WO2014040013A1 - Méthode et appareil destinés à traiter la rupture des ligaments croisés chez le chien - Google Patents

Méthode et appareil destinés à traiter la rupture des ligaments croisés chez le chien Download PDF

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Publication number
WO2014040013A1
WO2014040013A1 PCT/US2013/058877 US2013058877W WO2014040013A1 WO 2014040013 A1 WO2014040013 A1 WO 2014040013A1 US 2013058877 W US2013058877 W US 2013058877W WO 2014040013 A1 WO2014040013 A1 WO 2014040013A1
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WO
WIPO (PCT)
Prior art keywords
implant
displacement
femur
target tissue
canine
Prior art date
Application number
PCT/US2013/058877
Other languages
English (en)
Inventor
Vivek Shenoy
Original Assignee
Cotera, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Cotera, Inc. filed Critical Cotera, Inc.
Publication of WO2014040013A1 publication Critical patent/WO2014040013A1/fr
Priority to US14/642,121 priority Critical patent/US9861408B2/en
Priority to US15/864,796 priority patent/US11517360B2/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/0858—Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0876—Position of anchor in respect to the bone
    • A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone

Definitions

  • the present invention generally relates to the field of veterinary orthopedic disease.
  • the present invention is directed to an interventional technique and an implant for treating canine cruciate ligament disease.
  • the cruciate ligaments are the primary stabilizing structures of canine stifle joint.
  • the canine stifle joint is condylar synovial joint.
  • the primary motion of joint is flexion and extension.
  • the three major muscles comprising the caudal thigh group are the biceps femoris, the semitendinosus and the semimembranosus, also collectively known as the hamstring muscles.
  • the bones, muscles, tendons, ligaments etc. of the canine stifle joint are shown in detail in Figures 1 - 6 (Reference: Carpenter, D.H. et al, Mini Review of Canine Stifle Joint Anatomy, Anat. Histol. Embryol., 29, 321-329, 2000).
  • FIG. 1A A cranial view of the left stifle showing associated ligaments and structures is shown in Figure 1.
  • the following features are identified: 1A, femoral trochlea; 2A, lateral ridge of femoral trochlea; 3A, tendon of long digital extensor; 4A, tendon of popliteus; 5 A, lateral collateral ligament; 6A, lateral meniscus; 7 A, tibial tuberosity; 8A, patellar ligament; 9A, patella; 10A, parapatellar fibrocartilage; 11A, inherentlyscal ligament; 12A, medial meniscus; 13 A, medial collateral ligament; 14A, cranial cruciate ligament; 15 A, caudal cruciate ligament; 16 A, medial ridge of the trochlea.
  • FIG. 2B A caudal view of the right stifle showing associated ligaments and structures is shown in Figure 2.
  • the following features are identified: IB, cranial cruciate ligament; 2B, lateral collateral ligament, 3B, lateral meniscus; 4B, cranial ligament of the fibular head; 5B, caudal ligament of the fibular head; 6B, fibula; 7B, caudal meniscotibial ligament of the lateral meniscus; 8B, caudal cruciate ligament; 9B, medial meniscus; 10B, medial collateral ligament; 11B, meniscofemoral ligament.
  • FIG. 3 A lateral view of the right stifle showing associated ligaments and structures is shown in Figure 3.
  • the following features are identified: 1C, popliteus tendon; 2C, lateral collateral ligament; 3C, sesamoid; 4C, lateral femoropatellar ligament; 5C, quadriceps muscle group tendon of insertion; 6C, patella; 7C, patellar ligament; 8C, lateral meniscus; 9C, tibial tuberosity; IOC, tibial crest; 11C, long digital extensor tendon of origin; 12C, cranial ligament of fibular head; 13C, fibula; 14C, tibia; 15C, os femoris.
  • a medial view of the right stifle showing associated ligaments and structures is shown in Figure 4.
  • ID os femoris
  • 2D medial femoropatellar ligament
  • 3D sesamoid
  • 4D medial collateral ligament
  • 5D popliteus tendon of origin
  • 6D cranial ligament of the fibular head
  • 7D fibula
  • 8D tibia
  • 9D tibial crest
  • 10D tibial tuberosity
  • 11D patellar ligament
  • 12D medial meniscus
  • 13D patella
  • 14D quadriceps muscle group tendon of insertion.
  • FIG. 5 A medial view of the left pelvic limb muscles and associated structures is shown in Figure 5.
