WO2024091382A1 - Prothèses multi-éléments pour structure osseuse - Google Patents

Prothèses multi-éléments pour structure osseuse Download PDF

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Publication number
WO2024091382A1
WO2024091382A1 PCT/US2023/034825 US2023034825W WO2024091382A1 WO 2024091382 A1 WO2024091382 A1 WO 2024091382A1 US 2023034825 W US2023034825 W US 2023034825W WO 2024091382 A1 WO2024091382 A1 WO 2024091382A1
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WIPO (PCT)
Prior art keywords
joint
dysfunctional
bone structure
elongated member
bone
Prior art date
Application number
PCT/US2023/034825
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English (en)
Inventor
Richard S. Ginn
Richard Brown
Original Assignee
Tenon Medical, 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
Priority claimed from US17/972,785 external-priority patent/US20230037755A1/en
Application filed by Tenon Medical, Inc. filed Critical Tenon Medical, Inc.
Publication of WO2024091382A1 publication Critical patent/WO2024091382A1/fr

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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
    • A61B17/16—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
    • A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
    • A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
    • 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8685—Pins or screws or threaded wires; nuts therefor comprising multiple separate parts
    • 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
    • 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
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B2017/8655—Pins or screws or threaded wires; nuts therefor with special features for locking in the bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/101—Computer-aided simulation of surgical operations
    • A61B2034/105—Modelling of the patient, e.g. for ligaments or bones
    • 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
    • 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
    • A61F2/30988—Other joints not covered by any of the groups A61F2/32 - A61F2/4425
    • A61F2002/30995—Other joints not covered by any of the groups A61F2/32 - A61F2/4425 for sacro-iliac joints

Definitions

  • the present invention relates to systems, apparatus and methods for treating dysfunctional bone structures. More particularly, the present invention relates to systems, apparatus and methods for treating dysfunctional sacroiliac (SI) joints and structures proximate thereto.
  • SI sacroiliac
  • the sacroiliac (SI) joint 6 comprises a diarthrodial synovial joint, which, as illustrated in Fig. 1A, is defined by the interface between the articular surfaces of the sacrum 2 and the ilium 4.
  • the SI joint 6 is defined by (and, hence, comprises) portions of the sacrum 2 and ilium 4.
  • the SI joint 6 generally comprises the shape of an inverted capital letter “L” (denoted “13”) lying on its side (rather than a triangle), where the long arm of the inverted “L” 15 (i.e., SI joint 6) is oriented along the posterior wall of the pelvis 11 (denoted “25” in Fig. 1 A) and is also oriented relatively straight through its entire course.
  • the sacral floor (denoted “21” in Fig. 1C), which is defined by the region between the anterior sacral promontory 19a and the apex 19b of the sacrum 2, generally slopes downward and laterally at an approximately 30% grade relative to the cephalocaudal axis 27.
  • the short arm of the inverted “L” (denoted “17”) is generally oriented parallel to the transverse plane of the L5-S1 lumbosacral joint and limited superiorly by the sacral ala (denoted “23” in Fig. 1C).
  • the SI joint further comprises a SI joint dorsal recess or gap 7 that is disposed between the sacrum 2 and ilium 4 proximate the S2 segment region of the sacrum 2, as illustrated in Fig. ID.
  • the SI joint further comprises articular cartilage, i.e., hyaline and fibrocartilage, and a strong, extensive ligamentous architecture, which stabilizes the SI joint.
  • articular cartilage i.e., hyaline and fibrocartilage
  • a strong, extensive ligamentous architecture which stabilizes the SI joint.
  • the articular surfaces of the sacrum 2 and the ilium 4 that define the SI joint 6 comprise cortical bone 8, which is more compact, dense and hard relative to softer trabecular bone 10, which, as further illustrated in Fig. 1 A, is disposed in the interior regions of the sacrum and ilium 2, 4.
  • the SI Joint is distinguished from other synovial joints by the atypical articulation of the different articular surfaces of the sacrum and ilium; the articular surface of the sacrum comprising hyaline cartilage and the articular surface of the ilium comprising substantially stronger fibrocartilage.
  • the primary plane of motion of the SI joint is anterior-posterior along a transverse axis.
  • the terms often employed to describe the relative motion of the sacrum and ilium are nutation, which refers to anterior-inferior movement of the sacrum while the coccyx (denoted “3” in Fig. 1A) moves posteriorly relative to the ilium, and counternutation, which refers to posterior-superior movement of the sacrum while the coccyx moves anteriorly relative to the ilium.
  • the SI joint range of motion in flexion-extension is approximately 3°, approximately 1.5° in axial rotation, and approximately 0.8° in lateral bending.
  • the SI joint performs several seminal biomechanical functions.
  • the primary functions of the SI joint are to attenuate loads exerted on the upper body and to distribute the loads to the lower extremities.
  • the SI joint also functions as a shock absorber for loads exerted on spine.
  • SI joint dysfunction is estimated to be the primary cause of lower back pain in 15-30% of subjects afflicted with such pain.
  • lower back pain associated with SI joint dysfunction is suspected to be far more common than most healthcare providers realize, since such pain is often associated with other skeletal and musculoskeletal dysfunctions.
  • SI joint dysfunction and pain associated therewith, can be caused by various SI joint abnormalities and/or disorders, including traumatic fracture dislocation of the pelvis, degenerative arthritis, sacroiliitis, i.e., an inflammation or degenerative condition of the sacroiliac joint; osteitis condensans ilii, and other degenerative conditions of the SI joint structures and associated structures.
  • SI joint abnormalities and/or disorders including traumatic fracture dislocation of the pelvis, degenerative arthritis, sacroiliitis, i.e., an inflammation or degenerative condition of the sacroiliac joint; osteitis condensans ilii, and other degenerative conditions of the SI joint structures and associated structures.
  • SI joint stabilization i.e., reinforcing or modulating articulation by and between the sacrum and ilium, via surgical intervention.
  • SI joint stabilization typically comprises surgical placement of a bone structure prosthesis proximate to or in a dysfunctional SI joint and is generally characterized by the direction of access to the dysfunctional SI joint, e.g., lateral.
  • a major disadvantage associated with many conventional SI joint stabilization surgical methods is that the surgeon is required to make a substantial incision in and through the skin and tissues of a subject to access the dysfunctional SI joint.
  • open surgery these surgical methods have the attendant disadvantages of requiring general anesthesia and often involve increased operative time, pain, hospitalization, and recovery time due to the extensive soft tissue damage.
  • post-surgical complication associated with open surgery methods, such as nosocomial infection.
  • a major disadvantage associated with many conventional minimally-invasive SI joint stabilization methods is that such methods are difficult to perform and the associated surgical systems often require extensive, system-specific surgical training and experience. Indeed, it has been found that, notwithstanding the level of surgical training and experience that a surgeon may possess, when such conventional minimally-invasive SI joint stabilization systems and methods are employed, there is still a substantial incidence of damage to the lumbosacral neurovascular structures proximate to the SI joint.
  • a further disadvantage associated with many conventional minimally-invasive SI joint stabilization systems and methods is that they comprise anterior or lateral approaches to the dysfunctional SI joint and, hence, muscles, e.g., gluteal aponeurotic fascia and gluteus maxims, and ligaments are typically disrupted, and nerves and blood vessels are susceptible to damage during placement of a bone structure prosthesis in a dysfunctional SI joint.
  • muscles e.g., gluteal aponeurotic fascia and gluteus maxims, and ligaments are typically disrupted, and nerves and blood vessels are susceptible to damage during placement of a bone structure prosthesis in a dysfunctional SI joint.
  • the present invention is directed to systems, apparatus and methods for treating dysfunctional SI joints.
  • the multi-member bone structure prosthesis comprises a first elongated member, a second elongated member and an osteotome member, the first elongated member adapted to be advanced into the sacrum bone structure of the dysfunctional SI joint in a first posterior trajectory, the first elongated member comprising a first exterior rail section, the second elongated member adapted to be advanced into the ilium bone structure of the dysfunctional SI joint in the first posterior trajectory, the second elongated member comprising a second exterior rail section, the osteotome member configured and adapted to be advanced into the intraarticular region of the dysfunctional SI joint in the first posterior trajectory, whereby the osteotome member transverses the sacrum bone structure, the intraarticular region and the ilium bone structure of the dysfunctional SI joint, the osteotome member comprising a first rail slot configured and adapted to slidably receive the first exterior rail section of the first elongated member and a second rail slot configured and adapted to slidably receive the second
  • the first posterior trajectory advancement of the first and second elongated members and osteotome member comprises an inferiorposterior trajectory.
