WO2023102247A1 - Dispositifs et procédés de préparation de greffon de tissu - Google Patents

Dispositifs et procédés de préparation de greffon de tissu Download PDF

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Publication number
WO2023102247A1
WO2023102247A1 PCT/US2022/051748 US2022051748W WO2023102247A1 WO 2023102247 A1 WO2023102247 A1 WO 2023102247A1 US 2022051748 W US2022051748 W US 2022051748W WO 2023102247 A1 WO2023102247 A1 WO 2023102247A1
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WO
WIPO (PCT)
Prior art keywords
graft
guide tube
region
orientation
relative
Prior art date
Application number
PCT/US2022/051748
Other languages
English (en)
Inventor
Ali HOSSEINI
Jay A. SHAH
Matthew D. Cunningham
Nehal N. PATEL
Dennis P. Colleran
Timothy Young
Original Assignee
Smith & Nephew, Inc.
Smith & Nephew Orthopaedics Ag
Smith & Nephew Asia Pacific Pte. Limited
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 Smith & Nephew, Inc., Smith & Nephew Orthopaedics Ag, Smith & Nephew Asia Pacific Pte. Limited filed Critical Smith & Nephew, Inc.
Publication of WO2023102247A1 publication Critical patent/WO2023102247A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4644—Preparation of bone graft, bone plugs or bone dowels, e.g. grinding or milling bone material
    • 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
    • A61B17/1635—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for grafts, harvesting or transplants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis
    • A61B90/11—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis with guides for needles or instruments, e.g. arcuate slides or ball joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/142—Surgical saws ; Accessories therefor with reciprocating saw blades, e.g. with cutting edges at the distal end of the saw blades
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/14—Surgical saws ; Accessories therefor
    • A61B17/15—Guides therefor
    • 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
    • A61B17/1637—Hollow drills or saws producing a curved cut, e.g. cylindrical
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
    • A61B17/17—Guides or aligning means for drills, mills, pins or wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/062—Measuring instruments not otherwise provided for penetration depth
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4644—Preparation of bone graft, bone plugs or bone dowels, e.g. grinding or milling bone material
    • A61F2002/4649—Bone graft or bone dowel harvest sites
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4662—Measuring instruments used for implanting artificial joints for measuring penetration depth

Definitions

  • the present disclosure relates to tissue graft preparation devices and, more particularly, to devices and methods for surgical repair of damaged articular cartilage.
  • Damage to articular cartilage can result from several causes, including sports injuries, accidents, or wear and tear over time. Surgeons use several procedures for repairing articular cartilage.
  • One surgical procedure includes taking a cartilage graft from a donor and transferring the graft to the damaged area of the patient’s cartilage. In such procedures, the surgeon must match the donor graft topography to the destination topography as closely as possible. Otherwise, the placed graft has a discontinuous surface relative to the surrounding cartilage. For example, the graft may have one side that sits proud to the surrounding cartilage and an opposite side that sits below the surface of the surrounding cartilage. In the first scenario, the graft produces a catching motion, while in the second, the graft cannot provide proper support. Current techniques often require the surgeon to visually estimate alignment, which can lead to much variation from the desired orientation.
  • the disclosure describes devices and methods for quickly and accurately preparing a tissue graft to match the cutting plane orientation of a hole in a cartilage defect without requiring the user to visually estimate the graft alignment.
  • a tissue graft cutting assembly of this disclosure include a depth measuring tool having a plurality of sliding pegs for contacting the bottom surface of a hole in the tissue defect. After the user sets a height of the pegs based on the height of the hole, the user couples the tool to a plate of a graft cutting guide configured to be angled based on the height of the pegs. A cored tissue graft is placed within the guide and a saw is extended along a cutting plane to cut the tissue graft at the set angle.
  • the disclosure also describes height cutting tools for cutting the graft to a desired height and cutting plane orientation.
  • the disclosure also describes methods of providing a single measurement at the center of a hole in a tissue defect, rather than a plurality of measurements around the circumference of the hole.
  • Examples of a graft cutting assembly of this disclosure include a depth measuring tool configured for measuring a depth of a hole in a tissue defect.
  • the depth measuring tool includes a shaft having a proximal end and a distal end.