  • the following features are identified: IE, cranial sartorius; 2E, caudal sartorius; 3E, cranial tibial; 4E, deep digital flexor; 5E, tibia; 6E, common calcanean tendon; 7E, superficial digital flexor; 8E, gastrocnemius; 9E, biceps femoris tendon of insertion; 10E, semitendinosus, HE, gracilus; 12E, pectineus; 13E, vastus medialis; 14E, adductor magnus et brevis; 15E, semimembranosus.
  • IE cranial sartorius
  • 2E caudal sartorius
  • 3E cranial tibial
  • 4E deep digital flexor
  • 5E tibia
  • 6E common calcan
  • FIG. 6 A lateral view of the right pelvic limb muscles and associated structures is shown in Figure 6. The following features are identified: IF, middle gluteal; 2F, tensor fasciae latae; 3F, cranial sartorius; 4F, vastus lateralis; 5Fcranial tibial; 6F,
  • gastroenemiius 7F, superficial digital flexor; 8F, long digital extensor; 9F, common calcanean tendon; 10F, biceps femoris tendon of insertion; 11F, caudal head of biceps femoris; 12F, cranial head of biceps femoris; 13F, semitendinosus; 14F,
  • the cranial cruciate ligament prevents cranial tibial translation or the tibial forward thrust, limits excessive internal rotation of the tibia and prevents hyper extension of the stifle.
  • the cranial cruciate ligament prevents cranial tibial translation or the tibial forward thrust, limits excessive internal rotation of the tibia and prevents hyper extension of the stifle.
  • stance phase weight bearing phase
  • loading of the stifle joint leads to a ventrally directed compressive force, and a horizontally directed force, or a cranial tibial thrust.
  • the CrCL resists this force, minimizing any cranial translation of the tibia.
  • TPLO Tibial Plateau Levelling Osteotomy
  • TTA Tibial Tuberosity Advancement
  • TPLO and TTA both carry a risk of failure due to poor bone healing after the osteotomy, as well as a risk of failure due to fracture of the bone weakened by the osteotomy. Moreover, these surgeries require significant pain management following surgery and entail long recovery times.
  • Exemplary methods disclosed herein comprise selecting at least one of the muscles and connective tissues associated with the canine stifle joint as target tissue for treatment, and displacing the target tissue without severing the bones or target tissue, thereby achieving a therapeutic effect.
  • the target tissue is displaced by placing an implant in contact with the target tissue and displacing the target tissue to reduce cranial tibial thrust.
  • the implant may be secured to a bone and/or to soft tissues, which may include the target tissue.
  • the implant is completely outside the capsule surrounding the joint.
  • a method for treating canine cruciate ligament disease comprises securing an implant on the medial side of the femur and displacing connective tissue caudal to the femur.
  • a method for treating canine cruciate ligament disease comprises securing an implant on the medial side of the femur and displacing connective tissue cranial to the femur.
  • a method for treating canine cruciate ligament disease comprises securing an implant on the lateral side of the femur and displacing connective tissue caudal to the femur.
  • a method for treating canine cruciate ligament disease comprises securing an implant on the lateral side of the femur and displacing connective tissue cranial to the femur.
  • a method for treating canine cruciate ligament disease comprises securing an implant on the caudal side of the femur and displacing connective tissue caudal to the femur.
  • a method for treating canine cruciate ligament disease comprises securing an implant on the cranial side of the femur and displacing connective tissue cranial to the femur.
  • a method for treating canine cruciate ligament disease comprises securing an implant on the lateral side of the tibia and displacing connective tissue caudal to the tibia.
  • a method for treating canine cruciate ligament disease comprises securing an implant on the medial side of the tibia and displacing connective tissue caudal to the tibia.
  • a method for treating canine cruciate ligament disease comprises securing an implant on the lateral side of the tibia and displacing connective tissue cranial to the tibia.
  • a method for treating canine cruciate ligament disease comprises securing an implant on the medial side of the tibia and displacing connective tissue cranial to the tibia.
  • a method for treating canine cruciate ligament disease comprises securing an implant on the caudal side of the tibia and displacing connective tissue caudal to the tibia.
  • the target connective tissue is the quadriceps muscle or tendon.
  • the target connective tissue is the patellar tendon.
  • the target connective tissue is the biceps femoris muscle or tendon.
  • the target connective tissue is the semitendinosus muscle or tendon.
  • the target connective tissue is the semimembranosus muscle or tendon.
  • the quadriceps muscle or tendon is displaced cranially.
  • the patellar tendon is displaced cranially.
  • the biceps femoris muscle or tendon is displaced caudally.
  • the semitendinosus muscle or tendon is displaced caudally.
  • the semimembranosus muscle or tendon is displaced caudally.
