Patent Description:
This disclosure relates to systems for the repair of defects that occur in articular cartilage on the surface of bones, particularly the shoulder.

Articular cartilage, found at the ends of articulating bone in the body, is typically composed of hyaline cartilage, which has many unique properties that allow it to function effectively as a smooth and lubricious load-bearing surface. When injured, however, hyaline cartilage cells are not typically replaced by new hyaline cartilage cells. Healing is dependent upon the occurrence of bleeding from the underlying bone and formation of scar or reparative cartilage called fibrocartilage. While similar, fibrocartilage does not possess the same unique aspects of native hyaline cartilage and tends to be far less durable.

In some cases, it may be necessary or desirable to repair the damaged articular cartilage using an implant. While implants may be successfully used, the implant should have a shape substantially corresponding to the articular cartilage proximate the area where the implant is to be placed in order to maximize the patient's comfort, minimize damage to surrounding areas, and maximize the functional life of the implant. <CIT> relates a pin placement instrument for placing a pin in a bone comprises an anatomical interface with a hook-like portion being opened in a lateral direction of the instrument to receive a bone therein in a planned position. <CIT> relates to a to a system and method for associating at least one landmark with patient tissue for assisting with attachment of a stock prosthetic implant to the patient tissue. <CIT> relates to a surgical guide including a first portion comprising an outer surface configured to conform to a portion of an acetabulum of a particular patient.

The invention relates to a system for repairing a defect on at least a portion of an articular surface of a glenoid as defined in the appended claims.

The above-mentioned and other features of this disclosure, and the manner of attaining them, may become more apparent and better understood by reference to the following description of aspects described herein taken in conjunction with the accompanying drawings. The system of the invention is illustrated in <FIG>, the remaining figures do not show a system according to the invention.

The present disclosure may feature a systems for resurfacing at least a portion of an articular surface having one or more defects by replacing a portion of the articular surface with an implant. The implant may comprise a load bearing surface having a contour and/or shape substantially corresponding to the patient's original articular surface about the defect site which may be configured to engage and cooperate with an adjacent articular surface. The present disclosure will describe a systems for replacing a portion of the articular surface of the glenoid; however, it should be understood that the systems according to the present disclosure may also be used to resurface articular surfaces other than the glenoid.

As an initial matter, many of the devices described herein comprise cannulated components configured to be arranged over other components. The degree to which the cannulated passageway (i.e., internal diameter of the passageway/cavity) of a first component corresponds to the external diameter of the component over which it is being placed may be close enough to generally eliminate excessive movement. Excessive movement may be defined as an amount of movement that may result in surgically relevant misalignment of the implant relative to the articular surface.

Referring now to <FIG>, one aspect of an excision device <NUM> and an implant <NUM> are generally illustrated. As will be explained in greater detail herein, the excision device <NUM> may be configured to form an excision site within the articular surface (e.g., the glenoid) configured to receive at least a portion of the implant <NUM>. The implant <NUM> may be configured to replace the articular surface in an area proximate one or more defects. The system consistent with the present disclosure may repair a defect on the articular surface of a glenoid without having to replace the entire glenoid.

Accordingly to at least one aspect, the implant <NUM> may be configured to replace only a portion of the articular surface proximate the defect site rather than the entire articular surface. As such, the implant <NUM> may minimize the amount of the articular surface which is operated on thus allowing more of the patient's original articular surface to be unaffected and providing a more physiologically normal joint. The system consistent with one aspect of the present disclosure may allow for "key-hole" surgery in which a minimum number and size of incisions are made. As may be appreciated, "key-hole" surgery may reduce the amount of pain and/or discomfort experienced by the patient and may reduce healing times.

The excision device <NUM> may include a cannulated shaft <NUM> defining a passageway <NUM> configured to be received over at least a portion of a guide pin or the like (not shown). The excision device <NUM> may also include at least one cutter 16a, 16b extending radially outwardly (transversely) and away from a distal end <NUM> of the shaft <NUM>. Each cutter 16a, 16b may have a cutting surface <NUM> configured to create a hemispherical implant site, i.e., an excision site to receive the implant. For example, the cutting surface <NUM> may have a generally arcuate shape which sweeps towards the proximal end of the shaft <NUM> as the radius Re from the shaft <NUM> increases on the cutter 16a, 16b. It may be appreciated that the hemi-spherical excision site may exhibit some degree of deviation and the hemi-spherical excision site may be, in some examples, teardrop shaped or pyriform.

The contour of the cutting surfaces <NUM> may define the contours of the excision site as the cutters 16a, 16b are rotated about the central axis of the excision site. While the cutting surfaces <NUM> are illustrated having a generally constant arc or curvature, the cutting surfaces <NUM> may include one or more protrusions and/or recesses configured to create corresponding radial groove and/or lips/protrusions within the excision site. These radial grooves and/or lips/protrusions on the cutting surfaces <NUM> may facilitate alignment of the implant <NUM> and/or may increase the mechanical coupling of the implant <NUM> within the excision site.

Turning now to <FIG>, the overall radius Re of the cutters 16a, 16b may define the radius of the implant site created by the excision device <NUM> within the articular surface and may also substantially correspond to the radius Ri of the implant <NUM>. In addition, the depth D of the cutters 16a, 16b may also define the height of the excision site created by the excision device <NUM> and may also substantially correspond to the height H of the implant <NUM>. For example, the overall radius Re of the cutters 16a, 16b may be between <NUM> to <NUM>, for example, <NUM> to <NUM> and/or <NUM> to <NUM> (including all values and ranges therein) and the depth D may be between <NUM> to <NUM>, for example, <NUM> (including all values and ranges therein).

According to at least one aspect, the excision device <NUM> may include a first and a second cutter 16a, 16b which may be disposed approximately <NUM> degrees relative to each other. For example, the cutters 16a, 16b may extend generally radially outwardly from the shaft about a first and a second generally opposite side of the distal end <NUM> of the shaft <NUM>. The cutters 16a, 16b may also have a generally slim profile configured to be disposed between two adjacent articular surfaces as explained further herein. For example, the cutters 16a, 16b may have a cross-sectional thickness (t) of <NUM> to <NUM>, for example, <NUM> (including all values and ranges therein). In one aspect the at least one cutter may provide a generally hemispherical excision site regardless of the angle which the guide pin is disposed relative to the articular surface <NUM>.

The implant <NUM> may include a load bearing surface <NUM> and a bone facing surface <NUM>. Turning now to <FIG>, a top perspective view of an implant <NUM> consistent with at least one aspect herein is generally illustrated. The load bearing surface <NUM> may have a contour substantially corresponding to or based on the contour of the patient's articular surface being replaced (i.e., the articular surface which is removed by the excision device <NUM>). The contour of the load bearing surface <NUM> may be based on a plurality of measurements taken at the patient's articular surface (for example, using a measuring and/or mapping tool as generally described in <CIT>,<CIT>, <CIT>,<CIT> and<CIT>) and/or may be based on one or more templates.

The load bearing surface <NUM> may be based on two or more curvatures, for example, the anterior-posterior (AP) curvature and the superior-inferior (SI) curvature. One or more of the AP and/or SI curvatures may themselves be based on multiple curves, (for example, as generally described in <CIT> and entitled SYSTEM AND METHOD FOR JOINT RESURFACE REPAIR). The load bearing surface <NUM> may be generally concaved. For example, the load bearing surface <NUM> may have a generally hemi-spherical shape.

The load bearing surface <NUM> may also include a beveled region <NUM> disposed about the perimeter of the load bearing surface <NUM>. The beveled region <NUM> may reduce the potential of further damage to the surrounding articular surface by eliminating a hard transition between the load bearing surface <NUM> and the remaining articular surface. The beveled region <NUM> may be particularly helpful if a portion of the implant <NUM> is slightly proud with respect to the remaining articular surface.

The bone facing surface <NUM> may be configured to be generally received in the excision site created by the excision device <NUM>. For example, the bone facing surface <NUM> may have a generally hemi-spherical shape substantially corresponding to the contour of the cutting surfaces <NUM> of the cutters 16a, 16b. The bone facing surface <NUM> may also include one or more lips, protrusions, ribs or the like 28a-28n configured to increase the mechanical connection between the implant <NUM> and the patient's bone within the excision site. Again, these lips or the like 28a-28n may generally correspond to the contours of the cutting surfaces <NUM> of the cutters 16a, 16b. The voids or space 30a-30n between the lips 28a-28n may create pockets for bone in-growth and/or bone cement.