  • the first elongated member comprises a first internal lumen that extends from a proximal end to a distal end of the first elongated member
  • the second elongated member comprises a second internal lumen that extends from a proximal end to a distal end of the second elongated member.
  • the first and second internal lumens are adapted to receive an osteogenic composition therein.
  • the osteogenic composition comprises a bone material selected from the group consisting of demineralized bone matrix, autograft bone material, allograft bone material and xenograft bone material.
  • the osteogenic composition comprises a bone morphogenic protein (BMP) selected from the group consisting of BMP-1, BMP2a, BMP2b, BMP3, BMP4, BMP5, BMP6, BMP7 and BMP8a.
  • BMP bone morphogenic protein
  • the first and second members further comprise a plurality of slots in communication with the first and second internal lumens, the plurality of slots configured and adapted to allow the osteogenic composition, when disposed in the first and second internal lumens, to be dispersed out of the first and second internal lumens and delivered to a dysfunctional SI joint when the multi-member bone structure prosthesis is disposed therein.
  • the distal ends of the first and second elongated members comprise tapered regions.
  • FIGURE 1A is a schematic illustration of a human pelvic region from an anteroposterior (AP) perspective showing the SI joints thereof;
  • FIGURE IB is another schematic illustration of a human pelvic region from a posterior perspective showing the adjoining sacrum and ilium bone structures, and ligamentous structures thereof;
  • FIGURE 1C is a schematic illustration of the sacrum and coccyx from a lateral perspective showing the sacral promontory and the articular surface of sacrum;
  • FIGURE ID is another schematic illustration of a human pelvic region from an inferior-posterior perspective showing the adjoining sacrum and ilium bone structures of an SI joint, and an SI joint dorsal recess between the sacrum and ilium bone structures;
  • FIGURE IE is an illustration of a SI joint from a superior perspective showing the adjoining sacrum and ilium articular surfaces
  • FIGURE IF is another illustration of a SI joint from a posterior perspective showing the adjoining sacrum and ilium articular surfaces
  • FIGURE 1G is a further illustration of the SI joint shown in FIGURE IF illustrating lateral and posterior approaches to the SI joint, in accordance with the invention
  • FIGURE 2A is a perspective view of one embodiment of a single-member bone structure prosthesis, in accordance with the invention.
  • FIGURE 2B is a further perspective view of the single-member prosthesis shown in FIGURE 2A, in accordance with the invention.
  • FIGURE 2C is a rear plan view of the single-member prosthesis shown in FIGURE 2A, in accordance with the invention.
  • FIGURE 2D is a front plan view of the single-member prosthesis shown in FIGURE 2A, in accordance with the invention.
  • FIGURE 2E is a right-side plan view of the single-member prosthesis shown in FIGURE 2A, in accordance with the invention;
  • FIGURE 2F is a right-side sectional plan view of the single-member prosthesis shown in FIGURE 2A, in accordance with the invention.
  • FIGURE 3A is a front plan view of one embodiment of a multi-member bone structure prosthesis, in accordance with the invention.
  • FIGURE 3B is a top perspective view of the multi-member prosthesis shown in FIGURE 3A, in accordance with the invention.
  • FIGURE 3C is a further front plan view of the multi-member prosthesis shown in FIGURE 3A illustrating the first and second elongated members of the prosthesis partially secured to the central member, in accordance with the invention
  • FIGURE 3D is a perspective view of the right-side elongated member of the multimember prosthesis shown in FIGURE 3A, in accordance with the invention.
  • FIGURES 3E, 3F and 3G are perspective views of the central member of the multimember prosthesis shown in FIGURE 3A, in accordance with the invention.
  • FIGURE 3H is a side plan view of one embodiment of a threaded elongated member that can be employed with the multi-member prosthesis shown in FIGURE 3A, in accordance with the invention
  • FIGURE 31 is a side plan view of another embodiment of a threaded elongated member that can be employed with the multi-member prosthesis shown in FIGURE 3 A, in accordance with the invention.
  • FIGURE 3 J is a side plan view of the threaded elongated member shown in FIGURE
  • FIGURE 3K is a side plan view of yet another embodiment of a threaded elongated member that can be employed with the multi-member prosthesis shown in FIGURE 3 A, in accordance with the invention
  • FIGURE 3L is a side plan view of the threaded elongated member shown in FIGURE 3K in a post-deployment configuration, in accordance with the invention
  • FIGURE 3M is a side plan view of a non-threaded elongated member, i.e., pin, that can be employed with the multi-member prosthesis shown in FIGURE 3A, in accordance with the invention
  • FIGURE 4A is a front plan view of another embodiment of a multi-member bone structure prosthesis, in accordance with the invention.
  • FIGURE 4B is a top plan view of the right-side elongated member of the multimember prosthesis shown in FIGURE 4A, in accordance with the invention.
  • FIGURE 4C is a top perspective view of the multi-member prosthesis shown in FIGURE 4A, in accordance with the invention.
  • FIGURE 4D is a further front plan view of the multi-member prosthesis shown in FIGURE 4A illustrating the elongated members partially engaged to the central member, in accordance with the invention
  • FIGURE 4E is a perspective view of the left-side elongated member of the multimember prosthesis shown in FIGURE 4A, in accordance with the invention.
  • FIGURES 4F and 4G are perspective views of the central member of the multimember prosthesis shown in FIGURE 4A, in accordance with the invention.
  • FIGURE 5A is a front perspective view of another embodiment of a multi-member bone structure prosthesis, in accordance with the invention.
  • FIGURE 5B is a top plan view of the multi-member prosthesis shown in FIGURE 5A, in accordance with the invention.
  • FIGURE 5C is a front plan view of a bone structure engagement member or rod, in accordance with the invention.
  • FIGURES 5D and 5E are perspective views of the bone structure engagement member shown in FIGURE 5C, in accordance with the invention.
  • FIGURES 6A and 6B are illustrations of pilot SI joint openings that can be created with the drill guide shown in FIGURE 7A, in accordance with the invention
  • FIGURE 7A is an exploded perspective view of a drill guide, in accordance with the invention.
  • FIGURE 7B is further perspective view of the drill guide shown in FIGURE 7A in an assembled configuration, in accordance with the invention.
  • FIGURE 7C is a top plan view of the drill guide base shown in FIGURE 7A, in accordance with the invention.
  • FIGURE 7D is a front plan view of the drill guide base shown in FIGURE 7A, in accordance with the invention.
  • FIGURES 7E and 7F are perspective views of the drill guide insert shown in FIGURE 7A.
  • ranges can be expressed herein as from “about” or “approximately” one particular value, and/or to “about” or “approximately” another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value. Similarly, when values are expressed as approximations, by use of the antecedent “about” or “approximately”, it will be understood that the particular value forms another embodiment. It will be further understood that the endpoints of each of the ranges are significant both in relation to the other endpoint, and independently of the other endpoint.
  • bone and “bone structure” are used interchangeably herein, and mean and include any skeletal member or structure that comprises osseous tissue.
  • the terms “bone” and “bone structure” thus mean and include complete and partial skeletal members or bone structures, including articulating and non-articulating bone structures, (e.g., vertebrae, sacrum, ilium, femur, etc.) and portions thereof.
  • sacroiliac joint As used interchangeably herein, and mean and include any region proximate to articulating regions of the sacrum and ilium bone structures and, hence, a junction between and defined by sacrum and ilium bone structures.
  • the terms “sacroiliac joint” and “SI joint” thus mean and include a “bone” and “bone structure”.
  • the term “dysfunctional” as used in connection with a bone structure means and includes a physiological abnormality, disorder or impairment of a bone structure.
  • the term “dysfunctional” as used in connection with a SI joint thus means and includes, without limitation, a traumatic fracture dislocation of the pelvis, degenerative arthritis, sacroiliitis, i.e., an inflammation or degenerative condition of the SI joint; osteitis condensans ilii, and other degenerative conditions of SI joint bone structures.
  • fusion and “arthrodesis” are used interchangeably herein in connection with bone structures, and mean and include partial or complete immobilization of adjacent bone structures.
  • stabilization means and includes reinforcing bone structures or sections thereof, e.g., modulating motion of adjacent articular bone structures; particularly, the sacrum and ilium bone structures.
  • stabilization thus, in some instances, means and includes fusion and arthrodesis of adjacent bone structures.
