Patent ID: 12193687

DETAILED DESCRIPTION

The present disclosure may feature a systems and methods 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 and methods for replacing a portion of the articular surface of the glenoid; 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.

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 toFIG.1, one embodiment of an excision device10and an implant12are generally illustrated. As will be explained in greater detail herein, the excision device10may be configured to form an excision site within the articular surface (e.g., the glenoid) configured to receive at least a portion of the implant12. The implant12may be configured to replace the articular surface in an area proximate one or more defects. The system and method 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 embodiment, the implant12may be configured to replace only a portion of the articular surface proximate the defect site rather than the entire articular surface. As such, the implant12may 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 and method consistent with one embodiment 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 device10may include a cannulated shaft14defining a passageway15configured to be received over at least a portion of a guide pin or the like (not shown). The excision device10may also include at least one cutter16a,16bextending radially outwardly (transversely) and away from a distal end18of the shaft14. Each cutter16a,16bmay have a cutting surface20configured to create a hemispherical implant site, i.e., an excision site to receive the implant. For example, the cutting surface20may have a generally arcuate shape which sweeps towards the proximal end of the shaft14as the radius Refrom the shaft14increases on the cutter16a,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 surfaces20may define the contours of the excision site as the cutters16a,16bare rotated about the central axis of the excision site. While the cutting surfaces20are illustrated having a generally constant arc or curvature, the cutting surfaces20may 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 surfaces20may facilitate alignment of the implant12and/or may increase the mechanical coupling of the implant12within the excision site.

Turning now toFIG.2, the overall radius Reof the cutters16a,16bmay define the radius of the implant site created by the excision device10within the articular surface and may also substantially correspond to the radius Riof the implant12. In addition, the depth D of the cutters16a,16bmay also define the height of the excision site created by the excision device10and may also substantially correspond to the height H of the implant12. For example, the overall radius Reof the cutters16a,16bmay be between 7.0 mm to 20.0 mm, for example, 7.0 mm to 15.0 mm and/or 10.0 mm to 12.5 mm (including all values and ranges therein) and the depth D may be between 4.0 mm to 10.0 mm, for example, 5 mm (including all values and ranges therein).

According to at least one embodiment, the excision device10may include a first and a second cutter16a,16bwhich may be disposed approximately 180 degrees relative to each other. For example, the cutters16a,16bmay extend generally radially outwardly from the shaft about a first and a second generally opposite side of the distal end18of the shaft14. The cutters16a,16bmay also have a generally slim profile configured to be disposed between two adjacent articular surfaces as explained further herein. For example, the cutters16a,16bmay have a cross-sectional thickness (t) of 0.5 mm to 3.0 mm, for example, 2.0 mm (including all values and ranges therein). In one embodiment 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 surface54.

The implant12may include a load bearing surface22and a bone facing surface24. Turning now toFIG.3, a top perspective view of an implant12consistent with at least one embodiment herein is generally illustrated. The load bearing surface22may 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 device10). The contour of the load bearing surface22may 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 U.S. Pat. Nos. 6,520,964, 6,610,067, 6,679,917, 7,029,479 and 7,510,558, which are fully incorporated herein by reference) and/or may be based on one or more templates.

The load bearing surface22may 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 U.S. patent application Ser. No. 12/027,121, filed Feb. 6, 2008 and entitled SYSTEM AND METHOD FOR JOINT RESURFACE REPAIR, which is fully incorporated herein by reference). The load bearing surface22may be generally concaved. For example, the load bearing surface22may have a generally hemi-spherical shape.

The load bearing surface22may also include a beveled region26disposed about the perimeter of the load bearing surface22. The beveled region26may reduce the potential of further damage to the surrounding articular surface by eliminating a hard transition between the load bearing surface22and the remaining articular surface. The beveled region26may be particularly helpful if a portion of the implant12is slightly proud with respect to the remaining articular surface.

The bone facing surface24may be configured to be generally received in the excision site created by the excision device10. For example, the bone facing surface24may have a generally hemi-spherical shape substantially corresponding to the contour of the cutting surfaces20of the cutters16a,16b. The bone facing surface24may also include one or more lips, protrusions, ribs or the like28a-28nconfigured to increase the mechanical connection between the implant12and the patient's bone within the excision site. Again, these lips or the like28a-28nmay generally correspond to the contours of the cutting surfaces20of the cutters16a,16b. The voids or space30a-30nbetween the lips28a-28nmay create pockets for bone in-growth and/or bone cement.

Turning now toFIGS.4and5a, the implant12may optionally include at least one keel or tail32extending generally outwardly from the bone facing surface24. For example, the implant12may include at least one keel32including a protrusion or button34disposed about a distal end of a base region36as generally illustrated inFIG.4. For example, the implant12may include a single keel32extending generally downwardly and away from the bottom surface38of the bone facing surface24generally along the central axis C of the implant12. The base region36may be coupled to the bottom surface38of the bone facing surface24and may have an hour-glass shape which may initially taper radially inwardly and then taper radially outwardly. The bottom surface33of the button34may have a curvature substantially corresponding to the curvature of the implant site. For example, the bottom surface of the button34may have a curvature (generally illustrated by dotted curve D) substantially corresponding to the curvature of the cutting surfaces20.

The button34may extend generally radially outwardly from a distal end of the base region36. As such, the button34may have a diameter Db greater than at least a portion of the base region36, for example, the portion of the base region adjacent to the button34. According to one embodiment, the diameter Db of the button34may 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 button34may form an interference fit with the cavity in the excision site which may secure the implant12to the bone and may also facilitate alignment of the implant12with respect to the articular surface and the excision site. Alternatively, the diameter Db of the button34may be slightly smaller than the diameter of the cavity in which it is configured to be received. As such, the button34may also facilitate alignment of the implant12with 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 keel32and the bone.

