Abstract:
A collection device for collecting material during a surgical procedure includes a collection chamber defined by an encompassing wall and having an opening sufficient for permitting collection of the material during the surgical procedure. A wicking material is positioned outside the collection chamber and is in fluid association therewith sufficient to wick fluid from within the collection chamber. The device also includes a scoop wall extending from the collection chamber and having a distal end portion for positioning proximate a source of the material and for guiding the material to the collection chamber wherein the scoop wall includes curved sidewall portions that are separated from the encompassing wall such that the scoop wall is bendable with respect to the chamber.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     The present invention relates to the field of surgery, and particularly, to the field of knee surgery. More specifically, the present invention relates to a device for the harvesting of bone reamings produced during anterior cruciate ligament reconstruction surgery.  
         [0002]     One of the more commonly performed procedures in knee surgery is reconstruction of the anterior cruciate ligament. These reconstructions are almost always done arthroscopically. One of the problems faced in anterior cruciate ligament knee surgery is that defects are created in the bone during surgery. One such defect is called the patellar defect.  
         [0003]     For several reasons, bone reamings resulting from the surgery provide the most desirable material for treating a bone defect. The reamings provide greater surface area of bone, which promotes healing. The reamings are more pliable than other bone material and therefore, mold well to the shape of the patellar defect. Other types of grafting material such as bone core and curetting tibial bone have time, difficulty, and cost disadvantages. It takes more time for a surgeon to use a bone core because it is rigid and has to be sized, cut and formed to fit the defect. It is also more difficult for a surgeon to work with and is more costly because of the additional operating room and staff time needed. Due to a bone core&#39;s rigidity, even after taking the time to size, cut and form the bone, it does not fit the defect as well as reamings. In addition to the same time, difficulty, and cost disadvantages of using a bone core, curetting tibial bone from the tibial defect at the harvest site creates further morbidity to the tibia. Additionally, autogenous grafting material provides the most optimal healing and effective recovery for the patient.  
         [0004]     It has been known to use a stiff metal medicine cup to attempt to collect bone chips from reamings for use as grafting material in anterior cruciate ligament reconstruction surgery.  
       BRIEF SUMMARY OF THE INVENTION  
       [0005]     The present invention includes a collection device for collecting material during a surgical procedure. The device includes a collection chamber defined by an encompassing wall and having an opening sufficient for permitting collection of the material during the surgical procedure. A wicking material is positioned outside the collection chamber and is in fluid association with an interior of the chamber sufficiently to wick fluid from within the collection chamber. The device also includes a scoop wall extending from the encompassing wall and having a distal end portion for being positioned proximate a source of the material and for guiding the material to the collection chamber wherein the scoop wall includes curved sidewall portions that are separated from the encompassing wall such that the scoop wall is bendable with respect to the chamber. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0006]      FIG. 1  is a perspective view showing the front and side of the present invention.  
         [0007]      FIG. 2  is a sectional view taken along the line  2 - 2  in  FIG. 4 .  
         [0008]      FIG. 3  is a perspective view illustrating the present invention in use.  
         [0009]      FIG. 4  is a top view of the present invention.  
         [0010]      FIG. 5  is a sectional view of the device on a surface in a resting position.  
         [0011]      FIG. 6  is a front elevational view of an alternative embodiment of the present invention.  
         [0012]      FIG. 7  is a sectional view taken along the line  7 - 7  in  FIG. 6 .  
         [0013]      FIG. 8  is a sectional view of the alternative embodiment on a surface in a resting position.  
         [0014]      FIG. 9  is a perspective view of the alternative embodiment illustrating the wicking material.  
     
    
     DETAILED DESCRIPTION  
       [0015]     The present invention allows for collection of surgical materials, such as bone reamings during anterior cruciate ligament (ACL) knee surgery. The collected reamings may later be used as autogenous graft material.  
