Abstract:
The present disclosure relates to bone resurfacing. One embodiment includes a method for preparing an implant site in bone, comprising establishing a first working axis extending from said bone; establishing a second working axis extending from said bone, the second working axis is displaced from the first working axis; creating a first socket in the bone by reaming about the first working axis; and creating a second socket in the bone, adjacent the first socket, by reaming about the second working axis.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation of U.S. patent application Ser. No. 12/397,095 (now U.S. Pat. No. 7,896,883), filed Mar. 3, 2009, which is a continuation-in-part of U.S. patent application Ser. No. 12/027,121 filed Feb. 6, 2008, which claims the benefit of U.S. Provisional Patent Application Ser. No. 60/888,382, filed Feb. 6, 2007 and which is itself a continuation-in-part of U.S. patent application Ser. No. 11/359,891 (now U.S. Pat. No. 7,713,305), filed Feb. 22, 2006, which itself is a continuation-in-part of U.S. patent application Ser. No. 10/373,463 (now U.S. Pat. No. 7,678,151), filed Feb. 24, 2003, which is a continuation-in-part of U.S. patent application Ser. No. 10/162,533 (now U.S. Pat. No. 6,679,917), filed Jun. 4, 2002, which is itself a continuation-in-part of U.S. patent application Ser. No. 10/024,077 (now U.S. Pat. No. 6,610,067), filed Dec. 17, 2001, which is itself a continuation-in-part of U.S. patent application Ser. No. 09/846,657 (now U.S. Pat. No. 6,520,964), filed May 1, 2001, which claims the benefit of U.S. Provisional Application Ser. No. 60/201,049, filed May 1, 2000. This application is a continuation of Ser. No. 12/397,095 (now U.S. Pat. No. 7,896,883), filed Mar. 3, 2009, which is also a continuation-in-part of U.S. patent application Ser. No. 11/169,326, filed Jun. 28, 2005 which claims the benefit of U.S. Provisional Patent Application Ser. No. 60/583,549, filed Jun. 28, 2004, which is also a continuation-in-part of U.S. patent application Ser. No. 10/994,453 (now U.S. Pat. No. 7,896,885), filed Nov. 22, 2004 which claims the benefit of U.S. Provisional Patent Application Ser. No. 60/523,810, filed Nov. 20, 2003, which is also a continuation-in-part of U.S. patent application Ser. No. 10/308,718, filed Dec. 3, 2002 (now U.S. Pat. No. 7,163,541). This application is a continuation of Ser. No. 12/397,095 (now U.S. Pat. No. 7,896,883), filed Mar. 3, 2009, which also claims the benefit of U.S. Provisional Application Ser. No. 61/033,136, filed Mar. 3, 2008. The entire disclosures all applications and/or patents are incorporated herein by reference. 
     
    
     FIELD 
       [0002]    This disclosure relates to devices and methods for the repair of bone surfaces, and particularly to bony articulating joint surfaces. 
       BACKGROUND 
       [0003]    Articular cartilage, found at the ends of articulating bone in the body, is typically composed of hyaline cartilage, which has many unique properties that allow it to function effectively as a smooth and lubricious load-bearing surface. When injured, however, hyaline cartilage cells are not typically replaced by new hyaline cartilage cells. Healing is dependent upon the occurrence of bleeding from the underlying bone and formation of scar or reparative cartilage called fibrocartilage. While similar, fibrocartilage does not possess the same unique aspects of native hyaline cartilage and tends to be far less durable. 
