Patent Publication Number: US-2023139232-A1

Title: Harvesting cancellous bone and marrow from distal femur, proximal tibia, distal tibia, or calcaneus using bone press apparatus

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     The present application is a continuation of, and claims priority under 35 U.S.C. §120 to, U.S. Pat. Application 16/916,099, filed Jun. 29, 2020, now U.S. Pat. 11,540,843, incorporated herein by reference, which ‘099 application is a continuation-in-part of, and claims priority under §120 to, international patent application PCT/US20/40037 designating the U.S., filed Jun. 28, 2020, the disclosure of which is incorporated herein by reference, and which international patent application is a U.S. Nonprovisional Pat. Application of, and claims priority under 35 U.S.C. §119(e) to, each of U.S. Provisional Pat. Application 62/868,855, filed Jun. 28, 2019, which ‘855 application is incorporated by reference herein; and U.S. Provisional Pat. Application 62/868,860, filed Jun. 28, 2019, which ‘860 application is incorporated by reference herein. Additionally, the present application is a U.S. Nonprovisional Pat. Application of, and claims priority under §119(e) to, each of U.S. Provisional Pat. application 62/868,855, filed Jun. 28, 2019, which ‘855 application is incorporated by reference herein; and U.S. Provisional Pat. Application 62/868,860, filed Jun. 28, 2019, which ‘860 application is incorporated by reference herein. The disclosures of the ‘855 and ‘860 applications are set forth in the appendices and the computer program listing, all of which is incorporated by reference herein. Furthermore, U.S. Pat. Application Publication 2020/0405911 is incorporated by reference herein. 
    
    
     COPYRIGHT STATEMENT 
     Any new and original work of authorship in this document—including any source code—is subject to copyright protection under the copyright laws of the United States and other countries. Reproduction by anyone of this document as it appears in official governmental records is permitted, but otherwise all other copyright rights whatsoever are reserved. 
     COMPUTER PROGRAM LISTING 
     Submitted concurrently herewith via the USPTO’s electronic filing system, and incorporated herein by reference, are computer program files including instructions, routines, and/or other contents of several computer programs. A table setting forth the name and size of files included in the computer program listing is included below. 
     
       
         
           
               
               
               
             
               
                 File Name 
                 Creation Date 
                 File Size (bytes) 
               
             
            
               
                 ascify.txt 
                 12/23/2022 15:10 
                 37,473 
               
               
                 readme-62868855.txt 
                 12/23/2022 15:09 
                 2,780 
               
               
                 one1.txt 
                 12/23/2022 15:10 
                 22478505 
               
               
                 one2.txt 
                 12/23/2022 15:09 
                 22478162 
               
               
                 one3.txt 
                 12/23/2022 15:09 
                 6004473 
               
               
                 readme.txt 
                 12/23/2022 15:09 
                 2,781 
               
               
                 two1.txt 
                 12/23/2022 15:10 
                 22478505 
               
               
                 two2.txt 
                 12/23/2022 15:11 
                 22478162 
               
               
                 two3.txt 
                 12/23/2022 15:11 
                 22477819 
               
               
                 two4.txt 
                 12/23/2022 15:11 
                 22477476 
               
               
                 two5.txt 
                 12/23/2022 15:11 
                 22477133 
               
               
                 two6.txt 
                 12/23/2022 15:11 
                 22476790 
               
               
                 two7.txt 
                 12/23/2022 15:12 
                 22476447 
               
               
                 two8.txt 
                 12/23/2022 15:12 
                 22476104 
               
               
                 two9.txt 
                 12/23/2022 15:12 
                 22475761 
               
               
                 two10.txt 
                 12/23/2022 15:10 
                 22475418 
               
               
                 two11.txt 
                 12/23/2022 15:10 
                 7518709 
               
            
           
         
       
