Method and apparatus for coring and reaming of bone

A method and apparatus for providing an implant of autogenous bone. Generally, the implant may be taken from a selected bone portion and implanted into another selected bone portion within during a procedure. The method may be used in conjunction with soft tissue reinsertion or attachment to the selected implant site.

FIELD

The present invention relates generally to orthopedic implants and procedures, and particularly to methods and apparatii for forming a core in a selected bone and harvesting a core from a selected bone.

BACKGROUND

In an anatomy, such as a human anatomy, various portions of the body are interconnected through soft tissues. For example, ligaments interconnect various boney portions of the anatomy to provide selected articulations of adjacent bone portions. The ligaments generally are attached or inserted naturally in the bone portions to provide tension to form the articulations and actions of the bones.

Nevertheless, over time the soft tissue, such as the ligaments, may become weakened or severed. The injuries may occur for various reasons, such as injury, fatigue, age, disease and other various reasons. The detachment of the ligament from its anatomical position reduces or eliminates the anatomical movement of the various bone portions.

If a ligament becomes detached, it may generally be repaired or replaced with a graft implant. Generally, a graft may be autogenus or zenographic. The graft may be implanted to interconnect the bone portions to substantially mimic the anatomical connection. The graft may be inserted or mechanically fixed to the bone portions. Nevertheless, it is desirable to increase pull out strength and increase bone regrowth after the implantation.

SUMMARY

A method and apparatus for providing a soft tissue implant to be fixed to a bone portion. The apparatus is used to form a bore in the bone to receive the graft. An autogenus or autograft of hard or cancelus bone tissue can then be positioned in the bore to seat the graft in the bore formed in the bone. Various supplementary fixation devices, such as a washer lock, described in U.S. Pat. No. 6,280,472 entitled “Apparatus And Method For Tibial Fixation Of Soft Tissue”, commonly assigned, can also be used to fix a soft tissue in a selected position. The autogenus bone graft can be taken from the patient into which the soft tissue graft is being positioned. This can reduce or eliminate rejection of the graft. Also, the bone graft can assist in quicker healing by including most generally present proteins and normal anatomical portions to allow for bone in-growth, fixation, and other advantages.

A corer or harvester is provided to form the bore in the bone portion and allow for the harvesting of other substantially similar or complementary bone or autogenus implant. The bore formed in the bone is generally formed with a reamer of a selected diameter. A coring apparatus can be used to form a core or a bone plug substantially equal in diameter to the reamed bore. Therefore, after the bore is reamed in the bone, the selected tool can be used to form a core of a substantially similar diameter to the reamed or cored bore. Therefore, the bone plug, or core, can be positioned in the reamed or cored bore to assist in holding the soft tissue within the bore.

According to an embodiment an apparatus for harvesting a bone core is described. The apparatus includes a collet assembly having a sleeve defining an internal bore and a collar disposed within the internal bore wherein the collar is moveable, within the sleeve, between an engaged position and a non-engaged position. The apparatus further includes a chuck engageable member extending from the collet assembly to interconnect a selected chuck and a harvesting member selectively engageable with the collet assembly. The harvesting member is able to move the collar between the engaged position and the non-engaged position. When the harvesting member has moved the collar to the engaged position the harvesting member is selectively held within a portion of the internal bore. The harvesting member is able to move the collar generally with a manual force.

According to various embodiments an apparatus for harvesting and implanting a bone core includes a collet assembly having a selectively engageable mechanism and defining an internal bore. A harvester to selectively engage the selectively engageable mechanism and to be disposed within the internal bore, the harvester defining a harvester bore. Also, a graspable assembly to selectively engage the collet and defining a graspable assembly bore that is generally aligned with the harvester bore when the graspable assembly selectively engages the collet assembly. A plunger may be disposed within the graspable assembly bore and the harvester bore. The plunger is operable with the harvester bore during a harvesting of the bone core. The collet is disengageable from the graspable assembly and the plunger is operable to remove the bone core from the harvester. The selectively engageable mechanism includes a generally quick-release mechanism wherein the harvester is engageable and disengageable from the selectively engageable mechanism with pressure from the user.

