  • the invention is in the field of medical technology and relates to methods and instruments according to the preambles of the corresponding claims.
  • the methods and instruments are used to repair endochondral and osteochondral defects, in particular defects that affect articular cartilage or articular cartilage and underlying bone tissue.
  • Defects in the articular cartilage or defects that affect the articular cartilage and underlying bone tissue are repaired according to the prior art by filling them with artificial, possibly vital cells-containing materials, by implanting in vitro grown cartilage tissue or by cartilage tissue in intact, advantageously unstressed areas removed and implanted as an auto-graft at the defective site, in particular the auto-grafts are mostly columns with an outer end of the cartilage and an inner end of the bone. In the case of larger defects, a plurality of such columns are usually implanted side by side in a mosaic-like manner.
  • tissue columns For implanting tissue columns, cylindrical openings are defined as precisely as possible in the area of the defect, a tissue cylinder being punched out or drilled out and then separated by turning at its base, or a cutting drill being used. Tissue columns are then removed from an unloaded joint (for example, the condylar region of the femur), the diameter of which is slightly larger than the inside diameter of the openings in the area of the defect. The tissue columns to be removed are drilled out with a hollow drill and then separated by turning the base. The removed tissue columns are then inserted into the defect openings, whereby a so-called "press fit" is created thanks to the different diameters, by means of which the columns are held in the openings. The openings resulting from the removal of the columns are usually filled with the material which has been removed from the defect, if this material is in good health, or they are closed by inserting artificial materials or material grown in vitro.
  • tubular instruments are usually used, which have an annular cutting edge on one end face and are equipped for holding and guiding at the other end .
  • an instrument advantageously has corresponding windows. The punched material is cut to the inside diameter of the
  • the invention is based on the object of known methods and instrument sets for repairing cartilage defects or defects affecting cartilage and underlying bone tissue, in particular articular cartilage defects, by implanting or transplanting vital tissue in the form of a column in order to increase the chances of success to improve.
  • the methods and instruments according to the invention are intended to make it possible to increase the precision of the repair while at the same time treating the manipulated tissue very gently.
  • the instruments according to the invention should nevertheless be easy to manufacture and, in particular, easy to handle.
  • the methods and devices according to the invention should in particular be suitable for repairing larger defects using a mosaic method, but of course they should at least partially also be applicable for small defects that can be repaired with only one implant.
  • the precision of the positioning and parallelism of the cylindrical openings produced in the region of the defect is increased. This is accomplished by creating the openings using appropriate gauges. This measure generally prevents tissue columns implanted in the openings from pressing against one another and thereby being exposed to additional loads, and it is ensured that each implanted column is at least in the area in which it is anchored in healthy tissue as completely as possible from native Tissue is surrounded, which improves wound healing.
  • the topography of the original, i.e. healthy or defect-free cartilage surface is reproduced with improved precision.
  • the axial length of the tissue columns to be implanted and, if possible, also the orientation of the cartilage surface relative to the column axis are specifically aligned to the cartilage surface to be simulated. This measure is particularly important in the case of relatively large defects that can be repaired with a plurality of implant columns. The better the original cartilage surface is simulated, the more evenly the surfaces of the individual implants are loaded when the repaired joint is used, and the more evenly is the total load distributed to the individual implants.
  • the cartilage surface of the repaired defect is made more gapless and also connected more seamlessly to the native cartilage.
  • the gaplessness of the cartilage surface is realized with a combination of transplanted or implanted tissue columns with in vitro grown cartilage tissue, with the gaps between the implanted
  • Tissue columns and possibly also gaps between the tissue columns and the native cartilage are filled.
  • a gapless cartilage surface encourages the implant and native cartilage to grow together and prevents consequential damage that can occur due to the fact that synovial fluid due to gaps in the
  • Cartilage layer reaches the underlying bone tissue. This measure is also important for larger defects that can be repaired with a plurality of graft columns, while the "press fit" already mentioned at the beginning is sufficient for small defects.
  • the material to be implanted is treated gently during harvesting as well as during implantation and in particular without pressure, so that uncontrolled deformations of the tissue column grafts and possibly the implant parts grown in vitro are avoided and the precision of the repair is also improved thereby.
  • the implanted tissue columns are advantageously autotransplants removed from an unloaded area for all cases, but can also consist of a bone substitute material on which cartilage tissue was previously grown in vitro.
  • Such columns to be implanted are also advantageously produced during the repair operation from appropriately prepared pieces by punching out or drilling out (hollow drill).
  • the methods and instruments according to the invention are suitable both for repair operations which are carried out as open surgery and for arthroscopy.
