Patent Description:
Many bones of the human musculoskeletal system include articular surfaces. The articular surfaces cooperate to facilitate different types and degrees of joint movement. The articular surfaces may erode or experience bone loss over time due to repeated use or wear or may fracture as a result of a traumatic impact. These types of bone defects may cause joint instability and pain. Some techniques may utilize a prosthesis to repair the articular surfaces. Tissue may be detached from the bone prior to placement of the prosthesis. The tissue may be reattached to the bone utilizing one or more fasteners situated adjacent to the prosthesis.

<CIT>discloses a surgical access port stabilization. <CIT>discloses a method and apparatus for a less invasive shoulder procedure.

The present invention is defined by independent claim <NUM>. This disclosure relates to shield guide assembly for an orthopaedic procedure. The shield guide assembly may be used to at least partially block access to a localized surface region of a bone during preparation of the surgical site.

A shield guide assembly for an orthopaedic procedure according to an exemplary aspect of this disclosure includes, inter alia, a base configured to be releasably secured to an implant, a guide arm extending from the base, and a shield moveable relative to the guide arm. The shield includes a shield body that is dimensioned to block access through the shield such that a projection of a perimeter of the shield body silhouettes a perimeter of the implant.

A kit for an orthopaedic procedure includes, inter alia, an implant including an implant body configured to be at least partially received in bone and a shield guide assembly. The shield guide assembly includes a base configured to be releasably secured to the implant, a guide arm extending from the base, and a shield translatable along a length of the guide arm to set a position of the shield relative to the implant. The shield includes a shield body establishing a shield perimeter. The shield body is dimensioned to block access through the shield body onto an adjacent bone surface region of the bone associated with a projection of the shield perimeter.

A method of installing an orthopaedic implant presently not claimed may include, inter alia, positioning an implant in bone and securing a shield guide assembly to the implant. The shield guide assembly may include a base, a guide arm extending from the base, and a shield secured to the guide arm. The securing step may include mounting the base to the implant. The method may include moving the shield along the guide arm to set a position of the shield relative to the implant. The shield body is dimensioned to block access through the shield body onto a bone surface region of the bone associated with a projection of the shield perimeter from the set position. The method may include forming at least one aperture in the bone adjacent to the bone surface region and the shield.

This disclosure relates to a shield guide assembly that may be utilized in an orthopaedic procedure for restoring functionality to a joint. The shield guide assembly described herein may be utilized during placement of a shoulder prosthesis in anatomical and reverse procedures for restoring functionality to shoulders having advanced cartilage disease. Visibility of portions of the prosthesis may be obscured due to placement in bone. The shield guide assembly and techniques disclosed herein may be utilized to block access to portions of the bone surrounding the prosthesis, thereby reducing a likelihood of contact from instrumentation and other devices that may be utilized for reattachment of any tissue that stabilizes a joint, such as soft tissue including tendons, ligaments and joint capsules, and other tissue, which may lead to improved healing. The tissue may include one or more rotor cuff tendons including a supraspinatus tendon, infraspinatus tendon, teres minor tendon and/or subscapularis tendon. For example, the surgeon may position the shield guide assembly relative to the prosthesis to reduce a likelihood of inadvertently contacting and forming holes into the prosthesis when preparing to reattach a subscapularis or other rotor cuff tendon to the bone.

A kit for an orthopaedic procedure according to an exemplary aspect of this disclosure includes, inter alia, an implant including an implant body configured to be at least partially received in bone and a shield guide assembly. The shield guide assembly includes a base configured to be releasably secured to the implant, a guide arm extending from the base, and a shield translatable along a length of the guide arm to set a position of the shield relative to the implant. The shield includes a shield body establishing a shield perimeter. The shield body is dimensioned to block access through the shield body onto an adjacent bone surface region of the bone associated with a projection of the shield perimeter. The shield body is dimensioned to block access through the shield such that a projection of a perimeter of the shield body silhouettes a perimeter of the implant.

In a further embodiment, the guide arm being elongated and extending along an arm axis from the base. The shield is translatable along the arm axis to set a position of the shield relative to the base (<NUM>).

In a further embodiment, the shield body may include at least one slot configured to slidably receive a portion of the guide arm along the arm axis.

In a further embodiment, a length of the guide arm may have a T-shaped cross section.