  • a swivel member couples to the distal end of the shaft such that the shaft is pivotable relative to the swivel member.
  • the swivel member is configured to contact a bottom surface of the hole.
  • a sleeve couples to an outer surface of the shaft and is slidable relative to the shaft.
  • the assembly also includes a guide tube having a proximal end, a distal end, and a cannulation extending between the proximal end and distal ends. The cannulation is configured for passage of the shaft and the sleeve when the guide tube is in a first orientation.
  • the sleeve includes a flange configured to contact a surface of tissue surrounding the hole.
  • the flange has a plurality of tabs spaced about a circumference of the flange.
  • the proximal end of the guide tube defines a plurality of slots disposed about a surface of the guide tube. The plurality of slots are configured to engage the plurality of tabs of the flange to prevent rotation of the shaft relative to the guide tube.
  • the assembly also includes an articulated saw guide configured to couple to the guide tube such that a slot of the saw guide is adjacent the proximal end of the guide tube.
  • the cannulation of the guide tube is further configured for passage of a coring instrument when the guide tube is inverted to a second orientation.
  • Examples of a method of cutting a tissue graft of this disclosure include inserting a depth measuring tool into a hole in a tissue defect.
  • the depth measuring tool includes a shaft having a proximal end and a distal end.
  • a swivel member couples to the distal end of the shaft such that the shaft is pivotable relative to the swivel member.
  • the swivel member is configured to contact a bottom surface of the hole.
  • a sleeve couples to an outer surface of the shaft and is slidable relative to the shaft.
  • the method also includes moving the sleeve relative to the shaft such that a flange of the sleeve contacts a surface of the tissue surrounding the hole.
  • the method also includes inserting the shaft through a cannulation of a guide tube positioned in a first orientation such that the swivel member is adjacent a proximal end of the guide tube.
  • the method also includes coupling a saw guide to the guide tube such that a slot of the guide tube is adjacent the swivel member.
  • the method also includes inserting a saw through the slot such that the saw is flush with a proximal face of the swivel member.
  • the method also includes locking the saw guide into position and removing the saw guide from the guide tube.
  • the method also includes inverting the guide tube to a second orientation and inserting a coring instrument through the cannulation of the guide tube into an area of healthy tissue such that a tissue graft is cut axially by the coring instrument.
  • the method also includes reattaching the saw guide to the inverted guide tube and inserting the saw through the slot to cut the tissue graft radially.
  • Examples of another graft cutting assembly of this disclosure include a dialing member having a first portion and a second portion.
  • the second portion includes a cutting plane and a plurality of adjustable features to set a height and orientation of the first portion relative to the cutting plane.
  • the assembly also includes a memory member having a first region and a second region.
  • the first region is adjustable to set a height and orientation of the first region relative to the second region.
  • the second region has a slot for passage of a cutting device.
  • the assembly also includes a guide tube having a proximal end and a distal end. The distal end is configured to contact tissue.
  • an outer surface of the guide tube has a first coupling member for attaching to the memory member.
  • the first portion of the dialing member has a same size and shape as a size and shape of the guide tube.
  • an outer surface of the dialing member has a second coupling member for attaching to the memory member.
  • the plurality of adjustable features includes a plurality of first rods. Each of the first rods is slidably disposed within a knob.
  • each of the plurality of first rods includes a spring disposed about the first rod.
  • each knob includes measurement markings for adjusting a position of the plurality of first rods based on a measurement of a hole in a tissue defect.
  • the first region of the memory member is adjustable relative to the second region by means of a plurality of second rods extending through the first region.
  • Examples of another method of cutting a tissue graft of this disclosure include coupling a dialing member of a graft cutting assembly to a memory member of the graft cutting assembly.
  • the dialing member has a first portion and a second portion.
  • the second portion includes a cutting plane and a plurality of adjustable features to set a height and orientation of the first portion relative to the cutting plane.
  • the memory member has a first region and a second region.
  • the first region is adjustable to set a height and orientation of the first region relative to the second region.
  • the second region includes a slot for passage of a cutting member.
  • the method also includes setting a height and orientation of the first portion of the dialing member relative to the cutting plane.