  • Figure 1 is a schematic representation of a known
  • FIG. 2 shows an exemplary embodiment of a teaching for creating the openings in the area of a defect to be repaired according to FIG. 1,
  • FIG. 3 shows a schematic representation of a cartilage defect to explain the improvement aspect of the reconstruction of the original cartilage surface by means of the corresponding axial length of tissue columns to be implanted and an example of a teaching for the reconstruction of the original cartilage surface
  • FIG. 4 shows an exemplary embodiment of an instrument for determining the distance between the original cartilage surface and the base area of a created opening in the area of a defect to be repaired according to FIG. 3, Figure 5 and
  • FIG. 6 shows schematic representations of a cartilage defect (FIG. 5) and a removal point (FIG. 6) to explain the
  • FIG. 7 shows an exemplary embodiment of an instrument for removing and implanting tissue columns with a predetermined angle ⁇ between the cartilage surface and the column axis
  • FIG. 8 shows a teaching according to FIG. 2 equipped for the implantation of tissue columns in a predetermined rotational position
  • FIG. 10 shows schematic representations of a repaired cartilage defect as a top view (FIG. 9) and in section (FIG. 10) to explain the improvement aspect of the gaplessness of the repaired cartilage surface
  • FIG. 11 shows an exemplary embodiment of a punching tool for producing an implant from cartilage tissue grown in vitro for a repair according to FIGS. 9 and 10,
  • Figure 12 shows an exemplary embodiment of an instrument for
  • FIGS. 13 to 16 show an exemplary embodiment of cooperating instruments (FIGS. 13 to 15 in section parallel to the axis) for the gentle removal and implantation of tissue columns,
  • FIG. 17 the instruments according to FIGS. 13, 15, 16 in a three-dimensional representation
  • Figure 18 shows an embodiment of an implant guide with recesses in the end face for receiving a stop pin provided on the extractor
  • Figure 19 shows an embodiment of a ram for ejecting a column of tissue from the extractor.
  • FIG. 1 shows a cartilage defect repaired according to the known mosaic method as a top view (left) and in section (right).
  • the top view shows the surface of the native cartilage layer 1 and the round surfaces of the cartilage layers 2 'of those implanted for the repair
  • Tissue columns 2 On average, the native bone tissue 3 lying under the native cartilage layer 1 is also visible and the tissue columns 2 implanted in corresponding cylindrical openings, which have an inner bone part 2 "under the cartilage layer 2 ', which in the case of transplanted columns of bone tissue, in the case of in vitro grown columns of a bone substitute material.
  • the aim is usually to arrange the columns as closely as possible. For this reason, it is important that the openings for the columns 2 to be implanted run as parallel as possible. With a high degree of parallelism, it can be ensured that the openings can be made very close to one another without overlapping, which would make implantation more difficult and create additional loads on the implanted columns. If, as will be described in connection with FIGS. 9 and 10, the spaces between the columns 2 are to be filled with a further implant, not only is high precision necessary with regard to the parallelism of the openings to be created but also with regard to the positioning of the openings .
  • FIG. 2 shows an exemplary embodiment of a guiding instrument, with the aid of which a plurality of cylindrical openings can be created in the region of a cartilage defect with a significantly higher precision than the surgeon's eye, as has been done up to now.
  • the exemplary embodiment of the guiding instrument shown is suitable for realizing a repair as shown in FIG. 1. It essentially consists of a hollow cylindrical ring guide 10 and at least two tubular punching or drilling guides 11 and 12, all of which are shown as a top view (like the top view of the repaired defect on the left in FIG. 1).
  • the ring guide 10 is positioned surrounding the defect and, for example, with the help of Kirschner wire which passes through the holes 13 or attached with another suitable fastener. It should be selected from a set of ring guides whose inner surface is of such a shape and size that it is matched as precisely as possible to the defect to be repaired.
  • the punching or drilling guides 11 and 12 have an inner diameter which is adapted to a punching or drilling instrument to be used and, for exact positioning in the ring guide 10 on the outside, have, for example, at least one axially extending comb 14 which fits into the inside surface of the Ring guide 10 axially extending grooves 15 fits, the radial height of the comb or combs 14 being adapted to the distance between the inner surface of the ring guide 10 and an opening to be created.
  • the punching or drilling guide 10 is intended for creating the central opening of the repair shown in FIG. 1, the punching or drilling guide 12 for creating the peripheral openings.
  • Both guides 11 and 12 have two combs 14 which can be positioned in mutually opposite grooves 15 of the ring guide 10. With a corresponding design of grooves and combs, it is also possible to provide only one comb for each punching or drilling guide.