  • prosthesis as used herein in connection with bone structures, means and includes a system or apparatus configured and adapted to stabilize bone structures.
  • prosthesis thus includes a system or apparatus adapted to modulate motion of articulating bone structures; particularly, sacrum and ilium bone structures.
  • inferior-posterior as used herein in connection with the trajectory of a single-member and multi-member bone structure prosthesis of the invention to a SI joint, means a posterior trajectory to a SI joint through the axial and sagittal planes of the ilium and sacrum bone structures and lower than the dorsal recess of the joint.
  • the term “transfixed”, as used herein in connection with the single-member and multi-member bone structure prostheses of the invention, means engagement of the bone structure prostheses to the ilium and sacrum bone structures, and the interface or joint therebetween.
  • biodegradable means the ability of a material; particularly, a polymer or adhesive, to breakdown and be absorbed within the physiological environment of a SI joint and/or a structure associated therewith, including sacrum and ilium bone structures, by one or more physical, chemical, or cellular processes.
  • Biodegradable polymers thus include, without limitation, polylactide polymers (PLA), copolymers of lactic and glycolic acids, including poly(lactic-co- glycolic) acid (PLGA) and poly(s-caprolactone-co-L-lactic) acid (PCL-LA); glycine/PLA copolymers, polyethylene oxide (PEO)/PLA block copolymers, acetylated polyvinyl alcohol (PVA)Zpolycaprolactone copolymers, poly(glycerol sebacate) (PGS) and its derivatives, including poly(glycerol-co-sebacate acrylate) (PGSA); poly(polyol sebacate) (PPS), poly(xylitol sebacate) (PXS), poly(xylitol glutamate sebacate) (PXGS), hydroxybutyrate-hydroxyvalerate copolymers, polyesters such as, but not limited to, aspartic acid (PLGA) and poly(s
  • Biodegradable adhesives thus include, without limitation, poly(glycerol-co-sebacate acrylate) (PGSA), poly(L-glutamic acid)-based compositions, poly(y- glutamic acid)-based compositions, poly(alkyl cyano acrylate)-based compositions, polyacrylic acid-based compositions, including polyacrylic acid crosslinked with pentaerythritol and/or allyl sucrose, polyacrylic acid crosslinked with divinyl glycol, and combinations thereof; fibrin-based compositions, collagen-based compositions, including collagen/poly(L-glutamic acid) compositions; albumin-based compositions, including BioGlue® (comprises purified bovine serum albumin (BSA) and glutaraldehyde); cyanoacrylate compositions, including butyl -2- cyanoacrylate adhesives (e.g., Indermil®, Histoacryl®, Histoacryl® Blue, and LiquiBand
  • osteoogenic composition means and includes an agent or composition that induces or modulates an osteogenic physiological or biological process, or cellular activity, e.g., induces proliferation, and/or growth and/or remodeling and/or regeneration of bone or osseous tissue.
  • osteoogenic composition thus means and includes, without limitation, the following osteogenic materials and compositions comprising same: demineralized bone matrix, autograft bone material, allograft bone material, xenograft bone material, polymethylmethacrylate, calcium-based bone material, including hydroxyapatite (HA) and tri calcium phosphate; and combinations or mixtures thereof.
  • osteogenic composition also means and includes, without limitation, the following polymer materials and compositions comprising same: poly(glycerol sebacate) (PGS), poly(glycerol-co-sebacate) acrylate (PGSA) and co-polymers, such as poly(glycerol sebacate)- co-poly(ethylene glycol) (PGS-PEG); and/or composites thereof, e.g., PGS-hydroxyapatite (HA) composites and PGS-poly(s-caprolactone) (PGS-PCL) composites.
  • PGS poly(glycerol sebacate)
  • PGSA poly(glycerol-co-sebacate) acrylate
  • co-polymers such as poly(glycerol sebacate)- co-poly(ethylene glycol) (PGS-PEG)
  • HA PGS-hydroxyapatite
  • PGS-PCL PGS-poly(s-caprolactone)
  • osteogenic composition also means and includes, without limitation, acellular extracellular matrix (ECM) derived from mammalian tissue sources.
  • ECM extracellular matrix
  • osteogenic composition thus means and includes, without limitation, acellular ECM derived from bone or osseous tissue, small intestine submucosa (SIS), epithelium of mesodermal origin, i.e., mesothelial tissue, placental tissue, omentum tissue, and combinations thereof.
  • SIS small intestine submucosa
  • biologically active agent and “biologically active composition” are used interchangeably herein, and mean and include agent or composition that induces or modulates a physiological or biological process, or cellular activity, e.g., induces proliferation, and/or growth and/or regeneration of tissue, including osseous tissue.
  • biologically active agent and “biologically active composition”, as used herein, thus include agents and compositions that can be varied in kind or amount to provide a therapeutic level effective to mediate the formation or healing of osseous tissue, cartilage and connective tissue, e.g., tendons and ligaments.
  • biologically active composition in some instances, thus means and includes an “osteogenic composition.”
  • biologically active agent and “biologically active composition” thus mean and include, without limitation, the following bone morphogenic proteins (BMPs) and compositions comprising same: BMP-1, BMP2a, BMP2b, BMP3, BMP4, BMP5, BMP6, BMP7 (also referred to as osteogenic protein 1 (OP-1)), and BMP8a.
  • BMPs bone morphogenic proteins
  • compositions comprising same: BMP-1, BMP2a, BMP2b, BMP3, BMP4, BMP5, BMP6, BMP7 (also referred to as osteogenic protein 1 (OP-1)), and BMP8a.
  • biologically active agent and “biologically active composition” also mean and include, without limitation, the following biological agents and compositions comprising same: platelet derived growth factor (PDGF), an insulin-like growth factor (IGF), including IGF-1 and IGF-2; basic fibroblast growth factor (bFGF) (also referred to as FGF2), transforming growth factor-P (TGF-0), including, TGF-
  • PDGF platelet
  • biologically active agent and “biologically active composition” also mean and include, without limitation, the following cells and compositions comprising same: bone marrow-derived progenitor cells, bone marrow stromal cells (BMSCs), osteoprogenitor cells, osteoblasts, osteocytes, osteoclasts, committed or partially committed cells from the osteogenic or chondrogenic lineage, hematopoietic stem cells, chondrocytes, chondrogenic progenitor cells (CPCs), mesenchymal stem cells (MSCs), and embryonic stem cells.
  • BMSCs bone marrow stromal cells
  • osteoprogenitor cells e.g., osteoblasts, osteocytes, osteoclasts, committed or partially committed cells from the osteogenic or chondrogenic lineage
  • hematopoietic stem cells hematopoietic stem cells
  • chondrocytes chondrocytes
  • chondrogenic progenitor cells CPCs
  • pharmacological agent and “active agent” are used interchangeably herein, and mean and include an agent, drug, compound, composition or mixture thereof, including its formulation, which provides some therapeutic, often beneficial, effect. This includes any physiologically or pharmacologically active substance (or composition comprising same) that produces a localized or systemic effect or effects in animals, including warm blooded mammals.
  • the terms “pharmacological agent” and “active agent” thus mean and include, without limitation, the following osteoinductive agents and compositions comprising same: icaritin, tumor necrosis factor alpha (TNF-a) inhibitors, including etanercept and infliximab; disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate and hydroxychloroquine; antibiotics, anti-viral agents, steroidal anti-inflammatories, non-steroidal anti-inflammatories, anti -thrombotic agents, including anti-coagulants and anti-platelet agents; and vasodilating agents.
  • TNF-a tumor necrosis factor alpha
  • DMARDs disease-modifying anti-rheumatic drugs
  • antibiotics and compositions comprising same: penicillin, carboxypenicillins, such as ticarcillin; tetracyclines, such as minocycline; gentamicin, vancomycin, ciprofloxacin, amikacin, aminoglycosides, cephalosporins, clindamycin, erythromycin, fluoroquinolones, macrolides, azolides, metronidazole, trimethoprimsulfamethoxazole, polymyxin B, oxytetracycline, tobramycin, cefazolin, and rifampin.
  • anti-inflammatory and “anti-inflammatory agent” are also used interchangeably herein, and mean and include a “pharmacological agent”, which, when a therapeutically effective amount is administered to a subject, prevents or treats bodily tissue inflammation, i.e., the protective tissue response to injury or destruction of tissues, which serves to destroy, dilute, or wall off both the injurious agent and the injured tissues.