According to another embodiment a method of harvesting and implanting a bone core includes interconnecting a harvesting member with a collet member in a quick-release manner and interconnecting the collet and a graspable member. The harvesting member is driven into a selected bone portion and traps a selected length of bone within the harvesting member. The selected length of bone is removed from the harvesting member into a selected location.

Further areas of applicability will become apparent from the detailed description provided hereinafter. It should be understood that the detailed description and specific examples, while indicating the various embodiments are intended for purposes of illustration only and are not intended to limit the scope of the appended claims.

DETAILED DESCRIPTION OF VARIOUS EMBODIMENTS

The following description of various embodiments is merely exemplary in nature and is in no way intended to limit various applications or uses. Although the following description relates generally to a ligament replacement in a knee portion, such as an ACL replacement, it will be understood that the various methods and apparatuses may be used in any appropriate procedure or any type of soft tissue replacement. For example, a tendon may also be replaced in an elbow joint, shoulder joint, or other appropriate joint. In addition, it may be desirable to form a reamed portion or a bore and provide therein a core of selected bone portion. Therefore, the replacement of a tendon or a ligament is not necessarily a requirement of the following apparatuses or methods. The apparatuses and methods may be augmented to provide for various or similar procedures without being outside of the scope of the following description and the appended claims.

With reference toFIG. 1, a harvesting instrument20according to an embodiment is illustrated. The harvesting instrument20generally includes an impact handle22, a coring or harvesting member24, a plunger25, and a quick-release collet26. As described in further detail herein, the quick-release collet26can be selectively affixed to the handle22and also quick releasingly engages the harvesting member24. The quick-release collet26can also be used to engage a reamer, as further described herein. Nevertheless, the coring instrument20can be used to core a selected boney portion in a selected procedure.

With reference toFIGS. 2 and 3, each portion of the instrument20may be dismantled or disassembled from the other portion. That is, the handle22is generally removably connected to the collet26with an appropriate mechanism. The collet26includes a engageable portion or chuck engageable member28. The chuck engageable member28is generally received within a sleeve30of the collet26. The chuck engageable portion28extends from a first or proximal end32of the sleeve30while a second end or tool engageable portion34of the collet26extends from a distal end35of the collet26.

The tool engageable portion34generally engages a selected portion of a tool such as the harvesting member24. Therefore, each of the portions, the handle22, the collet26and the harvesting member24may be disengaged at a selected time. This allows for the collet26and the harvesting member24to be removed from the handle22after the selected core is taken, as described herein. In addition, it allows for the harvesting member24to be used with any appropriate graspable member rather than only the handle22.

Nevertheless, the chuck engageable portion28allows the handle22to securely engage the collet portion26for manipulation of the harvesting member24.

The collet26may be generally triangular in shape. This allows for easy manipulation by user, such as a surgeon, during the use of the instrument20. Nevertheless, it will be understood that the collet26may be any appropriate shape, such as generally cylindrical and include portions that are knurled to allow for easy manipulation of the instrument.

With further reference toFIG. 3, the collet26may be a quick-release collet. Although the chuck engageable portion28may be substantially permanently or selectively engaged in a selected tool, the distal portion35of the collet26, including the portions included therein, are designed to allow for a generally substantially quick-release of the tool, such as the harvesting member24from the collet26. Therefore, the harvesting member24may be pressed into the collet26and held therein for a use without the need of other manipulation.

To this end, the internal mechanisms of the collet26may be any generally known quick-release mechanism. The following is merely exemplary, and not intended to limit the scope of the appended claims. An exemplary quick-release mechanism may include a compression spring36, a dowel pin38, a ball bearing40which are generally housed within or interact with collar42.

