Abstract:
A surgical method according to an exemplary aspect of the present disclosure includes, among other things, drying an osteochondral defect using a suction swab. The drying step includes suctioning moisture from the osteochondral defect through the suction swab or communicating a gas to the osteochondral defect through the suction swab.

Description:
BACKGROUND 
       [0001]    This disclosure relates to a surgical method involving the use of a suction swab for drying an osteochondral defect. 
         [0002]    Repetitive trauma to a joint, such as a knee, ankle, hip or shoulder joint, may cause osteochondral defects. Osteochondral defects are localized areas of damaged articular cartridge and adjacent subchondral bone of a joint. Osteochondral defects typically do not heal without treatment. For example, if not treated, the defect could further deteriorate the articular cartridge and underlying bone of the joint, and could result in relatively significant arthritic pain in some individuals. 
         [0003]    Microfracture surgery is sometimes performed to treat osteochondral defects. During microfracture surgery, a surgeon creates small holes, or fractures, in the subchondral bone plate to generate bleeding from the bone. Blood and bone marrow may seep out of the holes and create a blood clot over the osteochondral defect. Stem cells from the bone marrow and the underlying subchondral bone interact with the blood clot and eventually form a fibrocartilagenous tissue network over the defect. In some microfracture surgeries, a repair material, such as an allograft mixture, is applied over the defect to augment the tissue network. 
       SUMMARY 
       [0004]    A surgical method according to an exemplary aspect of the present disclosure includes, among other things, drying an osteochondral defect using a suction swab. The drying step includes suctioning moisture from the osteochondral defect through the suction swab or communicating a gas to the osteochondral defect through the suction swab. 
         [0005]    In a further non-limiting embodiment of the foregoing method, the suction swab includes a swab tip received on a distal end of a tube and an adaptor received on a proximal end of the tube. 
         [0006]    In a further non-limiting embodiment of either of the foregoing methods, the drying step includes suctioning the moisture through a swab tip of the suction swab, then through openings in a distal end of a tube of the suction swab, and then through a passage in the tube. 
         [0007]    In a further non-limiting embodiment of any of the foregoing methods, the drying step includes communicating a gas through a passage in a tube of the suction swab, then through openings in a distal end of the tube, and then through a swab tip. 
         [0008]    In a further non-limiting embodiment of any of the foregoing methods, the gas is an inert gas. 
         [0009]    In a further non-limiting embodiment of any of the foregoing methods, the method includes creating a bleeding bone bed near the osteochondral defect prior to the drying step. 
         [0010]    In a further non-limiting embodiment of any of the foregoing methods, the drying step is performed as part of an arthroscopic surgical procedure. 
         [0011]    In a further non-limiting embodiment of any of the foregoing methods, the drying step is performed as part of an open surgical procedure. 
         [0012]    In a further non-limiting embodiment of any of the foregoing methods, the moisture includes at least one of arthroscopy fluid, synovial fluid, blood or bone marrow. 
         [0013]    In a further non-limiting embodiment of any of the foregoing methods, the drying step includes both suctioning moisture from the osteochondral defect through the suction swab and communicating the gas to the osteochondral defect through the suction swab. 
         [0014]    A surgical method according to another exemplary aspect of the present disclosure includes, among other things, performing microfracture surgery to obtain a microfracture site and drying the microfracture site using a suction swab. 
         [0015]    In a further non-limiting embodiment of the foregoing surgical method, the drying step includes suctioning moisture through the suction swab. 
         [0016]    In a further non-limiting embodiment of either of the foregoing surgical methods, the drying step includes communicating a gas to the microfracture site through the suction swab. 
         [0017]    In a further non-limiting embodiment of any of the foregoing methods, the microfracture site includes a plurality of perforations formed in subchondral bone near an osteochondral defect. 
         [0018]    In a further non-limiting embodiment of any of the foregoing methods, the method includes applying a repair material over the microfracture site subsequent to the drying step. 
         [0019]    A surgical method according to another exemplary aspect of the present disclosure includes, among other things, identifying an osteochondral defect in a joint space, creating a bleeding bone bed in bone near the osteochondral defect, drying the osteochondral defect with a suction swab, and delivering an allograft mixture over the osteochondral defect. 
         [0020]    In a further non-limiting embodiment of the foregoing surgical method, the drying step includes suctioning moisture through the suction swab. 
         [0021]    In a further non-limiting embodiment of either of the foregoing surgical methods, the drying step includes communicating a gas to the osteochondral defect through the suction swab. 
         [0022]    In a further non-limiting embodiment of any of the foregoing surgical methods, the creating step includes performing a microfracture procedure in the bone. 
         [0023]    In a further non-limiting embodiment of any of the foregoing surgical methods, the method includes applying a layer of fibrin over the allograft mixture. 