  • the guide instrument shown in FIG. 2 is intended for an approximately circular defect. In the same way, guiding instruments for differently shaped defects can be provided.
  • the ring guide 10 of the guide instrument according to FIG. 2 is fastened, for example, with Kirschner wire positioned around the defect to be repaired.
  • the ring guide 10 can also be attached, for example by means of a three-point fixation, to a fixing point remote from the defect point on the bone on which the Defect is to be repaired.
  • Such attachments are known from joint prosthesis surgery. They can be used for both open surgery and arthroscopy.
  • At least the ring guide 10 advantageously consists of a transparent material or has corresponding windows.
  • the guide instrument shown in FIG. 2 represents an exemplary embodiment of such an instrument.
  • a guide instrument has means with which it can be positioned in the area of a defect to be repaired, and has means for guiding punching or drilling instruments on one Majority of positions.
  • cartilage defects have a set of different guiding instruments which may be adapted to the joint to be treated and the defect to be expected.
  • the surgeon performing the repair selects the appropriate one from the set of guide instruments, positions the ring guide 10 on the defect and fixes it. Then he inserts a punching or drilling guide 11 or 12 into the ring guide 10 and uses it to guide the punching or drilling instrument used to create a corresponding opening. To create additional openings, the punching or drilling guide is exchanged or its position changed.
  • Figure 3 shows a cartilage defect 20 at a strongly curved joint point in section. Defects of this size are not uncommon at knee and hip joints.
  • the defect 20 and three in the area of the defect, for example Openings 21 created in the guide instrument according to FIG. 2 are shown in solid lines.
  • the original cartilage surface 22, which is to be reproduced as accurately as possible by the repair, is indicated by a dash-dotted line.
  • FIG. 3 clearly shows that a measurement of the depth of the openings made in the defective area to determine the axial length of the tissue columns necessary for the repair is a poor approximation.
  • the gauges 23 of the gauge set can, for example, be simple, one-dimensional radius gauges through which the original
  • Cartilage surface 22 is approximated as a spherical surface.
  • one-dimensional or two-dimensional gauges 23 are also conceivable for customary sizes and shapes of certain joint areas.
  • Figure 4 shows an exemplary embodiment of an instrument for
  • the instrument essentially consists of a ring guide 10, a surface template 24 and a measuring rod 25.
  • the ring guide 10 of this instrument advantageously serves as a ring guide for determining the length.
  • This surface template 24 is the template from a set of differently shaped templates 24, which corresponds to the teaching 23 selected prior to the creation of the openings for the reconstruction of the original cartilage surface 22 in its shape (curvature), and it has a pattern of measuring openings 26 which corresponds to this Pattern of the created openings 21 corresponds.
  • the measurement openings 26 of the surface template 24 are aligned with the pattern of the openings 21.
  • the measuring template 24 is also used directly as a shape gauge 23. In this case it is advantageous if it consists of a transparent material.
  • the measuring rod 25 has a diameter matched to the measuring openings 26 and a measuring scale 28 which takes into account the distance between the original cartilage surface 22 and the measuring template 24.
  • the necessary length of the tissue columns to be created for the repair can be read directly on the measuring scale 28, for example to within half a millimeter.
  • each form gauge 23 of a set of gauges to a specific measurement template 24 of a set of templates, these are to be designated accordingly, which can be implemented, for example, with a color code.
  • the measuring templates 24 run parallel to an original cartilage surface 22 and the distance between this surface and the measuring template essentially corresponds to the axial height of the ring guide 10, one measuring rod 25 is sufficient for all measurements. So that openings with an oblique angle between the opening axis and the original cartilage surface 22 (peripheral openings of the defect according to FIG. 3) can be ensured that the same opening depth is always measured,
  • the measuring rod 25 and the measuring openings 26 can be provided with axially extending grooves and ridges (not shown in FIG. 4), by means of which the measuring rod 25 can only be inserted into a measuring opening 26 in a defined rotational position.
  • the instruments according to FIGS. 3 and 4 for determining the original topography of a defect area and for determining the lengths of tissue columns for repairing the defect are exemplary embodiments.
  • such instruments have form gauges for determining the topography and means adapted to the form gauges for determining the column lengths, wherein the form gauges themselves can be part of the means for determining the column lengths.
  • a surgeon who has to repair the defect shown in FIG. 3 proceeds in the following steps:
  • Figure 5 shows the same defect as Figure 3 at a strongly curved joint. It is evident from FIG. 5 that the original cartilage surface 22 can be reconstructed with a higher precision if the Angles ⁇ .1, ⁇ .2 and ⁇ .3 between the original cartilage surface and the axis of the openings 21.1, 21.2 and 21.3 are not left to chance, but are specifically reconstructed. It is therefore advantageous for increased chances of success of the repair to determine the angles ⁇ for the differently implantable tissue columns and to remove the tissue columns in a targeted manner from another location or to punch them out of a cartilage grown in vitro.