The chuck engageable portion28and the tool engaging portion34are generally integrally formed as a single unit. Nevertheless, it will be understood that they may be formed of two or more portions. Regardless, the chuck engageable portion28and the tool engaging portion34generally define a member44that is held within or interacts with the collar42. The collar42may be held or secured within a central chamber or bore46formed within the sleeve30. The compression spring36allows for the collar42and the member44to move axially in the direction of arrow A relative to the sleeve30. The compression spring36biases the member44towards the distal end35of the collet26prior to insertion of the harvesting member24. As described herein, pressure from insertion of the harvesting member24into the distal end35of the collet26moves the collar42and allows for interaction of the pin38and the bearing40to generally interconnect the harvesting member24with the collet26and in turn the handle22.

The harvesting member24, with reference toFIGS. 4A and 4B, generally defines a coring or sharpened end or portion50and a collet engaging end52. The collet engaging end52generally includes openings or apertures54that are able to engage selected portions of the collet26, such as the bearings40. An additional aperture56is provided to engage the pin38within the collar. Therefore, as the harvesting member24is passed over and may encompass at least a portion of the tool engaging portion34, the pin engaging portions56are able to engage the pin38and the bearing apertures54are generally engaged by the bearings40.

The pin engaging portions56allow for the pin38to interact with harvesting member24such that a torque may be passed from the collet portion26, or from the chuck engaging member28to the harvesting member24. The bearing apertures54, in addition and alternatively to the pin38, interact with the bearings40to assist in alignment of the harvesting member24with the collet26. As the harvesting member24is pressed over to encompass at least a portion of the collar42, it engages a shoulder or coring engaging portion58to press the collar42towards the proximal end32of the sleeve30. As this occurs, the bearings40are able to pass through the bearing apertures54and engage a bearing locking depression60formed within the sleeve30. At this position, the bearings are generally able to hold the collar42in a selected position relative to the sleeve30which, in turn, holds the harvesting member24in the selected position relative to the sleeve30for the operation of the harvesting member24. The compression spring36provides tension to the mechanism to allow for the bearings40to generally engage and hold the mechanism in a selected position. Nevertheless, the bearings40are generally allowed to move a distance and may further include a compression spring held near the bearing40. With the application of a selected force, such as pulling the harvesting member24towards the distal end35of the sleeve30, the bearings40may disengage from the depression60to allow for removal of the harvesting member24from the collet26.

The member44, including the chuck engageable portion28and the tool engaging portion34generally define a cannula62. Similarly, the harvesting member24generally defines a cannula64. The two cannula62,64are generally aligned after forming the interconnection of the harvesting member24with the collet26, for reasons described herein.

With additional reference toFIGS. 4A and 4B, the harvesting member24is generally elongated and is formed of a selected material that defines the internal cannula64. The internal cannula64defined by the harvesting member that defines a tube24is substantially equal in diameter, or a selected distance, between the cutting end50and the collet engaging end52. As an example, the internal cannula64being of a substantially equal distance throughout may allow any material positioned therein to be removed from either the cutting end50or the collet engaging end52. Therefore, the material positioned therein can be removed if either of the two ends becomes damaged or blocked due to other reasons.

The cutting end50is generally tapered and includes a sharpened portion or cutting edge66. The cutting edge66may be used to cut a selected portion, such as a selected bone portion. In addition, on an exterior of the harvesting member24may be demarcations68that may include any appropriate scale. For example, markings may be included at approximately 10 mm intervals such that markings at 10, 20, 30, 40 mm are provided on the exterior of the harvesting member24. The demarcation68may be used to provide or select a length or depth of a core portion. A user may view the markings68on the exterior of the harvesting member24to determine the depth of the harvesting member24within the selected member. It will be understood, that the harvesting member24may be formed of any appropriate material. For example, various biocompatible metals may be used that may be easily formed and sharpened to form the sharpened edge66. Various alternatives may also include ceramics and polymers.