     
     One of these files, “readme-62868855.txt”, contains instructions for extracting information from “one1.txt”, “one2.txt”, and “one3.txt”; “one1.txt”, “one2.txt”, and “one3.txt” collectively represent a compressed binary file that has been converted to ascii format. These files can be converted back to a compressed .zip archive utilizing an assembly conversion program source code for which is contained in “ascify.txt”. The readme file includes instructions for compiling and running this conversion program, and instructions for converting the other text files to a compressed, binary file. This compressed, binary file includes an .mp4 video file for a video illustrating aspects and features in accordance with one or more preferred embodiments of the invention relating to harvesting autologous cancellous bone and marrow from the proximal tibial. 
     One of these files, “readme.txt”, contains instructions for extracting information using “ascify.txt” from the other .txt files. The other .txt files named “twoX.txt”, where X = 1 to 11, collectively represent a compressed binary file that has been converted to ascii format. These files can be converted back to a compressed .zip archive utilizing an assembly conversion program source code for which is contained in “ascify.txt”. The readme file includes instructions for compiling and running this conversion program, and instructions for converting the other text files to a compressed, binary file. This compressed, binary file includes four .mov video files illustrating aspects and features in accordance with one or more preferred embodiments of the invention. 
     BACKGROUND OF THE INVENTION 
     The invention generally relates to methods and apparatus used for harvesting cancellous bone and marrow and, preferably, harvesting autologous cancellous bone and marrow from a distal femur, proximal tibia, distal tibia, or calcaneus of an individual for use as an autograft for that individual; and an intramedullary canal that is formed in a medullary cavity of a bone of an individual for use as an autograft for that individual, which bone of the medullar cavity may be the tibia or the femur. 
     With regard to harvesting autologous bone, it is known when forming a intermedullary canal by reaming—which is basically done for a medullary nail—that autologous cancellous bone contained on the reamer after withdrawal may be recovered and used, if desired. Additionally with regard to specifically harvesting autologous cancellous bone and marrow, a procedure is known that is used for shallow-core harvesting of cancellous bone and marrow from the posterior superior iliac spine immediately prior to an anterior cervical discectomy/fusion (“ACDF”), wherein the harvested cancellous bone and marrow is used in that individual during the ACDF procedure. The procedure has been nicknamed the “Ray Iliac Procedure” and is disclosed in U.S. Pat. Application 62/868,779 and in 16/916,012, both of which are incorporated herein by reference. The Ray Iliac Procedure is intended for use in the orthopedic surgical field. 
     The Ray Iliac Procedure is based on a repurposed use of a bone press apparatus as disclosed, for example, in U.S. Pat. No. 8,920,393, which is incorporated herein by reference. Such bone press apparatus are commercially sold by Hensler Surgical Products, LLC, of Wilmington, North Carolina. The bone press apparatus was designed for harvesting high-speed drilled bone during spinal procedures, which harvested bone was found to be a moldable and malleable matrix that could be reused in the patient to increase fusion healing rates. 
     While the Ray Iliac Procedure is believed to be adequate for use in harvesting cancellous bone and marrow in conjunction with an ACDF procedure, it is believed that additional improvements can be made in harvesting cancellous bone and bone marrow from other areas of the body by repurposing such bone press apparatus. Such additional improvements are believed to be provided by one or more methods in accordance with one or more aspects and features of the invention, especially when harvesting cancellous bone and bone marrow from condyles of the tibia and femur and from the calcaneous, and when harvesting cancellous bone and bone marrow from an intermedullary canal formed in the tibia or femur. 
     Indeed, it has been discovered that one or more methods in accordance with one or more aspects and features of the invention result in unexpectedly high yields of cancellous bone and bone marrow, especially when harvested from an intermedullary canal formed in the tibia or femur; and unexpectedly high yield rates of cancellous bone and bone marrow, especially when harvested from the condyles of the tibia and femur and from the calcaneous, and from an intermedullary canal formed in the tibia or femur. 
     SUMMARY OF THE INVENTION 
     The invention includes many aspects and features. Moreover, while many aspects and features relate to, and are described in, the context of harvesting from a distal femur, a proximal tibia, a distal tibia, a calcaneus, and an intermedullary canal, the invention is not limited to use only in such areas. For example, it is contemplated that the invention also is applicable to other areas, as will become apparent from the following summaries and detailed descriptions of aspects, features, and one or more embodiments of the invention. 
     Accordingly, in an aspect of the invention, a method of harvesting cancellous bone and bone marrow comprises the steps of: (a) creating an intermedullary canal, including loosening for extraction cancellous bone and bone marrow along the canal; (b) inserting a suction tube through the intermedullary canal and extracting the loosened cancellous bone and bone marrow along the intermedullary canal through the suction tube, the bone marrow comprising a liquid, the suction tube being attached to a first lid of a collection container, the collection container having a first cup and a suction port to which a suction source is connected; (c) after extracting the cancellous bone and bone marrow, disconnecting the suction source from the suction port of the collection container; (d) removing the first lid of the collection container from the first cup of the collection container; (e) attaching a second lid to the first cup of the collection container, the second lid having a plunger with a press head configured to filter the extracted liquid contained in the first cup; (f) filtering the extracted liquid by depressing the plunger of the second lid toward a bottom of the first cup; and (g) pouring the filtered liquid from the first cup through a suction port into a second cup while depressing the plunger, thereby separating the liquid from a spongy semi-solid mass of cancellous bone that remains in the first cup. 
