US20210177435A1 - Device and method for allografting - Google Patents

Abstract

In one embodiment, a cutting guide is disclosed for use in a surgical procedure to removed damaged tissue from a patient and form a recipient site configured and dimensioned to receive a donor graft. The cutting guide includes a first aim that abuts a section of the damaged tissue to be removed, and a second arm including a hole and a slot that receives a cutting implement, the first arm and the slot defining a distance therebetween corresponding to a desired dimension of the recipient site. In another embodiment, a cutting guide is disclosed for use in forming a donor graft from donor tissue. The cutting guide includes a body that receives the donor tissue, and a shaping member that is rotatably secured to the body. The shaping member includes at least one vane that shapes the donor tissue so as to form the donor graft.

Description

RELATED APPLICATION
• This application claims the benefit of, and priority to, U.S. Provisional Patent Application Ser. No. 61/967,257, entitled “Device and Method for Tibial Plateau Allografting,” filed Mar. 13, 2014, the entire content of which is hereby incorporated by reference.
BACKGROUND1. Field
• The present disclosure relates to apparatus, systems, and methods for use in tissue grafting procedures, e.g., allografting procedures. For example, the present disclosure relates to apparatus, methods, and systems for use in tibial plateau allografting procedures.
2. Discussion
• Few options are available for long term treatment of tibial plateau articular cartilage and/or meniscal injuries, e.g., in young patients, which due to trauma or degeneration, render the joint painful, insufficient, and beyond the ability of native tissue repair techniques. Current standard of care allograft and/or autograft cartilage transplantation techniques are sometimes inappropriate or unable to address tibial plateau cartilage defects, e.g., due to limitations of surgical exposure and current grafting techniques. Additionally, meniscus positioning and attachment to the tibia limits surgical options without disruption of the meniscus. Moreover, during meniscal transplantation, it is often difficult to establish an effective meniscus-bone interface with properties sufficient to withstand physiological loading due to the complex biologic and biomechanical nature of the interface.
• As such, a need remains for apparatus, systems, and methods that aid in the graft implantation process, and have sufficient healing and functional performance to be utilized in a wide range of patients with joint pathology.
SUMMARY
• In one aspect of the present disclosure, an allograft tibial plateau implant system is described, as well as corresponding methods of use, that utilize a tongue-and-groove interlocking mechanism. More specifically, the disclosed system and methods create and use an allograft tibial plateau implant with a bulging outward-curved ledge (tongue member) that is received by an implant recipient site prepared with a matching inward-curved groove/channel (groove member). This “tongue-and-groove” interlocking system and method may be utilized in a wide range of patients with joint pathology to enhance healing and functional performance.
• In another aspect of the present disclosure, a recipient site cutting guide for preparing a recipient site in tissue is described. The recipient site cutting guide comprises a height-determination (H-G) arm and a blade arm with a cutting slot, one or more guide holes, and one or more fixation holes. In one embodiment, the height-determination (H-G) arm and the blade arm are arranged so as to define an “L” shape. The configurations, dimensions, and orientations of the cutting slot, the guide hole(s), and the fixation hole(s) may be altered or varied such that the recipient site may be created according to any desired specifications, e.g., such that the recipient site and the groove/channel define a particular length, height, and/or width.
• In certain embodiments, the cutting slot may be configured as an elongate cavity running horizontally, e.g., more than half-way, across the blade arm in parallel relation to the height-determination (H-G) arm.
• In certain embodiments, the guide hole(s) may be located near an end of the cutting slot, and a bottom curve/edge of the guide hole(s) may be set lower than the cutting slot.
• In certain embodiments, the fixation hole(s) may be located below the cutting slot (on an opposite side of the height-determination (H-G) arm).
• During use of the recipient site cutting guide, the height-determination (H-G) arm is placed on a surface of a patient's articular cartilage such that the distance between the height-determination (H-G) arm and the cutting slot on the blade arm determines the height of recipient site to receive a harvested allograft implant.
• Multiple cutting guides defining varying distances between the height-determination (H-G) arm and the cutting slot may be employed to create recipient sites of varying heights to accommodate different grafting requirements.
• In another aspect of the present disclosure, a method of preparing a recipient site, e.g., a patient's tibial plateau, for receipt of an allograft is disclosed (which may comprise bone and articular cartilage), with or without attached meniscus. The method includes: i) selecting a recipient site cutting guide with a desired distance being defined between a height-determination (H-G) arm and a cutting slot, ii) placing the height-determination (H-G) arm on a surface of the patient's articular cartilage, iii) securing the recipient site cutting guide by temporary fixation methods via one or more fixation holes; iv) making a shelf locating cut from anterior to posterior in a central aspect of the recipient bone; and v) cutting along the cutting slot to detach a portion of the recipient bone to be removed.
