Abstract:
A drill guide assembly enabling a surgeon to drill a plurality of parallel tunnels in a patella in order to repair a patellar or quadriceps tendon rupture. The drill bit used with the drill guide assembly doubles as a needle for drawing the sutures through the tunnels after the tunnels are drilled. The drill guide assembly clamps securely on the patella while the tunnels are drilled and the sutures pulled. The drill guide holes are made open to one surface of the drill guide so the sutures can be freed from the drill guide after being pulled.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]     This application is a continuation-in-part of U.S. Ser. No. 11/362,301 filed Feb. 24, 2006, entitled D-TAIL PATELLAR BONE TUNNELING SYSTEM, which contains disclosure from and claims the benefit under Title 35, United States Code, §119(e) of the following U.S. Provisional Application: U.S. Provisional Application Ser. No. 60/656,574 filed Feb. 25,  2005 , entitled D-TAIL PATELLAR BONE TUNNELING SYSTEM. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT  
       [0002]     Not Applicable  
       BACKGROUND OF THE INVENTION  
       [0003]     1. Field of the Invention  
         [0004]     This invention relates generally to a medical device, and more particularly to a method and apparatus to aid in repairing a patellar or quadriceps tendon rupture.  
         [0005]     2. Background Art  
         [0006]     The U.S. Provisional Application Ser. No. 60/656,574 filed Feb. 25, 2005, entitled D-TAIL PATELLAR BONE TUNNELING SYSTEM is hereby incorporated by reference.  
         [0007]     According to the article written by Dr. Bernard C. Ong and Dr. Orrin Sherman entitled  Acute Patellar Tendon Rupture: A New Surgical Technique  in the Journal of Arthroscopic and Related Surgery, vol. 16 No. 8, patellar tendon rupture is usually remedied by making three longitudinal, parallel tunnels through the patella. Sutures are pulled through the tunnels, and connected to the tendon. The sutures are pulled tight, providing positive tendon to bone contact.  
         [0008]     The aforementioned article,  Acute Patellar Tendon Rupture: A New Surgical Technique,  is hereby incorporated by reference.  
         [0009]     Another article describing the above procedure, also hereby incorporated by reference, is  Quadriceps Tendon Rupture  by Dr. Doron I. Ilan, Dr. Mitchell Keschner, and Dr. Matthew Leibman, published in the Journal of the American Academy of Orthopaedic Surgions, vol. 11 No. 3. The tunnels are described as being two millimeter diameter holes. The sutures are tied with the knee in full extension.  
         [0010]     A drill guide assembly was disclosed in U.S. Pat. No. 4,920,958 for use in arthroscopic surgery. This drill guide provides a means for drilling a single hole before repositioning. It must be disassembled and removed before the suture may be threaded into the eyelet of the associated pin.  
         [0011]     A drill guide assembly for producing a bone tunnel is disclosed by Chan in U.S. Pat. No. 6,120,511. The design of this assembly makes it difficult to align the distal end of the unit to the target exit point on the uninjured pole of the patella.  
         [0012]     Neither of the drill guide devices disclosed in the above two U.S. Patents were designed for aiding the repair of patellar and quadriceps tendons. Additionally, securing these devices to the patella would permit the bony structure to rotate on the axis of the two-point axial fixation arrangement. Because an injured patella is a free floating bone with only one attached tendon, the patella becomes very difficult to manipulate with only two points of the drill guide secured.  
         [0013]     There is, therefore, a need for a drill guide made for assisting in the repair of patellar and quadriceps tendons providing solid securing. There is a further need for a drill guide making it possible to drill a plurality of parallel tunnels without removing the drill guide. Additionally, there is a need for a drill guide that may be left attached while the sutures are pulled, with provision to remove the drill guide and free the sutures from the drill guide. There is another need for a drill guide wherein the drill bit is used to pull the sutures through the tunnels.  
       BRIEF SUMMARY OF THE INVENTION  
       [0014]     The drill guide assembly of the present invention comprises two major components. The first of these components is the drill guide block, comprising a plurality of apertures through which the drill is passed when drilling and pulling sutures. The second component is a retainer which engages a pole of the patella opposite the pole engaged by the drill guide block.  
