(19)
(11)EP 2 724 676 B1

(12)EUROPEAN PATENT SPECIFICATION

(45)Mention of the grant of the patent:
27.04.2016 Bulletin 2016/17

(21)Application number: 13189679.7

(22)Date of filing:  22.10.2013
(51)Int. Cl.: 
A61B 17/16  (2006.01)
A61B 17/17  (2006.01)

(54)

Articulating drill guide

Gelenkig ausgeführte Bohrführung

Guide de perceuse articulée


(84)Designated Contracting States:
AL AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR

(30)Priority: 23.10.2012 US 201261717311 P

(43)Date of publication of application:
30.04.2014 Bulletin 2014/18

(73)Proprietor: Arthrex, Inc.
Naples, FL 34108-1945 (US)

(72)Inventor:
  • Perez III, Arley
    Bonita Springs, Florida 34135 (US)

(74)Representative: Margue, Robert Germain et al
Haseltine Lake LLP Bürkleinstrasse 10
80538 München
80538 München (DE)


(56)References cited: : 
US-A1- 2009 281 545
US-A1- 2010 049 199
US-A1- 2010 049 196
  
      
    Note: Within nine months from the publication of the mention of the grant of the European patent, any person may give notice to the European Patent Office of opposition to the European patent granted. Notice of opposition shall be filed in a written reasoned statement. It shall not be deemed to have been filed until the opposition fee has been paid. (Art. 99(1) European Patent Convention).


    Description

    FIELD OF THE INVENTION



    [0001] The present invention is directed to surgical instruments and, particularly, to a drill guide used in arthroscopic procedures.

    BACKGROUND OF THE INVENTION



    [0002] Arthroscopic procedures typically require a surgeon to work through a series of portals. For the hip joint, in particular, it is difficult to insert instrumentation through this series of portals. As a result, many RF devices designed for hip applications utilize a steerable mechanism which allows the device to enter the joint in a straight configuration/orientation and then curve, which effectively increases the surgeon's area of access within the joint.

    [0003] Such a device is disclosed in US-A- 2009281545.

    [0004] There is a need for a femoral guide that confers the surgeon the ability to target any surface of the femoral head. Also needed is a guide that allows a surgeon the ability to specify a location on the femoral head from outside the joint. The drill guide should desirably maintain contact on the bone to protect the soft tissue surrounding the bone.

    SUMMARY OF THE INVENTION



    [0005] This object is achieved by an articulating drill guide as disclosed in claim 1. Preferred embodiments have been disclosed in the dependent claims.

    [0006] The present application discloses an articulating drill guide comprising a body having an arcuate configuration, a first end and a second end; a first guide member secured to the first end and comprising a cylindrical shaft terminating in a plurality of articulating segments, a most distal articulating segment being configured to articulate from a first, non-articulated position to a second, articulated position; a second guide member secured to the second end; and an articulating mechanism in communication with the first guide member, the articulating mechanism being configured to articulate the most distal articulating segment of the first guide member from the first, non-articulated position to the second, articulated position. In a preferred embodiment of the articulating drill guide, the second guide member aligns with the most distal articulating segment of the first guide member when the most distal articulating segment is in the second, articulated position. The articulating mechanism may comprise at least one wire or cable for tensioning the most distal articulating segment of the first guide member and move the most distal articulating segment from the first, non-articulated position to the second, articulated position. The articulating member may further be designed to be actuated from a first location, in which the articulating member is axially aligned with a central axis of the first guide member, to a second location, in which the articulating member is not aligned with a central axis of the first guide member.

    [0007] Another embodiment relates to an articulating drill guide, wherein the articulating mechanism comprises a locking mechanism for locking the most distal articulating segment in the second, articulated position. In a preferred embodiment, the second guide member is a tubular sleeve that allows introduction of at least one surgical instrument therethrough. The surgical instrument may be a drill or a guide wire.

    [0008] The present application provides systems and drill guides that maintain contact on the bone even in areas where rigid instruments cannot access the areas. Although the drill guides of the present invention have particular application to the hip joint, the drill guides may be employed in any ligament reconstruction, bone resurfacing and/or replacement in any kind of joint and are not limited to hip joint.