Turning now to <FIG> and <FIG>, the implant <NUM> may optionally include at least one keel or tail <NUM> extending generally outwardly from the bone facing surface <NUM>. For example, the implant <NUM> may include at least one keel <NUM> including a protrusion or button <NUM> disposed about a distal end of a base region <NUM> as generally illustrated in <FIG>. For example, the implant <NUM> may include a single keel <NUM> extending generally downwardly and away from the bottom surface <NUM> of the bone facing surface <NUM> generally along the central axis C of the implant <NUM>. The base region <NUM> may be coupled to the bottom surface <NUM> of the bone facing surface <NUM> and may have an hour-glass shape which may initially taper radially inwardly and then taper radially outwardly. The bottom surface <NUM> of the button <NUM> may have a curvature substantially corresponding to the curvature of the implant site. For example, the bottom surface of the button <NUM> may have a curvature (generally illustrated by dotted curve D) substantially corresponding to the curvature of the cutting surfaces <NUM>.

The button <NUM> may extend generally radially outwardly from a distal end of the base region <NUM>. As such, the button <NUM> may have a diameter Db greater than at least a portion of the base region <NUM>, for example, the portion of the base region adjacent to the button <NUM>. According to one aspect, the diameter Db of the button <NUM> may be the same as or slightly larger than the diameter of the cavity in the excision site in which it is configured to be received. As such, the button <NUM> may form an interference fit with the cavity in the excision site which may secure the implant <NUM> to the bone and may also facilitate alignment of the implant <NUM> with respect to the articular surface and the excision site. Alternatively, the diameter Db of the button <NUM> may be slightly smaller than the diameter of the cavity in which it is configured to be received. As such, the button <NUM> may also facilitate alignment of the implant <NUM> with respect to the articular surface and the excision site. In addition, bone cement or the like may be disposed around the keel within the cavity to increase the mechanical connection between the keel <NUM> and the bone.

<FIG> illustrates another aspect of a keel <NUM>. The keel <NUM> may include a base region <NUM> extending generally outwardly/downwardly and away from the bottom surface <NUM> of the bone facing surface <NUM> generally along the central axis C of the implant <NUM>. For example, the keel <NUM> may extend outwardly/downwardly and away from the bottom surface <NUM> of the bone facing surface <NUM> beyond the curvature D substantially corresponding to the curvature of the cutting surfaces <NUM>. The keel <NUM> may be configured to be received in an additional cavity, pocket or the like formed within the excision site. The additional cavity may be formed subsequent to the formation of the excision site using an additional cutter, chisel, drill or the like (not shown).

The base region <NUM> may include one or more radial lips, grooves, protrusions or the like <NUM>. The keel <NUM> may also include a protrusion <NUM> extending generally downwardly and away from the base portion <NUM> generally along the central axis C of the implant <NUM>. The protrusion <NUM> may include one or more radial lips, grooves, protrusions or the like 44a-44n. As discussed herein, the keel <NUM> may be configured to engage a cavity or the like disposed within the excision site and may be configured align the implant <NUM> with respect to the articular surface and/or the excision site and may also increase the mechanical coupling of the implant <NUM> to the bone.

While the keels <NUM> illustrated in <FIG> and <FIG> are shown having a generally concentric shape, the keel <NUM> may have other configurations. For example, in the aspect illustrated in <FIG> the keel <NUM> and/or the protrusion <NUM> extending from the keel <NUM> may have a shape configured to prevent rotations of the implant <NUM> with respect to the articular surface. The keel <NUM> may have a non-circular shape configured to be received in the excision site in a lock-and-key configuration. By way of example, the keel <NUM> may have a generally multifaceted geometry (such as, but not limited to, rectangular, pentagonal, hexagonal or the like) configured to received in the excision site. Similarly, the protrusion <NUM> may exhibit a multifaceted geometry such as generally oblong or rectangular, pentagonal, hexagonal, or the like. The protrusion <NUM> may also exhibit an additional (or second) protrusion 44a extending outwardly in a radial direction from the central axis of the implant <NUM>, which may form a raised edge or surface around the perimeter of the protrusion <NUM>. As illustrated, protrusion <NUM> may end in a relatively pointed tip, or may exhibit a curvature as illustrated in <FIG>. <FIG> illustrates a further aspect of protrusion <NUM>, wherein the protrusion <NUM> may be formed from a variety of features, such as circular, rectangular, etc. It may be appreciated that, the implant <NUM> and the keel <NUM> may be a single, integral or unitary component or may be formed from two or more pieces which may be secured to each other (either permanently or removably secured).

Turning now to <FIG>, one method of installing an implant <NUM> consistent with the present disclosure is generally illustrated. One or more incisions <NUM> may be created proximate the patient's shoulder <NUM> to provide access to the defect <NUM> on the patient's articular surface <NUM>, for example, using a scalpel or the like. The incision <NUM> may be made through the anterior portion of the patient. Again, the present disclosure will describe a system for replacing a portion of the articular surface of the glenoid; however, it should be understood that the system according to the present disclosure may also be used to resurface articular surfaces other than the glenoid. The system consistent with one aspect of the present disclosure may allow for "key-hole" surgery in which a minimum number and size of incisions are made. As may be appreciated, "key-hole" surgery may reduce the amount of pain and/or discomfort experienced by the patient and may reduce healing times.

Once the incision is created, a guide pin <NUM>, <FIG>, may be positioned about the glenoid <NUM> on the scapula <NUM> to provide an access passageway to the glenoidal articular surface <NUM> as will be described herein. Consistent with one aspect, the guide pin <NUM> may comprise threaded and/or self-tapping tip (not shown) configured to be secured to the patient's bone. The guide pin <NUM> may be secured to the bone using a drill or the like (not shown) and at least a portion of which may be disposed proximate to and/or within the defect site <NUM> on the articular surface <NUM>. Optionally, a drill guide (not shown) may be used to facilitate alignment of the guide pin <NUM> with respect to the articular surface <NUM>.

The guide pin <NUM> may be disposed at an angle α relative to the articular surface <NUM>. Angle α may be less than or equal to <NUM> degrees, wherein α ≤ <NUM> degrees with respect to the articular surface <NUM>. In some examples, angle α may be less or equal to <NUM> degrees and greater than or equal to <NUM> degrees with respect to the articular surface <NUM>, wherein <NUM> degrees ≤ α ≤ <NUM> degrees with respect to the articular surface <NUM>. In further examples, <NUM> degrees > α > <NUM> degrees and/or <NUM> degrees > α ≥ <NUM> degrees, with respect to the articular surface <NUM>. The degree of the angle α may depend on the location and/or size of the defect <NUM> and may be selected to avoid contact with the humerus <NUM>. In some circumstances, the degree of the angle α may also be selected to avoid contact with the perimeter of the articular surface <NUM>.

Once the guide pin <NUM> is secured to the articular surface <NUM>, the excision device <NUM> may be advanced over the guide pin <NUM> as generally illustrated in <FIG>. For example, the guide pin <NUM> may be received within the passageway <NUM> defined by the cannulated shaft <NUM>. According to at least one aspect, the cutters 16a, 16b may be generally aligned in a single plane extending along the longitudinal axis of the excision device <NUM>. The plane of the cutters 16a, 16b may be orientated generally tangential to the articular surface <NUM> of the humerus <NUM> such that the cutters 16a, 16b may slide by the articular surface <NUM> of the humerus <NUM> and between the humerus <NUM> and the scapula <NUM> as generally illustrated in <FIG> and <FIG>.

Once the cutters 16a, 16b are advanced over the guide pin <NUM> to the articular surface <NUM>, the excision device <NUM> may be rotated about the guide pin <NUM>. As may be best seen in <FIG>, a pocket of cavity <NUM> may be present between the articular surface <NUM> of the glenoid <NUM> and the articular surface <NUM> of the humerus <NUM>. The cutters 16a, 16b of the excision device <NUM> may therefore rotate about the guide pin <NUM> without contacting the articular surface <NUM> of the humerus <NUM>. The cutters 16a, 16b may have generally flat cutting surfaces <NUM>, forming a point along the length thereof, or may have serrated cutting surfaces.

The excision device <NUM> may thus be rotated about the guide pin <NUM> to form an excision site <NUM> within the articular surface <NUM> of the glenoid <NUM> as generally illustrated in <FIG>. Due to the contour of the cutting surfaces <NUM> of the cutters 16a, 16b, the excision site <NUM> created by the excision device <NUM> may have a generally hemi-spherical configuration regardless of the angle α of the guide pin <NUM>.