         [0004]    In some cases, it may be necessary or desirable to repair the damaged articular cartilage using an implant. While implants may be successfully used, the implant should have a shape substantially corresponding to the articular cartilage proximate the area where the implant is to be placed in order to maximize the patient&#39;s comfort, minimize damage to surrounding areas, and maximize the functional life of the implant. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0005]    Features and advantages of the present invention are set forth by description of embodiments consistent with the present invention, which description should be considered in conjunction with the accompanying drawings wherein: 
           [0006]      FIG. 1  is a plain view illustrating an excision; 
           [0007]      FIG. 2  is a plain view of a drill guide and a tip; 
           [0008]      FIG. 3  is a side view of the drill guide of  FIG. 2  disposed about the articular surface; 
           [0009]      FIG. 4  is a side view of a pin and the drill guide of  FIG. 2 ; 
           [0010]      FIG. 5  is a plan view of centering shaft and the pin of  FIG. 4 ; 
           [0011]      FIG. 6  is a side view of the centering shaft of  FIG. 5  and the pin of  FIG. 4  disposed about the articular surface; 
           [0012]      FIG. 7  is a plan view of a contract probe, the centering shaft of  FIG. 5 , and the pin of  FIG. 4 ; 
           [0013]      FIG. 7   a  is an enlarged view of measuring indicia of the contract probe of  FIG. 7 ; 
           [0014]      FIG. 8  depicts measurements taken along the anterior-posterior (AP) plane and the medial-lateral (ML) plane using the contact probe of  FIG. 7 ; 
           [0015]      FIG. 9  depicts a sizing card; 
           [0016]      FIG. 10  is a side view of a surface reamer, the centering shaft of  FIG. 5 , and the pin of  FIG. 4 ; 
           [0017]      FIG. 11  is a cross-sectional view of a surface reamer of  FIG. 10 , the centering shaft of  FIG. 5 , and the pin of  FIG. 4 ; 
           [0018]      FIG. 12  is a perspective view of a guide block and a drill guide; 
           [0019]      FIG. 13  is a side plan view of the guide block and drill guide shown in  FIG. 12 ; 
           [0020]      FIG. 14  is a side plan view of the guide block and drill guide shown in  FIG. 12  disposed about the articular surface; 
           [0021]      FIG. 15  is a side plan view of the guide block and drill guide shown in  FIG. 13  including additional pins; 
           [0022]      FIG. 16  is a side plan view of the guide block and drill guide shown in  FIG. 15  being removed; 
           [0023]      FIG. 17  is a side plan view of the pins disposed about the articular surface and a reamer; 
           [0024]      FIG. 17   a  is an enlarged view of the shoulder/stop of the reamer of  FIG. 17 ; 
           [0025]      FIG. 18  is a side plan view of an implant sizing trial; 
           [0026]      FIGS. 19 and 20  are a side and end plan view of the implant sizing trial of  FIG. 18  disposed about the articular surface; 
           [0027]      FIG. 21  is a perspective view of a pilot drill and the implant sizing trial of  FIG. 18 ; 
           [0028]      FIG. 22  is a side plan view of the pilot drill of  FIG. 21  disposed about the articular surface; 
           [0029]      FIG. 23  is a perspective view of a step drill; 
           [0030]      FIG. 24  is a perspective view of a tap; 
           [0031]      FIG. 25  is a perspective view of a tapered post and a driver; 
           [0032]      FIG. 26  depicts the tapered post of  FIG. 25  disposed about the articular surface; 
           [0033]      FIG. 27  depicts the tapered post of  FIG. 25  and the implant sizing trial of  FIG. 18  disposed about the articular surface; 
           [0034]      FIGS. 28-29  depict the tapered post of  FIG. 25  being fully advanced within the articular surface; 
           [0035]      FIG. 30  depicts a reamer disposed about the tapered post of  FIG. 25 ; 
           [0036]      FIG. 31  is the bone-facing surface of an implant; 
           [0037]      FIG. 32  is the bone-facing surface of an implant of  FIG. 31  with an adhesive; 
           [0038]      FIG. 33  depicts the implant of  FIG. 31  mating with the tapered post of  FIG. 25 ; 
           [0039]      FIG. 34  is a perspective view of a guide handle assembly; 
           [0040]      FIG. 35  is a plan view of a guide handle assembly of  FIG. 34 ; 
           [0041]      FIG. 35   a  is an enlarged cross-sectional view of the guide handle assembly of  FIG. 35 ; 
           [0042]      FIG. 36  is a perspective view of the guide handle assembly of  FIG. 34  and a driver; 
           [0043]      FIG. 36   a  is an enlarged cross-sectional view of the guide handle assembly and the driver of  FIG. 36 ; 
           [0044]      FIG. 37  depicts the tapered post being advanced along the guide pin; 
           [0045]      FIG. 37   a  is an enlarged cross-sectional view of  FIG. 37 ; 
           [0046]      FIG. 38  is a perspective view of a trial, placement gauge, and guide handle; and 
           [0047]      FIG. 39  is a side plan view of the trial, placement gauge, and guide handle of  FIG. 38  disposed about the articular surface. 
       
    
    
     DETAILED DESCRIPTION 
       [0048]    As an overview, the present disclosure is directed to systems and methods for bone resurfacing and for preparing an implant site to resurface bone. While the following detailed description will proceed with reference to resurfacing the femoral condyle of the knee joint, the concepts, methodologies and systems described herein may be applied to any bony surface, for example, articulating joints of the ankle, hip and/or shoulder. In at least one embodiment, the present disclosure may feature a system and method for resurfacing at least a portion of an articular surface having a defect by replacing a portion of the articular surface with an implant. The implant may comprise a load bearing surface having a contour and/or shape substantially corresponding to the patient&#39;s original articular surface about the defect site which may be configured to engage an adjacent articular surface. The present disclosure will describe a system and method for replacing a portion of the articular surface of the femoral condyle; however, it should be understood that the system and method according to the present disclosure may also be used to resurface articular surfaces other than the femoral condyle. 