With reference toFIG. 5, the plunger25is illustrated. The plunger25generally includes a shaft72and a plunger end or portion74. The plunger portion74is generally similar in exterior diameter to the interior diameter of the cannula64defined by the harvesting member24. The shaft72may be any appropriate size, but is generally sized to allow for a rigid interaction with the plunger portion74and any harvested or selected bone portion. In addition, the harvester shaft72may be bent or sized to provide for an interference fit with the member44within the collet26. The shaft portion72of the plunger25may pass through the cannula defined by the handle22, the collet26, and the member44including the chuck engageable portion28and the tool engageable portion34. In addition, the plunger shaft72may also include markings76to provide for an indication to a user. Again, the markings76may be provided at any appropriate definition, such as 5 or 10 mm. As described herein, the markings76allow a user to determine the length of a core or harvested portion that is harvested or being positioned back into a body.

With references toFIGS. 6 and 7, a harvesting member80according to an alternative embodiment is illustrated. The harvesting member80generally includes an extended body portion82that defines a cannula84. As discussed above in relation to the tube64, the cannula84of the tube80may be substantially equal in a dimension, such as a diameter, between the cutting or distal end94and the collet engaging end88. A proximal end of the harvesting member80includes a collet engaging end88that defines a pin engaging portion90and bearing engaging apertures92. The harvesting member80also defines a distal end94that includes a cutting portion96. The cutting portion96defines a plurality of cutting teeth98. The cutting teeth98may be defined in any appropriate manner such that they may be rotated to harvest a selected portion of bone. Therefore, the harvesting member80can be rotated to harvest a selected portion of bone which can be collected within the cannula84defined by the shaft portion82. It will be understood that markings, such as depth markings, may also be included on the exterior of the harvesting member80.

The harvesting member80may be rotated by a selected tool, such as a drill or other commonly known rotating apparatus. Therefore, the harvesting member80is not necessarily used with the handle22, but may be used with a cannulated drill. Nevertheless, the collet26can engage the pin apertures90and the bearing apertures92while the chuck engaging portion28of the collet26engages a chuck of a tool or drill. Therefore, the harvesting member80can be used in addition or alternatively to the harvesting member24to create a selected core portion, but still with the quick-release collet26.

It will be understood that various changes may be made to the tools described above to perform a selected reaming and coring apparatus or method. The following method, described with reference toFIGS. 8-13, may be followed with the instruments described above. Nevertheless, it will be understood that any appropriate method may be used to provide a selected core for a selected procedure. In addition, although the following description relates generally to a method to perform an ACL replacement, it will be understood that the instruments may be used for any appropriate method and the method may be altered depending upon selected portions which are being cored and implanted.

With initial reference toFIG. 8, the instrument20is first prepared for use by interconnecting the handle22with the collet26and the harvesting member24. In addition, the plunger25is positioned through the cannula defined by the harvesting member24, the collet26, and the handle22. The plunger25may be designed such that a portion of the shaft72extends from the proximal end of the handle22before insertion or does not extend at all. Generally, when the harvesting member24is provided, the handle22is used as a striking surface to force the harvesting member24into the bone to be cored. Therefore, providing the plunger25to extend through the handle22may disrupt the ability to strike the proximal end of the handle22.

With reference toFIG. 9, an exemplary procedure may include an anterior cruciate ligament (ACL) reconstruction. As discussed above, an ACL construction is simply exemplary as the general process described herein can be used to remove a bone core from any selected portion of the anatomy, such as from the femur, from a humerus, or any other appropriate bone portion. In addition, the bone core may be removed from any appropriate bone portion and positioned in the appropriate bone portion for any selected procedure and not simply only an ACL reconstruction. Therefore, a selected knee joint100can be first prepared for the procedure. First, an incision102may be formed in the soft tissue104surrounding the knee joint. After the incision102is formed, a reamer106may be used to ream a selected portion of a tibia108. Appropriate reamers106are generally known and need not be described in detail herein. Also, techniques for guiding and providing a bore110formed by the reamer are also generally known and not described in detail herein. One generally skilled in the art will understand the various methods that may be used to form the bore110in addition to the methods described herein. According to one embodiment, the reamer106may be used to ream through the cortex bone of the tibia108.

