WO1997000644A1 - Surgical sighting instrument - Google Patents
Surgical sighting instrument Download PDFInfo
- Publication number
- WO1997000644A1 WO1997000644A1 PCT/BE1995/000059 BE9500059W WO9700644A1 WO 1997000644 A1 WO1997000644 A1 WO 1997000644A1 BE 9500059 W BE9500059 W BE 9500059W WO 9700644 A1 WO9700644 A1 WO 9700644A1
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- WO
- WIPO (PCT)
- Prior art keywords
- instrument
- axis
- point
- arm
- tunnel
- Prior art date
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1714—Guides or aligning means for drills, mills, pins or wires for applying tendons or ligaments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1764—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the knee
Definitions
- the present invention relates to a surgical sighting instrument, and more particularly to an arthroscopic sighting instrument for aligning and guiding a drilling tool intended to make a tunnel through a tibia, the axis of which passes through two points of the knee joint, namely a point on the tibial plateau and a point in the region between the condyles of the femur.
- each tunnel must emerge at a determined point, respectively of the tibial plateau and the intercondylar region of the femur.
- These points can be determined by the surgeon, before the intervention, for example by radiography or by any other known method (see for example documents EP-B-0 162 027 and EP-A-0 408416), or even during the intervention, by direct arthroscopic observation.
- a problem which arises for the surgeon during such an operation is to pierce the tunnel in the tibia so that it emerges at the first determined point, of the tibial plateau, and that its axis also passes through the second determined point. of the femur.
- the tunnel in the tibia and the tunnel in the femur are perfectly aligned, in addition to opening at the desired points, in the joint.
- This alignment is important because in the techniques of endoscopic ligamentoplasty providing for the alignment of the tibial and femoral tunnels, we most often start with tibial drilling, and then take advantage of the tibial tunnel to insert the drilling instruments intended to dig the tunnel.
- Document EP-B-0162027 discloses an instrument for aligning and guiding a drill bit intended to pierce a tunnel through the tibia and the femur comprising, at one end, a first guide element intended to be inserted between the condyles of the femur and, at a second end, a second guide element in line with the first, remaining outside the joint.
- the two aligned guide elements are connected by an L-shaped body, so as to be able to circumvent the edge of the tibial plateau, and the first guide element is provided with a point intended to be planted in the tibial plateau, to form a fixed point. around which the instrument can rotate around a vertical axis and a horizontal axis.
- the alignment axis of the two aligned guide elements makes a predefined angle with a branch of the L-shaped body so that, when said branch of L is horizontal, the alignment axis, and therefore the angle penetration of the drill bit into the tibia, is correct.
- a level can be provided to control the horizontality of the horizontal branch.
- the first guide element located at the distal end of the instrument and to be inserted into the joint, has a predefined length of 31 mm, corresponding to a standard or theoretical length of the cruciate ligament, and a drawback of this instrument , is the size of this distal part, which requires wide opening of the joint (arthrotomy), with the trauma that this causes, and which also makes it difficult to position the instrument inside the joint.
- the instrument positioned with respect to the predetermined tibial point can pivot slightly around the longitudinal axis of its horizontal arm, or even in the horizontal plane until its end abuts the condyle, it cannot however practically not pivot in the vertical plane because the horizontal arm then abuts against the tibial plateau. It follows that the surgeon cannot - or very difficult - place the instrument at an angle other than the preset angle, to take account of the anatomical particularities of the patient. The surgeon is likewise bound by the predefined length of 31 mm, which does not allow individual variations to be taken into account. The correct positioning of the instrument moreover often requires the use of an image intensifier during the intervention, which significantly increases the operating gesture.