         [0049]    As an initial matter, many of the devices described herein comprise cannulated components configured to be arranged over other components. The degree to which the cannulated passageway (i.e., internal diameter of the passageway/cavity) of a first component corresponds to the external diameter of the component over which it is being placed may be close enough to generally eliminate excessive movement. Excessive movement may be defined as an amount of movement that may result in misalignment of the implant relative to the articular surface. 
         [0050]    Referring now to  FIG. 1 , an incision  10  may be created proximate the patient&#39;s knee  12  to provide access to the defect  14  on the patient&#39;s articular surface  16 , for example, using a scalpel  18  or the like. Once the incision  10  is created, a drill guide  20 ,  FIG. 2 , may be advanced against the articular surface  16 . The drill guide  20  may include a cannulated shaft  22 , a proximal end  23  comprising an AP arcuate shaped tip  24  and a first and a second ML prong  26   a ,  26   b , and optionally a handle  28 . The AP arcuate shaped tip  24  may include two ends  30   a ,  30   b  which may be generally aligned in a first plane and the ML two prongs  26   a ,  26   b  may be arranged in a second plane. These two planes may be configured to be substantially perpendicular to each other as shown. In addition, the AP arcuate shaped tip  24  and the two ML prongs  26   a ,  26   b  may be both coupled to the shaft  22  of the drill guide  20  and moveable with respect to each other by way of a biasing device (not shown) such as a spring or the like. 
         [0051]    Turning now to  FIG. 3 , because the AP arcuate shaped tip  24  and the two ML prongs  26   a ,  26   b  are moveable with respect to each other, the drill guide  20  may be advanced against the articular surface  16  until the ends  30   a ,  30   b  of the AP arcuate shaped tip  24  contact the articular surface  16  generally along the anterior-posterior (AP) plane of the articular surface  16  and the two ML prongs  26   a ,  26   b  contact the articular surface  16  generally along the medial-lateral (ML) plane of the articular surface  16 . The four points of contact (i.e., ends  30   a ,  30   b  and prongs  26   a ,  26   b ) of the drill guide  20  may be proximate, but generally not within, the defect site  14  and may be used to establish a reference axis  32  (or first working axis  32 ) extending from the bone. In one embodiment, the reference axis may extend generally approximately normal to the articular surface  16  about the defect site  14 , however, in other embodiments reference axis may extend from the bone but not necessarily normal to the bone. 
         [0052]    Turning now to  FIG. 4 , with the four points of the drill guide  20  against the articular surface, a threaded guide pin  34  may be advanced through the cannulated drill guide  20  along the reference axis  32  and into the bone beneath the defect site  14 , for example using a drill or the like. To that end, arcuate shaped tip  24  of the drill guide  20  may also include a bore or passageway aligned with the lumen in the cannulated handle. The guide pin  34  may include one or more indicia  36  (for example, but not limited to, laser markings or the like) on the shaft  38  of the guide pin  34  that may be used to control the depth of the guide pin  34  into the bone. By way of example, the indicia  36  on the guide pin  34  may be set relative to the length of the drill guide  20  such that the depth of the guide pin  34  is set when the indicia  36  is aligned with the distal end  40  of the drill guide  20  (i.e., the end opposite the AP arcuate shaped tip  24  and the ML prongs  26   a ,  26   b ). Once the guide pin  34  is coupled to the bone, the drill and the drill guide  20  may be removed leaving just the guide pin  34  coupled to the bone and extending along the reference axis  32  (i.e., substantially normal to the original articular surface about the defect site  14 ). It should be noted that the cannulated passageway of the drill guide  20  may have an internal diameter substantially corresponding to the outer diameter of the guide pin  34 . 
         [0053]    Turning now to  FIG. 5 , a centering shaft  40  may be advanced over the guide pin  34 . The centering shaft  40  may be cannulated and may comprise a tap  42  at a first end of the cannulated shaft  44 . At least a portion of the tap  42  (for example, a portion proximate the first end of the cannulated shaft  44 ) may extend radially outwardly beyond the outer surface of the cannulated shaft  44  to form a shoulder or abutting surface  45 . The centering shaft  40  may be advanced into the bone until a marking  46  (such as, but not limited to, a laser marking or the like) is substantially flush with the original articular surface  16  over the defect site  14  as generally shown in  FIG. 6 . As may be appreciated, the alignment of the marking  46  with the original articular surface  16  of the defect site  14  may have to be estimated. In addition, it should be noted that the marking  46  may not be aligned to be flush with the actual defect site  14 . 
