WO2012103871A1

WO2012103871A1 - Device for arthroscopy simulation and tibia element

Info

Publication number: WO2012103871A1
Application number: PCT/DE2012/000075
Authority: WO
Inventors: Stephan CASPERS; Ulrich CASPERS
Original assignee: Zwo3Vier Ug In Gründung
Priority date: 2011-02-03
Filing date: 2012-01-30
Publication date: 2012-08-09
Also published as: DE202011002311U1

Abstract

The invention relates to a device for arthroscopy simulation with an artificial joint having at least two joint partners with condyles that transmit joint force. The invention furthermore relates to a tibia element. In order to be able to practice arthroscopic procedures as realistically as possible, it is proposed that the joint has a joint space into which the joint partners respectively project, at least with an end section of their respective condyle which transmits the joint force, with it being possible to fill said joint space with a fluid and/or gaseous medium and to seal said joint space in a fluid-tight and/or gastight manner to the outside by means of a sealing device. Furthermore, it is purposed that the meniscus elements are only secured to the tibia element in securing regions, which at least approximately correspond to the securing regions of natural meniscuses on a natural tibia.

Description

Apparatus for arthroscopy simulation and tibial element

The invention relates to a device for arthroscopy simulation with an artificial joint, which has at least two joint partners with joint power transmitting joint heads. The invention further relates to a tibial element.

Such devices are used instead of expensive anatomical specimens for the simulation of arthroscopic surgery on human and / or animal joints. Such interventions are becoming increasingly necessary, in particular in the case of joints subject to high mechanical stress, such as the human knee joint, the damage to the joint giving rise to this being extremely different.

Essential to this is that the device enables a simulation in which the joint in question, the necessary procedures and the movements of the joint required during the procedure can be trained as realistically as possible. For this purpose, essentially two different ways are pursued in the prior art.

On the one hand, as described for example in EP 1 038 286 B1, electronically realistic to natural-like joints are reproduced via computer simulation on a display, in which, for example, virtual pin-like probes and / or instrument sensors can be used to intervene. For this purpose, push-buttons and / or instrument sensors can be moved by a user without hindrance and coupled with force sensors in an actual space ("black box"), however, this can only give an impression of actual conditions, in particular the effective forces, during actual engagement It is hardly possible to practice the complex processes in arthroscopy in a realistic manner.There are also proposals for the virtual representation of certain forms of movement of joints, as described, for example, in DE 101 30485 C2, and secondly, there are mechanical joint models which are generally only for certain arthroscopic applications are laid down in GB 2 204 175 A For example, an artificial human knee joint with colored joint partners and ligaments is shown.

The object of the invention is to provide a generic device for arthroscopy simulation by means of which arthroscopic interventions can be practiced in a realistic manner.

The stated object is achieved by the features of claim 1. Advantageous developments are described in the subclaims. The stated object is already achieved in that the joint has a joint space into which the joint partners each protrude at least with an end region of the joint head transmitting the joint force, which can be filled with fluid and / or a gaseous medium, and which is outwardly sealed by means of a sealing device can be sealed fluid- and / or gas-tight.

With this measure, the possibility is created to prepare the artificial joint so that by means of the device navigation ability and arthroscopic interventions in the joint under normal conditions of engagement, d. H. under fluid and / or gas filling, can be practiced. The artificial joint may be formed as an animal or human joint.

With a fluid filling, due to a different optical refractive index of the fluid as compared to a gaseous medium, a different visual appearance can be achieved with a corresponding image transfer from the joint. The inventive device for arthroscopy simulation allows a corresponding practice in dealing with such difficulties. In addition, with the filling of gaseous medium and / or fluid in a clinical arthroscopy changed motion conditions of the joint, which can also be practiced by means of the device according to the invention. Further, for example, in joint damage or in the elimination of the same, such as a damaged natural meniscus, loosely floating, sinking or floating tissue parts, resulting in an arthroscopic procedure to obscure and / or obstruct the field of vision. A handling of these phenomena and / or a suction or removal of the tissue parts by means of a suction as part or by means of a gripping instrument, such as forceps, can also be practiced by means of the device according to the invention for arthroscopy simulation.

Advantageously, the filling of the device according to the invention can take place under overpressure. Thus, the envelope joint space enlarging elastic or inflate. The joint or joint space can be dilated or inflated under overpressure. With the filling, changes in geometric relationships or spacings, for example, of the joint partners and / or other elements of the joint within the same can thus be established. By means of this measure, a surgeon can operate better with arthroscopic instruments, such as probe hooks, pincers, shavers and optical camera, into the joint space between the joint partners in a joint space and / or between the sheath and joint partners.

The sealing device may comprise at least one tubular flexible sheath. The sheath can be designed to be fixable on both sides sealingly on the joint partners. With regard to its position relative to the joint space, the sheath can be arranged such that it is positioned at least approximately equal to a joint capsule of a natural joint. Thus, the space limited by the flexible shell joint space may be at least approximately equal to a joint cavity of a natural joint. Advantageously, the shell can be adapted to the material side, in particular with regard to tightness, flexibility and / or strength of a corresponding natural joint capsule. In this case, at least locally limited tissue deposits may be provided in a shell for generating a correspondingly locally increased strength. The inner sheath is preferably fixed in position on the femur element in the case of an artificial joint with a femur element and a tibial element designed as a knee joint. Here, in imitation of the joint capsule of an anatomical knee joint, as a joint space, it can limit a corresponding joint cavity with, for example, upper, inner (medial), lateral (lateral), inner posterior (dorsomedial) and / or laterally posterior (dorsolateral) joint pockets (recess) , In general, a reference to the anatomy of the corresponding part of the natural joint to be imitated is to be understood as meaning the elements imitating the part in terms of topographical anatomy, ie external shape and / or relative position, and / or internal anatomy, ie a material quality and / or an internal structure to which the part to be imitated are at least approximately or largely adapted.

By means of the sheath can also pathological changes of a joint capsule, such as crack, marginal detachment and / or surface enlargement by villi formation (synovitis), presented and their removal practiced.

As in the case of clinical arthroscopy, access to the joint space can be achieved by penetrating the sheath at specific sites or portals. These can be used for training purposes, for example

be marked by outline. For exercise purposes, the portals may be formed as fixed, preferably closable inputs.

Advantageously, the sealing device can have two hose-like flexible sheaths. In this case, one of the sheaths can be arranged as an inner sheath facing the joint space. The other can be arranged as an outer shell facing away from the joint space. The inner casing and / or the outer casing can each be designed to be sealingly fixable on both sides of the joint partners. Preferably, the outer shell preferably completely overlaps the inner shell. With regard to their respective position relative to the joint space, the inner sheath can be positioned at least approximately equal to a joint capsule of a natural joint corresponding to the artificial joint and / or the outer sheath at least approximately equal to a natural body surface. The inner sheath may be shaped and / or dimensioned at least approximately like a joint capsule of a natural joint corresponding to the artificial joint and / or the outer sheath at least approximately equal to a natural body surface. The joint space can be positioned at least approximately equal to a joint cavity of a natural joint and dimensioned. be nier. The outer shell can simultaneously form the outside of the device at least in the area of the artificial joint. The inner shell and / or the outer shell are advantageously arranged exchangeably in the device. Inner shell and outer shell may include a gap. For the imitation of body tissue, the intermediate space may have a filler, such as a gel, in particular an aqueous gel, and / or preferably small, advantageously spherical particles of a preferably hydrophobic material, in particular of polystyrene. This filler is preferably designed to provide a mechanical resistance to movement of the artificial joint which is advantageously at least approximately equal to the resistance created by surrounding tissue in a natural joint.

The casings can be part of a set for equipping the device according to the invention. The set may comprise a series of inner and / or outer sheaths, each of which may have different sizes and / or defects to represent pathological changes. The casings may have mimicked materials or material combinations in imitation of the joint capsule or the outside of the body. For filling and for manipulating the fluid and / or gaseous medium, a preferably valve-controlled or regulated filling device can be provided. This may have an entrance and exit to or from the joint space and / or to or from a gap between the inner shell and the outer shell. Input and / or output can be channel-like introduced into at least one of the joint partners. The input and / or the output can be arranged axially extending in at least one of the joint partners, at least with a main path component. By means of input and output, a flow direction for the gaseous medium or the fluid can be defined. It can also be provided that the flow direction can be changed. This can also happen in constant change. The filling device may have a pressure control or regulation for an internal pressure in the joint space. The filling device may alternatively or additionally have access to an arthroscopic insertable feeder. The filling device may, for example, have a preferably operable from the outside suction device with a movable suction element, such as proboscis, for sucking suspended particles in the fluid. About the pressure control, the suction of suspended particles can be done at least within a certain tolerance range without pressure loss, so this can be done without affecting the expansion of the joint space. The access and suction tube can be inserted arthroscopically through the inner sheath into the joint space. Both can be combined into one unit. About the filling and pathological changes of synovial fluid, for example, in terms of their amount and / or their composition, can be displayed in the joint space. The filling of the joint space can take place such that the fluid and / or the gaseous medium is introduced primarily or at least predominantly into the inner shell. This can inflate under pressure. Furthermore, this can flush the joint space. For arthroscopic intervention in the artificial joint, the inner and / or the outer sheath, as in an arthroscopy at the natural joint, for example, by means of a scalpel in a small section are opened. With insertion of the arthroscope, the cut edges of the cut can rest against the arthroscope at least approximately sealingly due to the advantageous flexibility of the casings.