- An object of one invention is therefore to provide a surgical sighting instrument for aligning and guiding a drill bit intended to pierce through a tibia a tunnel whose axis passes through two predefined points of the knee joint, namely a point of the tibial plateau and a point of the region located between the condyles of the femur, instrument comprising, at its distal end intended to be inserted into the intra-articular space, a first organ, having a temporary anchoring point in the bone, for positioning the instrument relative to one of said predefined points, a means for positioning the instrument relative to the second of said predefined points, a second hollow member, for aligning and guiding the drill bit, aligned with said first member, and defining with it the axis of the tunnel to be drilled, a planar, angular arm, connecting the first and second members, and a handle, said instrument being characterized in that said tip of an provided
- said positioning means comprises the edge end of the arm, at the junction of the arm and the point; it includes a bulge, at the junction between the distal end of the arm and the tip; - Said handle is provided on the alignment and guide member, and is centered on said axis; the axis of the handle is located in the plane of the arm.
- FIGS. 1 and 2 are side views of variants of an arthroscopic sighting instrument according to the invention
- FIG. 2a is a sectional view along II-II in FIG. 2
- FIG. 3 is an end view of the embodiment of FIG. 2
- Figure 4 is a schematic side view of the instrument of the invention in position in the knee joint
- Figure 5 is a schematic front view of the instrument in the same position as in Figure 4.
- the instrument of the invention consists of a body consisting of a flat arm 2 formed at a point 3 at one end (distal end) and provided with an alignment and guiding member 4 at its other end (proximal end).
- the alignment and guiding member 4 is hollow, and is intended to guide a spindle to pierce a tunnel in the tibia. It is also provided at its outer periphery with projecting elements 5, to serve as a handle when the instrument is manipulated by the surgeon.
- Figure 2 differs from that of Figure 1, on the one hand in that the arm 2 comprises rectilinear segments in Figure 2, instead of having a continuous curvature as in Figure 1; on the other hand, the end edge of the arm, at the junction between the tip 3 and the arm 2 is rectilinear in Figure 1 (in 6), while it has a boss or bulge 7 - the function of which will be explained below - in Figure 2.
- the distal end of the arm 2 is connected to the tip 3 at an angle ⁇ .
- This angle is such that, when the instrument is in position in the joint, with the tip inclined according to the predefined angle ⁇ , the end part of the arm is still at least slightly spaced from the tibial plateau ( Figure 4).
- An arm 2 with rectilinear segments according to FIG. 2 is preferred because the areas of connection between the rectilinear segments can serve as a guide for the surgeon, as to the depth of insertion of the instrument into the joint.
- the anchor points of the replacement ligament which are formed by the opening of the tunnels, are located respectively at the posterior part of the internal cheek of the external femoral condyle (point "a") and on the tibial plateau (point "b"), between the two projections of the spinal massif.
- the insertion point "a” in the femur, and the insertion point "b” in the tibial plateau, determined beforehand by radiography or the like, are located using landmarks anatomical, while the surgeon also determines the angle ⁇ formed by the projection into a vertical plane, of the axis XX passing through the points "a” and "b", with respect to the tibial shaft "c". Generally, this angle is in the range between 50 ° and 70 °.
- a feature of the invention is that the tip 3 of the instrument is located on the axis XX passing through the center of the alignment and guiding member 4. This point makes it possible to position the instrument very precisely relative to one of the pre-established points (point a), thus ensuring the accuracy of the aiming.
- a point at the distal end makes it possible to reduce as much as possible the bulk of this end which must be inserted most deeply into the joint, and thus to facilitate the manipulation of the instrument in the joint, in particular the insertion of the instrument through a vertical opening of small dimension (8 to 10 mm), and the subsequent pivoting, in the vertical plane and in the horizontal plane, of the instrument planted at the point of femoral insertion. . .
- the arm 2 connecting the two ends of the instrument is a flat, flat arm, the median plane of which passes through the axis X-X.
- An advantage of such a flat element is that it slides more easily into the joint, passing through a short incision in the joint capsule; another advantage is that it allows arthroscopic control of the verticality of the instrument.