         [0054]    Next, measurements of the patient&#39;s articular surface may be taken in order to determine the appropriate contour of the implant. Referring to  FIG. 7 , one or more contact probes  50  may be advanced over the centering shaft  40  and/or the guide pin  34 . The contact probe  50  may comprise a cannulated shaft  52  and an outrigger  54  extending radially outwardly and axially outwardly from a distal end  55  of the cannulated shaft  52 . A first and a second contact probe  50   a ,  50   b  may be provide having outriggers  54  extending radially outwardly at a distance of 40 mm and 20 mm, respectively. Of course, other distances are also possible depending on the size of the implant to be delivered as well as the geometry of the defect site  14  and/or the articular surface  16 . 
         [0055]    The contact probe  50  may also include measuring indicia  56 , which may optionally be disposed in a portion of a handle  58 . A close up of one embodiment of the measuring indicia  56  is shown in  FIG. 7   a . The measuring indicia  56  may include a plurality of measurement markings  60  indicating relative distances. In use, the contact probe  50  may be placed over the centering shaft  40  such that the distal end  62  of the outrigger  54  contacts the articular surface  16 . A measurement may be taken by based on the alignment of at least one marking on the centering shaft  40  (for example, the second end  64  of the centering shaft) with the plurality of measurement markings  60 . 
         [0056]    Turning now to  FIG. 8 , a first (and optionally a second) measurement of the patient&#39;s articular surface  16  proximate the defect site  14  may be taken along the AP plane using the first contact probe  50   a  by placing the distal end  62  of the 40 mm outrigger  54  against the patient&#39;s articular surface  16 . In addition, a first (and optionally a second) measurement of the patient&#39;s articular surface  16  proximate the defect site  14  may be taken along the ML plane using the second contact probe  50   b  by placing the distal end  62  of the 20 mm outrigger  54  against the patient&#39;s articular surface  16 . The size of the outriggers  54  may be selected based on the size of the defect site  14  such that the distal end  62  of the outrigger  54  contacts the articular surface  16  and not the defect site  14 . 
         [0057]    The measurements obtained from the contact probes  50   a ,  50   b  may be recorded onto a sizing card  70 ,  FIG. 9 . The sizing card  70  may include a first area  72  graphically representing the AP and the ML planes. In particular, a first and a second query box  74   a ,  74   b  may be provided to fill in the first and second AP measurements and a first and a second query box  76   a ,  76   b  may be provided to fill in the first and second ML measurements. The query boxes  74   a ,  74   b  may optionally be connected by a circle representing the size of the outrigger  46  of the first contact probe  50   a  while query boxes  76   a ,  76   b  may optionally be connected by a circle representing the size of the outrigger  46  of the second contact probe  50   b . The sizing card  70  may also include query boxes  78   a ,  78   b  provided to fill in the maximum values of the AP plane and the ML plane, respectively. 
         [0058]    Based on the maximum values of the AP and ML plane in query boxes  78   a ,  78   b , the offset values of the implant and test implant may be determined. As shown, the surgeon may select from a set of implants having predetermined offset values  79   a - c . The values  79   a - c  correspond to the AP measurement  79   a , ML measurement  79   b , and depth  79   c  of the implant/test implant. It should be noted that the offset values of the implant/test implant may be used in combination with known geometrical ratios of the articular surface for a particular region of the articular surface. These geometric ratios may be found in published literature and may be utilized, for example, when the implant is placed proximate the interface between the posterior and distal regions of the articular surface. If further accuracy is desired (for example, but not limited to, defects extending further towards the posterior region and/or the anterior regions of the articular surfaces), the contour of the implant and articular surface may be determined as described in U.S. patent application Ser. No. 12/027,121 entitled System and Method for Joint Resurface Repair filed Feb. 6, 2008, which is fully incorporated herein by reference. 
         [0059]    Turning now to  FIG. 10 , the diameter of a surface reamer  80  may be selected based on, for example, the maximum ML value (e.g., the value filled in query box  78   b  of sizing card  70 ). The surface reamer  80  may include a cannulated shaft  82  configured to be disposed over the centering shaft  40  and/or the guide pin  34  along the reference axis  32  and coupled to a drill  81 . The surface reamer  80  may also include one or more cutting surfaces  84  and a shoulder  86  disposed about the opening  88  of the cannulated shaft  82 . 
         [0060]    The surface reamer  80  may be advanced over the centering shaft  40  and/or the guide pin  34  along the reference axis  32  until the shoulder  86  of the surface reamer  80  abuts against the shoulder  45  of the centering shaft  40  as shown in  FIG. 11 . The contact between the two shoulders  86 ,  45  may be configured to control the depth of the excision in the articular surface. The cutters  84  may optionally be positioned about the surface reamer  80  to leave more material proximate the centering shaft  40  and/or the guide pin  34  along the reference axis  32  to facilitate removal and insertion of devices further along the method. Once the articular surface  16  has been excised about the reference axis  32 , the surface reamer  80  and the centering shaft  40  may be removed. 