     In a feature, the step of creating the intermedullary canal is performed using an orthopedic reamer, wherein the method further preferably comprises collecting cancellous bone and bone marrow from the reamer after withdrawing the reamer from the intermedullary canal. 
     In a feature, the intermedullary canal that is formed begins at a distal end of a tibia and extends along a longitudinal axis of the tibia toward a proximal end of the tibia. 
     In a feature, extracting the loosened cancellous bone and bone marrow along the intermedullary canal comprises passing the suction tube in and out of the intermedullary canal while spinning the tube with one hand and holding with the other hand the collection container to which the suction tube is attached. 
     In a feature, extracting the loosened cancellous bone and bone marrow along the intermedullary canal comprises passing the suction tube in and out of the intermedullary canal over a guide wire that extends within the intermedullary canal. 
     In a feature, the method further comprises pouring or drawing the filtered liquid from the second cup into a syringe and injecting the liquid within an autograft or directly into an operative site to promote healing. 
     In a feature, the method further comprises leaving the suction apparatus attached to the lid for repeating the harvesting method. 
     In a feature, no irrigation is performed during the method that would dilute the extracted liquid. 
     In a feature, the second lid having the plunger additionally comprises a vent, whereby a low pressure is not created within the first cup during pouring of the liquid through the suction port while depressing the plunger. 
     In yet another feature, no suction is applied to the first cup during depressing of the plunger and pouring of the liquid from the first cup. In this respect, it will be appreciated that while the liquid is poured through a “suction” port in preferred methods of the invention, suction is not actually applied at this port; such reference to this port being a “suction” port refers to the use of this port when the incorporated bone press apparatus is used as originally intended in accordance with the reference initially disclosing such bone press apparatus, namely, U.S. Pat. No. 8,920,393 incorporated by reference above. 
     In another aspect, a method of harvesting cancellous bone and bone marrow comprises the steps of: (a) creating an opening in cortical bone; (b) accessing through the opening and loosening for extraction cancellous bone and bone marrow; (c) inserting a suction apparatus through the opening and extracting the loosened cancellous bone and bone marrow, the bone marrow comprising a liquid, the suction apparatus being attached to a first lid of a collection container, the collection container having a first cup and a suction port to which a suction source is connected; (d) after extracting the cancellous bone and bone marrow, disconnecting the suction source from the suction port of the collection container; (e) removing the first lid of the collection container from the first cup of the collection container; (f) attaching a second lid to the first cup of the collection container, the second lid having a plunger with a press head configured to filter the extracted liquid contained in the first cup; (g) filtering the extracted liquid by depressing the plunger of the second lid toward a bottom of the first cup; and (h) pouring the filtered liquid from the first cup through a suction port into a second cup while depressing the plunger, thereby separating the liquid from a spongy semi-solid mass of cancellous bone that remains in the first cup. 
     In a feature, the suction apparatus comprises a suction wand, and extracting the loosened cancellous bone and bone marrow preferably comprises sweeping a distal end of the suction wand in various directions while extracting the loosened cancellous bone and bone marrow, wherein the sweeping step is performed while holding the collection container to which the suction apparatus is attached. 
     In a feature, the method further comprises pouring or drawing the filtered liquid from the second cup into a syringe and injecting the liquid within an autograft or directly into an operative site to promote healing. 
     In a feature, the method further comprises leaving the suction apparatus attached to the lid for repeating the harvesting method. 
     In a feature, no irrigation is performed that would dilute the extracted liquid. 
     In a feature, no suction is applied to the first cup during depressing of the plunger. 
     In a feature, the step of creating an opening in cortical bone comprises using a high-speed drill having a cutting burr to create the opening. The cutting burr preferably is used to create the opening and to loosening the cancellous bone and bone marrow for extraction that is accessed through the opening. The cutting burr preferably is a 4 mm cutting burr or a 5 mm cutting burr. (As used herein, “burr” and “bur and interchangeable and intended to mean the same thing.) 
     In a feature, the step of creating an opening in cortical bone comprises using a drill comprising a 4 mm cutting burr followed by replacing the 4 mm cutting burr with a 5 mm cutting burr and continuing to use the drill. 
     In a feature, the method preferably comprises using 6 mm and then 7 mm currettes to increase the size of the opening when a large amount of cancellous bone and bone marrow is needed. 
     In a feature, a maximum dimension of the opening created is approximately 6 mm to 7 mm. 
     In a feature, a drill is used and the depth of drilling is between 1.8 cm to 2.3 cm inclusive. 
     In yet another feature, 8 cc to 12 cc of cancellous bone and 10 cc to 15 cc of bone marrow is obtained within 8 minutes. 