In a further embodiment, the at least one slot may be a row of interconnected T-shaped slots corresponding to respective radial positions of the shield relative to the arm axis, and the length of the guide arm may be insertable into each one of the T-shaped slots to set the respective radial position of the shield.

In a further embodiment, the shield body excludes any apertures between the row of slots and the shield perimeter.

In a further embodiment, the base may include a recess configured to at least partially receive an end portion of the implant.

In a further embodiment, the base may be rotatable about an implant axis of the implant to vary a circumferential position of the shield relative to the implant axis.

In a further embodiment, the shield may be dimensioned to abut the adjacent bone surface region in an installed position.

In a further embodiment, the adjacent bone surface region may be associated with a humerus.

In a further embodiment, the base may be rotatable about an implant axis of the implant to vary a circumferential position of the shield relative to an implant axis of the implant.

In a further embodiment, the perimeter of the shield may be offset outwardly by a maximum distance of no more than <NUM> millimeter from the perimeter of the implant for substantially all positions along the perimeter of the implant below a bottom of the base relative to the implant axis.

In a further embodiment, the shield may be moveable relative to the guide arm to vary a radial position of the shield relative to the implant axis.

In a further embodiment, the shield body may be dimensioned to block access through the shield onto an adjacent bone surface region associated with a humerus.

In a further embodiment, the shield perimeter may define a shield width that is greater than an implant width of the portions of the implant configured to be received in bone.

In a further embodiment, the implant body may extend along an implant axis between first and second end portions. The base may be configured to be secured to the first end portion. The shield may be rotatable about the implant axis to vary a circumferential position of the shield relative to the implant body in an installed position.

In a further embodiment, the implant may include a trunnion configured to be secured to the implant body and an articulation head configured to be secured to the implant body. The trunnion may be configured to engage a resected surface along a humerus. The articulation head may include an articulating face dimensioned to interface with an opposed articular surface associated with a glenoid or a glenoid implant.

In a further embodiment, a plurality of threads may extend about a circumference of the implant body, and the plurality of threads may be dimensioned to secure the implant body in bone.

A method of installing an orthopaedic implant according to an exemplary aspect not presently claimed may include, inter alia, positioning an implant in bone and securing a shield guide assembly to the implant. The shield guide assembly includes a base, a guide arm extending from the base, and a shield secured to the guide arm. The securing step may include mounting the base to the implant. The method may include moving the shield along the guide arm to set a position of the shield relative to the implant. The shield body is dimensioned to block access through the shield body onto a bone surface region of the bone associated with a projection of the shield perimeter from the set position. The method may include forming at least one aperture in the bone adjacent to the bone surface region and the shield.

In a further embodiment, the tissue may be soft tissue, and the method may include positioning a fastener in the at least one aperture to secure the soft tissue to the bone.

In a further embodiment, the bone may be a humerus, the fastener may be a suture anchor, and the soft tissue may include a subscapularis tendon.

In a further embodiment, the bone may be a humerus. The method may include resecting the humerus along a humeral head to establish a resected surface, and then embedding at least a portion of the implant in the resected surface.

In a further embodiment, the method may include rotating the shield about an implant axis of the implant to set a circumferential position of the shield relative to the implant. The moving step may occur such that the shield abuts the bone along the bone surface region in the set position. The forming step may occur subsequent to the rotating step and the moving step.

In a further embodiment, the implant may include an implant body, a trunnion configured to be secured to the implant body, and an articulation head. The articulation head may include an articulating face dimensioned to interface with an opposed articular surface associated with a glenoid or a glenoid implant. The step of positioning the implant may include moving the trunnion into engagement along the resected surface.

In a further embodiment, a plurality of threads may extend about a circumference of the implant body. The step of positioning the implant may include rotating the implant body about an implant axis to fixedly attach the implant body in the bone. The method may include securing the articulation head to the trunnion to trap an end portion of the implant body between the trunnion and the articulation head.

<FIG> illustrate an exemplary shield guide assembly <NUM>. The assembly <NUM> may be utilized for various surgical procedures, such as orthopaedic procedures for restoring functionality of a joint. The assembly <NUM> may be utilized in the repair of articular surfaces along a humerus in anatomical and reverse shoulder replacement procedures. The assembly <NUM> may be utilized during attachment of soft tissue including tendons, ligaments and joint capsules, and other tissue at a surgical site, such as reattachment of a subscapularis or other rotator cuff tendon to bone subsequent to implantation of a prosthesis in the humerus. The surgeon may situate the assembly <NUM> to block a pathway to portions of the bone surrounding the implant during preparation of the surgical site, thereby reducing a likelihood of contact from instrumentation and other devices such as guide pins and fasteners that may be utilized for attachment of the tissue. Although the assembly disclosed herein primarily refer to shoulder reconstructions, the disclosed assembly may be utilized to restore functionality to other locations of the patient, such as knee and hip joints.