The reamer106may only provide a bore through the cortex bone prior to the use of the instrument20. It will also be understood that the instrument20may be used to form a bone core in any appropriate location. Although the following description describes providing a bore formed using the instrument20relative to a bore formed by the reamer106, it will be understood that a bone core may be harvested from any appropriate bone portion and is only exemplary described to be removed from the tibia. Thus, the reamer106may form the entire bore110through which the soft tissue graft will be passed. In addition the instrument generally forms a bone core including substantially bone material. Therefore, the reamer106may ream both the initial portion of the bore110and the final portion to ensure that the bone core consists substantially of bone.

Nevertheless, the reamer106may also remove the distal end of the bore110therefore the instrument20only removes a portion of the cortical bone to form a portion of the bore110. That is, that the instrument20may produce a bone core including any appropriate portion or selection of bone material while a separate instrument, such as the reamer106, may be used to remove other portions of the anatomy, such as the soft tissue adjacent the bone core being removed.

It will also be understood that the incision102may be any appropriate size, but is generally between about 1 cm to about 10 cm. Therefore, the procedure may be augmented with an arthroscope that is either passed through the incision102or other appropriate incisions. Nevertheless, the reamer106may be guided with a guide wire112over which the instrument may also pass. Therefore, the guide wire112may be used to guide the coring instrument26as it passes into the tibia108to harvest a core therefrom.

The instrument20may be used to harvest a core by positioning the coring instrument20relative to the tibia108and striking a proximal end of the handle22with a mallet or other appropriate instrument114. The instrument20may be struck several times to provide a core of a selected depth. As discussed above, the markings on the exterior of the coring instrument20may be used to determine the depth at which the harvesting member24has penetrated the tibia108. The markings may be viewed either through the incision102or through a selected arthroscope or other viewing instrument. In addition, the markings may be radio opaque so that a fluoroscopy or other appropriate techniques may be used to view the depth indications on the harvesting member24. After the harvesting member24has passed the selected distance into the tibia108, the harvesting member24may be loosened or removed from the bone by rotating the instrument20. A rotation may break off the core portion that is positioned within the cannula64defined by the harvesting member24.

As mentioned above, the instrument20is able to form the bore110through which the soft tissue graft may be passed to provide for the interconnection of the selected bone portions. Therefore, as the core is harvested from the tibia108with the harvesting member24, the harvesting member24is also forming the bore110. Although the reamer106forms an initial portion of the bore110, the harvesting member24provides the final bore110by removing the selected core portion. It is this core portion that may be replaced into the bore110at a selected time, as described herein. Nevertheless, the bore110may be formed entirely with the reamer106and a selected bone core harvested from an alternative area to be replaced into the bore110. Therefore, it is not necessary to harvest the bone core from the bore110but may be harvested from any appropriate location.

It will be understood that as the harvesting member24is driven into the tibia108, it substantially surrounds and collects within the cannula64a selected core portion. Therefore, the only portion of the bone core still attached to the tibia108is the portion at the distal end of the harvesting member24and rotating the instrument20may allow for removal of the instrument20from the tibia108while retaining the core within the harvesting member24.

According to an alternative harvesting member80rotating core instrument80may be used to provide or harvest a core in a similar manner. Although, the rotating harvesting member80need not be struck with the mallet114, it may be provided to obtain a core from a selected bone portion. Although not specifically illustrated, the rotating harvesting member80can be provided on a drill and guided with a guide wire112to harvest the core from the tibia108. The sawteeth98are generally able to cut through the bone of the tibia108to provide a substantially clean cut of the bone and provide the core within the cannula84of the harvesting member80. Also the use of the rotating harvesting member80may eliminate the need for initially reaming a selected portion of the tibia. That is, the sawteeth98of the harvesting member80may be able to pass through the cortex bone of the tibia108. Nevertheless, it may be desirable to ream the cortex portion of the bone regardless such that it is not repositioned into the bore110.