         [0016]     Bone reamings (chips) created during surgery are generally not utilized or are underutilized as autogenous bone graft material because there are no current generally accepted collection methods that allow for efficient and effective collection and separation of the reamings. A collection device of the present invention generally indicated at  10  in  FIG. 1 , allows a surgeon to readily gather, separate, and apply bone reamings as graft material during surgery.  
         [0017]     The collection device  10  is comprised of a collection chamber  12  and a scoop wall  24 . Throughout the drawings, like reference characters will be used to indicate like elements. The collection chamber  12  is formed from a front face  14  and a back face  16  defining an opening  17 . The front face  14  and the back face  16  are connected at sides  18 A,  18 B, and bottom  20 . As illustrated in the exemplary embodiment, the connection between the front face  14  and the back face  16  is seamless and forms an encompassing wall that defines the collection chamber  12 . The upper center of the front face  14  has a cutout  22  that facilitates the surgeon&#39;s use. of a reamer. The cutout on the front of the device allows it to be positioned on the patient&#39;s leg below the site where the reamer enters the body to create the tibial tunnel while not interfering with the reamer positioning or the proper angle the surgeon needs for correctly creating the tibial bone tunnel. In the exemplary embodiment, the cutout  22  is approximately 0.830 inch wide and 0.788 inch in length, which is about twice the size of a typical reamer used in ACL reconstruction surgery. The cutout being larger than the diameter of the reamer permits angular positioning and repositioning if needed of the reamer in the cutout.  
         [0018]     The back face  16  of the collection chamber  12  is extended and forms the scoop wall  24 . The scoop wall  24  serves as a collection surface for the collection chamber  12 , in which the scoop wall  24  functions as a slide, scoop or funnel. The dimensions of the scoop wall  24  can vary. Additionally, in the exemplary embodiment, the back face  16  is integral with the scoop wall  24  as one continuous piece. Variations of the extended rear surface of the collection chamber  12  can include the back face  16  and the scoop wall  24  as two separate pieces which are then connected or attached to form the extended back surface.  
         [0019]     The scoop wall  24  also includes a depression  25  disposed centrally at a top edge  26  which allows for better positioning of the reamer and the scoop wall  24  against the leg. The scoop wall  24  includes a central portion and sidewall portions  30 A and  30 B. The sidewall portions  30 A and  30 B extend outwardly from the central portion and curve forwardly to form a channel to guide bone reamings to the collection chamber  12 . In this exemplary embodiment, the scoop wall  24  is approximately 1.394 inches in length (when measured from the top edge  26  of the scoop wall  24  to the collection chamber top edge  28 ) not taking into account the depression which is approximately 1.0 cm and approximately 2.572 inches in width.  
         [0020]     The scoop wall  24  is tapered such that a portion closer to the collection chamber  12  has the same thickness as the collection chamber  12 , which is approximately 0.062 inch in the exemplary embodiment. The thickness of scoop wall  24  begins to taper off approximately one third of the way distal from the defined back face  16  of the collection chamber  12  to a final thickness of approximately 0.025 inch at a top edge  26 . The tapered surface of the scoop wall  24  allows for the top portion of scoop wall  24  to be more flexible to conform to the patient&#39;s leg below the operative site.  
         [0021]     The scoop wall  24  forms an obtuse angle a with the back face  16  of the collection chamber  12  so that when the device  10  is placed on a surface  27  such as a table, the bone chips are retained within the chamber  12  as is seen in  FIG. 5 . When placed on a surface, the collection chamber  12  is tilted upwardly, to retain the bone chips.  
         [0022]     On the lower portion of the back face  16  of the collection chamber  12  are openings  32  through which fluid drains from the collection chamber  12 . In the exemplary embodiment, there are eighteen openings  32  that are approximately 0.12 inches each in diameter. The openings  32  are set apart approximately 0.25 inches horizontally and approximately 0.187 inches vertically. The openings  32  are positioned in three rows with five openings  32  in the row closest to the back face  16 , six openings  32  in the middle row and seven openings  32  in the row closest to the front face  14 . However, the openings  32  can be located anywhere within the collection chamber and in any formation so long as fluid continues to drain from the chamber when the device is held or is placed on a surface. When the chamber is filled with bone chips, the bone chips may stop fluid from flowing from the chamber through the openings  32 . The device may then be pressed against or placed on a sponge to wick away further liquid from the chamber before the bone chips are used as explained subsequently below.  