Once the excision site <NUM> is formed within the articular surface <NUM>, the excision device <NUM> and the guide pin <NUM> may be removed as generally illustrated in <FIG>. The removal of the guide pin <NUM> may leave a cavity <NUM> formed by the distal tip of the guide pin <NUM>. The implant <NUM> may then be received in the excision site <NUM>. The spherical configuration of the excision site <NUM> may normalize the implant <NUM> with respect to the remaining articular surface <NUM>. The load bearing surface <NUM> of the implant <NUM> may substantially match the original contour of the patient's articular surface <NUM> which was removed.

As illustrated in <FIG>, the system and method according to the present disclosure may also repair a defect <NUM> on the articular surface <NUM> in which a portion of the perimeter of the articular surface <NUM> is damaged or missing. For example, the posterior portion P of the articular surface <NUM> may have a defect <NUM> wherein a portion of the perimeter of the articular surface <NUM> is missing which may be caused by advanced chronic shoulder dislocation and/or early onset arthritis. To repair a defect <NUM> proximate the perimeter of the articular surface <NUM>, the guide pin <NUM> may be moved further towards the posterior end P of the articular surface <NUM>. The exact location of the guide pin <NUM> with respect to the articular surface <NUM> may depend on the location and size of the defect <NUM> as well as the size of the cutters 16a, 16b of the excision device <NUM>.

According to one aspect, the guide pin <NUM> may be located a distance away from the perimeter of the articular surface <NUM> which generally corresponds to the radius Re of the cutters 16a, 16b. The excision device <NUM> may be advanced over the guide pin <NUM> and rotated as described herein. Accordingly, the cutters 16a, 16b may remove a portion of the articular surface <NUM> to form an excision site <NUM> disposed about the perimeter of the articular surface <NUM> as generally illustrated in <FIG>. The excision device <NUM> and the guide pin <NUM> may then be removed and the implant <NUM> may be received within the excision site <NUM>. As may be seen in <FIG>, a portion of the implant <NUM> may replace the perimeter of the articular surface <NUM> which was damaged and/or missing.

The implant <NUM> may also include a keel <NUM> as generally illustrated in <FIG> and <FIG>. The keel <NUM> may facilitate alignment of the implant <NUM> with respect to the articular surface <NUM> and/or may provide an increased mechanical connection between the implant <NUM> and the bone. As discussed herein, the excision site <NUM> may also include one or more cavities <NUM>, <FIG>, configured to received at least a portion of the keel <NUM> (for example, but not limited to, one or more radial lips 44a-44n of the protrusion <NUM>.

Once the position/orientation of the implant <NUM> has been confirmed (i.e., the contour of the load bearing surface <NUM> has been confirmed along the AP and/or SI planes to generally correspond to the original contour of the articular surface), the implant <NUM> may be secured to the bone. The implant <NUM> may be held in place by the lips, protrusions, ribs or the like 28a-28n of the bone facing surface <NUM>, the keel <NUM>, and/or bone cement or the like.

Turning to <FIG>, one system and/or method for locating an implant <NUM> consistent with the present disclosure is generally illustrated. The description of the system and methods herein are not limited to the treatment of any single articular surface of the glenoid and may apply not only to the one or more articular surfaces that may be present in the glenoid but to other articular surfaces through out the body as well.

One or more incisions <NUM> may be created proximate to the patient's shoulder <NUM> to provide access to the defect on the patient's articular surface <NUM>, using, for example, a scalpel or the like. As may be appreciated, the glenoid may include one or more articular surfaces <NUM>. Each of the articular surfaces may define a concavity as illustrated in <FIG>.

A portion of an excision guide <NUM> may be positioned within the incision and located between the humerus <NUM> and the articular surface <NUM> of the glenoid <NUM>. The excision guide may include an arm <NUM> and a head <NUM>, which may, in some aspects, be inserted through the incision in such a manner to avoid contact with the humerus <NUM>. <FIG> and c illustrate aspects of the excision guide head <NUM> and, in particular, variations in the contact surfaces <NUM> of the excision guide head <NUM> located on the lower portion <NUM> of the excision guide head <NUM>. For example, in one aspect, illustrated in <FIG>, the contact surface <NUM> may generally conform to the articular surface <NUM>. In another aspect, illustrated in <FIG>, the contact surface <NUM> may be a ring near the periphery of the lower portion <NUM> of the excision guide head <NUM>. As may be appreciated in some aspects, when in the shape of a ring, the contact surface may be continuous or may, in other aspects, be discontinuous forming ridges around the contact surface <NUM>. The excision guide <NUM> may also include a handle <NUM>, which may or may not include one or more indentations <NUM> to assist in manipulation and/or stabilization of the excision guide <NUM>. The handle may be affixed to the upper portion of the excision guide head <NUM>.

The head <NUM> of the excision guide <NUM> may be located over a defect <NUM> of an articular surface <NUM>. The head <NUM> may locate the excision guide <NUM> relative to the articular surface <NUM>. In some aspects, the head <NUM> may be generally centered on the articular surface <NUM> including the defect <NUM>. For example, in one aspect, the head <NUM> may be located generally centered in the concavity <NUM> of the articular surface <NUM>. Once the head <NUM> is positioned over the defect <NUM>, the guide pin <NUM> may be received into and pass through a guide sleeve <NUM> disposed on the head <NUM>. As illustrated in <FIG> and c, the guide sleeve <NUM> may define an opening from the upper surface <NUM> of the excision guide head <NUM> through the lower surface <NUM> of the excision guide head <NUM>. The guide sleeve <NUM> may position the guide pin <NUM> relative to the defect <NUM> on the articular surface. In addition, the guide sleeve <NUM> may be formed in and/or integral to the head <NUM> or may be formed in an insert connected to the head <NUM>.

As illustrated in <FIG>, the excision guide <NUM> may orient the working axis (W) of the guide pin <NUM> in one or more planes. For example, in one aspect, the guide sleeve <NUM> may angle the guide pin <NUM>, such that the guide pin may be positioned at an angle α that may be <NUM> degrees or less from the articular surface, including all values and increments in the range of <NUM> degrees to <NUM> degrees, such as in one aspect <NUM> degrees to <NUM> degrees or in a further aspect <NUM> degrees from the articular surface <NUM>.

In another aspect, the guide sleeve <NUM> of the excision guide <NUM> may orient the working axis (W) of the guide pin <NUM> at an angle β relative to a normal axis (N). The normal axis (N) may, in some aspects, be generally normal and central to a defect <NUM> in the articular surface <NUM>. Angle β may be <NUM> degrees or less and in some examples, including all values and increments in the range of <NUM> degrees and <NUM> degrees, such as in the range of <NUM> degrees to <NUM> degrees. <FIG> illustrates another example of the working axis (W) defined by the guide sleeve <NUM> to an axis (N) generally central and normal to the lowest point of the contact surface <NUM> of the excision guide head <NUM>, which may correspond to the axis generally normal and centrally located to defect <NUM> or to the deepest point of the excision site <NUM>.

The guide sleeve <NUM> may also offset the intended entry point <NUM> of the guide pin <NUM> in the articular surface <NUM> radially outward from the axis (N) normal and generally central to the excision site and/or the articular surface <NUM>. <FIG> illustrates an aspect of the positioning of the at least one cutter 16a, 16b relative to the positioning of the excision guide <NUM>. In one aspect, the offset (O) may be determined based on the angle of entry of the guide pin <NUM> (α or β) into the articular surface <NUM> and/or the depth of the desired excision site, or the height of the desired implant. For example, the offset (O) may be proportional to the angle α of the guide pin <NUM> to the articular surface <NUM> or angle β of the guide pin <NUM> to the normal axis (N).

The working axis (W) may be positioned at an angle β in the range of <NUM> degrees to <NUM> degrees, such as in one aspect, <NUM> degrees to <NUM> degrees, or in a further aspect <NUM> degrees from the normal axis (N). As may be appreciated, in some aspects, the surface of the excision guide head <NUM> may exhibit some degree of curvature and may be convex. The curvature of the surface of the excision guide head <NUM> may be configured to generally match the curvature of at least a portion of the articular surface <NUM>. In some aspects, it may be appreciated, that the curvature of the articular surface <NUM> and the surface of the excision guide head may not match exactly but may provide a "close fit" sufficient to locate the excision guide head <NUM> within the glenoid <NUM>. In some non-limiting aspects, the curvature of the excision guide head surface <NUM> may be generally hemispherical, including pyriform or teardrop in shape.