With reference toFIG. 11, after the instrument20has been removed from the knee joint100, the collet26may be removed from the handle22to reveal the plunger25, and particularly, the shaft72thereof. The markings76can be read on the shaft72of the plunger25to assure that a selected length of a core116of the tibia18has been received. The markings76are generally read relative to a plane A which is defined by a proximal end of the chuck engageable portion28. It will be understood that the markings76may be formed relative and read relative to any appropriate portion of the assembly or any other selected region, but is generally provided that the markings76may be read relative to the plane A. The core116of bone is trapped within the cannula64and the plunger portion74generally rests on an end thereof. Therefore, the markings76on the plunger25can verify the depth of the core116in addition to the markings formed on the exterior of the harvesting member24.

With reference toFIG. 12, after the core116has been taken, the bore110is substantially completed. After this, a soft tissue graft120may be passed through the bore110according to appropriate and generally known techniques. In addition, the graft may be fixed to the tibia108with generally known techniques such as with a washer lock122described in U.S. Pat. No. 6,280,472 and commonly assigned, incorporated herein by reference. Therefore, the soft tissue graft120may be fixed to the tibia108through any appropriately or known techniques. Nevertheless, after the soft tissue graft has been fixed with the washer lock122, or any other device to the tibia108, the core116may be repositioned into the bore110to provide for additional fixation and assist in eliminating tunnel or bore dilation.

According to an embodiment, the bore110may first be dilated or enlarged from the diameter formed by the harvesting member24. The end of the bore110is enlarged to allow replacement of the core116in a substantially easy manner. The bore110may be dilated through any appropriate technique, such as with an expander. Nevertheless, the bore110is generally enlarged just enough to allow for replacement of the harvesting member20and appropriate protecting portions, describing herein, into the bore110to allow for implantation of the harvested core116.

After the bore110has been dilated, bone chips, such as chips formed during reaming of the bore110may be provided and impacted in the bore110. After this has occurred, the bone core116may be provided into the bore110. With reference toFIG. 13, a protective sleeve130can be positioned over the cutting end of the harvesting member24. This ensures that the harvesting member24does not again pass into the bore110or cut the soft tissue graft120that has been fixed to the tibia108. In addition, the dilation of the bore110allows for the positioning of the protective sleeve130into the bore110and still allowing for the positioning of the harvesting member24relative thereto. After the protective sleeve130is positioned on the harvesting member24, it may be positioned back into the bore110, generally through the incision102. The plunger25may then be used as a striking surface to be struck with the mallet114to force the bone core116out of the harvesting member24and into the bore110. Therefore, the core116can be positioned back into the bore110from which it was removed to further fix the soft tissue graft120in the bore110.

It will be understood that a generally friction fit between the core116and the tibia108is formed as it forced back into the bore110. Nevertheless, additional fixation media can be used to assure a substantially permanent fixation between the core116and the bore110. For example, additional screws and pins may be implanted to fix the bone therein or materials, such as bone cement or bone glue, may be used to further fix the core116in the selected position.

Nevertheless, the core116generally allows for a osteoinduction of bone back into the bore110to allow for a substantially permanent fixation of the soft tissue graft120in the bore110. Therefore, the soft tissue graft120can provide for an interconnection of the fibia (not numbered) to the tibia108. An ACL restruction can be performed using the soft tissue graft120and the core116. Nevertheless, as discussed above, other appropriate methods may be performed with the instruments to provide for fixation of the selected soft tissue relative to a selected bone.

It will be understood that although the bone core116is illustrated to be positioned into the bore110defined by the tibia, it will be understood that the core116may be positioned into any appropriate portion. For example, even in the exemplary ACL replacement procedure, the bone core may be positioned into the femur to assist in fixation of the soft tissue graft therein. Alternatively, the bone core116may be positioned in any appropriate bone member depending upon the selected procedure. Furthermore, the bone core116may be taken from any appropriate bone portion and positioned in the bore110defined in the tibia. For example, it may be desired to form the bone core116from a portion of the femur and positioned in the bone core116in the bore110defined in the tibia. The bore110defined in the tibia may be defined by the instrument20or with the reamer106to provide for receiving the bone core116. Therefore, it is understood that the above described procedure is simply exemplary of any appropriate procedure that may use a selected bone core.