  • a pharmaceutical agent which, when a therapeutically effective amount is administered to a subject, prevents or treats bodily tissue inflammation, i.e., the protective tissue response to injury or destruction of tissues, which serves to destroy, dilute, or wall off both the injurious agent and the injured tissues.
  • Anti-inflammatory agents thus include, without limitation, dexamethasone, betamethasone, prednisone, prednisolone, methylprednisolone sodium succinate, methylprednisolone, cortisone, ketorolac, diclofenac, and ibuprofen.
  • pharmaceutical composition means and includes a composition comprising a “pharmacological agent” and “active agent”.
  • the term “therapeutically effective”, as used herein, means that the amount of the “pharmacological agent” and/or “pharmacological composition” and/or “biologically active agent” and/or “biologically active composition” administered is of sufficient quantity to induce a physiological reaction, preferably, a positive or desirable physiological reaction in a subject.
  • the terms “patient” and “subject” are used interchangeably herein, and mean and include warm blooded mammals, humans and primates; avians; domestic household or farm animals, such as cats, dogs, sheep, goats, cattle, horses and pigs; laboratory animals, such as mice, rats and guinea pigs; fish; reptiles; zoo and wild animals; and the like.
  • substantially means and includes the complete or nearly complete extent or degree of an action, characteristic, property, state, structure, item, or result to function as indicated.
  • an object that is “substantially” enclosed would mean that the object is either completely enclosed or nearly completely enclosed.
  • the exact allowable degree of deviation from absolute completeness may in some cases depend on the specific context, such that enclosing nearly all the length of a lumen would be substantially enclosed, even if the distal end of the structure enclosing the lumen had a slit or channel formed along a portion thereof.
  • the present invention is directed to minimally-invasive systems, apparatus and methods for treating dysfunctional bone structures; particularly, dysfunctional SI joints.
  • the minimally-invasive apparatus comprise single-member bone structure prostheses, as set forth in Co-pending priority U.S. App. No. 17/833,960.
  • the minimally-invasive apparatus comprise multi-member bone structure prostheses.
  • the single-member and multi-member bone structure prostheses are configured and adapted to be delivered to dysfunctional SI joints via a posterior trajectory, more preferably, an inferior-posterior trajectory, such as illustrated in Fig. 1C and denoted by arrow “B”, to stabilize the dysfunctional SI joints.
  • SI joint stabilization typically comprises surgical placement of a bone structure prosthesis proximate to or in a dysfunctional SI joint via anterior or lateral trajectories.
  • an anterior approach to the SI joint 6 shown in Fig. 1A would be substantially perpendicular to the page upon which Fig. 1A is printed.
  • a posterior trajectory has been employed to advance a bone structure prosthesis proximate to and in a dysfunctional SI joint.
  • Fig. IE there is shown an illustration of a SI joint 6 and surrounding structures.
  • a uniform layer of cortical bone 8 is shown adjacent to a deeper layer of trabecular bone 10 on both of the depicted sacrum 2 and ilium 4 structures.
  • a uniform layer of cortical bone 8 is shown adjacent to a deeper layer of trabecular bone 10 on both of the depicted sacrum 2 and ilium 4 structures.
  • such layers are far less uniform and homogeneous.
  • Fig. IF there is shown a view of the same structure from a different posterior perspective. From the perspective of Fig. IF, a posterior approach or trajectory to the SI joint 6 (and, hence, a dysfunctional SI joint) would be substantially perpendicular to the page upon which Fig. IF is printed. Indeed, referring to Fig. 1G, a variation similar to that depicted in Fig. IE is illustrated, showing an approximate approach vector for a lateral trajectory to the SI joint 6 versus a posterior trajectory, using the orientation paradigms introduced in Figs. 1 A and 1F-1G. Such paradigms are used to illustrate various embodiments of the subject invention in various figures that follow Figs. lA and 1F-1G.
  • posterior delivery particularly, inferior-posterior delivery
  • anterior delivery of the bone structure prostheses of the invention to a dysfunctional SI joint is much less invasive. Indeed, less tissue and fewer muscles are disrupted, and nerves and large blood vessels are avoided.
  • the bone structure prostheses are also transfixed to optimal regions of cortical bone proximate a dysfunctional SI joint and, thereby, provide superior arthrodesis of the dysfunctional SI joint.
  • the single-member and multi-member bone structure prostheses of the invention are configured and adapted to be delivered to and inserted into dysfunctional SI joints via a posterior trajectory.
  • the single-member and multi-member bone structure prostheses of the invention are configured and adapted to be delivered to and inserted into dysfunctional SI joints via an inferior-posterior trajectory.
  • FIGs. 2A-2F there are shown depictions of one embodiment of a single-member bone structure prosthesis (denoted “70”) of the invention.
  • the single-member bone structure prosthesis 70 comprises a biocompatible and, hence, implantable member comprising proximal and distal ends 72, 74, and first and second elongated partially cylindrical sections or pontoons 76a, 76b connected to a bridge section 78, i.e., a transfixing osteotome bridge, whereby the single-member bone structure prosthesis 70 comprises a continuous exterior surface comprising first and second partially cylindrical surface regions 77a, 77b.
  • the first and second partially cylindrical sections 76a, 76b comprise proximal and distal ends 79a, 79b.
  • the bridge section 78 similarly comprises proximal and distal ends 81a, 81b.
  • the single-member bone structure prosthesis 70 can comprise any suitable length from the proximal ends 79a to the distal ends 79b of the partially cylindrical sections 76a, 76b.
  • the singlemember bone structure prosthesis 70 comprises a length in the range of 20 - 50 mm, more preferably, a length in the range of 30 - 40 mm.
  • the first partially cylindrical surface region 77a of the first partially cylindrical section 76a preferably comprises a partially cylindrical surface region shape that corresponds to at least a first portion of a pilot SI joint opening in the dysfunctional SI joint
  • the second partially cylindrical surface region 77b of the second partially cylindrical section 76b similarly preferably comprises a partially cylindrical surface region shape that corresponds to at least a second portion of the pilot SI joint opening in the dysfunctional SI joint.
  • the distal end 81b of the bridge section 78 preferably comprises a taper region 82, which is configured and adapted to disrupt, i.e., cut into and through, articular cartilage and cortical bone 8 (and, in some aspects, trabecular bone 10).
  • the distal ends 79b of the first and second partially cylindrical sections 76a, 76b also preferably comprise tapered regions 84a, 84b, which facilitate insertion of the first and second elongated partially cylindrical sections 76a, 76b into dysfunctional SI joints.
  • the first and second partially cylindrical sections 76a, 76b of the single-member bone structure prosthesis 70 comprise internal prosthesis engagement member lumens 86a, 86b, respectively.
  • the internal prosthesis engagement member lumens 86a, 86b comprise internal threaded regions 87 adapted to engage a prosthesis deployment assembly, which is adapted to advance the single-member bone structure prosthesis 70 to and into a dysfunctional SI joint.
  • the internal prosthesis engagement lumens 86a, 86b are also configured to receive one or more of the aforementioned biologically active agents and compositions, including osteogenic agents and compositions, and pharmacological agents and compositions that promote or induce proliferation, and/or growth and/or remodeling and/or regeneration of osseous tissue and/or facilitate osseous tissue ingrowth into the single-member bone structure prosthesis 70 when the prosthesis 70 is disposed in a dysfunctional SI joint.
  • the single-member bone structure prosthesis 70 further comprises a plurality of slots 90 and apertures 92, which preferably are in communication with the internal prosthesis engagement member lumens 86a, 86b; the first and second partially cylindrical sections 76a, 76b thus comprising hollow, fenestrated members.
  • the apertures 92 are sized and configured to allow the biologically active agent compositions and/or pharmacological agent compositions to be dispersed out of the internal prosthesis engagement member lumens 86a, 86b and delivered to a dysfunctional SI joint when the single-member bone structure prosthesis 70 is disposed therein.
  • the single-member bone structure prosthesis 70 when the single-member bone structure prosthesis 70 is disposed in a SI joint, the single-member bone structure prosthesis 70 is transfixed thereto, i.e., the first partially cylindrical section 76a is transfixed to the ilium bone structure, the second partially cylindrical section 76b is transfixed to the sacrum bone structure (or vice versa), and the bridge section 78 is transfixed to the interface between the ilium and sacrum bone structures.
  • Figs. 3A-3G there are shown depictions of one embodiment of a multi-member bone structure prosthesis (denoted “170”) of the invention.