A preferably end-side sealing of the shell or the shells can advantageously be carried out simply according to the tongue and groove principle. For this purpose, the inner sheath and / or the outer sheath may each have at both ends a circumferential thickening or bulge, which may engage sealingly in each case in one or together in an associated provided on the corresponding joint partner groove. Less expedient, but possible, the sheaths may each have provided grooves, in particular provided on the joint partner particular bead-like thickening can intervene. The intervention of the thickening can be carried out under elastic expansion of the respective sheath, so that the thickenings can each engage under bias in the associated groove. Alternatively or additionally, an external contact force can be exerted on the thickening, by means of which the thickening can be pressed into its associated groove and / or held. To generate the external contact force, for example, an additional ring-like or sleeve-like clamping element can be clamped on the outside over a region of the sleeve with the respective bead. The tensioning element can be tensioned elastically and / or by shortening its length. The tensioning element may be a rubber ring or sleeve, a tension belt or a cable tie.

In an alternative embodiment of the device, at least the rod ends of the joint partners can be shaped at least approximately equal to the outer anatomy of the joint partners of the natural joint corresponding to the artificial joint. Here, the Geienkpartner, preferably only the condyle or condyle with an adjacent shaft portion, be molded from a natural specimen. Thus, the joint partners, the condyle or the condyle with an adjacent shank portion of the joint partners according to the impression exactly the geometries of corresponding joint partners naturally tend to have joints.

In general, bone imitations of the device for arthroscopy simulation can be made of plastic, preferably hard plastic, such as hard foam or cast resin, preferably with a medium to high Shore hardness. This measure makes it possible to practice realistically on the imitation bone also bores or abrasions, for example by means of milling. It can only be a core of the bone imitation made of hard plastic, which may be coated to imitate a natural cartilage layer on the bone substance with a softer plastic material material has at least similar properties, in particular Shore hardness and toughness as the natural cartilage. Useful are rubber-like materials or silicone. For example, at least the joint head may be made of plastic, preferably with a medium Shore hardness, in particular made of silicone. The Shore hardness can be 60, for example. The bones in the itate may be at least partially coated with silicone to imitate cartilage areas. To imitate attached to the condyle parts, such as menisci, the function of a natural joint having a lower hardness than the condyle, a plastic may be provided which has a much lower Shore hardness, in particular a Shore hardness of about 15 to 30 , may have. Inner and outer sheath can be made of a flexible plastic, in particular of a rubber-like material or silicone. Here, a low to medium Shore hardness of about 30 to 50, preferably of at least about 40, is considered suitable. Outer shell and / or inner shell can be designed in multiple layers, in particular in the area of valves and / or access, in particular in areas of inflow and / or outflow for the fluid or gaseous medium into the joint space. Over this higher strength can be achieved. Foam material may be incorporated between the layers to improve the tightness of the outer cover. Alternatively, a blend technique with the help of silicone fins in question. Thus, the cases can be formed so pliable that they can perform all necessary movements of the artificial joint with. If two shells, the inner and the outer sheath, are provided, then only the outer sheath can be at least almost fluid and gas tight. The flexible plastic, in particular the inner shell, can be used to imitate reinforcing structures in natural joints, as a matrix for incorporating fiber structures. These fiber structures can be partially stored at specific locations and / or aligned differently effective mechanical force.

In an alternative embodiment of the device for arthroscopy simulation, at least in one of the joint partners, the condyle or the condyle with an adjoining shaft section may be designed at least approximately corresponding to the anatomy as bone-like. The shaft or the same with an area of the condyle adjacent to it can be designed such that it emerges. tende forces and moments at least biomechanically approximate and anatomically correct transmits.

Alternatively, the device may be modular. This has the advantage that on the one hand easily individual parts of the device can be replaced. Furthermore, the device can be easily disassembled and stowed as a simulation apparatus, for example, for storage and / or transport to certain training locations. The geienkpartner can be counted as the first modules, the meniscus elements and / or the shells for this modular structure.

Preferably, at least one end portion of the joint head with force-transmitting joint surfaces, the joint head as a whole, the shaft portion and / or the joint head with shaft portion may each be formed as a separate component, which is preferably exchangeable. This has the advantage that just the areas of the device for arthroscopy simulation, which become so unusable, for example, by removal and drilling for further intervention, as wear parts in the form of replacement parts cost, easy and time-saving can be replaced. The replacement component may thus be part of the modular structure. The separate component can be fixed to a provided first base of the joint partner at least axially shift resistant and rotationally fixed. Preferably, this is a releasable axial locking connection, in particular a so-called shuttle lock, is provided. The first base may thus be part of the modular design of the arthroscopic simulation device. The first base can be fixed in place, for example, on a table or a room wall as a second base for simulation. A joint partner can be constructed of a first base and a separate component. The separate component may preferably be fixable to the first base by means of a tongue and groove connection, in particular a dovetail connection. For this purpose, tongue and groove may preferably extend perpendicular to a longitudinal direction of the respective associated Gelenkpartners. Thus, the separate component can be fixed by means of lateral or with respect to the longitudinal radial pushing on the first base. Preferably, additionally Locking of the first base and separate component to be provided in a certain position.

For fixing the separate component to the first base, for example, an adapter may be provided. This can be arranged as an intermediate piece between the separate component and the first base. In this case, the component can be fixed to the adapter, for example, by sliding it laterally onto the adapter. For this purpose, the above-described tongue and groove connection or dovetail connection can be provided for connecting the separate component to the adapter. The adapter can be rotationally fixed to the first base. For this purpose, the

Adapter be formed by means of an axial connector frontally fixable. The connector may have two radially spaced pins. At least one of the plug pins can lock on the joint partner. Preferably, the adapter can taper in the installation position in the direction of the separate component. For simplified manufacture, the adapter may be plate-like.

The joint partners may be designed to match each other corresponding to those of the natural joint to be simulated. Thanks to the interchangeability of the joint partners or the separate components through pairings, the device according to the invention offers the possibility of representing corresponding malformations in the shape congruence of the joint partners, to deal with them or to practice their at least partial elimination.

In particular, when the separate component comprises only the end portion of the joint head with the force transmitting joint surfaces or the joint head as a whole, it may be advantageous that the first base in a region facing the joint with respect to its radial extent dimensioned smaller than the associated joint partner of the natural Joint is. Thus, a correspondingly expanded operating field for the user can be created, in which he can handle the tools to be used more easily. In this case, the region can be, for example, rod, tube or truncated cone or at least approximately the same size as the bone in the region of the associated natural Joint partner be formed. The area may be integrally disposed on the first base. Advantageously, the adapter can be designed like the region of the first base facing the joint. This has the advantage that simplifying the production, the first base, for example, at least approximately equal to the outer shape of the corresponding natural joint partner can be produced.

In addition, the operation field and / or a length of the associated artificial joint partner can be set via the adapter, for example.

The first base may be formed at least approximately corresponding to the natural shape of the respective joint partner. For example, in the case of the artificial joint formed as a knee joint, the first base in the tibial element as a joint partner may preferably comprise the part of the lower leg adjoining the separate component up to the ankle or at least parts of the foot corresponding to its outer geometric shapes. The foot may be stiff, in particular in one piece, or possibly articulated connected to the lower leg. Correspondingly, the first base of the femoral element may comprise at least the part of the femur adjoining the component. Preferably, the weight of the respective joint partner is bez. the lower leg may be designed with foot and thigh so that it is at least approximately equal to the weight of an associated natural joint partner. The weight of the respective joint partner may preferably correspond approximately to that of an associated natural joint partner in which a cavity is provided in the relevant joint partner, which can be filled with material for weighting. Anatomical variants of the leg-weight of a natural leg can be generated by a variable degree of filling and / or by a variable filling material of the cavities of the artificial joint partners. An additional advantage of this design feature is that the transport weight of the entire device can be kept as low as possible by not filling the cavities.

All of these measures allow a user of the device according to the invention during training to get a feeling for realistic dimensions and weights of the joint partners and to learn how to cope with them. It is understood that by means of the device according to the invention, for example, symmetrical joints these can each be represented accordingly. For example, arthroscopy can be simulated on a right and left knee joint.

In a special embodiment of the device, the artificial joint is designed as a knee joint with a femoral element and a tibial element with meniscal elements as a joint partner. In this case, the meniscal elements of the artificial joint can be fixed to a tibial-headed head of the tibial element in an advantageous proximity to a natural knee joint only in certain fixing areas. The setting areas are preferably selected to correspond at least approximately to the setting ranges of natural menisci of a natural knee joint. Thus, the meniscal elements may be arranged to extend over the tibial-headed head and, bounded by the attachment areas, to form pockets with the tibial-head, which, like a natural joint, are instrumentally accessible during arthroscopic surgery. This also allows the underside of the meniscal elements to be examined. The femoral element may have a femoral head.

