Patent Description:
A Latarjet operation, also known as the Latarjet-Bristow procedure, is a surgical procedure used to treat recurrent shoulder dislocations, typically caused by bone loss or a fracture of the glenoid. The Latarj et procedure typically involves the removal and transfer of a section of the coracoid process, as well as its attached soft tissue, to the glenoid cavity. This placement of the coracoid acts as a bone block which, combined with the transferred soft tissue, prevents further dislocation of the joint. During the procedure, holes are generally drilled through both of the coracoid and the glenoid through which screws or sutures attached to anchors or buttons can be placed for securing the section of the coracoid to the glenoid.

Surgical drill guides can be used to place the holes in the glenoid neck at a fixed distance from the glenoid articulating surface to align with the drill holes of the coracoid. However, misalignment between the two sets of holes can occur. When the holes are misaligned, the suture/anchor or button constructs generally allow some tolerance in aligning the coracoid flush to the glenoid surface, because the suture has play within the drill holes. However, when a surgeon wants to use screws instead of the suture/anchor or button construct, retroactive alignment is not possible once the holes are drilled. Surgeons generally address the misalignment by shaving down the thickness of the coracoid with a burr. However, use of a burr can potentially cause cartilage damage and affect the accuracy of the surface alignment between the glenoid and the coracoid, as well as affecting surface quality.

<CIT> relates to a vertical adjustable fixed point malposition distance guide needle collimation hollow screw fixation minimally invasive device.

Described herein is a drill guide assembly in which the drill guide is adjustable for properly aligning the holes in the glenoid with the holes in the coracoid in a Latarjet procedure. The drill guide has an aimer arm extending from the body of the drill guide which has a fixed angle with respect to a drill sleeve inserted through the guide. The aimer arm can move up or down relative to the drill sleeve while maintaining the fixed angle relative to the drill sleeve by actuation of a translation member on the body. The aimer arm can move in a stepped fashion in <NUM> increments, or in a non-stepped fashion. A locking knob on the aimer arm can be used to lock the aimer arm at the desired position. Advantageously, the component parts of the drill guide assembly can be disassembled for cleaning.

Examples of the drill guide assembly of this disclosure may include one or more of the following, in any suitable combination.

In examples, a drill guide assembly of this disclosure includes an elongate body including a proximal end, a distal end and a longitudinal axis extending between the proximal and distal ends. At least one channel extends along the longitudinal axis of the body from the proximal end to the distal end. A sleeve is slidably disposed within the at least one channel. A distal end of the sleeve is configured to be secured to a first surface of a bone. An aimer arm extends distally from the body. A distal end of the aimer arm is configured to be secured to a second surface of the bone. The aimer arm extends at a fixed angle with respect to the sleeve. A vertical distance between the aimer arm and the sleeve is adjustable to a pre-selected distance by actuation of a translation member on the body such that the aimer arm maintains the fixed angle with respect to the sleeve.

In examples, the assembly further includes a handle extending from a lower surface of the body configured to be held by a user. In examples, the preselected distance is between <NUM> and <NUM>. In examples, the at least one channel is two channels extending on opposing sides of the aimer arm, and a distance between the two channels is about <NUM>. In examples, the sleeve includes a bore extending from a proximal end to a distal end of the sleeve for the passage of a drill. In examples, the assembly further includes a locking mechanism for locking the sleeve at a predetermined position within the at least one channel. In examples, the proximal end of the sleeve includes a depth stop. A diameter of the depth stop selected to be larger than a diameter of the channel for limiting distal movement of the sleeve within the channel. In examples, the fixed angle is <NUM>°. In examples, the distance between the aimer arm and the sleeve is adjustable in a stepped or a non-stepped manner. In examples, the assembly further includes an alignment member extending from an upper surface of the body adjacent the distal end of the body. The alignment member defines a plurality of longitudinal slots. In examples, the translation member is a rotatable wheel. In examples, the aimer arm extends through opposing ones of the plurality of slots along the longitudinal axis. A projection of the aimer arm is configured to serially engage the rotatable wheel such that the distance between the aimer arm and the sleeve is adjustable by rotation of the rotatable wheel by <NUM>°. In examples, a pivot point of the rotatable wheel is offset from a center of the rotatable wheel in both a horizontal and a vertical direction. In examples, a proximal end of the aimer arm includes a locking knob for securing the aimer arm against the alignment member at the preselected distance. In examples, the assembly further includes a compression spring disposed within the alignment member for biasing the projection of the aimer arm against the rotatable wheel.

