WO2016057576A1 - Instrument de microfracturation - Google Patents
Instrument de microfracturation Download PDFInfo
- Publication number
- WO2016057576A1 WO2016057576A1 PCT/US2015/054326 US2015054326W WO2016057576A1 WO 2016057576 A1 WO2016057576 A1 WO 2016057576A1 US 2015054326 W US2015054326 W US 2015054326W WO 2016057576 A1 WO2016057576 A1 WO 2016057576A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- vibration generator
- instrument
- tip
- tissue
- microfracturing
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1604—Chisels; Rongeurs; Punches; Stamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3472—Trocars; Puncturing needles for bones, e.g. intraosseus injections
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
- A61B2017/32007—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with suction or vacuum means
-
- 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
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
- A61B2017/922—Devices for impaction, impact element
Definitions
- the present invention relates generally to the field of medical devices, and more particularly relates to instruments and methods for microfracturing tissue.
- Some embodiments include a tip that is moved generally laterally relative to the surface of tissue being microfractured and has cutting features that are positioned to cut when moved in the generally lateral direction.
- Defects in bone and tissues around bone may result from various circumstances or conditions. For example, tissue may be damaged, diseased, or simply worn or degraded as a result of repetitive motions. Excessive defects may result in the loss of full function of a joint, and ultimately even to the need for joint replacement. Repair treatments have been developed to restore some or even all of the function of a joint.
- one common method to repair defects such as osteo-chondral defects, is to "microfracture" bone that is exposed in a defect.
- a surgeon may create relatively small fractures in a subchondral bone plate causing the release of multipotent mesenchymal stem cells from bone marrow. This procedure may lead to healing resulting from growth of repair tissue such as one or more of fibrous tissue, fibrocartilage, and hyaline-like cartilage.
- Such a microfracture treatment is typically accomplished with a pointed awl or pick being applied directly to subchondral bone.
- a pointed awl or pick is applied directly to subchondral bone.
- Force typically has to be applied to the pointed awl or pick at a proximal location, which is usually distant from the distal point of impact with the tissue to be treated.
- the angles at which the pointed awl and pick are capable of receiving force effectively do not necessarily lead to the distal end of the pointed awl or pick making an accurate and effective tissue cut.
- a pointed pick or awl may be driven into subchondral bone, either directly or indirectly by applying force with a hammer.
- This may lead to inaccurate and unsatisfactory microfracturing.
- soft tissue may have a damping effect on the forces required to perform microfracturing. Therefore, an even greater force may have to be applied in such situations. Application of greater forces increases the risk of collateral damage to surrounding tissue.
- An improved device may require less aggressive application of force and result in more precise application of fracturing or cutting force than may result from such actions as striking an instrument with a hammer, for example. It may also be useful to apply cutting motion forces in only the directions or in more nearly the directions that are effective to cut tissue as needed to accomplish microfracturing.
- An embodiment of the invention is a microfracturing instrument with a vibration generator, a shaft, and a tip.
- the vibration generator may have a generally longitudinal axis
- the shaft may be coupled with the vibration generator and configured to be moved at the speed and direction of the vibrations of the vibration generator.
- the tip may be coupled to the shaft such that and the tip is configured to move at the speed and direction of the vibrations of the vibration generator and engage tissue to create microfractures in the tissue.
- Another embodiment of the invention is a microfracturing instrument with a vibration generator, a shaft, and a tip.
- the vibration generator may have a generally longitudinal axis
- the shaft may be coupled with the vibration generator and configured to be moved at the speed and direction of the vibrations of the vibration generator.
- the tip may be fixedly coupled to the shaft and have one or more cutting elements of the tip used to create microfractures that are transverse to the longitudinal axis of the vibration generator
- Yet another embodiment of the invention is a method of microfracturing tissue.
- the method may include providing a microfracturing instrument that includes a vibration generator with a longitudinal axis, a shaft coupled with the vibration generator and configured to be moved at the speed and direction of the vibrations of the vibration generator, and a tip coupled to the shaft.