• In another aspect of the invention, a method for preparing an allograft recipient site, e.g., a patient's tibial plateua, is described. The method includes: i) selecting a recipient site cutting guide comprising a H-G arm and a blade arm, which further comprises a cutting slot, one or more guide holes with a slot or other such opening, and one or more fixation holes, so that the height between the H-G arm and the cutting slot is compatible with the allograft to be implanted, ii) placing the H-G arm of the cutting guide on a surface of the patient's articular cartilage, iii) securing the cutting guide by temporary fixation methods via the fixation hole(s), iv) creating a channel from anterior to posterior by drilling (or forming a channel) through the guide hole(s), and v) removing a portion of the native tibial plateau by cutting along the cutting slot.
• In another aspect of the present disclosure, a donor cutting guide is disclosed that is used to create an allograft implant (which may comprise bone and articular cartilage), with or without an attached meniscus, having a desired thickness and a bulging outward-curved ledge (tongue member) that is configured and dimensioned for positioning within the groove/channel (groove member) created at the recipient site through use of the recipient site cutting guide.
• In another aspect of the disclosure, a cutting guide is disclosed for use in a surgical procedure to removed damaged tissue from a patient and form a recipient site configured and dimensioned to receive a donor graft. The cutting guide includes a first arm configured and dimensioned for abutment with a section of the damages tissue to be removed, and a second aim connected to the first arm.
• The second arm includes at least one slot that is configured and dimensioned to receive a first cutting implement, as well as at least one hole. The first arm and the at least one slot define a distance therebetween corresponding to a desired dimension of the recipient site, e.g., the height of the recipient site.
• In certain embodiments, the first arm and the second arm may subtend an angle approximately equal to 90°.
• The at least one hole includes a first hole that is configured and dimensioned to receive a second cutting implement. The first hole defines a periphery, and is positioned adjacent an end of the at least one slot.
• In certain embodiments, a portion of the periphery defined by the first hole may be positioned below the at least one slot. Additionally, or alternatively, a portion of the periphery defined by the first hole may be positioned above the at least one slot.
• In certain embodiments, the at least one slot and the first hole may be oriented such that a central axis defined by the at least one slot bisects the first hole.
• In certain embodiments, the at least one hole may further include a second hole that is configured and dimensioned to receive a fixation member to secure the cutting guide in relation to the damaged tissue.
• In certain embodiments, the at least one slot may be linear in configuration.
• In certain embodiments, the at least one slot may include a first slot and a second slot. In such embodiments, the first arm and the first slot define a first distance therebetween, and the first arm and the second slot define a second distance therebetween greater than the first distance.
• In another aspect of the disclosure, a surgical cutting guide is disclosed for use in forming a donor graft from donor tissue. The cutting guide includes a body defining a channel extending along a first axis that is configured and dimensioned to receive the donor tissue, and a shaping member that is secured to the body such that the shaping member is rotatable in relation to the body about a second axis.
• The body of the cutting guide defines an upper shelf and a lower shelf positioned on opposite sides of the shaping member.
• The shaping member includes at least one vane having a linear portion and a non-linear portion, and extends into the channel such that as the donor tissue is advanced through the channel, the at least one vane shapes the donor tissue so as to form the donor graft.
• In certain embodiments, the shaping member may be secured to the body of the cutting guide such that the second axis is transverse, e.g., orthogonal, in relation to the first axis.
• The linear portion and the non-linear portion of the at least one vane are configured and dimensioned such that the donor graft defines a planar section and a tongue member positioned adjacent the planar section such that the tongue member extends outwardly in relation to the planar section.
• In certain embodiments, the non-linear portion of the at least one vane may define at least one recess.
• The cutting guide further includes a sled movable in relation to the body of the cutting guide to facilitate movement of the donor tissue through the channel.
• In certain embodiments, the sled may include a textured surface to increase friction between the sled and the donor tissue during movement of the donor tissue through the channel.
• In another aspect of the disclosure, a surgical system is disclosed for use in: (i) forming a donor graft from donor tissue; and (ii) removing damaged tissue from a patient to form a recipient site configured and dimensioned to receive the donor graft. The system includes a first cutting guide configured and dimensioned to form the donor graft from the donor tissue, and a second cutting guide configured and dimensioned to facilitate formation of the recipient site.
• The first cutting guide includes a body defining a channel that is configured and dimensioned to receive the donor tissue, and a shaping member that is secured to the body such that the shaping member is rotatable in relation to the body.
• The shaping member includes at least one vane having a linear portion and a non-linear portion, and extends into the channel whereby as the donor tissue is advanced through the channel, the at least one vane shapes the donor tissue to form the donor graft to include a planar section and a tongue member that extends outwardly in relation to the planar section.