The disclosure will be more fully understood by reference to the detailed description, in conjunction with the following figures, wherein:.

In the description that follows, like components have been given the same reference numerals, regardless of whether they are shown in different examples. To illustrate example(s) in a clear and concise manner, the drawings may not necessarily be to scale and certain features may be shown in somewhat schematic form. Features that are described and/or illustrated with respect to one example may be used in the same way or in a similar way in one or more other examples and/or in combination with or instead of the features of the other examples.

As used in the specification and claims, for the purposes of describing and defining the invention, the terms "about" and "substantially" are used to represent the inherent degree of uncertainty that may be attributed to any quantitative comparison, value, measurement, or other representation. The terms "about" and "substantially" are also used herein to represent the degree by which a quantitative representation may vary from a stated reference without resulting in a change in the basic function of the subject matter at issue. "Comprise," "include," and/or plural forms of each are open ended and include the listed parts and can include additional parts that are not listed. "And/or" is open-ended and includes one or more of the listed parts and combinations of the listed parts. Use of the terms "upper," "lower," and the like is intended only to help in the clear description of the present disclosure and are not intended to limit the structure, positioning and/or operation of the disclosure in any manner.

Referring now to <FIG>, an exemplary drill guide assembly <NUM> of this disclosure is shown in a perspective view. The assembly <NUM> includes a guide body <NUM> having a proximal end 102a and a distal end 102b. An upper surface 102c and a lower surface 102d extend between the proximal end 102a and the distal end 102b of the body <NUM>. A handle <NUM> extends from the lower surface 102d of the body <NUM> and is configured to be held by a user in a "pistol-style" configuration. In alternative examples, not shown, the handle <NUM> is an in-line handle, formed substantially coaxially with the body <NUM>. The body <NUM> further includes at least one cylindrical channel <NUM> extending from the proximal end 102a to the distal end 102b of the body <NUM> for slidably receiving an elongate drill sleeve <NUM> (<FIG>). The drill sleeve <NUM> is configured for the passage of a guidewire (not shown) for locating the bone tunnels to be drilled in the bone. In the example of <FIG>, two channels <NUM> are defined on opposite sides of the body <NUM> configured for positioning two parallel bone tunnels through the bone. In examples, a distance between the channels <NUM> is about <NUM>, ensuring accurate and consistent placement of the bone tunnels about <NUM> apart within the bone. An elongate aimer arm <NUM> extends distally from the body <NUM> at about a <NUM>° angle toward the longitudinal axis L of a path defined by the channels <NUM> for insertion of the drill sleeve <NUM>. The aimer arm <NUM> includes a distal tip <NUM> with a spiked hook <NUM> which is configured to contact a bone surface. In alternative examples, not shown, the distal tip <NUM> could be pointed or comprise a blunted end, such as a spherical tip. The assembly <NUM> is configured such that a vertical distance between the aimer arm <NUM> and the drill sleeve <NUM> is adjustable based on a pre-measured thickness of the bone to be drilled by actuation of a translation member on the body, such as a rotatable wheel <NUM>, while still maintaining the <NUM>° angle between the aimer arm <NUM> and the drill sleeve <NUM>. The upper surface 102c of the body <NUM> also includes at least one threaded opening <NUM> adjacent the proximal end 102a for receiving a threaded ratchet pawl (not shown) for locking the drill sleeve <NUM> within the channel <NUM> at a desired position.