  • the multi-member bone structure prosthesis 170 (also referred to hereinafter as a “multi-member prosthesis”), comprises a biocompatible and, hence, implantable member comprising first and second elongated members 176a, 176b and a central member 100 (also referred to herein as an “osteotome member”); the central member 100 comprising proximal and distal ends 102a, 102b.
  • the first elongated member 176a preferably comprises a cross-sectional shape that corresponds to at least a portion of the cross-sectional shape of a first portion of a pilot SI joint opening in the dysfunctional SI joint, such as the sacrum portion 1003 of the pilot SI joint opening 1000 shown in Figs. 6A and 6B
  • the second elongated member 176b similarly preferably comprises a cross-sectional shape that corresponds to at least a portion of the cross-sectional shape of a second portion of the pilot SI joint opening in the dysfunctional SI joint, such as the ilium portion 1004 of the pilot SI joint opening 1000.
  • the first and second elongated members 176a, 176b comprise proximal and distal ends 179a, 179b.
  • the first elongated member 176a comprises a first elongated member internal lumen 186a and the second elongated member 176b similarly comprises a second elongated member internal lumen 186b.
  • the distal ends 179b of the first and second elongated members 176a, 176b comprise closed distal ends, whereby the first and second elongated member internal lumens 186a, 186b do not extend through the distal ends 179b of the first and second elongated members 176a, 176b.
  • the first and second elongated member internal lumens 186a, 186b are configured to receive agents and compositions that facilitate adhesion of the first and second elongated members 176a, 176b and, hence, multi -member bone structure prosthesis 170 to and, hence, in dysfunctional SI joints.
  • agents and compositions are set forth in in Co-pending U.S. App. No. 17/463,831, which is incorporated by reference herein.
  • the first and second elongated member internal lumens 186a, 186b are also configured to receive one or more the aforementioned biologically active agents and compositions, including osteogenic agents and compositions, and pharmacological agents and compositions that promote or induce proliferation, and/or growth and/or remodeling and/or regeneration of osseous tissue and/or facilitate osseous tissue ingrowth into the multimember bone structure prosthesis 170 when the prosthesis 170 is disposed in a dysfunctional SI joint.
  • the aforementioned biologically active agents and compositions including osteogenic agents and compositions, and pharmacological agents and compositions that promote or induce proliferation, and/or growth and/or remodeling and/or regeneration of osseous tissue and/or facilitate osseous tissue ingrowth into the multimember bone structure prosthesis 170 when the prosthesis 170 is disposed in a dysfunctional SI joint.
  • the first and second elongated members 176a, 176b further comprise a plurality of slots 190, 194 and apertures 192, which preferably are in communication with the first and second elongated member internal lumens 186a, 186b; the first and second elongated members 176a, 176b thus similarly comprising hollow, fenestrated members.
  • the slots 190, 194 and apertures 192 are sized and configured to allow the adhesive compositions and/or biologically active agent compositions and/or pharmacological agent compositions to be dispersed out of the first and second elongated member internal lumens 186a, 186b and delivered to a dysfunctional SI joint when the multimember prosthesis 170 is disposed therein.
  • slots 194 are preferably aligned with slots 109 of the central member 100 to facilitate osseous tissue ingrowth into the multi-member prosthesis 170 when the prosthesis 170 is disposed in a dysfunctional SI joint.
  • the first and second elongated member internal lumens 186a, 186b comprise internal threads (shown in phantom and denoted “177” in Fig. 3D) proximate the proximal ends 179a, such as internal prosthesis engagement member lumens 86a, 86b of the single-member bone structure prosthesis 70 shown in Figs. 2E and 2F, to cooperate with a prosthesis deployment instrument that is adapted to advance the first and second elongated members 176a, 176b to and into a bone structure; particularly, bone structures that define a dysfunctional SI joint.
  • the central member 100 comprises elongated member securing means that is sized and configured to releasably receive and secure the first and second elongated members 176a, 176b to the central member 100, as illustrated in Figs. 3A and 3C.
  • the elongated member securing means comprises first and second open regions 105a, 105b, comprising openings 110 that are sized and configured to releasably receive and allow the first and second elongated members 176a, 176b to slidably translate therethrough.
  • the openings 110 in the first and second open regions 105a, 105b have a shape that substantially corresponds to the cross-sectional shape of the first and second elongated members 176a, 176b.
  • the elongated member securing means can comprise additional open regions to further stabilize the first and second elongated members 176a, 176b, when received by the elongated member securing means.
  • the elongated member securing means comprises third and fourth open regions 105c, 105d, as shown in phantom in Fig. 3G.
  • the central member 100 of the multi -member bone structure prosthesis 170 further comprises opposing first and second concave seat regions 104a, 104b that are configured to seat the first and second elongated members 176a, 176b, as illustrated in Fig. 3A.
  • the distal end 102b of the central member 100 comprises a taper region 103, which is configured and adapted to disrupt, i.e., cut into and through, articular cartilage and cortical bone 8 (and, in some aspects, trabecular bone 10), which define a SI joint.
  • the central member 100 of the multi-member prosthesis 170 further comprises a guidewire lumen 106 extending from the proximal end 102a to the distal end 102b of the central member 100, which is sized and configured to receive an elongated guide pin or wire, such as the elongated guide pin described in Co-pending U.S. App. No. 17/833,960, therein.
  • the distal ends 179b of the first and second elongated members 176a, 176b also preferably comprise tapered regions 184a, 184b, respectively, which facilitate insertion of the distal ends 179b of the first and second elongated members 176a, 176b into pilot SI joint openings and, thereby dysfunctional SI joints.
  • the first and second elongated members 176a, 176b can comprise any suitable length to accommodate placement of the multi-member bone structure prosthesis 170 in various SI joints and other bone structures.
  • the first and second elongated members 176a, 176b comprise a length less than 50 mm.
  • the first and second elongated members 176a, 176b comprise a length in the range of 20 - 50 mm.
  • the first and second elongated members 176a, 176b can also comprise different or offset lengths.
  • the first elongated member 176a can thus comprise a length of 30 mm and the second elongated member 176b can comprise a length of 40 mm.
  • the first and second elongated members 176a, 176b can also comprise any suitable outer diameter (or cross-sectional area) to accommodate advancement of first and second elongated members 176a, 176b into various sizes of pilot SI joint openings.
  • the first and second elongated members 176a, 176b comprise an outer diameter in the range of approximately 5.0 - 20.0 mm (or cross-sectional area in the range o -19.63 - 314.16 mm 2 ).
  • the first and second elongated members 176a, 176b can comprise any suitable shape and configuration.
  • the first and second elongated members 176a, 176b comprise a substantially cylindrical shape.
  • the first and second elongated members 176a, 176b can also comprise threaded members and mechanisms.
  • Exemplar threaded members and mechanisms include, without limitation, the threaded elongated member 150a illustrated in Fig. 3H, comprising a threaded distal end, the threaded elongated member 150b illustrated in Figs. 31 and 3 J, comprising a molly bolt mechanism;
  • Fig. 31 illustrating the elongated member 150b in a pre-deployment configuration and
  • Fig. 3 J illustrating the elongated member 150b in a postdeployment configuration, and the threaded elongated member 150c, comprising an anchor bolt mechanism, illustrated in Figs. 3K and 3L;
  • Fig. 3K illustrating the elongated member 150c in a pre-deployment configuration and
  • Fig. 3L illustrating the elongated member 150c in a postdeployment configuration, and like members and mechanisms.
  • the first and second elongated members 176a, 176b can also comprise a simple pin configuration, such as pin 160 shown in Fig. 3M.
  • the above referenced alternative elongated members can similarly comprise hollow, fenestrated structures, i.e., comprise apertures and/or slots and internal lumens; the internal lumens preferably adapted to receive and contain adhesive compositions and/or biologically active agent compositions and/or pharmacological agent compositions of the invention therein.
  • one or both of the first and second elongated members 176a, 176b can further comprise one of the bone stabilizing prostheses described in Applicant’s Co-pending U.S. App. No. 17/834,392, which is incorporated by reference herein in its entirety, and/or one of the multi -function bone structure prostheses described in Applicant’s Co-pending U.S. App. No. 17/903,310, which is also incorporated by reference herein in its entirety.
  • the cross-sectional areas of the elongated members 176a, 176b are at least 0.05% greater than the cross-sectional areas defined by the sacrum and ilium portions of the pilot SI joint opening, e.g., sacrum and ilium portions 1003, 1004 of pilot SI joint opening 1000.
  • the central member 100 of the multi-member bone structure prosthesis 170 can similarly comprise any suitable length to accommodate placement of the prosthesis 170 in various SI joints and other bone structures.
