Patent Publication Number: US-2017367715-A9

Title: Reconstructive joint tunnel drilling locator

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This application is a divisional of U.S. patent application Ser. No. 13/076,766 filed Mar. 31, 2011 entitled RECONSTRUCTIVE JOINT TUNNEL DRILLING LOCATOR, the contents of which are incorporated by reference herein in their entirety for all purposes. 
    
    
     BACKGROUND 
     Reconstructive bone and ligament surgery often involves drilling bone tunnel into skeletal members to attach connective elements such as ligament and tendon grafts, as well as various artificial replacements and/or attachments for articulated joints. In particular, reconstructive surgery of the shoulder joint often involves reduction and drilling of the Acromioclavicular/Coracoclavicular (AC/CC) joint. Such drilling is typically facilitated by a guide for disposing an insertion wire or drilling member to an insertion location on a surgical member. Careful placement and subsequent drilling ensures maximum joint mobility from the resulting reconstruction. 
     SUMMARY 
     Reconstructive surgery for flexible joints such as arm and leg joints often involves surgical attachments that are subject to substantial force due to the pivotal movement these joints provide. Connective tissue or a suitable replacement attaches to a surgical member such as an arm or leg bone. Reconstructive surgery involving functional, structural fixation to bone members often involves drilling into a structurally sound area of the corresponding bone. Typically this involves drilling tunnels into the bone for providing a passage or attachment of a ligament. In the case of an acromioclavicular (shoulder) joint repair, the proposed approach employs a reconstructive joint tunnel drilling locator, or acromioclavicular joint guide, to facilitate compression of a joint and drilling of two holes for repairs and/or rebuilding of the acromioclavicular (AC) and/or coracoclavicular (CC) joint. When the AC/CC joint is ruptured, particular repair techniques require a graft to be passed under the coracoid and form a sling whose ends are anchored in the clavicle. Further, it is desirable to install a suture anchor in the coracoid tied to the clavicle to take the load off the graft during initial healing. 
     The guide includes two ratcheting sleeves, a central sleeve and a second sleeve pivoting around the axis of the first to allow a second hole to be drilled offset from the first at a known or predetermined distance. The guide includes an aimer arm to provide a target for the first hole and allow compression of the joint, or surgical member being drilled. The sleeves each define an insertion member such as a drill guide for advancement to the entry location of the respective drilling sites. The aimer arm is disposable at an opposed side of a joint from the drilling sites, and is securable for positioning the insertion members for a guidewire or other drilling member. The first member is fixable at a primary location for drilling, and the second member is positionable by rotating the second insertion member about the axis defined by the first insertion member to locate a second drilling site at the predetermined distance and optimal location from the primary location, for drilling a substantially parallel (non-intersecting) tunnel, thus obviating the need for separate right and left or other permutations of a drilling guide. 
     Configurations herein are based, in part, on the observation that repairs and/or rebuilding of the acromioclavicular (AC) and/or coracoclavicular (CC) joint may require a graft to be passed under the coracoid and form a sling whose ends are anchored in the clavicle. Further, it is desirable to install a suture anchor in the coracoid tied to the clavicle to take the load off the graft during initial healing. Unfortunately, conventional approaches suffer from the shortcoming that the available guides provide for placement of only a single hole and further require a right and left guide depending on the operative side. 
     Configuration herein substantially overcome the above described shortcomings by providing a reconstructive joint tunnel locator in the form of an acromioclavicular joint guide for drilling two holes (tunnels) spaced apart by a predetermined distance, and by orienting the drill guides in a pivoting arrangement allowing one drill guide to pivot around the axis of the other at a predetermined distance for locating the second drill hole at the predetermined distance on either the right or left side of a surgical patient. 
     In an example configuration discussed further below, the acromioclavicular joint guide includes a tunnel locating device for compressing a surgical member between an insertion member and an aimer point to permit an operator, such as a surgeon, to dispose an insertion wire along an axis defined by the insertion member. The device includes a plurality of insertion members including a primary insertion member and moveable, or pivoting, insertion members, such that the pivoting insertion members are disposed at a predetermined distance around a primary insertion axis defined by the primary insertion member. 