• The second cutting guide includes a first aim that is configured and dimensioned for abutment with a section of the damaged tissue to be removed, and a second arm that is connected to the first arm. The second arm includes at least one slot that is configured and dimensioned to receive a first cutting implement so as to define a planar surface at the recipient tissue corresponding in configuration and dimensions to the planar section of the donor graft. The second arm also includes at least one hole that is configured and dimensioned to receive a second cutting implement so as to define a channel at the recipient site configured and dimensioned to receive the tongue member of the donor graft such that the recipient site receives the donor graft in an interlocking fashion.
• In certain embodiments, the first arm and the second arm may subtend an angle of approximately 90°.
• The at least one hole includes a first hole defining a periphery that is positioned adjacent an end of the at least one slot.
• In certain embodiments, a portion of the periphery defined by the first hole is positioned below the at least one slot.
• In certain embodiments, the at least one hole includes a second hole configured and dimensioned to receive a fixation member to secure the second cutting guide in relation to the damaged tissue.
• The channel defined by the body of the first cutting guide extends along a first axis, and the shaping member is rotatable in relation to the body of the first cutting guide about a second axis. In certain embodiments, the shaping member may be secured to the body of the first cutting guide such that the second axis is transverse, e.g., orthogonal, in relation to the first axis.
• The linear portion of the at least one vane is configured and dimensioned to shape the planar section of the donor graft, and the non-linear portion of the at least one vane is configured and dimensioned to shape the tongue member of the donor graft.
• In certain embodiments, the non-linear portion of the at least one vane may define at least one recess.
• In certain embodiments, the at least one recess may be curvate in configuration.
• In another aspect of the disclosure, a method of performing a surgical procedure is disclosed that includes inserting donor tissue into a donor cutting guide, which may include bone and cartilage, as well as an attached meniscus, and advancing the donor tissue into contact with a shaping member rotatably secured to a body of the donor cutting guide such that a vane of the shaping member shapes the donor tissue into a donor graft including a planar section and a tongue member that extends outwardly in relation to the planar section.
• In certain embodiments, the method may further include harvesting the donor tissue from a donor site.
• In certain embodiments, harvesting the donor tissue may include harvesting the donor tissue with an attached meniscus.
• Inserting the donor tissue into the donor cutting guide includes positioning the donor tissue within a channel defined by the body of the donor cutting guide, and more specifically, on a lower shelf defined by the body of the donor cutting guide.
• The disclosed method further includes advancing the donor tissue beyond the shaping member such that the donor tissue is positioned on an upper shelf defined by the body of the donor cutting guide after shaping into the donor graft.
• Advancing the donor tissue includes repositioning a sled in contact with the donor tissue to thereby reposition the donor tissue.
• Advancing the donor tissue into contact with the shaping member includes shaping a first portion of the donor tissue with a linear portion of the vane to thereby form the planar section of the donor graft, and shaping a second portion of the donor tissue with a non-linear portion of the vane to thereby form the tongue member of the donor graft.
• In certain embodiments, shaping the second portion of the donor tissue may include shaping the donor tissue with a recess defined by the vane.
• In certain embodiments, shaping the donor tissue with the recess may include contacting the donor tissue with an arcuate surface defined by the recess.
• The method further includes removing damaged tissue from a patient to faun a recipient site configured and dimensioned to receive the donor graft in an interlocking fashion.
• Forming the recipient site includes positioning a first arm of a recipient cutting guide in abutment with a section of the damaged tissue to be removed, and a second arm of the recipient cutting guide in abutment with a section of tissue that will not be removed.
• In certain embodiments, forming the recipient site may further include securing the recipient cutting guide in relation to the damaged tissue, e.g., via attachment of a fixation member to the tissue that will not be removed through a hole in the recipient cutting guide.
• Forming the recipient site further includes forming a channel configured and dimensioned to receive the tongue member of the donor graft, e.g., by passing a cutting implement through a hole in the recipient cutting guide.
• Forming the recipient site further includes making a cut that intersects the channel so as to form a planar surface at the recipient site configured and dimensioned for engagement with the planar section of the donor graft, i.e., by passing a cutting implement through a slot extending through the second aim of the recipient cutting guide.
• The method further includes positioning the donor graft such that the donor graft interlocks with the recipient site, e.g., such that the tongue member of the donor graft is positioned within the channel at the recipient site.
• In certain embodiments, the method may further include securing the donor graft to the recipient site.
• Other objects, features, and advantages of various illustrative embodiments of the present disclosure will become apparent with reference to the accompanying drawings, and the detailed description that follows.
BRIEF DESCRIPTION OF THE DRAWINGS
• Various embodiments of the present disclosure are described herein with reference to the figures, wherein:
• FIG. 1 is a front, elevational view illustrating a recipient cutting guide according to the principles of the present disclosure useful in the removal of damaged tissue, e.g., bone and cartilage, and the formation of a recipient site configured and dimensioned to receive a donor graft;
• FIG. 2 is a side, elevational view of the presently disclosed recipient cutting guide;
• FIG. 3 is a side, elevational view of a donor graft following the removal of damaged tissue and formation of the recipient site;
• FIG. 4 is a top, perspective view of the recipient site;
• FIG. 5 is a side, elevational view illustrating placement of the donor graft at the recipient site;
• FIG. 6 is a top, perspective view illustrating placement of the donor graft at the recipient site;
• FIG. 7 is a side, elevational view of the presently disclosed recipient cutting guide;
• FIG. 8 is a front, elevational view of the presently disclosed recipient cutting guide;
• FIGS. 9 and 10 are top, perspective views of the presently disclosed recipient cutting guide;
• FIGS. 11 and 12 are bottom, perspective views of the presently disclosed recipient cutting guide;
• FIG. 13 is a side, elevational view of an alternate embodiment of the presently disclosed recipient cutting guide;
• FIG. 14 is a top, perspective view of the recipient cutting guide shown inFIG. 13;
• FIG. 15 is a top, perspective view of a donor cutting guide useful in forming the donor graft shown inFIG. 3 from donor tissue;
• FIG. 16 is an end view of the presently disclosed donor cutting guide and the donor tissue;
• FIG. 17 is a longitudinal, cross-sectional view of the presently disclosed donor cutting guide and the donor tissue;
• FIG. 18 is a partial, end view of the presently disclosed donor cutting guide;
• FIG. 19 is a side, elevational view illustrating a shaping member of the presently disclosed donor cutting guide; and
• FIG. 20 is a partial, end view illustrating a sled of the presently disclosed donor cutting guide together with the donor tissue.
DETAILED DESCRIPTION
• In the following detailed description, reference is made to the accompanying drawings, which depict non-limiting, illustrative embodiments of the present disclosure. Throughout the present disclosure, the term “tissue” should be understood as including many forms of biological structural material, including, but not limited to, bone and cartilage. Additionally, the term “damaged tissue” should be understood to encompass any negatively affected tissue, including, but not limited to inflamed tissue, scarred tissue, and joint pathology. Additionally, the terms “height,” “width,” “thickness,” “above,” “below,” “closer,” “further,” and any variation(s) thereof used herein are relative in character, and are intended to be interpreted in accordance with the perspective shown in the corresponding figure(s).
• The present disclosure relates to apparatus, systems, and methods adapted for use in grafting procedures, e.g., tibial plateau allografting (with or without attached meniscus), and provides numerous benefits over known apparatus, systems, and methods. For example, the apparatus, systems, and methods disclosed allow for maintenance of the meniscus/bone junction, and facilitate transplantation of healthy cartilage and a healthy meniscus as a unit, as opposed to being transplanted separately. Moreover, the apparatus disclosed herein minimize the amount of native tissue that is removed to form the recipient site, while still allowing for appropriate fixation of the donor graft.
• With reference now toFIGS. 1-12, a cuttingguide10 is illustrated for use during a surgical procedure in the preparation of a recipient site5 (FIGS. 3-6) intissue2, e.g., a patient's tibial plateau, to receive adonor graft1, e.g., a tibial plateau allograft, and the removal of damaged tissue.
• The recipientsite cutting guide10 may include, e.g., be formed from, any material suitable for use in surgical practice, e.g., plastics, polymers, aluminum, stainless steel, titanium, and combinations thereof, and includes a generally horizontal first arm, e.g., a height-determination (H-G) arm, identified by thereference character20, and a generally vertical second aim, e.g., a blade aim, identified by thereference character30. In the illustrated embodiment, thearms20,30 are integrally, e.g., monolithically, formed. In alternate embodiments, however, other suitable methods of attachment may be employed to connect thearms20,30, e.g., one or more connectors or fasteners may be employed, or thearms20,30 may be welded together.
• Thearms20,30 are connected such that the cuttingguide10 defines a generally “L-shaped” configuration, e.g., such that thearms20,30 subtend a fixed angle α (FIG. 7) of approximately 90°, e.g., 60°-120°. In alternate embodiments, however, if necessary or desirable, the configuration of the cuttingguide10 may be varied to alter the angle α. For example, thearms20,30 may be arranged such that the angle α lies outside the range of 60°-120° dependent upon the requirements of a particular surgical procedure. Additionally, it is envisioned that thearms20,30 may movably connected to one another such that the angle α may be adjusted by the user on an as-needed basis, e.g., during the course of a surgical procedure.
• Thesecond arm30 includes a cuttingslot40, one or more guide holes,50, and one or more fixation holes60. Although illustrated as including asingle cutting slot40, asingle guide hole50, and a pair of fixation holes60 in the embodiment illustrated inFIGS. 7-12, the number of cuttingslots40, guide holes50, and fixation holes60 may be varied in alternate embodiments of the cuttingguide10 without departing from the scope of the present disclosure.
• The cuttingslot40 extends horizontally across thesecond arm30, and is configured and dimensioned to receive a cutting implement, e.g., a sagittal saw (not shown). In the illustrated embodiment, the cuttingslot40 and thefirst arm20 are shown as extending in parallel relation, i.e., along non-intersecting axes. In alternate embodiments, however, the cuttingslot40 and thefirst arm20 may be arranged so as to extend along intersecting axes. Additionally, while the cuttingslot40 is illustrated as being linear in configuration in the embodiment shown inFIGS. 7-12, in alternate embodiments, the cuttingslot40 may be non-linear in configuration. For example, the cuttingslot40 may include one or more arcuate and/or linear segments or sections.