     Another aspects relate to a method of harvesting, from an individual, in an operating room and within 8 minutes, at least 8 cc to 12 cc of a spongy semi-solid mass of cancellous bone of the individual and, separated therefrom, at least 10 cc to 15 cc of liquid bone marrow of the individual. The method comprises: (a) using a high-speed drill having a cutting burr to create a cortical window in cortical bone; (b) further using the high-speed drill to loosen for extraction cancellous bone and bone marrow accessed through the cortical window; (c) inserting a suction apparatus through the cortical window and extracting the loosened cancellous bone and bone marrow, the bone marrow comprising a liquid, the suction apparatus being attached to a first lid of a collection container, the collection container having a first cup and a suction port to which a suction source is connected; (d) after extracting the cancellous bone and bone marrow, disconnecting the suction source from the suction port of the collection container; (e) removing the first lid of the collection container from the first cup of the collection container; (f) attaching a second lid to the first cup of the collection container, the second lid having a plunger with a press head configured to filter the extracted liquid contained in the first cup; (g) filtering the extracted liquid by depressing the plunger of the second lid toward a bottom of the first cup; and (h) pouring the filtered liquid from the first cup through a suction port into a second cup while depressing the plunger, thereby separating the liquid from a spongy semi-solid mass of cancellous bone that remains in the first cup. 
     In a feature, the cortical window is created in cortical bone at a distal tibia. 
     In a feature, the cortical window is created in cortical bone at a distal femur. 
     In a feature, the cortical window is created in cortical bone at a proximal tibia. 
     In a feature, the cortical window is created in cortical bone at a calcaneus. 
     In another aspect, a method comprises the steps of using a drill to create a cortical window in cortical bone and fragment trabecular bone under the cortical bone; inserting a suction apparatus through the cortical window and sweeping the distal ends of the suction apparatus in various directions to extract by suction cancellous bone and bone marrow of the fragmented trabecular bone, the suction apparatus being attached to a collection container to which as suction source is connected; disconnecting the suction source from the collection container; removing a lid of the collection container from a cup of the collection container, to which lid the suction apparatus is attached; attaching a second lid having a plunger with press head for filtering cancellous bone from bone marrow; depressing the plunger and compacting the cancellous bone against the bottom of the cup; and pouring bone marrow from the cup into another cup while depressing the plunger against the cancellous bone, thereby separating the bone marrow from the cancellous bone. 
     In a feature, the suction apparatus comprises a suction wand. 
     In a feature, the cortical bone is of the distal femur, proximal tibia, distal tibia, or calcaneus of an individual. 
     In a feature, the sweeping step is performed while holding the collection container to which the suction apparatus is attached. 
     In a feature, the method further comprises pouring or drawing bone marrow into a syringe and injecting the drawn bone marrow within the harvested bone graft or directly into an operative site to promote healing. 
     In a feature, the method further comprises leaving the suction apparatus attached to the lid for repeating harvesting using another cup. 
     Other aspects comprise methods disclosed herein for harvesting cancellous bone and marrow. 
     Another aspect comprises a method includes steps for harvesting cancellous bone and marrow and, preferably, harvesting autologous cancellous bone and marrow from a distal femur, proximal tibia, distal tibia, or calcaneus of an individual for use as an autograft for that individual. 
     Another aspect comprises a method includes steps for harvesting cancellous bone and marrow and, preferably, harvesting autologous cancellous bone and marrow from an intramedullary canal that is formed in a medullary cavity of a bone of an individual for use as an autograft for that individual, which bone of the medullar cavity preferably is the tibia or the femur. 
     Another aspect comprises apparatus that are used to perform the methods disclosed herein. 
     Additional aspects and features are disclosed in the appendices, the disclosures of which are incorporated herein by reference, including the disclosures and teachings of the videos. 
     In addition to the aforementioned aspects and features of the invention, it should be noted that the invention further encompasses the various logical combinations and subcombinations of such aspects and features. Thus, for example, claims in this or a divisional or continuing patent application or applications may be separately directed to any aspect, feature, or embodiment disclosed herein, or combination thereof, without requiring any other aspect, feature, or embodiment. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       One or more preferred embodiments of the invention now will be described in detail with reference to the accompanying drawings. 
         FIG.  1    is a flow chart of a preferred method of harvesting cancellous bone and bone marrow in accordance with one or more aspects and features of the invention. 
         FIG.  2    is a flow chart of another preferred method of harvesting cancellous bone and bone marrow in accordance with one or more aspects and features of the invention. 
         FIG.  3    is a flow chart of another preferred method of harvesting cancellous bone and bone marrow in accordance with one or more aspects and features of the invention. 
         FIG.  4    is a flow chart of another preferred method of harvesting cancellous bone and bone marrow in accordance with one or more aspects and features of the invention. 
         FIG.  5    is a perspective view of a leg illustrating locations for harvesting of bone of one or more preferred methods in accordance with one or more aspects and features of the invention. 
         FIG.  6    is a table of case facts relating to a preferred harvesting of the invention performed in connection with the drilling and suctioning in  FIGS.  6  and  7    of U.S. Pat. Application Publication 2020/0405911 (“the ‘911 Publication”). 
         FIG.  7    is a table of case facts relating to a preferred harvesting of the invention performed in connection with the pouring and suctioning shown respectively in  FIGS.  39  and  40    of the ‘911 Publication, the results of which are seen in  FIG.  41    of the ‘911 Publication. 
         FIG.  8    is a table of case facts relating to another preferred harvesting of the invention performed in accordance with one or more aspects and features of the invention. 
         FIG.  9    is a table of case facts relating to the preferred harvesting of the invention performed in connection with the drilling, reaming, inserting, suctioning, and pouring shown respectively in  FIGS.  45 ,  46 ,  56 ,  57 , and  58    of the ‘911 Publication. 
     