Once the guide pin <NUM> is positioned in the articular surface <NUM> of the glenoid <NUM>, as illustrated in <FIG>, the excision guide <NUM> may be removed from the glenoid <NUM> by sliding the excision guide <NUM> up the guide pin <NUM> away from the glenoid <NUM>. As illustrated in <FIG>, the excision device <NUM>, including one or more cutters 16a and 16b, may be slid (in direction of arrow) over the guide pin <NUM> and, as described above, the excision device <NUM> may be rotated forming an excision site <NUM> in the articular surface <NUM>.

The excision device <NUM> may then be removed from the guide pin <NUM> and an impact guide <NUM> may be inserted through the incision <NUM> and over the guide pin <NUM>, an aspect of which is illustrated in <FIG>. The impact guide <NUM> may include an impact guide arm <NUM>, an impact guide head <NUM> and an impact guide handle <NUM>. In one aspect, the impact guide <NUM> may be the same as the excision guide <NUM>, wherein the head <NUM> of the excision guide <NUM> may be interchangeable with the one or more impact guide heads <NUM>. In another aspect, the impact guide <NUM> may be separately provided from the excision guide <NUM>.

As may be appreciated, the impact guide heads <NUM> may generally correspond to or mimic the size and shape of an implant, described above. An aspect of an impact guide head is illustrated in <FIG>, wherein the impact guide head <NUM> may include a lower portion <NUM> that substantially conforms to the generally hemispherical excision site. The impact guide head may exhibit a given height Ht and radius Rt matching that of an implant to be provided in the excision site <NUM> (see <FIG>). In another aspect, illustrated in <FIG>, the impact guide may include a lower portion <NUM> that includes a ring or bevel around the periphery that may conform to the excision site. The remainder of the lower portion <NUM> may be recessed.

The impact guide head <NUM> may include a guide notch <NUM>, which may be inserted over the guide pin <NUM> or around the guide pin <NUM> (as illustrated in <FIG>). It may be appreciated that while a notch is illustrated defining an opening in the periphery of the impact guide head <NUM>, i.e., extending to the periphery of the impact guide head <NUM>, the guide notch <NUM> may also include a sleeve defined in the impact guide head <NUM>. As illustrated in <FIG>, the guide notch <NUM> may generally define an opening from the upper portion <NUM> through the lower portion <NUM> of the impact guide head <NUM>. In addition, the guide notch <NUM> may include at least one surface <NUM> that may accommodate the angle and offset of the guide pin <NUM> relative to the articular surface <NUM>, such that the impact guide head <NUM> may be positioned generally central within the excision site <NUM> and the guide pin <NUM> may rest on the surface <NUM>.

Upon placement of the impact guide head <NUM> by the impact guide <NUM> into the excision site <NUM>, a determination may be made as to whether the excision site <NUM> is sufficiently deep enough to accommodate the implant that may eventually be placed within the excision <NUM>. As may be appreciated, if the excision site <NUM> is not sufficient deep, or properly formed, the impact guide <NUM> may be removed from the excision site <NUM> and the guide pin <NUM>. The excision device <NUM> may again be placed over the guide pin <NUM> and further excision may be provided to deepen or further form the excision site <NUM>. This procedure of checking the excision site <NUM> using the impact guide head <NUM> may be repeated until it is determined that an implant will fit within the excision site <NUM>. In some aspects, the use of the impact guide <NUM> may be to prevent the implant from being too proud in the excision site and from rising above the articular surface <NUM>. In other aspects, the impact guide head <NUM> and/or the impact guide <NUM>, may be interchanged with one or more impact guide heads and/or impact guides to determine which implant may better fit or accommodate the excision site in terms of the implant radius or height. Accordingly, one or more impact guide heads <NUM> may be provided. In some aspects, the impact guide heads <NUM> may be interchangeable and removable from the impact guide <NUM>. In other aspects, a number of impact guides <NUM> may be provided including different sized impact guide heads <NUM> fixed to the impact guide <NUM>.

Once an impact guide has been selected based on, for example, the size of the excision site, the impact guide head <NUM> may be seated in the excision site <NUM> as illustrated in the aspect of <FIG>. In one aspect, the guide pin <NUM> may optionally be removed before or after seating the selected impact guide head <NUM>. The impact guide head <NUM> may include an impact slot <NUM> defined therein. As illustrated in <FIG>, the impact slot <NUM> is generally rectangular in cross-section; however, as may be appreciated, other cross-sectional geometries may be provided, such as circular, as illustrated in <FIG>, as well as elliptical shaped, square shaped, etc. An impact device <NUM>, such as a chisel, punch or awl may be provided, the distal end <NUM> of which may fit in and extend through the impact slot <NUM>. Therefore, in some aspects, the distal end may be longer than the length of the impact slot. In addition, the distal end of the impact device <NUM> may exhibit a cross-sectional area that may be slightly smaller than that of the impact slot <NUM>. The proximal end <NUM> of the impact device <NUM> may provide a striking surface <NUM>, which may be hit by hand, or with a hammer or other device, causing the impact device <NUM> to extend through the impact slot <NUM> creating a secondary excision site <NUM> in the primary or first excision site <NUM>. In some aspects, the impact device may include a sagittal saw or other cutting device, which may be inserted through the impact slot <NUM>. If the guide pin <NUM> has not yet been removed, it may be removed at this time.

While the proximal end <NUM> of the impact device <NUM> is illustrated in <FIG> as being provided at an angle γ to the arm <NUM> of the impact guide <NUM>, wherein angle γ may be in the range of <NUM> degrees to <NUM> degrees, including all values and increments therein, in some aspects, the impact device <NUM> may be inserted closer to the impact guide <NUM>, wherein angle γ may be in the range of <NUM> degrees to <NUM> degrees, including all values and increments therein. In other aspects, the proximal portion <NUM> of the impact device may be generally parallel to the arm <NUM> of the impact guide <NUM>. In such a manner, the impact device <NUM> may be inserted into incision <NUM> in the patient (<FIG>) without the need for expanding the size of the incision <NUM> greater than necessary to accommodate the head of the excision guide or the head of the impact guide. Further, the impact device <NUM> may include a curvature <NUM>, which may generally fit over the curvature <NUM> of the arm <NUM> of the impact guide <NUM>.

<FIG> illustrates an aspect of a secondary excision site <NUM> provided in an excision site <NUM>. The secondary excision site <NUM> is illustrated as being generally rectangular; other cross-sectional geometries may be provided as well. In addition, the depth Ds of the secondary excision site (illustrated in broken lines) may be formed to generally correspond with protrusions <NUM>, <NUM>, 44a-d that may extend from the keel <NUM> of the bone facing surface of the implant <NUM>, illustrated in the aspects of <FIG> and <FIG>-f.

While the implant <NUM> may be held in place in some examples through a mechanical fit, such as through an interference fit bone adhesive may be used to secure the implant <NUM> in place in other aspects. In such a manner a layer of bone adhesive may be delivered to the excision site <NUM>, and optionally to the secondary excision site <NUM> and the implant <NUM> may be situated over the adhesive and positioned within the excision site.

Turning to <FIG>, another apparatus, system, and/or method for resurfacing at least a portion of an articular surface <NUM> having a defect <NUM> by replacing a portion of the articular surface <NUM> with an implant <NUM>, as well as for locating an implant <NUM>, consistent with the present disclosure, is generally illustrated. Again, the description of the apparatuses, systems and methods herein are not limited to the treatment of any single articular surface <NUM> of the glenoid <NUM>, and may apply, not only to the one or more articular surfaces <NUM> that may be present in the glenoid <NUM>, but to other articular surfaces through out the human body as well. Stated another way, the present disclosure describes apparatuses, systems, and/or methods for replacing a portion of the articular surface <NUM> of the glenoid <NUM>, however, it should be understood that the apparatuses, systems, and/or methods according to the present disclosure may also be used to resurface articular surfaces other than the glenoid <NUM>.

Similar to the previous aspect, one or more incisions <NUM> may be created proximate to the patient's shoulder <NUM> to provide access to one or more defect sites <NUM> on articular surface <NUM> of the glenoid <NUM>, using, for example, a scalpel or the like with an anterior approach. Thereafter, a portion of an excision guide <NUM> may be positioned within the incision and located between the humerus <NUM> and the articular surface <NUM> of the glenoid <NUM>.