Advantageously, the hardness of the used engineering materials may be at least similar to those of the natural materials. In the case of the natural tibial plateau, there are essentially three areas to be distinguished with regard to the materials: bone substance, bone cartilage or periosteum as well as menisci. The natural menisci are located in their hardness between those of the hard bone substance and the softer articular cartilage or periosteum. This can be represented technically by means of appropriate plastics. It is, as noted above, advantageous to use as material a silicone having a mean Shore hardness of, for example, about 5 to 25 as a material. The meniscus elements for the artificial joint may, for example, by means of mechanical methods, such as clamping or sewn, and / or chemical methods, such as gluing or by means of chemical compounds, in particular bridge connections, with the tibial element get connected. The tibial element and / or the femoral element can be made of hard plastic for imitation of a bone substance. In this way, conventional bores, for example for fixing a torn off ligament or tendon and / or milling bone substance, can be practiced on the artificial bone. To simplify the device can be provided that the tibial plateau is made of a plastic, in particular silicone, average Shore hardness of 50 to 70. The technical imitation of the natural articular cartilage or the natural periosteum can be dispensed with in many applications.

In preferred embodiments, the tibial element and / or the femoral element can be coated with a softer plastic or rubber, in particular with silicone, at least on the joint surfaces. This coating serves, among other things, to imitate a cartilaginous layer over the hard bone substance in a natural joint. This coating may have a location-dependent layer thickness corresponding to the natural cartilage layer. Advantageously, the meniscus elements also made of silicone can be positioned against the tibial-head head in such a way that solid silicone compounds can form in the fixing areas with the hardening of the silicones between the meniscal elements and the condyle in a type of vulcanization process. Since simpler production technology, the tibial element or the replacement component can be made of silicone with a preferred Shore hardness of about 60, on which the meniscus elements are applied with lower Shore hardness. On the material side, the meniscus elements in the plastic or silicone can have fiber structures embedded as a matrix for imitating collagen fibers of natural menisci. The meniscal elements may have a specific gravity that is greater than or equal to the specific gravity of a fluid intended for filling the joint space. In order to avoid floating of separated parts of the meniscal elements during training, so that these parts float floating in the fluid used or fall in the same. The meniscal elements can be prefabricated for training purposes various malformations and / or pathological changes, such as various crack shapes have. For the apparatus for arthroscopy simulation, a set may be provided which, in each case as an exchange component, has at least two or more identically and / or differently dimensioned components and / or components with unnatural shapes for simulating damage and / or malformation. The damage and / or malformation to be represented can ultimately affect every part of the joint. Advantageously, because of its frequency, the damage and / or malformation to be represented may affect the menisci.

In an alternative embodiment of the device functional elements may be provided which serve in the artificial joint as a substitute for joint and / or capsule ligaments or tendons of an anatomical joint and / or the anatomical joint over and / or spanning tendons and / or ligaments. In natural joints, joint or capsular ligaments connect the joint partners or tendons and muscles, which have a powerful effect on the joint. The functional elements may be designed to be fixable according to the anatomy and / or according to their force-mechanical effect on the anatomical joint, preferably at the joint partners of the artificial joint. The functional elements can each be at least approximately adapted to the material side of the associated natural tendon or ligament. As a substitute for forces that are exerted by tissue and / or muscles on an anatomical joint, at least one spring element can be provided as part of a spring device, which can act on the Geienk according to force mechanics. Preferably, the spring force is adjustable in terms of amount, direction and / or point or attack points. As a result, it is possible, for example, to simulate a natural contact pressure of the patella on the joint, in the case of a knee joint on the femur, and pathological changes, for example with regard to the point of force application and / or pressure of the patella. By means of the functional elements can also be any pathological and / or caused by accidents deviations from anatomically normal training, Arrangements and / or functions of the joint and / or capsular ligaments or tendons of an anatomical joint and / or the anatomical joint over and / or spanning tendons and / or ligaments are imitated and practiced on these arthroscopic examinations and / or interventions.

In a further alternative embodiment, the device may be provided with a frame with a guide and / or receptacle for guiding and / or fixing of functional elements. Such a frame may be an additional component of the artificial joint that is not part of the anatomical joint. Mitteis the frame, for example, at least some of the functional elements can be added instead of or in addition to one of the Geienkpartner on a page or end. Thus, the one joint partner can be arranged free of connecting functional elements in the artificial joint, so that at this point a solution of the joint can be done more easily. Thus, the one joint partner can be easily removed as the first module of the device. The frame may have an approximately hollow cylindrical shape with an interior for receiving the one joint partner. In this case, the inner contour of the frame of the outer contour of a joint partner can be adapted in the region of the frame. Preferably, the inner contour of an anatomically modeled or molded from a natural specimen.

The frame is preferably connected to the one joint partner in such a way that this joint partner can be pulled off the frame with the solution of the compound in a direction pointing away from the other joint partner. Preferably, the frame and the joint partner are designed such that they have no undercuts with respect to a relative movement into or out of a connection position. The frame can serve as a driver for one joint partner by being able to be moved against the other joint partner, preferably by means of the functional elements fixed to it. Thus, the frame can provide a joint connection. Preferably, the frame is arranged circumferentially to the hinge. Alternatively or additionally, the frame may be fixed to the one joint partner. For its determination, an elongate connecting element, such as screw rod or a secured by splint rod, be arranged radially to the joint partner guided by a guided through the joint partner and the frame bore. In this way, a form-fitting and / or non-positive connection can be established via the frame fixed to the one joint partner and via the functional elements fixed to it and to the other joint partner

Joint partners are produced. As a result, the joint partners can rest relative to one another via a joint gap or be positioned at a distance. The joint gap can be adjustable by means of the definition of the functional elements on the frame. By adjusting the effective length of a functional element or lengths of several Funktionselerfiente anatomical variations, pathological and / or malformed changes in this power flow between the joint partners as well as symmetrical or asymmetric spacing and / or concerns of the joint partners can be simulated. In an artificial joint as a knee joint with tibial element and femoral element and when fixing the frame to the tibial element, the tibial element can be removed from the knee joint, for example, to exchange its replacement component out of the frame.

The frame may preferably be fixed to the one joint partner, preferably exchangeable. The frame fixed to the one joint partner can in this case be positioned such that it leaves at least the joint surfaces of this joint partner by preferably projecting beyond the frame in the direction of the other joint partner.

The frame can be designed, for example, at least in sections as a rod or grid component. Preferably, the frame has a hollow cylindrical wall with provisions, such as receptacles, openings and / or guides, for the functional elements. By means of the measures provided for on the frame, the functional elements can be arranged at least approximately anatomically correctly guided over the joint and can advantageously be operated on a specific force-mechanically effective manner. same length. Thus, an arthroscopy simulation can be carried out even closer to reality.

The frame may be disposed between the outer shell and the inner shell. He can press the inner shell, in particular at its thickening or bead sealing at least against one of the two joint partners. Through openings designed as portals can be provided on the frame, which hold certain intervention fields uncovered for arthroscopic engagement in the artificial joint from the frame. This is particularly advantageous when the frame presses the inner shell to its holder and seal both sides against the joint partners and this axially overlaps the inner shell. For example, for surgery on meniscus elements of an artificial knee joint openings may be provided in the installation position in the amount of menisci, the arthroscopic observation and freedom of movement for handling arthroscopic or surgical devices, such as for sewing defective meniscal parts allow.

With the definition of the respective functional element a force-mechanically effective length for artificial joint can be fixed. This length can be adjusted by their definition on the frame and / or on the one joint partner. The effective length of the functional elements may be adjustable individually, in groups or in their entirety. By means of the measures provided for on the frame, the functional elements can be arranged at least approximately anatomically correctly guided over the joint, so that an arthroscopy simulation can be carried out even more realistically.

Individual or all functional elements can be designed modularly as individual components. These can each be cut to a required length, for example, from suitable prefabricated yard goods in the form of ribbons, ropes and the like. The functional elements may be fixed in position on the frame, for example via clamping or crimping connections. For this purpose, the crimp can have a sleeve for round functional elements or a flat, preferably reinforced on the inside guide channel for flat functional elements in the or in which at least one screw or an eccentric can be screwed in laterally for clamping the respective functional element. For a stepless adjustment of the force-mechanically effective length of the respective functional element is possible.

For example, in the formation of the artificial joint as a knee joint with a femoral element and a tibial element as a joint partner, the artificial joint may have as functional elements anterior and posterior cruciate ligament element, patellar tendon element or quadriceps tendon element with interposed patellar or patella element, medial and lateral sideband element and / or populus tendon element , These functional elements can each be fixed with a first end region on the tibial element or the femoral element and can be fixed to the frame with a second end region. The attachment to the frame and femur element may preferably be such that the forces transmitted by the functional elements in magnitude and / or direction are at least approximately equal to those in a corresponding anatomical joint. Thus, the tibial articular head {or femur head) may be freely accessible, at least with respect to its articular surfaces, such that, for example, meniscal interventions are freely accessible. It will be understood that in reversal of the arrangement, the frame may be fixed to the femoral head.

