RU208291U1 - Articular cartilage resection device - Google Patents

Abstract

The utility model relates to medicine, in particular to traumatology and orthopedics, and can be used for resection of articular cartilage during arthroscopic surgical interventions. The task to be solved by the claimed utility model is the development of a device for resection of articular cartilage, which will improve efficiency and reduce the time of the procedure. The technical result of the proposed utility model is to enable complete economical resection of the articular cartilage with ease of use. The technical result of the proposed model is achieved by the fact that the device consists of a handle, a rod and a working part with a cutting edge, according to the utility model, the handle is made in the form of an oval frame; the rod starts from the center of the handle oval; notches are made on the surface of the handle and the proximal third of the rod; the working part is made in the distal third of the rod and has the shape of a tetrahedral pyramid flattened towards its rear surface; at the top of the working part at an angle of 90 ° to the back surface of the pyramid, a blade is made with one-sided sharpening inward; the angle of transition of the working part into the blade is rounded; the blade of the working part in width and length does not exceed the diameter of the rod.

Description

The useful model relates to medicine, in particular to traumatology and orthopedics, and can be used for resection of articular cartilage during arthroscopic surgical interventions.

The device can be useful for resecting limited areas of cartilage of various localizations, for example, in the area of osteochondral damage to the talus block, as well as removing cartilage during arthrodesis of the ankle and subtalar joints.

Osteochondral damage to the talus block is a common problem in a cohort of young able-bodied patients: the group of patients aged 25-45 makes up 73-76% of all cases. The main symptom is deep diffuse pain in the ankle joint [1].

The main method of their treatment is surgical. The most widespread are surgical interventions aimed at surgical treatment of the damaged area and stimulation of the bone marrow (tunneling, microfracturing), the first stage of which is the treatment of the defect with resection of the articular cartilage. It aims to stabilize bone and cartilage within the lesion and create an environment conducive to the formation of fibrous cartilage tissue. [2, 3].

In recent years, arthroscopic techniques have been used predominantly to perform this type of intervention, which allows minimizing potential damage to soft tissues and bone structures [1, 3]. This helps to reduce the risk of complications typical for arthrotomy, shortens the time of rehabilitation and hospital stay.

Despite the obvious advantages of arthroscopic interventions, the limited volume of the ankle cavity makes it difficult to adequately resect the articular cartilage of the talus due to the limited range of motion of the instruments.

Therefore, osteochondral lesions of the talus block are an illustrative example in relation to the possibility of clinical application of devices for resection of articular cartilage of various designs.

Known devices - ring, spoon-shaped and D-shaped curettes [4], used for resection of non-viable cartilage during arthroscopic intervention. Curettes contain a fenestrated working part with a pointed edge, a shaft and a handle. The disadvantage of their use is the impossibility of palpation differentiation between damaged and intact cartilage due to the shape of the working part of the instrument. In addition, due to the curved shape of the cutting edge of the curettes, when processing the edges of damage, it is possible to form uneven scalloped borders and incomplete excision of pathological tissues due to the formation of defects of the "groove" type.

Also known are devices - arthroscopic knives, used for cartilage resection with subsequent removal [5]. Arthroscopic knives consist of a handle and a shaft extending into the working part like a scalpel blade. The disadvantage of these devices is the risk of damage to intact cartilage due to the plane of the blade and the complexity of manipulations in the limited space of the ankle joint (limited viewing angle due to the spatial characteristics of the ports and the bending of the talus block, small volume of the joint cavity during arthroscopy).

In addition, these devices require the use of additional instrumentation for lifting the separated chondral fragments - elevators of cartilage defects [4].

The closest device that we have chosen as a prototype is the 014896 osteotome from Smith & Nephew [6]. It consists of a handle, a support bar and a working part. The handle has an anatomical smooth shape. The length of the support rod, which is circular in cross-section, allows easy manipulation through standard arthroscopic ports. The working part, 1 cm long, is located at an angle of 30 ° to the rod and carries a cutting edge like an osteotome with one-sided sharpening.