According to one aspect, any one of the excision guides <NUM> described herein may be used to establish at least one (e.g., a first) guide pin <NUM> extending from the articular surface <NUM> at angle β. Referring now to <FIG>, yet another aspect of an excision guide <NUM> is generally illustrated. The excision guide <NUM> of <FIG> may be similar to the previous aspects described herein and may include an arm <NUM> and a head <NUM>, which may, in some aspects, be inserted through the incision <NUM> in such a manner to avoid contact with the humerus <NUM>. One or more contact surfaces <NUM> located on the lower portion <NUM> of the excision guide head <NUM> may generally conform to the articular surface <NUM> (see <FIG>. In other aspects, the contact surface <NUM> may be a ring or partial ring (e.g., one or more arcuate regions) near the periphery of the lower portion <NUM> of the excision guide head <NUM>. As may be appreciated in some aspects, when in the shape of a ring, the contact surface <NUM> may be continuous or may, in other aspects, be discontinuous forming ridges around the contact surface <NUM> (see <FIG>). The excision guide <NUM> may also include a handle <NUM> (seem for example, a handle as generally illustrated in <FIG>) to assist in manipulation and/or stabilization of the excision guide <NUM>. The handle <NUM> may be affixed to the upper portion of the excision guide head <NUM>.

The head <NUM> of the excision guide <NUM> may be positioned in overlying relationship onto the articular surface <NUM>, which may or may not be located over the defect site <NUM> of the articular surface. For example, in some aspects, the head <NUM> may be generally centered in the concavity <NUM> (glenoid cavity) of the articular surface <NUM>, including the defect <NUM>. However, in other aspects, the head <NUM> may be located generally centered in the concavity <NUM> (glenoid cavity) of the articular surface <NUM>, but not over the defect site <NUM>, which may be located on the glenoid rim.

The head <NUM> may locate the excision guide <NUM> relative to the articular surface <NUM>. Once the head <NUM> suitably positioned, at least one cylindrical guide pin <NUM> may be received into and pass through a cylindrical guide pin sleeve <NUM> disposed on the head <NUM> as generally described herein. As illustrated in <FIG>, the guide pin sleeve <NUM> may define an opening from the upper surface <NUM> of the excision guide head <NUM> through the lower surface <NUM> of the excision guide head <NUM>. The guide pin sleeve <NUM> may position the guide pin <NUM> relative to the defect <NUM> on the articular surface. In addition, the guide pin sleeve <NUM> may be formed in and/or integral to the head <NUM> or may be formed in an insert connected to the head <NUM>.

As with the previous aspect (e.g. see <FIG> and <FIG>), the guide pin sleeve <NUM> of the excision guide <NUM> may orient the working axis (W) of the guide pin <NUM> at an angle β relative to a normal axis (N). The working axis (W) may be defined by the guide pin sleeve <NUM> to an axis (N) generally central and normal to the lowest point of the contact surface <NUM> of the excision guide head <NUM>. Angle β may be <NUM> degrees or less and in some examples, including all values and increments in the range of <NUM> degrees and <NUM> degrees, such as in the range of <NUM> degrees to <NUM> degrees.

The guide pin sleeve <NUM> may also offset the intended entry point of the guide pin <NUM> in the articular surface <NUM> radially outward from the normal axis (N). The offset (O) may be determined based on the angle β of entry of the guide pin <NUM> into the articular surface <NUM> and/or the depth of the desired excision site, or the height of the desired implant. For example, the offset (O) may be proportional to the angle β of the guide pin <NUM> to the normal axis (N).

The working axis (W) may be positioned at an angle β in the range of <NUM> degrees to <NUM> degrees, such as in one aspect, <NUM> degrees to <NUM> degrees, or in a further aspect <NUM> degrees from the normal axis (N). As may be appreciated, in some aspects, the contact surface(s) <NUM> of the excision guide head <NUM> may exhibit some degree of curvature and may be convex. The curvature of the contact surface <NUM> of the excision guide head <NUM> may be configured to generally match the curvature of at least a portion of the articular surface <NUM>. In some aspects, it may be appreciated, that the curvature of the articular surface <NUM> and the contact surface <NUM> of the excision guide head <NUM> may not match exactly but may provide a "close fit" sufficient to locate the excision guide head <NUM> within the glenoid <NUM>. In some non-limiting aspects, the curvature of the contact surface <NUM> may be generally hemispherical, including pyriform or teardrop in shape.

As may be appreciated, any of the excision guides <NUM> described herein may be used to establish the first guide pin <NUM> at the angle β. Once the first guide pin <NUM> is established, at least a second guide pin <NUM> may also be secured extending from the articular surface <NUM>.

According to one aspect, the excision guide <NUM> of <FIG> may also be used to establish the second or more guide pins <NUM>, or, alternatively as disclosed below, the guide body <NUM> disclosed herein may be used to establish the second or more guide pins <NUM>.

For example, once the first guide pin <NUM> is positioned in the articular surface <NUM> of the glenoid <NUM>, the second (or more) cylindrical guide pin <NUM> may be received into and pass through a cylindrical guide pin sleeve <NUM> disposed on the head <NUM>. As illustrated in <FIG>, the guide pin sleeve <NUM> may define an opening from the upper surface <NUM> of the excision guide head <NUM> through the lower surface <NUM> of the excision guide head <NUM>. The guide pin sleeve <NUM> may position the guide pin <NUM> relative to the defect <NUM> on the articular surface. In addition, the guide pin sleeve <NUM> may be formed in and/or integral to the head <NUM> or may be formed in an insert connected to the head <NUM>.

As shown, guide pin sleeve <NUM> is substantially parallel to guide pin sleeve <NUM> such that guide pin <NUM> will be substantially parallel to guide pin <NUM> (e.g. within plus or minus <NUM> degrees). It may be appreciated, however, that the second guide pin <NUM> may also be non-parallel relative to first guide pin <NUM>, or any other guide pin (not shown) secured to the articular surface <NUM>. Also, while second guide pin <NUM> is shown to have a length substantially equal to the length of first guide pin <NUM>, the second guide pin <NUM> may be shorter than first guide pin <NUM>.

Once the guide pin <NUM>, and in certain aspects guide pin <NUM>, are positioned in the articular surface <NUM> of the glenoid <NUM>, the excision guide <NUM> may be removed from the glenoid <NUM> by sliding the excision guide <NUM> up the guide pin <NUM>, and in certain aspects guide pin <NUM>, away from the glenoid <NUM>. Once excision guide <NUM> is removed, an excision apparatus <NUM> may be installed thereon.

As shown in <FIG>, excision apparatus <NUM> may comprise an elongated guide body <NUM>, for example, having a generally T-shaped cross-sectional profile. Guide body <NUM> has a proximal end <NUM> and a distal end <NUM>, and comprises a plurality of cylindrical guide pin sleeves <NUM>, <NUM>, <NUM> and <NUM> configured to contain/receive guide pins <NUM> and <NUM>. As shown, cylindrical guide pin sleeves <NUM>, <NUM>, <NUM> and <NUM> have a diameter substantially equal to guide pins <NUM> and <NUM> (e.g. greater in diameter by less than or equal to <NUM> inches, and more particularly by less than or equal to <NUM> inches). Also as shown, the guide pin sleeves <NUM>, <NUM>, <NUM> and <NUM> are substantially parallel (e.g. within plus or minus <NUM> degrees, and more particularly within plus or minus <NUM> degrees).

Guide body <NUM> also includes an excision device sleeve <NUM> to receive/contain an excision device <NUM>. Excision device <NUM> may comprises a shaft <NUM> and a cutting head <NUM> located at a distal end of the shaft <NUM>. As such, it may be understood that excision device sleeve <NUM> holds shaft <NUM>. As shown, cutting head <NUM> is a reamer and more particularly a hemispherical (acorn) reamer.

As shown, excision device sleeve <NUM> terminates proximal to any of guide pin sleeves <NUM>, <NUM>, <NUM>, or <NUM>. In such manner, the distal end <NUM> of the guide body <NUM> may be stepped with a raised shoulder portion 209a which provides a contact face/surface (to contact articular surface <NUM>) 208a. Distal end <NUM> further comprises a recessed face/surface (non-contact) 208b, and a recess/pocket 209b adjacent the shoulder 209a to contain the cutting head <NUM> with the distal end thereof proximal to distal end contact surface 208a.