  • Area corresponds, and the tissue columns in an arrangement that is identical to the arrangement of the openings created in the defect area.
  • the less stressed condylar region of the femur which has its own shape, is available for removal, and it is advantageous to perform the withdrawals in a row and to keep the distances between the removal sites as large as possible.
  • angles ⁇ have to be determined for a precise reconstruction of the original cartilage surface 22 and the columns have to be removed at the removal point at a corresponding angle.
  • FIG. 6 shows such a removal point and the tissue columns 2.1, 2.2 and 2.3 to be removed, corresponding to the openings 21.1, 21.2 and 21.3, for which the angles ⁇ between the cartilage surface and the column axis are
  • an instrument is to be provided with the aid of which a column with a predetermined one is provided Angle between the column axis and the cartilage surface and can be removed in a defined rotational position and can be implanted in a likewise defined rotational position.
  • Figure 7 shows an exemplary embodiment of such
  • Removal instrument which consists essentially of an extractor guide 30 and an extractor 31.
  • the extractor guide 30 is essentially tubular and has at one end a support flange 32 which is aligned at an angle ⁇ to the tube axis.
  • a support flange 32 which is aligned at an angle ⁇ to the tube axis.
  • the support flange 32 can have holes (not shown) for its attachment, through which it can be nailed to the tissue with Kirschner wire.
  • An external three-point fixation, as already mentioned in connection with FIG. 2, is also possible for fastening the extractor guide.
  • the extractor guide 30 has an inner diameter matched to the extractor 31 and a guide groove 33 which runs axially on the inner surface and runs, for example, at the point on the inner circumference corresponding to the highest or lowest point of the support flange 32.
  • the inside diameter is on the radial extension of the guide groove
  • the extractor 31 is also tubular and has an inner diameter which corresponds to the diameter of the column to be removed. One end is pointed like a blade.
  • the Extractor 31 On its outer surface, the Extractor 31 has a guide cam 35 which runs in the guide groove 33 of the extractor guide 30 when the extractor 31 is inserted into the extractor guide 30.
  • This guide cam 35 is arranged axially in such a way that it is positioned in the enlarged end region 34 of the extractor guide 30 when the tapered end face of the extractor 31 has reached the depth in the tissue which corresponds to the length of the column to be removed. Thanks to the guide cam, the extractor 31 can only be inserted into the extractor guide 30 in a defined rotational position, but can be rotated at its base in the extractor guide in order to detach the column.
  • the extractor has at least one axially extending and advantageously cutting-like rotary stop 36 on its inner surface as close as possible to the tapered end face, projecting radially into the inner cavity. It turns out that the radial extent of such a rotation stop need not be greater than one millimeter.
  • the extractor 31 guided through the extractor guide 30 can be used to punch out a column of tissue, as indicated by the lines S, and to detach it by rotating its base.
  • a hollow drill pre-drilled along the lines S.
  • a hollow drill corresponds in shape to the extractor 31, the guide cam 35 and the rotary stop 36 being missing.
  • the tapered edge is advantageously made of a diamond-containing material or coated with such a material.
  • the drill also has suitable means for determining the drilling depth.
  • FIG. 7 also shows a plunger 37 for ejecting an extracted tissue column from the extractor 31.
  • the plunger has a distal end face which, like the support flange 32, unites with the plunger axis Forms angle ⁇ . So that the plunger 37 can only be inserted into the extractor in the rotational position corresponding to the flange position, it has an axially extending guide groove 38 and the extractor 31 has a corresponding guide comb 39, which, however, does not extend into the area of a tissue column positioned in the extractor.
  • the distal end of the plunger 37 has a reduced diameter so that it can be pushed past the rotary stop 36 to the end of the extractor 31.
  • FIG. 8 shows an implantation instrument for implanting the tissue column removed with the removal instrument according to FIG. 7.
  • the instrument is shown as a top view.
  • This is an implantation guide 40 which is configured in the same way as the punching or drilling guides 11 and 12 in FIG. 2 and can be positioned in the same ring guide 10 (indicated by a dash-dotted circular line).
  • the inside diameter of the implant guide 40 is matched to the outside diameter of the extractor 31. So that the extractor 31 can only be inserted into the implantation guide 40 in the predetermined rotational position, the latter has an axially extending guide groove 41 on its inner surface, in which the guide cam 35 of the extractor 31 can be positioned.