Referring to <FIG>, the assembly <NUM> includes a base <NUM>, an elongated guide arm <NUM> and a shield <NUM> carried by and secured to the guide arm <NUM>. The base <NUM> is configured to be releasably secured to an implant <NUM> (shown in dashed lines in <FIG> for illustrative purposes). The assembly <NUM> may be utilized with implants of various shapes and sizes. A geometry of the implant <NUM> of <FIG> is exemplary and is not intended to be limiting. The shield <NUM> is translatable along a length of the guide arm <NUM> to set a position of the shield <NUM> relative to the base <NUM> and the implant <NUM>.

Referring to <FIG> and <FIG>, with continuing reference to <FIG>, the base <NUM> may have a generally dome shaped geometry for interfacing with the implant <NUM> (<FIG>). The base <NUM> may extend along a base axis BA. The assembly <NUM> may include a handle <NUM> extending outwardly from the base <NUM>, such as along the base axis BA as illustrated in <FIG>. The handle <NUM> may be dimensioned for manipulation by the surgeon to place the assembly <NUM> at a desired position and/or orientation along a surgical site. The handle <NUM> may have a generally cylindrical-shaped geometry. The handle <NUM> may be integrally formed with the base <NUM> or may be a separate and distinct component mechanically attached to the base <NUM> with one or more fasteners.

The base <NUM> may include a recess <NUM> configured to at least partially receive a first end portion <NUM> of the implant <NUM> to secure the base <NUM> to the implant <NUM>, as illustrated in <FIG>. The base <NUM> may define one or more openings <NUM> (e.g., windows) for viewing the first end portion <NUM> of the implant <NUM>, which may assist in positioning of the assembly <NUM>. The implant <NUM> may include an implant body <NUM> extending along an implant axis IA between a first end portion <NUM> and a second end portion <NUM>. The base axis BA may be collinear or otherwise substantially parallel to the implant axis IA of the implant <NUM> in an installed position, as illustrated in <FIG>. In other implementations, the base <NUM> may be dimensioned such that the base axis BA is transverse to the implant axis IA. For the purposes of this disclosure, the terms "about," "approximately" and "substantially" mean within ±<NUM>% of the stated value or relationship unless otherwise indicated. The recess <NUM> may be dimensioned to have a geometry that complements a periphery of the first end portion <NUM> of the implant <NUM>.

The base <NUM> may be rotatable in a direction R1 about the implant axis IA to vary a circumferential position of the shield <NUM> relative to the implant axis IA and implant body <NUM> of the implant <NUM> in an installed position. In other implementations, the recess <NUM> is dimensioned to establish an interference fit with the periphery of the implant body <NUM> to limit or otherwise oppose relative rotation.

The guide arm <NUM> may be cantilevered from a periphery of the base <NUM>. The guide arm <NUM> may extend along an arm axis AA from the base <NUM>. The guide arm <NUM> may be dimensioned such that the arm axis AA is substantially perpendicular to the base axis BA and such that the shield <NUM> is substantially parallel to the base axis BA, as illustrated in <FIG>. In other implementations, the assembly <NUM> may be dimensioned such that the shield <NUM> is substantially non-parallel to the base axis BA and angled relative to the base <NUM>. The shield <NUM> is translatable in a direction D1 along the arm axis AA to set a position of the shield <NUM> relative to the base <NUM>. Exemplary positions of the shield <NUM> along the guide arm <NUM> are illustrated by shields <NUM>-<NUM>, <NUM>-<NUM> in <FIG> (<NUM>-<NUM> indicated in dashed lines for illustrative purposes). The periphery of the base <NUM> may define the axially innermost position of the shield <NUM> relative to the arm axis AA. Moving the shield <NUM> in the direction D1 along the guide arm <NUM> may occur such that the shield <NUM> abuts bone B in the set position (bone B shown in dashed lines in <FIG> for illustrative purposes).