         [0061]    A guide block  90 ,  FIG. 12 , may be selected based on the maximum AP measurement value taken previously (e.g., the value filled in query box  78   a  of sizing card  70 ). The guide block  90  may be used to establish one or more working axis (for example, a superior and inferior working axis) for excising the articular surface  16  on either side of the reference axis along the AP plane. The guide block  90  may include a body  92  having an arcuate shaped interior surface  94  configured to contact the articular surface  16  along at least two points (e.g., the two end regions of the guide block  90 ). The guide block  90  may comprise a first bushing  95  defining a passageway or bore sized to receive the guide pin  34 . The guide block  90  may be configured to be coupled to the drill guide  20 . For example, according to one embodiment the AP arcuate shaped tip  24  may be removed from the drill guide  20  as shown in  FIG. 12  and the guide block  90  may be coupled to the drill guide  20  with the first bushing  95  aligned with the cannulated passageway of the drill guide  20  as generally shown in  FIG. 13 . 
         [0062]    Turning now to  FIG. 14 , the first bushing  95  of the guide block  90  may be advanced along the guide pin  34  towards the articular surface  16 , for example using the drill guide  20 , such that the guide block  90  is generally aligned along the AP plane of the articular surface  16  and the ML prongs  26   a ,  26   b  of the drill guide  20  contact the bone within the excision site  98  formed by the surface reamer  80 . The guide block  90  may include a superior and inferior pin sleeve receiver  99   a ,  99   b  configured to removably receive a superior and inferior pin sleeve  100   a ,  100   b , respectively. The superior and inferior pin sleeve  100   a ,  100   b  may be provided to facilitate proper alignment of the inferior and superior working axis. 
         [0063]    For example, a first and a second threaded pin  102   a ,  102   b ,  FIG. 15 , may be advanced through the superior and inferior pin sleeve  100   a ,  100   b  (for example, using a drill or the like) along the superior and inferior axis  101   a ,  101   b . The depth of the pins  102   a ,  102   b  may be controlled using markings (for example, but not limited to, laser markings) disposed on the shaft  104  of the pins  102   a ,  102   b.    
         [0064]    Once the superior and inferior pins  102   a ,  102   b  are coupled to the bone, the superior and inferior pin sleeves  100   a ,  100   b  may be removed from the superior and inferior pin sleeve receivers  99   a ,  99   b . Turning now to  FIG. 16 , the guide block  90  may now be removed from the articular surface along the guide pin  34 . The superior and inferior pin sleeve receivers  99   a ,  99   b  may be provided with slots  104   a ,  104   b  configured to allow the superior and inferior pins  102   a ,  102   b  to pass through the guide block  90  as the guide block  90  is slid along the guide pin  34 . 
         [0065]    Once the guide block is removed and the superior and inferior pins  102   a ,  102   b  have been established, the guide pin  34  may be removed. Next, a first and a second cannulated reamer  110 ,  FIG. 17 , may be advanced over the superior and inferior pins  102   a ,  102   b  to excise a first and a second portion of the articular surface  16  about the superior and inferior pins  102   a ,  102   b . The reamer  110  may have one or more cutting surfaces  112  and may be provided with a depth stop  114  configured to control the depth of the excision sites about the superior and inferior pins  102   a ,  102   b . According to one embodiment, the depth stop  114 ,  FIG. 17   a , may comprise a shoulder or stop  116  disposed within the cannulated passageway  118  of the reamer  110 . The shoulder or stop  116  may be configured to engage with a distal end of the superior and inferior pins  102   a ,  102   b , thereby preventing the reamer  110  from being advanced any further along the superior and inferior pins  102   a ,  102   b  and controlling the depth of the excision sites. 
         [0066]    Turning now to  FIG. 18 , an implant sizing trial  120  may be selected based on the measurements taken of the articular surface  16 . The implant sizing trial  120  may comprise a shape/contour generally corresponding to the shape/contour of the implant to be delivered. The implant sizing trial  120  may comprise a threaded opening  122  configured to be concentrically disposed about the working axis  32 . The threaded opening  122  may also be configured to be threadably engaged with a cannulated shaft/handle  126 . The implant sizing trial  120  may also include superior and inferior slots  128   a ,  128   b  configured to allow the implant sizing trial  120  to be advanced over the superior and inferior pins  102   a ,  102   b  as it is inserted into the excision sites  98  in the articular surface  16 . Once the implant sizing trial  120  is inserted into the excision sites  98  in the articular surface  16 , the fitment of the implant sizing trial  120  along the AP and ML planes may be confirmed visually as generally shown in  FIGS. 19 and 20 . 