• Thefirst arm20 and the cuttingslot40 define a distance D (FIG. 7) therebetween that determines the vertical height (thickness) of the recipient site5 (FIGS. 3-6), as discussed in further detail below. In general, the distance D will lie within the range of approximately 2 cm to approximately 20 cm (±25%). In most surgical applications, however, a distance D of approximately 6 cm to approximately 10 cm is standard.
• Theguide hole50 is located adjacent an end of the cuttingslot40, and defines a periphery P (FIG. 8). Although illustrated as being separated from the cuttingslot40, i.e., such that there is not communication between theguide hole50 and the cuttingslot40, in alternate embodiments, theguide hole50 and the cuttingslot40 may intersect. Additionally, while illustrated as circular in configuration inFIGS. 7-12, theguide hole50 may define alternate configurations in other embodiments of the cuttingguide10, e.g., theguide hole50 may be elliptical, ovoid, rectangular, etc.
• As seen inFIG. 8, for example, theguide hole50 and the cuttingslot40 are oriented such that an upper portion of the periphery P of theguide hole50 is located above the cutting slot40 (closer to the first arm20), and a lower portion of the periphery P of theguide hole50 is located below the cutting slot40 (further from the first arm20). For example, it is envisioned that a central axis X_CS(FIG. 8) of the cuttingslot40 may bisect theguide hole50.
• With continued reference toFIGS. 7-12, the fixation holes60 will be discussed. The fixation holes60 are configured and dimensioned to removably receive fixation members (not shown), e.g., pins, screws, nails, or the like, which can be used to secure the cuttingguide10 to the tissue2 (FIGS. 3-6), e.g., tibial bone, in which therecipient site5 is formed, as discussed in further detail below. In the illustrated embodiment, the fixation holes60 are located below the cuttingslot40. In alternate embodiments, however, the specific location of the fixation holes60 may be altered or varied. For example, in one embodiment, it is envisioned that the fixation holes60 may be located above the cuttingslot40, whereas in another embodiment, it is envisioned that the cuttingguide10 may include onefixation hole60 located above the cuttingslot40, and anotherfixation hole60 located below, or in line with, the cuttingslot40.
• Although illustrated as being circular in configuration in the embodiment of the cuttingguide10 shown inFIGS. 7-12, the fixation holes60 may define alternate configurations in other embodiments of the present disclosure. For example, the fixation holes60 may be elliptical, ovoid, rectangular, etc.
• With reference now toFIGS. 1-12, use of the recipientsite cutting guide10 will be discussed in connection with the removal of damaged tissue, and formation of the recipient site5 (FIGS. 3-6) in preparation to receive adonor graft1.
• Initially, the recipientsite cutting guide10 is selected according to the requirements of the procedure, e.g., such that the dimensions defined by therecipient site5 correspond to those of thedonor graft1, which may include an attachedmeniscus4, as seen inFIGS. 3, 5, and6. For example, the recipientsite cutting guide10 may be selected based upon the distance D (FIG. 7) defined between thefirst arm20 and the cuttingslot40 such that therecipient site5 is dimensioned to define a particular height in correspondence with the height (thickness) of thedonor graft1. The selected recipientsite cutting guide10 is then positioned such that thefirst arm20 abuts a portion3_A(FIG. 2) of thetissue2 to be removed, i.e., damaged tissue, located above the cuttingslot40, and thesecond arm30 abuts a portion3_Bof thetissue2 that will not be removed, located below the cuttingslot40. The configuration and dimensions of the recipientsite cutting guide10, e.g., the location and dimensions of the cuttingslot40, are such that the amount ofnative tissue2 removed to form therecipient site5 is minimized, while still allowing for appropriate fixation of thedonor graft1.
• After positioning the recipientsite cutting guide10, the cuttingguide10 is then secured to thetissue2 by fixation members (not shown) inserted through the fixation holes60. Alternatively, the user may simply apply pressure to the recipientsite cutting guide10 to hold the recipientsite cutting guide10 in place.
• Thereafter, a drill bit (not shown), or other such cutting implement, is inserted into, and advanced through, theguide hole50 into contact with thetissue2 to create a channel6 (FIGS. 3, 4), e.g., from anterior to posterior. A cut is then made along the cuttingslot40 using a saggital saw (not shown), or other such cutting implement, until thechannel6 is reached so as to define anupper surface7 of therecipient site5. For example, with reference toFIGS. 1-6 in particular, due to the linear configuration of the cuttingslot40 included in the cuttingguide10, the cut made in thetissue2 results in a planar configuration at theupper surface7 of therecipient site5. In alternate embodiments, however, i.e., embodiments wherein thecuttings slot40 is non-linear in configuration, theupper surface7 of therecipient site5 may be formed so as to define a non-planar, or otherwise irregular configuration.
• After completion of the cut, the cutting implement is removed from the cuttingslot40, the fixation members (not shown) can be removed from the fixation holes60, and the portion3_A(FIG. 2) of thetissue2 to be removed can be separated from the remainder of thetissue2, revealing therecipient site5, including theaforementioned channel6 andupper surface7.
• FIGS. 13 and 14 illustrate an alternate embodiment of the presently disclosed recipient site cutting guide, which is referred to generally by thereference character110. The cuttingguide110 is identical to the cuttingguide10 discussed above in connection withFIGS. 7-12, for example, hut for any distinctions that are specifically noted. Accordingly, a discussion of certain features common to the cutting guides10,110 may be omitted in the interest of brevity.