         [0024]    The embodiments, examples and alternatives of the preceding paragraphs, the claims, or the following description and drawings, including any of their various aspects or respective individual features, may be taken independently or in any combination. Features described in connection with one embodiment are applicable to all embodiments, unless such features are incompatible. 
         [0025]    The various features and advantages of this disclosure will become apparent to those skilled in the art from the following detailed description. The drawings that accompany the detailed description can be briefly described as follows. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0026]      FIG. 1  illustrates a suction swab. 
           [0027]      FIG. 2  is a cross-section of a swab tip of a suction swab. 
           [0028]      FIG. 3  illustrates an adaptor of a suction swab. 
           [0029]      FIG. 4  schematically illustrates the use of a suction swab to dry an osteochondral defect by suctioning moisture from the defect. 
           [0030]      FIG. 5  schematically illustrates the use of a suction swab to dry an osteochondral defect by communicating a gas to the defect. 
           [0031]      FIGS. 6, 7, 8, 9, 10 and 11  schematically illustrate a method of using a suction swab for preparing an osteochondral defect for a subsequent surgical procedure. 
       
    
    
     DETAILED DESCRIPTION 
       [0032]    This disclosure describes surgical methods for drying an osteochondral defect. The surgical methods include using a suction swab to dry the osteochondral defect. In some embodiments, the suction swab suctions moisture away from the osteochondral defect to dry the defect. In other embodiments, the suction swab communicates a gas to the osteochondral defect to dry the defect. The suction swab may be used to dry the osteochondral defect during microfracture surgeries or other osteochondral defect repairs. These and other features are described in greater detail in the following paragraphs of this disclosure. 
         [0033]      FIGS. 1, 2 and 3  illustrate a suction swab  10 . The suction swab  10  includes a tube  12  that extends along a longitudinal axis A between a distal end  14  and a proximal end  16 . A swab tip  18  is disposed at the distal end  14 , and an adaptor  20  is disposed at the proximal end  16 . In one embodiment, the distal end  14  of the tube  12  is received within the swab tip  18 , and the proximal end  16  of the tube  12  is received within the adaptor  20 . 
         [0034]    The tube  12  may be cannulated such that a passage  22  extends through its body. The passage  22  is disposed about the longitudinal axis A and may extend from the distal end  14  to the proximal end  16 . The distal end  14  of the tube  12  may include a plurality of openings  24 , or fenestrations, formed through the tube  12 . The openings  24  are in fluid communication with the passage  22 . In one non-limiting embodiment, the tube  12  is made of polystyrene. However, the tube  12  may be constructed of other similar materials within the scope of this disclosure. 
         [0035]    The swab tip  18  is received over the distal end  14  of the tube  12 . In one embodiment, the swab tip  18  is received over the distal end  14  of the tube  12  such that the openings  24  are positioned inside the swab tip  18 . The swab tip  18  may be made of a wicking and/or moisture absorbing material. Cotton and foam are non-limiting examples of such materials. In one non-limiting embodiment, the swab tip  18  is capable of absorbing fluids including but not limited to arthroscopy fluid, synovial fluid, blood, bone marrow, etc. 
         [0036]    The adaptor  20  of the suction swab  10  is configured for connection to a power device (not shown), such as a suction or gas device. In one embodiment, the adaptor  20  is a barbed adaptor (see  FIG. 1 ). In another embodiment, the adaptor  20  is a luer type adaptor or a tapered adaptor (see  FIG. 3 ). Other adaptor configurations are also contemplated. 
         [0037]    The suction swab  10  can be used during surgical procedures to dry an osteochondral defect  30 . The osteochondral defect  30  includes localized, damaged areas of articular cartridge and adjacent subchondral bone within a joint space, such as a knee, hip, ankle or shoulder joint space. The suction swab  10  can also be used to perform fluid management within the joint space during a surgical procedure. 
         [0038]    For example, as shown in  FIG. 4 , moisture M (which could include arthroscopy fluid, synovial fluid, blood, bone marrow, etc.) that has pooled on the osteochondral defect  30  may be absorbed by the swab tip  18  of the suction swab  10 . The moisture M is suctioned through the openings  24  of the tube  12  and then through the passage  22  to remove the moisture M and dry the osteochondral defect  30 . 
         [0039]    In an alternative embodiment, shown in  FIG. 5 , the suction swab  10  can be used to communicate a gas G to dry moisture M that has accumulated at the osteochondral defect  30 . The gas G may be communicated through the passage  22  of the tube  12 , then through the openings  24 , and then through the swab tip  18  to dry the osteochondral defect  30 . In one embodiment, the gas G is an inert gas, such as compressed air or nitrogen. 
         [0040]    In yet another embodiment, the suction swab  10  can be used to dry the osteochondral defect  30  by both suctioning moisture from the osteochondral defect  30  and communicating the gas G to the osteochondral defect  30 .  FIGS. 4 and 5  are not necessarily drawn to scale and may be exaggerated to better illustrate the features of the suction swab  10 . 