However, such a bending angle complicates the resection of the articular cartilage of the talus: the shape, size of the working part of the instrument and the need to rotate it during the resection of a rounded chondral fragment complicate manipulations in a limited space, which was taken into account when developing the proposed device.

The problem to be solved by the claimed useful model is the development of a device for resection of articular cartilage, which will improve the efficiency and reduce the time of the procedure.

The technical result of the claimed utility model is to provide the possibility of a complete economical resection of the articular cartilage with ease of use.

The technical result of the claimed model is achieved by the fact that the device consists of a handle, a rod and a working part with a cutting edge, according to the utility model, the handle is made in the form of an oval frame; the rod starts from the center of the oval of the handle; notches are made on the surface of the handle and the proximal third of the rod; the working part is made in the distal third of the rod and has the shape of a tetrahedral pyramid, flattened towards its back surface; on the top of the working part at an angle of 90º to the back surface of the pyramid there is a blade with one-sided sharpening inward; the angle of transition of the working part to the blade is rounded; the blade of the working part in width and length does not exceed the diameter of the rod.

The advantages of the proposed device:

1.the blade of the working part is made at an angle of 90 ° to its back surface, which in conditions of limited volume, for example, of the ankle joint, allows for a more thorough and complete excision of non-viable cartilage in comparison with standard arthroscopic instrumentation due to vertical movements of the device;

2. one-sided sharpening, made on the inner surface of the blade of the working part of the device, minimizes the risk of damage to the intact cartilage surrounding the damaged area;

3. The handle of the device is made in the form of an elongated oval frame (for example, with two parallel rectilinear sections - long sides) with notches over the entire surface, which ensures reliable fixation of the device in the surgeon's hand. The shape of the handle allows you to place an emphasis on the palmar surface of the hand during work;

4. The shape of the transition point of the handle into the rod forms a convenient rest for the fingers, which allows better control of the device and increases control over the depth and direction of resection of the articular cartilage;

5.In the distal third, the rod acquires a tetrahedral cross-section and flattens towards its rear surface, forming a working part, the width of which does not exceed the diameter of the rod, thereby allowing to maintain the optimal length of the blade without increasing the vertical size of the device (the length of the blade does not exceed the diameter of the rod), which is of fundamental importance for arthroscopic manipulations in conditions of a limited joint volume;

6. the diameter of the rod, the length of the rod with the working part at the end, as well as the width of the working part are standardized in terms of size and compatibility with instruments for arthroscopy and allows for cartilage resection through standard ports;

7. the blade of the device is made at an angle of 90 ° to the back surface of the working part, which makes it possible to perform the elevation of the resected cartilage sections without the use of additional arthroscopic instrumentation;

8. the angle of transition of the working part to the blade is rounded, the blade of the working part does not exceed the diameter of the rod in width and length, which allows minimizing damage to soft tissues when positioning the device through standard arthroscopic ports;

9. the shape of the blade of the working part of the device allows palpation to determine the border of resection by the difference in the density of the damaged and intact cartilage;

10. The proposed device is easy to operate and multifunctional, allowing to minimize the number of used arthroscopic instruments, thereby reducing the time of surgery;

11. the possibility of sterilization and reuse determines the economic feasibility of using the claimed device for cartilage resection.

The illustrations show

FIG. 1 - general view of the device (diagram: side view), where the handle is 1, the rod is 2, the working part is 3, the finger rest is 4, the blade of the working part is 5.

FIG. 2 - general view of the device (diagram: bottom view), where the handle is 1, the rod is 2, the working part is 3, the finger rest is 4, the blade of the working part is 5.

FIG. 3 - positioning the device through the standard arthroscopic ports to the ankle joint, where the anteromedial port is 6, the anterolateral port - 7, the ankle joint - 8, positioning the device through the anterolateral port - 9.