  • the height and orientation of the first portion of the dialing member relative to the cutting plane is transferred to the height and orientation of the first region relative to the second region of the memory member.
  • the method also includes removing the dialing member from the memory member, coupling the memory member to a guide tube attached to a tissue graft, and inserting the saw through the slot of the memory member to cut the tissue graft axially.
  • setting a height and orientation of the first portion of the dialing member relative to the cutting plane includes setting the height and orientation with a plurality of first rods, each of the first rods being slidably disposed within a knob.
  • FIGS. 1 A and IB show an example of a depth measuring tool of this disclosure
  • FIG. 2A shows an example of a graft cutting guide for use with the depth measurement tool of FIGS. 1A and IB;
  • FIG. 2B shows an example of the plate of the graft cutting guide coupled to a base member of this disclosure
  • FIG. 2C shows an example of the depth measuring tool of FIGS. 1A and IB coupled to the base member of FIG. 2B;
  • FIGS. 3A and 3B show examples of a method cutting a tissue graft using the graft cutting guide of this disclosure
  • FIGS. 4A-D show another example of a graft cutting tool of this disclosure
  • FIGS. 4E and 4F show an alternative example of the graft cutting tool of FIGS.
  • FIGS. 5A-5C show another example of a depth measurement tool of this disclosure
  • FIGS. 5D-K show an example of a method of cutting a tissue graft using the depth measurement tool of FIGS. 5A-5C;
  • FIG. 6A shows another example of a graft cutting assembly of this disclosure
  • FIGS. 6B-I illustrate a method of cutting a tissue graft using the graft cutting assembly of FIG. 6 A.
  • FIGS. 7A-C illustrate another method of cutting a tissue graft of this disclosure.
  • the terms “about” and “substantially” represent the inherent degree of uncertainty attributed to any quantitative comparison, value, measurement, or other representation.
  • the terms “about” and “substantially” moreover represent the degree by which a quantitative representation may vary from a stated reference without resulting in a change in the basic function of the subject matter at issue.
  • Open-ended terms, such as “comprise,” “include,” and/or plural forms of each, include the listed parts and can include additional parts not listed, while terms such as “and/or” include one or more of the listed parts and combinations of the listed parts.
  • FIGS. 1 A and IB show an example of a depth measuring tool 100 for measuring a depth and cutting plane orientation of a hole 124 in a tissue defect 118.
  • the tool 100 may comprise a substantially flat, circular body 102.
  • the body 102 may comprise spiraling features 126 configured for expanding a circumference of the body depending on the size of the hole 124.
  • a plurality of legs 104 may be spaced equidistant from one another about a circumference of a lower surface of the body 102.
  • Each of the legs 104 may be configured for the passage of a sliding peg 106.
  • the plurality of legs 104 is four legs 104. However, the disclosure contemplates more or fewer than four legs 104.
  • the sliding pegs 106 can project from the legs 104 to contact the bottom surface of the hole 124.
  • the legs 104 may comprise locking features 120 spaced at intervals (e.g., 1 mm apart) to engage corresponding locking features on the pegs 106 to lock the pegs 106 into place.
  • FIG. 2A shows an example of a graft cutting guide 200 for use with the depth measuring tool of FIGS. 1A and IB.
  • the graft cutting guide 200 may comprise a foot member 202 having a first end 202a and a second end 202b.
  • the foot member 202 may be configured to be hand-held.
  • a circular plate 204 couples to the first end 202a.
  • the plate 204 may be slidably disposed within a first portion 206a of cutting plane 206, shown in a transparent view for ease of illustration.
  • the first portion 206a may form a collar 214 for wrapping around a circumference of the plate 204.
  • a second portion 206b of the cutting plane 206 may extend in a same plane as the plate 204.
  • the second portion 206b may have a first region 206b’ offset from a second region 206b” at about a 90° angle in the same plane as the plate 204.
  • FIG. 2B shows the plate 204 coupled to a base member 208.
  • the plate 204 may couple to the base member 208 such that a user can angle the plate 204 relative to the base member 208 but cannot axially move the plate 204 relative to the base member 208.
  • the base member 208 may define a substantially circular channel 210 extending from a first open end 208a to a second open end 208b of the base member 208 along a longitudinal axis A.