The anterior cruciate ligamentous element and / or the cruciate ligamentous element may, similar to the anatomy, be formed as a roundish band and may be made, for example, from a synthetic, strong to high-strength rope, which may comprise carbon fiber, for example. The diameter may be, for example, 8-10 mm each. They can be fixed to the frame and tibial element so that a functional anatomy is guaranteed dynamically in the range of motion from extension to flexion. With regard to the anterior cruciate ligament, functional joint play can be simulated or adjusted for valgus stress and for anterior stability. With regard to the posterior cruciate ligament, functional joint play may be practiced in valgus and varus stress and for dorsal stability. The second end region of the anterior cruciate ligament or of the posterior cruciate ligament can be guided on the frame in a respectively assigned guide channel and can be adjustably fixed in position. With the setting of the effective length of the anterior cruciate ligament element and / or posterior cruciate ligament element, for example, for training purposes, a front and / or posterior cruciate ligament insufficiency can be represented. Furthermore, a defined gel kspaitbreite can be set over this, over which the joint partners rest on their joint heads and are spaced.

Medial sideband element and / or lateral sideband element can in each case be designed as a flat band made of advantageously tension-resistant, preferably synthetic material, such as, for example, a roller blind strip, in adaptation to anatomical sidebands. The first end region of the medial sideband element can be arranged on the medial side of a medial femoral condyle of the femur element in such a way that the functional anatomy is ensured in both extension and flexion, and functional joint play is enhanced

Valgusstress can be practiced by means of the device. The first end region of the lateral sideband element may be on a lateral side of a lateral

Femoral condyle of the femoral element can be placed so that the functional anatomy in both extension and flexion is ensured, and the functional joint play in varus stress (also the foursome position) can be practiced by means of the device. The second end region of the medial side band element and / or the lateral side band can each be arranged to be fixable in an associated flat guide channel in the frame. Both side band elements can fix the frame position on the femoral element and / or prevent it from opening medially or laterally thereof.

The Popliteussehnenelement may be similar to the anatomy designed as a round band. The first end region of the politeus tendon element can be arranged similar to the anatomy on the lateral side of the lateral femoral condyle so that the functional anatomy is ensured both in extension and in flexion and the functional joint play can be practiced in varus stress (quad position) by means of the device. The second end region of the politeus tendon element may be preferably be fixed in a threaded sleeve in an associated guide channel on the frame. The attachment of the first end region of the popliteus tendon element can be effected in the vicinity of the attachment of the lateral sideband element to the femoral condyle.

The patellar tendon element and / or the quadriceps tendon element may also be cut to length from a strap material described in more detail above. The above-mentioned spring device may act on the quadriceps tendon element to simulate a naturally existing tensile force on the natural quadriceps tendon. The spring device may comprise a tension spring element which preferably directly biases the quadriceps tendon element. The pulling mechanism may be disposed within the outer sheath ventral to the condyle of the femoral element and / or be forceful. In this way, it is advantageously possible to produce a specific pretensioning of the joint in the suspended position of one of the joint partners, that is to say in the case of an artificial joint designed as a knee joint, in the bent position of the knee joint. Furthermore, with passive extension of the trainer, a certain tension of the stretching apparatus can be simulated. The traction can advantageously be adjusted so that no hypercompression of the patella occurs. This allows easy passage with a tactile hook and / or an arthroscope between the femoral plain bearing and the patella. This tensile force can be adjustable, for example, to represent a pathological condition of the extensor apparatus and / or the patellar tendon element and / or the quadriceps tendon element.

The tendon elements can each be made of a hard elastic band material. In a simplified construction, patellar tendon element and

Quadrizepssehnenelement be made of a band. On the band, the patella element can be fixed dorsally, ie on the side of the band facing the joint space, in anatomically correct position or, for the simulation of pathological changes, displaced from the anatomically correct position. A determination can be made purely mechanically. Constructively inexpensive, a screw can through the tape must be screwed into the patella element. Between band and patella element, the inner shell may be arranged. At the same time, the inner sheath can be fixed in position or clamped on the patella element by means of the connection between the ligament and the patella element.

The kneecap or patella may be formed at least approximately according to the anatomy. In nature, the patella acts as a flexion-deflecting sliding component ("hypomochlion of the extensor apparatus"), which transmits forces of the musculature, the extensor apparatus, from the thigh to the lower leg, with the patella being displaced to the femoral head The patella is anatomically covered by a smooth, translucent (hyaline) cartilage tissue for friction reduction on its sliding surface, which can be mimicked in the device, for example, by means of a suitably smooth cap made of a plastic The plastic can be a rubber-like material or silicone The plastic can be the same as the plastic that is used to imitate cartilage tissue in the bone of the joint partners.The silicone cap can under elastic expansion over a hard plastic core, such as rigid foam or casting resin as an imitation for an anatomically bony core of the patella, preferably exchangeably drawn and fixed under pretension to the core. The silicone cap may be slipped around the core with a kind of annular bead. The silicone cap can be exchangeable. Here too, prefabricated defects and / or deformities on the silicone cap can be provided for the simulation. Thanks to the use of hard plastic, drilling and removal, in particular milling, can also be practiced here.

On the inside of the inner shell, in a ventral, i. with respect to the knee front region of the joint space as a substitute for a naturally present in an anatomical knee joint so-called Hoffaschen fat body be arranged a faux. The extravasation fat body may be at a clinical

Arthroscopy very easily hinders access to the interior of the knee joint and can obstruct vision from time to time in the optical field of vision of the surgeon pushing. With the arrangement of this imitation anatomically correct place in the knee joint can be practiced by means of the device and this difficulty in arthroscopy. As a possible material can be porous plastic, in particular foam, serve. The imitation is preferably interchangeable.

In an alternative embodiment of the device, deviating from the anatomy of a natural joint, a compensation device for compensation of forces and moments of force acting on the joint in a corresponding natural joint and not directly on joint and / or capsule bands or tendons of an anatomical Be transmitted joint, be provided. These forces and moments of force can be caused, for example, by muscles that overlap the natural joint or tendons that lead to muscles, or by tissues that generally surround the natural joint, which can manifest themselves, in particular, in a movement inhibition and / or limitation of movement. As a result, for example, an overstretching of a natural joint can be prevented. To simulate this effect on the natural joint is very meaningful for a realistic practice of arthroscopy. Single or multiple, possibly force-mechanically interconnected functional elements can preferably simulate these forces summarily. A single functional element can transmit forces with soft-elastic and / or hard-elastic parts over a certain range of motion of the artificial joint, wherein at least one force application point of the functional element is preferably arranged remotely to the joint surfaces on one of the joint partners. The soft-elastic portion can be simulated by means of spring elements, for example. The hard-elastic portion can be simulated in a structurally simple manner by means of suitably hard-elastic bands, such as a roller blind band.

Anatomically, joints are limited in their range of motion (extension and flexion, external and internal rotation as well as abduction and adduction) by overarching muscles and / or tendons. A simple technical representation for the simulation of this movement limit would be possible, for example, by means of appropriate stops. Alternatively, additional functional elements may be be provided elements between the joint partners. These can be designed, preferably spring-loaded and / or have a certain functional length, which is effective only from a certain angle of flexion and / or angle of rotation. For this purpose, the connecting element may be formed, for example, as a band element which spans force-transmitting and thus movement-inhibiting with a certain flexion angle and / or angle of rotation.

The band member may be cut to length from a band material, such as roller shutter band. If, for example, the artificial joint is designed to simulate a natural knee joint, a longitudinal band element may additionally be provided as a band element in the simulated knee joint, which dorsally extend beyond the knee joint to simulate the posterior thigh and / or lower leg muscles as the rear longitudinal band element can. By means of the additional rear

The longitudinal ligament element can be fixed with its first end region on the back or dorsal side of the femur head and with its second end region on the back or dorsal side of the tibial articular head If a frame is provided, it may be fixable with its first end region on the posterior or dorsal side of the femoral head and with its second end region on distal-dorsal to the outside of the frame at the level of the tibial-articular head Preferably, the rear longitudinal band element is preferably stable up to about 30 kp and advantageously hard-elastic, ie it has little or no extensibility, and can have a flat shape Ormalfall be sized so that the knee joint can be stretched up to a maximum of 180 degrees or according to a so-called neutral zero method up to 0 degrees. For clinical examination of hyperextension or limited extension of the knee joint, the force-mechanically effective length of the rear longitudinal band element can be extended or shortened. As mentioned, the device may be modular in an alternative embodiment. For movement simulation of the artificial joint, at least one of the joint partners may be connected to at least one second module on a side remote from the artificial joint and / or facing away from it. Preferably, the second module with respect to the artificial joint force-mechanically at least about the same effective as a corresponding natural body part may be formed. The second module may be formed as a second artificial joint connecting the first module to a third module. In the formation of the artificial joint as a knee joint, the second module, subsequent to the femoral element, be a hip joint module, which in turn is connected to a pelvic element as a third module. The hip joint module can be a common artificial hip joint with head and socket. A calf bone element and / or a foot element may adjoin the tibia element laterally (laterally) in a caudal manner in a region facing away from the joint.

By virtue of this mode of construction, the device may, for example, become a complete limb, i. Leg or arm, to be assembled. This has the advantage that also the type of movements required in clinical arthroscopy in which the limb as a whole has to be moved in various ways (such as valgus stress) in order to widen certain interiors or pockets of the joint to be arthroscopically in order to reach them instrumentally, one can practice. It is preferably provided that the device can be attached and / or fixed in position, for example, via a further module on the preferably static second base. This can be for example a screw clamp or vise.