• To increase versatility of the cuttingguide110, and the creation of recipient sites5 (FIGS. 3-6) of various dimensions, e.g., heights, the cuttingguide110 includes afirst arm120, and asecond arm130 with a series of cuttingslots140, each of which is located a different distance from thefirst arm120. For example, in the embodiment illustrated inFIGS. 13 and 14, thesecond aim130 includes cuttingslots140_A,140_B,140_C, wherein thefirst arm120 is spaced a distance D_Afrom the cuttingslot140_A, a distance D_Bfrom the cuttingslot140_Bgreater than the distance D_A, and a distance D_Cfrom the cuttingslot140_Cgreater than the distance D_B.
• The method of using the cuttingguide110 is identical to that of the cuttingguide10, but for the fact that the user has the ability to choose a specific cutting slot, e.g., one of the cuttingslots140_A,140_B,140_Cin the embodiment shown inFIGS. 13 and 14, based upon the requirements of the particular procedure. For example, dependent upon the characteristics of the patient, and/or those of the damaged tissue to be removed, the user may elect to use one of the cuttingslots140_A,140_B,140_Cas opposed to another to guide the cutting implement during formation of the upper surface7 (FIGS. 3-7) of therecipient site5.
• In an alternate method of use, it is envisioned that more than one of the cuttingslots140_A,140_B,140_Cmay be employed during a surgical procedure. For example, an initial cut may be made using thecutting slot140_A, and thereafter, one ore more additional cuts may be made using thecutting slot140_Band/or thecutting slot140_Cto allow for the progressive removal of the tissue and definition of therecipient site5, e.g., to reduce patient trauma and/or inflammation at therecipient site5.
• With reference now toFIGS. 15-20, a donorimplant cutting guide200 will be discussed useful in formation of the aforementioned donor graft1 (FIGS. 3-6, 15). The cuttingguide200 may include, e.g., be formed from, any material suitable for use in surgical practice, e.g., plastics, polymers, aluminum, stainless steel, titanium, and combinations thereof, and includes abody202, a shapingmember204, and amovable sled206.
• Thebody202 of the cuttingguide200 defines achannel208 that is configured and dimensioned to receive donor tissue T, which may include an attached meniscus4 (FIGS. 3, 5, 6, 15, 16). Thechannel208 extends along an axis X, and is defined by sidewalls210,212, and respective lower andupper shelves214,216 positioned on opposite sides of the shapingmember204. Thelower shelf214 is spaced a first distance D₁(FIG. 17) from abottom wall218 of thebody202, and theupper shelf216 is spaced a second, greater distance D₂from thebottom wall218 of thebody202.
• Although illustrated as extending in parallel relation to thebottom wall218 of thebody202 in the embodiment illustrated inFIGS. 15-20, in alternate embodiments of the cuttingguide200, theshelf214 and/or theshelf216 may extend at an angle to thebottom wall218 so as to either assist or resist movement of the donor tissue T through thechannel208. For example, either or both of theshelves214,216 may be angled toward the shapingmember204, or away from the shapingmember204.
• The shapingmember204 resides within a well220 defined by thebody202, and is secured to thebody202 such that the shapingmember204 is rotatable in relation to thebody202 about a fixed axis Y (FIG. 15) that extends in transverse relation to the axis X defined by thechannel208. For example, in the embodiment seen inFIG. 15, the shapingmember204 is oriented such that the axis Y is orthogonal in relation to the axis X. In alternate embodiments, however, the shapingmember204 may be oriented such that the axes X, Y subtend an angle other than 90°, e.g., 45°.
• The shapingmember204 may be actuated, i.e., caused to rotate, by an automated mechanism, e.g., a motor (not shown), or alternatively, under manual power via the application of force by a user. For example, the shapingmember204 may be rotated by a crank (not shown) connected to the shapingmember204.
• The shapingmember204 includes adrum222, and one ormore vanes224. While thevanes224 may include sharpened cutting edges226 (FIGS. 18, 19), as illustrated in the embodiment seen inFIGS. 15-20, thevanes224 may be devoid of any sharpened edges in alternate embodiments of the cuttingguide200. Additionally, while the shapingmember204 is illustrated as including four (4)vanes224 in the embodiment of the cuttingguide200 shown inFIGS. 15-20, the number ofvanes224 may be increased or decreased in alternate embodiments of the cuttingguide200 without departing from the scope of the present disclosure, e.g., to reduce manufacturing costs.
• Thevanes224 extend outwardly from thedrum222 into thechannel208. Specifically, the shapingmember204 is positioned within the well220 such that theedges226 of thevanes224 align with theupper shelf216, i.e., such that the maximum linear separation realized between thevanes224 and thebottom wall218 of thebody202 during rotation of the shapingmember204 is equivalent to the distance D₂(FIG. 17) defined between theupper shelf216 and thebottom wall218.
• Thevanes224 are configured and dimensioned to shape the donor tissue T into the donor graft1 (FIGS. 3, 5, 6) in correspondence with the configuration of the recipient site5 (FIGS. 3-6). For example, in the embodiment of the cuttingguide200 illustrated inFIGS. 15-20, to facilitate shaping of the donor tissue T in the desired manner, thevanes224 include a linear portion228 (FIG. 19), and anon-linear portion230 defining one or more recesses232. In the specific embodiment shown, thevanes224 are illustrated as including a single,curvate recess232 defining anarcuate surface234 that extends inwardly, toward the axis Y, resulting in a generally C-shaped configuration. In alternate embodiments, however, therecesses232 may be present in greater number, and/or may define alternative configurations. For example, eachvane224 may include a pair ofrecesses232 that arc triangular in configuration.