  • the length of the central member 100 is at least 50%, more preferably, at least 70% of the length of the first and/or second elongated members 176a, 176b.
  • the central member 100 can also comprise any suitable width to accommodate placement of the central member 100 in various SI joints and other bone structures.
  • the central member 100 comprises a width (denoted “wi” in Fig. 3F) from the first concave seat region 104a to the second concave seat region 104b in the range of approximately 4.5 - 30 mm.
  • the multi-member bone structure prosthesis 170 is transfixed thereto, i.e., the first elongated member 176a is transfixed to the ilium bone structure, the second elongated member 176b is transfixed to the sacrum bone structure (or vice versa), and the central member 100 is transfixed to the interface between the ilium and sacrum bone structures.
  • FIGs. 4A-4G there are shown depictions of another embodiment of a multi-member bone structure prosthesis (denoted “270”) of the invention.
  • the multi-member bone structure prosthesis 270 (also similarly referred to hereinafter as a “multi-member prosthesis”), comprises a biocompatible and, hence, implantable member comprising first and second elongated members 276a, 276b and a central member 200 (also referred to herein as an “osteotome member”); the first and second elongated members 276a, 276b comprising proximal and distal ends 279a, 279b and the central member 200 comprising proximal and distal ends 202a, 202b.
  • the first elongated member 276a preferably comprises a cross-sectional shape that corresponds to at least a portion of the cross-sectional shape of a first portion of a pilot SI joint opening in the dysfunctional SI joint, such as the sacrum portion 1003 of the pilot SI joint opening 1000 shown in Figs. 6A and 6B
  • the second elongated member 276b similarly preferably comprises a cross-sectional shape that corresponds to at least a portion of the cross-sectional shape of a second portion of the pilot SI joint opening in the dysfunctional SI joint, such as the ilium portion 1004 of the pilot SI joint opening 1000.
  • the first and second elongated members 276a, 276b comprise rail slots or seats 225a, 225b that are sized and configured to receive the elongated member rails 224a, 224b of the central member 200 discussed below.
  • the first elongated member 276a further comprises a first elongated member internal lumen 286a and the second elongated member 276b further comprises a second elongated member internal lumen 286b.
  • the distal ends 279b of the first and second elongated members 276a, 276b similarly comprise closed distal ends, whereby the first and second elongated member internal lumens 286a, 286b do not extend through the distal ends 279b of the first and second elongated members 276a, 276b.
  • first and second elongated member internal lumens 286a, 286b are similarly configured to receive agents and compositions that facilitate adhesion of the first and second elongated members 276a, 276b and, hence, multi-member bone structure prosthesis 270 to and, hence, in dysfunctional SI joints.
  • the first and second elongated member internal lumens 286a, 286b are also similarly configured to receive one or more the aforementioned biologically active agents and compositions, including osteogenic agents and compositions, and pharmacological agents and compositions that promote or induce proliferation, and/or growth and/or remodeling and/or regeneration of osseous tissue and/or facilitate osseous tissue ingrowth into the multi-member bone structure prosthesis 270 when the prosthesis 270 is disposed in a dysfunctional SI joint.
  • biologically active agents and compositions including osteogenic agents and compositions, and pharmacological agents and compositions that promote or induce proliferation, and/or growth and/or remodeling and/or regeneration of osseous tissue and/or facilitate osseous tissue ingrowth into the multi-member bone structure prosthesis 270 when the prosthesis 270 is disposed in a dysfunctional SI joint.
  • the first and second elongated members 276a, 276b further comprise a plurality of slots 290, 294 and apertures 292, which preferably are similarly in communication with the first and second elongated member internal lumens 286a, 286b; the first and second elongated members 276a, 276b thus similarly comprising hollow, fenestrated members.
  • the slots 290, 294 and apertures 292 are similarly sized and configured to allow the adhesive compositions and/or biologically active agent compositions and/or pharmacological agent compositions to be dispersed out of the first and second elongated member internal lumens 286a, 286b and delivered to a dysfunctional SI joint when the multimember prosthesis 270 is disposed therein.
  • slots 294 are similarly preferably aligned with slots 209 of the central member 200 to facilitate osseous tissue ingrowth into the multi-member prosthesis 270 when the prosthesis 270 is disposed in a dysfunctional SI joint.
  • the first and second elongated member internal lumens 286a, 286b also comprise internal threads proximate the proximal ends 279a thereof, such as the internal prosthesis engagement member lumens 86a, 86b of the singlemember bone structure prosthesis 70 shown in Figs. 2E and 2F, to cooperate with a prosthesis deployment instrument that is adapted to advance the first and second elongated members 276a, 276b to and into a bone structure; particularly, a dysfunctional SI joint.
  • the central member 200 similarly comprises elongated member securing means sized and configured to releasably receive and secure the first and second elongated members 276a, 276b to the central member 200, as illustrated in Fig. 4A.
  • the elongated member securing means comprises first and second discontinuous rails 224a, 224b that are sized and configured to be received in the rail slots or seats 225a, 225b of the first and second elongated members 276a, 276b (discussed below), whereby the first and second elongated members 276a, 276b are secured to the central member 200.
  • the first and second discontinuous rails 224a, 224b and rail slots 225a, 225b can comprise various corresponding shapes, e.g., square, triangular, round, etc., and sizes.
  • the first and second discontinuous rails 224a, 224b and rail slots 225a, 225b comprise corresponding substantially triangular shapes.
  • the distal end 202b of the central member 200 similarly comprises a taper region 203, which is configured and adapted to disrupt, i.e., cut into and through, articular cartilage and cortical bone 8 (and, in some aspects, trabecular bone 10), which define a SI joint.
  • the central member 200 of the multi-member prosthesis 270 further comprises a guidewire lumen 201 extending from the proximal end 202a to the distal end 202b of the central member 200, which is similarly sized and configured to receive an elongated guide pin or wire, such as the elongated guide pin described in Co-pending U.S. App. No. 17/833,960, therein.
  • the distal ends 279b of the first and second elongated members 276a, 276b also preferably comprise tapered regions 284a, 284b, respectively, which facilitate insertion of the distal ends 279b of the first and second elongated members 276a, 276b into pilot SI joint openings and, thereby dysfunctional SI joints.
  • the first and second elongated members 276a, 276b can similarly comprise any suitable length to accommodate placement of the multi-member bone structure prosthesis 270 in various SI joints and other bone structures.
  • the first and second elongated members 276a, 276b similarly comprise a length less than 50 mm.
  • the first and second elongated members 276a, 276b comprise a length in the range of 20 - 50 mm.
  • the first and second elongated members 276a, 276b can also similarly comprise different or offset lengths.
  • the first elongated member 276a can thus comprise a length of 30 mm and the second elongated member 276b can comprise a length of 40 mm.
  • first and second elongated members 276a, 276b can also comprise any suitable outer diameter (or cross-sectional area) to accommodate advancement of first and second elongated members 276a, 276b into various sizes of pilot SI joint openings.
  • the first and second elongated members 276a, 276b comprise a cross-sectional area in the range of -19.63 - 314.16 mm 2 .
  • first and second elongated members 276a, 276b can similarly comprise any suitable shape and configuration.
  • the first and second elongated members 276a, 276b comprise a partially cylindrical shape.
  • first and second elongated members 276a, 276b can also similarly comprise the threaded members and mechanisms illustrated in Figs. 3H-3L, and the pin configuration and structure illustrated in Fig. 3M, and like structures.
  • the above referenced alternative elongated members can similarly comprise hollow, fenestrated structures, i.e., comprise apertures and/or slots and internal lumens; the internal lumens preferably adapted to receive and contain adhesive compositions and/or biologically active agent compositions and/or pharmacological agent compositions of the invention therein.
  • one or both of the first and second elongated members 276a, 276b can similarly additionally comprise one of the bone stabilizing prostheses described in Applicant’s Co-pending U.S. App. No. 17/834,392 and/or one of the multi -function bone structure prostheses described in Applicant’s Co-pending U.S. App. No. 17/903,310.
  • the aforementioned threaded members and mechanisms, bone stabilizing prostheses, and multi-function bone structure prostheses can also comprise at least one rail slot or seat that is sized and configured to receive the first and second discontinuous rails 224a, 224b of the central member 200.
  • the aforementioned threaded members and mechanisms, bone stabilizing prostheses, and multi-function bone structure prostheses can also comprise at least one rail slot or seat that is sized and configured to receive the first and second discontinuous rails 224a, 224b of the central member 200.