The modular construction of the device optionally also includes all previously named and / or described individual components, such as sheaths, replacement component, adapters, ligaments, tendons, joint partners or parts thereof, such as tibial head or femoral head, and / or the above-mentioned modules. This makes it possible, by means of the modular structure of the device, the artificial joint or parts thereof, in addition to represent the body parts adjacent to the joint or its joint partner as imitations and in addition to these body parts adjacent body parts as imitations.

The individual modules are preferably matched to one another in such a way that, in their entirety and / or individually, they have at least approximately the weight of equivalent parts of a corresponding natural joint or, for example, a corresponding natural limb.

For example, to build a limb, a set can be put together that has all the individual modules of the limb for this purpose. Additionally or alternatively, replacement parts of, in particular, wear parts, such as the replacement part, the sheaths and / or the chordable tendon and / or ligament material, may be provided alone or in addition in a set. Furthermore, in another set alone or in addition, for example, embodiments may be included, for example, the replacement part with representation of damaged areas and / or with different dimensions. According to a further advantageous embodiment, it is provided that for the observation and objectification of movements of the optics and the instruments of the surgeon at least one camera is permanently installed in the device and / or an optic is arranged in the device so that the movements can be documented and the simulation process remains unaffected. The optic is advantageously flexible and / or designed as a bronchoscope.

The present invention is explained in more detail below with reference to an embodiment of the device with the artificial joint shown in a drawing. The drawing shows diagrammatically and diagrammatically a longitudinal section view of a first embodiment of a device with an artificial joint in the extended position a longitudinal sectional view of a second embodiment of the device with a joint formed as a knee joint in the extended position or in flexed position, comprising femoral element, tibial, patella and inner sheath, a cross-sectional view of the first embodiment of the knee joint according to section line III - III in Figure 2a, a 2a, a side view of another embodiment of the femoral element, a detailed view according to the detail VII in FIG. 2a, a side view of a third embodiment of the device with a modular artificial leg a knee joint according to Figure 2, a longitudinal sectional view of a section IX in Figure 8, a detailed view according to the section X in Figure 8, a side view of the artificial leg of Figure 8 in the bent position of the knee joint with a one end it tibia articulated head tibial element as a separate component, a side view of the artificial leg according to Figure 11, but disassembled in the bent position of the knee joint, 12a: a side view of the disassembled separate component,

13 is a detail view according to section XIII in Figure 8, but this ventral or from the front,

14a-14d: respectively a view of the separate component according to FIG. 12a, FIG.

FIG. 15 is a longitudinal sectional view of the separate component according to FIG

Sectional view XV - XV in FIG. 14a,

FIG. 16 is a plan view of one half of the separate component with an outer shell lying on the outside, FIG. 17 is a detail view according to detail XVII in FIG. 15;

18a-18c each show a side view of the frame according to FIG. 8;

Fig. 19: a cross-sectional view of the frame according to the sectional profile

IXX - IXX in Figure 18a with screw,

FIG. 20 shows a detail view according to section XX in FIG. 18a with functional element, FIG. 21 shows a side view of femoral element and frame from FIG

Functional elements,

22 shows a view of the cross-sectional profile XXII - XXII according to FIG 18b with a separate component and inner shell,

FIG. 23: a plan view with partial section of a separate one arranged inside one another. FIG

Component, inner shell and frame, FIG. 24: a perspective top view of a section XXIV according to FIG. 23, but with a defective meniscus, FIG. 25: a longitudinal sectional view of the knee joint according to FIG

stretched position, but without inner shell and with functional elements,

FIG. 26 is a longitudinal sectional view of the knee joint according to FIG. 25, but in the bent position, FIG.

FIG. 27: a longitudinal sectional view of the detail XXVII according to FIG. 25, but additionally with inner and outer sheaths, FIG. 28: a plan view of the frame according to FIG. 18a with additional one

Fastener,

29: a side view of an adapter from FIG. 2a, FIG. 30: a side view of a first base from FIG. 8, FIG.

FIG. 31 is a plan view of the first base according to FIG. 30 and FIG

FIG. 32 shows a longitudinal sectional view of a connection region of the first base according to FIG. 30.

Several embodiments of a device V for arthroscopy simulation with an artificial joint G, the two joint partners P articulated heads K transmitting joint force, as well as parts or individual components of the device V are shown in detail views, individual representations and sectional views in FIGS. The joint G shown in FIG. 1 does not relate to a specific natural joint and is therefore only purely schematic. understand the table. Not shown in the drawing is a joint with more than two joint partners, which is also within the invention. The illustrations shown in FIGS. 2 to 32 relate to a joint G designed as an artificial knee joint 1, which is designed in each case as a joint partner P with a tibial element 3 having a tibial head 2 and a femoral element 5 having a femoral head 4. The artificial knee joint 1 is designed here as a left knee joint. A right knee joint has the same anatomy as a mirror-symmetrical structure.

The joint V or the joint G has a joint space R into which the joint partners P1 respectively project at least with a joint force transmitting end portion E of their respective joint head K. The joint space R can be filled by means of a filling device B with fluid F and / or gaseous medium not shown here. A sealing device A is provided by means of which the joint space R can be fluid-tight and / or gas-tight to the outside.

The sealing device A has a tubular flexible inner shell 6.1, which is fixed at both ends sealingly to the joint partners P. With regard to its position relative to the joint space R, the inner sheath 6.1 is arranged such that it is positioned approximately equal to a joint capsule, not shown here, of a natural joint. Thus, the joint space R shown here corresponds at least approximately to a natural joint cavity. The inner shell 6.1 is mainly constructed of a flexible material and has reinforcements, not shown here, in the form of fibrous structures in some places. The inner shell 6.1 is thus formed approximately equal to the joint capsule of a natural joint in terms of their position, shape and material properties. The inner shell 6.1 is provided at both ends with a circumferential bead 7, which engages sealingly in an associated circumferential groove 8.

The filling device B has two accesses 9, one of which serves as an input and one as an output. In FIGS. 1 and 2, the bottom access 9 as an input 10 and the top access 9 as an exit 11 are used on the basis of a flow direction f of the fluid F, by way of example. The entrances 9 are valve-controlled. This can be the Joint space R under inflation of the inner shell 6.1 be subjected to pressure. Furthermore, as described above, this rinses and possibly exhausts done. As in the figures 1 and 2 by way of example by means of a

Double arrow for the flow direction f indicated, the flow direction f can be reversed, with a filling advantageously takes place against gravity.

In the first embodiment of the device V for arthroscopy simulation according to Figure 1 is as a part of the filling device B in the joint partners P respectively a channel 9 introduced approximately axially guided by the joint partner P channel-like, which opens into the joint space R. Furthermore, the joint partners P each have a circumferential groove 8, in which the inner shell 6.1 sealingly engages with its bead 7 on the upper side or underside under bias.

In the second embodiment of the device V for arthroscopy simulation according to FIG. 2, an access 9 is axially introduced into the femoral element 5 and an access 9 is axially introduced into the tibial element 3. In addition, here the joint partner P designed as a femur element 5 has a circumferential groove 8 (FIGS. 5 and 6) which is externally introduced into the femoral element 5 in a curved shape, in which the joint capsule grows together with the femur in the case of a natural knee joint is. To engage in this groove 8, the course of the provided here in the upper part of the inner shell 6.1 bead 7 is formed accordingly. As a result, the inner sheath 6. 1 engages in force mechanically similar to the joint capsule on the femoral head of a natural knee joint on the femur element 5 of the artificial knee joint 1. In FIG. 7, a detailed view in longitudinal section view, the inside-side engagement of the bead 7 in the groove 8 introduced in the femur element 5 is shown schematically. In the imitation of a joint cavity of a natural knee joint, the joint space has corresponding joint pockets, of which an upper joint pocket 12.1 or a rear joint pocket 12.2 are shown here by way of example in FIGS. 2a and 2b. The entrances 9 of the filling device B open into the upper joint pocket 12. 1 or into the rear joint pocket. Notwithstanding the first embodiment of the device V according to FIG. 1, the second embodiment according to FIG. 2 additionally has a sleeve-like frame 13, which is arranged circumferentially to the tibia head 2 in the insert position shown in FIG. 2 and the inner sleeve 6.1 sealingly engages against the tibial shaft head 2. stuck. Moreover, the frame 13 on the inside a groove 8, in which under reinforcement of a sealing effect in the here lower part of the inner shell 6.1 provided bead 7 is pressed under back pressure of the tibial head 2. This is shown in Figure 4 schematically and in sections in a longitudinal section. FIG. 8 shows a third embodiment of the device V for arthroscopy simulation, in which the sealing device A has two tube-like flexible sheaths, the inner sheath 6.1 and an outer sheath 6.2 facing away from the joint space R. The inner shell 6.1 of the third embodiment is here, as the inner shell 6.1 of the second embodiment of the device V, set the end sealing. The outer shell 6.2 has at both ends also in each case a circumferential bead 7, wherein here both are arranged inside and circumferentially and sealingly under expansion and thus materially under hard elastic bias in a designated annular groove 9 on the tibial 3 and the femoral element 5 sealingly engages. This is shown by way of example and at the same time very schematically in a longitudinal section in FIG. The outer shell 6.2 has on the material side silicone and is provided in some places with reinforcements not shown here in the form of fiber structures. The outer shell 6.2 is positioned and shaped with respect to their position at least approximately equal to a natural body surface. As in the case of clinical arthroscopy, access to the joint space R can be achieved by penetrating the inner sheath 6.1 or the outer sheath 6.2 and the inner sheath 6.1 at specific locations or portals.