• Additionally, or alternatively, it is envisioned that thenon-linear portion230 of thevanes224 may include one or more projections (not shown) extending outwardly, away from the axis Y.
• With reference now toFIGS. 15 and 20 in particular, thesled206 will be discussed. During operation of the cuttingguide200, thesled206 is used to stabilize and move the donor tissue T through thechannel208 across thelower shelf214 into contact with the shapingmember204 and onto theupper shelf216. To facilitate movement of the donor tissue T, thesled206 is configured and dimensioned to slide in relation to thebody202 of the cuttingguide200, and may be either fixedly or removably connected thereto in any manner facilitating movement in this manner. For example, thesled206 may rest uponupper surfaces236,238 (FIG. 15) defined by thesidewalls210,212 of thebody202 such that thesled206 slides along theupper surfaces236,238 during movement.
• In one embodiment, such as the embodiment shown inFIGS. 15 and 20, for example, thesled206 includes ashoulder240 that depends from an underside242 (FIG. 20) thereof which may be used to urge the donor tissue T into contact with one of thesidewalls210,212 (FIG. 15) during movement of the donor tissue T through thechannel208 to further stabilize the donor tissue T, e.g., during shaping.
• In one embodiment, seen inFIGS. 15 and 20 for example, theunderside242 of thesled206 may include atextured surface244 to increase friction between thesled206 and the donor tissue T, and thus, control over the donor tissue T during movement through thechannel208. For example, theunderside242 of thesled206 may include one ormore protrusions246 configured as detents, teeth, or the like. Alternatively, theunderside242 of thesled206 may be non-textured.
• Additionally, or alternatively, thesled206 may include retaining structure (not shown), e.g., one or more pins, clamps, jaws, or the like, to secure the donor tissue T to thesled206.
• With reference now toFIGS. 3-6 and 15-20, use of the cuttingguide200 will be discussed in connection with formation of theaforementioned donor graft1.
• Initially, the donor tissue T is harvested from a larger section of tissue (not shown), e.g., through use of a saggital saw, scalpel etc., and is fed into the cuttingguide200. If necessary, the donor tissue T can be shaped or trimmed so as to fit within the confines of the channel208 (FIG. 15) defined by thebody202 of the donorimplant cutting guide200. Specifically, the donor tissue T is positioned on thelower shelf214, and is stabilized using thesled206, i.e., the donor tissue T is positioned between thelower shelf214 and thesled206. Using thesled206, the donor tissue T is advanced into contact with the shapingmember204 whereby thevanes224 remove portions of the donor tissue T in accordance with a pattern determined by the configuration and dimensions thereof. Specifically, in the illustrated embodiment, the linear portion228 (FIG. 19) of thevanes224 shape a section of the donor tissue T so as to define a planar section8 (FIG. 3) that corresponds in configurations and dimensions to theupper surface7 of therecipient site5, while the non-linear portion230 (FIG. 19) of thevanes224 simultaneously shape an adjacent section of the donor tissue T so as to define a tongue member9 (FIG. 3). Thetongue member9 corresponds in configurations and dimensions to thechannel6 defined by therecipient site5, and extends transversely in relation to the length and width of theplanar section8 of thedonor graft1 such that thetongue member9 extends outwardly in relation to theplanar section8.
• As the donor tissue T passes by the shapingmember204, it is supported by theupper shelf216. After shaping of the donor tissue T has been completed, i.e., when thedonor graft1 has been formed, thedonor graft1 is placed at the recipient site5 (FIGS. 3-6). Specifically, theplanar section8 of thedonor graft1 is positioned in abutment with theupper surface7 of therecipient site5, and thetongue member9 is positioned within thechannel6, as shown inFIGS. 3, 5 and 6, whereby thedonor graft1 and therecipient site5 mate in an interlocking fashion so as to inhibit movement of thedonor graft1 in relation to therecipient site5, e.g., motion in the medial-lateral direction.
• In various embodiments of the present disclosure, the configurations, dimensions, and orientations of the cuttingslot40, theguide hole50, and the fixation holes60 of the cutting guide10 (FIGS. 7-12) may be altered or varied, as can the configuration and dimensions of thevanes224, therecesses232, and theshelves214,216 of the cutting guide200 (FIG. 15), so as to create a recipient site5 (FIG. 3) and adonor graft1 that interlock in any desired manner.
• With reference again toFIG. 3, following placement of thedonor graft1, thedonor graft1 can be attached to therecipient site5 using either temporary or permanent attachment structures (not shown), e.g., fixation screws, bone plates, or the like.
• While the present disclosure has been described in connection with specific embodiments thereof, it will be understood that the subject matter of the present disclosure is capable of further modifications. For example, persons skilled in the art will understand that additional components and features may be added to any of the embodiments discussed herein above, and that those elements and features described in connection with any one embodiment may also be applicable to, or combined with, those of any other embodiment, without departing from the scope of the present disclosure.
• The scope of the present disclosure is intended to cover any variations, uses, and/or adaptations of the presently disclosed subject matter in accordance with the principles of the present disclosure, including such departures from the present disclosure as come within known or customary practice within the art to which the present disclosure pertains, and as may be applied to the elements, components, and features set forth herein above.