  • One of the exemplary methods disclosed herein comprises selecting at least one of the associated muscle and connective tissues as target tissue for treatment, displacing the target tissue without severing the bones or target tissue, and reducing cranial tibial thrust to achieve a therapeutic effect.
  • the apparatus may be completely outside the capsule surrounding the stifle joint or may be in contact with the exterior of the capsule.
  • FIG. 1 is the cranial view of a left canine stifle joint showing ligaments and associated structures.
  • FIG. 2 is the caudal view of a right canine stifle joint showing ligaments and associated structures.
  • FIG. 3 is the lateral view of a right canine stifle joint showing ligaments and associated structures.
  • FIG. 4 is the medial view of a right canine stifle joint showing ligaments and associated structures.
  • FIG. 5 is the medial view of a left canine pelvic limb showing muscles and associated structures.
  • FIG. 6 is the lateral view of a right canine pelvic limb showing muscles and associated structures.
  • FIG. 7 is a schematic representation of Tibial Plateau Levelling Osteotomy.
  • FIG. 8 is a schematic representation of Tibial Tuberosity Advancement osteotomy.
  • FIG 9 is a cranial view of a left canine stifle joint illustrating positioning of an exemplary embodiment of the present invention for treating cruciate ligament disease.
  • FIG 10 is a cranial view of a left canine stifle joint illustrating positioning of another exemplary embodiment of the present invention for treating cruciate ligament disease.
  • FIG 11 is a medial view of a right canine stifle joint illustrating positioning of a further exemplary embodiment of the present invention for treating cruciate ligament disease.
  • FIG 12 is a lateral view of a right canine stifle joint illustrating positioning of yet another exemplary embodiment of the present invention for treating cruciate ligament disease.
  • FIG 13 is a medial view of a right canine stifle joint illustrating positioning of another exemplary embodiment of the present invention for treating cruciate ligament disease.
  • FIG 14 is a medial view of a right canine stifle joint illustrating positioning of another exemplary embodiment (#600) of the present invention for treating cruciate ligament disease.
  • FIG 15 is a lateral view of a right canine stifle joint illustrating positioning of another exemplary embodiment of the present invention for treating cruciate ligament disease.
  • FIG 16 is a caudal view of a right canine stifle joint illustrating positioning of another exemplary embodiment of the present invention for treating cruciate ligament disease.
  • FIG 17 is a caudal view of a right canine stifle joint illustrating positioning of another exemplary embodiment of the present invention for treating cruciate ligament disease.
  • FIG 18 is a caudal view of a right canine stifle joint illustrating positioning of another exemplary embodiment of the present invention for treating cruciate ligament disease.
  • FIG 19 is a cranial view of a left canine stifle joint illustrating positioning of another exemplary embodiment of the present invention for treating cruciate ligament disease.
  • FIG 20 is a cranial view of a left canine stifle joint illustrating positioning of another exemplary embodiment of the present invention for treating cruciate ligament disease.
  • joint conditions that result from or exacerbate unbalanced force distribution through the joint may be addressed by interventional techniques involving a redistribution of forces exerted on the joint without the need for highly invasive surgeries requiring significant trauma to the joint and associated muscle and connective tissues. Redistribution of forces within the target joint in accordance with embodiments described herein may thus provide pain relief or slow down articular cartilage degeneration or enhance cartilage regeneration.
  • increased forces can be selectively applied to one side of a joint by routing select muscle, tendons, ligaments, and/or other connective tissues (target tissues) around a longer, curved, or more angled path, thus increasing the magnitude, altering the effective direction, and/or changing the moment arm of forces exerted by such muscles or tissues on the joint.
  • target tissues connective tissues
  • This may be accomplished, for example, by appropriately shaped implants that may be positioned to displace selected target tissues relatively non-invasively compared to current surgical techniques for addressing such conditions.
  • the amount of displacement of the target tissue may not need to be large in order to provide a substantial therapeutic effect on the target joint.
  • displacements of greater than about 2 mm up to about 25 mm may be sufficient, with displacements in the range of about 3 mm to about 20 mm also suitable, or more specifically about 4 - 15 mm.
  • Exemplary embodiments of the invention described herein are particularly directed to treatment of canine cruciate ligament disease, although the principles of the invention may be applied to other canine or human articular joints as described in the above identified related applications of the present provisional application, which as stated above are incorporated by reference herein.
  • the principles of the invention may be applied to other canine or human articular joints as described in the above identified related applications of the present provisional application, which as stated above are incorporated by reference herein.
  • specific features described in connection with one exemplary embodiment may be incorporated in other exemplary embodiments unless otherwise noted.
  • the exemplary embodiments described are thus included to illustrate features of the invention, not limit it.
  • therapeutic effect means an effect on a treated joint that reduces forces acting on the articular surfaces, reduces abnormal motion of the bones during flexion/extension, reduces wear, lessens pain or provides another positive outcome for the patient whether across the joint as a whole or in particular parts of the joint.
  • therapeutic effect would generally be associated with a reduction in cranial tibial thrust.
  • Therapeutic effect does not imply, and should not be understood as requiring, any specific, quantified outcome other than as stated above.
  • dorsal means directed towards the back, ventral means directed towards the belly, medial means directed towards the mid-line, lateral means directed away from the mid-line towards the flank, cranial means directed towards the cranium (head) and caudal towards the tail.
  • Proximal refers to the end of a structure nearest a major point of reference and distal to the end furthest from a point of reference. The point of reference is usually the origin of a structure (such as a limb).
  • Dorsal plane is parallel to the back, transverse plane is perpendicular to the long axis of the body and sagittal plane divides the body into right/left parts.
  • Implants according to embodiments of the present invention may be configured and secured in a variety of ways as described below in more detail with respect to exemplary embodiments.
  • prostheses or implants according to embodiments of the invention may comprise a fixation portion 101 configured to be secure to the bone at a specific location, and which may provide means for securing or anchoring the prosthesis, such as holes for bone screws 110, and a displacement portion 103 configured and dimensioned to displace the target tissue(s) from a pretreatment path as described herein.
  • Other means for securing the fixation portion may include bone ingrowth surfaces, barbs, bone cement, features for fastening sutures or wires, and other devices known in the art for securing implants to bone.
  • the fixation and displacement portions may be separated by a spanning section 102 configured and dimensioned to position the displacement portion with respect to the fixation portion as appropriate to accommodate the anatomical structures at the location of treatment and fixation.
  • the spanning section may be configured to avoid tendon attachment sites between the fixation and displacement region.
  • the displacement portion 102 may be provided with a bearing member for engaging the target tissue, which may be the same or a different material than the underlying substrate.
  • thickness of the fixation portion may be uniform throughout the implant or may vary across the implant. Regions of the fixation portion under higher mechanical load may be thicker than regions under lower mechanical loads. The thickness of the fixation region may also be selected to ensure that the screw-heads used to fix the implant do not protrude over the surface of the implant.
  • the spanning section may have thickness similar to that of the fixation portion.
  • a principal consideration for spanning section is sufficient structural integrity to maintain the displacement portion at the desired treatment position.
  • displacement distance and thickness may be considered separately.
  • Displacement distance is the distance by which the bearing surface of the displacement portion displaces the target tissue beyond the natural anatomical track of the target tissue, in other words, the displacement of tissue created by the implant.
  • the thickness of the displacement portion may or may not be related to the displacement distance.
  • components of the prosthesis may be a compliant material such as an elastomer, capsules filled with water, saline, silicone, hydrogels, etc.
  • compliant portions could be placed in a deflated state and then inflated to the appropriate thickness.
  • bearing members may be filled with other flowable materials including beads or other particles made of metal, polymer, or foam material, optionally in a liquid medium, which conform to the adjacent bone or tissue surfaces.
  • Thixotropic materials such as hydrogels derived from hyaluronic acid, change their mechanical properties as shear stress is applied to them.
  • Implants may be coated with materials to reduce friction such as hydrophilic coatings or polytetrafluoroethylene (PTFE) coatings. Additionally or alternatively, the prosthesis may be adjustable to allow the dimensions such as thickness of the prosthesis to be adjusted during surgery or any time after surgery.
  • PTFE polytetrafluoroethylene
  • Rigid or substantially rigid prostheses according to embodiments of the invention described herein could be made of known bone-compatible implant materials such as titanium or stainless steel. Biocompatible polymers, ceramics, and other materials may also be used.
  • the bearing surface of the prostheses should be designed to minimize negative effects of movement of the connective tissues across the implant surface, e.g. comprising a smooth, atraumatic, low-friction material, coating or surface treatment.
  • Such prostheses could be implanted arthroscopically or using a mini-open or open surgical approach.
  • the displacement portion and the fixation portion of prostheses according to the invention may be of unibody construction, or may be formed of two or more parts depending on desired function.
  • the fixation portion may be stainless steel or titanium textured to enhance bony ingrowth and solid screw fixation
  • the displacement portion could be made of a different material, for example, pyrolytic carbon to enhance the ability of overlying tissues to slide across the implant, or PTFE, silicone or other low-friction polymer with suitable wear
  • the displacement portion may comprise a separate bearing member with a bearing surface on which the target tissue bears.
  • the bearing surface may be formed as an integral part of the displacement portion.
  • the displacement portion could be comprised of a substrate of one material with an overlying layer forming the bearing member. The substrate could be either attached to or contiguous with the fixation portion.
  • the fixation portion of the implant may have a relief feature to minimize contact with the underlying bone, thereby minimizing disruption of the periosteal layer.
  • the bearing member and/or bearing surface in embodiments of the invention will be hard and smooth, made from materials such as polished pyrolytic carbon, steel, or titanium, or coated or covered with a lubricious material, such as PTFE.
  • the bearing surface may be designed to encourage adhesion and ingrowth of the connective tissue onto this surface.
  • such a surface may be porous, roughened, or configured with openings into which bone or scar tissue may grow to enhance adhesion.
  • the implant could be anchored to the underlying bone with suitable fasteners such as screws.
  • suitable fasteners such as screws.
  • unicortical screws, bicortical screws, cancellous screws, cannulated screws, polyaxial screws, screws that lock into the implant etc. may be used.
  • the screw holes may be locking threads or other locking features.
  • the screws holes may be oriented in different directions to improve the stability of the anchored implant.
  • different types of screws may be used in different regions of the implant. For example, cortical screws may be used in the region of the implant in contact with the femoral shaft while cancellous screws may be used in another part of the implant in contact with femoral condyle.
  • supplemental fixation such as cancellous bone screws
  • joint pain, joint stiffness or joint osteoarthritis may result from cranial tibial translation caused by cruciate ligament disease.
  • caudally displacing the caudal muscles or tendons like the semitendinosus, semimembranosus or biceps femoris muscle or tendon the moment arm of the muscle or tendon as it crosses the joint may be increased, thereby stabilizing the joint during the gait cycle.
  • cranially displacing the cranial muscles or tendons like the quadriceps muscle or tendon, or patellar tendon the moment arm of the muscle or tendon as it crosses the joint may be increased, thereby stabilizing the joint during the gait cycle.
  • displacement of the target tissue results in the decrease in the cranial tibial translation or thrust in the target stifle joint by at least about 0.5mm, more preferably by at least about 1mm, most preferably by at least about 1.5mm.
  • Reduction in cranial translation refers to decrease in translation, either maximum or average translation, either measured or calculated, during a normal gait cycle, running, jogging or any other physical activity which results in mechanical loading of articular cartilage in a stifle joint.
  • Figure 9 shows one exemplary embodiment of the present invention for cranial displacement of the quadriceps muscle or tendon.
  • Implant 100 is anchored to the medial side of the femur.
  • Fixation portion 101 of the implant is used to anchor the implant, e.g. with screws 110, and displacement portion 103 displaces the quadriceps muscle or tendon cranially.
  • Spanning section 102 would be configured to transition from fixation portion 101 mostly parallel to the medial side of the femur to displacement portion 103, which is disposed on a more cranial aspect of the femur so as to displace the quadriceps muscle or tendon cranially.
  • FIG 10 shows another exemplary embodiment of the present invention for cranial displacement of the patellar tendon.
  • implant 200 may be anchored to the medial side of the tibia.
  • Fixation portion 201 of the implant is used to anchor the implant, e.g. with screws, and displacement portion 203 displaces the patellar tendon cranially.
  • the fixation portion is separated from the displacement portion by spanning section 202 so that the fixation portion may be shaped and dimensioned to optimize anchoring, holes 209 for screws may be more numerous and separated further apart, and the location on the bone for anchoring may be more easily accessed and visualized by the surgeon.
  • Displacement portion 203 preferably has a convex curvature on its outer tissue-engaging surface (bearing surface), preferably being curved at least around an axis generally parallel to the tibial shaft, usually being curved also around an axis perpendicular to the tibial shaft, and more preferably being spherical or partially spherical. Displacement portion 203 is disposed over a more cranial aspect of the tibia so as to be located under the patellar tendon between the tendon insertion point and the dorsal end of the tibia. [0075] In embodiments of the present invention, implants may be configured such that the displacement portion of the implant is separated from the fixation portion of the implant.
  • the fixation portion of the implant may be configured to be affixed to the bone at a location which can securely fix the implant in place, is accessible to the surgeon, is not covered by the target tissue, and is separated from tendon insertion points and other anatomical features.
  • the implant may have a spanning section configured and dimensioned to bridge the distance between the fixation portion and the displacement portion.
  • the implants may be configured to move the tendon anteriorly or medially or anterior-medially or laterally or antero-laterally. This may be accomplished by making one side (lateral or medial) of the displacement surface higher than the other, and/or by forming a track with ridges on one or both sides of the bearing surface to urge the tendon in a lateral or medial direction.
  • Figure 11 shows an exemplary embodiment of the present invention for cranial displacement of the patellar tendon.
  • Implant 300 is anchored to the medial side of the tibia.
  • Figure 12 shows an exemplary embodiment of the present invention for cranial displacement of the patellar tendon.
  • Implant 400 is anchored to the lateral side of the tibia.
  • Figure 13 shows an exemplary embodiment of the present invention for caudal displacement of the hamstring muscles.
  • Implant 500 is anchored to the medial side of the femur.
  • Implant 500 has a displacement portion configured to be located along a caudal aspect of the femur under the hamstring muscle so as to displace the hamstring caudally, that is, away from the femoral shaft.
  • Figure 14 shows an exemplary embodiment of the present invention for caudal displacement of the hamstring muscles.
  • Implant 600 is anchored to the medial side of the tibia.
  • Figure 15 shows an exemplary embodiment of the present invention for caudal displacement of the hamstring muscles.
  • Implant 700 is anchored to the lateral side of the femur.
  • Figure 16 shows an exemplary embodiment of the present invention for caudal displacement of the hamstring muscles.
  • Implant 800 is anchored to the medial side of the femur.
  • Figure 17 shows an exemplary embodiment of the present invention for caudal displacement of the hamstring muscles.
  • Implant 900 is anchored to the lateral side of the femur.
  • Figure 18 shows an exemplary embodiment of the present invention for caudal displacement of the hamstring muscles.
  • Implant 1000 is anchored to the medial side of the tibia.
  • Figure 19 shows an exemplary embodiment of the present invention for cranial displacement of the patellar tendon.
  • Implant 1100 is anchored to the lateral side of the tibia.
  • Figure 20 shows an exemplary embodiment of the present invention for cranial displacement of the quadriceps muscle or tendon.
  • Implant 1200 is anchored to the lateral side of the femur.
  • the displacement of the target tissue can be altered by changing the length, curvature and angle of the spanning section and/or dimensions of the displacement and fixation portions as appropriate for specific canine anatomy.
  • the spanning sections may also comprise adjustable mechanisms (e.g. a pin or hinge) to movably or pivotably alter the orientation or angle between the two parts to achieve the appropriate level of tissue displacement.
  • adjustable mechanisms e.g. a pin or hinge
  • the displacement of the connective tissue could be adjusted by adjusting the device pre-operatively, intra- operatively or post-operatively.
  • Devices may include mechanisms that are remotely controlled and/or enable wireless communication to alter the displacement after implantation.
  • the displacement may be adjusted by applying an energy fields (e.g.; magnetic field, electric field, thermal field etc.) transdermally from an external location.
  • an energy fields e.g.; magnetic field, electric field, thermal field etc.
  • the adjustment mechanisms themselves may be radiopaque and/or otherwise discemable from the rest of the implant under x-ray in order to enable post-surgical percutaneous adjustment of the device.
  • target features can be built into the device to locate the adjustment points without having the screws or adjustment means themselves radiopaque, such as radiopaque rings or markers built into the nearing surface of the device itself.
  • the implants described above may be implanted in areas adjacent to the joint such that the soft tissue is displaced in a region it crosses the joint.
  • the device could be implanted away from the joint and displace the target soft tissue in a region that it is not crossing the joint.
  • displacement portions of previously described static implants may be provided with a roller or other dynamic feature to further reduce wear or trauma to the displaced tissue.
  • the inferior surface of the displacement region is elevated off the underlying tissue.
  • the underlying tissue could be bone or soft tissue like tendon, muscle, ligament, bursa, capsule etc. Elevating the inferior surface off the underlying tissue could be beneficial by minimizing damage to soft tissue, reducing any potential restriction to joint motion due to
  • the displacement region will have a continuous bearing surface which is in contact with the target connective tissue (muscle, tendon, ligament etc.) and is devoid of any discontinuities.
  • Discontinuities would include fixation channels for long-term fixation like screw holes, holes for sutures etc. as well as fixation channels for temporary fixation like holes for Kirschner-wires (K-wires). The lack of
  • the bearing surface of the displacement section may be polished, coated or modified in other ways to minimize wear of the bearing surface and/or wear of the target connective tissue.
  • the bearing surface of the displacement region which is in contact with the target connective tissue may have features that enable adhesion or attachment of the target connective tissue to the bearing surface. Attachment of the target connective tissue on the implant surface may minimize motion of the tissue across the implant surface during joint motion. These features would include channels for formation of fibrous tissue from the target connective tissue anchoring the connective tissue to the displacement surface of the implant.
  • the bearing surface of the displacement region may have surface features that enable adhesion or attachment of the target connective tissue to the bearing surface. These features would include projections, microprojections, bumps, ridges, pin-like projections, granular surface etc.
  • the inferior surface of the displacement region may be in contact with the underlying tissue. In other embodiments, part of the inferior surface of the displacement section may be in contact with the underlying tissue.
  • the inferior region may have features like channels for fibrous or bony tissue ingrowth to enable adhesion or attachment of the underlying tissue to the bearing surface.
  • the inferior region may have features like projections, microprojections, bumps, ridges, pin-like projections, granular surface etc. Attachment of any soft connective tissue underneath the inferior surface of the displacement region may minimize motion of the tissue under the implant during joint motion.
  • the inferior surface may have pins for anchoring the implanting into underlying bone.
  • the device may be a two-part device with the first part (base unit) comprising the fixation section, the spanning section and the displacement section, and the second part (bearing unit) configured to attach to the displacement section of the base unit.
  • the bearing unit may be configured to attach to the spanning section and to cover the displacement section of the base unit.
  • the bearing unit may be configured to minimize tissue wear or to enable tissue adhesion or attachment.
  • the displacement section and the bearing unit would have features to attach the two units.
  • the displacement region may have channels to assist in positioning, placement or temporarily anchoring of the implant intra-operatively.
  • the dimensions of the exemplary embodiments above can be altered to address differences in joint size, condyle size, level of the tissue displacement etc. as well as to enable positioning and securing the implant at the surgical site while minimizing trauma to the surrounding bone, tendons, muscles, ligaments and other anatomical structures.
  • the devices of the present invention may be used to displace any of the muscles and connective tissues around the stifle joint to achieve a therapeutic effect.
  • the muscle displaced could be the popliteus muscle, gastrocnemius muscle, vastus lateralis muscle, vastus medialis muscle and the semimembranous muscle.
  • the tendon associated with any of the muscles could be displaced.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Vascular Medicine (AREA)
  • Transplantation (AREA)
  • Cardiology (AREA)
  • Rheumatology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Rehabilitation Therapy (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Prostheses (AREA)

Abstract

La présente invention concerne des prothèses et des méthodes destinées à traiter la rupture des ligaments croisés chez le chien, comprenant la mise en place d'un implant spécialement conçu sur le fémur ou le tibia afin de déplacer le muscle ciblé ou les tissus conjonctifs ciblés, associés au grasset, de sorte à réduire la contrainte craniale tibiale.
PCT/US2013/058877 2009-08-27 2013-09-10 Méthode et appareil destinés à traiter la rupture des ligaments croisés chez le chien WO2014040013A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
US14/642,121 US9861408B2 (en) 2009-08-27 2015-03-09 Method and apparatus for treating canine cruciate ligament disease
US15/864,796 US11517360B2 (en) 2009-08-27 2018-01-08 Method and apparatus for treating canine cruciate ligament disease

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US201261699089P 2012-09-10 2012-09-10
US61/699,089 2012-09-10

Related Parent Applications (2)

Application Number Title Priority Date Filing Date
US13/002,829 Continuation-In-Part US9795410B2 (en) 2009-08-27 2010-08-27 Method and apparatus for force redistribution in articular joints
PCT/US2010/046996 Continuation-In-Part WO2011025959A1 (fr) 2009-08-27 2010-08-27 Procédé et appareil pour la redistribution de force dans des articulations

Related Child Applications (1)

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US14/642,121 Continuation US9861408B2 (en) 2009-08-27 2015-03-09 Method and apparatus for treating canine cruciate ligament disease

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WO2014040013A1 true WO2014040013A1 (fr) 2014-03-13

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US10238427B2 (en) 2015-02-19 2019-03-26 Nuvasive Specialized Orthopedics, Inc. Systems and methods for vertebral adjustment
US10271885B2 (en) 2014-12-26 2019-04-30 Nuvasive Specialized Orthopedics, Inc. Systems and methods for distraction
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US10405891B2 (en) 2010-08-09 2019-09-10 Nuvasive Specialized Orthopedics, Inc. Maintenance feature in magnetic implant
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US10646262B2 (en) 2011-02-14 2020-05-12 Nuvasive Specialized Orthopedics, Inc. System and method for altering rotational alignment of bone sections
US10660675B2 (en) 2010-06-30 2020-05-26 Nuvasive Specialized Orthopedics, Inc. External adjustment device for distraction device
US10729470B2 (en) 2008-11-10 2020-08-04 Nuvasive Specialized Orthopedics, Inc. External adjustment device for distraction device
US10743794B2 (en) 2011-10-04 2020-08-18 Nuvasive Specialized Orthopedics, Inc. Devices and methods for non-invasive implant length sensing
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US10835290B2 (en) 2015-12-10 2020-11-17 Nuvasive Specialized Orthopedics, Inc. External adjustment device for distraction device
US10918425B2 (en) 2016-01-28 2021-02-16 Nuvasive Specialized Orthopedics, Inc. System and methods for bone transport
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US11234849B2 (en) 2006-10-20 2022-02-01 Nuvasive Specialized Orthopedics, Inc. Adjustable implant and method of use
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USRE49061E1 (en) 2012-10-18 2022-05-10 Nuvasive Specialized Orthopedics, Inc. Intramedullary implants for replacing lost bone
US11357547B2 (en) 2014-10-23 2022-06-14 Nuvasive Specialized Orthopedics Inc. Remotely adjustable interactive bone reshaping implant
US11577097B2 (en) 2019-02-07 2023-02-14 Nuvasive Specialized Orthopedics, Inc. Ultrasonic communication in medical devices
US11589901B2 (en) 2019-02-08 2023-02-28 Nuvasive Specialized Orthopedics, Inc. External adjustment device
US11596456B2 (en) 2015-10-16 2023-03-07 Nuvasive Specialized Orthopedics, Inc. Adjustable devices for treating arthritis of the knee
US11602380B2 (en) 2009-04-29 2023-03-14 Nuvasive Specialized Orthopedics, Inc. Interspinous process device and method
US11696836B2 (en) 2013-08-09 2023-07-11 Nuvasive, Inc. Lordotic expandable interbody implant
US11712268B2 (en) 2004-07-02 2023-08-01 Nuvasive Specialized Orthopedics, Inc. Expandable rod system to treat scoliosis and method of using the same
US11737787B1 (en) 2021-05-27 2023-08-29 Nuvasive, Inc. Bone elongating devices and methods of use
US11766252B2 (en) 2013-07-31 2023-09-26 Nuvasive Specialized Orthopedics, Inc. Noninvasively adjustable suture anchors
US11801187B2 (en) 2016-02-10 2023-10-31 Nuvasive Specialized Orthopedics, Inc. Systems and methods for controlling multiple surgical variables
US11806054B2 (en) 2021-02-23 2023-11-07 Nuvasive Specialized Orthopedics, Inc. Adjustable implant, system and methods
US11839410B2 (en) 2012-06-15 2023-12-12 Nuvasive Inc. Magnetic implants with improved anatomical compatibility
US11857226B2 (en) 2013-03-08 2024-01-02 Nuvasive Specialized Orthopedics Systems and methods for ultrasonic detection of device distraction
US11925389B2 (en) 2008-10-13 2024-03-12 Nuvasive Specialized Orthopedics, Inc. Spinal distraction system
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US11234849B2 (en) 2006-10-20 2022-02-01 Nuvasive Specialized Orthopedics, Inc. Adjustable implant and method of use
US11672684B2 (en) 2006-10-20 2023-06-13 Nuvasive Specialized Orthopedics, Inc. Adjustable implant and method of use
US11871974B2 (en) 2007-10-30 2024-01-16 Nuvasive Specialized Orthopedics, Inc. Skeletal manipulation method
US10349995B2 (en) 2007-10-30 2019-07-16 Nuvasive Specialized Orthopedics, Inc. Skeletal manipulation method
US11172972B2 (en) 2007-10-30 2021-11-16 Nuvasive Specialized Orthopedics, Inc. Skeletal manipulation method
US11925389B2 (en) 2008-10-13 2024-03-12 Nuvasive Specialized Orthopedics, Inc. Spinal distraction system
US10729470B2 (en) 2008-11-10 2020-08-04 Nuvasive Specialized Orthopedics, Inc. External adjustment device for distraction device
US11974782B2 (en) 2008-11-10 2024-05-07 Nuvasive Specialized Orthopedics, Inc. External adjustment device for distraction device
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US11207110B2 (en) 2009-09-04 2021-12-28 Nuvasive Specialized Orthopedics, Inc. Bone growth device and method
US11944358B2 (en) 2009-09-04 2024-04-02 Nuvasive Specialized Orthopedics, Inc. Bone growth device and method
US11497530B2 (en) 2010-06-30 2022-11-15 Nuvasive Specialized Orthopedics, Inc. External adjustment device for distraction device
US10660675B2 (en) 2010-06-30 2020-05-26 Nuvasive Specialized Orthopedics, Inc. External adjustment device for distraction device
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