         [0067]    With the implant sizing trial  120  inserted within the excision sites  98  and the fitment confirmed, a cannulated pilot drill  130 ,  FIG. 21 , may be advanced through the handle  126  and the implant sizing trial  120  into the bone along the reference axis  32 . The pilot drill  130  may also include a depth control device such as, but not limited to, a marking (e.g., a laser marking or the like). With the cannulated pilot drill  130  secured in the bone, the implant sizing trial  120  and handle  126  may be removed and the guide pin  34  may be advanced through the cannulated passageway of the pilot drill  130  into the bone along the reference axis  32  as shown in  FIG. 22 . Again, the depth of the guide pin  34  may be controlled by way of a marking  132  (e.g., a laser marking or the like) along the shaft of the guide pin  34 . For example, the depth of the guide pin  34  may be set once the laser marking  132  is flush with the end of the pilot drill  130 . 
         [0068]    Turning now to  FIG. 23 , a cannulated step drill  134  may be advanced over the pilot drill  130  and the guide pin  34  into the articular surface  16  about the reference axis  32 . The use of the pilot drill  130  and the cannulated step drill  134  may be configured to incrementally provide a larger opening in the bone about the reference axis  32  in the articular surface  16  to reduce the potential of chipping the bone about the reference axis  32 . The cannulated step drill  134  may also include a depth stop for controlling the depth of the step drill  134  into the bone, for example, as generally described above with respect to  FIG. 17   a.    
         [0069]    Once the depth of the step drill  134  is set, the step drill  134  and the pilot drill  130  may be removed and a cannulated tap  136  may be advanced over the guide pin  34  as generally shown in  FIG. 24 . The depth that the tap  136  is advanced into the bone may be controlled based on a marking (e.g., a laser marking) on the guide pin  32 . The tap  136  may be configured to provide a threaded opening  138  in the bone about the reference axis  32  to threadably receive the implant post as will be described below. 
         [0070]    With the opening about the reference axis  32  tapped, the tap  136  may be removed and the tapered post  140 ,  FIG. 25 , may be advanced over the guide pin  34  at least partially into the threaded opening  138 , for example, using a hex driver  142 . The tapered post  140  may include a tapered and threaded first end  144  and a second end  145  having a tapered exterior surface  146 , for example, as described in U.S. Pat. Nos. 6,520,964, 6,610,067 and 6,679,917, all of which are fully incorporated herein by reference. The second end  145  may also include a hex-shaped internal cavity  147  configured to engage with a corresponding hex-shaped driver  148  of the hex driver  142 . Both the tapered post  140  and the hex driver  142  may be cannulated such that they may be advanced over the guide pin  34 . 
         [0071]    Referring now to  FIG. 26 , the tapered post  140  may be advanced along the guide pin  34  and partially inserted into the threaded opening  138  (for example, approximately half way) using the hex driver  142 . According to one embodiment, the tapered post  140  may be inserted in the threaded opening  138  such at least most of the threaded end  144  is within the threaded opening  138 . Once the tapered post  140  is partially received in the threaded opening  138 , the hex driver  142  may be removed 
         [0072]    Turning now to  FIG. 27 , the implant sizing trial  120  may be placed into the excision sites  98 . As can be seen, the second end  145  of the tapered post  140  may at least partially extend through the threaded opening  122  of the implant sizing trial  120 . Using the hex driver  142 , the implant sizing trial  120  may be fully advanced into the threaded opening  138  as generally shown in  FIG. 28 . The hex driver  142  may include a flared end  150  which may engage a shoulder  152  disposed about the opening  122  in the implant sizing trial  120  as shown in  FIG. 29 . The engagement of the flared end  150  and the shoulder  152  may control the final depth of the tapered post  140  into the threaded opening  138  in the bone. 
         [0073]    Once the tapered post  140  is fully advanced into the threaded opening  138 , the hex driver  142 , implant sizing trial  120  and superior and inferior pins  102   a ,  102   b  may be removed. Optionally, a cannulated reamer  160 ,  FIG. 30 , may be advanced over the guide pin  34  to remove any excess material about the reference axis  32 . The depth of the reaming may be controlled when the shoulder  162  of the reamer  160  contacts the end of the tapered post  140  in a manner similar to that of  FIG. 11  described above. The reaming may be provided to extra material left about the reference axis  32  during the reaming discussed with respect to  FIGS. 10 and 11 . This extra material may have been left to prevent accidental chipping during the subsequent operations. 