         [0023]     When used during surgical procedures, the collection device  10  is placed below a reamer  44  with the scoop wall  24  pressed against the leg just below the operative site. While the reamer  44  is being used to create a tunnel in the bone, the lower portion of the reamer  44  can be maneuvered because of the space created by the cutout  22  in the upper front face  14  of the collection chamber  12 . Bone reaming expelled from the tunnel slide down the scoop wall  24  and fall into the collection chamber  12 . The bone reamings settle to the bottom of the collection chamber. Some saline or other fluids are then slowly poured from the device over  18 A or  18 B and the remaining. fluids are allowed to drain from the collection device  10  through openings  32  in collection chamber  12 . As illustrated in  FIGS. 2 and 4 , the openings  32  are of a size to provide efficient draining of fluids while retaining the majority of the reamings. In addition, the collection device is of a sufficient width that when positioned below the operative site a major portion of the bone reamings that are generated are deposited within the collection device. Although a collection device having a substantially cylindrical configuration will collect bone reamings, a device having a substantially oval or rectangular configuration and whose backwall can be placed to conform to the surface next to the operative site and which will conform to a surface of the operative site collects a major portion of the bone reamings being generated.  
         [0024]     To understand the context in which the present invention is used, the following is a description of the surgical procedure. The order of some of these “steps”, especially  5  and  6 , can be changed and often are depending on when the bone-tendon-bone (B-T-B) graft is ready. To begin the procedure, a patient is placed in a supine position with a tourniquet on the operative proximal thigh. The thigh is placed in a leg holder with the foot of the bed down at 90 degrees, allowing the knee to bend 90 degrees. The leg is then prepped and draped in the routine sterile fashion. A superolateral portal is placed just proximal and lateral to the patella, and the inflow cannula is placed in the portal. Saline is pumped into the knee with the inflow pump. The standard anterolateral and anteromedial portals are established. Once the portals are established, the procedure can be divided into six basic steps: 1. Debride the torn ACL and perform an intercondylar notchplasty, 2. Harvest B-T-B Graft from patella/tibia, 3. Ream tibial tunnel and collect reamings, 4. Ream femoral tunnel, 5. Pass and secure B-T-B ACL graft (that surgeon harvested from the patella/patella tendon/tibia), and 6. Place reamings in patellar defect and close peritenon. The order of the steps are interchangeable.  
         [0025]     First, torn fragments of the ACL are debrided with a standard arthroscopic shaver through the anteromedial portal. The notchplasty is then performed, taking bone from the lateral and superior edge of the intercondylar notch of the femur. An arthroscopic burr is used to abrade bone and soft tissue in the intercondylar femoral notch until the femoral attachment of the ACL is visualized. The burr is then used to make a small divot approximately 2-3 mm from the over-the-top position at either the 11 o&#39;clock (right knee) or 1 o&#39;clock (left knee) position in the intercondylar notch of the femur.  
         [0026]     Second, a skin incision is made adjacent to the patellar tendon. It is carried through the subcutaneous tissue to the peritenon. Retraction of skin and subcutaneous tissue is accomplished to visualize the entire patellar tendon from the tibial tubercle to the patella. The peritenon is then split midline and stripped from the patella and patellar tendon to give full visualization of the patellar tendon in its medial to lateral width. The central one-third of the patellar tendon is then harvested.  
         [0027]     Using a powered saw blade, the patella is cut at approximately a 60 degree angle both on the medial and lateral sides. A slightly angled cut is also made on the cephalad surface. An osteotome is then used to wedge the pie-shaped piece of bone out of the patella. On the distal end similar saw cuts are made in the tibia and the autogenous graft is then lifted. At this point, the surgeon has obtained a fragment of the patellar bone, a piece of patellar tendon and a fragment of the tibial tubercle. The wound is then thoroughly irrigated.  