Turning now to <FIG>, in the example of the assembly <NUM>, an alignment member <NUM> extends from the upper surface 102c of the body <NUM> adjacent the distal end 102b. The alignment member <NUM> defines a plurality of longitudinal slots <NUM> within the alignment member <NUM>. The aimer arm <NUM> extends through opposing slots <NUM> along the longitudinal axis and is vertically moveable within the slots <NUM> relative to the drill sleeve <NUM>. A proximal end of the aimer arm <NUM> includes a locking knob <NUM> which can be used to secure the aimer arm <NUM> in the desired vertical position within the slots <NUM>. A projection <NUM> on the aimer arm <NUM> extends through a third slot <NUM> and is configured to serially engage a flat edge of the rotatable wheel <NUM>, as further described below. A compression spring <NUM> is disposed within the alignment member <NUM> between the aimer arm <NUM> and an upper knob <NUM>. The spring <NUM> is configured to bias the projection <NUM> of the aimer arm <NUM> against the rotatable wheel <NUM>. In <FIG>, the rotatable wheel <NUM> is shown rotated <NUM>° from the position of the rotatable wheel <NUM> shown in <FIG>. In <FIG>, the spring <NUM> is also shown as more compressed and the aimer arm <NUM> in a higher vertical position than the spring <NUM> and the aimer arm <NUM> of <FIG>.

Turning now to <FIG>, the rotatable wheel <NUM> includes a pivot point <NUM> that is offset from the center of the rotatable wheel <NUM> in both a horizontal and vertical direction. For example, the pivot point <NUM> may be disposed at a first distance A from a first flat edge 126a of the rotatable wheel <NUM> selected to be smaller than a second distance B from a second flat edge 126b of the rotatable wheel <NUM> in a horizontal direction. In examples, the first distance A may be <NUM> and second distance B may be <NUM>. Similarly, the pivot point <NUM> may be disposed at a third distance C from a third flat edge 126c of the rotatable wheel <NUM> selected to be smaller than a fourth distance D from a fourth flat edge 126d of the rotatable wheel <NUM> in a vertical direction. In examples, the third distance C may be <NUM> and the fourth distance D may be <NUM>. In this manner, by a <NUM>° rotation of the rotatable wheel <NUM>, the distance between the aimer arm <NUM> and the drill sleeve <NUM> may be adjusted in a stepped manner in <NUM> increments from about <NUM> to about <NUM>.

Turning now to <FIG>, the drill guide assembly <NUM> is shown with drill sleeves <NUM> inserted through the channels <NUM>. Each drill sleeve <NUM> includes a depth stop <NUM> at a proximal end of the drill sleeve <NUM>. The depth stop <NUM> can be used by a surgeon to grasp and manipulate the drill sleeve <NUM> during surgery. The depth stop <NUM> has a larger outer diameter than that of the channel <NUM>, such that when drill sleeve <NUM> is inserted through the channel <NUM>, the depth stop <NUM> prevents drill sleeve <NUM> from being inserted completely through the channel <NUM>. The distal end of the drill sleeve <NUM> may be angled and include a plurality of teeth <NUM> for securing the drill sleeve <NUM> against bone. A diameter of a proximal portion 134a of the drill sleeve <NUM> is selected to be larger than a diameter of a distal portion 134b of the drill sleeve <NUM>. The drill sleeve <NUM> has a cylindrical bore <NUM> (FIG. 2A) extending through the drill sleeve <NUM> which provides a passageway for a guidewire (not shown). The proximal portion 134a of the drill sleeve <NUM> also includes a rack <NUM> in the form of a series of ratchet teeth or radial grooves along one side of drill sleeve <NUM>. A ratchet pawl <NUM> (FIG. 2A) is configured to engage with the rack <NUM> and lock the drill sleeve <NUM> in a desired position within channel <NUM>.