FIG.5aillustrates another embodiment of a keel32. The keel32may include a base region36extending generally outwardly/downwardly and away from the bottom surface38of the bone facing surface24generally along the central axis C of the implant12. For example, the keel32may extend outwardly/downwardly and away from the bottom surface38of the bone facing surface24beyond the curvature D substantially corresponding to the curvature of the cutting surfaces20. The keel32may 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 region36may include one or more radial lips, grooves, protrusions or the like40. The keel32may also include a protrusion42extending generally downwardly and away from the base portion36generally along the central axis C of the implant12. The protrusion42may include one or more radial lips, grooves, protrusions or the like44a-44n. As discussed herein, the keel32may be configured to engage a cavity or the like disposed within the excision site and may be configured align the implant12with respect to the articular surface and/or the excision site and may also increase the mechanical coupling of the implant12to the bone.

While the keels32illustrated inFIGS.4and5aare shown having a generally concentric shape, the keel32may have other configurations. For example, in the embodiment illustrated inFIG.5bthrough5fthe keel32and/or the protrusion42extending from the keel32may have a shape configured to prevent rotations of the implant12with respect to the articular surface. The keel32may have a non-circular shape configured to be received in the excision site in a lock-and-key configuration. By way of example, the keel32may 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 protrusion42may exhibit a multifaceted geometry such as generally oblong or rectangular, pentagonal, hexagonal, or the like. The protrusion42may also exhibit an additional (or second) protrusion44aextending outwardly in a radial direction from the central axis of the implant12, which may form a raised edge or surface around the perimeter of the protrusion42. As illustrated, protrusion42may end in a relatively pointed tip, or may exhibit a curvature as illustrated inFIG.5a.FIG.5gillustrates a further embodiment of protrusion42, wherein the protrusion42may be formed from a variety of features, such as circular, rectangular, etc. It may be appreciated that, the implant12and the keel32may 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 toFIGS.6-10, one method of installing an implant12consistent with the present disclosure is generally illustrated. One or more incisions49may be created proximate the patient's shoulder50to provide access to the defect52on the patient's articular surface54, for example, using a scalpel or the like. The incision49may be made through the anterior portion of the patient. Again, the present disclosure will describe a system and method for replacing a portion of the articular surface of the glenoid; however, it should be understood that the system and method according to the present disclosure may also be used to resurface articular surfaces other than the glenoid. The system and method consistent with one embodiment 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 pin56,FIG.6, may be positioned about the glenoid58on the scapula60to provide an access passageway to the glenoidal articular surface54as will be described herein. Consistent with one embodiment, the guide pin56may comprise threaded and/or self-tapping tip (not shown) configured to be secured to the patient's bone. The guide pin56may 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 site52on the articular surface54. Optionally, a drill guide (not shown) may be used to facilitate alignment of the guide pin56with respect to the articular surface54.

The guide pin56may be disposed at an angle α relative to the articular surface54. Angle α may be less than or equal to 90 degrees, wherein α≤90 degrees with respect to the articular surface54. In some examples, angle α may be less or equal to 90 degrees and greater than or equal to 45 degrees with respect to the articular surface54, wherein 45 degrees≤α≤90 degrees with respect to the articular surface54. In further examples, 90 degrees>α>45 degrees and/or 90 degrees>α≥45 degrees, with respect to the articular surface54. The degree of the angle α may depend on the location and/or size of the defect52and may be selected to avoid contact with the humerus62. In some circumstances, the degree of the angle α may also be selected to avoid contact with the perimeter of the articular surface54.

Once the guide pin56is secured to the articular surface54, the excision device10may be advanced over the guide pin56as generally illustrated inFIG.7. For example, the guide pin56may be received within the passageway15defined by the cannulated shaft14. According to at least one embodiment, the cutters16a,16bmay be generally aligned in a single plane extending along the longitudinal axis of the excision device10.

The plane of the cutters16a,16bmay be orientated generally tangential to the articular surface64of the humerus62such that the cutters16a,16bmay slide by the articular surface64of the humerus62and between the humerus62and the scapula60as generally illustrated inFIGS.7and8.

Once the cutters16a,16bare advanced over the guide pin56to the articular surface54, the excision device10may be rotated about the guide pin56. As may be best seen inFIG.8, a pocket of cavity66may be present between the articular surface54of the glenoid58and the articular surface64of the humerus62. The cutters16a,16bof the excision device10may therefore rotate about the guide pin56without contacting the articular surface64of the humerus62. The cutters16a,16bmay have generally flat cutting surfaces20, forming a point along the length thereof, or may have serrated cutting surfaces.

The excision device10may thus be rotated about the guide pin56to form an excision site70within the articular surface54of the glenoid60as generally illustrated inFIG.9. Due to the contour of the cutting surfaces20of the cutters16a,16b, the excision site70created by the excision device10may have a generally hemi-spherical configuration regardless of the angle α of the guide pin56.

Once the excision site70is formed within the articular surface54, the excision device10and the guide pin56may be removed as generally illustrated inFIG.10. The removal of the guide pin56may leave a cavity72formed by the distal tip of the guide pin56. The implant12may then be received in the excision site70. The spherical configuration of the excision site70may normalize the implant12with respect to the remaining articular surface54. The load bearing surface22of the implant12may substantially match the original contour of the patient's articular surface54which was removed.

As illustrated inFIG.11, the system and method according to the present disclosure may also repair a defect80on the articular surface54in which a portion of the perimeter of the articular surface54is damaged or missing. For example, the posterior portion P of the articular surface54may have a defect80wherein a portion of the perimeter of the articular surface54is missing which may be caused by advanced chronic shoulder dislocation and/or early onset arthritis. To repair a defect80proximate the perimeter of the articular surface54, the guide pin56may be moved further towards the posterior end P of the articular surface54. The exact location of the guide pin56with respect to the articular surface54may depend on the location and size of the defect80as well as the size of the cutters16a,16bof the excision device10.

According to one embodiment, the guide pin56may be located a distance away from the perimeter of the articular surface54which generally corresponds to the radius Reof the cutters16a,16b. The excision device10may be advanced over the guide pin56and rotated as described herein. Accordingly, the cutters16a,16bmay remove a portion of the articular surface54to form an excision site81disposed about the perimeter of the articular surface54as generally illustrated inFIG.12. The excision device10and the guide pin56may then be removed and the implant12may be received within the excision site81. As may be seen inFIG.12, a portion of the implant12may replace the perimeter of the articular surface54which was damaged and/or missing.

The implant12may also include a keel32as generally illustrated inFIGS.12and13. The keel32may facilitate alignment of the implant12with respect to the articular surface54and/or may provide an increased mechanical connection between the implant12and the bone. As discussed herein, the excision site81may also include one or more cavities83,FIG.13, configured to received at least a portion of the keel32(for example, but not limited to, one or more radial lips44a-44nof the protrusion42.

Once the position/orientation of the implant12has been confirmed (i.e., the contour of the load bearing surface22has been confirmed along the AP and/or SI planes to generally correspond to the original contour of the articular surface), the implant12may be secured to the bone. The implant12may be held in place by the lips, protrusions, ribs or the like28a-28nof the bone facing surface24, the keel32, and/or bone cement or the like.

Turning toFIGS.14-21, one system and/or method for locating an implant12consistent 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 incisions49may be created proximate to the patient's shoulder50to provide access to the defect on the patient's articular surface54, using, for example, a scalpel or the like. As may be appreciated, the glenoid may include one or more articular surfaces54. Each of the articular surfaces may define a concavity as illustrated inFIG.14a.

A portion of an excision guide102may be positioned within the incision and located between the humerus62and the articular surface54of the glenoid58. The excision guide may include an arm104and a head106, which may, in some embodiments, be inserted through the incision in such a manner to avoid contact with the humerus62.FIGS.14bandcillustrate embodiments of the excision guide head106and, in particular, variations in the contact surfaces116of the excision guide head106located on the lower portion117of the excision guide head106. For example, in one embodiment, illustrated inFIG.14b, the contact surface116may generally conform to the articular surface54. In another embodiment, illustrated inFIG.14c, the contact surface116may be a ring near the periphery of the lower portion117of the excision guide head106. As may be appreciated in some embodiments, when in the shape of a ring, the contact surface may be continuous or may, in other embodiments, be discontinuous forming ridges around the contact surface116. The excision guide102may also include a handle108, which may or may not include one or more indentations110to assist in manipulation and/or stabilization of the excision guide102. The handle may be affixed to the upper portion of the excision guide head119.

The head106of the excision guide102may be located over a defect52of an articular surface54. The head106may locate the excision guide102relative to the articular surface54. In some embodiments, the head106may be generally centered on the articular surface54including the defect52. For example, in one embodiment, the head106may be located generally centered in the concavity55of the articular surface54. Once the head106is positioned over the defect52, the guide pin56may be received into and pass through a guide sleeve112disposed on the head106. As illustrated inFIGS.14bandc, the guide sleeve112may define an opening from the upper surface119of the excision guide head106through the lower surface117of the excision guide head106. The guide sleeve112may position the guide pin56relative to the defect52on the articular surface. In addition, the guide sleeve112may be formed in and/or integral to the head106or may be formed in an insert connected to the head106.

As illustrated inFIG.15, the excision guide102may orient the working axis (W) of the guide pin56in one or more planes. For example, in one aspect, the guide sleeve112may angle the guide pin56, such that the guide pin may be positioned at an angle α that may be 90 degrees or less from the articular surface, including all values and increments in the range of 10 degrees to 90 degrees, such as in one embodiment 45 degrees to 75 degrees or in a further embodiment 60 degrees from the articular surface54.

In another aspect, the guide sleeve112of the excision guide102may orient the working axis (W) of the guide pin56at an angle β relative to a normal axis (N). The normal axis (N) may, in some embodiments, be generally normal and central to a defect80in the articular surface54. Angle β may be 90 degrees or less and in some examples, including all values and increments in the range of 5 degrees and 80 degrees, such as in the range of 10 degrees to 30 degrees.FIG.16illustrates another example of the working axis (W) defined by the guide sleeve112to an axis (N) generally central and normal to the lowest point of the contact surface116of the excision guide head106, which may correspond to the axis generally normal and centrally located to defect80or to the deepest point of the excision site70.

The guide sleeve112may also offset the intended entry point114of the guide pin56in the articular surface54radially outward from the axis (N) normal and generally central to the excision site and/or the articular surface54.FIG.17illustrates an embodiment of the positioning of the at least one cutter16a,16brelative to the positioning of the excision guide102. In one embodiment, the offset (0) may be determined based on the angle of entry of the guide pin56(α or β) into the articular surface54and/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 pin56to the articular surface54or angle β of the guide pin56to the normal axis (N).

The working axis (W) may be positioned at an angle β in the range of 10 degrees to 90 degrees, such as in one embodiment, 15 degrees to 45 degrees, or in a further embodiment 60 degrees from the normal axis (N). As may be appreciated, in some embodiments, the surface of the excision guide head116may exhibit some degree of curvature and may be convex. The curvature of the surface of the excision guide head116may be configured to generally match the curvature of at least a portion of the articular surface54. In some embodiments, it may be appreciated, that the curvature of the articular surface54and the surface of the excision guide head may not match exactly but may provide a “close fit” sufficient to locate the excision guide head106within the glenoid58. In some non-limiting embodiments, the curvature of the excision guide head surface116may be generally hemispherical, including pyriform or teardrop in shape.

Once the guide pin56is positioned in the articular surface54of the glenoid58, as illustrated inFIG.15, the excision guide102may be removed from the glenoid58by sliding the excision guide102up the guide pin56away from the glenoid58. As illustrated inFIG.18, the excision device10, including one or more cutters16aand16b, may be slid (in direction of arrow) over the guide pin56and, as described above, the excision device10may be rotated forming an excision site70in the articular surface54.

The excision device10may then be removed from the guide pin56and an impact guide120may be inserted through the incision49and over the guide pin56, an embodiment of which is illustrated inFIGS.19athrough19c. The impact guide120may include an impact guide arm122, an impact guide head124and an impact guide handle126. In one embodiment, the impact guide120may be the same as the excision guide102, wherein the head106of the excision guide102may be interchangeable with the one or more impact guide heads124. In another embodiment, the impact guide120may be separately provided from the excision guide102.

As may be appreciated, the impact guide heads124may generally correspond to or mimic the size and shape of an implant, described above. An embodiment of an impact guide head is illustrated inFIG.19b, wherein the impact guide head124may include a lower portion125that substantially conforms to the generally hemispherical excision site. The impact guide head may exhibit a given height Htand radius Rtmatching that of an implant to be provided in the excision site70(seeFIG.19a). In another embodiment, illustrated inFIG.19c, the impact guide may include a lower portion127that includes a ring or bevel around the periphery that may conform to the excision site. The remainder of the lower portion125may be recessed.

The impact guide head124may include a guide notch128, which may be inserted over the guide pin56or around the guide pin56(as illustrated inFIG.19a). It may be appreciated that while a notch is illustrated defining an opening in the periphery of the impact guide head124, i.e., extending to the periphery of the impact guide head124, the guide notch128may also include a sleeve defined in the impact guide head124. As illustrated inFIGS.19band19c, the guide notch128may generally define an opening from the upper portion127through the lower portion125of the impact guide head124. In addition, the guide notch128may include at least one surface129that may accommodate the angle and offset of the guide pin56relative to the articular surface54, such that the impact guide head124may be positioned generally central within the excision site70and the guide pin56may rest on the surface129.

Upon placement of the impact guide head124by the impact guide120into the excision site70, a determination may be made as to whether the excision site70is sufficiently deep enough to accommodate the implant that may eventually be placed within the excision70. As may be appreciated, if the excision site70is not sufficient deep, or properly formed, the impact guide120may be removed from the excision site70and the guide pin56. The excision device10may again be placed over the guide pin56and further excision may be provided to deepen or further form the excision site70. This procedure of checking the excision site70using the impact guide head124may be repeated until it is determined that an implant will fit within the excision site70. In some embodiments, the use of the impact guide120may be to prevent the implant from being too proud in the excision site and from rising above the articular surface54. In other embodiments, the impact guide head124and/or the impact guide120, 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 heads124may be provided. In some embodiments, the impact guide heads124may be interchangeable and removable from the impact guide120. In other embodiments, a number of impact guides120may be provided including different sized impact guide heads124fixed to the impact guide120.

Once an impact guide has been selected based on, for example, the size of the excision site, the impact guide head124may be seated in the excision site70as illustrated in the embodiment ofFIG.20. In one embodiment, the guide pin56may optionally be removed before or after seating the selected impact guide head124. The impact guide head124may include an impact slot130defined therein. As illustrated inFIG.20, the impact slot130is generally rectangular in cross-section; however, as may be appreciated, other cross-sectional geometries may be provided, such as circular, as illustrated inFIG.21, as well as elliptical shaped, square shaped, etc. An impact device132, such as a chisel, punch or awl may be provided, the distal end134of which may fit in and extend through the impact slot130. Therefore, in some embodiments, the distal end may be longer than the length of the impact slot. In addition, the distal end of the impact device132may exhibit a cross-sectional area that may be slightly smaller than that of the impact slot130. The proximal end136of the impact device132may provide a striking surface138, which may be hit by hand, or with a hammer or other device, causing the impact device132to extend through the impact slot130creating a secondary excision site140in the primary or first excision site70. In some embodiments, the impact device may include a sagittal saw or other cutting device, which may be inserted through the impact slot130. If the guide pin56has not yet been removed, it may be removed at this time.

While the proximal end136of the impact device132is illustrated inFIG.20as being provided at an angle γ to the arm122of the impact guide120, wherein angle γ may be in the range of 15 degrees to 120 degrees, including all values and increments therein, in some embodiments, the impact device132may be inserted closer to the impact guide120, wherein angle γ may be in the range of 0 degrees to 45 degrees, including all values and increments therein. In other embodiments, the proximal portion136of the impact device may be generally parallel to the arm122of the impact guide120. In such a manner, the impact device132may be inserted into incision49in the patient (FIG.6) without the need for expanding the size of the incision49greater than necessary to accommodate the head of the excision guide or the head of the impact guide. Further, the impact device132may include a curvature137, which may generally fit over the curvature123of the arm122of the impact guide120.

FIG.22illustrates an embodiment of a secondary excision site140provided in an excision site70andFIG.23illustrates one embodiment of an implant12received in an excision site70. The secondary excision site140is illustrated as being generally rectangular; other cross-sectional geometries may be provided as well. In addition, the depth Dsof the secondary excision site (illustrated in broken lines) may be formed to generally correspond with protrusions34,42,44a-dthat may extend from the keel32of the bone facing surface of the implant12, illustrated in the embodiments ofFIGS.4and5a-f.

While the implant12may 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 implant12in place in other embodiments. In such a manner a layer of bone adhesive may be delivered to the excision site70, and optionally to the secondary excision site140and the implant12may be situated over the adhesive and positioned within the excision site.

Turning toFIGS.24-30, another apparatus, system, and/or method for resurfacing at least a portion of an articular surface54having a defect52by replacing a portion of the articular surface54with an implant12, as well as for locating an implant12, 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 surface54of the glenoid58, and may apply, not only to the one or more articular surfaces54that may be present in the glenoid58, 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 surface54of the glenoid58, 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 glenoid58.

Similar to the previous embodiment, one or more incisions49may be created proximate to the patient's shoulder50to provide access to one or more defect sites52on articular surface54of the glenoid58, using, for example, a scalpel or the like with an anterior approach. Thereafter, a portion of an excision guide102may be positioned within the incision and located between the humerus62and the articular surface54of the glenoid58.

According to one embodiment, any one of the excision guides102described herein may be used to establish at least one (e.g., a first) guide pin56extending from the articular surface54at angle β. Referring now toFIG.24, yet another embodiment of an excision guide102is generally illustrated. The excision guide102ofFIG.24may be similar to the previous embodiments described herein and may include an arm104and a head106, which may, in some embodiments, be inserted through the incision49in such a manner to avoid contact with the humerus62. One or more contact surfaces116located on the lower portion117of the excision guide head106may generally conform to the articular surface54(seeFIG.14B.). In other embodiments, the contact surface116may be a ring or partial ring (e.g., one or more arcuate regions) near the periphery of the lower portion117of the excision guide head106. As may be appreciated in some embodiments, when in the shape of a ring, the contact surface116may be continuous or may, in other embodiments, be discontinuous forming ridges around the contact surface116(seeFIG.14C). The excision guide102may also include a handle108(seem for example, a handle as generally illustrated inFIG.14A) to assist in manipulation and/or stabilization of the excision guide102. The handle108may be affixed to the upper portion of the excision guide head119.

The head106of the excision guide102may be positioned in overlying relationship onto the articular surface54, which may or may not be located over the defect site52of the articular surface. For example, in some embodiments, the head106may be generally centered in the concavity55(glenoid cavity) of the articular surface54, including the defect52. However, in other embodiments, the head106may be located generally centered in the concavity55(glenoid cavity) of the articular surface54, but not over the defect site52, which may be located on the glenoid rim.

The head106may locate the excision guide102relative to the articular surface54. Once the head106suitably positioned, at least one cylindrical guide pin56may be received into and pass through a cylindrical guide pin sleeve112disposed on the head106as generally described herein. As illustrated inFIG.24, the guide pin sleeve112may define an opening from the upper surface119of the excision guide head106through the lower surface117of the excision guide head106. The guide pin sleeve112may position the guide pin56relative to the defect52on the articular surface. In addition, the guide pin sleeve112may be formed in and/or integral to the head106or may be formed in an insert connected to the head106.

As with the previous embodiment (e.g. seeFIG.16andFIG.17), the guide pin sleeve112of the excision guide102may orient the working axis (W) of the guide pin56at an angle β relative to a normal axis (N). The working axis (W) may be defined by the guide pin sleeve112to an axis (N) generally central and normal to the lowest point of the contact surface116of the excision guide head106. Angle β may be 90 degrees or less and in some examples, including all values and increments in the range of 5 degrees and 80 degrees, such as in the range of 10 degrees to 30 degrees.

The guide pin sleeve112may also offset the intended entry point of the guide pin56in the articular surface54radially outward from the normal axis (N). The offset (O) may be determined based on the angle β of entry of the guide pin56into the articular surface54and/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 pin56to the normal axis (N).

The working axis (W) may be positioned at an angle β in the range of 10 degrees to 90 degrees, such as in one embodiment, 15 degrees to 45 degrees, or in a further embodiment 60 degrees from the normal axis (N). As may be appreciated, in some embodiments, the contact surface(s)116of the excision guide head106may exhibit some degree of curvature and may be convex. The curvature of the contact surface116of the excision guide head106may be configured to generally match the curvature of at least a portion of the articular surface54. In some embodiments, it may be appreciated, that the curvature of the articular surface54and the contact surface116of the excision guide head106may not match exactly but may provide a “close fit” sufficient to locate the excision guide head106within the glenoid58. In some non-limiting embodiments, the curvature of the contact surface116may be generally hemispherical, including pyriform or teardrop in shape.

As may be appreciated, any of the excision guides102described herein may be used to establish the first guide pin56at the angle θ. Once the first guide pin56is established, at least a second guide pin57may also be secured extending from the articular surface54.

According to one embodiment, the excision guide102ofFIG.24may also be used to establish the second or more guide pins57, or, alternatively as disclosed below, the guide body204disclosed herein may be used to establish the second or more guide pins57.

For example, once the first guide pin56is positioned in the articular surface54of the glenoid58, the second (or more) cylindrical guide pin57may be received into and pass through a cylindrical guide pin sleeve113disposed on the head106. As illustrated inFIG.24, the guide pin sleeve113may define an opening from the upper surface119of the excision guide head106through the lower surface117of the excision guide head106. The guide pin sleeve113may position the guide pin57relative to the defect52on the articular surface. In addition, the guide pin sleeve113may be formed in and/or integral to the head106or may be formed in an insert connected to the head106.

As shown, guide pin sleeve113is substantially parallel to guide pin sleeve112such that guide pin57will be substantially parallel to guide pin56(e.g. within plus or minus 5 degrees). It may be appreciated, however, that the second guide pin57may also be non-parallel relative to first guide pin56, or any other guide pin (not shown) secured to the articular surface54. Also, while second guide pin57is shown to have a length substantially equal to the length of first guide pin56, the second guide pin57may be shorter than first guide pin56.

Once the guide pin56, and in certain embodiments guide pin57, are positioned in the articular surface54of the glenoid58, the excision guide102may be removed from the glenoid58by sliding the excision guide102up the guide pin56, and in certain embodiments guide pin57, away from the glenoid58. Once excision guide102is removed, an excision apparatus200may be installed thereon.

As shown inFIGS.25-28, excision apparatus200may comprise an elongated guide body204, for example, having a generally T-shaped cross-sectional profile. Guide body204has a proximal end206and a distal end208, and comprises a plurality of cylindrical guide pin sleeves210,212,214and216configured to contain/receive guide pins56and57. As shown, cylindrical guide pin sleeves210,212,214and216have a diameter substantially equal to guide pins56and57(e.g. greater in diameter by less than or equal to 0.04 inches, and more particularly by less than or equal to 0.02 inches). Also as shown, the guide pin sleeves210,212,214and216are substantially parallel (e.g. within plus or minus 10 degrees, and more particularly within plus or minus 5 degrees)

Guide body204also includes an excision device sleeve220to receive/contain an excision device240. Excision device240may comprises a shaft244and a cutting head250located at a distal end of the shaft244. As such, it may be understood that excision device sleeve220holds shaft244. As shown, cutting head250is a reamer and more particularly a hemispherical (acorn) reamer.

As shown, excision device sleeve220terminates proximal to any of guide pin sleeves210,212,214, or216. In such manner, the distal end208of the guide body204may be stepped with a raised shoulder portion209awhich provides a contact face/surface (to contact articular surface54)208a. Distal end208further comprises a recessed face/surface (non-contact)208b, and a recess/pocket209badjacent the shoulder209ato contain the cutting head250with the distal end thereof proximal to distal end contact surface208a.

The proximal end of guide body204, and more particularly, the entrance to excision device sleeve220may be stepped with a notch230which may allow a clinician using excision apparatus200, to use one or more cylindrical scribe markings or indicia (e.g., laser markings)248formed on shaft244to determine cutting depth. For example, first excision apparatus200may be first arranged such the cutting head250is in contact with recessed surface208band indicia248is proximal to the top of the notch230defined by proximal end surface206a. Then as shaft244and cutting head are moved distally, cutting head250may come into contact with the articular surface, for example, when indicia248is parallel with proximal end surface206a. Thereafter, a clinician may move excision device240distally until indicia248becomes parallel with proximal end surface206bat the bottom of the notch230, at which time the clinician may be informed that the desired cutting depth has been achieved.

As best shown inFIG.25, excision apparatus200is first assembled with shaft244of excision device positioned within excision device sleeve220of guide body204. Thereafter, the excision apparatus200is installed on guide pins56and57, particularly by locating guide pin56in guide pin sleeve210and guide pin57in any of guide pin sleeves212,214or216, and sliding guide body204distally down the length of guide pins56and57. Alternatively, as set forth above, guide body204may be slid distally down the length of only guide pin56, and the position of second guide pin57may then be established in the articular surface54using the guide body204.

As shown inFIGS.28A-28C, the center-to-center distance D between the center longitudinal axis of guide pin sleeve210and the center longitudinal axis of guide pin sleeve212(FIG.28A), which is substantially equal (e.g. within 0.02 inch, and more particularly within 0.01 inch) to the center-to-center distance between the center longitudinal axis of guide pin56and the center longitudinal axis of guide pin57, is substantially equal (e.g. within 0.02 inch, and more particularly within 0.01 inch) to the center-to-center distance D′ between the center longitudinal axis of guide pin sleeve210and the center longitudinal axis of guide pin sleeve214(FIG.28B), as well as the center-to-center distance D″ between the center longitudinal axis of guide pin sleeve210and the center longitudinal axis of guide pin sleeve216(FIG.28C).

During use of excision apparatus200, guide pin sleeve210of guide body204may be rotated (e.g., indexed) on guide pin56, which may be used as a pivot to rotate a position of the cutting head250of excision device240along radius R with respect to the articular surface54. For example, a first excision site (e.g., first planetary excision site) may be formed in articular surface54in a first excision position P1when guide pin56is positioned in guide pin sleeve210and guide pin57is positioned in guide pin sleeve212(as shown byFIG.28A) to retain (lock) the guide body204against rotation.

Thereafter, guide body204may then be slid proximally upward on guide pins56and57until guide body204clears guide pin57(in the case where guide pin57is shorter than guide pin56). After guide pin57is cleared, guide body204may be rotated counterclockwise on guide pin56to a second excision position P2such that guide pin sleeve214is aligned axially with guide pin57(as shown byFIG.28B), which retains the guide body204in fixed position against rotation, at which point guide body204may be slid distally downward with guide pins56and57in guide pin sleeves210,214, respectively, to form a second excision site (e.g., second planetary excision site) corresponding to the second excision position P2.

Thereafter, guide body204may then be slid proximally upward on guide pins56and57until guide body204clears guide pin57once again. After guide pin57is cleared, guide body204may be rotated clockwise on guide pin56to a third excision position P3such that guide pin sleeve216is aligned axially on guide pin57(as shown byFIG.28C), which retains the guide body204in fixed position against rotation, at which point guide body204may be slid distally downward with guide pins56and57in guide pin sleeves210,216, respectively, to form a third excision site (e.g., third planetary excision site) corresponding to the third excision position P3.

Alternatively, when guide body204is slid proximally on guide pins56and57, guide body204may clear both guide pins56and57, and be rotated by hand, without the aid of guide pin sleeve210on guide pin56as a pivot, from the first excision position P1to the second excision position P2, and from the second excision position P2to 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 apparatus200(e.g., guide body204) 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 reamer240and 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 toFIGS.29A-29G, inFIG.29A, guide body204is shown in a first excision position P1with guide pins56and57within guide pin sleeves210and212, respectively, and cutting head250of excision device240retracted into recess/pocket209bof the guide body204.

As shown, shoulder50may be understood to be the left shoulder, particularly given the positioning of the coracoid process50aand the ancromion50b. Defect site52may comprise a portion of the articular surface54. As may appreciated, the glenoid58may include one or more articular surfaces54, which may define a concavity. As such, the defect site52may comprise a portion of the articular surface54of the glenoid58, and more particularly the glenoid cavity (glenoid fossa and/or glenoid vault) and the glenoid rim (glenoid labrum).

InFIG.29B, cutting head250on excision device240is extended into contact with articular surface54to make a first excision site281a(e.g., first planetary excision site). Thereafter, as shown inFIG.29C, after guide body204has been positioned such that guide pins56and57are within guide pin sleeves210and214, respectively, as discussed above, cutting head250on excision device240is extended into contact with articular surface54to make a second excision site281b(e.g., second planetary excision site). Thereafter, as shown inFIG.29D, after guide body204has been positioned such that guide pins56and57are within guide pin sleeves210and216, respectively, as discussed above, cutting head250on excision device240is extended into contact with articular surface54to make a third excision site281c(e.g., third planetary excision site).

Once planetary excision sites281a,281band281care formed, guide body204, along with excision device240, may be removed from the surgical site. Similarly, guide pin57may also be removed from the surgical site. Thereafter, as shown inFIG.29E, excision device10may be introduced into the surgical site, particularly by passing guide pin56through cannulated shaft14, to form a fourth excision site270(e.g., central or vault excision site). Excision device10may be used to form the excision site270as set forth with the previous embodiment. As may be appreciated, the vault excision site270partially overlaps with the plurality of planetary excision sites281a,281b,281c.

As shown inFIGS.29F and29G, with the above excision pattern/arrangement, central hemispherical or vault excision site270is located generally in the center of glenoid52, while one or more of the adjacent hemispherical planetary excision sites281a-281csurround the periphery of the central hemispherical or vault excision site270. After forming the planetary excision sites281a,281b,281cand vault excision site270, implant12may be located thereon, and bonded to the glenoid52, particularly with bone cement as discussed with previous embodiments.

As shown byFIG.30A, implant12may include a load bearing surface22. The load bearing surface22may 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 surface22may 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 U.S. Pat. Nos. 6,520,964, 6,610,067, 6,679,917, 7,029,479 and 7,510,558, which are fully incorporated herein by reference) and/or may be based on one or more templates.

The load bearing surface22may 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 U.S. patent application Ser. No. 12/027,121, filed Feb. 6, 2008 and entitled SYSTEM AND METHOD FOR JOINT RESURFACE REPAIR, which is fully incorporated herein by reference). The load bearing surface22may be generally concaved. For example, the load bearing surface22may have a generally hemi-spherical shape.

As shown inFIG.30A, the load bearing surface22may be divided into two regions22aand22b. Also as shown, load bearing surface region22may comprise a circular glenoid cavity or vault region22aand a semi-circular glenoid rim or planetary region22bwhich surrounds approximately 180 degrees of the periphery of the circular cavity region22a. However it should be understood that the glenoid cavity region22amay be surrounded by a glenoid rim region22bhaving other sizes. For example, in certain embodiments, the glenoid rim region22bmay surround from 10 degrees to 270 degrees of the glenoid cavity region22a. In certain other embodiments, the glenoid rim region22bmay surround from 30 degrees to 240 degrees of the glenoid cavity region22a. In other embodiments, the glenoid rim region22bmay surround from 50 degrees to 210 degrees of the glenoid cavity region22a. In still other embodiments, the glenoid rim region22bmay surround from 60 degrees to 180 degrees of the glenoid cavity region22a. In still other embodiments, the glenoid rim region22bmay surround from 80 degrees to 150 degrees of the glenoid cavity region22a.

As shown inFIGS.30B-30D, the bone facing surface24may be configured to be generally received in the excision formed by planetary excision sites281a,281b,281cand vault excision site270. As such, the bone facing surface24comprises a plurality of hemispherical regions24a-24dwhich are configured to substantially match and correspond to the contour of the plurality of hemispherical planetary excision sites281a,281b,281cand vault excision site270.

For example, the vault region24dof bone facing surface24corresponding to central hemispherical vault excision site270, 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 surfaces20of the cutters16a,16b. Similarly, the planetary regions24ato24cof bone facing surface24corresponding to hemispherical planetary excision sites281ato281cperipheral to the central hemispherical excision site270, which may be in the glenoid rim region, may have generally hemi-spherical shape substantially corresponding to the contour of the cutting surfaces250of the cutting head250.

The bone facing surface24may also include one or more lips, protrusions, ribs, or the like28a-28n, shown inFIG.3, configured to increase the mechanical connection between the implant12and the patient's bone within the excision site. Again, these lips or the like28a-28nmay generally correspond to the contours of the cutting surfaces20of the cutters16a,16b. The voids or space30a-30nbetween the lips28a-28nmay create pockets for bone in-growth and/or bone cement. Moreover, the implant12may optionally include one or more keels or tails32extending generally outwardly from the bone facing surface24as shown inFIGS.4and5A to5G. For example, the keel or tail32may extend generally outward from the vault region24dof the bone facing surface24.

Turning toFIGS.31-32, yet another apparatus, system and/or method for resurfacing at least a portion of an articular surface54having a defect by replacing a portion of the articular surface54with an implant12, as well as for locating an implant12, 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 glenoid58and may apply, not only to the one or more articular surfaces that may be present in the glenoid58, 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 surface54of the glenoid58; 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 glenoid58.

As shown inFIG.31A, guide pins56and57are once again shown secured to the glenoid58, particularly through the articular surface54. Guide pins56and57may be secured thereto using any method discussed with the prior embodiments.

As shown inFIG.31B, excision apparatus300may comprise an elongated guide body304, for example, having a generally T-shaped cross-sectional profile. Guide body304comprises a plurality of cylindrical guide pin sleeves310and312configured to contain guide pins56and57. Guide body304also includes a plurality of excision device sleeves320a-320eto contain an excision device340. Excision device340may comprises a shaft344and a cutting head350located at a distal end of the shaft344. As such, it may be understood that excision device sleeve320holds shaft244. As shown, cutting head350comprises a spiral groove formed in shaft344to provide a drilling tip.

As shown inFIG.31B, guide body304of excision apparatus300may be installed on guide pins56and57, particularly by locating guide pin56in guide pin sleeve310and guide pin57in guide pin sleeve312, and sliding guide body304distally down the length of guide pins56and57until distal end308makes contact with the articular surface54.

Thereafter, as shown inFIG.31C, shaft344of excision device340may be extended distally and inserted through excision device sleeve320a, and cutting head350may form a cylindrical planetary excision site381ain the articular surface54of glenoid58. Thereafter, excision device340may be retracted proximally and removed from excision device sleeve320a, and extended distally and inserted through excision device sleeve320b, and cutting head350may form a cylindrical planetary excision site381bin the articular surface54of glenoid58. In repetitive fashion, cutting head350may then be extended through excision device sleeves320cto320eto form a plurality of cylindrical planetary excision sites381cto381e, respectively. As shown, the cylindrical planetary excision sites381cto381eextend 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 inFIG.31C, cylindrical planetary excision sites381ato381eare formed in a substantially linear row with the axis of each cylindrical planetary excision site381cto381eextending 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 portion385ato385dof the glenoid58may be located between adjacent planetary excision sites381ato381eafter planetary excision sites381ato381eare formed. Thereafter, guide body304may be slid proximally upward on guide pins56and57until it is removed from the guide pins56and57.

As shown inFIG.31D, once guide body304is removed, a second elongated guide body404may be installed in guide pins56and57. As shown, similar to guide body304, guide body404comprises a plurality of cylindrical guide pin sleeves410and412configured to contain guide pins56and57. Guide body404also includes a plurality of excision device sleeves320a-320eto contain excision device340.

As shown, guide body404may be installed in guide pins56and57, particularly by locating guide pin56in guide pin sleeve410and guide pin57in guide pin sleeve412, and sliding guide body404distally down the length of guide pins56and57until distal end408makes contact with the articular surface54.

Thereafter, as shown inFIG.31D, shaft344of excision device340may be extended distally and inserted through excision device sleeve420a, and cutting head350may form a partially cylindrical planetary excision site481ain the articular surface54of glenoid58, and, in doing so, eliminate intermediate portion385aof the glenoid58between planetary excision site381aand planetary excision site381b. Thereafter, excision device340may be retracted proximally and removed from excision device sleeve420a, and extended distally and inserted through excision device sleeve420b, and cutting head350may form a partially cylindrical planetary excision site481bin the articular surface54of glenoid58. In doing so, the planetary excision site481a481beliminates intermediate portion385bof the glenoid58between planetary excision site381band planetary excision site381c. As shown, the planetary excision sites481aand481bextend 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 sites481a-481emay not extend all the way through the bone. In repetitive fashion, cutting head350may then be extended through excision device sleeves320cand320dto eliminate intermediate portions385cand385d, respectively.

In eliminating the intermediate portions385ato385dbetween cylindrical planetary excision sites381ato381e, a substantially linear planetary excision site may be formed in glenoid58which extends substantially parallel to the coronal plane. As shown, the planetary excision site is adjacent the posterior glenoid rim. In addition, another partially cylindrical excision481emay be made after excision381eto 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 portions385ato385dhas been described as being performed with a second guide body404, it may be possible to only use first guide body304, such as by flipping guide body304over such that the proximal end becomes the distal end, and vice-versa.

As a result of the planetary excision sites381ato381eand481ato481e, which form a substantially linear elongated (slot) planetary excision site, posterior rim segment59of the glenoid may be separated from a remainder of the glenoid58except for connection to the glenoid58by a superior attachment point61aand an inferior attachment point61beach having a cross-sectional thickness approximately equal or less than a maximum cross-sectional thickness of the posterior rim segment59, particularly in the transverse plane.

Thereafter, guide body404may be slid proximally upward on guide pins56and57until it is removed from the guide pins56and57. Furthermore, guide pin57may be removed. Thereafter, as shown inFIG.31E, excision device10may be introduced into the surgical site in a manner as set forth in previous embodiments. In order to properly locate excision device10, guide pin56may be passed through cannulated shaft14, or another guide pin introduced to the glenoid as set forth herein, to form excision site370. Excision device10may be used to form the vault excision site as set forth with the previous embodiments.

As shown inFIG.31F, thereafter the posterior rim segment59may be removed, from the glenoid58by cutting the superior attachment point61aand an inferior attachment point61b, such as with a pair of snips, particularly in an orientation parallel the transverse plane. After removal of posterior rim segment59, and forming of the excision site, implant12may be inserted into the resulting excision sites as shown inFIG.31G, and bonded to the glenoid52, particularly with bone cement as discussed with previous embodiments.

As best shown inFIG.31F, similar to the previous embodiment, implant12may include a load bearing surface22, which may be divided into two regions22aand22b. Also as shown, load bearing surface region22may comprise a circular glenoid vault cavity region22aand a semi-circular glenoid planetary rim region22bwhich surrounds approximately 90 degrees of the periphery of the circular cavity region22a. However it should be understood that the glenoid vault cavity region22amay be surrounded by a glenoid planetary rim region22bhaving other sizes. For example, in certain embodiments, the glenoid planetary rim region22bmay surround from 10 degrees to 120 degrees of the glenoid vault cavity region22a. In certain other embodiments, the glenoid planetary rim region22bmay surround from 30 degrees to 110 degrees of the glenoid vault cavity region22a. In other embodiments, the glenoid planetary rim region22bmay surround from 50 degrees to 100 degrees of the glenoid vault cavity region22a. In still other embodiments, the glenoid planetary rim region22bmay surround from 60 degrees to 90 degrees of the glenoid vault cavity region22a.

Similar to the prior embodiment, as shown inFIG.32, the bone facing surface24may be configured to be generally received in the excision formed by plurality of planetary excision sites381a-381e,481a-481e, vault excision site370and the removal of posterior rim segment59. As shown, the bone facing surface24comprises a hemispherical region24awhich is configured to substantially match and correspond to the contour of the hemispherical vault excision site370, and a flange region24bwhich corresponds to the remaining planetary excision sites. Moreover, the implant12may optionally include one or more keels or tails32extending generally outwardly from the bone facing surface24as shown inFIGS.4and5A to5G. For example, the keel or tail32may extend generally outward from the vault region24dof the bone facing surface24.

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 embodiments, 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 90 degrees. In some embodiments, angle β may be in the range of 10 degrees to 90 degrees. In further embodiments, angle β may be in the range of 10 degrees to 30 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 embodiments, 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 embodiments, 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 embodiments, 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.

The impact device may be configured to be received in and extend through the impact slot. The impact device may include a proximal end and a distal end, wherein the proximal end includes a striking surface and the distal end is configured to be received in and extend through the impact slot. In some embodiments, the impact device may include a chisel. The impact device may be positioned at an angle γ relative to the impact guide arm, wherein angle γ is in the range 0 degrees to 45 degrees. The impact guide may also include an impact guide arm and the impact device may include a proximal end and a distal end, and the proximal end of the impact device may be configured to be disposed generally parallel to the impact guide arm when the distal end is received in the impact slot.

Another aspect of the present disclosure relates to a method for repairing a defect on a patient's articular surface. The method may include positioning on an articular surface an excision guide, wherein the excision guide includes a guide head and a guide sleeve disposed on the guide head, wherein the guide head may include a contact surface configured to locate the excision guide relative to the articular surface. The method may also include advancing a guide pin through the guide sleeve, wherein the guide sleeve is 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 90 degrees. The guide pin may then be secured to the articular surface.

The method may also include advancing an excision device over the guide pin, wherein the excision device includes a cannulated shaft and at least one cutter. A generally hemi-spherical excision site may be formed in the articular surface with the cutter. A secondary excision site may also be formed within the generally hemi-spherical excision site in which a portion of the implant may be positioned.

In some embodiments, the method may include advancing an impact guide over the guide pin, wherein the impact guide includes an impact guide head, a guide notch defined in the impact guide head and an impact slot defined in the impact guide head, wherein the guide notch may be configured to receive the guide pin. The impact guide head may then be located in the excision site.

As mentioned above, the present disclosure is not intended to be limited to a system or method which must satisfy one or more of any stated or implied object or feature of the present disclosure and should not be limited to the preferred, exemplary, or primary embodiment(s) described herein. The foregoing description of a preferred embodiment of the present disclosure has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the present disclosure to the precise form disclosed. Obvious modifications or variations are possible in light of the above teachings. The embodiment was chosen and described to provide the best illustration of the principles of the present disclosure and its practical application to thereby enable one of ordinary skill in the art to utilize the present disclosure in various embodiments and with various modifications as is suited to the particular use contemplated. All such modifications and variations are within the scope of the present disclosure.