    
    
     DETAILED DESCRIPTION 
     As a preliminary matter, it will readily be understood by one having ordinary skill in the relevant art (“Ordinary Artisan”) that the invention has broad utility and application. Furthermore, any embodiment discussed and identified as being “preferred” is considered to be part of a best mode contemplated for carrying out the invention. Other embodiments also may be discussed for additional illustrative purposes in providing a full and enabling disclosure of the invention. Furthermore, an embodiment of the invention may incorporate only one or a plurality of the aspects of the invention disclosed herein; only one or a plurality of the features disclosed herein; or combination thereof. As such, many embodiments are implicitly disclosed herein and fall within the scope of what is regarded as the invention. 
     Accordingly, while the invention is described herein in detail in relation to one or more embodiments, it is to be understood that this disclosure is illustrative and exemplary of the invention and is made merely for the purposes of providing a full and enabling disclosure of the invention. The detailed disclosure herein of one or more embodiments is not intended, nor is to be construed, to limit the scope of patent protection afforded the invention in any claim of a patent issuing here from, which scope is to be defined by the claims and the equivalents thereof. It is not intended that the scope of patent protection afforded the invention be defined by reading into any claim a limitation found herein that does not explicitly appear in the claim itself. 
     Thus, for example, any sequence(s) and/or temporal order of steps of various processes or methods that are described herein are illustrative and not restrictive. Accordingly, it should be understood that, although steps of various processes or methods may be shown and described as being in a sequence or temporal order, the steps of any such processes or methods are not limited to being carried out in any particular sequence or order, absent an indication otherwise. Indeed, the steps in such processes or methods generally may be carried out in various different sequences and orders while still falling within the scope of the invention. Accordingly, it is intended that the scope of patent protection afforded the invention be defined by the issued claim(s) rather than the description set forth herein. 
     Additionally, it is important to note that each term used herein refers to that which the Ordinary Artisan would understand such term to mean based on the contextual use of such term herein. To the extent that the meaning of a term used herein—as understood by the Ordinary Artisan based on the contextual use of such term—differs in any way from any particular dictionary definition of such term, it is intended that the meaning of the term as understood by the Ordinary Artisan should prevail. 
     With regard solely to construction of any claim with respect to the United States, no claim element is to be interpreted under 35 U.S.C. 112(f) unless the explicit phrase “means for” or “step for” is actually used in such claim element, whereupon this statutory provision is intended to and should apply in the interpretation of such claim element. With regard to any method claim including a condition precedent step, such method requires the condition precedent to be met and the step to be performed at least once but not necessarily every time during performance of the claimed method. 
     Furthermore, it is important to note that, as used herein, “comprising” is open-ended insofar as that which follows such term is not exclusive. Additionally, “a” and “an” each generally denotes “at least one” but does not exclude a plurality unless the contextual use dictates otherwise. Thus, reference to “a picnic basket having an apple” is the same as “a picnic basket comprising an apple” and “a picnic basket including an apple”, each of which identically describes “a picnic basket having at least one apple” as well as “a picnic basket having apples”; the picnic basket further may contain one or more other items beside an apple. In contrast, reference to “a picnic basket having a single apple” describes “a picnic basket having only one apple”; the picnic basket further may contain one or more other items beside an apple. In contrast, “a picnic basket consisting of an apple” has only a single item contained therein, i.e., one apple; the picnic basket contains no other item. 
     When used herein to join a list of items, “or” denotes “at least one of the items” but does not exclude a plurality of items of the list. Thus, reference to “a picnic basket having cheese or crackers” describes “a picnic basket having cheese without crackers”, “a picnic basket having crackers without cheese”, and “a picnic basket having both cheese and crackers”; the picnic basket further may contain one or more other items beside cheese and crackers. 
     When used herein to join a list of items, “and” denotes “all of the items of the list”. Thus, reference to “a picnic basket having cheese and crackers” describes “a picnic basket having cheese, wherein the picnic basket further has crackers”, as well as describes “a picnic basket having crackers, wherein the picnic basket further has cheese”; the picnic basket further may contain one or more other items beside cheese and crackers. 
     The phrase “at least one” followed by a list of items joined by “and” denotes an item of the list but does not require every item of the list. Thus, “at least one of an apple and an orange” encompasses the following mutually exclusive scenarios: there is an apple but no orange; there is an orange but no apple; and there is both an apple and an orange. In these scenarios if there is an apple, there may be more than one apple, and if there is an orange, there may be more than one orange. Moreover, the phrase “one or more” followed by a list of items joined by “and” is the equivalent of “at least one” followed by the list of items joined by “and”. 
     Referring now to the drawings, one or more preferred embodiments of the invention are next described. The following description of one or more preferred embodiments is merely exemplary in nature and is in no way intended to limit the invention, its implementations, or uses. 
     Generally described, preferred methods of harvesting cancellous bone and bone marrow include extracting loosened cancellous bone and bone marrow—including a liquid component thereof—to a collection container that has a first cup and a suction port to which a suction source is connected. After suctioning, the suction source is disconnected and a lid of the collection container is removed and replaced with a lid having a plunger with a press head that is configured to filter the extracted liquid by depressing the plunger toward a bottom of the first cup. The filtered liquid is poured through a suction port into a second cup while depressing the plunger, thereby separating the liquid from a semi-solid mass of cancellous bone that remains. The bone is extracted through a cortical opening in the femur, tibia, or calcaneus, and preferably from a condyle; however, in other preferred methods the cone is extracted from an intermedullary canal that is formed by reaming of the tibia or femur using an orthopedic reamer. 
     Accordingly,  FIG.  1    is a flow chart of an exemplary preferred method  100  of harvesting cancellous bone and bone marrow in accordance with one or more aspects and features of the invention. This preferred method is used to harvest such bone from the distal femur, proximal tibia, distal tibia, or calcaneous. The method  100  comprises steps  102  through  110 . Step  102  comprises extracting loosened cancellous bone and bone marrow—including a liquid component thereof—by suction to a collection container having a cup and a suction port to which a suction source is connected. Step  104  comprises, after step  102 , disconnecting the suction source from the suction port. Step  106  comprises replacing a lid of collection container with a lid having a plunger with a press head that is configured to filter the extracted liquid by depressing the plunger toward a bottom of the cup. Step  108  comprises depressing the plunger toward the bottom of the cup to filter the extracted liquid. Step  110  comprises pouring the filtered liquid from the first cup through a suction port into a second cup while depressing the plunger, thereby separating the liquid from a semi-solid mass of cancellous bone that remains in the first cup. 