  • a slot 212 in communication with the channel 210 may extend along a side of the base member 208 between the first open end 208a and the second open end 208b.
  • the plate 204 may initially couple to the base member 208 such that the plate 204 is disposed within the channel 210 in a plane substantially orthogonal to the longitudinal axis A and the cutting plane 206 extends through the slot 212.
  • FIG. 2C shows the tool 100 of FIGS. 1 A and IB coupled to the cutting guide 200.
  • the user may place the body 102 of the tool 100 against the first open end 208a of the base member 208.
  • the user may then angle the cutting plane 206 and the plate 204 relative to the longitudinal axis A such that the pegs 106 contact the circular plate 204.
  • the user may then lock the position of the cutting plane 206 in place at the desired angle.
  • the user may then remove the plate 204 and the foot member 202 from the cutting plane 206. As shown in FIG.
  • the user may then insert a cored tissue graft 118 into the channel 210 of the base member 208 such that a top surface of the tissue graft 118 aligns with the first open end 208a of the base member 208 and a bottom portion of the graft 118 extends through the collar 214.
  • the tissue graft 118 can comprise donor tissue (i.e., an “allograft”).
  • the cartilage tissue can come from the patient’s own tissue (i.e, an “autograft”).
  • the user may then extend a saw 216, such as a sagittal saw, along the first region 206b’ (FIG. 3A) of the cutting plane 206 to cut the graft 118 to a matched depth and geometry to the hole 124.
  • the user can use a height cutting tool 300 to cut the graft 118 to the desired height and cutting plane orientation.
  • the user may first measure the hole 124 at, for example, three or four locations, and then apply those measurements by putting clips 301 through holes 303 in pins 302 extending above an upper plane 304 of the tool 300.
  • the holes 303 are separated, for example, by 1 mm increments to set the appropriate distance and orientation between the upper plane 304 and a cutting plane 306.
  • the upper plane 304 may be spaced from the cutting plane 306 by springs 308, which may be constantly under tension to separate the upper plane 304 and the cutting plane 306.
  • the cutting plane 306 may define an open slot 310 for insertion of the graft 118.
  • the user may then load the graft 118 into the open slot 310 using a plug holder 314.
  • the user may then insert a saw (not shown) into a cutting plane slot 312 to cut through the graft 118, creating a graft 118 with a matched depth and geometry to the recipient hole 124 in the patient.
  • An alternative version of the height cutting tool 300’ is illustrated in FIGS. 4E and 4F.
  • the user may turn a knob 316 on the pins 302 to adjust the distance and orientation between the planes 304, 306 (FIG. 4F).
  • the pins 302 may include indicia 318 corresponding to a height measurement from the recipient hole 124.
  • FIG. 5 A shows another example of a tool 500 for creating a tissue graft 118 with a correct depth and cutting plane orientation for a hole 124 in a tissue defect 122.
  • the tool 500 may comprise an elongated shaft 502 having a proximal end 502a and a distal end 502b.
  • a swivel member 504 may couple to the distal end 502b such that the shaft 502 is pivotable relative to the swivel member 504.
  • a sleeve 506 may couple to an outer surface of the shaft 502 such that the sleeve 506 is slidable relative to the shaft 502. As shown in FIG.
  • the sleeve 506 may include a flange 508 comprising a plurality of tabs 510 spaced equally apart about a circumference of the flange 508.
  • the plurality of tabs 510 may be three tabs, as shown. However, the disclosure contemplates more or fewer than three tabs 510.
  • the swivel member 504 may be configured to contact the bottom surface of the hole 124 in the tissue defect 122. The user can then slide the sleeve 506 such that the flange 508 contacts the upper surface of the tissue 122 when the shaft 502 is at a selected angle with respect to the swivel member 504. The user can then lock the tool 500 into place at the selected angle.
  • the user may then insert the shaft 502, including the sleeve 506, of the tool 500 into a cannulation 513 of a guide tube 512 such that the swivel member 504 is adjacent a proximal end 512a of the guide tube 512.
  • the proximal end 512a of the guide tube 512 may define a plurality of slots 514 disposed about a surface of the guide tube 512 and configured to engage the plurality of tabs 510 on the flange 508.