- the method may also include positioning the microfracturing instrument tip against a surface of the tissue to be microfractured and activating the vibration generator.
- the method may also include applying a force to the microfracturing instrument in the direction of the surface of the tissue to be microfractured, wherein unless the force is applied in the direction of the surface of the tissue to be microfractured, the tip would not substantially engage the tissue to microfracture the tissue.
- FIG. 1 is a perspective view of an embodiment of a microfracturing instrument.
- FIG. 2 is a perspective view of the tip of the microfracturing instrument illustrated in FIG. 1.
- FIG. 3 is a perspective view of the microfracturing instrument illustrated in FIG. 1 in use on a posterior patellar surface.
- FIG. 4 is an enlarged perspective view of the distal end of the
- FIG. 5 is a perspective view of an embodiment of a microfracturing instrument.
- FIGS. 1-5 A microfracturing instrument 1 and its components are illustrated collectively, separately, and in use in FIGS. 1-5.
- the microfracturing instrument 1 is shown in FIGS. 1 and 3 with a vibration generator 10, a shaft 20, and a tip 30.
- the vibration generator 10 shown has a generally longitudinal shape with a longitudinal axis lengthwise through the vibration generator 10.
- the vibration generator 10 depicted is configured to create vibration at its distal end 11 in a reciprocating motion substantially only along the longitudinal axis. Motion in one or both of this and other directions may be generated by vibration generators of other embodiments.
- a power cord 12 is included to provide electrical energy to the vibration generator 10.
- energy to drive an embodiment of a vibration generator may be supplied by any effective mechanism.
- an energy source may be one or more of a battery, pneumatic power, and hydraulic pressure.
- the frequency of vibration of various embodiments of a vibration generator may be any effective frequency, including ultrasonic frequencies and frequencies either lower or higher than ultrasonic frequencies.
- the shaft 20 is depicted coupled with the vibration generator 10 and is configured to be moved at the speed and direction of the vibrations of the vibration generator 10.
- the illustrated shaft 20 includes a curve 21 (FIGS. 1 and 3) that may assist in effectively positioning the microfracturing instrument 1 in surgical procedures.
- a shaft of the microfracturing instrument may include two or more curves, which may assist in more precisely positioning a microfracturing instrument to be more effectively used.
- the two or more curves may be in the same plane or may be in different planes.
- the two or more curves may be configured such that the tip of the microfracturing instrument is parallel with the longitudinal axis of the vibration generator or may be configured to create any other effective relative orientation between a vibration generator and a tip.
- One or more curves may essentially be bends with large radii relative to a diameter of a shaft or may be of any effective radii.
- a shaft of some embodiments may be substantially straight.
- the tip 30 shown in FIGS. 1, 2, and 4 is coupled to the shaft 20 such that the tip 30 is configured to move at the speed and direction of the vibrations of the vibration generator and engage tissue to create microfractures in the tissue.
- tissue may refer to bone, to tissue typically surrounding bone, or to other tissue. Bone tissue may include but is not limited to cortical bone and subchondral bone. Tissue typically surrounding bone may include but is not limited to fibrous tissue, fibrocartilage, and hyaline-like cartilage.
- the tip 30 may also be described as fixedly coupled to the shaft 20 in the illustrated embodiment.
- the term "fixedly" means that the coupling does not provide for articulation, substantial flexing, or substantial relative movement between a shaft and a tip. This definition does not exclude typical yield, non-plastic deformation that may occur within a component or at the interface of two non-articulating connected components. In the embodiment depicted, a distal end of the tip 30 is not configured to move closer to and further from the shaft 20.
- the illustrated tip 30 also includes an appendage 31 (FIGS. 1, 2, and 4) with a longitudinal axis that is transverse to the longitudinal axis of the vibration generator.
- a vibration generator, shaft, and tip may be configured such that a longitudinal axis of the appendage is substantially
- the appendage may not be moved substantially along the longitudinal axis of the appendage by activation of the vibration generator. This lack of substantial movement along the longitudinal axis of the appendage does not exclude devices that are minimally moved by typical flexing of the shaft or by flexing of fixed couplings between one or more of the vibration generator, the shaft, and the tip.