     The suction port through which the liquid is poured in step  110  may be part of the first cup or may be part of the lid having the plunger; in the former case, the suction port to which the suction source is attached when performing step  102  is the suction port through which the liquid is poured in subsequent step  110 , and in the latter case, the suction port to which the suction source is attached when performing step  102  is a suction port of the first lid, which first lid is replaced in step  106  by the second lid having the plunger. Moreover, it will be appreciated that the former case represents a modification to the cup design of the incorporated bone press apparatus, in which apparatus the cup itself does not include a suction port. 
       FIG.  2    is a flow chart of another preferred method  200  of harvesting cancellous bone and bone marrow in accordance with one or more aspects and features of the invention. This preferred method is used to harvest such bone from an intermedullary canal formed in a medullary cavity. The method  200   comprises steps  202  through  214 . Step  202  comprises creating within a medullary cavity an intermedullary canal, including loosening for extraction cancellous bone and bone marrow along the intermedullary canal. Step  204  comprises inserting a suction tube through the intermedullary canal and extracting by suction through the suction tube the loosened cancellous bone and bone marrow along the intermedullary canal, wherein the bone marrow comprises a liquid, and wherein the suction tube is attached to a lid of a collection container having a cup and a suction port to which a suction source is connected. Step  206  comprises, after extracting the cancellous bone and bone marrow, disconnecting the suction source from the suction port. Step  208  comprises removing the lid of the collection container from the cup of the collection container. Step  210  comprises attaching a second lid to the cup of the collection container, the second lid having a plunger with a press head that is configured to filter the extracted liquid contained in the cup. Step  212  comprises filtering the extracted liquid by depressing the plunger of the second lid toward a bottom of the cup. Step  214  comprises pouring the filtered liquid from the cup through a suction port into another cup while depressing the plunger, thereby separating the liquid from a spongy semi-solid cancellous bone mass that remains in the cup. 
     The suction port through which the liquid is poured in step  214  may be part of the first cup or may be part of the lid having the plunger; in the former case, the suction port to which the suction source is attached when performing step  204  is the suction port through which the liquid is poured in subsequent step  214 , and in the latter case, the suction port to which the suction source is attached when performing step  204  is a suction port of the first lid, which first lid is replaced in steps  208  and  210  by the second lid having the plunger. Moreover, it will be appreciated that the former case represents a modification to the cup design of the incorporated bone press apparatus, in which apparatus the cup itself does not include a suction port. 
       FIG.  3    is a flow chart of another preferred method  300  of harvesting cancellous bone and bone marrow in accordance with one or more aspects and features of the invention. This preferred method is used to harvest such bone from the distal femur, proximal tibia, distal tibia, or calcaneous. The method  300  comprises steps  302  through  316 . Step  302  comprises creating an opening in cortical bone. The opening preferably is made using a circular cutting burr, but other methods of creating an opening can in cortical bone may be used within the scope of the invention, such as first drilling holes and then creating an opening with a hammer and osteotome. One or more curettes also may be used to further expand the opening or round out the opening. Step  304  comprises accessing through the opening and loosening for extraction cancellous bone and bone marrow. Preferably the cutting burr also is used to perform such loosening. Step  306  comprises inserting a suction apparatus through the opening and extracting the loosened cancellous bone and bone marrow, wherein the bone marrow comprises a liquid and the suction apparatus is attached to a collection container having cup and a suction port to which a suction source is connected. Step  308  comprises, after extracting, disconnecting the suction source from the suction port of the collection container. Step  310  comprises removing the lid from the cup of the collection container, and step  312  comprises attaching another lid to the same cup, wherein the second lid has a plunger with a press head that is configured to filter the extracted liquid contained in the cup. Step  314  comprises filtering the extracted liquid by depressing the plunger toward a bottom of the cup. Step  316  comprises pouring the filtered liquid from the cup through a suction port into another cup while depressing plunger, thereby separating the liquid from a spongy semi-solid cancellous bone mass that remains in the first cup. 
     The suction port through which the liquid is poured in step  316  may be part of the first cup or may be part of the lid having the plunger; in the former case, the suction port to which the suction source is attached when performing step  306  is the suction port through which the liquid is poured in subsequent step  316 , and in the latter case, the suction port to which the suction source is attached when performing step  306  is a suction port of the first lid, which first lid is replaced in steps  310  and  312  by the second lid having the plunger. Moreover, it will be appreciated that the former case represents a modification to the cup design of the incorporated bone press apparatus, in which the cup does not have a suction port. 
       FIG.  4    is a flow chart of a preferred method  400  of harvesting from an individual, in an operating room and within 8 minutes, at least 8 cc to 12 cc of a spongy semi-solid mass of cancellous bone of the individual and, separated therefrom, at least 10 cc to 15 cc of liquid bone marrow of the individual, all in accordance with one or more aspects and features of the invention. This preferred method is used to harvest such bone from the distal femur, proximal tibia, distal tibia, or calcaneous. The method  400  comprises steps  402  through  416 . Step  402  comprises using a high-speed drill with a cutting burr to create a cortical window in cortical bone. Step  404  comprises further using the high-speed drill to loosen for extraction cancellous bone and bone marrow accessed through the cortical window. Step  406  comprises inserting a suction apparatus through the cortical window and extracting with suction the loosened cancellous bone and bone marrow, the bone marrow comprising a liquid, and the suction apparatus being attached to a lid of a collection container having a cup and a suction port to which a suction source is connected. Step  408  comprises, after extracting, disconnecting the suction source from the suction port. Step  410  comprises removing the lid from the cup. Step  412  comprises attaching another lid to the cup which lid has a plunger with a press head that is configured to filter extracted liquid contained in cup. Step  414  comprises filtering the extracted liquid by depressing the plunger toward a bottom of the cup. Step  416  comprise pouring filtered liquid from the cup through a suction port into a second cup while depressing plunger, thereby separating the liquid from a spongy semi-solid cancellous bone mass that is left remaining in the first cup. 