         [0028]     Third, with electrocautery, an incision is made on the tibia just proximal to the attachment of the pes anserine tendons, midway between the anterior and posterior edge on the medial side of the tibia. The area is stripped of its periosteum to give access for the tibial guide used to produce the tibial tunnel.  
         [0029]     With the arthroscope in the anterolateral portal, the tibial guide is then placed in the anteromedial portal. A guidepin is drilled from the external surface of the tibia to the above-mentioned site intra-articularly. Generally, the tibial guide is placed so that the guidepin of the tibial guide will exit intra-articularly in the footprint of the ACL at approximately the junction of the attachment of the posterior edge of the anterior horn of the lateral meniscus.  
         [0030]     As illustrated in  FIG. 3 , the bone collection device  10  is manually held by the surgeon (not shown) and/or an operating room assistant (not shown) against the leg  40  on the external surface  42  so that the collecting surface, scoop wall  24 , is held firmly just below the reamer  44 . The tibia  46  is illustrated in broken lines. The scoop wall  24  is flexible such that it conforms to the surface  42  of the leg  40 . However, alternatively, if the device of the present invention did not include the scoop wall  24 , but instead just the chamber, the chamber wall could also be sufficiently flexible to conform to the surface of the leg. As the surgeon (not shown) creates the tibial tunnel with a standard rigid reamer, bone reamings are collected and pulled toward the external surface and into the device. Once the reamer enters the “joint”, the saline or other fluid earlier pressurized by an inflow pump to create extension within the knee joint releases suddenly through the tibial tunnel. Saline and reamings flush rapidly from the tunnel, down the scoop wall  24  and into the collection chamber  12 . As the saline immediately begins to drain out of the collection chamber  12  including via the openings  32  along the bottom  20  of the collection chamber  12 , the majority of the reamings are retained. Since they are denser than the fluids, the reamings settle to the bottom of the collection chamber but do not flow through the openings  32 .  
         [0031]     The majority of the fluid in the collection chamber  12  is then slowly poured over either side  18 A or  18 B with care taken not to pour out the bone graft reamings. The collection device  10  is set down with back face  16  facing downwardly and placed on or pressed against a sponge (not shown) to permit remaining fluids to continue draining and wicking through the openings  32 . As illustrated in  FIG. 5 , the reamings are maintained in the collection chamber  12 , because of the obtuse angle between the scoop wall and the back face  16  of the chamber  12 . This angled feature also helps the collection device  10  to continue to drain fluids when set down. Once the fluids have drained, the reamings can be used as graft material.  
         [0032]     Fourth, the tibial guidepin is then placed through the tibial tunnel, up through the intraarticular area, through the femoral notch, and into the burred hole on the posterior aspect of the intercondylar notch at the femoral attachment of the ACL. The tibial guidepin is then pounded in a couple of millimeters. An acorn reamer is then brought in over the guidepin and the femoral tunnel is reamed up to the inner side of cortical bone.  
         [0033]     As the saline inflow is pumping and a tunnel plug placed in the tibial tunnel to maintain fluid within the knee joint, an arthroscopic debrider blade is used to suction out and debride out any excess bone fragments from the femoral tunnel and knee joint. Other soft tissue debris is also debrided at this time.  
         [0034]     There are many known options for the femoral fixation and it is intended that all are included within the present invention. The method described herein is the endo button fixation. For this method, a guidepin is brought through the tibial tunnel into the femoral tunnel. The guidepin is then drilled through the outer cortex of the femur. An endo button reamer is then brought over the guidepin and a hole is reamed in the femoral cortex. A depth gauge is then utilized to measure the femoral tunnel length. This length is utilized to secure the endo button to the ACL graft.  