         [0041]      FIGS. 6-11 , with continued reference to  FIGS. 1-5 , schematically illustrate a method of using the suction swab  10  to prepare an osteochondral defect  30  for a subsequent surgical procedure. The method is illustrated and described as an arthroscopic method; however, the suction swab  10  could also be used in open procedures to dry defects. 
         [0042]    In one non-limiting embodiment, the suction swab  10  is used to dry the osteochondral defect  30  to prepare a joint space  32  for receiving a repair material. Although the joint space  32  of  FIGS. 6-11  is illustrated as a knee joint, the suction swab  10  of this disclosure could be used to dry osteochondral defects located anywhere within the human body. 
         [0043]    Referring first to  FIG. 6 , after the surgeon has identified the osteochondral defect  30  within the joint space  32 , the osteochondral defect  30  is debrided to a stable border having perpendicular margins. Tools, such as a curette  40  and an elevator  42 , can be used to create the vertical margins and debride the calcified cartilage layer at the base of the osteochondral defect  30 . 
         [0044]    Next, as shown in  FIG. 7 , a microfracture procedure may be performed to obtain a microfracture site  44 . During the microfracture surgery, the surgeon creates multiple perforations  46  in the subchondral bone  48  that extends beneath the articular cartilage  49  located near the osteochondral defect  30  of the joint space  32 . In one embodiment, the microfracture procedure is performed using a tool  53 , such as Arthrex&#39;s PowerPick™, to form the perforations  46  of the microfracture site  44 . The formation of the perforations  46  creates a bleeding bone bed that stimulates bone marrow seepage into the microfracture site  44 . 
         [0045]    After creating the microfracture site  44 , the osteochondral defect  30  is dried to remove excess moisture that could interfere with implantation of a repair material. As shown in  FIG. 8 , the osteochondral defect  30  is dried using the suction swab  10 . The suction swab  10  is positioned within the joint space  32 , and the swab tip  18  of the suction swab  10  may be positioned at the microfracture site  44  to begin wicking and/or absorbing any excess moisture. The moisture may be dried by suctioning the moisture out of the osteochondral defect  30  through the suction swab  10  or by introducing a gas to the osteochondral defect  30  through the suction swab  10 . 
         [0046]    It should be understood that the suction swab  10  of this disclosure is not limited to uses associated with microfracture surgeries. For example, in another non-limiting embodiment, the curette  40  shown in  FIG. 6  could be used to create the bleeding bone bed within the joint space  32 . The bleeding bone bed can then be dried as necessary using the suction swab  10  to prepare the osteochondral defect  30  for receiving a repair material or graft. 
         [0047]    Referring to  FIG. 9 , a cannula  50  can be utilized in an arthroscopic portal that resides over the osteochondral defect  30 . Distraction is applied with the cannula  50  to improve visualization of the osteochondral defect  30 . A repair material  52  can then be applied over the osteochondral defect  30  using a delivery needle  54 . In one non-limiting embodiment, the repair material  52  is an allograft mixture. The repair material  52  may include allograft cartilage in the form of micronized cartilage particulates which may be cartilage delivered in its native form, dehydrated via lyophilization, dehydrated via desiccation, or dehydrated by any other method. One non-limiting example of a suitable repair material  52  is Arthrex&#39; s BioCartilage®, which is a micronized cartilage matrix. 
         [0048]    The repair material  52  serves as a scaffold over the osteochondral defect  30  and provides a tissue network that can potentially signal autologous cellular interactions and improve the degree and quality of tissue healing within the osteochondral defect  30 . The repair material  52  can be smoothed within the osteochondral defect  30  so that it remains slightly recessed to the surrounding cartilage (see  FIG. 10 ). 
         [0049]    A layer of fibrin  60  may be applied over the repair material  52  via an applicator  62  (see  FIG. 10 ). After letting the fibrin  60  and the repair material  52  sit for a predefined amount of time, such as approximately five minutes, the joint space  32  may be gently ranged before closure to assure adherence of the repair material  52  and completion of the final repair  70  (see  FIG. 11 ). 
         [0050]    Although the different non-limiting embodiments are illustrated as having specific components, the embodiments of this disclosure are not limited to those particular combinations. It is possible to use some of the components or features from any of the non-limiting embodiments in combination with features or components from any of the other non-limiting embodiments. 
         [0051]    It should be understood that like reference numerals identify corresponding or similar elements throughout the several drawings. It should also be understood that although a particular component arrangement is disclosed and illustrated in these exemplary embodiments, other arrangements could also benefit from the teachings of this disclosure. 
         [0052]    The foregoing description shall be interpreted as illustrative and not in any limiting sense. A worker of ordinary skill in the art would understand that certain modifications could come within the scope of this disclosure. For these reasons, the following claims should be studied to determine the true scope and content of this disclosure.