As shown by way of example only in FIG. 1, the joint partners P have a core 14 made of hard plastic for imitation of a bone substance and a coating 15 of silicone for the imitation of natural cartilage substance. The hard plastic allows practicing arthroscopic drillings in the respective joint partner for the definition of ligaments and / or tendons and / or milling of "bone substance".

The joint partners P of the artificial joint 1 are made in the region of their heads 2, 4 from a cast of corresponding anatomical preparations. Thus, in the field of casting technology, they have exact natural-like external forms, such as the natural knee joint. Thus, the femur head 4 has a medial

Femoral condyle 16.1 and a lateral femoral condyle 16.2 (FIG. 6) and, corresponding to the shape, the tibial condyle 2 has a medial tibial plateau 17.1 and a lateral tibial plateau 17.2 with an elevation 18 arranged therebetween. Subsequent to the femur head 2, a femoral shaft 19 is arranged.

The second and the third embodiment of the device V is constructed modularly in each case with the two joint partners P as first modules 20.1. The possible complete modular construction of the device V will be explained below with reference to the third embodiment of the device according to FIG.

The two joint partners P of the knee joint 1 each have a first base 21.1 and a fixable on the first base 21.1, as a replacement component 22 ausgefegtes separate component. The replacement component 22 of the femur element 5 comprises a section 23 of the femoral shaft 19 with subsequent femur joint head 4. The replacement component 22 can be secured against rotation and displacement on the first base 21.1 by means of a conventional shuttle lock 24. Here, the shuttle lock 24 has on the first base 21.1 for latching a latching opening 24.1 for receiving a latching pin 24.3 provided on the replacement component 22 and for preventing rotation a plug-in opening 24.2 spaced from the latching opening 24.1 for receiving a plug-in pin 24.4 provided on the replacement component 22 (FIGS 29 - 32). For locking the locking pin 24.4 in the detent opening 24.1 engages laterally here sketchily shown resiliently mounted locking element 24.5 against the detent pin 24.3 in the detent opening 24.1. The replacement component 22 of the tibial element 3 comprises only one end portion 25 (FIG. 13) of the tibial-articular head 2 with the tibial plateaus 17.1, 17.2. The replacement component 22 of the tibial element 3 is connected to the first base via an adapter 26

21.1 of the tibial element 3 can be fixed. The adapter 26 is for this purpose also by means of a shuttle lock 24 rotatably and non-displaceably fixed to the first base 21.1.

The replacement component 22 of the tibial element 3 is in turn by means of a here formed as a dovetail connection 27 with groove 27.1 and spring

27.2 can be fixed to the adapter 26, wherein it is for its determination under engagement tongue / groove laterally, d. H. perpendicular to the axial longitudinal direction 1, on the adapter 26 can be pushed. This has the advantage that only the region of the artificial knee joint 1, in which the vast majority of arthroscopic interventions take place in practice and which correspondingly frequently "wears out" as a result of the operative practice of these interventions by means of the device V according to the invention, must be exchanged, while the remaining parts of the device V are reusable.

The device 1 furthermore has functional elements 28 which serve as replacement for joint and / or capsular ligaments or tendons of the here anatomical knee joint or for the anatomical knee joint over and / or spanning tendons and / or ligaments in the artificial joint 1 , These functional elements 28 are each designed to be elongated with a first end region 29.1 and a second end region 29.2. In the embodiments of the device 1 shown here, the functional elements 28 are fixed to the first end region 29.1 on the femur element 5 and to the second end region 29.2 on the frame 13. At the same time, an effective length w is determined by means of the fixing of the functional elements 28 at both ends, via which forces are transmitted from the femoral element 5 to the frame 13 by means of the functional elements 28. Since the functional elements 28 are here fixed to the frame 13 {and not like the ligaments and tendons in nature on the tibia), the tibial element 3 or here the replacement part 22 with the tibial plateau 17.1, 17.2 can be detached from the knee joint 1, without specifically for this purpose the functional elements 28 in its second end portion 29.2 detached must be, with the frame 13 by means of the functional elements 28 against the Femurgeienkkopf 4 held on the same remains.

For transmitting the forces acting on the frame 13 by the functional elements 28 on the tibia element 3, the frame 13 is in turn force-effectively connected to the tibial element 3 by means of a screw connection 30 by, as Figures 28 and 29 removable, a screw 31 radially to the longitudinal direction. 1 by appropriate through holes 31.1 the adapter 26 and by the circumferentially thereto arranged frame 13 feasible and can be fixed by means of an associated nut 31.2. With loosening of the screw connection 30, the frame 13 is released from the tibial element 3, whereby at the same time the inner sheath 6.1 can be pulled off the tibial element 3. Thus, the tibial element 3 is released from the joint 1 and can be withdrawn in the longitudinal direction 1 of the joint 1, wherein the frame 13 remains on the knee joint 1. This process is reproduced in FIG. 12, wherein the illustration of the screw connection has been omitted for the sake of clarity, and FIG. 12 shows the joint 1 with the tibia element 3 removed.

The frame 13 is arranged in the third embodiment of the device V between the inner shell 6.1 and the outer shell 6.2. In order to release the tibial element 3 from the knee joint 1, the outer sheath 6.2 with its bead 7 must first be removed from the groove 8 provided on the first base 21.1 of the tibial element 3. Then, after loosening the screw 29, the tibial element 3 can be withdrawn from the knee joint (FIG. 12). Subsequently, the replacement part 22 can be withdrawn from the adapter 26 perpendicular to the longitudinal direction 1 (FIG. 12a) and exchanged.

The engagement of the bead 7 of the outer sheath 6.2 in the groove 8 provided on the first base 21.1 of the tibial element is shown schematically in FIG. A groove 8 is also provided on the first base 21.1 of the femoral element 5 according to FIG. 10, into which the outer sheath 6.2 engages on the femoral side in the same way as on the tibial side with a bead, which, however, is not specifically shown here. Here, the first base 21.1 of the tibial element 3 has the dimensions of a corresponding lower leg section of a natural leg and is additionally provided with a foot element 32 which is firmly seated here and which also has the outer dimensions of a natural foot. The first base 21.1 of the femur element 5 according to FIG. 10, pointing away from the knee joint 1, is connected to a second module 20.2, which is designed here as a conventional artificial hip joint 33 with head 33.1 and socket 33.2, according to the anatomy of the head 33.1 the first base 21.1 and the pan 33.2 are fixed to a pool element 34 as a third module 20.3. The pelvic element 34, in turn, is set according to FIGS. 11 and 12 by way of example at a table T as the second base 21.2. Thus, with respect to the influence on the mobility of the knee joint 1, a complete leg C can be simulated up to the determination of the leg C on a table or other pad and at the same the different operative positions of the leg C can be practiced.

The functional elements 28 are, depending on the type to be imitated tendon or band, formed essentially lacing or band-like and are cut to a certain length of a cord or a band. On the material side, the functional elements 28 are largely aligned with the strengths and the expansion behavior of the corresponding anatomical tendons and ligaments.

In order to fix the functional elements 28 in their second end region 29.2 on the frame 13, a clamping connection 35 is provided with screw 31 and nut 35.1 cast in the frame 13, wherein the functional elements 28 are each guided on the frame 13 by a guide channel 26 and here by means of a screw 31 can be clamped in the guide channel 28. Thus, at the same time a certain effective length of the respective functional element 28 can be defined, ie it can also pathological conditions, such as too short or too long or torn or dissolved or ligaments and / or tendons, presented and their treatment be practiced. At the here shown second and third embodiments of the device V with the knee joint 1 as artificial joint G, all essential ligaments and tendons of the natural knee joint are imitated and fixed in position or positionally fixed according to their anatomically correct position on the femur element 5 or on the frame 13. It is understood that also pathological dislocations of tendons and / or ligaments can be represented by a correspondingly changed

Femurelement be provided with offset fixed position functional elements and / or a correspondingly modified frame with one or more dislocated guide channels.

In detail, the artificial knee joint 1 has as function elements 28 a front cruciate ligament element 37.1 and posterior cruciate ligament element 37.2 (FIG. 13), a patellar tendon element 38.1 or quadhopeps tendon element 38.2 with an interposed patella element 38.3 (FIGS. 25-27), a medial sideband element 39.1 and lateral sideband element 39.2 (FIG. 21) and a poplitus tendon element 40 (FIG. 21). In addition, as anatomically without a model, a rear side band member 41 is provided which mimics the forces and the cohesion, which or which are transmitted dorsally by means of overarching muscles and tendons on the anatomical knee joint.