         [0015]     An object of the present invention is to provide a secure drilling jig or guide for drilling a plurality of parallel tunnels for the purpose of repairing a quadriceps or patellar tendon rupture. To effect the securing of the drill guide, a plurality of pins, integral with the drill guide block, engages the injured pole of the patella. At the opposite patellar pole, a plurality of pins associated with the retainer also engages the bony structure. By sliding the retainer relative to the drill guide block, the distance between these sets of pins may be adjusted. Hence, the drill guide assembly may be squeezed down onto the patella for a secure mounting of the drill guide assembly.  
         [0016]     The retainer is held in a fixed position relative to the drill guide block by a locking mechanism. The locking mechanism may be released to spread the retainer pins from the drill guide block pins for installation onto or removal from the patella.  
         [0017]     Another object of the present invention is to provide a drill guide assembly enabling a practitioner to drill a plurality of parallel tunnels through the patella. In the preferred embodiment, drill guide holes for three parallel tunnels are provided. The drill bit is engaged in one of the drill guide holes in the drill guide block. The drill guide hole comprises a diameter slightly greater than the drill bit, so the drill bit slides easily into the aperture, but is positively guided within the aperture.  
         [0018]     An additional object of the present invention is to allow all the plurality of tunnels to be drilled, and the sutures pulled through the tunnels before disengaging the drill guide assembly and removing the same. To effect this object, grooves are provided in the drill guide block that open the drill guide holes along their entire lengths to the region outside the drill guide block. After the sutures are pulled through the apertures and the drilled tunnels, the drill guide assembly is released and removed. The sutures pass through the grooves and are thereby freed from the drill guide block.  
         [0019]     Still another object of the present invention is to provide a patellar drill guide system whereby the drill bit is also used to pull the sutures. In the preferred embodiment, the tunnel is drilled and the drill bit pushed through the tunnel while still under power of the drill until a significant length of the drill bit extends out the patella. The drill bit is then removed from the drill and a suture engaged into an eye provided in the back end of the drill bit. The drill bit, with the suture, may now be pulled through the tunnel to pull the suture through the tunnel. 
     
    
     BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS  
       [0020]      FIG. 1  is a side elevation view of the drill guide assembly;  
         [0021]      FIG. 2  is a plan view of the drill guide assembly;  
         [0022]      FIG. 3  is a rear elevation view of a drill guide block and tower;  
         [0023]      FIG. 4  is a top plan view of the drill guide block and tower;  
         [0024]      FIG. 5  is a side elevation view of the drill guide block and tower;  
         [0025]      FIG. 6  is a top plan view of the retainer;  
         [0026]      FIG. 7  is a side elevation view of the retaining guide;  
         [0027]      FIG. 8  is the retainer viewed from the receiving end;  
         [0028]      FIG. 9  shows the drill bit;  
         [0029]      FIG. 10  is a detail of the drill bit;  
         [0030]      FIG. 11  is a perspective view of the drill guide block, tower, drill bit, and sutures;  
         [0031]      FIG. 12  shows a portion of the skeletal structure of a knee with the drill guide assembly installed for use; and  
         [0032]      FIG. 13  shows a portion of the skeletal structure of a knee with the drill guide assembly removed and sutures passed through the tunnels. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0033]     With reference now to the various figures in which identical elements are numbered identically throughout, a description of various exemplary aspects of the present invention will now be provided. The preferred embodiment is shown in the drawings and described with the understanding that the present disclosure is to be considered an exemplification of the invention and is not intended to limit the invention to the embodiments disclosed. Any references, herein, to directions will be determined by the associated figure.  
         [0034]     The bone tunneling drill guide assembly  100  is shown assembled in  FIGS. 1 and 2  and comprises a drill guide member  110  and a retainer  120 . The retainer  120  is slidably engaged to the drill guide member  110  and may be locked in place with a locking mechanism  130 . Ultimately, the patella  1210  (see  FIG. 12 ) is engaged between retainer pins  140  and drill guide member pins  150  in use.  
         [0035]     The drill guide member  110  is detailed in  FIGS. 3-5 . The drill guide member  110  comprises a drill guide block  310  and a retainer receiver  320 , integral with one another or rigidly connected together. The drill guide block  310  includes three drill guide holes  330  for receiving the drill bit. A groove  340  is formed between each of the three drill guide holes  330  and the bottom surface  350  of the drill guide block  310  to allow for suture  1110  release (see  FIG. 11 ). On the inside of the drill guide block  310 , the four drill guide member pins  150  are shown spaced between the guide holes  330 . The retainer receiver  320  has an aperture  360  into which the retainer  120  is slidably engaged. At the top of the retainer receiver  320 , a spring loaded locking mechanism  130  is provided to lock the retainer  120  at a desired position for use.  