    [0009] The drill guide of the present invention is an articulating drill guide that comprises an articulating mechanism for positioning the guide in at least two positions, i.e., an undeployed (non-articulated or straight) position and a deployed (articulated or bent) position. The articulating drill guide delivers guide wires, drills and/or additional instruments at any angle while maintaining contact to the bone.

    [0010] These and other features and advantages of the invention will be more apparent from the following detailed description that is provided in connection with the accompanying drawings and illustrated exemplary embodiments of the invention.

    BRIEF DESCRIPTION OF THE DRAWINGS



    [0011] 

    FIG. 1 illustrates an exemplary articulating drill guide of the present invention in the straight or non-articulated position;

    FIG. 2 illustrates the articulating drill guide of FIG. 1 in the bent or articulated position;

    FIG. 3 illustrates another exemplary articulating drill guide of the present invention (a hip articulating drill guide with an angular change) in the articulated position.


    DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS



    [0012] The present invention provides systems and articulating drill guides which maintain contact on the bone (even in areas where rigid instruments cannot access the areas) while placing drill guides and/or wires and/or additional instruments into the bone, at a specific target location or area of the bone. In a particular exemplary embodiment, the articulating drill guide of the present invention is used where femoral head targeting would be useful. Examples are femoral head resurfacing/replacement and ligament reconstructions (for example, teres ligament reconstruction) in hip or other reconstructions.

    [0013] Although the drill guides of the present invention have particular application to the hip joint, the drill guides may be employed in any ligament reconstruction, bone resurfacing and/or replacement in any kind of joint and are not limited to hip joint.

    [0014] The drill guide allows for minimally invasive bone targeting (for example, femoral head targeting). The drill guide may be employed in various surgical procedures, for example, torn ligament reconstruction and femoral head resurfacing/replacement, among others.

    [0015] The drill guide of the present invention is an articulating drill guide that comprises an articulating mechanism for positioning the guide in at least two positions, i.e., an undeployed (non-articulated or straight) position and a deployed (articulated or bent) position. The articulating mechanism may include at least one cable (for example, a single cable or a plurality of cables) or may consist of a positioning arm mechanism designed to position the most distal end of an arm on a targeted bone surface area, as detailed below. In the embodiment where a plurality of cables are employed, and depending in which position the surgeon would like the articulating guide to be in, the surgeon would tension the particular cable designated for the particular position. The articulating mechanism may be also a device that is actuated with a drive unit and/or, alternatively, actuated manually, to position the articulated arm (the most distal end of the articulated arm) at the desired location on the bone. The articulating mechanism may optionally include a locking mechanism, so that the articulated arm can be locked and secured against accidental movement.

    [0016] The articulating drill guide may be used with a guide handle or on its own. The articulating drill guide delivers guide wires, drills and/or additional instruments at any angle while maintaining contact to the bone.

    [0017] An exemplary method of surgery with the articulating drill guide of the present invention comprises inter alia the steps of: (i) providing a drill guide including an articulating mechanism configured to articulate the drill guide in at least two positions, i.e., a first undeployed (non-articulated or straight) position and a second deployed (articulated or bent) position; (ii) inserting the articulating drill guide in a first (straight) position through a portal (for example, the hip portal); (iii) articulating the drill guide from the first (straight) position to a second (articulated) position to target an area of the bone (for example, the femoral head) where rigid instruments cannot access; and (iv) conducting at least one surgical procedure relating to the target area of the bone (for example, the femoral head).

    [0018] Referring now to the drawings, where like elements are designated by like reference numerals, FIGS. 1-3 illustrate articulating drill guides 100, 200 of the present invention which may be positioned on a bone (for example, the femoral head of the hip joint) at a specific location on the bone and following the normal curvature of the bone.