The guide arm <NUM> may be dimensioned to limit rotation of the shield <NUM> about the arm axis AA. In other implementations, the shield <NUM> may be rotatable about the arm axis AA. The guide arm <NUM> may include a main body <NUM> extending along the arm axis AA and a pair of rails <NUM> (<FIG>) on opposed sides of the main body <NUM>. The rails <NUM> may be arranged along the main body <NUM> such that a length of the guide arm <NUM> has a substantially T-shaped cross-sectional geometry, as illustrated in <FIG>. The rails <NUM> may be dimensioned to extend from the periphery of the base <NUM> and may be spaced apart from an abutment <NUM> at a free end of the guide arm <NUM> to establish a pair of opposed slots <NUM> (<FIG>). The abutment <NUM> may define an axially outermost position of the shield <NUM> relative to the arm axis AA.

The shield <NUM> may include a shield body <NUM> dimensioned with respect to a predetermined implant geometry to block a pathway or access through the shield body <NUM> onto an adjacent localized bone surface region, such as during formation of one or more apertures utilized for reattachment of tissue, including any tissue disclosed herein, such as a subscapularis or other rotator cuff tendon subsequent to at least partially embedding the implant <NUM> in bone.

Referring to <FIG>, with continuing reference to <FIG>, the shield body <NUM> may include a first portion <NUM> and a second portion <NUM>. The first portion <NUM> may face towards the free end of the guide arm <NUM>, and the second portion <NUM> may face towards the base <NUM>. The first and second portions <NUM>, <NUM> may be integrally formed or may be separate and distinct components mechanically attached or otherwise secured to each other. The first portion <NUM> may have a substantially rectangular geometry. The second portion <NUM> may include a pair of wings <NUM> dimensioned to extend outwardly of the first portion <NUM>. The first and second portions <NUM>, <NUM> of the shield body <NUM> cooperate to establish a shield perimeter <NUM> (shown in dashed lines for illustrative purposes).

The shield body <NUM> may be dimensioned with respect to a geometry of the surgical site. The shield body <NUM> may have a substantially planar geometry along the second portion <NUM>, as illustrated in <FIG>. In other implementations, the shield <NUM> may be dimensioned to substantially complement or approximate a contour of an adjacent surface of bone B, as illustrated by shield body <NUM> in <FIG>. Contouring the shield body <NUM> may reduce a likelihood of placing instrumentation and other devices between the shield body <NUM> and the bone B. In this disclosure, like reference numerals designate like elements where appropriate and reference numerals with the addition of one-hundred or multiples thereof designate modified elements that are understood to incorporate the same features and benefits of the corresponding original elements.

The shield <NUM> may be moveable relative to the guide arm <NUM> to vary a radial position of the shield <NUM> relative to the implant axis IA of the implant <NUM>. The shield body <NUM> may include at least one slot <NUM> extending through the first and second portions <NUM>, <NUM>. The slot <NUM> is configured to slidably receive a portion of the guide arm <NUM> along the arm axis AA, as illustrated in <FIG>. The slot <NUM> may have various geometries such as a row of interconnected T-shaped slots <NUM>. The T-shaped slots <NUM> may correspond to respective radial positions of the shield <NUM> relative to the arm axis AA and/or a set of predetermined implant size(s). For example, the shield body <NUM> may define four slots <NUM> corresponding to a set of predetermined implant size(s) (e.g., small, medium, large, and extra-large). The shield body <NUM> may be aligned with one of the slots <NUM> in the guide arm <NUM>, and then the shield <NUM> may be moved in a direction D2 to set the radial position of the shield <NUM> relative to the arm axis AA, as illustrated by shields <NUM>-<NUM>, <NUM>-<NUM> in <FIG>. The rails <NUM> along the length of the guide arm <NUM> may be insertable into each one of the T-shaped slots <NUM> to set the radial position of the shield <NUM> relative to the arm axis AA. The shield <NUM> may be dimensioned such that the shield body <NUM> excludes any apertures between the row of slots <NUM> and the shield perimeter <NUM>, as illustrated in <FIG>.