- the appendage 31 illustrated is substantially the shape of a pyramid. In this embodiment, the pyramid is a square pyramid with four base edges, but in other embodiments may be a pyramid of any number of base edges greater than two.
- the appendage 31 shown is coupled to the rest of the tip 30 at the base of the pyramid, and the apex of the appendage 31 pyramid extends away from the rest of the tip 30 along the longitudinal axis of the appendage 31.
- the vertical edges 33 (FIG. 2) of the appendage 31 shown are transverse to the longitudinal axis of the vibration generator and serve as cutting elements of the tip 30, and may be used to create microfractures.
- Other embodiments of an appendage with a longitudinal axis transverse to the longitudinal axis of the vibration generator may include one or more cutting elements extending out from the longitudinal axis of the appendage of configurations that are different from the illustrated pyramid.
- an appendage may be a one or more sided blade, a hook, a round element with cutting elements, a polygon with edge cutting elements or other attached cutting elements, and a polygon that includes convex sides or concave sides (such as, for example, an appendage with the cross-sectional shape of a star).
- An appendage may also be a cone or other shaped component that in some respect has a relatively sharp portion that is effective as a cutting element.
- FIG. 5 Another embodiment of a microfracturing instrument is illustrated in FIG. 5.
- a microfracturing instrument 100 is shown in FIG. 5 with a vibration generator 1 10, a shaft 120, and a tip 130.
- the vibration generator 110 is essentially the same as the vibration generator 10, including all variations described above and will not be further described.
- the shaft 120 is essentially the same as the shaft 20, including all variations described above, and will not be further described.
- the tip 130 shown in FIG. 5 is coupled to the shaft 120 such that the tip 130 is configured to move at the speed and direction of the vibrations of the vibration generator and engage tissue to create microfractures in the tissue.
- the tip 130 is fixedly coupled to the shaft 120 in the illustrated embodiment.
- the term "fixedly” means that the coupling does not provide for articulation, substantial flexing, or substantial relative movement between a shaft and a tip. This definition does not exclude typical yield, non-plastic deformation that may occur within a component or at the interface of two non-articulating connected components.
- a distal end of the tip 130 is not configured to move closer to and further from the shaft 120.
- the illustrated tip 130 includes a curette.
- the curette shown is a ring curette with one or more sharpened edges along peripheries of the ring. With this type of ring curette, tissue is removed by scraping a sharpened edge along tissue with the sharpened edge positioned transverse to the tissue.
- a curette could be another type of curette, for example and without limitation, a ring curette or a cup curette. Other embodiments may include cutting or scraping instruments of any effective type at a tip of a
- a segment of the illustrated ring curette with a sharpened edge may also be considered an appendage with a longitudinal axis that is transverse to the longitudinal axis of the vibration generator.
- a vibration generator, shaft, and tip may be configured such that an axis passing through the segment and a sharpened edge are substantially perpendicular to the longitudinal axis of the vibration generator.
- the segment with a sharpened edge may not be moved substantially along the axis of the segment with a sharpened edge by activation of the vibration generator. This lack of substantial movement along the axis of the segment with a sharpened edge does not exclude devices that are moved by typical flexing of the shaft or by flexing of fixed couplings between one or more of the vibration generator, shaft, and tip.
- Some embodiments may include mechanisms for delivery of fluid to the area of the tip 30, 130.
- fluid may be provided at least in part through one or both of the shaft 20, 120 and the tip 30, 130.
- Fluid may be provided through a conduit that runs alongside the instrument 1, 100 or by any other effective delivery structure.
- Suction structures may also be included in the shaft 20, 120, and tip 30, 130, and alongside the instrument 1, 100.
- An embodiment of the invention is a method of microfracturing tissue that includes the use of a microfracturing instrument with a vibration generator with a longitudinal axis, a shaft coupled with the vibration generator and configured to be moved at the speed and direction of the vibrations of the vibration generator, and a tip coupled to the shaft.