  • the guide tube 512 may further include a coupling 515 on an outer surface of the guide tube 512 configured to couple to an articulated saw guide. As shown in FIG.
  • the user may contact the flange 508 with the proximal end 512a of the guide tube 512 such that the plurality of tabs 510 engage the plurality of slots 514, preventing rotation of the shaft 502 relative to the guide tube 512.
  • the user may then attach an articulated saw guide 516 to the coupling 515 of the guide tube 512 such that a slot 517 of the saw guide 516 is adjacent the swivel member 504.
  • the user may then insert a sawblade 518 through the slot 517 such that the sawblade 518 is flush with a proximal face of the swivel member 504.
  • the user may then remove the sawblade 518 and lock the saw guide 516 into place at the selected angle created by contacting the sawblade 518 with the swivel member 504. For example, the user may lock the saw guide into place with a lockable knob 519. The user may then remove the tool 500 from the guide tube 512.
  • the user may then invert the guide tube 512 in a second orientation and extend a trephine or other coring instrument 520 through the cannulation 513 into healthy tissue 122 to cut the tissue graft 118 axially.
  • the user may then reattach the locked saw guide 516 to the guide tube 512 in the inverted position and remove the coring instrument 520.
  • the user may then extend the saw blade 518 through the slot 517 in the saw guide 516 to cut the graft 118 at the correct depth and selected angle corresponding to the hole 124.
  • the user may then insert the tissue graft 118 into the hole 124 and confirm proper fit of the graft 118 with the surrounding cartilage tissue 122.
  • FIG. 6A shows another example of a graft cutting assembly 600 of this disclosure for axial cutting of a tissue graft.
  • the graft cutting assembly 600 may generally comprise a guide tube 602, a dialing member 604, and a memory member 606.
  • any of the guide tube 602, the dialing member 604, and the memory member 606 can either be reusable or disposable.
  • the guide tube 602 may have a proximal end 602a and a distal end 602b. The distal end 602b may be configured to contact a tissue graft.
  • An outer surface of the guide tube 602 may further comprise a first coupling member 603 for attaching the guide tube 602 to the memory member 606.
  • the dialing member 604 may include a first portion 604a and a second portion 604b.
  • the first portion 604a may be identical in size and shape to the guide tube 602.
  • An outer surface of the first portion 604a may also comprise a second coupling member 605 for attaching the dialing member 604 to the memory member 606.
  • the second portion 604b may comprise a cutting plane 610 and a plurality of first rods 618 (for example, three as shown) slidably received within a plurality of dialing knobs 608 for raising a lowering a height of the first portion 604a relative to the cutting plane 610, as well as changing an angle of the first portion 604a relative to the cutting plane 610.
  • Springs 616 disposed around the first rods 618 may be constantly under tension to separate the first portion 604a relative to the cutting plane 610.
  • An upper surface of the first portion 604a may include a marking to indicate a north or 12 o’clock position (not shown) corresponding to one of the rods 618. Thus, if heights of the recipient hole 124 are measured at 4, 8 and 12 o’clock positions, those heights measurements may be transferred to one of each of the three rods 618.
  • the memory member 606 may have a first region 606a adjustable relative to a second region 606b by means of second rods 624.
  • the dialing member 604 When coupled to the memory member 606, the dialing member 604 may be configured to transfer the height and orientation measurements of the dialing member 604 to the memory member 606, as further described below.
  • the memory member 606 may include a cutting slot 612 for passage of a cutting device.
  • the cutting slot 612 may be in a same plane as the cutting plane 610.
  • FIGS. 6B-6I illustrate a method of cutting a tissue graft using the tissue cutting assembly 600 of FIG. 6 A.
  • the user may initially couple the dialing member 604 to the memory member 606 (for example, with bolts or nuts 622).
  • the user may then apply these height measurements to separate ones of the dialing knobs 608 by using the measurement marks 620 on dialing knobs 608 to raise or lower the first rods 618, thus raising or lowering and angling the first portion 604a of the dialing member 604 relative to the cutting plane 610.