Referring to <FIG>, with continuing reference to <FIG> and <FIG>, the shield perimeter <NUM> is dimensioned with respect to a predetermined geometry of an implant or set of implants. The implant <NUM> establishes an implant perimeter <NUM>. The implant perimeter <NUM> corresponds to an entirety of the implant <NUM> including portions configured to extend outwardly from bone. The shield perimeter <NUM> is dimensioned such that a projection of the shield perimeter <NUM> completely surrounds the implant perimeter <NUM>. The shield <NUM> is dimensioned to block access through the shield body <NUM> onto an adjacent localized bone surface region <NUM> associated with a projection of the shield perimeter <NUM>. The bone surface region <NUM> may be established along an external surface contour of a bone B that at least partially receives the implant <NUM>, such as a humeral head. The shield <NUM> may be dimensioned to abut the bone surface region <NUM> in an installed position, as illustrated in <FIG> (see also <FIG>). The shield perimeter <NUM>, implant perimeter <NUM>, bone surface region <NUM> and related features are shown in dashed lines in <FIG> for illustrative purposes.

The perimeter <NUM> of the shield <NUM> may establish a first width W1. The first width W1 may extend between a pair of lateral walls of the shield body <NUM>. The perimeter <NUM> of the implant <NUM> may establish a second width W2. <FIG> shows shield <NUM>' dimensioned to closely approximate a profile of implant <NUM>'. A perimeter <NUM>' of the shield <NUM>' is dimensioned to substantially follow a perimeter <NUM>' of the implant <NUM>' such that a projection of the perimeter <NUM>' of the shield <NUM>' silhouettes the perimeter <NUM>' of the implant <NUM>' to block access through the shield body <NUM>' onto an adjacent localized bone surface region <NUM>'. A first width W1' of the shield <NUM>' may be substantially equal to a second width W2' of the implant <NUM>'. The perimeter <NUM>' of the shield <NUM>' may be offset outwardly by a maximum distance of no more than <NUM> millimeter (mm) from the perimeter <NUM>' of the implant <NUM>' for at least a majority or substantially all positions along the perimeter <NUM>', including at least positions of the perimeter <NUM>' below a bottom <NUM>' of base <NUM>' relative to implant axis IA' (see also bottom <NUM> of base <NUM> in <FIG>). The disclosed techniques may facilitate more closely positioning instrumentation relative to the implant <NUM>' during formation of one or more features in bone B', which may improve fixation and healing of the patient.

<FIG> illustrate an exemplary orthopaedic implant <NUM> that may be utilized with the shield guide assembly <NUM>. The implant <NUM> may be representative of a stemless implant sold under the tradename Eclipse System™ and manufactured by Arthrex®, Inc. The assembly <NUM> and disclosed implants may be provided to the surgeon as a kit for performing an orthopaedic procedure. The kit may include implants of various shapes and sizes. The particular implant may be selected from the kit according to an anatomy of the patient. Other implants may be utilized with the teachings disclosed herein, including implants having a stem portion received within an internal cavity of a bone, intramedullary nails, and bone plates.

The implant <NUM> may include an implant body <NUM>, a trunnion <NUM> and an articulation head <NUM>. The implant body <NUM> may be configured to be at least partially received in bone, such as along a resected surface of a humeral head. The implant body <NUM> may be a cage screw including one or more threads <NUM> extending about a circumference of the implant body <NUM>. The threads <NUM> may be dimensioned to secure the implant body <NUM> in bone. The implant body <NUM> may be rotatable in a direction R3 (<FIG>) about an implant axis IA to secure the implant body <NUM> in bone. The implant body <NUM> may define a hollow cavity <NUM> and one or more openings <NUM> in a wall of the implant body <NUM>. The openings <NUM> may promote bone growth from surrounding bone into the cavity <NUM>, which may improve healing of the patient.

The trunnion <NUM> may be configured to be secured to the implant body <NUM>. The trunnion <NUM> may be configured to engage a resected surface of a bone, such as a resected surface along a humerus (see, e.g., <FIG>). The trunnion <NUM> may include a passage <NUM> (<FIG>) configured to at least partially receive the implant body <NUM> along the implant axis IA. During assembly, the implant body <NUM> may be moved in a direction D3 along the implant axis IA and into the passage <NUM> until a collar <NUM> of the implant body <NUM> abuts a main body <NUM> of the trunnion <NUM>. The trunnion <NUM> may include one or more protrusions <NUM> configured to engage a bone surface for securing the implant <NUM>.