- Microfracturing instruments for use in the method may be essentially similar to the microfracturing instruments 1, 100 described in detail herein, along with any other effective variations. Other microfracturing instruments within the scope of the method described may also be used in carrying out the method.
- a method of use of a microfracturing instrument is illustrated in FIGS. 3 and 4. In the illustrated embodiment, the microfracturing instrument 1 is being used to treat tissue on the posterior side of a patella 50.
- Methods of the invention may be applied to any other area of an anatomy where microfracturing of tissue may be efficacious for a patient.
- a method within the scope of the invention may be accomplished on articular surfaces of a hip joint or shoulder joint or at other locations within a knee joint.
- method embodiments may include positioning the microfracturing instrument tip 30 against a surface of the tissue to be microfractured, as shown generally in FIG. 3 and in more detail in FIG. 4. More particularly in the embodiment shown, the appendage 31 (FIG. 2) is positioned against a surface of the tissue to be microfractured (FIG. 4). With the instrument tip 30 positioned, the method may further include activating the vibration generator 10. In the embodiment shown, activating the vibration generator 10 will cause the shaft 20 to be moved back and forth in the direction of the longitudinal axis of the vibration generator 10. Method embodiments may further include applying a force to the microfracturing instrument in the direction of the surface of the tissue to be microfractured.
- the vibration generator 10 Longitudinal oscillations transmitted from the vibration generator 10, 110 to the microfracture tip 30, 130 cause cutting to occur at the tip 30, 130 when it is applied to a tissue surface.
- the force of application in the direction of the tissue surface is therefore greatly reduced over that required for current microfracture procedures.
- the vibrations are in the range of tens of kHz, soft tissue contacting the non-cutting portions of microfracture tip will not be affected because the soft tissue's elastic nature will absorb vibrational energy.
- the vibration generator 10 includes an exterior that may be gripped and to which a force may be applied and transferred to the tip 30 in the direction of the tissue surface through the shaft 20.
- the illustrated appendage 31 of the tip 30 with its pyramid shape would not substantially engage the tissue to microfracture the tissue when vibrated in the direction of the longitudinal axis of the vibration generator 10 without application of the force to the micro fracturing instrument toward the surface of the tissue. This is because the appendage 31 would not penetrate deeply enough into the tissue without a force being applied to the micro fracturing instrument and the direction of vibration would not significantly force the appendage 31 into the tissue to substantially engage the tissue.
- substantially engage means to penetrate the tissue deeply enough to result in effective tissue microfracturing, ultimately leading to tissue healing.
- a sharpened edge of the curette embodiment of the tip 130 may require the application of a force in the direction of the surface of the tissue to be microfractured or otherwise treated to substantially engage the tissue to microfracture or otherwise treat the tissue.
- Method embodiments may additionally include the act of applying a force to the microfracture instrument 1, 100 in the opposite direction from the surface of the tissue to be microfractured after a microfracturing in a first location has been accomplished.
- force applied in the opposite direction from the surface of the tissue to be microfractured disengages the tip 30, 130 from the tissue.
- the tip 30, 130 of the microfracturing instrument 1, 100 may then be repositioned at a separate location on the surface of the tissue to be microfractured and a force applied to the microfracturing instrument in the direction of the surface of the tissue to be microfractured in order to microfracture an additional portion of the surface of the tissue. This sequence may be repeated multiple times to microfracture a desired area.
- biocompatible materials may include in whole or in part: non-reinforced polymers, reinforced polymers, metals, ceramics, adhesives, reinforced adhesives, and combinations of these materials. Reinforcing of polymers may be accomplished with carbon, metal, or glass or any other effective material.
- biocompatible polymer materials include polyamide base resins, polyethylene, Ultra High Molecular Weight (UHMW) polyethylene, low density polyethylene, polymethylmethacrylate (PMMA), polyetheretherketone (PEEK), polyetherketoneketone (PEKK), a polymeric hydroxyethylmethacrylate (PHEMA), and polyurethane, any of which may be reinforced.
