Surgical tools and joint kinematic reconstruction techniques

The disclosure relates to surgical tools and methods. The surgical tools can include a handle, a first rod extending from the handle, and a second rod extending from the handle. At least one of the first and second rods may be rotatable between a folded position and a spread position. The first and second rods may be closer together in the folded position than in the spread position.

BACKGROUND

This disclosure relates to surgical tools and assorted surgical techniques for improving the joint kinematics of an unstable joint.

Normal joint kinematics are achieved through balanced soft tissues that surround the articulating bones of a joint. An unstable joint can occur if there is significant disruption of the articulating bones or the surrounding soft tissues. Unstable joints can also occur within a replaced joint subsequent to an arthroplasty procedure. The resulting joint instability may cause pain, dysfunction, accelerated bone loss, soft tissue tears and premature arthritis.

SUMMARY

This disclosure relates to surgical tools and techniques. Surgical tools may include a handle and one or more rods extending from the handle. The surgical tools may be positionable between a folded position and a spread position. The techniques may be employed to reconstruct and/or improve the joint kinematics of any joint of the human musculoskeletal system.

A surgical tool according to an exemplary aspect of this disclosure may include, inter alia, a handle, a first rod extending from the handle, and a second rod extending from the handle. At least one of the first and second rods may be rotatable between a folded position and a spread position. The first and second rods may be closer together in the folded position than in the spread position.

A surgical tool according to an exemplary aspect of this disclosure may include, inter alia, a handle providing a first opening, a second opening, and a third opening. A first rod may extend from the handle and may be received in the first opening. A second rod may be selectively receivable in the second opening and in the third opening.

A surgical method of attaching a graft to a joint according to another exemplary aspect of this disclosure may include, inter alia, rolling a graft on a surgical tool outside of a joint space. A surgical tool may be inserted with the rolled graft through a portal. The graft may be unrolled by the surgical tool inside the joint space.

DETAILED DESCRIPTION

FIG. 1illustrates a joint10of the human musculoskeletal system. The joint10may be any joint of the musculoskeletal system of the human body. In one embodiment, the joint10is the glenohumeral joint of a shoulder. The joint10includes multiple bones including a scapula12and a humerus16. Some of these bones articulate relative to one another. For example, the joint10includes a ball and socket joint formed between a head18of the humerus16and a glenoid14, which is a cup-like recession of the scapula12configured to receive the head18.

A capsule20generally covers the joint10and is surrounded and reinforced by various muscles, tendons and ligaments that are responsible for keeping the adjoining bones of the joint10together. The joint10may become unstable if there is significant disruption of the articulating bones (e.g., the humerus16and the glenoid14), the capsule20, or other surrounding muscles, tendons and/or ligaments. In one embodiment, the joint10could become unstable in response to a massive irreparable rotator cuff tear.

This disclosure describes joint kinematic reconstruction techniques for reconstructing an unstable joint, such as in response to a massive irreparable rotator cuff tear or other injury. Although joint kinematic reconstruction of a shoulder joint is described throughout this disclosure as one example joint kinematic reconstruction technique, this disclosure is not intended to be limited to shoulder reconstructions. In other words, the various techniques described herein may be employed to reconstruct and/or improve the joint kinematics of any joint of the human musculoskeletal system.

FIG. 2illustrates an example surgical tool22that may be used in a surgical procedure, such as a joint kinematic reconstruction technique, for example. The surgical tool22includes a handle24, and a first rod26and a second rod28extending from the handle24. The example rod26is received in an opening30in the handle24and may include a slot32extending to its distal end34for receiving a graft (not shown). The rod28is received in an opening36in the handle spaced from the opening30. The rod28may include a slot38extending to its distal end40for receiving a graft. In another embodiment, the slots32,38do not extend to the distal end. Although slots32,38are utilized in the example for receiving a graft, other attachment features, including those shown inFIGS. 9-10in some examples, may be used for attaching a graft to the rods26,28.

FIG. 3illustrates the example surgical tool22having the rod28extending along and rotatable within an axis A1, which extends through the opening36in the handle24. The rod28may include a knob42near its proximal end portion44opposite the handle24from the distal end40. The knob42may be manipulated to provide a rotational input to the rod28. In the example surgical tool22, the rod26is fixed; however, in other examples, both rods26,28may be rotatable. One or both of the rods26,28may be rotated for folding a graft received in the rods26,28before shuttling the graft to a graft site, such as within a joint space, as is discussed further below. The graft may be folded using the surgical tool22for ease of insertion through an opening, one example being an arthroscopic portal, such as a cannula, during an arthroscopic procedure.