     The suction port through which the liquid is poured in step  416  may be part of the first cup or may be part of the second lid having the plunger; in the former case, the suction port to which the suction source is attached when performing step  406  is the suction port through which the liquid is poured in subsequent step  416 , and in the latter case, the suction port to which the suction source is attached when performing step  406  is a suction port of the first lid, which first lid is replaced in steps  410  and  412  by the second lid having the plunger. Moreover, it will be appreciated that the former case represents a modification to the cup design of the incorporated bone press apparatus, in which apparatus the cup itself does not include a suction port. 
     With reference now to U.S. Pat. Application Publication 2020/0405911 (“the ‘911 Publication”), which is incorporated herein by reference, the incorporated components of the bone press apparatus that are utilized in preferred methods are perhaps best shown in  FIG.  5    of the ‘911 Publication. The components comprise a first cup  502  with a first lid  504  attached thereto, and a second cup  506  with a second lid  508  attached thereto. The second lid  508  comprises a plunger  510  having a press head for filtering liquid from cancellous bone and a suction port  512 . The first lid  504  also includes a suction port  514  and another port  516  for connection to a suction apparatus or suction tube. The cups  502 ,  506  in the bone press apparatus are substantially identical and interchangeable with each other. The bone press apparatus also includes an optional elbow connector  524 . 
     A preferred suction tube  518  is shown in  FIG.  6    of the ‘911 Publication, and a suction apparatus comprising a suction wand  520  is shown in  FIG.  7    of the ‘911 Publication The suction tube  518  preferably is used to connect the suction wand  520  to the port  516  of the first lid  504  in certain preferred methods of the invention that include harvesting of bone from the distal femur, proximal tibia, distal tibia, and calcaneous, all of which areas are identified in  FIG.  5   . 
     Additionally, the suction tube  518  may be cut at desired length forming a distal end thereof for passing the distal end of the suction tube  518  within an intermedullary canal when harvesting bone from the intermedullary canal, in which case the suction wand  520  is not used. In this respect,  FIG.  8    of the ‘911 Publication also illustrates intermedullary canals formed in the tibia and femur. 
       FIG.  9    of the ‘911 Publication illustrates a collection container comprising cup  502  and lid  504  connected by tubing  518  from port  516  to suction wand  520 .  FIG.  9    of the ‘911 Publication further illustrates another tube  522  that connects a suction source (not shown) to suction port  512  of the lid  504 . 
       FIG.  10    of the ‘911 Publication illustrates the second lid  508  having the plunger  510  wherein the second lid  508  has been unscrewed and removed from the cup  506 . 
       FIG.  11    of the ‘911 Publication illustrates that lid  508  having the plunger  510  may be screwed onto either of the two cups  502 ,  506  of the bone press apparatus, as the cups are interchangeable. 
       FIG.  12    of the ‘911 Publication illustrates the second lid  508  screwed onto one of the cups of the bone press apparatus. 
     Similarly,  FIG.  13    of the ‘911 Publication illustrates the lid  504  screwed onto one of the cups  502 ,  506  of the bone press apparatus, and  FIG.  14    of the ‘911 Publication illustrates the first lid  504  unscrewed and removed from the cup of  FIG.  13    of the ‘911 Publication 
       FIGS.  15 - 18    of the ‘911 Publication illustrate various views of another suction wand  620  used in preferred methods of the invention. As shown in these figures, the suction wand  620  includes a slider control  622  by which suction that is applied at suction tip  624  of the wand  620  is variably adjusted by a user. 
       FIG.  19    of the ‘911 Publication illustrates the connection of the suction wand  620  to the collection container comprising cup  502 ,  506  and lid  504  for use in certain preferred embodiments of the invention. 
       FIG.  20    of the ‘911 Publication illustrates holding of the suction wand  620  to a collection container using suction tubing during use in certain preferred embodiments of the invention. The wand  620  is used in preferred methods by extending the suction tip thereof through a cortical window for extraction, by suction, of cancellous bone and bone marrow. The extracted cancellous bone and bone marrow is received and collected in the collection container formed by lid  504  and one of the cups  502 ,  506  of the bone press apparatus. The suction wand  620  preferably has variable-suction control. Importantly, no irrigation is added to the bone marrow that would dilute the bone marrow and, additionally, no suction is applied during use of the press head of the plunger and the separation of the bone marrow and cancellous bone by pouring of the bone marrow into the second cup through a suction port. 
     Harvesting of cancellous bone and bone marrow from a tibia, femur, or cancellous bone is now described for purposes of an exemplary illustration of a preferred method in accordance with one or more aspects and features of the invention. 
     In particular,  FIG.  21    of the ‘911 Publication is a perspective view of a drill  702  with burr  704  coming within proximity of cortical bone  706 .  FIG.  22    of the ‘911 Publication is a perspective view of the drill  702  being used to form a cortical opening  708  in the cortical bone  706 .  FIG.  23    of the ‘911 Publication is a perspective view of the drill  702  extended through the cortical opening  708  and being used to loosen cancellous bone and bone marrow.  FIG.  24    of the ‘911 Publication is a perspective view of the withdrawal of the drill  702  from the opening  704 .  FIG.  25    of the ‘911 Publication is a perspective view of the apparatus of  FIG.  20    of the ‘911 Publication being used to extract loosened cancellous bone and bone marrow through the opening  708  in the cortical bone  706 .  FIG.  26    of the ‘911 Publication is a perspective view of the approach of the suction tip  624  of the suction wand  620  to the opening  708  in the cortical bone  706 .  FIG.  27    of the ‘911 Publication is a perspective view of the extraction through suction of the loosened cancellous bone and bone marrow through the opening  708  in the cortical bone  706 .  FIG.  28    of the ‘911 Publication is another perspective view of the extraction through suction of the loosened cancellous bone and bone marrow through the opening in the cortical bone.  FIG.  29    of the ‘911 Publication is a perspective view of the withdrawal of the apparatus of  FIG.  20    of the ‘911 Publication from the opening  708  in the cortical bone  706 .  FIG.  30    of the ‘911 Publication is a view of the apparatus of  FIG.  29    of the ‘911 Publication after withdrawal and after the suction source has been disconnected from the collection container.  FIG.  31    of the ‘911 Publication is a perspective view showing the removal of the lid  504  from the cup  502 ,  506  of the collection container and further is a perspective view of the second lid  508  with plunger and suction port  512  to be attached to the cup  502 ,  506 .  FIG.  32    of the ‘911 Publication is a perspective view of the second lid attached to the cup and further is a perspective view of a second cup not which liquid  802  from the first cup is to be poured through the suction port of the second lid.  FIG.  33    of the ‘911 Publication is a partial perspective view of the pouring of the liquid through the suction port of the second lid into the second cup.  FIG.  34    of the ‘911 Publication is a perspective view of the second lid removed from the first cup, the first cup containing the spongy mass  804  of cancellous bone, and the second cup containing the liquid bone marrow  802 .  FIG.  35    of the ‘911 Publication is a perspective view showing the withdrawal and staging of the spongy mass  804  of cancellous bone from the first cup. 