The proximal end of guide body <NUM>, and more particularly, the entrance to excision device sleeve <NUM> may be stepped with a notch <NUM> which may allow a clinician using excision apparatus <NUM>, to use one or more cylindrical scribe markings or indicia (e.g., laser markings) <NUM> formed on shaft <NUM> to determine cutting depth. For example, first excision apparatus <NUM> may be first arranged such the cutting head <NUM> is in contact with recessed surface 208b and indicia <NUM> is proximal to the top of the notch <NUM> defined by proximal end surface 206a. Then as shaft <NUM> and cutting head are moved distally, cutting head <NUM> may come into contact with the articular surface, for example, when indicia <NUM> is parallel with proximal end surface 206a. Thereafter, a clinician may move excision device <NUM> distally until indicia <NUM> becomes parallel with proximal end surface 206b at the bottom of the notch <NUM>, at which time the clinician may be informed that the desired cutting depth has been achieved.

As best shown in <FIG>, excision apparatus <NUM> is first assembled with shaft <NUM> of excision device positioned within excision device sleeve <NUM> of guide body <NUM>. Thereafter, the excision apparatus <NUM> is installed on guide pins <NUM> and <NUM>, particularly by locating guide pin <NUM> in guide pin sleeve <NUM> and guide pin <NUM> in any of guide pin sleeves <NUM>, <NUM> or <NUM>, and sliding guide body <NUM> distally down the length of guide pins <NUM> and <NUM>. Alternatively, as set forth above, guide body <NUM> may be slid distally down the length of only guide pin <NUM>, and the position of second guide pin <NUM> may then be established in the articular surface <NUM> using the guide body <NUM>.

As shown in <FIG>, the center-to-center distance D between the center longitudinal axis of guide pin sleeve <NUM> and the center longitudinal axis of guide pin sleeve <NUM> (<FIG>), which is substantially equal (e.g. within <NUM> inch, and more particularly within <NUM> inch) to the center-to-center distance between the center longitudinal axis of guide pin <NUM> and the center longitudinal axis of guide pin <NUM>, is substantially equal (e.g. within <NUM> inch, and more particularly within <NUM> inch) to the center-to-center distance D' between the center longitudinal axis of guide pin sleeve <NUM> and the center longitudinal axis of guide pin sleeve <NUM> (<FIG>), as well as the center-to-center distance D" between the center longitudinal axis of guide pin sleeve <NUM> and the center longitudinal axis of guide pin sleeve <NUM> (<FIG>).

During use of excision apparatus <NUM>, guide pin sleeve <NUM> of guide body <NUM> may be rotated (e.g., indexed) on guide pin <NUM>, which may be used as a pivot to rotate a position of the cutting head <NUM> of excision device <NUM> along radius R with respect to the articular surface <NUM>. For example, a first excision site (e.g., first planetary excision site) may be formed in articular surface <NUM> in a first excision position P1 when guide pin <NUM> is positioned in guide pin sleeve <NUM> and guide pin <NUM> is positioned in guide pin sleeve <NUM> (as shown by <FIG>) to retain (lock) the guide body <NUM> against rotation.

Thereafter, guide body <NUM> may then be slid proximally upward on guide pins <NUM> and <NUM> until guide body <NUM> clears guide pin <NUM> (in the case where guide pin <NUM> is shorter than guide pin <NUM>). After guide pin <NUM> is cleared, guide body <NUM> may be rotated counterclockwise on guide pin <NUM> to a second excision position P2 such that guide pin sleeve <NUM> is aligned axially with guide pin <NUM> (as shown by <FIG>), which retains the guide body <NUM> in fixed position against rotation, at which point guide body <NUM> may be slid distally downward with guide pins <NUM> and <NUM> in guide pin sleeves <NUM>, <NUM>, respectively, to form a second excision site (e.g., second planetary excision site) corresponding to the second excision position P2.

Thereafter, guide body <NUM> may then be slid proximally upward on guide pins <NUM> and <NUM> until guide body <NUM> clears guide pin <NUM> once again. After guide pin <NUM> is cleared, guide body <NUM> may be rotated clockwise on guide pin <NUM> to a third excision position P3 such that guide pin sleeve <NUM> is aligned axially on guide pin <NUM> (as shown by <FIG>), which retains the guide body <NUM> in fixed position against rotation, at which point guide body <NUM> may be slid distally downward with guide pins <NUM> and <NUM> in guide pin sleeves <NUM>, <NUM>, respectively, to form a third excision site (e.g., third planetary excision site) corresponding to the third excision position P3.

Alternatively, when guide body <NUM> is slid proximally on guide pins <NUM> and <NUM>, guide body <NUM> may clear both guide pins <NUM> and <NUM>, and be rotated by hand, without the aid of guide pin sleeve <NUM> on guide pin <NUM> as a pivot, from the first excision position P1 to the second excision position P2, and from the second excision position P2 to the third excision position P3. It also should be understood that while the present description describes three excision positions (e.g., corresponding to three planetary excision sites), the excision apparatus <NUM> (e.g., guide body <NUM>) may be configured to form a plurality of planetary excision sites and that any reasonable number of excision positions may be utilized depending on the number of guide pin sleeves, as well as the radius of the reamer <NUM> and the length of the articular surface to be replaced. The planetary excision sites may partially overlap with an adjacent planetary excision site. Additionally, the planetary excision sites may be formed in any order, and the above description is merely for illustrative purposes only.

Referring now to <FIG>, in <FIG>, guide body <NUM> is shown in a first excision position P1 with guide pins <NUM> and <NUM> within guide pin sleeves <NUM> and <NUM>, respectively, and cutting head <NUM> of excision device <NUM> retracted into recess/pocket 209b of the guide body <NUM>.

As shown, shoulder <NUM> may be understood to be the left shoulder, particularly given the positioning of the coracoid process 50a and the ancromion 50b. Defect site <NUM> may comprise a portion of the articular surface <NUM>. As may appreciated, the glenoid <NUM> may include one or more articular surfaces <NUM>, which may define a concavity. As such, the defect site <NUM> may comprise a portion of the articular surface <NUM> of the glenoid <NUM>, and more particularly the glenoid cavity (glenoid fossa and/or glenoid vault) and the glenoid rim (glenoid labrum).

In <FIG>, cutting head <NUM> on excision device <NUM> is extended into contact with articular surface <NUM> to make a first excision site 281a (e.g., first planetary excision site). Thereafter, as shown in <FIG>, after guide body <NUM> has been positioned such that guide pins <NUM> and <NUM> are within guide pin sleeves <NUM> and <NUM>, respectively, as discussed above, cutting head <NUM> on excision device <NUM> is extended into contact with articular surface <NUM> to make a second excision site 281b (e.g., second planetary excision site). Thereafter, as shown in <FIG>, after guide body <NUM> has been positioned such that guide pins <NUM> and <NUM> are within guide pin sleeves <NUM> and <NUM>, respectively, as discussed above, cutting head <NUM> on excision device <NUM> is extended into contact with articular surface <NUM> to make a third excision site 281c (e.g., third planetary excision site).

Once planetary excision sites 281a, 281b and 281c are formed, guide body <NUM>, along with excision device <NUM>, may be removed from the surgical site. Similarly, guide pin <NUM> may also be removed from the surgical site. Thereafter, as shown in <FIG>, excision device <NUM> may be introduced into the surgical site, particularly by passing guide pin <NUM> through cannulated shaft <NUM>, to form a fourth excision site <NUM> (e.g., central or vault excision site). Excision device <NUM> may be used to form the excision site <NUM> as set forth with the previous aspect. As may be appreciated, the vault excision site <NUM> partially overlaps with the plurality of planetary excision sites 281a, 281b, 281c.

As shown in <FIG> and <FIG>, with the above excision pattern/arrangement, central hemispherical or vault excision site <NUM> is located generally in the center of glenoid <NUM>, while one or more of the adjacent hemispherical planetary excision sites 281a-281c surround the periphery of the central hemispherical or vault excision site <NUM>. After forming the planetary excision sites 281a, 281b, 281c and vault excision site <NUM>, implant <NUM> may be located thereon, and bonded to the glenoid <NUM>, particularly with bone cement as discussed with previous aspects.

As shown by <FIG>, implant <NUM> may include a load bearing surface <NUM>. The load bearing surface <NUM> may have a contour substantially corresponding to or based on the contour of the patient's articular surface being replaced. The contour of the load bearing surface <NUM> may be based on a plurality of measurements taken at the patient's articular surface (for example, using a measuring and/or mapping tool as generally described in <CIT>, <CIT>, <CIT>, <CIT> and <CIT>,) and/or may be based on one or more templates.