The articulation head <NUM> may be configured to be secured to the implant body <NUM>. The articulation head <NUM> may include an articulating face <NUM> dimensioned to interface with an opposed articulated surface. The opposed articulated surface may be associated with a glenoid or a glenoid implant utilized in an anatomic or reverse shoulder repair procedure. The articulating face <NUM> may have a convex geometry for an anatomical shoulder procedure, as illustrated in <FIG>, or may have a concave face for a reverse shoulder procedure. The articulation head <NUM> may be moved in the direction D3 along the implant axis IA and impacted on, or otherwise secured to, the implant body <NUM> and/or main body <NUM> of the trunnion <NUM>.

<FIG> illustrates an non-claimed method of installing an orthopedic implant in a flow chart <NUM>. The method <NUM> may be utilized to perform an arthroplasty for restoring functionality to a joint such as a shoulder having advanced cartilage disease, for example. The method <NUM> may be utilized with the shield guide assembly <NUM> and any of the orthopedic implants disclosed herein. Method <NUM> may be utilized to attach any tissue disclosed herein, including soft tissue such as tendons, ligaments and joint capsules. The tissue may be one of the rotor cuff tendons of a patient including a supraspinatus, infraspinatus, teres minor and/or subscapularis tendon. Fewer or additional steps than are recited below could be performed within the scope of this disclosure, and the recited order of steps is not intended to limit this disclosure.

Referring to <FIG>, with continuing reference to <FIG>, a surgical site S may be prepared at step 290A. The surgical site S may be a joint, such as a shoulder joint including a glenoid G and humerus H (see, e.g., <FIG>). The surgical site S may be established along bone B associated with an articular surface of the shoulder joint, such as a humeral head HH of the humerus. One or more operations can be performed to prepare the surgical site S, such as one or more reaming, milling and drilling operations to establish a desired geometry of the surgical site S.

Step 290A may include resecting a portion of the bone B at step 290B to establish a resected surface RS. Step 290B may include excising a portion of the humerus along the humeral head HH at a resection angle α relative to an axis BB of the bone B to establish the resected surface RS. The bone B may be resected utilizing one or more cutting instruments and guide blocks, for example.

Step 290A may include forming a bone cavity BC along the resected surface RS and into the bone B. The bone cavity BC may be an annulus, as illustrated in <FIG>. The bone cavity BC may be dimensioned to receive at least a portion of an implant body <NUM> of an implant <NUM>, as illustrated in <FIG>. In other implementations, a core CC may be removed such that the bone cavity BC is substantially hollow. Various techniques for forming the bone cavity BC may be utilized, such as impacting an annular coring template into the resected surface RS, or a reaming or drilling operation.

Referring to <FIG>, with continuing reference to <FIG>, the implant <NUM> may be positioned at least partially in the bone B at step 290C. The implant <NUM> may be a stemless implant. Other implants may be utilized with the method <NUM> and the shield guide assembly <NUM>, including implants having an elongated stem received a humeral canal and any of the implants disclosed herein. Step 290C may include embedding at least a portion of the implant body <NUM> in the resected surface RS subsequent to resecting the bone B. A trunnion <NUM> may be moved into engagement or otherwise positioned along the resected surface RS.

The implant body <NUM> may be positioned at least partially in the bone cavity BC, which may occur subsequent to positioning the trunnion <NUM>. The implant body <NUM> may be moved in the direction D3 along an implant axis IA and at least partially into a passage <NUM> of the trunnion <NUM> until a collar <NUM> of the implant body <NUM> abuts a main body <NUM> of the trunnion <NUM>. Step 290C may include rotating the implant body <NUM> in a direction R3 about the implant axis IA to cause one or more threads <NUM> to fixedly attach or otherwise secure the implant body <NUM> in the bone B along the bone cavity BC.

Referring to <FIG>, with continuing reference to <FIG>, at step 290D a shield guide assembly <NUM> is releasably secured to the implant <NUM> to at least partially block access to a localized bone surface region <NUM> along the surgical site S (see <FIG>). The shield guide assembly <NUM> may include a base <NUM>, a guide arm <NUM> and a shield <NUM>. Step 290D may include mounting the base <NUM> to the trunnion <NUM> or another portion of the implant <NUM>, as illustrated in <FIG>. In other implementations, the assembly <NUM> may be mounted directly to the implant body <NUM> (<FIG>). The assembly <NUM> may be secured to the implant <NUM> such that the guide arm <NUM> is be cantilevered from a periphery of the base <NUM>.