     In the example arrangement, two tunnels are employed corresponding to a primary insertion member and a pivoting, or secondary insertion member. A pivot block has a plurality of apertures forming sleeves in the pivot block for accommodating each of the insertion members, such that each of the sleeves defines an insertion axis for a respective insertion member of the plurality of the insertion members. The insertion members are each disposed in a respective sleeve of the pivot block for insertion toward the surgical member along nonintersecting axes defined by the sleeve, such that the insertion members following generally parallel paths into the surgical member (i.e. bone). An elongated arm attaches to the pivot block at a proximate portion or end and has a aimer point at a distal portion or end, in which the elongated arm may extend around the surgical member via an inverted portion or bend such that the aimer point is on the insertion axis of the primary insertion member. In this manner, the aimer point locates an exit of the hole from the insertion point defined by the primary insertion member, and the pivoting insertion member defines a second tunnel located at the predetermined distance from the primary tunnel. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The foregoing and other objects, features and advantages of the invention will be apparent from the following description of the particular embodiments of the invention, as illustrated in the accompanying drawings in which the reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention. 
         FIG. 1  shows a perspective view of the tunnel drilling locator; 
         FIGS. 2-3  show a flowchart of tunnel locating using the tunnel drilling locator of  FIG. 1  for use with an insertion wire; 
         FIG. 4  shows a perspective downward view of the tunnel drilling locator of  FIG. 1 ; 
         FIG. 5  shows a perspective upward view of the tunnel drilling locator of  FIG. 1 ; and 
         FIG. 6  shows a top perspective angle view of the tunnel drilling locator. 
     
    
    
     DETAILED DESCRIPTION 
     Disclosed below is an example configuration and deployment of the AC/CC tunnel drilling locator. The tunnel drilling locator operates as a guide for facilitating tunnel placement by an operator of the guide, typically a surgeon. A surgical member such as a patient bone structure is employed as an example in reconstructive procedure of an AC/CC joint. Other surgical members involving other joints may also benefit from application of the disclosed guide. The example below depicts a particular configuration and usage of the guide; other arrangements and usages, such as those involving additional tunnels, may be apparent to those of skill in the art. 
       FIG. 1  shows a perspective view of the tunnel drilling locator  100 . Referring to  FIG. 1 , the tunnel drilling locator  100  includes a primary insertion member  110  and a secondary insertion member  120  disposed in sleeves  112 ,  122  (respectively) through apertures  114 ,  124  in pivot block  130 . The apertures  114 ,  124  form sleeves  112 ,  122  for insertion of the insertion members  110 ,  120  and adapted for ratcheting movement through the sleeves  112 ,  122  via ratcheting teeth  116 ,  126  in the insertion members  110 ,  120 . Each of the insertion members  110 ,  120  is adapted for ratcheting movement along a primary insertion axis  150  and a secondary insertion axis  152 , respectively. An engaging tip  154 ,  156  on each insertion member  110 ,  120  (also referred to as a “bullet”) fixes the insertion member  110 ,  120  to surgical members upon sufficient insertion and compression, discussed further below. A knob  118 ,  128  on each of the insertion members permits insertion force and rotational force for disengaging the teeth and releasing the ratchet. 
     An elongated arm  140  attaches the pivot block  130  for permitting rotational communication around the primary insertion axis  150 , allowing the secondary (moveable, or pivoting) insertion member  120  to rotate or pivot around the primary insertion axis  110  at a predetermined distance  160  determined by the sleeves  112 ,  122  in the pivot block  130 , as shown by arrows  132 . The pivot block  130  therefore allows the moveable insertion member to pivot around the primary insertion member  110  to accommodate right or left shoulder positioning while maintaining the fixed distance  160  between the insertion members  110 ,  120  for optimal drilling placement of tunnels. In a particular configuration, also shown in greater details in  FIG. 4 , the pivot block  130  may be adapted to slide off the proximate end  142 ′ of the arm for reverse installation on the opposed side  142 ″ of the proximate end  142  at the tip  147  for pivoting from the opposed side  142 ″. 
     The elongated arm  140  includes a proximate end  142  and a distal end  144  coupled by a bend  146 . The bend  146  allows the proximate end  142  to extend around the surgical member and inverts the arm  140  such that that distal end  144  terminates in an insertion point  148 , referring to the flat area proximal and perpendicular to the tip. aligned with the insertion axis  150  such that the primary insertion member  110 , when disposed through the sleeve  112  via ratcheting teeth  126 , compresses the surgical members between the aimer point  148  and the engaging tip  154  of the primary insertion member  110  for defining a point of insertion for an insertion wire or other drilling tool. Subsequent to fixing the primary insertion point, the pivoting insertion member  120  may pivot for defining a secondary insertion point allowing optimal hole position in a surgical member, (e.g. a clavicle of a surgical patient) defined by advancement of the moveable insertion member  120  at the predetermined distance  160  on the surgical member to dispose the engaging tip  156  of the pivoting insertion member  120 . 
       FIGS. 2-3  show a flowchart of tunnel locating using the tunnel drilling locator  100 . One particular use of the drill guide devices is for an acromioclavicular joint report for drilling two holes (tunnels) spaced apart by a predetermined distance. The method for locating insertion sites for surgical joint repair of a surgical joint member such as the acromioclavicular/coracoclavicular joint as performed by an operator (surgeon) includes, at step  200 , providing a surgical aiming device  100  for compressing a surgical member between primary insertion member  110  and an aimer point  148 . The insertion member  110  is typically a drill guide or other elongated structure having a bore for delivering an insertion wire. The aimer point  148  locates an exit point for disposing an insertion wire  170  ( FIG. 4 ) along the primary insertion axis  150  defined by the insertion member  110 , such that the aimer point  148  is coupled to the primary insertion member  110  by an inverted, elongated arm  140  coupling the aimer point  148  to the insertion members  110 ,  120  around opposed sides of a surgical member. 
     The operator disposes the aimer point  148  at a target location on the surgical member coaxial with the primary insertion member  110 , as depicted at step  201 . The aimer point  148  is disposed at a distal end of an elongated arm  140  having a proximate end  142  extending from the pivot block  130  away from the primary axis  150 , and a distal end  144  extending toward the primary axis  150 , the proximate end  142  and distal end coupled by a bend  146 , in which the distal end  144  terminates in the aimer point  148  which is located on the primary insertion axis  150  disposed on an intersecting path with the primary insertion member  110 , as disclosed at step  202 . 
     The operator locates a primary insertion point by disposing the primary insertion member  110  and engaging tip  154  on an opposed side of the surgical member, as depicted at step  203 . Once the aimer point  148  is located (set) at the drilling terminus and affixed by the pointed end, the primary insertion member  110  allows the operator to locate the start of the tunnel for drilling. The primary insertion member is configured for directing the drilling wire  170  into a primary insertion location of a surgical site, as shown at step  204 . Locating the primary insertion member  110  may also include disposing, via a slot  180  in the pivot block  130  for receiving the proximate end  142  of the elongated arm  140 , the aimer point  140  on the opposed side of the surgical member, as depicted at step  205 , to change the angle of the distal end  144 . The proximate end  142  has an arcuate contour adapted for slideable movement along the slot  180  in the pivot block  130 , while the aimer point  148  maintains alignment on the primary insertion axis  150  through a range of the slideable movement. Such slideable movement allows optimal placement of the insertion member  150  and the aimer point  148  on opposed sides of the surgical member. 
     The operator begins advancing the primary insertion member  110  to the surgical site via the pivot block  130  having a primary sleeve  112 , such that the primary sleeve  112  defines the primary insertion axis  150  through a primary aperture  114  in the pivot block  130 , as disclosed at step  206 . The primary insertion member  150  slideably engages the primary sleeve  112  for ratcheting movement along the primary insertion axis  150  via ratcheting teeth  126  on the primary insertion member  110 . Advancing the primary insertion member  110  includes advancing such that the primary insertion member  110  is disposed via the fixed (non-pivoting) aperture  114  and travels an intersecting path with the aimer point  148 , in which the aimer point  148  is configured for compressing a surgical member between the primary insertion member  110  and the aimer point  148  for fixing the primary insertion member  110  on a path toward the aimer point  148  for surgical entry defined by the primary insertion axis  150 , as depicted at step  207 . 
     Once the location of the primary tunnel is identified, the pivot block  130  is employed to identify second tunnel at a predetermined distance around the primary tunnel. The operator locates a second insertion point by rotating the pivot block  130  around the primary insertion axis  100 , as depicted at step  208 . To locate the tunnel, the pivot block  130  includes a secondary sleeve  122  in the pivot block  130 , such that the secondary sleeve  122  defines a secondary insertion axis  152  through the pivoting aperture  124  in the pivot block  130 , in which the secondary sleeve  122  is in pivotal communication with the primary sleeve  112  via the pivot block  130 , as shown at step  209 . The secondary sleeve  122  is adapted to pivot around the primary insertion axis  150  for pivotally disposing the pivoting insertion member  120  around the primary insertion axis  150  at the predetermined distance  160  for locating the second insertion point with engaging tip  156 , as depicted at step  210 . The operator disposes the pivoting insertion member  120 , in which the secondary sleeve  122  is receptive to the pivoting insertion ember  120  for ratcheting movement along the secondary insertion axis  152 , as disclosed at step  211 . The pivot block  130  maintains a predetermined distance  160  between the primary  112  and secondary sleeves  122  and orients the primary insertion axis  150  and secondary insertion axis  152  on nonintersecting paths for forming parallel tunnels, as depicted at step  211 . 
     The operator advances the second insertion member  120  to contact a second insertion site on the surgical member with the engaging tip  156 , as disclosed at step  212 , and compresses the surgical member by ratcheting at least one of the first and second insertion members  110 ,  120  to compress the surgical member between the insertion members and the aimer point  148 , as depicted at step  213 . As the primary insertion member is typically located first, the primary insertion member  110  and the aimer point  148  compress the surgical member uniformly due to axial alignment on the primary insertion axis  150 . The secondary insertion member  120  is then positioned by rotating, or pivoting of the pivot block  130 . Once both insertion members  110 ,  120  are fixed, the operator directs a drilling wire  170  via the primary insertion member  110 , and at the secondary insertion location at the predetermined distance  160  from the primary insertion location to dispose the second sleeve in alignment with the second insertion point, as depicted at step  214 . 
       FIG. 4  shows a perspective downward view of the tunnel drilling locator for  FIG. 1 . Referring to  FIGS. 1 and 4 , an insertion wire  170 ,  172  is insertable through the insertion members  110 ,  120  respectively, for drilling the primary and secondary tunnels. Pivotal movement  132  of the pivoting insertion member  120  is along a side  142 ′ of the proximate end  142  of the elongated arms  140 , or the pivot block  130  may be disposed along the arm to a tip  147  for pivoting along the opposed side  142 ″ or for removal and reinstallation of the pivot block  130 . 
       FIG. 5  shows a perspective upward view of the tunnel drilling locator of  FIG. 1 . Referring to  FIGS. 1 and 5 , a knob  130  secures the pivot block  130  to the proximate end  142  via a threaded screw or other suitable mechanism. Exit apertures  114 ′ and  124 ′ defined the exit points of the sleeves  112 ,  122  corresponding to apertures  114  and  124 , respectively. 
       FIG. 6  shows a top perspective angle view of the tunnel drilling locator. Referring to  FIGS. 1, 4 and 6 , the pivot block  130  includes a slideable portion  133  and a rotating portion  135 . The slideable portion  133  includes the slot  180  responsive to the proximate end  142  of the elongated arm  140  for arcuate, sliding movement thereto. A fixing knob  186  turns a screw for fixing the pivot block on the arm  140 . The rotating portion  135  couples to the slideable portion  133  by a top bracket  188  and a bottom bracket  190  secured in rotational communication by the primary insertion member  110  passing through hinge apertures  192  in the top and bottom brackets  188 ,  190 . A guide slot  194  in the bottom bracket  190  defines the pivoting (rotational) movement range  132 . In this manner, the secondary insertion member  120  is permitted pivotal movement around the primary insertion member  110  while both are afforded slideable movement along the proximate end  142  relative to the aimer tip  148 . 
     While this invention has been particular shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be mad therein without departing from the spirit and scope of the present application as defined by the appended claims. Such variations are intended to be covered by the scope of this present application. As such, the foregoing description of embodiments of the present application is not intended to be limiting, the full scope rather being conveyed by the appended claims.