     Additionally,  FIG.  36    of the ‘911 Publication is a perspective view of drilling a cortical window in the cortical bone of the tibia in accordance with one or more aspects and features of the invention.  FIG.  37    of the ‘911 Publication is a perspective view of the suctioning of cancellous bone and bone marrow through the cortical window created in  FIG.  36    of the ‘911 Publication to the collection container of a bone press apparatus in accordance with one or more aspects and features of the invention.  FIG.  6    is a table of case facts relating to a preferred harvesting of the invention performed in connection with the drilling and suctioning in  FIGS.  36  and  37    of the ‘911 Publication.  FIG.  39    of the ‘911 Publication is a perspective view of the pouring of filtered liquid from a first cup into a second cup while depressing a plunger in accordance with one or more aspects and features of the invention.  FIG.  40    of the ‘911 Publication is a perspective view of suctioning a cancellous bone and bone marrow through a cortical window created in a tibia in accordance with one or more aspects and features of the invention.  FIG.  41    of the ‘911 Publication is a perspective view within the first and second cups after a preferred harvesting of the invention performed in connection with the pouring and suctioning shown respectively in  FIGS.  39  and  40    of the ‘911 Publication.  FIG.  7    is a table of case facts relating to a preferred harvesting of the invention performed in connection with the pouring and suctioning shown respectively in  FIGS.  39  and  40   . 
       FIG.  8    is a table of case facts relating to another preferred harvesting of the invention performed in accordance with one or more aspects and features of the invention.  FIG.  44    of the ‘911 Publication is a perspective view of the spongy mass of cancellous bone resulting from the preferred harvesting of  FIG.  43    of the ‘911 Publication. 
     Harvesting of cancellous bone and bone marrow from an intermedullary canal is now described for purposes of an exemplary illustration of a preferred method in accordance with one or more aspects and features of the invention. 
     In particular,  FIG.  45    of the ‘911 Publication is a perspective view of the drilling of a medullary cavity performed in a preferred harvesting in accordance with one or more aspects and features of the invention.  FIG.  46    of the ‘911 Publication is a perspective view of reaming of a medullary canal following the drilling of  FIG.  45    of the ‘911 Publication, done in the preferred harvesting in accordance with one or more aspects and features of the invention. 
       FIG.  47    of the ‘911 Publication is a view of reamers used in the reaming of  FIG.  46    of the ‘911 Publication, showing bone on the reamers which may be harvested and combined and used with the bone that is suctioned in accordance with one or more aspects and features of the invention.  FIGS.  48  to  55    of the ‘911 Publication are elevational views showing an exemplary creation of an intermedullary canal in accordance with one or more aspects and features of the invention, which is representative of the creation of the intermedullary canal in the preferred harvesting of  FIGS.  45  and  46    of the ‘911 Publication done in accordance with one or more aspects and features of the invention. 
       FIG.  56    of the ‘911 Publication is a perspective view showing a suction tube to be inserted into the intermedullary canal formed by the drilling and reaming respectively of  FIGS.  45  and  46    of the ‘911 Publication done in the preferred harvesting in accordance with one or more aspects and features of the invention.  FIG.  57    of the ‘911 Publication is a perspective view of suctioning of cancellous bone and bone marrow through the suction tube of  FIG.  56    of the ‘911 Publication during insertion in the intermedullary canal.  FIG.  58    of the ‘911 Publication is a perspective view of the pouring of liquid from the first cup into a second cup after the suctioning of  FIG.  57    of the ‘911 Publication in the preferred harvesting in accordance with one or more aspects and features of the invention.  FIG.  59    of the ‘911 Publication is a side view of the second cup following the pouring of  FIG.  50    of the ‘911 Publication, showing liquid bone marrow that has been poured into the second cup during performance of the preferred harvesting in accordance with one or more aspects and features of the invention.  FIG.  9    is a table of case facts relating to the preferred harvesting of the invention performed in connection with the drilling, reaming, inserting, suctioning, and pouring shown respectively in  FIGS.  45 ,  46 ,  56 ,  57 , and  58    of the ‘911 Publication. 
     As a result of the methods disclosed herein utilizing the bone press apparatus with the suction for collecting both cancellous bone and bone marrow and then separating the bone marrow from the cancellous bone using the press head of the plunger, it has been discovered that an unexpectedly large yield of cancellous bone and bone marrow is obtained following intramedullary reaming. From actual implementation, 20 cc and more of cancellous bone and 20 cc and more of bone marrow have been obtained following traditional intramedullary reaming procedures used in connection for an intramedullary nail or rod. 
     In recap of  FIGS.  45 - 60    of the ‘911 Publication, preferred methods of the invention include harvesting cancellous bone and marrow from an intramedullary canal of an individual for use as an autograft for that individual following drilling and reaming. An exemplary method is now set forth. In particular, a long pilot hole is created by a drill within the center of a long bone such as the tibia. Drilling and intramedullary reaming loosens up the cancellous bone and marrow. Preferably, an intramedullary rod is inserted into the canal afterwards. Once depth of drilling to create the intramedullary canal is satisfactory for the surgeon, the reamer is used. The reamer is cannulated whereby the guide wire remains within the canal the entire time. Multiple reamers are used and set aside for keeping the bone to be added to the press later. The bone captured on the reamers is scraped off with an instrument and used in the autograft. Once the reaming is complete, the bone press apparatus with suction is employed. A suction line is cut approximately 2-3 feet and attached to the silicon tubing. The tubing can be cut and the new suction tubing can be placed over the superior port, but this is not necessary, as the bone press apparatus preferably has a right angle for connecting the tubes. With suction on, the cut suction line is inserted around the guide wire. The guide wire does not leave the canal. Then by moving the suction tubing all the way in and spinning the tubing in multiple in and out motions within the canal and over the guide wire, cancellous bone and marrow is harvested from the medullary cavity along the intramedullary canal created by the intramedullary reaming. Once done, the collection is handed off to the scrub tech and the press top is attached. Of note, suction is not applied when the press head is used. Instead, the plunger is fully pressed downward and the apparatus tilted to pour off the liquid marrow into a second container. Of note, suction is not applied when the press head is used. Instead, the plunger is fully pressed downward and the apparatus tilted to pour off the liquid marrow into a second container that is part of the bone press apparatus. 
     Based on the foregoing description, it will be readily understood by those persons skilled in the art that the invention has broad utility and application. Many embodiments and adaptations of the invention other than those specifically described herein, as well as many variations, modifications, and equivalent arrangements, will be apparent from or reasonably suggested by the invention and the foregoing descriptions thereof, without departing from the substance or scope of the invention. Accordingly, while the invention has been described herein in detail in relation to one or more preferred embodiments, it is to be understood that this disclosure is only illustrative and exemplary of the invention and is made merely for the purpose of providing a full and enabling disclosure of the invention. The foregoing disclosure is not intended to be construed to limit the invention or otherwise exclude any such other embodiments, adaptations, variations, modifications or equivalent arrangements, the invention being limited only by the claims appended hereto and the equivalents thereof.