As shown in <FIG>, the load bearing surface <NUM> may be divided into two regions 22a and 22b. Also as shown, load bearing surface region <NUM> may comprise a circular glenoid cavity or vault region 22a and a semi-circular glenoid rim or planetary region 22b which surrounds approximately <NUM> degrees of the periphery of the circular cavity region 22a. However it should be understood that the glenoid cavity region 22a may be surrounded by a glenoid rim region 22b having other sizes. For example, in certain aspects, the glenoid rim region 22b may surround from <NUM> degrees to <NUM> degrees of the glenoid cavity region 22a. In certain other aspects, the glenoid rim region 22b may surround from <NUM> degrees to <NUM> degrees of the glenoid cavity region 22a. In other aspects, the glenoid rim region 22b may surround from <NUM> degrees to <NUM> degrees of the glenoid cavity region 22a. In still other aspects, the glenoid rim region 22b may surround from <NUM> degrees to <NUM> degrees of the glenoid cavity region 22a. In still other aspects, the glenoid rim region 22b may surround from <NUM> degrees to <NUM> degrees of the glenoid cavity region 22a.

As shown in <FIG>, the bone facing surface <NUM> may be configured to be generally received in the excision formed by planetary excision sites 281a, 281b, 281c and vault excision site <NUM>. As such, the bone facing surface <NUM> comprises a plurality of hemispherical regions 24a-24d which are configured to substantially match and correspond to the contour of the plurality of hemispherical planetary excision sites 281a, 281b, 281c and vault excision site <NUM>.

For example, the vault region 24d of bone facing surface <NUM> corresponding to central hemispherical vault excision site <NUM>, which may be in the glenoid cavity region including the glenoid vault region, may have generally hemi-spherical shape substantially corresponding to the contour of the cutting surfaces <NUM> of the cutters 16a, 16b. Similarly, the planetary regions 24a to 24c of bone facing surface <NUM> corresponding to hemispherical planetary excision sites 281a to 281c peripheral to the central hemispherical excision site <NUM>, which may be in the glenoid rim region, may have generally hemi-spherical shape substantially corresponding to the contour of the cutting surfaces <NUM> of the cutting head <NUM>.

The bone facing surface <NUM> may also include one or more lips, protrusions, ribs, or the like 28a-28n, shown in <FIG>, configured to increase the mechanical connection between the implant <NUM> and the patient's bone within the excision site. Again, these lips or the like 28a-28n may generally correspond to the contours of the cutting surfaces <NUM> of the cutters 16a, 16b. The voids or space 30a-30n between the lips 28a-28n may create pockets for bone in-growth and/or bone cement. Moreover, the implant <NUM> may optionally include one or more keels or tails <NUM> extending generally outwardly from the bone facing surface <NUM> as shown in <FIG> and <FIG> to <NUM>. For example, the keel or tail <NUM> may extend generally outward from the vault region 24d of the bone facing surface <NUM>.

Turning to <FIG>, yet another apparatus, system and/or method for resurfacing at least a portion of an articular surface <NUM> having a defect by replacing a portion of the articular surface <NUM> with an implant <NUM>, as well as for locating an implant <NUM>, consistent with the present disclosure, is generally illustrated. Again, the description of the apparatuses, systems, and/or methods herein are not limited to the treatment of any single articular surface of the glenoid <NUM> and may apply, not only to the one or more articular surfaces that may be present in the glenoid <NUM>, but to other articular surfaces through out the human body as well. Stated another way, the present disclosure describes apparatuses, systems, and/or methods for replacing a portion of the articular surface <NUM> of the glenoid <NUM>; however, it should be understood that the systems and methods according to the present disclosure may also be used to resurface articular surfaces other than the glenoid <NUM>.

As shown in <FIG>, guide pins <NUM> and <NUM> are once again shown secured to the glenoid <NUM>, particularly through the articular surface <NUM>. Guide pins <NUM> and <NUM> may be secured thereto using any method discussed with the prior aspects. The following aspects relating to an excision apparatus comprising a plurality of excision device sleeves are not according to the invention and are present for illustration purposes only.

As shown in <FIG>, excision apparatus <NUM> may comprise an elongated guide body <NUM>, for example, having a generally T-shaped cross-sectional profile. Guide body <NUM> comprises a plurality of cylindrical guide pin sleeves <NUM> and <NUM> configured to contain guide pins <NUM> and <NUM>. Guide body <NUM> also includes a plurality of excision device sleeves 320a-320e to contain an excision device <NUM>. Excision device <NUM> may comprises a shaft <NUM> and a cutting head <NUM> located at a distal end of the shaft <NUM>. As such, it may be understood that excision device sleeve <NUM> holds shaft <NUM>. As shown, cutting head <NUM> comprises a spiral groove formed in shaft <NUM> to provide a drilling tip.

As shown in <FIG>, guide body <NUM> of excision apparatus <NUM> may be installed on guide pins <NUM> and <NUM>, particularly by locating guide pin <NUM> in guide pin sleeve <NUM> and guide pin <NUM> in guide pin sleeve <NUM>, and sliding guide body <NUM> distally down the length of guide pins <NUM> and <NUM> until distal end <NUM> makes contact with the articular surface <NUM>.

Thereafter, as shown in <FIG>, shaft <NUM> of excision device <NUM> may be extended distally and inserted through excision device sleeve 320a, and cutting head <NUM> may form a cylindrical planetary excision site 381a in the articular surface <NUM> of glenoid <NUM>. Thereafter, excision device <NUM> may be retracted proximally and removed from excision device sleeve 320a, and extended distally and inserted through excision device sleeve 320b, and cutting head <NUM> may form a cylindrical planetary excision site 381b in the articular surface <NUM> of glenoid <NUM>. In repetitive fashion, cutting head <NUM> may then be extended through excision device sleeves 320c to 320e to form a plurality of cylindrical planetary excision sites 381c to 381e, respectively. As shown, the cylindrical planetary excision sites 381c to 381e extend completely through the glenoid and exit through the dorsal surface of the glenoid/scapula, though it may be understood that one or more of the plurality of planetary excision sites do not have to extend all the way through the bone.

As shown in <FIG>, cylindrical planetary excision sites 381a to 381e are formed in a substantially linear row with the axis of each cylindrical planetary excision site 381c to 381e extending substantially transverse to the midsagittal plane, and the row extending substantially parallel to the coronal plane. It should be appreciated, however, that the plurality of planetary excision sites do not have to be linearly arranged, and may be arranged in an arcuate and/or nonlinear configuration. Also as shown, a narrow intermediate portion 385a to 385d of the glenoid <NUM> may be located between adjacent planetary excision sites 381a to 381e after planetary excision sites 381a to 381e are formed. Thereafter, guide body <NUM> may be slid proximally upward on guide pins <NUM> and <NUM> until it is removed from the guide pins <NUM> and <NUM>.

As shown in <FIG>, once guide body <NUM> is removed, a second elongated guide body <NUM> may be installed in guide pins <NUM> and <NUM>. As shown, similar to guide body <NUM>, guide body <NUM> comprises a plurality of cylindrical guide pin sleeves <NUM> and <NUM> configured to contain guide pins <NUM> and <NUM>. Guide body <NUM> also includes a plurality of excision device sleeves 320a-320e to contain excision device <NUM>.

As shown, guide body <NUM> may be installed in guide pins <NUM> and <NUM>, particularly by locating guide pin <NUM> in guide pin sleeve <NUM> and guide pin <NUM> in guide pin sleeve <NUM>, and sliding guide body <NUM> distally down the length of guide pins <NUM> and <NUM> until distal end <NUM> makes contact with the articular surface <NUM>.

Thereafter, as shown in <FIG>, shaft <NUM> of excision device <NUM> may be extended distally and inserted through excision device sleeve 420a, and cutting head <NUM> may form a partially cylindrical planetary excision site 481a in the articular surface <NUM> of glenoid <NUM>, and, in doing so, eliminate intermediate portion 385a of the glenoid <NUM> between planetary excision site 381a and planetary excision site 381b. Thereafter, excision device <NUM> may be retracted proximally and removed from excision device sleeve 420a, and extended distally and inserted through excision device sleeve 420b, and cutting head <NUM> may form a partially cylindrical planetary excision site 481b in the articular surface <NUM> of glenoid <NUM>. In doing so, the planetary excision site 481a 481b eliminates intermediate portion 385b of the glenoid <NUM> between planetary excision site 381b and planetary excision site 381c. As shown, the planetary excision sites 481a and 481b extend completely through the glenoid and exit through the dorsal surface of the glenoid/scapula as above. Again, as discussed above, one or more of the planetary excision sites 481a-481e may not extend all the way through the bone. In repetitive fashion, cutting head <NUM> may then be extended through excision device sleeves 320c and 320d to eliminate intermediate portions 385c and 385d, respectively.