  • the angles ⁇ of the tissue columns to be implanted are clearly determined for each column by the shape of the previously selected surface template 24 (FIG. 4). It is therefore sufficient to provide the surgeon with a removal instrument with a set of different extractor guides 30, which can be correlated, for example, with a code with the corresponding measurement opening of the surface template or with the corresponding opening created in the defect area. Different numbers of lines for different pairs of measuring openings and extractor guides for a surface template to be correlated are conceivable as a code, the lines for different surface templates having different colors.
  • the Extractor guides 30 can also be designated by the size of the angle ⁇ and the same sizes can be noted on the surface templates next to the measurement openings.
  • a surgeon will therefore read from the surface template 24 which extractor guide 30 he has to use to remove each column of tissue. He assembles the extractor guide 30 at a suitable extraction point, he drills the tissue column through the extractor guide 30 with internal and external cooling, he drives an extractor 31 into the pilot hole, detaches the tissue column from its base by rotating the extractor, and rotates the extractor 31 back to its original rotational position and removes the extractor 31 with the tissue column from the extractor guide 30.
  • the axial length of the tissue column removed is determined per se if means are provided with which the drilling depth and the insertion depth of the extractor into the tissue can be adjusted. Nevertheless, it may be advantageous to check this length before the implantation and correct it if necessary. For this purpose, 31 windows (see also FIGS.
  • the extractor 13 and 17 are provided in the extractor, which are arranged such that the cartilage surface of the removed column comes to lie in the area of the windows, and length scales in the area of the windows, with the aid of which the distance between the tapered edge of the extractor and the cartilage surface of the tissue column can be determined. If the tissue column removed is too long, it is pushed forward slightly with the aid of the ram 37 and the part protruding from the extractor is cut off.
  • FIGS. 9 and 10 show a top view and in section of a repaired cartilage defect which, in addition to implanted tissue columns 2, has an implanted cartilage layer 50 grown in vitro.
  • the cartilage layer 50 fills the gaps between the tissue columns 2 and those between the tissue columns 2 and the native cartilage layer 1.
  • the implanted cartilage layer 50 is where the defect is deeper than the thickness of the cartilage layer 50 backfilled with a suitable filling material 51.
  • the main advantage of the repair according to FIGS. 9 and 10 with an implanted cartilage layer 50 compared to the repair according to FIG. 1 without such a cartilage layer is that with the cartilage layer 50 the gaps between the implanted tissue columns 2 are completely closed, as a result of which synovial fluid penetrates the bone tissue can be prevented. As a result, the columns can also be implanted a little further apart, so that they are completely surrounded by native bone tissue, which considerably accelerates the complete adhesion of native and implanted tissue.
  • the cartilage layer 50 is previously grown from autologous cells either on a base made of a bone substitute material or without such a base.
  • the shape of the resulting cartilage is determined by the space that is made available to the cells during cultivation.
  • the in vitro grown cartilage layer 50 For an implantation, the in vitro grown cartilage layer 50 must be punched or cut as precisely as possible into the shape that corresponds to an opening made in the area of the defect to be repaired, and openings for the tissue columns must be created therein, which openings in turn for a "press fit "should have a slightly smaller diameter than the fabric columns. Furthermore, the thickness of the grown cartilage layer must be determined for a precise backfilling of the cartilage layer or for a corresponding cutting out of the defect.
  • a ring guide 10 (FIG. 2) is mounted in the defect area and the native cartilage tissue is cut vertically along it with a corresponding ring punch instrument or with a scalpel and then removed or removed against the defect, in such a way that within the The guidance of the cartilage or bone surface is deeper than the original cartilage surface by at least the thickness of the cartilage layer to be implanted.
  • FIGS. 9 and 10 A repair with six rotationally symmetrically arranged tissue columns 2 is shown in FIGS. 9 and 10.
  • FIGS. 9 and 10 A repair with six rotationally symmetrically arranged tissue columns 2 is shown in FIGS. 9 and 10.
  • other column arrangements with different numbers of tissue columns, in particular also with only one tissue column, can be carried out in the same way.
  • FIG. 11 shows an exemplary embodiment of a punching instrument for producing a desired implant from the cartilage layer 50 for a repair, as is shown in FIGS. 9 and 10.
  • the punching instrument essentially consists of a support surface 60 and a die 61.
  • the shape (curvature) of the support surface 60 advantageously corresponds to the shape of the cartilage surface 22 to be reconstructed (FIGS. 3 and 4) or the surface template 24 (FIG. 4), according to which the Cartilage surface is reconstructed.
  • the punching die 61 has a shape corresponding to the support surface 60 and has punching blades 62 corresponding to the outline of the implant to be created and the openings to be made for tissue columns, the punching blades having a width which is greater than the thickness of the cartilage layer to be punched.