         [0035]     Fifth, a passing pin is manually brought from the tibial side through the tibial tunnel, the intraarticular area and the femoral tunnel and carried through the skin over the femur. The B-T-B ACL autograft, harvested earlier, is then brought through the tibial and then into the femoral tunnels by placing sutures, which are in the endobutton, into the passing pin. The passing pin with sutures and graft is then pulled through both tunnels, the endo button hole, and quadriceps muscle and skin. Using the sutures the graft is pulled up into the joint, into the femoral tunnel with the endo button. It is advanced until the endobutton is pulled through the femoral cortex, thus the graft is in the anatomic position.  
         [0036]     The endo button is flipped so it locks on the outer cortex of the femur. The graft is then pulled distally giving femoral fixation. When this is completed approximately 28 mm of patellar tendon from the graft are centered within the articular surface and the bone portions of the graft are within the bone tunnels of the femur and tibia respectively. The endo button is locked on the femoral side and distal traction can be placed on the graft with the sutures in the tibial side of the graft. The knee is brought into extension to ensure that there is no impingement on the graft within the femoral notch. At this point, a hole is drilled in the tibia just distal to the tibial tunnel. A screw with a washer is placed in the drilled hole. This is used as a post and the sutures which are on the tibial side within the bone plug of the ACL graft are then wrapped around the post while pulling traction and keeping the knee flexed approximately 30 degrees and putting posterior pressure on the tibia as these sutures are secured. The screw is tightened against the tibia to secure the graft. The incision area is then thoroughly irrigated with saline.  
         [0037]     Sixth, skin and subcutaneous tissue retraction is then accomplished about the patella, thereby exposing the trough or pie-shaped area where the top portion of the autogenous bone-tendon-bone graft had been harvested in the early parts of the procedure. The present invention is then retrieved and the bone reamings earlier collected are used. In the typical case there are approximately 2-3 ml of bone reamings. These reamings are then used as grafting material for the previously created patellar defect. The interior surface of the chamber has a smooth and concave surface to facilitate effective retrieval and scooping out of the reamings. The reamings are scooped out of the collection device  12  by the surgeon using an operating room instrument such as the back end of an Adson&#39;s forceps and transferring the graft to the patellar defect. The surgeon compresses the reamings to conform to the defect in the patella. Usually all of the reamings are packed into the defect.  
         [0038]     The peritenon which had been previously opened is then brought back over the defect. The peritenon is closed over the defect and the patella, which is now filled with graft material. Closure is continued distally over the patellar tendon. This ensures that the graft material will stay within the defect. The wounds are again irrigated. Two drains are then placed in two separate areas, one in the intraarticular area through the superolateral portal and one in the subcutaneous area where the ACL graft had been harvested. All cannulas are removed and the subcutaneous tissue is closed. The skin is closed. The wounds are sterilely dressed and a knee ranger brace is placed in full extension on the knee. Drains are utilized for 12-24 hours to drain fluid and blood that accumulate in the subcutaneous area and the knee joint. The tourniquet is deflated and the patient is then returned to recovery room.  
         [0039]     Another embodiment of the collection device generally indicated at  50  is illustrated in  FIGS. 6-9 . The collection device  50  includes a collection chamber  52  and a scoop wall  64  and is similar to the collection device  10  illustrated in  FIGS. 1-5 . The collection device  50 , however, as explained in more detail below has a scoop wall  64  that can be bent further and has a wicking mechanism  80  to wick fluid from the bone reamings.  
         [0040]     The collection chamber  52  includes a front face  54  and a back face  56  defining an opening  57 . As in the collection device  10 , the connection between the front face  54  and the back face  56  is seamless and forms an encompassing wall that defines the collection chamber  52 . The front face  54  also has a cutout  62  that facilitates the surgeon&#39;s use of a reamer. The cutout  62  is the same or very similar to the cutout  22  as illustrated in  FIGS. 1-5  including its position, size and orientation. The back face.  56  extends upwardly and includes the scoop wall  64 . Similar to the scoop wall  24  of  FIGS. 1-5 , the scoop wall  64  includes a depression  65  disposed centrally at a top edge  66 . The scoop wall  64  along with the collection chamber  52  are formed as an integral unit.  