The anterior cruciate ligament element 37.1 and posterior cruciate ligament element 37.2 are similar to the anatomy designed as a round band and made of a synthetic, high-strength rope. As can be seen in particular from FIGS. 6 and 13 (the knee joint 1 is shown in knee flexion in FIG. 13), the first end region 29.1 of the anterior cruciate ligament 37.1 is arranged medially of the lateral femoral condyle 16.2, guided by a guide channel 36 introduced into the femoral element 5 and is fixed in position at an outer attachment point 42 on the femur element 5. Thus, a functional anatomy is guaranteed in both extension and flexion, whereby a functional joint play in valgus stress and in terms of an anterior stability can be practiced. Accordingly, the first end portion 29.1 of the posterior cruciate ligament 37.2 is guided by an associated guide channel 36 and laterally of the medial femoral condyle 16.1 in one Fixing point 42 is fixed in position that the functional anatomy in both extension and flexion is guaranteed and the functional joint play in valgus and varus stress and in terms of dorsal stability can be practiced. The second end portion 29.2 of the anterior cruciate ligament 37.1 and the posterior cruciate ligament 37.2 are guided on the frame 13 in each case in an associated guide channel 36 and adjustably fixed in position in the same by means of a screw 31 {Figure 20). With the setting of the effective length w of the anterior cruciate ligament element 37.1 and / or posterior cruciate ligament element 37.2, for example, an anterior and / or posterior cruciate ligament insufficiency may be displayed for training purposes. Furthermore, a joint gap width g can be set via which the

Joint partner P abut their rod ends K or, as shown in Figure 3, are spaced.

The medial side band member 39.1 and the lateral side band member 39.2 are similar to the anatomy each cut to length as a flat band of tensile synthetic roller blind belt. As shown in FIG. 21, the first end region 29.1 of the medial lateral ligament element 39.1 is arranged medially to the medial femoral condyle 16.1 of the femoral element 5 in such a way that the functional anatomy is ensured both in extension and in flexion and the functional joint play in valgus stress by means of the device V can be practiced. The first end area

29.1 of the lateral sideband element 39.2 is lateral to the lateral femoral condyle

16.2 of the femur element 5 so determined in an attachment point 42 that the functional anatomy in both extension and in flexion is ensured, and the functional joint play in Varus Stress {also the foursome position) can be practiced by means of the device V. The second end region 29.2 of the medial side band element 39.1 and the lateral side band 39.2 is in each case adjustably fixed in an associated flat guide channel 36 in the frame 13 by means of the clamping connection 35 with nut 35.1 and screw 31 cast in the frame 13 (FIG. 19). Both side band elements 39.1, 39.2 are thus fixed in position on the frame 13 and on the femur element 5, whereby a fixing of the frame 13 on the femur element 5 allows and a medial or lateral unfolding of the knee joint 1 is prevented. Corresponding pathological changes, such as ligament tear or shortening, can accordingly with detachment of the position fixing or

Relaxation of the respective sideband element 39.1, 39.2 are shown.

The Popliteussehnenelement 40 is formed as a roundish band. The first end region 29. 1 of the poplite tendon element 40 is arranged laterally on the lateral femoral condyle 16. 2 in the same way as the anatomical anatomy is ensured both in extension and in flexion, and the functional joint play can be practiced with the device V in case of varus stress. The second end region 29. 2 is fixed in position in an associated guide channel 36 in the frame 13. The attachment of the first end portion 29.1 takes place in an associated attachment point 42 dorsal of the attachment point 42 of the lateral sideband element 39.2 on the lateral femoral condyle 16.2. The course of the popliteus tendon element 40 takes place within the inner sheath 6.1 to form a dorso-lateral or posterior-lateral part of the frame 13 in a dorsal or posterior joint pocket 43 (recess) (FIG. 22) below meniscal elements 46. The guide channel 36 for the popliteus tendon element 40 is reinforced by means of a cast-in metal sleeve 44.

The patellar tendon element 38. 1 and the quadriceps tendon element 38. 2 are produced in one piece with one another from a hard-elastic band material (FIGS. 27-29). To simulate a naturally existing tensile force on the natural Quadrtzepssehne a spring device 45 is provided, which is shown here purely schematically inserted into the Quadrizepssehnenelement 38.2. The spring device 45 directly clamps the quadriceps tendon element 38. The spring device 45 is arranged inside the outer sheath 6.2 ventrally of the femoral head 4 and is effective in terms of its force. By means of the spring device 45, among other things, a certain bias of the knee joint 1 in a hanging position of one of its joint partner P can be generated. The patella element 38.3 can be screwed by means of a screw 31 to the patellar tendon element 38.1 and the quadriceps tendon element 38.2 (FIG. 27), wherein, to imitate an anatomical adhesion of the patella with the joint capsule, the inner sheath 6.1 between see patellar tendon element 38.1 or the quadriceps tendon element 38.2 and the patella element 38.1 is clamped.

The patella element 38.3 is formed approximately corresponding to the anatomy. It has a core 14 made of hard plastic, which is coated with a replaceable cap-like coating 15 made of silicone under prestress. Again, prefabricated defects and / or deformities on the coating 15 can be provided for training. The rear longitudinal belt element 41 is flat as a belt and resistant to tension, i. Hard elastic or hardly stretchable, formed. It runs dorsally over the knee joint 1 away (Figure 21). The rear longitudinal band element 41 is fastened with its first end region 29.1 on the rear or dorsal side of the femur head 4 and with its second end region 29.2 distal-dorsally on the outside of the frame 3 in the installed position at the level of the tibial head 2, in each case by means of a screw 31, via the screw - Exercise his force-mechanically effective length w is adjustable. The force-mechanically effective length w is dimensioned for the normal case so that the knee joint 1 can be stretched up to 180 degrees. For clinical examination, the force-mechanically effective length w of the rear longitudinal band element 41 can be lengthened or shortened.

In the figures 14 to 17 different views and longitudinal sections are shown with individual representations of the exchange part 22 with the Endabschnttt 25 of the Tibiagelenkkopfs 2 and the groove 27.1 of the dovetail joint 27. The tibial head 2 has the meniscus elements 46 at the end. These are formed in terms of their shape and extent similar to natural menisci. Further, according to the natural meniscuses, the meniscal elements 46 are fixed to the tibia head 2 only in certain fixing areas 47. The fixing areas 47, which are marked by "x" in the longitudinal sectional views according to FIGS. 15 and 17, extend laterally and circumferentially around the tibial-head 2 and in tip-end areas 48 of the upper-half crescent-like shapes of the meniscal elements 46 according to FIG. 16. Like the natural menisci form thus the meniscus elements 46 with the tibial head 2 from pockets 49, which are bounded laterally by the fixing areas 47 and otherwise laterally accessible for arthroscopic tool, not shown here, such as a tactile hook. Meniscus elements 46 are made of silicone of low Shore hardness and the Tibiagelenkkopf 2 with a not shown here coating of silicone with a medium Shore hardness. To connect the meniscus elements 46, they are brought into close contact with the tibia head 2 prior to the completion of the curing process in the attachment regions 47, so that they form a close chemical compound and thus also a cohesive connection with the further curing. As shown in FIG. 14, a recess 50 for the rear hinge pocket 43 for the popliteus tendon element 40 is provided laterally. Further recesses 50 are provided dorsally and ventrally for the posterior cruciate ligament element 37.2 or anterior cruciate ligament element 37.1 in the center of the tibia head 2. This is also clearly Figure 23 removed.

To imitate collagenous fibers of natural menisci, fibers 51 are embedded in the silicone of the meniscus elements 46 as a matrix. On the material side, the meniscus elements 46 furthermore have a specific weight which is approximately equal to the specific weight of the fluid F provided for filling the joint space R.

By way of example, additional slot-shaped portals 52 are provided in frame 13 according to FIG. 18, which serve accesses for arthroscopic observation and freedom of movement for handling arthroscopic or surgical devices. FIG. 24 shows a section of the end section 25 of the tibial plateau 2 with the adjoining frame 13 and inner shell 6.1 clamped therebetween in a perspective plan view. Pictorially here a needle 53 is sketched, which is used by using the portal 52 for sewing a "cracked" meniscus element 46.

As can be seen in FIGS. 10 and 30, in the first base 12. 1 of the femoral element 5 and the first base 2. 1 of the tibial element 3, one of the two Accesses 9 of the Befülivorrichtung B provided so that the provided for filling fluid and / or gaseous medium can be introduced into a gap 54 between the inner shell 6.1 and outer shell 6.2.