Claims (10)

1. A cutting guide for use in a surgical procedure to remove damaged tissue from a patient and form a recipient site configured and dimensioned to receive a donor graft, the cutting guide comprising:

a first arm configured and dimensioned for abutment with a section of the damaged tissue to be removed; and

a second arm connected to the first arm, the second arm including at least one slot configured and dimensioned to receive a first cutting implement, and at least one hole, the first arm and the at least one slot defining a distance therebetween corresponding to a desired dimension of the recipient site.

2. The cutting guide ofclaim 1, wherein the first arm and the second arm subtend an angle approximately equal to 90°.

3. The cutting guide ofclaim 1, wherein the at least one hole includes a first hole positioned adjacent an end of the at least one slot, the first hole defining a periphery and being configured and dimensioned to receive a second cutting implement.

4. The cutting guide ofclaim 3, wherein a portion of the periphery defined by the first hole is positioned below the at least one slot.

5. The cutting guide ofclaim 4, wherein a portion of the periphery defined by the first hole is positioned above the at least one slot.

6. The cutting guide ofclaim 5, wherein the at least one slot and the first hole are oriented such that a central axis defined by the at least one slot bisects the first hole.

7. The cutting guide ofclaim 3, wherein the at least one hole further includes a second hole configured and dimensioned to receive a fixation member to secure the cutting guide in relation to the damaged tissue.

8. The cutting guide ofclaim 1, wherein the at least one slot is linear in configuration.

9. The cutting guide ofclaim 1, wherein the at least one slot includes a first slot and a second slot, the first arm and the first slot defining a first distance therebetween, and the first arm and the second slot defining a second distance therebetween greater than the first distance.

10.-50. (canceled)

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