The rod28may include an offset portion46that is offset from a main portion48, such that a central axis A2extending through the offset portion46is spaced a distance D1from the axis A1. The offset portion46may be distal of the main portion48. However, other offset configurations are contemplated within the scope of this disclosure. In an example, the main portion48is rotatable about the axis A1and includes a portion48A received in the handle24and a portion48B extending distally from the handle24. The example rod26does not have an offset; however, in other examples, both the rods26and28may have an offset. The rod26extends along a central axis A3. Two or more of the axes A1, A2, and A3may be substantially parallel in some examples, and, in the example shown, the axes A1, A2, and A3are substantially parallel.

FIG. 4illustrates a graft49received by the first rod26and the second rod28of the surgical tool22. The surgical tool22and the graft49are shown in a spread position. In an example, in the spread position, the offset portion46of the rod28is its greatest distance D2from the first rod26, such that the coverage of the graft49with the rods26,28is maximized. In some examples, the spread position of the graft49mimics the desired implanted position of the graft during a procedure. Utilizing one or more offsets allows the distance D2to be greater than it would be without offsets, thus providing greater control and stability when shuttling and placing the graft49during a procedure.

The graft49could include either an allograft or an autograft. In one embodiment, the graft49is an acellular dermal extracellular matrix. ArthroFlex®, sold by Arthrex, Inc., is one type of graft49suitable for use to perform an exemplary joint kinematic reconstruction technique.

FIG. 5illustrates the graft49received in a folded position in the first rod26and the second rod28of the surgical tool22. The knob42may be rotated in the direction R to rotate the rod28from the spread position to the folded position. In the folded position, the offset portion46is closer to the first rod26than it is in the spread position shown inFIG. 4. In an example, the knob42may include one or more protrusions47and the handle24may include one or more protrusions51configured to interface with the protrusion47at a rotational limit, which could be set to any degree of rotation. In the folded position, the graft49and the rods26,28are able to be shuttled through openings having a diameter or width smaller than the distance D2(FIG. 4).

FIG. 6illustrates another exemplary surgical tool122. The surgical tool122is similar to the surgical tool22, except that it includes a third opening150in the handle124for receiving the second rod128. The first rod126may be fixed and received in an opening130in the handle124; in other examples, the first rod126is rotatable in the opening130. The second rod128may be receivable in the opening136as shown, or may be removed from the opening136and then inserted into the third opening150. The positioning of the second rod128can be adjusted by providing openings136and150that can each receive the second rod128. In some examples, this adjustability is based on a desired spread distance D3between the offset portion146and the first rod126, which is the maximum width between the offset portion146and the first rod126in the spread position. The actual spread distance D3could be set at any dimension to accommodate different sized grafts. In some examples, the first rod126also includes an offset portion, and the distance D3is the maximum width between offset portions of the first rod126and the second rod128in the spread position.

The adjustability may additionally or alternatively be based on a desired spread distance D4between the main portion148and the first rod126. The spread distance D4is the maximum width between the first rod126and the main portion148of the second rod128.

In the example shown, the second rod128has the offset; however, in other examples, the first rod126may alternatively have the offset, or both the first rod126and the second rod128may have an offset. In another example, a non-offset one of the rods126,128is the removable and interchangeable rod.

FIG. 7illustrates an end view of the distal face152of the handle124. The first rod126and second rod128are removed forFIG. 7for ease of viewing. The center of the opening130and the center of the opening136are spaced apart by a distance D5. The center of the opening130and the center of the opening150are spaced apart a distance D6. The center of the opening136and the center of the opening150are spaced apart a distance D7. In an example, the distance D5is different from the distance D6. In an example, the openings130,136, and150are aligned substantially linearly; however, non-linear arrangements of the openings130,136, and150may alternatively be utilized. In addition, although three openings are shown in the example, more than three openings may be used in other examples.

FIG. 8illustrates the example surgical tool122in the folded position. As shown, in an example, a portion of the offset portion146may rotate beyond the first rod126in the folded position. In other examples, the offset portion146does not rotate beyond the first rod126in the folded position or rotates to be substantially aligned with the first rod126. The adjustability of the surgical tool122may therefore additionally or alternatively be based on a desired spread distance D8between the rods126,128when positioned in the folded position. In the example shown, in which the offset portion146rotates beyond the first rod126in the folded position, the distance D8is the maximum width of the main portion148and the offset portion146of the rod128. The distance D8may be selected based on the size of the arthroscopic portal to be used, among other factors.

FIG. 9illustrates an example surgical tool222in a spread position. In this example, the rod226is rotatable about the axis A3and the rod228is rotatable about the axis A1. In some examples, both rods226,228are rotatable between 0-90 degrees. In other examples, one of the rods226,228may be fixed. In this example, the rod226includes an offset portion245, and the rod228includes an offset portion246. In other examples, only one of the rods226,228includes an offset portion. The rod226includes suture slots232, which may be provided at the offset portion245. The rod228includes suture slots238, which may be provided at the offset portion246. In the example, each rod226,228includes two suture slots232,238, but more or fewer suture slots may be utilized. The suture slots232,238are configured to receive one or more suture strands, suture tape, any other suture-like product, or any thread-like material, which may be attached to a graft. In one example, sutures are attached at four corners of a graft and the sutures are received in the slots232,238.