In eliminating the intermediate portions 385a to 385d between cylindrical planetary excision sites 381a to 381e, a substantially linear planetary excision site may be formed in glenoid <NUM> which extends substantially parallel to the coronal plane. As shown, the planetary excision site is adjacent the posterior glenoid rim. In addition, another partially cylindrical excision 481e may be made after excision 381e to increase the overall length of the excision. Again, it should be appreciated that the resulting planetary excision site does not have to be linear, and may be arcuate and/or non-linear depending on the intended application.

While eliminating the intermediate portions 385a to 385d has been described as being performed with a second guide body <NUM>, it may be possible to only use first guide body <NUM>, such as by flipping guide body <NUM> over such that the proximal end becomes the distal end, and vice-versa.

As a result of the planetary excision sites 381a to 381e and 481a to 481e, which form a substantially linear elongated (slot) planetary excision site, posterior rim segment <NUM> of the glenoid may be separated from a remainder of the glenoid <NUM> except for connection to the glenoid <NUM> by a superior attachment point 61a and an inferior attachment point 61b each having a cross-sectional thickness approximately equal or less than a maximum cross-sectional thickness of the posterior rim segment <NUM>, particularly in the transverse plane.

Thereafter, guide body <NUM> may be slid proximally upward on guide pins <NUM> and <NUM> until it is removed from the guide pins <NUM> and <NUM>. Furthermore, guide pin <NUM> may be removed. Thereafter, as shown in <FIG>, excision device <NUM> may be introduced into the surgical site in a manner as set forth in previous aspects. In order to properly locate excision device <NUM>, guide pin <NUM> may be passed through cannulated shaft <NUM>, or another guide pin introduced to the glenoid as set forth herein, to form excision site <NUM>. Excision device <NUM> may be used to form the vault excision site as set forth with the previous aspects.

As shown in <FIG>, thereafter the posterior rim segment <NUM> may be removed, from the glenoid <NUM> by cutting the superior attachment point 61a and an inferior attachment point 61b, such as with a pair of snips, particularly in an orientation parallel the transverse plane. After removal of posterior rim segment <NUM>, and forming of the excision site, implant <NUM> may be inserted into the resulting excision sites as shown in <FIG>, and bonded to the glenoid <NUM>, particularly with bone cement as discussed with previous aspects.

As best shown in <FIG>, similar to the previous aspect, implant <NUM> may include a load bearing surface <NUM>, which may be divided into two regions 22a and 22b. Also as shown, load bearing surface region <NUM> may comprise a circular glenoid vault cavity region 22a and a semi-circular glenoid planetary rim region 22b which surrounds approximately <NUM> degrees of the periphery of the circular cavity region 22a. However it should be understood that the glenoid vault cavity region 22a may be surrounded by a glenoid planetary rim region 22b having other sizes. For example, in certain aspects, the glenoid planetary rim region 22b may surround from <NUM> degrees to <NUM> degrees of the glenoid vault cavity region 22a. In certain other aspects, the glenoid planetary rim region 22b may surround from <NUM> degrees to <NUM> degrees of the glenoid vault cavity region 22a. In other aspects, the glenoid planetary rim region 22b may surround from <NUM> degrees to <NUM> degrees of the glenoid vault cavity region 22a. In still other aspects, the glenoid planetary rim region 22b may surround from <NUM> degrees to <NUM> degrees of the glenoid vault cavity region 22a.

Similar to the prior aspect, as shown in <FIG>, the bone facing surface <NUM> may be configured to be generally received in the excision formed by plurality of planetary excision sites 381a-381e, 481a-481e, vault excision site <NUM> and the removal of posterior rim segment <NUM>. As shown, the bone facing surface <NUM> comprises a hemispherical region 24a which is configured to substantially match and correspond to the contour of the hemispherical vault excision site <NUM>, and a flange region 24b which corresponds to the remaining planetary excision sites. Moreover, the implant <NUM> may optionally include one or more keels or tails <NUM> extending generally outwardly from the bone facing surface <NUM> as shown in <FIG> and <FIG> to <NUM>. For example, the keel or tail <NUM> may extend generally outward from the vault region 24d of the bone facing surface <NUM>.

Accordingly, an aspect of the present disclosure relates to a system for repairing a defect on a patient's articular surface. The system may include a guide pin configured to be secured into an articular surface of a glenoid, an excision guide and an excision device.

The excision guide may include a guide head wherein the guide head includes a contact surface configured to locate the excision guide relative to the articular surface. In some aspects, the guide head may be configured to be positioned generally central on the articular surface. The excision guide may also include a guide sleeve disposed on the guide head. The guide sleeve may be configured to receive the guide pin therethrough and position the guide pin at an angle β relative to an axis generally normal and central to a defect on the articular surface, wherein angle β is less than <NUM> degrees. In some aspects, angle β may be in the range of <NUM> degrees to <NUM> degrees. In further aspects, angle β may be in the range of <NUM> degrees to <NUM> degrees. The guide sleeve may also be configured to radially offset a point of entry the guide pin into the articular surface from the axis. The excision guide may further include an excision guide arm affixed to the guide head and a handle affixed to the guide arm.

The excision device may include a cannulated shaft and at least one cutter. The cannulated shaft may be configured to be advanced over the guide pin. The at least one cutter may be configured to form a generally hemi-spherical excision site in the articular surface.

A further aspect of the present disclosure relates to a system for repairing a defect on a patient's articular surface. The system may include a guide pin configured to be secured into an articular surface of a glenoid, an impact guide and an impact device.

The impact guide may include an impact guide head having an upper portion and a lower portion. In some aspects, the impact guide head may have a height Ht that corresponds to a height H of an implant configured to be received in the excision site. In some aspects, the impact guide head may have a radius Rt that corresponds to a radius Ri of an implant configured to be received in the excision site. In further aspects, the impact guide head may be releasably coupled to an impact guide arm.

The impact guide head may also have a guide notch defining a first opening through the impact guide head from the upper portion to the lower portion of the impact guide head. The impact guide head may also include a periphery and the first opening may extend to the periphery. The guide notch may be configured to receive the guide pin.

The impact guide may also include an impact slot defining a second opening through the impact guide head from the upper portion of the impact guide head to the lower portion of the impact guide head. The lower portion of the guide head may be configured to be received in an excision site of the articular surface.

Claim 1:
A system for repairing a defect on at least a portion of an articular surface of a glenoid, said system comprising:
at least two guide pins (<NUM>, <NUM>), said at least two guide pins (<NUM>, <NUM>) comprising a first guide pin (<NUM>) and a second guide pin (<NUM>), said first guide pin (<NUM>) and said second guide pin (<NUM>) configured to be secured to said glenoid;
an excision apparatus (<NUM>) comprising a first guide body (<NUM>) and an excision device;
said first guide body (<NUM>) comprising a plurality of guide pin sleeves (<NUM>, <NUM>, <NUM>, <NUM>) to contain said at least two guide pins (<NUM>, <NUM>), said plurality of guide pin sleeves (<NUM>, <NUM>, <NUM>, <NUM>) comprising at least a first guide pin sleeve (<NUM>) and a second guide pin sleeve (<NUM>), the first guide pin sleeve (<NUM>) and the second guide pin sleeve (<NUM>) being parallel to each other; and
wherein, when said first guide pin (<NUM>) is contained in said first guide pin sleeve (<NUM>) and said second guide pin (<NUM>) is contained in said second guide pin sleeve (<NUM>), said first guide body (<NUM>) is retained in a first excision position for said excision device; characterized in that
said first guide body (<NUM>) further comprises a third guide pin sleeve (<NUM>); and
wherein, when said first guide pin (<NUM>) is contained in said first guide pin sleeve (<NUM>) and said second guide pin (<NUM>) is contained in said third guide pin sleeve (<NUM>), said first guide body (<NUM>) is retained in a second excision position for said excision device and wherein said third guide pin sleeve (<NUM>) is parallel to said first guide pin sleeve (<NUM>) and to said second guide pin sleeve (<NUM>), and wherein the center-to-center distance between the center longitudinal axis of the first guide pin sleeve (<NUM>) and the center longitudinal axis of the second guide pin sleeve (<NUM>) is equal to the center-to-center distance between the center longitudinal axis of the first guide pin (<NUM>) sleeve and the center longitudinal axis of the third guide pin sleeve (<NUM>).