  • a pilot SI joint opening such as pilot SI joint opening 1000 illustrated in Figs.
  • the cross-sectional areas of the elongated members 276a, 276b are similarly at least 0.05% greater than the cross-sectional areas defined by the sacrum and ilium portions of the pilot SI joint opening, e g., sacrum and ilium portions 1003, 1004 of pilot SI joint opening 1000.
  • the central member 200 of the multi-member bone structure prosthesis 270 can similarly comprise any suitable length to accommodate placement of the prosthesis 270 in various SI joints and other bone structures.
  • the length of the central member 200 is similarly at least 50%, more preferably, at least 70% of the length of the first and/or second elongated members 276a, 276b.
  • the central member 200 can also similarly comprise any suitable width to accommodate placement of the central member 200 in various SI joints and other bone structures.
  • the central member 200 similarly comprises a width in the range of approximately 4.5 - 30 mm.
  • the multi-member bone structure prosthesis 270 when the first and second elongated members 276a, 276b of the multi-member bone structure prosthesis 270 are secured to the central member 200 and the multi-member bone structure prosthesis 270 is disposed in a SI joint, as described above, the multi-member bone structure prosthesis 270 is similarly transfixed thereto, i.e., the first elongated member 276a is transfixed to the ilium bone structure, the second elongated member 276b is transfixed to the sacrum bone structure (or vice versa), and the central member 200 is transfixed to the interface between the ilium and sacrum bone structures.
  • FIG. 5A there is shown a depiction of a further embodiment of the multi-member bone structure prosthesis (denoted “370”).
  • the multi-member bone structure prosthesis comprises the same basic structure and, hence, features of the single-member bone structure prosthesis 70 illustrated in Figs. 2A-2F and discussed in detail above.
  • the first and second prosthesis or pontoon sections (now denoted “376a” and “376b”) comprise open distal ends 79c, i.e., the internal lumens (now denoted “386a” and “386b”) extend therethrough.
  • the bridge section 78 also similarly comprises an internal lumen 378 that extends from the proximal end 81a to the distal end 81b that is sized and configured to receive an elongated guide pin or wire, such as the elongated guide pin described in Co-pending U.S. App. No. 17/833,960.
  • each continuous internal prosthesis engagement member lumen 386a, 386b is further sized and configured to receive a bone structure engagement member 300 of the invention, and, preferably, allow the bone structure engagement member 300 to slidably translate therethrough.
  • the bone structure engagement member 300 comprises proximal and distal ends 302a, 302b; the distal end 302b comprising a closed pointed end that facilitates advancement of the member 300 into pilot SI joint openings and directly into bone structures.
  • the bone structure engagement member 300 further comprises an internal lumen 308 and a plurality of slots 309 that are in communication with the internal lumen 308.
  • the slots 309 comprise a similar shape of the slots 90 in the first and second prosthesis sections 376a, 376b.
  • slots 309 and slots 90 are substantially aligned, whereby, when an adhesive composition and/or biologically active agent composition and/or pharmacological agent composition is disposed in the internal lumens 386a, 386b, the slots 390 and 90 allow the adhesive composition and/or biologically active agent composition and/or pharmacological agent composition to be dispersed out of the internal lumens 386a, 386b and delivered to a dysfunctional SI joint when the multi-member prosthesis 370 is disposed therein.
  • the open distal ends 79c of the first and second elongated prosthesis sections 376a, 376b preferably comprise a smaller diameter than the bone structure engagement member 300 to abate movement, i.e., linear and rotational translation, of the bone structure engagement member 300 in the internal lumens 386a, 386b.
  • the bone structure engagement members 300 can comprise any suitable length.
  • the bone structure engagement members 300 comprise a length in the range of 20 - 50 mm.
  • the bone structure engagement members 300 can similarly comprise any suitable shape and configuration.
  • the bone structure engagement members 300 comprise a substantially cylindrical shape.
  • the bone structure engagement members 300 can also similarly comprise threaded members and mechanisms similar to the threaded members and mechanisms illustrated in Figs. 3H-3L, and like structures.
  • one or both of the bone structure engagement members 300 can similarly additionally comprise a structure similar to the bone stabilizing prostheses described in Applicant’s Co-pending U.S. App. No. 17/834,392 and/or the multi-function bone structure prostheses described in Applicant’s Co-pending U.S. App. No. 17/903,310.
  • the multi-member bone structure prosthesis 370 when the multi-member bone structure prosthesis 370 is disposed in a SI joint, the multi -member bone structure prosthesis 370 is similarly transfixed thereto, i.e., the first prosthesis section 376a and a first bone structure engagement member 300 are transfixed to the ilium bone structure, the second prosthesis section 376b and a second bone structure engagement member 300 are transfixed to the sacrum bone structure (or vice versa), and the bridge section 78 is transfixed to the interface between the ilium and sacrum bone structures.
  • the single-member bone structure prosthesis 70 and multi-member bone structure prostheses 170, 270 and 370 and, hence members and components thereof can comprise various biocompatible materials, including metals and metal alloys, such as titanium, stainless-steel, cobalt-chromium alloys and nickel -titanium alloys, and various biocompatible polymers, including, without limitation, reinforced polymers, such as carbon fiber reinforced polymers and metal-framed polymers.
  • metals and metal alloys such as titanium, stainless-steel, cobalt-chromium alloys and nickel -titanium alloys
  • biocompatible polymers including, without limitation, reinforced polymers, such as carbon fiber reinforced polymers and metal-framed polymers.
  • the single-member bone structure prosthesis 70 and multi-member bone structure prostheses 170, 270 and 370 and, hence members and components thereof, can additionally comprise a porous structure to facilitate (i) bone or osseous tissue ingrowth into the singlemember prosthesis 70 and multi-member prostheses 170, 270 and 370 and (ii) adhesion of the single-member prosthesis 70 and multi-member prostheses 170, 270 and 370 in a SI joint opening and, thereby, dysfunctional SI joint.
  • the single-member bone structure prosthesis 70 and multi-member bone structure prostheses 170, 270 and 370 and, hence members and components thereof, can further comprises an outer coating.
  • the outer coating comprises one of the aforementioned osteogenic compositions.
  • the osteogenic composition comprises a demineralized bone matrix, autograft bone material, allograft bone material, xenograft bone material, polymethylmethacrylate or calcium-based bone material.
  • the osteogenic composition comprises a bone morphogenic protein (BMP).
  • BMP bone morphogenic protein
  • the BMP comprises BMP-1, BMP2a, BMP2b, BMP3, BMP4, BMP5, BMP6, BMP7, or BMP8a.
  • the outer coating comprises one of the aforementioned biologically active agents.
  • the outer coating comprises one of the aforementioned pharmacological agents.
  • the pharmacological agent comprises penicillin, a carboxypenicillin, a tetracycline, gentamicin, vancomycin, ciprofloxacin, amikacin, an aminoglycoside, a cephalosporin, clindamycin, erythromycin, a fluoroquinolone, a macrolide, an azolide, metronidazole, trimethoprim-sulfamethoxazole, polymyxin B, oxytetracycline, tobramycin, cefazolin, or rifampin.
  • the outer coating comprises a biocompatible adhesive composition.
  • Suitable adhesive compositions are set forth in priority U.S. App. No. 17/833,960, which is incorporated by reference herein.
  • the outer coating comprises one of the aforementioned polymers and/or compositions comprising same.
  • the polymer comprises poly(glycerol sebacate) (PGS) or a derivative thereof, including, without limitation, poly(glycerol-co-sebacate) acrylate (PGSA) and PGS co-polymers, such as poly(glycerol sebacate)-co-poly(ethylene glycol) (PGS-PEG); and/or composites thereof, e.g., PGS-hydroxyapatite (HA) composites and PGS- poly(s-caprolactone) (PGS-PCL) composites, and compositions comprising same.
  • PGS poly(glycerol sebacate)
  • PGS-PEG poly(glycerol-co-sebacate)
  • composites thereof e.g., PGS-hydroxyapatite (HA) composites and PGS- poly(s-caprolactone) (PGS-PCL) composites, and compositions comprising same.
  • a further seminal property of PGS is that its physical state can be modulated during synthesis by controlling the “degree of esterification” via at least one crosslinking agent, e g., methylene diphenyl diisocyanate (MDI), whereby the PGS exhibits adhesive properties.