Each suture slot232,238may include an elongated portion270elongated along its respective rod226,228and an access portion272transverse to the elongated portion270and extending to an outer surface of the respective rod226,228. In some examples, sutures are received in the rod226,228through the access portion272and secured in the elongated portion270.

FIG. 10illustrates the example surgical tool222in a folded position. The rods226,228are rotated such that the offset portions245and246are closer to one another than they were in a spread position.

The example surgical tools22/122/222may be utilized in joint kinematic reconstruction techniques. These techniques may include superior capsular reconstruction, for example. In other examples, the example surgical tools22/122/222may be utilized in any technique where a graft may be positioned against bone.

As illustrated inFIG. 11, a surgeon may begin an example joint kinematic reconstruction technique300by selecting a desired positioning for fixating various sutures354inside a joint space356. The fixation locations of the sutures354may be selected based on a surgeon's preference and are selected to best restore the joint kinematics of the joint being repaired. The sutures354may include individual suture strands, multiple suture strands, suture tape, any other suture-like product, or any thread-like material. The sutures354may be fixated inside the joint space356using various suture anchors358. Holes360may optionally be pre-formed for receiving the suture anchors358, such as with a drill, punch, and/or other tools (not shown) in some examples.

Any number of suture anchors358may be fixated inside the joint space356for attaching the sutures354, and this disclosure is not limited to the specific number of suture anchors shown in this embodiment. The actual number of suture anchors358used is surgery-specific and may be quantified as the minimum number of suture anchors that is necessary to achieve graft fixation to the bone or bones of the unstable joint.

The graft349can be used to reconstruct an unstable joint. Holes362may be punched through the graft349that correspond with the spacing of the holes360. The holes362are oriented and configured to accommodate the sutures354that are attached to the implanted suture anchors358. The holes362permit the sutures354to slide relative to the graft349as the graft349is shuttled, pulled, maneuvered, or otherwise manipulated into place within a joint space356.

As illustrated inFIG. 11, the graft349is first aligned and oriented at a location external to, or outside of, the joint space356in a manner that mimics its implanted position. Sutures354, which have already been fixated inside the joint space356, may then be retrieved from each implanted suture anchor358and pulled outwardly through a cannula364and then inserted through the graft349while the graft349is located outside of the joint space356. Each hole362of the graft349is configured to accommodate one or more of the sutures354. A person of ordinary skill in the art would be able to position the various arthroscopic portals required for performing an arthroscopic procedure. In another embodiment, the sutures354are retrieved from the joint space356one-by-one (i.e., sequentially), passed through the appropriate hole362of the graft349, and then tensioned prior to shuttling an additional suture354through the cannula364. In other embodiments, one or more sutures354may be passed through the graft349after the graft349is shuttled to the joint space356.

FIG. 12illustrates the surgical tool322receiving the graft349outside of the cannula364relative to the joint space356. The surgical tool322is in the spread position and receives the graft349in its mimicked implanted position. In the example shown, the rods326,328are placed internal to the openings362relative to the graft349. In another example, the rods326,328may be placed outside of the openings362relative to the graft349. With reference toFIGS. 9-10, in some examples at this position, the sutures354passed through the graft349are received in suture openings in the rods326,328. With reference to the embodiment shown inFIGS. 6-8, in some examples, one of the first rod326and second rod328may be adjustable within openings in the handle324based on a desired spacing of the rods326,328for dimensions of the graft349or the joint356.

FIG. 13illustrates the surgical tool receiving the graft349outside of the cannula364relative to the joint space356and rotated into the folded position. The rod328is rotated, such that the surgical tool322and the graft349are in a folded position. In other examples, both rods326and328may be rotated, including in examples where one or both rods326and328have offset portions. In the folded position, the rods326,328and the graft349are able to fit through the opening366in the cannula364for shuttling the graft349to the joint space356. The graft349is therefore shuttled through the opening366to the joint space356in the folded position. In some examples, the surgeon may manually provide an additional fold to the ends368of the graft349prior to insertion.

FIG. 14illustrates the graft349in the joint space356after being shuttled to the joint space356. As shown, the surgical tool322is now rotated to the spread position, allowing the graft349to be placed in its implanted position. That is, after the rods326and328and the graft349are shuttled through the cannula364, the rod328is rotated into the spread position to spread the graft349for placement in its implanted position. The rods326,328may then be disengaged from the graft349, such as, in some examples, by removing the graft349from slots (not shown) or the sutures354from suture slots (not shown) in the rods326,328. Tensioning of the sutures354may occur before and/or after disengagement of the rods326,328for positioning the graft349. The graft349may then be fixated to the bones of the joint.

Although the different 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 embodiments in combination with features or components from any of the other embodiments.

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.