  • the grown cartilage layer 50 is positioned on the support surface 60 and the die 61 is moved in parallel against the support surface 60 by means of suitable drive means until the punch blades 62 on the support surface 60 or rest on the counterblades and the cartilage layer 50 is completely severed at the intended locations.
  • FIG. 12 shows an exemplary embodiment of an instrument for determining the thickness of a cartilage layer 50 grown in vitro (with or without a base layer made of bone substitute material).
  • the instrument essentially consists of a measuring block 70 with indentations 71 of different depths and a weighting block 72, which advantageously consists of a transparent material and whose weight per contact surface essentially corresponds to the pressing force used during the implantation.
  • the depressions 71 advantageously have the shape of a defect to be repaired or the shape of an opening which has been created in the region of such a defect for the implantation of the cartilage layer 50.
  • the punched out cartilage layer 50 is placed in one of the depressions 71 and weighted down with the weighting block 72.
  • the thickness of the cartilage layer 50 relevant for the implantation corresponds to the depth of the depression 71 on which the weighting block 72 is no longer resting when the cartilage layer 50 is positioned therein.
  • An instrument set according to the invention for repairing a defect according to FIGS. 9 and 10 thus has, in addition to at least some of the instruments already described, an instrument for punching or cutting an in vitro grown cartilage layer 50 with a set of different pairs of support surfaces 60 and punching dies 61. Furthermore, the set of instruments advantageously has an instrument for measuring the thickness of such a cartilage layer that is relevant for the implantation, or a set of such instruments for different types of defects.
  • a surgeon carries out, for example, the following steps in the order given:
  • Tissue column 2 implantation of the tissue column 2 in the opening 21;
  • FIGS. 13 to 16 illustrate (FIGS. 13 to 15 in section parallel to the axis) parts of a further exemplary embodiment of an instrument for removing and implanting tissue columns: FIG. 13 an extractor 31.1, FIG. 14 an extractor guide 30.1 for guiding the extractor 31.1 when the tissue column is removed, FIG. 15 shows an implant guide 40.1 for guiding the extractor 31.1 during the implantation of the tissue column and FIG. 15 shows a plunger 37.1 for ejecting a tissue column from the extractor 31.1.
  • the instrument parts 31.1, 30.1, 40.1 and 37.1 correspond in many features to the functionally identical instrument parts 31, 30, 40, 37 already described in connection with FIGS. 7 and 8. Only the features in which they differ from these are described here differentiate. Further features are designated by the reference numerals in FIGS. 7 and 8.
  • the extractor 31.1 has, in its region facing the tapered front edge, two windows 80 lying opposite one another and a length scale 81 for the inspection and length measurement of a removed tissue column. Furthermore, the extractor on the side of the window 80 opposite the tapered end edge is divided longitudinally into two extractor parts up to its opposite end by two axially extending slots 82 arranged opposite one another. The end of the extractor opposite the tapered front edge is equipped for easy handling with a handle 83, also divided into two parts, which also limits the depth of insertion of the extractor 31.1 into a corresponding guide 30.1, 40.1.
  • the rotary stop 36 shown in FIG. 7 and the two rotary stops in FIG. 13, which prevent twisting of the extractor relative to the tissue column when a tissue column is twisted can also be made significantly longer than is shown in FIG. 13 or also in FIG.
  • such a rotation stop 36 can each extend over the maximum length that a tissue column to be removed with the corresponding extractor can have, or even over the entire length of the extractor. Extractors with longer ones
  • Rotation stops 36 are particularly advantageous when the surgeon or orthopedist has advanced the extractor into the area of the cancellous bone, but the cancellous bone is no longer able to offer the extractor the necessary support to hold the column of tissue from the floor, on which it is still anchored to turn. With a longer rotary stop 36, however, this rotary stop extends in any case into an area of the tissue column that offers sufficient hold to ensure that the tissue column is safely unscrewed even if this is not possible with a short rotary stop 36 due to the nature of the cancellous bone would.
  • the extractor guide 30.1 is not equipped like the extractor guide 30 for a precise removal angle ⁇ (FIGS. 6 and 7) and cannot be fixed at a removal point.
  • the implant guide 40.1 is also not equipped to be fixed in the defect area. It also has windows 80 lying opposite one another, through which the rotational position can be determined by aligning the windows in the extractor 31.1 of a tissue column during the implantation.
  • the inner diameter of the implant guide 40.1 corresponds to the outer diameter of the extractor 31.1 only in a distal end region and is otherwise larger than this. This allows the two extractor parts separated by the slots 82 to be spread apart during the implantation.
