Patent Publication Number: US-2023139576-A1

Title: Glenoid resurfacing system and method

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 15/606,643, (now U.S. Pat. No. 10,478,200) filed May 26, 2017, which is a continuation of U.S. patent application Ser. No. 12/762,948, (now U.S. Pat. No. 9,662,126), filed Apr. 19, 2010 which claims the benefit of U.S. Provisional Patent Application Ser. No. 61/170,290, filed on Apr. 17, 2009. The entire disclosures of all of the above listed applications are incorporated herein by reference. 
    
    
     FIELD 
     This disclosure relates to devices and methods for the repair of defects that occur in articular cartilage on the surface of bones, particularly the shoulder. 
     BACKGROUND 
     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. 
     In some cases, it may be necessary or desirable to repair the damaged articular cartilage using an plant. 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 DRAWINGS 
       The above-mentioned and other features of this disclosure, and the manner of attaining them, may become more apparent and better understood by reference to the following description of embodiments described herein, taken in conjunction with the accompanying drawings, wherein: 
         FIG.  1    illustrates a side view of an example of an excision device and an plant; 
         FIG.  2    illustrates a perspective view of an example of an excision device and an implant; 
         FIG.  3    illustrates an example of an implant; 
         FIG.  4    illustrates a side view of an example of an implant; 
         FIG.  5    illustrates a side view of another example of an implant; 
         FIG.  6    illustrates an example of a guide pin positioned in the glenoid surface of a scapula; 
         FIG.  7    illustrates an example of an excision device including a cannulated shaft and a cutter positioned at the distal end of the cannulated shaft passing over the guide pin positioned in the glenoid surface of a scapula; 
         FIG.  8    illustrates a side view of an example of an excision device including a cannulated shaft and a cutter positioned at the distal end of the cannulated shaft passing over the wide pin positioned in the glenoid surface of a scapula; 
         FIG.  9    illustrates a side-cross sectional view of an excision device including a cannulated shaft and a cutter positioned at the distal end of the cannulated shaft passing over the guide pin positioned in the glenoid surface of a scapula; 
         FIG.  10    illustrates a side-cross sectional view of an excision site including an implant; 
         FIG.  11    illustrates an example wherein a portion of the perimeter of the articular surface is damaged and the guide pin is positioned such that a repair nay be made at or near the perimeter of the articular surface; 
         FIG.  12    illustrates a side-cross sectional view of pan excision site including an example of an implant positioned at or near the perimeter of the articular surface; and 
         FIG.  13    illustrates an example of a side-cross sectional view of an example of an excision site including an example of an implant positioned at or near the perimeter of the articular surface. 
     
    
    
     DETAILED DESCRIPTION 
     According to one embodiment, the present disclosure may feature a system d method for resurfacing at least a portion of 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 glenoid; 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 glenoid. 
     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 surgically relevant misalignment of the implant relative to the articular surface. 
     Referring now to  FIG.  1    one embodiment of an excision device  10  and an implant  12  are generally illustrated. As will be explained in greater detail herein, the excision device  10  tray be configured to form an implant or excision site within the articular surface (e.g., the glenoid) configured to receive at least a portion of the implant  12 . The implant  12  may be configured to replace the articular surface in an area proximate one or more defects The system and method consistent with the present disclosure may repair a defect on the articular surface of a glenoid without having to replace the entire glenoid. 
     Accordingly to at least one embodiment, the implant  12  may be configured to replace only a portion of the articular surface proximate the defect site rather than the entire articular surface. As such, the implant  12  may minimize the amount of the articular surface which is operated on thus allowing more of the patient&#39;s original articular surface to be unaffected and providing a more physiologically normal joint. The system and method consistent with one embodiment of the present disclosure may allow for “key-hole” surgery in which a minimum number and size of incisions are made. As may be appreciated, “key-hole” surgery may reduce the amount of pain and/or discomfort experienced by the patient and, may reduce healing times. 