LIST OF REFERENCE NUMBERS

1 knee joint

2 tibial head

3 tibial element

4 femoral head

5 femoral element

6.1 inner shell

6.2 outer shell

7 bead

8 groove

9 access

10 entrance

11 output

12.1 upper joint pocket

12.2 rear hinge pocket

13 frames

14 core

15 coating

16.1 medial femoral condyle

16.2 lateral femoral condyle

17.1 medial tibial plateau

17.2 lateral tibial plateau

18 survey

19 femur shaft

20.1 first module

20.2 second module

20.3 third module

21.1 first base

21.2 second base

22 replacement part

23 section

24 shuttle lock

24.1 detent opening

24.2 plug-in opening

24.3 locking pin

24.4 plug pin

24.5 locking element

25 end section

26 adapters

27 dovetail joint

27.1 groove

27.2 spring

28 functional element

29.1 first end area

29.2 second end area

30 screw connection 31 screw

31.1 passage opening

31.2 mother

32 foot element

33 hip joint

33.1 head

33.2 pan

34 pool element

35 clamp connection

35.1 mother

36 guide channel

37.1 anterior cruciate ligament element

37.2 posterior cruciate ligamentous element 38.1 patellar tendon element 38.2 quadriceps tendon element

38.3 patella element

39.1 medial sideband element

39.2 lateral sideband element 40 Popliteussehnenelement 41 rear longitudinal band

42 attachment point

43 rear hinge pocket

44 metal sleeve

45 spring device

46 Meniscus element

47 Fixing area

48 lace area

49 bag

50 recess

51 fiber

52 portal

53 needle

54 gap

f flow direction

g joint width

I longitudinal direction

w effective length

A sealing device

B filling device

C leg

E end section

F fluid

G joint

K condyle

P joint partner

R joint space

T table

V device

Claims

claims

1. An apparatus for arthroscopy simulation with an artificial joint (G), which has at least two joint partners (P) with articulation-transmitting rod ends (K),

d a d u r c h e s e n c i n e s, d a s s

the joint (G) has a joint space (R) into which the joint partners (P) each protrude at least with an end portion (E) of their joint head (K) transmitting the joint force, which can be filled with fluid (F) and / or gaseous medium and the outside by means of a

Sealing device (A) fluid and / or gas-tight sealable.

2. Apparatus according to claim 1, characterized in that the sealing device (A) has at least one tubular flexible Hüile (6.1, 6.2), the sealing on both sides of the joint partners (P) can be fixed.

3. A device according to claim 2, characterized in that the sealing device (A) two tubular flexible sheaths (6.1, 6.2), one of the joint space (R) facing inner shell (6.1) and the joint space (R) facing away from the outer shell (6.2), wherein the inner shell

(6.1) and / or outer sheath (6.2) in each case at both ends of the joint partners (P) are sealingly fixed.

4. The device according to claim 3, characterized in that, with respect to their respective position to the joint space (R), the inner shell (6.1) at least approximately equal to a joint capsule of a natural joint and / or the outer shell (6.2) at least approximately the same a natural body surface are positioned and / or shaped. 5. Apparatus according to claim 3 or 4, characterized in that the inner sheath (6.1) and / or the outer sheath (6.2) each have at both ends each a circumferential thickening or bead (7), the dichroic tend in one or together in an associated on the corresponding joint partner (P) provided groove (8) engages.

Device according to one of claims 1 to 5, characterized in that at least the joint heads (K) of the joint partner (P) at least similar or at least approximately the same anatomy of the joint partner (P) of the artificial joint (G) corresponding natural joint are formed ,

Device according to one of claims 1 to 6, characterized in that at least one of the joint partners (P) has a first base (21.1) and as a replacement component (22) designed component having at least one shaft portion (23) with condyle (K), at least the condyle (K) or at least one end portion (25) of the condyle (K) with force transmitting joint surfaces of this joint partner (P) and which on the first base (21.1) can be fixed.

Apparatus according to claim 7, characterized in that the replacement component (22) by means of an adapter (26) on the associated joint partner (P) can be fixed.

Device according to claim 7 or 8, wherein the artificial joint (G) is designed as a knee joint (1) with a patella element (38.3) and a tibial element (3) and a femoral element (5) comprising meniscal elements (46) as a joint partner (P), characterized in that the meniscal elements (46) of the artificial joint (1) are fixed only in fixing areas (47) on the tibial element (3) which correspond at least approximately to the fixing areas of the natural menisci of a natural knee joint.

0. Device according to claim 9, characterized in that the

Meniscus elements (46) in the fixing areas (47) by means of mechanical nischer method, such as clamping or sewn, and / or chemical methods, such as gluing or vulcanization, are connected to the tibial element (3).

11. The device according to claim 10, characterized in that the

Meniscus elements (46) are made of plastic with a low Shore hardness.

12. The device according to claim 11, characterized in that in the

Plastic of Meniscus Elements (46) Fiber structures with fibers (51) are incorporated for imitation of collagen fibers of natural menisci.

13. Device according to one of claims 10 to 12, characterized in that the meniscus elements (46) have a specific weight which is greater than or equal to the specific gravity of a filling of the joint space (R) provided fluid (F).

14. Device according to one of claims 1 to 13, characterized in that functional elements (28) are provided which serve in an artificial joint (G) as a substitute for tendons and / or ligaments of this artificial joint (G) corresponding natural joint.

15. Device according to claim 14, wherein the artificial joint (G) is designed as a knee joint with a patella and with a femoral element (5) and a tibial element (3) as a joint partner (P), characterized in that the knee joint (1) is designed as functional elements (28 ) Anterior cruciate ligament element (37.1) and posterior cruciate ligament element (37.2), patellar tendon element (37.1) and quadriceps tendon element (38.2) with patella element (38.3) arranged therebetween, medial side band element (39.1) and lateral side band element (39.2), rear longitudinal band element (41) and or Popliteussehnenelement (40). Apparatus according to claim 14 or 15, characterized in that a frame (13) is provided with a guide and / or receptacle for guiding and / or fixing the functional elements (28), wherein the frame (13) in Einbauiage at least teilumfänglich to the artificial joint (G) is arranged.

Apparatus according to claim 16, characterized in that the frame (13) at least in one of the joint partner (P) can be fixed.

Apparatus according to claim 16 or 17, characterized in that the functional elements (28) with respective formation of an artificial joint (G) force mechanically effective length (w) in a first end region (29.1) on one of the joint partners (P) and in a second End region (29.2) on the frame (13) can be fixed.

Apparatus according to claim 18, characterized in that the effective length (w) of the Funktionsseiemente individually, in groups and / or in their entirety on their definition on the frame (13) and / or on one of the joint partner (P) is adjustable.

Device according to one of claims 16 to 19, characterized in that the frame (13) on a joint head (K) of one of the joint partners (P), leaving an end portion (25) of this joint head (K) with the force-transmitting joint surfaces and / or with the release of arthroscopy-specific intervention fields for the access of arthroscopic tools in the artificial joint (G) can be fixed.

21. Device according to claim 2 and one of claims 6 to 20,

characterized in that the frame (13), the inner shell (6.1) sealingly against at least one of the two joint partners (P) pressed. Device according to claim 21, wherein the artificial joint (G) is designed as a knee joint (1) with a tibia element (3) and a femoral element (5) as a joint partner (P), characterized in that the frame (13) forms the inner shell (6.1). sealingly pressed against the condyle of the tibial element.

Apparatus according to claim 3 and any one of claims 16 to 22, characterized in that the frame (13) between the outer shell (6.2) and the inner shell (6.1) is arranged.

Device according to one of claims 5 to 23, characterized in that it comprises a preferably valve-controlled or -regulated Befüllvor- direction (B) with input (10) and output (11) for bez. from the

Joint space (R) and / or to or from a gap (54) between the inner shell (6.1) and outer shell (6.2).

Apparatus according to claim 24, characterized in that the input (10) and / or the output (11) channel-like with at least one main path component axiaf running in at least one of the joint partners (P) is introduced.

Device according to one of claims 1 to 25, characterized in that it is constructed modularly with the joint partners (P) as first modules (20.1).

Apparatus according to claim 26, characterized in that for the simulation of movement of the artificial joint (G), at least one of the joint partners (P) at one of the artificial joint (G) remote and / or remote side with at least one second module (20.2) is connected , wherein the second module (20.2) with respect to the artificial joint (G) is force-mechanically at least approximately as effective as a corresponding natural body part. Apparatus according to claim 27, characterized in that the second module (20.2) on a side facing away from the associated first module (20.1) side indirectly via at least one further module or directly to a second base (20.2) can be added or fixed immovable.

Device according to claim 28, wherein the artificial joint (G) is designed as a knee joint (1) with a femoral element (5) and a tibial element (3) as a joint partner (P), characterized in that the femur element (5) is attached to the knee joint (1 ) on the opposite side via an artificial hip joint (33) as a second module (20.2) with a pelvic element as the third module (20.3) is pivotally connected.

Tibial element with meniscal elements (46) for a device (V) according to one of claims 1 to 29,

d a d u r c h e s e n c i n e s, d a s s

the meniscal elements (46) are fixed only in fixing areas (47) on the tibial element (3) which correspond at least approximately to the fixing areas of natural menisci of a natural tibia.

Tibial element according to claim 30, characterized in that the meniscal elements (46) in the fixing areas (47) are connected to the tibial element (3) by mechanical methods such as clamping or sewn, and / or chemical methods such as gluing or vulcanization.

32. Tibia element according to claim 31, characterized in that the

Meniscus elements (46) are made of plastic with a low Shore hardness. Tibial element according to claim 32, characterized in that in the plastic material of the meniscal elements (46) fiber structures are embedded with fibers (51) for imitation collagen fibers of natural menisci.

Tibial element according to one of Claims 30 to 33, characterized in that the meniscal elements (46) have a specific weight which is greater than or equal to the specific weight of a fluid (F) intended for filling the joint space (R).

Device according to one of claims 1 to 29, characterized in that the joint designed bone-free and made of plastic.

Device according to one of claims 1 to 29, characterized in that the knee joint has a Fermurelement and a tibial element and a patella as a joint partner.

37. Device according to one of claims 1 to 30, characterized in that each individual part of the knee joint is separately exchangeable.