  • the height and orientation of the first portion 604a of the dialing member 604 relative to the cutting plane 610 may be transferred to the first region 606a of the memory member 606 as the first region 606a moves relative to the second region 606b along the second rods 624.
  • a locking mechanism 614 may couple to the second rods 624 of the memory member 606 (shown in transparent view in FIG. 6F for ease of illustration) to lock the height and orientation of the memory member 606 into place.
  • FIG. 6G once the height and orientation of the first portion 604a of the dialing member 604 are transferred to the memory member 606, the user may then decouple the dialing member 604 from the memory member 606. As shown in FIG.
  • the user may then assemble the memory member 606 to the guide tube 602 in contact with the tissue graft 118 and lock the memory member 606 to the guide tube 602 using, for example, nuts or bolts 423.
  • the user may then insert a cutting device, such as a sagittal saw (not shown) through the cutting slot 612 to make an axial cut through the graft 118 at the correct height and orientation.
  • FIGS. 7A-C illustrate a method of providing a single measurement at the center of the hole 124.
  • the method may create a cut plane on the bottom of the graft 118 orthogonal to the axis of the graft 118 itself rather than angled to match the receiving geometry of the hole 124.
  • a 360-degree v-groove 702 may be machined into the walls of the graft 118 midway along the height of the graft 118. This may create a “tilt” mechanism to allow for the bottom of the graft 118 to tilt once it is placed at the bottom of the hole 124.
  • the disclosure also contemplates that a flexible pin or guidewire with a universal joint could be inserted through the graft 118 to allow for more stability.
  • the disclosure also contemplates that, using the pin or guidewire, the graft 118 could be segmented into two pieces at the v-groove 702 to allow for greater flexibility of the tilt of the graft 118.
  • the method provides for a faster and more accurate procedure with fewer tools required, and which retains the full-length graft 118 that contacts the bottom of the hole 124.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Transplantation (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Cardiology (AREA)
  • Vascular Medicine (AREA)
  • Dentistry (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Surgical Instruments (AREA)

Abstract

Un ensemble de coupe de greffon comprend un outil de mesure de profondeur (100) ayant une pluralité de chevilles coulissantes (106) pour entrer en contact avec la surface inférieure d'un trou (124) d'un défaut de tissu. Une fois que l'utilisateur règle une hauteur des chevilles sur la base de la hauteur du trou, l'utilisateur accouple l'outil à une plaque (204) d'un guide de coupe de greffon (200). La plaque du guide est conçue pour être inclinée sur la base de la hauteur des chevilles. Un greffon de tissu (118) prélevé est placé à l'intérieur du guide et une scie (216) est étendue le long d'un plan de coupe (206) pour couper le greffon de tissu à l'angle défini.
PCT/US2022/051748 2021-12-03 2022-12-03 Dispositifs et procédés de préparation de greffon de tissu WO2023102247A1 (fr)

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US202163285695P 2021-12-03 2021-12-03
US63/285,695 2021-12-03
US202263390833P 2022-07-20 2022-07-20
US63/390,833 2022-07-20

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CA2258281A1 (fr) * 1997-04-25 1998-11-05 Sulzer Orthopadie Ag Dispositif pour realiser des trous endochondraux et osteochondraux
US8162967B1 (en) * 2003-10-16 2012-04-24 Biomet Sports Medicine Llc Method and apparatus for coring and reaming of bone
EP2564792A1 (fr) * 2011-09-02 2013-03-06 Episurf Medical AB Kit chirurgical modulaire pour la réparation de cartilages
US20180110531A1 (en) * 2016-10-23 2018-04-26 Mis Ip Holdings Llc System and method for harvesting bone graft

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CA2258281A1 (fr) * 1997-04-25 1998-11-05 Sulzer Orthopadie Ag Dispositif pour realiser des trous endochondraux et osteochondraux
US8162967B1 (en) * 2003-10-16 2012-04-24 Biomet Sports Medicine Llc Method and apparatus for coring and reaming of bone
EP2564792A1 (fr) * 2011-09-02 2013-03-06 Episurf Medical AB Kit chirurgical modulaire pour la réparation de cartilages
US20180110531A1 (en) * 2016-10-23 2018-04-26 Mis Ip Holdings Llc System and method for harvesting bone graft

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