The use of the drill guide assembly <NUM>, outside the scope of the claims, will now be described with reference to <FIG>. The glenoid <NUM> may be initially prepared for the procedure by rasping the inferior surface 132a of the glenoid <NUM> for better attachment to the coracoid. Initially, drill holes <NUM> are drilled in a center of the coracoid <NUM> at a distance from the lateral border 151a (typically <NUM> to <NUM> from the lateral border 151a, depending on the width of the coracoid <NUM>). The distance of the drill holes <NUM> to the lateral border 151a of the coracoid <NUM> is measured and the result is used to set the pre-selected distance of the aimer arm <NUM> from the drill sleeve <NUM>. For example, if the distance of the drill holes <NUM> from the lateral border 151a of the coracoid <NUM> is <NUM>, the distance of the aimer arm <NUM> from the drill sleeve <NUM> is selected to be <NUM>. After an incision is made to introduce the assembly <NUM> into the patient's shoulder, the surgeon adjusts the orientation of aimer arm <NUM> until the hook <NUM> is placed on the inferior surface 132a of the glenoid <NUM> to hold the aimer arm <NUM> in place, making sure that the under surface of the aimer arm <NUM> is in full contact with glenoid cartilage. The drill sleeve <NUM> is then inserted through channel <NUM> of the assembly <NUM> so that the distal tip of the drill sleeve <NUM> is flush against the anterior surface 132b of the glenoid <NUM>. The drill sleeve <NUM> is then locked into the channel <NUM> by the ratchet pawl <NUM>. Subsequently, a drill (not shown) is inserted through the bore <NUM> of the drill sleeve <NUM> and drilled through the glenoid <NUM>. The assembly <NUM> is then removed from the patient's shoulder.

An alternative example of a drill guide assembly <NUM> is shown in <FIG>. In the example of <FIG>, a spring-loaded top knob <NUM> is used to adjust the height of the aimer arm <NUM> within the slots <NUM> in a non-stepped manner. The locking knob <NUM> is used to lock the height of the aimer arm <NUM> in place. In an alternative example of a drill guide assembly <NUM>, shown in <FIG>, the alignment member <NUM> includes a first plurality of teeth <NUM> spaced apart at a distance of about <NUM>. The plurality of teeth <NUM> are configured to engage a second plurality of teeth <NUM> (<FIG>) on the aimer arm <NUM> so that the height of the aimer arm <NUM> can be adjusted by <NUM> increments. A spring <NUM> is disposed within the alignment member <NUM> to ease the adjustment of the aimer arm <NUM>. The locking knob <NUM> is used to lock the height of the aimer arm <NUM> in place.

Another example of a drill guide assembly <NUM>, outside the scope of the claims, is shown in <FIG>. In the example of <FIG>, the aimer arm <NUM> is connected via a rotatable joint <NUM> to the guide body <NUM>. The height of the aimer arm <NUM> is adjusted by moving the aimer arm <NUM> up or down relative to the guide body <NUM>. A scale <NUM> on the guide body <NUM> would indicate the degree of adjustment in millimeters. The joint <NUM> could include a lock mechanism (e.g., a thumb wheel) to lock the aimer arm <NUM> at the desired height.

Claim 1:
A drill guide assembly (<NUM>), comprising:
an elongate body (<NUM>) including a proximal end (102a), a distal end (102b), a longitudinal axis extending (L) between the proximal and distal ends (102a, 102b) and upper and lower surfaces (102c, 102d) extending between the proximal end (102a) and the distal end (102b);
at least one channel (<NUM>) extending along the longitudinal axis (L) of the body from the proximal end (102a) to the distal end (102b);
a sleeve (<NUM>) slidably disposed within the at least one channel (<NUM>), a distal end of the sleeve configured to be secured to a first surface of a bone;
an aimer arm (<NUM>) extending distally from the body, a distal end of the aimer arm configured to be secured to a second surface of the bone,
characterized by the aimer arm extending from the body (<NUM>) towards the longitudinal axis (L) of the body (<NUM>) at a fixed angle with respect to the sleeve (<NUM>);
wherein a distance between the aimer arm (<NUM>) and the sleeve (<NUM>) is adjustable to a pre-selected distance by actuation of a translation member on the body (<NUM>) such that the aimer arm (<NUM>) moves up or down relative to the sleeve (<NUM>) while maintaining the fixed angle with respect to the sleeve (<NUM>).