  • the plunger 37.1 has a conical region 84 for the expansion of the extractor parts mentioned.
  • the plunger 37.1 also has a handle 85, which serves for its convenient handling and at the same time ensures that the plunger can only be pushed up to the pointed end of the extractor 31.1.
  • the features of the instrument parts 31.1, 30.1, 40.1 and 37.1 according to FIGS. 13 to 16 can be combined as desired with features of the functionally identical instrument parts 31, 30, 40, 37 according to FIGS. 7 and 8.
  • Figure 17 shows the instrument parts 31.1, 40.1 and 37.1 according to Figures 13, 15 and 16 in a three-dimensional representation.
  • FIGS. 18 and 19 show further exemplary embodiments for an implant guide 40.2 and a plunger 37.2 which are similar to the implant guide 40.1 and the plunger 37.1 from FIGS. 15 and 16.
  • the extractor 31.1 and also the extractor guide 30.1 can be kept essentially unchanged in the form shown in FIG. 13 and FIG. 14, but in particular the rotary stops 36 can extend over the entire length of the extractor 31.1.
  • the handle 83 has a stop pin 830 projecting downward on its underside.
  • This stop pin 830 is of no further importance for the removal of the tissue column at the harvesting point, except that the extractor guide 30.1 (FIG. 14) can have a corresponding recess 831 for receiving this stop pin 830, which then together with the stop pin represents an anti-rotation device.
  • the stop pin 830 can be of considerable importance if the implant guide is designed accordingly. In order to explain this meaning, the stop pin 830 can have a height of 3 mm, for example, for the following consideration (measured from the underside of the handle 83).
  • tissue column has been removed at the harvesting point with the aid of the extractor 31.1, which is then located in the extractor 31.1 and is, for example, flush with the extractor 31.1 at the bottom, this should be the case Tissue column - as explained earlier - are implanted in a corresponding hole or recess at the defect site.
  • This implantation is carried out in such a way that the tissue column is fitted into the hole at the defect site with a slight press fit ("press fit").
  • press fit it is of particular advantage for the success of such an implantation / transplant if the original shape of the cartilage (i.e. the shape before the defect appears) is reproduced as realistically as possible so that the cartilage again as good as possible after the healing process has its original shape.
  • the tissue column may be necessary, depending on the size of the defect, for the tissue column to either reach the bottom of the hole with the aid of the implant guide 40.2 and the plunger 37.2 (FIG. 18 or FIG. 19) the defect has been created, is pressed in, or that the tissue column has a predetermined distance from the bottom of the bore after the pressing in, so that the original shape of the cartilage can be reproduced as lifelike as possible.
  • the tissue column Under no circumstances should the tissue column be pressed in deeper than the bottom of the hole. This risk exists especially if the bottom of the hole lies within the (porous) cancellous bone. To achieve or avoid all of this, the surgeon or orthopedist should be given a simple instrument.
  • the implant guide 40.2 has on its proximal face (FIG. 18) two depressions 832 and 833, for example arranged opposite one another, of which the depression 832 has a depth of 1 mm and the depression 833 has a depth of 3 mm. If, during implantation, the extractor 31.1 (FIG. 13) containing the tissue column is first inserted into the implant guide 40.2 with the stop pin 830. (FIG. 18), the stop pin 830 can be introduced in three different positions relative to the implant guide 40.2. In the first position, the stop pin 830 comes to rest in the recess 833.
  • the stop pin 830 has a length of 3 mm in the selected embodiment, but the recess 833 also has a depth of 3 mm, the underside of the handle 83 of the extractor 31.1 comes to lie flat on the proximal end face of the implant guide 40.2.
  • the stop pin 830 comes to rest in the recess 832. This has a depth of 1 mm, so that the underside of the handle 83 of the extractor 31.1 is 2 mm above the proximal
  • the end face of the implant guide 40.2 comes to rest when the stop pin 830 stands on the bottom of the depression 832.
  • the stop pin 830 does not come to rest in either of the two depressions 832 or 833, but lies on the proximal end face of the implant guide 40.2.
  • the underside of the handle 83 of the extractor 31.1 comes to lie 3 mm above the proximal end face of the implant guide 40.2.
  • the implant guide 40.2 When the implant guide 40.2 is inserted, the implant guide 40.2 is placed at the location of the defect, in such a way that the distal end face of the implant guide 40.2 is placed on the subchondral bone around the hole already created. The plunger of tissue is then pressed out of the extractor into the bore using the ram.