     The excision device  10  may include a cannulated shaft  14  defining a passageway  15  configured to be received over at least a portion of a guide pin or the like (not shown). The excision device  10  may also include at least one cutter  16   a,    16   b  extending radially outwardly and away from a distal end  18  of the shaft  14 . Each cutter  16   a,    16   b  may have a cutting surface  20  configured to create a hemispherical implant site, i.e., an excision site to receive the implant. For example, the cutting surface  20  may have a generally arcuate shape which sweeps towards the proximal end of the shaft  14  as the radius R e  from the shaft  14  increases on the cutter  16   a,    16   b.  It may be appreciated that the hemi-spherical excision site may exhibit some degree of deviation and the hemi-spherical excision site may be, in some examples, teardrop shaped or pyriform. 
     The contour of the cutting surfaces  20  may define the contours of the excision site as the cutters  16   a,    16   b  are rotated about the central axis of the excision site. While the cutting surfaces  20  are illustrated having a generally constant arc or curvature, the cutting surfaces  20  may include one or more protrusions and/or recesses configured to create corresponding radial groove and/or lips/protrusions within the excision site. These radial grooves and/or lips/protrusions on the cutting surfaces  20  may facilitate alignment of the implant  12  and/or may increase the mechanical coupling of the implant  12  within the excision site. 
     Turning now to  FIG.  2   , the overall radius R e  of the cutters  16   a,    16   b  may define the radius of the implant site created by the excision device  10  within the articular surface and may also substantially correspond to the radius R i  of the implant  12 . In addition, the depth D of the cutters  16   a,    16   b  may also define the height of the excision site created by the excision device  10  and may also substantially correspond to the height H of the implant  12 . For example, the overall radius R e  of the cutters  16   a,    16   b  may be between 7.0 mm to 20.0 mm, for example, 7.0 mm to 15.0 mm and/or 10.0 mm, to 12.5 mm (including all values and ranges therein) and the depth D may be between 4.0 mm to 10.0 mm, for example, 5 mm (including all values and ranges herein). 
     According to at least one embodiment, the excision device  10  may include a first and a second cutter  16   a,    16   b  which may be disposed approximately 180 degrees relative to each other. For example, the cutters  16   a,    16   b  may extend generally radially outwardly from the shaft about a first and a second generally opposite side of the distal end  18  of the shaft  14 . The cutters  16   a,    16   b  may also have a generally slim profile configured to be disposed between two adjacent articular surfaces as explained further herein. For example, the cutters  16   a,    16   b  may have a cross-sectional thickness (t) of 0.5 mm to 3.0 mm, for example, 2.0 mm (including all values and ranges therein). In one embodiment the at least one cutter may provide a generally hemispherical excision site regardless of the angle which the guide pin is disposed relative to the articular surface  54 . 
     The implant  12  may include a load bearing surface  22  and a bone facing surface  24 . Turning now to  FIG.  3   , a top perspective view of an implant  12  consistent with at least one embodiment herein is generally illustrated. The load bearing surface  22  may have a contour substantially corresponding to or based on the contour of the patient&#39;s articular surface being replaced (i.e., the articular surface which is removed by the excision device  10 ). The contour of the load bearing surface  22  may be based on a plurality of measurements taken at the patient&#39;s articular surface (for example, using a measuring and/or mapping tool as generally described in U.S. Pat. Nos. 6,520,964, 6,610,067, 6,679,917, 7,029,479 and 7,510,558, which are fully incorporated herein by reference) and/or may be based on one or more templates. 
     The load bearing surface  22  may be based on two or more curvatures, for example, the anterior-posterior (AP) curvature and the superior-inferior (SI) curvature. One or more of the AP and/or SI curvatures may themselves be based on multiple curves, (for example, as generally described in U.S. patent application Ser. No. 12/027,121, filed Feb. 6, 2008 and entitled SYSTEM AND METHOD FOR JOINT RESURFACE REPAIR, which is fully incorporated herein by reference). The load bearing surface  22  may be generally concaved. For example, the load bearing surface  22  may have a generally hemi-spherical shape. 
     The load bearing surface  22  may also include a beveled region  26  disposed about the perimeter of the load bearing surface  22 . The beveled region  26  may reduce the potential of further damage to the surrounding articular surface by eliminating a hard transition between the load bearing surface  22  and the remaining articular surface. The beveled region  26  may be particularly helpful if a portion of the implant  12  is slightly proud with respect to the remaining articular surface. 
     The bone facing surface  24  may be configured to be generally received in the excision site created by the excision device  10 . For example, the bone facing surface  24  may have a generally hemi-spherical shape substantially corresponding to the contour of the cutting surfaces  20  of the cutters  16   a,    16   b.  The bone facing surface  24  may also include one or more lips, protrusions, ribs or the like  28   a - 28   n  configured to increase the mechanical connection between the implant  12  and the patient&#39;s bone within the excision site. Again, these lips or the like  28   a - 28   n  may generally correspond to the contours of the cutting surfaces  20  of the cutters  16   a,    16   b.  The voids or space  30   a - 30   n  between the lips  28   a - 28   n  may create pockets for bone in-growth and/or bone cement. 
     Turning now to  FIGS.  4  and  5   , the implant  12  may optionally include at least one keel or tail  32  extending generally outwardly from the bone facing surface  24 . For example, the implant  12  may include at least one keel  32  including a protrusion or button  34  disposed about a distal end of a base region  36  as generally illustrated in  FIG.  4   . For example, the implant  12  may include a single keel  32  extending generally downwardly and away from the bottom surface  38  of the bone facing surface  24  generally along the central axis C of the implant  12 . The base region  36  may be coupled to the bottom surface  38  of the bone facing surface  24  and may have an hour-glass shape which may initially taper radially inwardly and then taper radially outwardly. The bottom surface  33  of the button  34  may have a curvature substantially corresponding to the curvature of the implant site. For example. the bottom surface of the button  34  may have a curvature (generally illustrated by dotted curve D) substantially corresponding to the curvature of the cutting surfaces  20 . 
     The button  34  may extend generally radially outwardly from a distal end of the base region  36 . As such, the button  34  may have a diameter D b  greater than at least a portion of the base region  36 , for example, the portion of the base region adjacent to the button  34 . According to one embodiment, the diameter D b  of the button  34  may be the same as or slightly larger than the diameter of the cavity in the excision site in which it is configured to be received. As such, the button  34  may form an interference fit with the cavity in the excision site which may secure the implant  12  to the bone and may also facilitate alignment of the implant  12  with respect to the articular surface and the excision site. Alternatively, the diameter D b , of the button  34  may be slightly smaller than the diameter of the cavity in which it is configured to be received. As such, the button  34  may also facilitate alignment of the implant  12  with respect to the articular surface and the excision site. In addition, bone cement or the like may be disposed around the keel within the cavity to increase the mechanical connection between the keel  32  and the bone. 
       FIG.  5    illustrates another embodiment of a keel  32 . The keel  32  may include a base region  36  extending generally outwardly/downwardly and away from the bottom surface  38  of the bone facing surface  24  generally along the central axis C of the implant  12 . For example, the keel  32  may extend outwardly/downwardly and away from the bottom surface  38  of the bone facing surface  24  beyond the curvature D substantially corresponding to the curvature of the cutting surfaces  20 . The keel  32  may be configured to be received in an additional cavity, pocket or the like formed within the excision site. The additional cavity may be formed subsequent to the formation of the excision site using an additional cutter, chisel, drill or the like (not shown). 
     The base region  36  may include one or more radial lips, grooves, protrusions or the like  40 . The keel  32  may also include a protrusion  42  extending generally downwardly and away from the base portion  36  generally along the central axis C of the implant  12 . The protrusion  42  may include one or more radial lips, grooves, protrusions or the like  44   a - 44   n.  As discussed herein, the keel  32  may be configured to engage a cavity or the like disposed within the excision site and may be configured align the implant  12  with respect to the articular surface and/or the excision site a d may also increase the mechanical coupling of the implant  12  to the bone. 
     While the keels  32  illustrated in  FIGS.  4  and  5    are shown having a generally concentric shape, the keel  32  may have other configurations. For example, the keel  32  may have a shape configured to prevent rotations of the implant  12  with respect to the articular surface. The keel  32  may have a non-circular shape configured to be received in the excision site in a lock-and-key configuration. By way of example, the keel  32  may have a generally multifaceted geometry (such as, but not limited to, rectangular, pentagonal, hexagonal or the like) configured to received in the excision site. The implant  12  and the keel  32  may be a single, integral or unitary component car may be formed from two or more pieces which may be secured to each other (either permanently or removably secured). 
     Turning no to  FIGS.  6 - 10   , one method of installing an implant  12  consistent with the present disclosure is generally illustrated. One or more incisions  49  may be created proximate the patient&#39;s shoulder  50  to provide access to the defect  52  on the patient&#39;s articular surface  54 , for example, using a scalpel or the like. The incision  49  may be made through the anterior portion of the patient. Again, the present disclosure will describe a system and method for replacing a portion of the articular surface of the glenoid; 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 glenoid. The system and method consistent with one embodiment of the present disclosure may allow for “key-hole” surgery in which a minimum number and size of incisions are made. As may be appreciated, “key-hole” surgery may reduce the amount of pain and/or discomfort experienced by the patient and may reduce healing times. 
     Once the incision is created, a guide pin  56 ,  FIG.  6   , may be positioned about the glenoid  58  on the scapula  60  to provide an access passageway to the glenoidal articular surface  54  as will be described herein. Consistent with one embodiment, the guide pin  56  may comprise threaded and/or self-tapping tip (not shown) configured to be secured to the patient&#39;s bone. The guide pin  56  may be secured to the bone using a drill or the like (not shown) and at least a portion of which may be disposed proximate to and/or within the defect site  52  on the articular surface  54 . Optionally, a drill guide (not shown) may be used to facilitate alignment of the guide pin  56  with respect to the articular surface  54 . 
     The guide pin  56  may be disposed along a longitudinal or working axis (W) at an angle α relative to the articular surface  54 . Angle α may be less than or equal to 90 degrees, wherein α&lt;90 degrees with respect to the articular surface  54 . In some examples, angle α may be less or equal to 90 degrees and greater than or equal to 45 degrees with respect to the articular surface  54 , wherein 45 degrees≤α≤90 degrees with respect to the articular surface  54 . In further examples, 90 degrees&gt;α&gt;45 degrees and/or 90 degrees&gt;α≥45 degrees, with respect to the articular surface  54 . The degree of the angle α may depend on the location and/or size of the defect  52  and may be selected to avoid contact with the humerus  62 . In some circumstances the degree of the angle α may also be selected to avoid contact with the perimeter of the articular surface  54 . 
     Once the guide pin  56  is secured to the articular surface  54 , the excision device  10  may be advanced over the guide pin  56  as generally illustrated in  FIG.  7   . For example, the guide pin  56  may be received within the passageway  15  defined by the cannulated shaft  14 . According to at least one embodiment, the cutters  16   a,    16   b  may be generally aligned in a single plane extending along the longitudinal axis of the excision device  10 . The plane of the cutters  16   a,    16   b  may be orientated generally tangential to the articular surface  64  of the humerus  62  such that the cutters  16   a,    16   b  may slide by the articular surface  64  of the humerus  62  and between the humerus  62  and the scapula  60  as generally illustrated in  FIGS.  7  and  8   . 
     Once the cutters  16   a,    16   b  are advanced oven: the guide pin  56  to the articular surface  54 , the excision device  10  may be rotated about the guide pin  56 . As may be best seen in  FIG.  8   , a pocket of cavity  66  may be present between the articular surface  54  of the glenoid  58  and the articular surface  64  of the humerus  62 . The cutters  16   a,    16   b  of the excision device  10  tray therefore rotate about the guide pin  56  without contacting the articular surface  64  of the humerus  62 . 
     The excision device  10  may thus be rotated about the guide pin  56  to form an excision site  70  within the articular surface  54  of the glenoid  58  as generally illustrated in  FIG.  9   . Due to the contour of the cutting surfaces  20  of the cutters  16   a,    16   b,  the excision site  70  created by the excision device  10  may have a generally hemi-spherical configuration regardless of the angle α of the guide pin  56 . 
     Once the excision site  70  is formed within the articular surface  54 , the excision device  10  and the guide pin  56  may be removed as generally illustrated in  FIG.  10   . The removal of the guide pin  56  may leave a cavity  72  formed by the distal tip of the guide pin  56 . The implant  12  may then be received in the excision site  70 . The spherical configuration of the excision site  70  may normalize the implant  12  with respect to the remaining articular surface  54 . The load bearing surface  22  of the implant  12  may substantially match the original contour of the patient&#39;s articular surface  54  which was removed. 
     As illustrated in  FIG.  11   , the system and method according to the present disclosure may also repair a defect  80  on the articular surface  54  in which a portion of the perimeter of the articular surface  54  is damaged or missing. For example, the posterior portion P of the articular surface  54  may have a defect  80 , wherein a portion of the perimeter of the articular surface  54  is missing which may be caused by advanced chronic shoulder dislocation and/or early onset arthritis. To repair a defect  80  proximate the perimeter of the articular surface  54 , the guide pin  56  may be moved further towards the posterior end P of the articular surface  54 . The exact location of the guide pin  56  with respect to the articular surface  54  may depend on the location and size of the defect  80  as well as the size of the cutters  16   a,    16   b  of the excision device  10 . 
     According to one embodiment, the guide pin  56  may be located a distance away from the perimeter of the articular surface  54  which generally corresponds to the radius R e  of the cutters  16   a,    16   b.  The excision device  10  may be advanced over the guide pin  56  and rotated as described herein. Accordingly, the cutters  16   a,    16   b  may remove a portion of the articular surface  54  to form an excision site  81  disposed about the perimeter of the articular surface  54  as generally illustrated in  FIG.  12   . It may be appreciated that in such a manner, the perimeter may intersect a portion of the generally hemispherical excision site  81 . The excision device  10  and the guide pin  56  may then be removed and the implant  12  may be received within the excision site  81 . As may be seen in  FIG.  12   , a portion of the implant  12  may replace the perimeter of the articular surface  54  which was damaged and/or missing. 
     The implant  12  may also include a keel  32  as generally illustrated in  FIGS.  12  and  13   . The keel  32  may facilitate alignment of the implant  12  with respect to the articular surface  54  and/or may provide an increased mechanical connection between the implant  12  and the bone. As discussed herein, the excision site  81  may also include one or more cavities  83 ,  FIG.  13   , configured to received at least a portion of the keel  32  (for example, but not limited to, one or more radial lips  44   a - 44   n  of the protrusion  42 . 
     Once the position/orientation of the implant  12  has been confirmed (i.e., the contour of the load bearing surface  22  has been confirmed along the AP and/or SI planes to generally correspond to the original contour of the articular surface), the implant  12  may be secured to the bone. The implant  12  may be held in place by the lips, protrusions, ribs or the like  28   a - 28   n  of the bone facing surface  24 , the keel  32 , and/or bone cement or the like. 
     Accordingly, in one embodiment, the present disclosure is directed to a method of repairing an articular surface, wherein the method may include securing a guide pin to an articular surface of a glenoid, wherein the guide pin may define a working axis and the working axis is positioned at an angle α relative to the articular surface, wherein angle α is less than or equal to 90 degrees. It may be appreciated that n some embodiments the guide pin may be configured to be disposed at an angle α, wherein 90 degrees≥α≥45 degrees relative to the articular surface. In some examples, the articular surface includes a perimeter and the perimeter includes a defect and the excision site extends to the perimeter. 
     The method may also include advancing an excision device over the guide pin, wherein the excision device nay include a cannulated shaft and at least one cutter. In some embodiments the cutter may generally be aligned in a single plane. In some embodiments, the cutter may include a first cutter and a second cutter, which extend generally radially outwardly from the cannulated shaft at an angle of approximately 180 degrees from each other. In other embodiments, the cutter may have a cross-sectional thickness of 0.5 mm to 3.0 mm. 
     The method may also include forming a generally hemi-spherical excision site with the excision device within the articular surface of the glenoid. In some embodiments, the generally hemi-spherical excision site may be formed by rotating the at least one cutter about the guide pin. In addition, the method may also include removing the guide pin and placing an implant in the excision site. 