         [0041]     The scoop wall  64  is separated from the chamber  52  along lower edges  70 ,  72  of left and right wing portions  74  and  76 , all respectively. The separation between the wing portions  74  and  76  and the collection chamber  52  assist in bending the scoop wall  64  back away from the container portion  52 , as indicated by arrow  76  in  FIG. 7  and as illustrated in  FIG. 8 . In addition, a hinging portion  78  between the scoop wall  64  and the container portion  52  is thinned to facilitate bending back the scoop wall  64 . One suitable polymer device  50  is polypropylene.  
         [0042]     There are at least two reasons for bending the scoop wall  64  considerably more than the embodiment illustrated in  FIGS. 1-5 . A primary reason for bending the scoop wall  64  back further is to aid the surgeon in retrieving (scooping) the bone reamings out of the collection chamber  52 . Moving the scoop wall back further permits better access and a better angle to retrieve bone reamings. Another reason for bending the scoop wall  64  back further is to create a greater angle α′ between the collection chamber  52  and the scoop wall  64  when setting the collection device  50  on a flat surface after the reamings are collected, as illustrated in  FIG. 8 .  
         [0043]     Depending on the polymer used to construct the device  50 , the wall  64  may also be broken off. Breaking off the wall  64  just prior to retrieving the bone chips provides additional access to the chamber  52 .  
         [0044]     The collection device  50  also includes a wicking mechanism  80  positioned on a bottom surface  82  of the collection chamber  52 . The wicking mechanism  80  includes a protective rail  84  and a wicking material  81 . The protective rail  84  extends downwardly from the bottom surface  82  as best illustrated in  FIGS. 7 and 8 . The wicking material  81  is secured by a suitable adhesive to the bottom surface  82  within an area  83  defined by the rail  84 . The wicking material  81  wicks fluid from the bone reamings inside the collection chamber  52  and thereby removing fluid from the bone reamings contained therein to present the bone reamings in a better form for the surgeon to use.  
         [0045]     The technique of tibial tunnel reaming, collection and retention, and use of the collected reamings as grafting material to repair the patellar defect is superior to other methods of either not treating the patellar defect or other methods of treating the patellar defect in bone-tendon-bone ACL reconstruction. If the patellar defect is not treated, the patient can feel the defect on their “kneecap” which can have a negative psychological effect. Most patients do not like the feel of that “hole” in their kneecap. The generally accepted practice among orthopedic surgeons is to treat the patellar defect because it is believed that the patella is weaker if not treated.  
         [0046]     Using bone reamings is also superior to using a bone core because a bone core is rigid, is more difficult to work with, takes more time for a surgeon, operating room, and staff, for the OR procedure because it has to be sized, cut and formed to fit, is not pliable, and does not fit in the defect as well. Curetting tibial bone from the bottom of the tibia B-T-B graft harvest site also has the same time, difficulty, and resulting cost disadvantages as using a bone core; curetting bone also creates further morbidity to the tibia. It also is illogical to waste the reamings already available with the use of this device and create additional bone “chips” to use in the patella. Other methods using non-autogenous graft material are also more expensive.  
         [0047]     The bone reamings provide greater surface area of bone which promotes healing, is more readily accepted by the patient&#39;s body, is more pliable for surgeons to use, saves time for the surgeon and OR staff, saves OR costs and time, and is more flexible and molds to the shape of the patellar defect. Prior art methods do not provide these advantages. The method of the present invention also provides use of autogenous grafting material, which optimizes healing and effective recovery for the patient. Use of autogenous material also reduces the risk of infection and disease transmission. This invention makes this technique efficient and effective for the surgeon and operating room staff.  
         [0048]     Although the present invention has been described with reference to preferred embodiments, workers skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention.