Source: http://www.google.com/patents/US7758651?dq=5,960,411
Timestamp: 2016-07-24 13:48:04
Document Index: 789591730

Matched Legal Cases: ['art 34', 'art 36', 'art 34', 'art 36', 'arts 34', 'arts 34', 'art 34', 'art 36', 'art 34', 'art 34', 'art 34', 'art 34', 'art 34', 'art 34', 'art 36', 'art 36']

Patent US7758651 - Mis patellar preparation - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsInstruments and a method for preparing the articular surface of the patella to receive a patellar implant are utilized without everting the patella. A medial or lateral parapatellar incision and an anterior midline incision are made adjacent the patella. The patella is clamped with a patella clamp, a...http://www.google.com/patents/US7758651?utm_source=gb-gplus-sharePatent US7758651 - Mis patellar preparationAdvanced Patent SearchPublication numberUS7758651 B2Publication typeGrantApplication numberUS 11/583,469Publication dateJul 20, 2010Priority dateOct 18, 2006Fee statusPaidAlso published asUS20080177394, US20100160915Publication number11583469, 583469, US 7758651 B2, US 7758651B2, US-B2-7758651, US7758651 B2, US7758651B2InventorsSandeep K. Chauhan, Carlos E. Collazo, D'Alessio II Jerry, Philip F. Williams, IIIOriginal AssigneeHowmedica Osteonics Corp.Export CitationBiBTeX, EndNote, RefManPatent Citations (38), Referenced by (33), Classifications (10), Legal Events (4) External Links: USPTO, USPTO Assignment, EspacenetMis patellar preparation
US 7758651 B2Abstract
1. A method of preparing the articular surface of a patella to receive a patellar component comprising:
making at least one incision in the skin of the knee;
placing a drill on the anterior surface of the patella and drilling a hole from the anterior surface of the patella through the posterior articular surface of the patella;
inserting a drive shaft through the drilled hole of the patella, the drive shaft having a first end that extends outwardly beyond the articular surface;
attaching the first end of the drive shaft to a receiving end of a reamer device;
placing the reamer device in contact with the articular surface of the patella;
resecting the articular surface of the patella by rotating the reamer device and moving the drive shaft anteriorly such that the reamer device removes bone from the articular surface of the patella; and
inserting a patellar component through the at least one incision and securing the patellar component to the resected articular surface of the patella.
2. The method according to claim 1 further including providing a patella clamp having a first clamping part and a second clamping part for respectively engaging the anterior and posterior surfaces of the patella, the clamp including a drill guide; and disengaging the first and second clamping parts from the patella after drilling the hole from the anterior surface of the patella through the articular surface of the patella.
3. The method according to claim 1 wherein the reamer device has a bore forming element configured to prepare a recess in the articular surface of the patella as the drive shaft is rotated and moved anteriorly.
4. The method according to claim 3 wherein the patellar component includes a central peg for engaging said recess.
5. A method of implanting a prosthetic patellar component comprising:
making a parapatellar incision through the skin of the knee;
drilling a hole from the anterior surface of the patella through the articular surface of the patella;
inserting a reamer device having a coupling end through the parapatellar incision;
coupling the first end of the drive shaft to the coupling end of a reamer device;
resecting the articular surface of the patella by rotating the drive shaft and reamer and moving them anteriorly to prepare the articular surface of the patella; and
inserting a patellar component through the parapatellar incision and securing the patellar component to the resected articular surface of the patella.
6. The method according to claim 5 wherein the first clamping part, the second clamping part, and the drill guide each have a central axis.
7. The method according to claim 6 further including the step of aligning the central axis of each of the first clamping part, the second clamping part, and the drill guide before drilling the hole from the anterior surface of the patella through the articular surface of the patella.
8. The method according to claim 5 further including providing a patella clamp having a first clamping part and a second clamping part for respectively engaging the anterior and posterior surfaces of the patella, the clamp including a drill guide; and disengaging the first and second clamping parts from the patella after drilling the hole from the anterior surface of the patella through the articular surface of the patella.
9. The method according to claim 5 further including the step of centering the reamer device on the articular surface of the patella.
10. The method according to claim 5 wherein said reamer device includes a plurality of anteriorly facing cutting sites.
11. A method of preparing the posterior surface of a patella to receive a patellar component comprising:
making at least two incisions in the skin of the knee;
placing a drill through a first of the at least two incisions and onto an anterior surface of the patella;
drilling a hole with the drill from the anterior surface of the patella through the posterior surface of the patella along a central axis;
inserting a guide shaft through the drilled hole, the guide shaft having a first end that extends outwardly beyond the posterior surface of the patella;
inserting a reamer having a drive shaft attached thereto through the second of the at least two incisions along an axis transverse to the central axis;
attaching the first end of the guide shaft to a receiving end of the reamer;
placing a cutting surface of the reamer in contact with the posterior surface of the patella; and
resecting the posterior surface of the patella by rotating the reamer by way of the drive shaft and moving the reamer anteriorly such that the reamer removes bone from the posterior surface of the patella.
providing a patella clamp having a first clamping part and a second clamping part for respectively engaging the anterior and posterior surface of the patella, the clamp including a drill guide to guide the drill along the central axis.
disengaging the first and second clamping parts from the patella after drilling the hole from the anterior surface of the patella through the posterior surface of the patella.
14. The method according to claim 12, wherein the first clamping part, the second clamping part, and the drill guide each have a central axis.
15. The method according to claim 14, further comprising aligning the central axis of each of the first clamping part, the second clamping part, and the drill guide before drilling the hole from the anterior surface of the patella through the posterior surface of the patella along the central axis.
16. The method according to claim 11, wherein the reamer has a bore forming element configured to prepare a recess in the posterior surface of the patella as the drive shaft is rotated and the reamer is moved anteriorly.
17. The method according to claim 16, wherein the patellar component includes a central peg for engaging the recess.
inserting the patellar component through the second of the at least two incisions; and
securing the patellar component to the resected posterior surface of the patella by aligning the central peg of the patellar component with the prepared recess of the posterior surface of the patella.
Prior art devices for preparing the patella for receiving a patellar implant are well known to those skilled in the art. It is known in the art to prepare the patella during total knee replacement by everting, i.e. rotating the articular surface anteriorly, the patella approximately 180�, or with newer minimally invasive techniques between 45� and 90�. Patella clamps may be used to clamp the anterior and articular surfaces of the patella before resecting the articular surface of the patella. Additionally, some patella clamps may require fixation pegs or keels to engage the patella before everting it to a desired angle. Common methods to remove bone from the articular surface of the patella include saw resection or milling/planar systems. The removal of bone in either of these systems may provide a flat, stable platform to support, but not secure, a prosthetic patellar component.
Many patella resection guides are known, each having various designs to clamp and mill/saw the patella. Such designs are shown in prior U.S. Pat. Nos. 5,716,360; 5,575,793; 5,536,271; and 5,129,907. Improvements in patella resection guides allowing the patella to be reamed to receive an implant thereon without everting the patella during the reaming step are desirable. A minimally invasive method of preparing the patella to receive an implant thereon without everting the patella is desirable especially where only two small incisions through the skin of the knee are made. Specifically, the articular surface of a patella may be prepared to receive an implant thereon without everting the patella if a medial or lateral parapatellar incision is made through the knee capsule adjacent the patella to gain entry into the knee joint, and another anterior midline incision is made through the skin of the knee down to the anterior surface of the patella bone. More generally, the two incisions may be a medial or lateral parapatellar incision and a small anterior midline incision made above the centerline of the patella. Currently, there is no system that allows the entire patella preparation and implantation of a patellar component to be performed by reaming without everting the patella.
FIG. 3 is a partial assembled isometric view of the patella clamp of FIG. 2 engaging the patella of FIG. 1;
Referring to FIG. 1, there is shown a knee joint 10 in an extended position with a patella 12 in a non-everted position. Patellar tendon 14 attaches a distal end 16 of the patella 12 to tibia 18. Quadriceps tendon 20 attaches a proximal end 22 of the patella 12 to femur 19. If the patellar tendon 14 ruptures, the patella 12 loses its anchoring support to the tibia 18. Without this anchoring effect of the intact patella tendon 14, the patella tends to move superiorly (towards the hip) as the quadriceps muscle contracts. Without intact patella tendon 14, the patient is unable to straighten the knee 10. If a rupture of patella tendon 14 occurs, and the patient tries to stand up, the knee will usually buckle and give way because the body is no longer able to hold the knee in a position of extension.
In FIG. 1, patella 12 has an anterior surface 24 and a posterior articular surface 26. When the bone of the articular surfaces of femur 19 the knee joint and/or surface 26 of patella 12 is damaged through arthritis or other joint disease or injury or wear, the articular surface 26 may be resected in order to receive a prosthetic patellar component thereon. This is usually done in connection with total knee anthroplasty. If patellar tendon 14 is not ruptured, and the articular surface of the patella is damaged, it is beneficial for a patient receiving a patellar component to have the articular surface prepared to receive a patellar component without everting the patella. In this manner, the patella and quadriceps tendons are not strained if the procedure is performed without everting the patella. This allows for easier recovery after surgery and less post-operative pain.
Referring to FIG. 2 there is shown an exploded isometric view of a patellar clamp 30 with a drill guide apparatus 38 for use in the present invention. Such a clamp is shown in U.S. Publication 2004/0162561 the disclosure of which is incorporated herein by reference. Patellar clamp 30 comprises a main body portion 32, a first modular clamping part 34, a second clamping part 36, and a drill guide 38. Main body portion 32 of patellar clamp 30 includes a pair of handle portions 54 which are connected to moveable receptacles 200 and 202 which are coupled to the handle 54 by a linkage mechanism such as described in U.S. Publication 2004/0162561. Receptacles 200 and 202 include bores 204 and 206 into which insertion portions 208 of clamping part 34 and 210 of clamping part 36 are inserted. Insertion portions 208 and 210 are held within receptacles 202 and 204 by spring detent
which can be released by depressing buttons 212 and 214. Likewise an insertion element 216 is mounted on a frame 218 which is coupled to the linkage mechanism of main body portion 32. Drill guide 38 may be releasably attached to insertion portion 216 and, although not shown in FIG. 2, includes a receptacle similar to 202 and 204 with a quick release button 220 which operates in a similar manner as release buttons 212 and 214. Drill guide 38 includes a support arm 222 which allows the drill guide barrel 39 of drill guide 38 to be placed adjacent the centers of first and second clamping parts 34, 36. Barrel 39 includes an opening 52 through which a drive element or drill bit (not shown) may be inserted along axis 44. When clamping parts 34, 36 of patellar clamp 30 are assembled as shown in FIG. 3, a central axis 40 of first clamping part 34 and a central axis 42, of second clamping part 36, and a central axis 44 of drill guide 38 are aligned. First clamping part 34 includes a bore 46 to allow a drill bit inserted through an opening 52 of drill guide 38 to extend outwardly beyond articular surface 26 of patella 12, and thus will protect the anterior aspect of a native femur.
Additionally, the preferred surgical method of the present invention is a minimally invasive procedure for preparing the articular surface of the patella to receive a patellar implant without everting the patella. Before the apparatus of the present invention is inserted into the body, two skin incisions are preferably made through the skin of the knee. Specifically, a medial or lateral parapatellar incision and a small anterior midline incision are made. Once exposure to the knee is attained, the clamping part of a standard patellar clamp is inserted into the joint of the knee. For example with the knee in full extension, a first clamping part 34 of patella clamp 30 is inserted through the medial or lateral parapatellar incision. Preferably, patella 12 may be slightly raised in the anterior direction without everting the patella, to accommodate first clamping part 34 of patella clamp 30 thereunder. The top surface 43 of first clamping part 34 is brought into contact with articular surface 26 of patella 12. The articular surface 26 of patella 12 should be centered along axis 40 on first clamping part 34, specifically, at the location of counter bore 46. Preferably, first clamping part 34 of patella clamp 30 may include fixation pegs or spike 48 to dig into the articular surface of patella 12 so as to limit the movement of the patella during a subsequent drilling step.
Further, second clamping part 36 of patella clamp 30 may be placed on the anterior skin of the knee with a recess 50 surrounding patella 12. Recess 50 of modular clamping part 36 is placed over the anterior midline incision and drill guide 38 located at the center of recess 50 along axis 42 so that the axis 40, 42 and 44 are all coaxial. Drill guide 38 is first used to accommodate a drill bit used to create a hole or pathway through patella 12 from anterior surface 24 and exiting the articular surface 26. Drill guide 38 includes an upper stop surface 39 surrounding opening 52. Drill guide 38 may be later used to accommodate a drive shaft used to connect to a reamer device for resecting articular surface 26 of patella 12 and preparing the patella to receive a patella component thereon.
FIG. 3 is an assembled isometric view of the clamping end of patella clamp 30 of FIG. 2 engaging the patella of FIG. 1. Drill guide 38 is attached to patella clamp 30, which is used to center drill hole 52 on patella 12. The central axis of drill guide 44 is axially aligned with axis 40, 42 of the first and second clamping parts. Preferably, the patella clamp 30 extends medially or laterally and is set perpendicular to the patellar tendon. The preferred patella clamp is secured into place by squeezing handles 54 shown in FIG. 2.