- Polymers used as bearing surfaces in particular may in whole or in part include one or more of cross-linked and highly cross-linked polyethylene.
- Example biocompatible metals include stainless steel and other steel alloys, cobalt chrome alloys, zirconium, oxidized zirconium, tantalum, titanium, titanium alloys, titanium- nickel alloys such as Nitinol and other superelastic or shape-memory metal alloys.
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- Surgery (AREA)
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- Biomedical Technology (AREA)
- Medical Informatics (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Public Health (AREA)
- Heart & Thoracic Surgery (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Dentistry (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Surgical Instruments (AREA)
Abstract
Selon des modes de réalisation, cette invention concerne des instruments pour la microfracturation des tissus par activation du générateur de vibrations (10, 110) d'un instrument de microfracturation (1, 100) et application d'une pointe (30, 130) de l'instrument de microfracturation (1, 100) au tissu. Dans certains modes de réalisation, la microfracturation résulte d'une combinaison de vibrations de l'instrument (1, 100) et de la force appliquée à l'instrument (1, 100) par un opérateur et dirigée vers le tissu destiné à être microfracturé.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US201462060171P | 2014-10-06 | 2014-10-06 | |
US62/060,171 | 2014-10-06 |
Publications (1)
Publication Number | Publication Date |
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WO2016057576A1 true WO2016057576A1 (fr) | 2016-04-14 |
Family
ID=54337442
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US2015/054326 WO2016057576A1 (fr) | 2014-10-06 | 2015-10-06 | Instrument de microfracturation |
Country Status (1)
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WO (1) | WO2016057576A1 (fr) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2020007865A1 (fr) | 2018-07-03 | 2020-01-09 | Woodwelding Ag | Dispositif pour perforer une couche osseuse dense |
Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20070068329A1 (en) * | 2005-07-11 | 2007-03-29 | Phan Christopher U | Curette system |
US20080132932A1 (en) * | 2006-08-16 | 2008-06-05 | Biomet Sports Medicine, Inc. | Chondral Defect Repair |
US20100076440A1 (en) * | 2008-05-08 | 2010-03-25 | Chris Pamichev | Method and apparatus for performing arthroscopic microfracture surgery |
WO2011014677A1 (fr) * | 2009-07-30 | 2011-02-03 | Mtmed I, Llc | Instrument pour créer des micro-fractures dans un os |
US20120203231A1 (en) * | 2011-02-08 | 2012-08-09 | Howmedica Osteonics Corp. | Flexible microdrilling instrumentation, kits and methods |
US20140155896A1 (en) * | 2012-12-05 | 2014-06-05 | Depuy Mitek, Llc | Instrument and Method to Enhance Articular Cartilage Regeneration |
-
2015
- 2015-10-06 WO PCT/US2015/054326 patent/WO2016057576A1/fr active Application Filing
Patent Citations (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20070068329A1 (en) * | 2005-07-11 | 2007-03-29 | Phan Christopher U | Curette system |
US20080132932A1 (en) * | 2006-08-16 | 2008-06-05 | Biomet Sports Medicine, Inc. | Chondral Defect Repair |
US20100076440A1 (en) * | 2008-05-08 | 2010-03-25 | Chris Pamichev | Method and apparatus for performing arthroscopic microfracture surgery |
WO2011014677A1 (fr) * | 2009-07-30 | 2011-02-03 | Mtmed I, Llc | Instrument pour créer des micro-fractures dans un os |
US20120203231A1 (en) * | 2011-02-08 | 2012-08-09 | Howmedica Osteonics Corp. | Flexible microdrilling instrumentation, kits and methods |
US20140155896A1 (en) * | 2012-12-05 | 2014-06-05 | Depuy Mitek, Llc | Instrument and Method to Enhance Articular Cartilage Regeneration |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2020007865A1 (fr) | 2018-07-03 | 2020-01-09 | Woodwelding Ag | Dispositif pour perforer une couche osseuse dense |
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