         [0036]     The retainer  120  is detailed in  FIGS. 6-8  and comprises locking grooves  610  and an alignment post  710 . The plurality of locking grooves  610  encompasses at least a portion of the top of the retainer  120 . The locking grooves  610  are engaged by the locking mechanism  130 .  
         [0037]     The alignment post  710  extends from the receiving end of the retainer  120  downward at a predetermined length. At the lower end of the alignment post  710  there is an exit recess  810  through which the drill bit  910  (see  FIG. 9 ) passes. On the sides of the exit recess  810  are the pointed retainer pins  140 .  
         [0038]     The drill bit  910  comprises three flutes  920  of a predetermined length. The tail  930  is designed with an eye  940  of an appropriate diameter for securing suture  1110 , as shown in  FIG. 11 , in preparation of passing the suture  1110  through the bone tunnels  1310  ( FIG. 13 ). The tail  930  of the drill bit  910  is tapered as detailed in  FIG. 10 .  
         [0039]     In operation the surgeon uses the system of the present invention to create the bone tunnels  1310  necessary and provide a means of suture  1110  passing for the repair of a patellar or quadriceps tendon rupture. Before the surgeon applies this system to the procedure, the approach and soft tissue preparation must first be performed in the usual fashion, well known to those versed in the art. After the approach and soft tissue are prepared, the surgeon assembles the bone tunneling drill guide assembly  100  by placing the retainer  120  and drill guide member  110  together as per  FIGS. 1, 2 , and  12 . The retainer  120  will slide into the aperture  360  of the retainer receiver  320  and begin to lock into the locking mechanism  130 . The surgeon will place the retainer pins  140  of the retainer  120  into the uninjured pole of the patella  1210  centered in the anterior-posterior plane as well as in the medial-lateral plane. Then the surgeon will continue locking the bone tunneling drill guide assembly  100  by squeezing the alignment post  710  and the drill guide member  110  toward one another until contact is made between the injured pole of the patella  1210  and the drill guide member pins  150  of the drill guide member  110 . The drill guide member pins  150  should also be centered in the anterior-posterior plane as well as in the medial-lateral plane. After proper placement of all the pins  140 ,  150  has been established, the surgeon must then squeeze the bone tunneling drill guide assembly  100  together a final time to engage all the retaining pins  140 ,  150  deeper into the patella and complete the locking process. At this point, the bone tunneling drill guide assembly  100  is ready for the insertion of the drill bit  910 . The tail end  930  of the drill bit  910  is placed into a pin driver  1220  of a surgical drill and the opposite end of the drill bit  910  is inserted into a receiving end of the drill guide member  110  through one of the three drill guide holes  330 . Under the rotation provided by the surgical drill, the drill bit  910  is pushed through the patella  1210  until a generous amount of the fluted end of the drill bit  910  protrudes through the uninjured pole of the patella  1210 . The drill bit  910  is then separated from the pin driver  1220  and the suture  1110  is threaded through the eye  940  in the tail  930  of the drill bit  910 . The drill bit  910  is now ready for passing the suture  1110  and should be grasped by the fluted end and pulled out of the patella  1210  from the uninjured pole of the patella  1210  using the surgeon&#39;s tool of choice such as a pin puller (not shown). This step will pass the suture  1110  through the patellar tunnel  1310 , as shown in  FIG. 13 , releasing it on the proper end for securing. The drill bit  910  is again placed into the pin driver  1220  of the surgical drill and the opposite end of the drill bit  910  inserted into the receiving end of the drill guide member  110  through a second of the three drill guide holes  330  and the process repeated to produce a total of three patellar tunnels  1310 . Once three patellar tunnels  1310  have been produced and the sutures  1110  pulled through all three patellar tunnels  1310 , the bone tunneling drill guide assembly  100  may be removed from the patella  1210 . Upon removal of the bone tunneling drill guide assembly  100 , the locking mechanism  130  must first be released to free the retainer  120  from the drill guide member  110 . The two components  110 ,  120  must be separated completely leaving the drill guide member  110  in place on the patella  1210 . The sutures  1110  must now be drawn through the grooves  340  at the bottom of the guide holes  330  in order to withdraw the drill guide member  110  from the surgical field. The surgeon may continue the surgical procedure in the usual fashion to complete the repair of a patellar or quadriceps tendon rupture.