  • at least one crosslinking agent e g., methylene diphenyl diisocyanate (MDI)
  • MDI methylene diphenyl diisocyanate
  • PGS and its derivatives are also excellent platforms for delivery and, hence, administration of biologically active agents and pharmacological agents to mammalian tissue, including osseous or bone tissue.
  • the PGS outer coatings and PGS and PGSA based compositions further comprise one or more of the aforementioned biologically active or pharmacological agents.
  • the outer coating comprises a nickel-titanium alloy coating, such as the nickel-titanium alloy (i.e., NitinolTM) coatings disclosed in U.S. Pat. Nos. 9,278,000 and 9,750,850, which are incorporated by reference herein.
  • NitinolTM nickel-titanium alloy
  • the single-member bone structure prosthesis 70 and multi-member bone structure prostheses 170, 270 and 370 are described in connection with stabilizing and, hence, treating a dysfunctional SI joint, according to the invention, the single-member bone structure prosthesis 70 and multi-member bone structure prostheses 170, 270 and 370 can also be employed to stabilize other articulating and non-articulating bone structures, including individual skeletal members.
  • the single-member bone structure prosthesis 70 and multimember bone structure prostheses 170, 270 and 370 are configured and adapted to be advanced into pilot SI joint openings, such as pilot SI joint opening 1000 illustrated in Figs. 6A and 6B, and, thereby, a dysfunctional SI joint.
  • the pilot SI joint openings can be created by various systems and means.
  • the pilot SI joint openings are created by a drill guide assembly described in priority U.S. App. No. 17/833,960.
  • pilot SI joint openings are created by the drill guide assembly illustrated in Figs. 7A-7F and discussed in detail below.
  • the drill guide assembly (also referred to herein as a “drill guide”) 500 generally comprises a drill guide base 501, a bone dislodging apparatus; preferably, drill bit 700, and a drill guide insert 600, which is shown in Figs. 7E and 7F.
  • the drill bit 700 can comprise drill bit 501a, 501b or 501c described in detail in priority U.S. App. No. 17/833,960.
  • the drill guide base 501 comprises a proximal or top planar region 515, and proximal and distal ends 521a, 521b.
  • the drill guide base 501 further comprises two (2) K-wire lumens 529a, 529d, which extend from the proximal end 517a to the distal end 517b of the top planar region 515, i.e., extend through the top planar region 515.
  • the K-wire lumens 529a, 529d are sized and configured to receive K-wires, such as K-wires 509, therein, as illustrated in Fig. 7B.
  • the distal end 521b of the drill guide base 501 preferably comprises a pair of anchor members 531 that project from the distal end 521b of the drill guide base 501.
  • the anchor members 531 are designed and configured to pierce and, preferably, engage biological tissue to maintain a fixed position of the drill guide base 501 proximate thereto.
  • the proximal end 521a of the drill guide base 501 comprises an extended region 519, which comprises two (2) threaded holes 511a (not shown), 51 lb.
  • the threaded holes 511 a, 51 lb are sized and configured to receive the threaded end of a drill guide handle, such as the threaded end 514 of the handle 510a described in priority U.S. App. No. 17/833,960.
  • the drill guide base 501 further comprises an internal drill guide insert opening 560, which, as discussed in detail below, is sized and configured to receive the drill guide insert 600 and the single-member bone structure prosthesis 70 and multi-member bone structure prostheses 170, 270 and 370 therein.
  • the drill guide insert opening 560 extends from the proximal end 521a to the distal end 521b of the drill guide base 501 and comprises a “dogbone” or “bi-lobe” cross-sectional shape comprising contiguous first and second lobe portions 564a, 564b connected by a medial portion 562.
  • the drill guide insert opening 560 further comprises two (2) opposing guide channels 555a, 555b that are sized and configured to receive the guide rail 608 of drill guide insert 600 shown in Figs. 7A, 7E, and 7F.
  • the guide channels 555a, 555b are further configured to allow the guide rail 608 of drill guide insert 600 to slidably translate therethrough.
  • the medial portion 562 of the drill guide insert opening 560 is sized and configured to receive the center portion 603 of the drill guide insert 600.
  • the drill guide base 501 further comprises receiving slots 565a, 565b proximate the proximal end 521a thereof that are sized and configured to receive and seat the extended region 606 of the drill guide insert 600, as illustrated in Fig. 7B and discussed below.
  • the drill guide insert 600 comprises an elongated biluminal or “double-barrel” structure 610 that comprises first and second drill guide insert lumens 604a, 604b that are sized and configured to receive and position a drill bit, e.g., drill bit 700.
  • the first and second drill guide insert lumens 604a, 604b can be sized and configured to receive and position various sizes of drill bits to create various sizes of pilot SI joint openings.
  • the drill guide further comprises a drill alignment pin, K-wire member and temporary fixation pin, such as alignment pin 532, K-wire member 552 and temporary fixation pin 533 described in U.S. App. No. 17/833,960.
  • the first and second drill guide insert lumens 604a, 604b are further sized and configured to receive the drill alignment pin, temporary fixation pin and K-wire pin member therein.
  • the drill guide insert 600 further comprises a guide pin lumen 605, which, as illustrated in Fig. 7B, is sized and configured to receive a guide pin therethrough, such as guide pin 400 described in U.S. App. No. 17/833,960.
  • the drill guide insert 600 further comprises an extended region or member (i.e., a handle) 606 that extends outwardly in a perpendicular direction relative to a longitudinal axis of the drill guide insert 600, and an integral guide rail 608 that is sized and configured to engage and slidably translate through the guide channels 555a, 555b of the drill guide base 501.
  • the extended member 606 is sized and configured to be received and seated in the receiving slots 565a, 565b of the drill guide base 501, as illustrated in Fig. 7B.
  • the guide pin such as guide pin 400, is advanced via an inferior-posterior trajectory through the incision and into the dysfunctional SI joint.
  • the present invention provides numerous advantages compared to prior art systems and methods for stabilizing dysfunctional SI joints. Among the advantages are the following:

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
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  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Medical Informatics (AREA)
  • Neurology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
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  • Cardiology (AREA)
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Abstract

L'invention concerne une prothèse multi-éléments comprenant un premier et un second élément oblongs et un élément ostéotome, ladite prothèse multi-éléments étant conçue pour être avancée dans une ouverture d'articulation sacro-iliaque pilote dans ladite articulation sacro-iliaque dysfonctionnelle dans une approche postérieure, l'ouverture de l'articulation sacro-iliaque pilote comprenant une ouverture du sacrum et une ouverture d'ilium. Le premier élément oblong est conçu pour être avancé dans l'ouverture du sacrum et le second élément oblong est conçu pour être avancé dans l'ouverture d'ilium. L'élément ostéotome présente des premier et second moyen de fixation d'éléments oblongs conçus pour fixer les premier et second élément oblongs à ceux-ci.
PCT/US2023/034825 2022-10-25 2023-10-10 Prothèses multi-éléments pour structure osseuse WO2024091382A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US17/972,785 2022-10-25
US17/972,785 US20230037755A1 (en) 2010-07-27 2022-10-25 Multi-Member Bone Structure Prostheses

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WO2024091382A1 true WO2024091382A1 (fr) 2024-05-02

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20080154379A1 (en) * 2006-12-22 2008-06-26 Musculoskeletal Transplant Foundation Interbody fusion hybrid graft
US11147675B2 (en) * 2010-07-27 2021-10-19 Tenon Medical, Inc. System for sacro-iliac stabilization
US20220304813A1 (en) * 2010-07-27 2022-09-29 Tenon Medical, Inc. Systems for Sacroiliac Joint Stabilization
US20230000631A1 (en) * 2010-07-27 2023-01-05 Tenon Medical, Inc. Multi-Function Bone Structure Prostheses
US20230037755A1 (en) * 2010-07-27 2023-02-09 Tenon Medical, Inc. Multi-Member Bone Structure Prostheses

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20080154379A1 (en) * 2006-12-22 2008-06-26 Musculoskeletal Transplant Foundation Interbody fusion hybrid graft
US11147675B2 (en) * 2010-07-27 2021-10-19 Tenon Medical, Inc. System for sacro-iliac stabilization
US20220304813A1 (en) * 2010-07-27 2022-09-29 Tenon Medical, Inc. Systems for Sacroiliac Joint Stabilization
US20230000631A1 (en) * 2010-07-27 2023-01-05 Tenon Medical, Inc. Multi-Function Bone Structure Prostheses
US20230037755A1 (en) * 2010-07-27 2023-02-09 Tenon Medical, Inc. Multi-Member Bone Structure Prostheses

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