FIG. 4 - type of osteochondral injury before cartilage resection (arthroscopic picture on the monitor), where osteochondral injury on the talus block / resection border - 10, detached cartilaginous fragment - 11, cartilage of the articular surface of the talus block - 12.

FIG. 5 - positioning the device through a standard anterolateral port to the ankle joint (arthroscopic picture on the monitor), where the blade of the working part of the device is 5, osteochondral damage on the talus block / resection border - 10, cartilage of the articular surface of the talus block - 12.

FIG. 6 - a view of osteochondral damage after resection of cartilage, elevation and removal of the excised fragment (arthroscopic picture on the monitor), where the cartilage of the articular surface of the talus block is 12, the bone bed after treatment of the injury is 13.

FIG. 7 - X-ray of the patient's left ankle joint before surgery: A - frontal projection, B - lateral projection.

FIG. 8 - computed tomogram of the patient's left ankle joint before surgery: A - axial projection, B - frontal projection.

FIG. 9 - type of osteochondral injury (arthroscopic picture on the monitor): A - before cartilage resection, B - after cartilage resection.

FIG. 10 - X-ray of the patient's left ankle joint 6 weeks after surgery: A - frontal projection, B - lateral projection.

FIG. 11 - computed tomogram of the patient's left ankle joint 6 weeks after surgery: A - axial projection, B - frontal projection.

The device (Fig. 1, Fig. 2) is made of a metal or metal alloy approved for use in traumatology and orthopedics, and contains a handle 1, a rod 2, in the distal third of which the working part 3 is made with a cutting edge at the end. In this case, the working part 3 is bent at a right angle, forming a blade 5 with sharpening inward.

The handle 1 is made in the form of an oval round frame. Rod 2 of circular cross-section starts from the top of the oval of the handle 1. The shape of the transition point of the handle 1 into the rod 2 forms a stop for the fingers 4. Along the proximal third of the rod 2, as well as on the surface of the handle 1, notches are made. The diameters of the rod 2 and the oval of the handle 1 are the same.

The working part 3 is made in the distal part of the rod 2 and has the shape of a tetrahedral pyramid, flattened towards its rear surface. At the top of the working part 3 at an angle of 90 ° to the back surface of the pyramid, a blade 5 is made with one-sided sharpening inward.

Working part 3 and blade 5 have the same width. The blade 5 of the working part 3 in width and length does not exceed the diameter of the rod 2.

The plane of the handle 1 is perpendicular to the plane of the rear surface of the working part 3 and the plane of the rear surface of the blade 5.

This device is applied in the following way: the surgeon places 1-2 fingers on the upper and lower surfaces of the rod 2 in the area of the rest for fingers 4 with fixation of 4-5 fingers in the handle 1 or gripping the handle 1 with his palm for greater stability. This fixation provides control of the depth of resection (vertical movement of the instrument) and facilitates spatial manipulation.

After access through the standard arthroscopic ports 6, 7 to the ankle joint 8, the device is inserted into the port with the working part 3, positioning the blade 5 downward. The device is positioned in one of the ports 9, depending on the localization of osteochondral damage 10. Under visual control of the arthroscopic picture on the monitor, the border of resection 10 is palpated using the blade of the working part of the device 5 by the difference in the density of the damaged and intact cartilage. Free intra-articular bodies (detached cartilage fragments) 11 are removed using assistive devices. Cartilage is resected, while the angle of bending of the blade 5 to the back surface of the working part 3 allows the cartilage to be resected by vertical movements without the need for significant rotation of the instrument. This contributes to the formation of the boundaries of the resection 10, perpendicular to the articular surface 12. The dimensions of the working part 3 allow you to perform an adequate resection, and the wedge-shaped one-sided sharpening of the blade 5 of the working part 3 minimizes damage to the intact cartilage.

If necessary, change ports 6, 7 in order to fully resect cartilage in the area of osteochondral damage 10.