         [0074]    After the final reaming, the reamer  160  and the guide pin  32  may be removed leaving behind only the tapered post  140  in the bone. Next, the implant  170 ,  FIG. 31 , may be selected base on the measurements taken of the patient&#39;s articular surface  16 . As discussed previously, the implant  170  may have a load bearing surface including a contour based on the measurements taken of the patient&#39;s articular surface  16  such that the load bearing surface generally corresponds to the patient&#39;s original articular surface  16 . According to one embodiment, the implant  170  may include an implant as described in U.S. patent application Ser. No. 10/373,463 filed Feb. 24, 2003, U.S. Pat. No. 6,679,917 issued Jan. 20, 2004, U.S. Pat. No. 6,610,067 issued Aug. 26, 2003, U.S. Pat. No. 6,520,964 issued Feb. 18, 2003, and U.S. Provisional Application Ser. No. 60/201,049 filed May 1, 2000, all of which are fully incorporated hereby incorporated by reference. 
         [0075]    The bone facing surface  172  of the implant  170  may include indicia  176  representing either posterior and/or anterior sides of the implant  170 . This indicia  176  may be used by the surgeon to properly align the implant  170  along the AP and ML planes within the excision site  98 . The implant  170  may be inserted into the excision site  98  using a grasping device  178  such as, but not limited to, a suction cup coupled to a handle. 
         [0076]    Turning now to  FIG. 32 , an adhesive  180  (such as, but not limited to, bone cement or the like) may be applied to the bone facing surface  172  by way of a dispenser  182 , for example a dispenser as described in U.S. patent application Ser. No. 12/031,534 entitled Bone Cement Delivery Device filed on Feb. 14, 2008 which is fully incorporated herein by reference. The implant  170  may include a female opening configured to frictionally engage with the tapered second end of the tapered post  140 . For example, the implant  170  may be mated in the excision site  98  and to the tapered post  140  using an impactor  184  and hammer  186  as shown in  FIG. 33 . 
         [0077]    According to another embodiment, the tapered post  140  may be advanced into the bone as follows. After forming a threaded opening  138  (for example, but not limited to, as described above with respect to  FIG. 24 ), an implant sizing trial  220  may be advanced along the guide pin  34  into the excision site  98  as generally shown in  FIG. 34 . The implant sizing trial  220  may be similar to the implant sizing trial  120  described above, however, the implant sizing trial  220  according to this embodiment may include a threaded opening  222  having a diameter large enough to allow the tapered post  140  to be advanced along the guide pin  34  (and therefore the reference axis  32 ) through the threaded opening  222  and into the bone. The implant sizing trial  220  may be advanced along the guide pin  34  using a guide handle assembly  250 . The guide handle assembly  250  may include a cannulated shaft  252  to receive the guide pin  34  and may also include a flared end  254  configured to receive the tapered second end  145  of the tapered post  140 . 
         [0078]    For example, turning to  FIG. 35 , the guide handle assembly  250  and the tapered post  140  are shown together with the implant sizing trial  220 . As can be seen, the flared end  254  of the guide handle assembly  250  may be configured to engage with a shoulder  156  of the implant sizing trial  220  proximate the threaded opening  222 . Referring now to  FIG. 35   a , a close up of the flared end  254  of the guide handle assembly  250  and the tapered post  140  is shown. The flared end  254  may define an internal cavity  260  configured to at least partially receive the tapered post  140 . In particular, the internal cavity  260  may include a tapered portion  262  configured to frictional engage with the tapered second end  145  of the tapered post  140 . Additionally, as can be seen, the flared end  254  of the guide handle assembly  250  may include a shoulder  264  configured to engage against the shoulder  256  of the implant sizing trial  220 . At this point, the tapered post  140  may or may not be partially received within the threaded opening  138 . The final depth of the tapered post  140  may also not be set. 
         [0079]    Turning now to  FIG. 36 , the tapered post  140  may be partially advanced into the threaded opening  138  using a hex driver  270 . For example, the hex driver  270  may be advanced along the guide pin  34  and the reference axis  32  through the cannulated passageway of the guide handle assembly  250 . The hex driver  270 ,  FIG. 36   a , may include a male hex adapter  272  configured to engage with a corresponding female hex adapter  147  of the tapered post  140 . 