At step 290E, a position of the shield <NUM> may be set relative to the implant <NUM>. Step 290E may include aligning a shield body <NUM> of the shield <NUM> with a selected T-shaped slot <NUM> in the guide arm <NUM>, and then moving the shield <NUM> in a direction D2 to set the radial position of the shield <NUM> relative to the arm axis AA of the guide arm <NUM>. Step 290E may include inserting one or more rails <NUM> of the guide arm <NUM> into a selected one of the T-shaped slots <NUM> to set the respective radial position of the shield <NUM>. The rails <NUM> and slots <NUM> may be dimensioned to limit relative radial movement of the shield <NUM> relative to the arm axis AA such that the shield <NUM> sits on the guide arm <NUM> at a substantially constant height along a length of the rails <NUM>.

Step 290E may include rotating the shield <NUM> in a direction R1 about the implant axis IA to set a circumferential position of the shield <NUM> relative to the implant <NUM> (<FIG>). The assembly <NUM> may be dimensioned such that the shield <NUM> is rotatable approximately <NUM> degrees about the base axis BA to block access bone B surrounding the implant <NUM>. In some implementations, the assembly <NUM> may be dimensioned such that the shield <NUM> is rotatable less than <NUM> degrees about the base axis BA, such as equal to or less than about <NUM> degrees.

Step 290E may include moving the shield <NUM> in a direction D1 along a length of the guide arm <NUM> to set a position of the shield <NUM> relative to the implant <NUM>. Moving the shield <NUM> in the direction D1 along the guide arm <NUM> may occur such that the shield <NUM> abuts the bone B along the bone surface region <NUM> in the set position, as illustrated in <FIG> (see also <FIG>). The bone surface region <NUM> may be associated with a projection of the shield perimeter <NUM> (<NUM>, <NUM> respectively shown in dashed lines in <FIG> for illustrative purposes, see also <FIG>). The shield body <NUM> may be dimensioned to block access through the shield body <NUM> onto the bone surface region <NUM> in the set position.

At step 290F, one or more features may be formed at the surgical site S adjacent to the implant <NUM> while the assembly <NUM> is secured to the implant <NUM>. Step 290F may occur subsequent to setting a position of the shield <NUM> at step 290E. The features may include recesses or apertures <NUM> configured to receive a respective fastener such as a suture anchor. The apertures <NUM> and other features may be formed utilizing various techniques, such as drilling, punching, inserting a needle, etc., into the bone B. Step <NUM> may include forming one or more apertures <NUM> in the bone B adjacent to the bone surface region <NUM> and shield <NUM>, as illustrated in <FIG>. The apertures <NUM> may be formed in the humeral head HH outwardly of the shield perimeter <NUM> and bone surface region <NUM>, as illustrated by <FIG>. Four apertures <NUM> formed in the humeral head HH are shown for illustrative purposes. However, a different number of apertures <NUM> such as only one or two apertures <NUM> may be formed in bone B along the surgical site S while the shield guide assembly <NUM> is secured to the implant <NUM>. Step 290F may include forming one or more apertures <NUM>-<NUM> associated with a first bone surface region <NUM>-<NUM> corresponding to a first circumferential position of the shield <NUM> with respect to the base axis BA, rotating the shield <NUM> in the direction R1 to a second, different circumferential position at step 290E associated with a second, different bone surface region <NUM>-<NUM>, and then forming one or more apertures <NUM>-<NUM> adjacent to the second bone surface region <NUM>-<NUM>, as illustrated in <FIG> (see also <FIG>). The assembly <NUM> may be removed from the surgical site S subsequent to forming the features <NUM>.

Referring to <FIG>, with continuing reference to <FIG>, an articulation head <NUM> may be mounted to the implant body <NUM> to secure the articulation head <NUM> to the bone B at step <NUM>. Step <NUM> may occur such that an end portion of the implant body <NUM> is trapped between the trunnion <NUM> and articulation head <NUM> (see also <FIG>). The articulation head <NUM> may include an articulating face <NUM> dimensioned to interface with an opposed articular surface AS. The articular surface AS may be associated with a glenoid G or a glenoid implant GI. The articulating face <NUM> may have a generally convex geometry as illustrated in <FIG>, or may have a generally concave geometry.