  • the plunger is basically designed such that when the plunger is fully inserted into the extractor, the underside of the handle of the plunger rests on the proximal end face of the handle of the extractor 31.1. In this state it is distal end of the plunger flush with the distal end of the extractor - the distal end of the plunger has pushed the tissue column completely out of the extractor, but not necessarily completely out of the implant guide 40.2. That depends on the position in which the extractor has been inserted into the implant guide 40.2.
  • the plunger 37.2 has also pushed the tissue column completely out of the implant guide 40.2 (because the distal end of the extractor is then also flush with the distal end the implant guide) and has therefore normally pushed the tissue column to the bottom of the hole at the location of the defect, the tissue column does not protrude above the subchondral bone.
  • the plunger completely immersed in the extractor has pushed the tissue column completely out of the extractor 31.1, but not completely out of the implant guide 40.2 (because it is flat the distal end of the extractor is not flush with the distal end of the implant guide), and there still remains a length of 3 mm (length of the stop pin 830) minus 1 mm (depth of the bore 832), i.e. a length of 2 mm, by which the tissue column still protrudes into the implant guide 40.2.
  • the tissue column then also protrudes from the subchondral bone by this amount, but this can be desirable for larger defects in order to faithfully reproduce the shape of the original cartilage.
  • stop pin 830 stands on the proximal end face of the extractor 31.1 (third position), there is a corresponding amount of 3 mm by which the tissue column is still in the implant guide when the plunger is fully inserted 40.2 protrudes or protrudes above the subchondral bone at the location of the defect. It is clear that these values for the depth of the depressions 832 and 833 are only to be considered as examples, of course other values are also possible. The surgeon or orthopedist can then decide, depending on the circumstances at the location of the defect, how far he wants to press the tissue column into the hole.
  • the plunger 37.2 shown in FIG. 19 now has a special feature in comparison to the plunger 37.1 (FIG. 16).
  • the handle of the plunger 37.2 namely comprises two parts, an upper handle part 851, which is fixedly connected to the shaft of the plunger, and a lower handle part 852, which can be moved along the shaft and whose outer wall is conically tapered when viewed in the distal direction.
  • This lower grip part 852 can be moved along the shaft up to a bead 853 at most.
  • the lower handle part 852 can only be advanced until the underside of the lower handle part 852 bears against the proximal end face of the handle 83 of the extractor 31.1. In the case of the extractor 31.1 which is slightly spread in this way, this is further
  • Pressing out the column of tissue or pressing the column of tissue into the hole is facilitated because the slightly spread extractor makes it easier to press the column of tissue out of the extractor into the hole at the location of the defect.
  • the surgeon or orthopedic surgeon can also use a small hammer with which he lightly strikes the upper handle part 851 until the upper handle part 851 is in contact with the lower handle part 852, which in turn is on the proximal end face of the handle 83 of the extractor 31.1.

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Abstract

L'invention concerne la réparation des défauts cartilagineux ou ostéo-cartilagineux, notamment des défauts du cartilage articulaire. Le procédé de l'invention consiste à réaliser des trous cylindriques (21) dans la zone du défaut et à y implanter des colonnes de tissu (2) pourvues d'une couche de cartilage vivant (2') sur une de leurs faces. Les colonnes de tissu (2) sont prélevées, par exemple, dans une partie d'articulation peu sollicitée. Il s'avère qu'une plus grande précision améliore les chances de réussite d'une telle réparation. Pour réaliser les trous (21), on peut utiliser un instrument de guidage qui peut être positionné et fixé dans la zone défectueuse et qui permet le guidage précis d'instruments d'emporte-pièces et de perforation. On obtient ainsi une grande précision en termes de parallélisme et de position des trous. En outre, grâce à la détermination d'une surface cartilagineuse d'origine et à l'ajustage à cette surface cartilagineuse d'origine de la longueur axiale et de l'angle entre la surface cartilagineuse et l'axe de la colonne de tissu (2) à implanter, la surface cartilagineuse d'origine est restaurée avec une grande précision. En outre, la production d'un autre implant constitué d'une couche cartilagineuse cultivée in vitro (50), permet de remplir les interstices de la surface cartilagineuse restaurée, interstices situés entre les colonnes de tissu (2) implantées et sur les bords du défaut.
EP98944954A 1997-10-27 1998-10-07 Procede et instruments de reparation de defauts cartilagineux et osteo-cartilagineux Withdrawn EP1027001A1 (fr)

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
CH248597 1997-10-27
CH248597 1997-10-27
CH177998 1998-09-02
CH177998 1998-09-02
PCT/CH1998/000430 WO1999021497A1 (fr) 1997-10-27 1998-10-07 Procede et instruments de reparation de defauts cartilagineux et osteo-cartilagineux

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