         [0080]    With the shoulder  264  of the guide handle assembly  250  abutting against the shoulder  256  of the implant sizing trial  220 , the tapered post  140  may be advanced along the guide pin  34  and the reference axis  32  as shown in  FIG. 37  using the hex driver  270 . According to one embodiment, the tapered post  140  is advanced most of the way into the bone and the depth may be set based on a marking  276  (for example a laser marking or the like) on the shaft  278  of the hex driver  270 . This marking  276  may be used to set the tapered post  140  close to the final depth in the bone, for example by aligning the marking  276  with the distal end of the guide handle assembly  250 . Alternatively, it may be possible to set the final depth of the tapered post  140  based on this marking  276  and the guide handle assembly  250 . As may be seen in  FIG. 37   a , flared end  254  of the guide handle assembly  250  may include a threaded region  277  that may engage with the threaded opening  222  of the implant sizing trial  220 . Additionally, the tapered second end  154  of the tapered post  140  may be at least partially removed from the tapered portion  262  of the flared end  254  of the guide handle assembly  250  once the marking  276  is aligned with the guide handle assembly  250 . 
         [0081]    Turning now  FIG. 38 , the hex driver  270  and the guide handle assembly  250  may be removed and a placement gauge  280  may be advanced along the guide pin  34  towards the implant sizing trial  220 . The placement gauge  280  may be used to set the final depth of the tapered post within the bone. The placement gauge  280  may be advanced along the guide pin  34  using the guide handle assembly  250 . As shown in  FIG. 39 , the placement gauge  280  may include a tapered female cavity  290  configured to engage with the tapered second end  145  of the tapered post  140  in a manner substantially the same as the implant will ultimately engage with the tapered post  140 . 
         [0082]    With the tapered female cavity  290  of the placement gauge  280  frictionally engaged with the tapered post  140 , the placement gauge  280  and the tapered post  140  may be advanced along the guide pin  34  using the hex driver  270  until a shoulder  282  of the placement gauge  280  abuts against the shoulder  256  of the implant sizing trial  220 . The final depth of the implant  140  may be set based on the implant sizing trial  140  (and in particular, the depth of the shoulder/boss  256 ) and the depth of the tapered post  140  within the tapered cavity  290  of the placement gauge  280 . 
         [0083]    Once the tapered post  140  is set in the bone, the hex driver  270 , placement gauge  280 , and the implant sizing trial  220  maybe removed. Once removed, the guide pin  34  may be removed and (if still in place), the pins  102   a ,  102   b  may also be removed. The implant may then be coupled to the tapered post  140  as generally described above. 
         [0084]    The following patents or patent applications filed by the applicant or assignee of the present invention are hereby incorporated by reference in their entireties:
       U.S. Pat. No. 6,520,964 entitled System and method for joint resurface repair;   U.S. Pat. No. 6,610,067 entitled System and method for joint resurface repair;   U.S. Pat. No. 7,029,479 entitled System and method for joint resurface repair;   U.S. Pat. No. 6,679,917 entitled System and method for joint resurface repair;   U.S. Pat. No. 7,163,541 entitled Tibial resurfacing system;   U.S. Pat. No. 7,678,151 entitled System and method for joint resurface repair;   U.S. Pat. No. 7,713,305 entitled Articular surface implant;   U.S. Pat. No. 7,510,558 entitled System and method for joint resurface repair;   U.S. Pat. No. 7,604,641 entitled System and method for joint resurface repair;   U.S. Pat. No. 7,618,463 entitled System and method for joint resurface repair;   U.S. patent application Ser. No. 12/027,121 entitled System and method for joint resurface repair;   U.S. patent application Ser. No. 10/789,545 entitled Articular Surface Implant;   U.S. patent application Ser. No. 11/461,240 entitled System and method for articular surface repair;   U.S. patent application Ser. No. 11/169,326 entitled System for articular surface replacement;   U.S. patent application Ser. No. 11/209,170 entitled System and method for retrograde procedure;   U.S. Pat. No. 7,828,853 entitled Articular surface implant and delivery system;   U.S. patent application Ser. No. 11/326,133 entitled System and method for retrograde procedure;   U.S. patent application Ser. No. 11/551,912 entitled Retrograde excision system and apparatus;   U.S. patent application Ser. No. 12/001,473 entitled Retrograde resection apparatus and method;   U.S. patent application Ser. No. 11/779,044 entitled System and method for tissues resection; and   U.S. patent application Ser. No. 12/031,534 entitled Bone cement delivery device.       
 
         [0106]    As mentioned above, the present disclosure is not intended to be limited to a system or method which must satisfy one or more of any stated or implied object or feature of the present disclosure and should not be limited to the preferred, exemplary, or primary embodiment(s) described herein. The foregoing description of a preferred embodiment of the present disclosure has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the present disclosure to the precise form disclosed. Obvious modifications or variations are possible in light of the above teachings. The embodiment was chosen and described to provide the best illustration of the principles of the present disclosure and its practical application to thereby enable one of ordinary skill in the art to utilize the present disclosure in various embodiments and with various modifications as is suited to the particular use contemplated. All such modifications and variations are within the scope of the present disclosure.