Referring to <FIG>, with continuing reference to <FIG>, at step 290I tissue T may be reattached or otherwise secured to the bone B along the surgical site S. The tissue T is shown in dashed lines in <FIG> for illustrative purposes. Step 290I may include attaching one or more lengths of the suture SS to an end portion of the tissue T at step 290J. The tissue T may include any tissue disclosed herein, including a tendon, ligament, or joint capsule. The tissue T may be one of the rotor cuff tendons including a supraspinatus, infraspinatus, teres minor and/or subscapularis tendon associated with a humerus H of the patient. Step 290I may occur subsequent to removing the assembly <NUM> from the surgical site S. Step 290A may include peeling or otherwise moving a portion of the tissue T away from the humeral head HH to provide access for positioning the implant <NUM>. Step 290I may include moving the portion of tissue T over the articulating head <NUM> and to a position that substantially approximates an initial position of the tissue T prior to placement of the implant <NUM>.

Step 290I may include securing the tissue T with one or more fasteners <NUM> affixed or otherwise secured in the bone B. Step 290I may include positioning one or more fasteners <NUM> in the respective apertures <NUM> to secure the tissue T to the bone B at step <NUM>. Step <NUM> may include positioning the fasteners <NUM> in the respective apertures <NUM> to secure the tissue T such as a subscapularis tendon to the humeral head HH of the humerus. Example fasteners can include anchors comprising various materials such as polyether ether ketone (PEEK), metallic and biocomposite materials, suture material, other natural and synthetic materials, and/or one or more sutures.

The fasteners <NUM> may be suture anchors secured to the suture SS, for example. Step <NUM> may include at least partially inserting the fasteners <NUM> in respective apertures <NUM> to secure the suture SS at respective positions along the surgical site S. The fasteners <NUM> may have various geometries and configurations. For example, the fasteners <NUM> may have one or more threads or ribs to establish an interference fit with surfaces along the respective aperture <NUM>, as illustrated by <FIG>.

Various techniques may be utilized for securing the tissue T at step 290I. In some implementations, the tissue T may be secured to the bone B utilizing a double row technique as illustrated in <FIG>. Two rows of apertures <NUM> may be formed along the surgical site S outwardly of the respective bone surface region <NUM> associated with a projection of the shield perimeter <NUM> (see <FIG>). Fasteners <NUM> are situated in the respective apertures <NUM> to secure the suture SS and tissue T to bone B along the surgical site S. The suture SS may be arranged in a generally X-shaped pattern between the two rows of fasteners <NUM>. In other implementations, step 290I may include performing a single row technique to secure the tissue to the bone B in which a pair of apertures <NUM> are formed to secure respective fasteners <NUM>. <FIG> illustrates a completed repair including attachment of the tissue T as a result of step 290I, in which the tissue T is a subscapularis tendon reattached to the humeral head HH. One or more finishing operations may be performed at step <NUM>, including enclosing the surgical site S.

The novel shield guide assembly and methods of this disclosure may be utilized to block access to portions of a bone surrounding an embedded implant, which may reduce a likelihood of contacting or perforating the implant bone during formation of one or more features in close proximity to the implant. The shield guide assembly may be positioned circumferentially about the implant and/or at one or more heights to provide versality in selection of various implant geometries and to accommodate the respective bone profile of the patient. Apertures and other features may be formed in close proximity to the implant to provide improved bone purchase and fixation of a tendon or other tissue.

Although the different non-limiting embodiments are illustrated as having specific components or steps, the embodiments of this disclosure are not limited to those particular combinations.

It should further be understood that although a particular component arrangement is disclosed and illustrated in these exemplary embodiments, other arrangements could also benefit from the teachings of this disclosure.

Claim 1:
A kit for an orthopaedic procedure comprising:
an implant (<NUM>) including an implant body (<NUM>) configured to be at least partially received in bone; and
a shield guide assembly (<NUM>) comprising:
a base (<NUM>) configured to be releasably secured to the implant (<NUM>);
a guide arm (<NUM>) extending from the base (<NUM>); and
a shield (<NUM>) translatable along a length of the guide arm (<NUM>) to set a position of the shield (<NUM>) relative to the implant (<NUM>),
wherein the shield (<NUM>) includes a shield body (<NUM>) establishing a shield perimeter (<NUM>), and the shield body (<NUM>) is dimensioned to block access through the shield body (<NUM>) onto an adjacent bone surface region (<NUM>) of the bone associated with a projection of the shield perimeter (<NUM>) characterized in, that
the shield body (<NUM>) is dimensioned to block access through the shield (<NUM>) such that a projection of a perimeter (<NUM>) of the shield body (<NUM>) silhouettes a perimeter (<NUM>) of the implant (<NUM>).