     In another aspect, the present disclosure relates to a method of repairing an articular surface. The method may include creating an incision through an anterior surface of a patient proximate to the patient&#39;s shoulder, as may be appreciated the shoulder includes a glenoid including a first articular surface and a humerus including a second articular surface. The method may also include inserting a guide pin through the incision at an angle to avoid contact with the second articular surface. The method may further include securing the guide pin to the first articular surface, wherein the guide pin may be positioned at an angle α relative to the first articular surface, and angle α may be less than or equal to 90 degrees. In addition, the method may include advancing an excision device over the guide pin, wherein the excision device may include a cannulated shaft and at least one cutter. In some embodiments, the cutter may extend away from the cannulated shaft and exhibit a thickness of 0.5 mm to 3.0 mm. In further embodiments, the cutter may be oriented generally tangentially to the second articular surface avoiding contact with the humerus as the excision device is advanced over the guide pin. The method may also include forming a generally hemi-spherical excision site in the first articular surface with the excision device by rotating the at least one cutter without contacting the second articular surface. 
     A further aspect of the present disclosure relates to a system for repairing an articular surface. The system may include a guide pin configured to be secured into bone beneath the articular surface of a glenoid. In some embodiments, the guide pin may be configured to be disposed at an angle α relative to the articular surface, wherein angle α is &lt;90 degrees. In further embodiments, the guide pin may be configured to be disposed at an angle α relative to the articular surface, wherein 90 degrees≥α≥45 degrees. 
     The system may also include an excision device. The excision device may include a cannulated shaft configured to be advanced over the guide pin, and at least one cutter configured to form a generally hemispherical excision site in the glenoid about the guide pin. In one embodiment, the at least one cutter may have a cross-sectional thickness of 0.5 mm to 3.0 mm. The cutter may also include a cutting surface having a generally arcuate shape sweeping towards a proximal end of the cannulated shaft. The cutting surface may define a contour of the excision site as the excision device is rotated about the cannulated shaft. In another embodiment, the cutter may include a first cutter and a second cutter, wherein the first and second cutters may extend generally radially outwardly from the cannulated shaft at an angle approximately 180 degrees from each other. 
     The system nay further include an implant. The implant may have a load bearing surface and a bone facing surface, wherein the load bearing surface may exhibit a contour substantially corresponding to the contour of the articular surface and the generally hemi-spherical bone facing surface may be configured to be received in the generally hemispherical excision site. In some embodiments, the load bearing surface may include a beveled region disposed about a perimeter of the load bearing surface. In further embodiments, the bone facing surface may include at least one lip, protrusion and/or rib configured to increase a mechanical connection between the implant and bone within the excision site. In yet further embodiments, the implant may also include at least one keel extending generally outwardly from the bone facing surface. In additional embodiments, the at least one keel may include a protrusion disposed about a distal end of a base region. In one embodiment, the implant may include a single keel extending generally downwardly and away frown a bottom surface of the bone facing surface generally along a central axis C of the implant. The base region may be coupled to a bottom surface of the bone facing surface and include an hour-glass shape. In one embodiment, the bottom surface of the keel may include a curvature substantially corresponding to a curvature of the excision site. The bottom surface of the keel may also include a curvature substantially corresponding to a curvature of a cutting surface of the at least one cutter. In some embodiments, the at least one keel may extend outwardly and downwardly from a bottom surface of the bone facing surface beyond a curvature D substantially corresponding to a curvature of a cutting surface of the at least one cutter. 
     It may be appreciated that in some embodiments, an overall radius R e  of the at least one cutter tray define a radius of the excision site created by the excision device. In addition, in some embodiments, the overall radius R e  may substantially correspond to a radius R i  of the implant. In some embodiments, a depth D of the at least one cutter may define a height of the excision site created by the excision device. In additional embodiments, a depth D may substantially correspond to a height H of the implant. 
     As mentioned above, the present disclosure is not intended to be limited to a system or method which roust satisfy one or ore 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.