FIG. 8 is an isometric view of a reamer drive 70 inserted into and through hole 68. FIGS. 9-11 depict a preferred embodiment of a reamer drive 70 as shown in FIG. 8. Referring to FIGS. 8-11 drive shaft 71 includes an upper drive portion 72 which is configured to be inserted into a driver mechanism, such as a power tool used to rotate a drive shaft 71. Drive shaft 71 has a threaded portion 74 which mates with a threaded receiving portion of a reamer. It will be obvious to an ordinary person skilled in the art to have drive shaft 71 include any of a various different connection portions such as a quick connect portion that can couple the end of drive shaft 71 with a receiving end 96 of a reamer 90 shown in FIG. 13, such as but not limited to threads tapers, press-fit and spring detent mechanisms. Drive shaft 71 further includes a stopping portion 76, which is configured to prohibit the reamer drive 70 from advancing any further through aperture 52 of drill guide 38 once a stop surface 78 of stopping portion 76 comes in contact with top portion 39 of drill guide 38. FIG. 10 is a bottom view of the reamer drive 70 with a larger diameter 80 representing the outer diameter of stopping portion 76, and a diameter 82 representing the diameter of the shaft 71 and diameter 83 representing the diameter of thread 74 which is the preferred embodiment of a connection feature. Surface 78 is formed between diameters 76 and 82. Referring to FIG. 11, depth gauge markings 84 are provided along at least part of the length of drive shaft 71. In the preferred embodiment, once end portion 74 of drive shaft 71 is connected to a thread bore 97 of receiving portion 96 of reamer 90, these depth gauge markings 84 can be used for measuring the depth of the cut in articular surface 26 of patella 12.
The depth of the cut can be determined several ways. In a preferred embodiment, a depth gauge may be placed through the patella 12 with a surgeon placing its end flush with articular surface 26 of patella 12 to assess its overall thickness and using the depth gauge markings 84 on drive shaft 71 to remove the desired amount of bone from articular surface 26. In an alternate embodiment, a cannula 86 having a bore 89 as shown in FIG. 12, may be placed through drilled hole 68 previously made in the patella 12. The cannula 86 has depth gauge markings 88 on the outside surface which may be used to help set the depth of the resection. Drive shaft 71 is then inserted into 89 of cannula 86 and connected to receiving end of reamer device 40 shown in FIGS. 13-16 as previously described, through any one of a number of quick connect features. Once reamer head 90 begins to rotate and is pulled anteriorly, a top surface 94 of reamer 90 will touch the cannula 86 and set the depth limit. The cannula bore 89 has a diameter that is slightly larger than diameter 82 of drive shaft 71.
Referring to FIGS. 13-16, there is shown a preferred embodiment of reaming device 90. To assemble reaming device 90 to drive shaft 71 in situ, reamer device 90 is inserted through a medial or lateral parapatellar incision made through the skin of the knee. Preferably, the posterior facing surface 92 of reamer device 90 is made of a non-abrasive material such as polyethylene so as to minimize any damage on the anterior femur during reaming. Preferably, reamer device 90 is available in several diameters to approximate a range of sizes of patella 12.
A quick connect feature is provided to couple reamer 90 to shaft 71. In the preferred embodiment threaded end 74 of drive shaft 71 is configured to mate with threaded bore 97 of receiving end 96 of a reamer device 90. After the two threaded elements are joined the anterior surface 94 of the receiving end is placed in contact with articular surface 26 of patella. Top surface 94 of receiving end 96 forms a starting point for a bore cutting surface 98, which on anterior movement, creates a cylindrical recess 13 (shown in FIG. 23) in patella 12 as the reamer device is rotated during the reaming step. Reamer device further includes cutting teeth 102 in cutting surface 99. When pressure is applied between articular surface 26 of patella 12 and surface 94 of receiving end 96 of reamer device 90 while pulling a rotating drive shaft anteriorly and preferably applying downward force on the anterior surface 24 of the patella, cartilage and then bone will begin to be removed from the articular surface 26 of patella 12 and receiving end 96 will create the cylindrical recess 13 in patella 12. Eventually, cutting teeth 102 of reamer device 90 will begin to remove cartilage and bone from articular surface 26 of patella and create a flat, stable platform to mate with a flat anterior surface of a prosthetic patellar component. Preferably, a desired amount of bone may be removed through use of the depth gauge markings 84 of drive shaft 71 or cannula 86. FIG. 17 illustrates reaming device 90 in contact with articular surface 26 of patella 12. The reaming device is shown connected to drive shaft 71.
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