    [0019] The articulating drill guide 100 includes a first guide member 10 and a second guide member 20 attached to a frame 30 (body 30) having a generally curved configuration. Frame 30 is defined by side surfaces 31, 33 which are narrow and have a generally arcuate shape. Frame 30 has a shape, thickness and configuration that allows it to comfortably fit in a surgeon/operator's hand. An arcuate slot 35 having a general rectangular cross-section is formed in the frame 30 extending about two thirds of the length of the frame 30. Arcuate slot 35 follows the shape of sides 31, 33 and is configured to receive a radial arm 15 to slide therein or to be securely affixed thereto (i.e., slidingly or non-slidingly connected thereto). The radial arm 15 has essentially the same arc as that of the arcuate slot 35 and sides 31, 33.

    [0020] Frame 30 is also provided with first and second ends 32, 34 which allow attachments of the first and second guide members 10, 20, respectively, and as detailed below. The articulating drill guide 100 also includes an articulating mechanism 40 which is attached to the first guide member 10 (and in communication with it) to allow the first guide member 10 to articulate and to approximate the anatomical curvature of the bone, for example, of the femoral head of the hip joint, and as explained in more detail below.

    [0021] The first guide member 10 may include a cylindrical shaft or tube 11 (which may be fully or partially cannulated) with a longitudinal axis 10a and provided with a proximal end 12 and a distal end 14. The first guide member 10 terminates in a plurality of articulating segments or members 11 a, 11 b, 13 which, when actuated, can articulate and bend as shown in FIG. 2 (showing only two segments 11 b, 13 actuated/articulated/bent). The most distal segment 13 is preferably in the form of a hook or probe that terminates in an elongated rounded tip 13a. The surface of the hook or probe 13 is about concentrical to the targeted surface area of the bone. In this manner, when the first guide member 10 is actuated, at least one of the articulating segments articulates to allow hook or probe 13 to follow the contour of a bone surface that is being targeted.

    [0022] The second guide member 20 is an exemplary drill sleeve that allows insertion of an instrument 25 (for example, a guide wire or a drill or any other surgical instrument) as shown in FIG. 2, once the target area of the bone has been identified (e.g., the area to be drilled/resurfaced) with probe 13.

    [0023] Articulating mechanism 40 is attached to the first guide member 10 and in communication with it, to allow the first guide member 10 to articulate between at least two positions, i.e., a first, undeployed (non-articulated or straight) position and a second, deployed (articulated or bent) position. The articulating mechanism 40 may be any mechanism that allows articulation of last segments 11 b, 13 to bend/move/articulate as shown in FIG. 2. For example, the articulating mechanism may be formed of a single deploying cable or wire 44 or, alternatively, may be formed of a plurality of deploying cables or wires 44 (for example, two deploying cables or wires). Regardless of the number of cables/wires, the articulating mechanism 40 allows for the articulation of the first guide member 10. Depending in which position the surgeon would like the articulating guide to be in, the surgeon would tension the particular cable(s) 44 designated for the particular position, for example, a different cable for each of articulating members 11 b, 13. The articulating drill guide may be used with a guide handle or on its own.

    [0024] FIG. 1 shows the drill guide 100 with the first guide member 10 in the first, undeployed (non-articulated or straight) position. FIG. 2 shows the drill guide 100 with the first guide member 10 in the second, deployed (articulated or bent) position. Pushing on actuating member 44 of the articulating mechanism 40 from position A (FIG. 1) to position B (FIG. 2) pivots the articulating tip 13 between the locations shown in FIGS. 1 and 2. In position A (FIG. 1), actuating member 44 of the articulating mechanism 40 extends about parallel to the longitudinal axis 10a of the cylindrical tube 11 (in axial alignment with it). In position B (FIG. 2), actuating member 44 of the articulating mechanism 40 extends non-parallel to the longitudinal axis 10a of the cylindrical tube 11 and forms an angle α with the longitudinal axis 10a.

    [0025] Once the desired target area on the bone has been reached, the drill sleeve 20 may be tightened down with a locking device (for example, a twist knob or other similar device). Drill 25 (FIG. 2) is advanced through the drill sleeve 20, and into the bone, at a target area identified and delineated by articulating probe 13.

    [0026] FIG. 3 illustrates another embodiment 200 of the present invention wherein articulating drill guide 200 shows an angular change for the drill guide (i.e., with an angular shift different from that of the articulating drill guide 100). The articulating drill guide 200 is about similar to guide 100 described above but differs in that the articulating drill guide 200 includes articulating mechanism 140 which is designed to allow positioning of first guide member 110 and of the segments 11 b and 13, as shown in FIG. 3.

    [0027] The articulating drill guide of the present invention may be used where femoral head targeting would be useful. Examples are femoral head resurfacing/replacement and ligament reconstructions.

    [0028] An exemplary surgical method employing the articulating drill guide of the present invention comprises inter alia the steps of: (i) providing drill guide 100, 200 including an articulating mechanism 40, 140 configured to articulate the drill guide in at least two positions, i.e., a first undeployed (non-articulated or straight) position and a second deployed (articulated or bent) position; (ii) inserting the articulating drill guide 100, 200 in a first (straight) position through a joint portal; (iii) articulating the drill guide 100, 200 from the first (straight) position to a second (articulated) position to target an area of the bone where rigid instruments cannot access; and (iv) conducting at least one of bone resurfacing or replacement, or ligament reconstruction.

    [0029] An exemplary method of hip joint surgery with the articulating drill guide of the present invention comprises inter alia the steps of: (i) providing drill guide 100, 200 including an articulating mechanism 40, 140 configured to articulate the drill guide in at least two positions, i.e., a first undeployed (non-articulated or straight) position and a second deployed (articulated or bent) position; (ii) inserting the articulating drill guide 100, 200 in a first (straight) position through a hip portal; (iii) articulating the drill guide 100, 200 from the first (straight) position to a second (articulated) position to target an area of the femoral head 90 where rigid instruments cannot access, so that a most distal end of the drill guide aligns with a center of the area of the femoral head where rigid instruments cannot access; (iv) aligning a second member 20 with the a most distal end of the drill guide; and (v) passing a surgical instrument through the second guide member 20 and through the femoral head 90 to conduct at least one of femoral head resurfacing or replacement procedure.

    [0030] FIG. 3 illustrates articulating drill guide 200 positioned on femoral head 90 of a hip. Once the articulating drill guide 200 has been articulated to the second (articulated) position on the femoral head 90 (i.e., once the segment 11 b and probe 13 have been articulated so that the probe 13 engages the target area of the femoral head where a rigid instrument cannot access), a drilling step is conducted to form at least one tunnel 99 (FIG. 3) through the bone 90 with exemplary drill 25. As shown in FIG. 3, the most distal end of drill 25 aligns with a center of the surface of the hook/probe 13 (which in turn is about concentrical to the targeted surface area of bone 90).

    [0031] While the present invention is described herein with reference to illustrative embodiments for particular applications, it should be understood that the invention is not limited thereto. Those having ordinary skill in the art and access to the teachings provided herein will recognize additional modifications, applications, embodiments and substitution of equivalents.


    Claims

    1. An articulating drill guide (100, 200) comprising:

    a frame (30) having an arcuate configuration, a first end and a second end (32, 34);

    a first guide member (10) secured to the first end (32); a second guide member (20) secured to the second end (34); and

    an articulating mechanism (40) in communication with the first guide member (10);

    characterized in that

    the first guide member comprises a cylindrical shaft terminating in two articulating segments (11b, 13), a most distal articulating segment (13) being in the form of a hook or probe that terminates in an elongated rounded tip (13a), the articulating segment (13) being configured to articulate from a first, non-articulated position to a second, articulated position to approximate anatomical curvature of a bone;

    the articulating mechanism (40) being configured to articulate at least one of the two articulating segments, wherein at least one of the two articulating segments (11b, 13) of the first guide member (10) articulates from the first, non-articulated position to the second, articulated position to allow the hook or probe to follow the contour of a targeted bone surface of the bone.


     
    2. The articulating drill guide (100, 200) of claim 1, wherein the second guide member (20) aligns with the most distal articulating segment (13) of the first guide member (10) when the most distal articulating segment (13) is in the second, articulated position.
     
    3. The articulating drill guide (100, 200) of claim 1 or claim 2, wherein the articulating mechanism (40) comprises at least one wire or cable for tensioning the most distal articulating segment (13) of the first guide member (10) and move the most distal articulating segment from the first, non-articulated position to the second, articulated position.
     
    4. The articulating drill guide of any claim 1 to 3, wherein the articulating mechanism (40) comprises an articulating member (11b, 13) designed to be actuated from a first location, in which the articulating member (11b, 13) is axially aligned with a central axis of the first guide member (10), to a second location, in which the articulating member (11b, 13) is not aligned with a central axis of the first guide member (10).
     
    5. The articulating drill guide of any claim 1 to 4, wherein the articulating mechanism further comprises a locking mechanism for locking the most distal articulating segment (13) in the second, articulated position.
     
    6. The articulating drill guide of any claim 1 to 5, wherein the second guide member is a tubular sleeve (20) that allows introduction of at least one surgical instrument (25) therethrough.
     
    7. System comprising the articulating drill guide of any claim 1 to 6 and a surgical instrument, the surgical instrument (25) being a drill or a guide wire.
     


    Ansprüche

    1. Gelenkig ausgeführte Bohrführung (100, 200), umfassend

    einen Rahmen (30) mit einer bogenförmigen Ausrichtung, einem ersten Ende und einem zweiten Ende (32, 34);

    ein am ersten Ende (32) befestigtes erstes Führungsteil (10);

    ein am zweiten Ende (34) befestigtes zweites Führungsteil (20); und

    einen Gelenkmechanismus (40) in Verbindung mit dem ersten Führungsteil (10);

    dadurch gekennzeichnet, dass

    das erste Führungsteil einen zylindrischen Schaft umfasst, der in zwei gelenkigen Segmenten (11 b, 13) endet, wobei ein distaleres gelenkiges Segment (13) in der Form eines Hakens oder einer Sonde ist, die in einer länglichen, abgerundeten Spitze (13a) endet, wobei das gelenkige Segment (13) ausgelegt ist, um sich aus einer ersten, nicht artikulierten Stellung in eine zweite, artikulierte Stellung zu artikulieren, um die anatomische Biegung eines Knochens nachzuahmen;

    der Gelenkmechanismus (40) ausgelegt ist, um mindestens eines der zwei gelenkigen Segmente zu artikulieren, wobei mindestens eines der zwei gelenkigen Segmente (11 b, 13) des ersten Führungsteils (10) sich aus der ersten, nicht artikulierten Stellung in die zweite, artikulierte Stellung artikuliert, um zu ermöglichen, dass der Haken oder die Sonde den Umriss einer gewünschten Knochenoberfläche des Knochens folgt.


     
    2. Gelenkig ausgeführte Bohrführung (100, 200) gemäß Anspruch 1, wobei das zweite Führungsteil (20) sich nach dem distaleren gelenkigen Segment (13) des ersten Führungsteils (10) ausrichtet, ist das distalere gelenkige Segment (13) in der zweiten, artikulierten Stellung.
     
    3. Gelenkig ausgeführte Bohrführung (100, 200) gemäß Anspruch 1 oder 2, wobei der Gelenkmechanismus (40) mindestens einen Draht oder ein Kabel umfasst zum Spannen des distaleren gelenkigen Segments (13) des ersten Führungsteils (10) und zum Bewegen des distaleren gelenkigen Segments aus der ersten, nicht artikulierten Stellung in die zweite, artikulierte Stellung.
     
    4. Gelenkig ausgeführte Bohrführung gemäß irgendeinem Anspruch 1 bis 3, wobei der Gelenkmechanismus (40) ein Gelenkteil (11b, 13) umfasst, ausgelegt um von einem ersten Ort, in dem das Gelenkteil (11 b, 13) axial mit einer Mittenachse des ersten Führungsteils (10) ausgerichtet ist, in einen zweiten Ort, in dem das Gelenkteil (11b, 13) nicht axial mit einer Mittenachse des ersten Führungsteils (10) ausgerichtet ist, umgeschaltet zu werden.
     
    5. Gelenkig ausgeführte Bohrführung gemäß irgendeinem Anspruch 1 bis 4, wobei der Gelenkmechanismus zudem einen Feststellmechanismus umfasst zum Feststellen des distaleren gelenkigen Segments (13) in der zweiten, artikulierten Stellung.
     
    6. Gelenkig ausgeführte Bohrführung gemäß irgendeinem Anspruch 1 bis 5, wobei das zweite Führungsteil eine rohrförmige Hülse (20) ist, die das Einführen von mindestens einem chirurgischen Instrument (25) dadurch erlaubt.
     
    7. System, umfassend die gelenkig ausgeführte Bohrführung aus irgendeinem Anspruch 1 bis 6, und ein chirurgisches Instrument, wobei das chirurgische Instrument (25) ein Bohrer oder ein Führungsdraht ist.
     


    Revendications

    1. Un guide de forage articulé (100, 200), comprenant :

    un châssis (30) ayant une configuration arquée, une première extrémité et une seconde extrémité (32, 34) ;

    un premier élément de guidage (10) fixé à la première extrémité (32) ;

    un second élément de guidage (20) fixé à la seconde extrémité (34) ; et

    un mécanisme d'articulation (40) en communication avec le premier élément de guidage (10) ;

    caractérisé en ce que

    le premier élément de guidage comprend une terminaison à tige cylindrique en deux segments articulés (11 b, 13), un segment articulé le plus distal (13) ayant la forme d'un crochet ou d'une sonde qui se termine en une pointe arrondie allongée (13a), le segment articulé (13) étant configuré pour articuler à partir d'une première position non articulée vers une seconde position, afin de rapprocher la courbure anatomique d'un os ;

    le mécanisme d'articulation (40) étant configuré de manière à articuler au moins un des deux segments articulés, dans lequel au moins l'un des deux segments articulés (11 b, 13) du premier élément de guidage (10) articule à partir de la première position non articulée vers la seconde position articulée pour permettre au crochet ou à la sonde de suivre le contour d'une surface osseuse ciblée.


     
    2. Le guide de forage articulé (100, 200) selon la revendication 1, où le second élément de guidage (20) s'aligne avec le segment articulé le plus distal (13) du premier élément de guidage (10) lorsque le segment articulé le plus distal (13) se trouve dans la seconde position articulée.
     
    3. Le guide de forage articulé (100, 200) selon la revendication 1 ou la Revendication 2, où le mécanisme d'articulation (40) comprend au moins un fil ou un câble pour tendre le segment articulé le plus distal (13) du premier élément de guidage (10) et déplacer le segment articulé le plus distal de la première position non articulée vers la seconde position articulée.
     
    4. Le guide de forage articulé selon l'une quelconque des revendications 1 à 3, où le mécanisme d'articulation (40) comprend un élément articulé (11b, 13) destiné à être actionné à partir d'une première position, dans laquelle l'élément articulé (11b, 13) est aligné axialement avec un axe central du premier élément de guidage (10), vers un second emplacement, dans lequel l'élément articulé (11b, 13) n'est pas aligné avec un axe central du premier élément de guidage (10).
     
    5. Le guide de forage articulé selon l'une quelconque des revendications 1 à 4, où le mécanisme d'articulation comprend en outre un mécanisme de verrouillage pour verrouiller le segment articulé le plus distal (13) dans la seconde position articulée.
     
    6. Le guide de forage articulé selon l'une quelconque des revendications 1 à 5, où le deuxième élément de guidage est un manchon tubulaire (20) qui permet l'introduction d'au moins un instrument chirurgical (25).
     
    7. Système comprenant le guide de forage articulé selon l'une quelconque des revendications 1 à 6 et un instrument chirurgical, l'instrument chirurgical (25) étant un foret ou un fil guide.
     




    Drawing












    REFERENCES CITED IN THE DESCRIPTION



    This list of references cited by the applicant is for the reader's convenience only. It does not form part of the European patent document. Even though great care has been taken in compiling the references, errors or omissions cannot be excluded and the EPO disclaims all liability in this regard.

    Patent documents cited in the description