The bending angle of the blade 5 to the back surface of the working part 3 of the proposed device allows cartilage elevation without the use of additional devices. Removal from the joint cavity is performed using clamps or other gripping devices. The treated bone bed 13 after resection of non-viable cartilage is prepared for the next stages of surgery (Fig. 3-6).

Clinical example.

Patient Sh., 22 years old, was admitted with a diagnosis of "Osteochondral damage to the left talus block", confirmed by X-ray (Fig. 7). Computed tomography performed during the preoperative examination made it possible to clarify the size of the lesion: the largest diameter - 9.8 mm, the greatest depth - 3.7 mm (Fig. 8). During the operation, a full-fledged arthroscopic resection of the articular cartilage was performed to the entire depth of the injury using the claimed device, followed by tunneling (Fig. 9).

The postoperative period was uneventful. 6 weeks after the operation, the patient returned to her usual daily physical activity. On the radiographs made at the indicated time, the osteochondral lesion was not visualized, which indirectly indicated a decrease in its size (Fig. 10). Control computed tomography has reliably demonstrated a decrease in the size of the lesion: the largest diameter is 0.3 mm, the greatest depth is 0.4 mm (Fig. 11).

The patient notes an improvement in the quality of life: there is no pain in the ankle joint, and there are no restrictions on physical activity.

As mentioned above, osteochondral lesions of the talus block are the most illustrative example in relation to the clinical application of the claimed device, therefore, the possibilities of its use should not be limited to the specified pathology. The above clinical example was presented to illustrate the use of the device and is not exhaustive: it is also possible to use the proposed device in the surgical treatment of other joint pathologies associated with cartilage damage. This nosology was chosen as an example in order to better explain the clinical application of the device for cartilage resection, thereby providing an opportunity for specialists in the art to understand the operation of the device for other joint pathologies associated with cartilage damage in each specific clinical case.

Bibliography.

1. Looze CA, Capo J, Ryan MK, Begly JP, Chapman C, Swanson D, Singh BC, Strauss EJ. Evaluation and Management of Osteochondral Lesions of the Talus. Cartilage. 2017 Jan; 8 (1): 19-30. doi: 10.1177 / 1947603516670708.

2. Hannon CP, Bayer S, Murawski CD, Canata GL, Clanton TO, Haverkamp D, Lee JW, O'Malley MJ, Yinghui H, Stone JW; International Consensus Group on Cartilage Repair of the Ankle. Debridement, Curettage, and Bone Marrow Stimulation: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int. 2018 Jul; 39 (1_suppl): 16S-22S. doi: 10.1177 / 1071100718779392.

4. Polat G, Erüen A, Erdil ME, Kazelkurt T, Kelazorlu C, Ayek M. Long-term results of microfracture in the treatment of talus osteochondral lesions. Knee Surg Sports Traumatol Arthrosc. 2016 Apr; 24 (4): 1299-303. doi: 10.1007 / s00167-016-3990-8.

5.https: //www.arthrex.com/resources/brochures/m0H5Hj4fI0yingFvGAQUYA - p. 23-24.

6.https: //www.karlstorz.com/cps/rde/xbcr/karlstorz_assets/ASSETS/3331576.pdf - p. 46.

7.https: //www.smith-nephew.com/global/assets/pdf/v1-chapter_j_2006.pdf - p. 8 (J-7).

Claims (1)

A device for resection of articular cartilage, including a handle, a rod and a working part with a cutting edge, characterized in that the handle is made in the form of an oval frame; the rod starts from the center of the oval of the handle; notches are made on the surface of the handle and the proximal third of the rod; the working part is made in the distal third of the rod and has the shape of a tetrahedral pyramid, flattened towards its back surface; at the top of the working part at an angle of 90 ° to the back surface of the pyramid, a blade is made with one-sided sharpening inward; the angle of transition of the working part to the blade is rounded; the blade of the working part in width and length does not exceed the diameter of the rod.

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