- the width of the arm is not a parameter of the invention; it will be as small as possible, to limit the size, while being sufficient to provide it with the desired rigidity, taking into account its thickness and the nature of the material which constitutes it.
- the arm 2 is on the other hand angled or curved in the longitudinal direction, to allow the tip of the instrument to be inserted at point "a" of the femur, starting from a short incision in the articular capsule with the antero face - internal knee (shown schematically in "d” in Figure 4), and passing through the narrow space between the tibial plateau and the roof of the intercondylar notch of the femur.
- This curve also allows the instrument to bypass the tibial plateau when the instrument is pivoted in the vertical plane to bring it to the desired angle ⁇ .
- the surgeon inserts the distal end 3 into the joint, using a short incision (8 to 10 mm) made on the anteromedial side of the knee, until the point 3 is planted at the point of insertion "a" into the femur, point "a” having preferably been determined beforehand by radiography or the like.
- the surgeon monitors the progress of the instrument in a known manner endoscopically, and uses anatomical landmarks to visually locate the point "a" previously determined.
- step a For the orientation of step a), the surgeon rotates the instrument to palpate the tibial plateau using the edge 6 or 7 at the junction between the arm 2 and the tip 3. In doing so, and possibly using anatomical landmarks, it can quite easily locate the hollow of the interspinal space of the tibia, the orientation of step a) (orientation according to Figure 5) being reached when the edge 6 or 7 abuts against the bottom said spinal hollow.
- the plane of the arm is kept substantially vertical, to avoid an angular error in the positioning of the axis XX during step a).
- the axis XX of the instrument does not pass through the edge 6 or 7 but above so that, during step a), when the surgeon palpates with the edge 6 or 7 the middle of the spinal mass (this is ie the bottom of the hollow between the spinal ridges), the axis passes precisely above this medium, only when the plane of the arm is vertical.
- step b) orientation according to FIG. 4
- the surgeon must then orient the viewfinder in the vertical plane, according to step b) (orientation according to FIG. 4), to bring it to the predetermined angle ⁇ .
- This can be done by eye, for a surgeon who is sufficiently trained; better, the surgeon will apply to the tibial shaft a branch of a goniometer preset at the angle ⁇ , and will then orient the axis XX of the viewfinder (given by the axis of the alignment means 4, or even by the axis with a very tapered square tip, inserted into it in order to make a marking pre-hole) by comparison with the other branch of the goniometer.
- the square point is then replaced by a spindle guide which allows a pin to be inserted through the tibia.
- the instrument is then removed, as is the piercing pin, and the surgeon then manually inserts a slightly thinner pin, which will serve as a guide for the cannulated drill bit intended to pierce the tunnel.
- the tibial tunnel is later used as a means of access and then drilling the femoral tunnel (blind tunnel). To do this, the surgeon introduces a pin through the tibial tunnel and enters the femur at the level of the orifice created by the point of the viewfinder. This pin then serves as a guide for the cannulated drill bit intended to pierce the femoral tunnel.
- the positioning of the handle 5, 5 on the axis XX facilitates the manipulation of the viewfinder, in particular because that the orientation movements are more instinctive, and that an involuntary pivoting movement of the viewfinder plane around the handle only produces a rotation of the axis on itself, and not a change of orientation, as for example in the viewfinder according to EP-0 162 027.
- a handle in the plane of the arm facilitates the manipulation since the surgeon is thus aware of the position of the plane of the arm.
- the length of the tip 3 is not a critical parameter of the invention, however, it will be sufficient to allow a firm anchoring of the tip in the femur (with generally a penetration of 3 to 5 mm), all still allowing the surgeon to carry out the palpation step of the interspinal hollow of the tibia, mentioned above.
- a tip length of 20 to 30 mm is suitable, measured on the axis X-X between the end of the tip and the internal edge of the arm 2
Abstract
A surgical sighting instrument (1) for forming a tibial tunnel with an axis passing through two predetermined points in the knee joint, i.e. a point on the tibial plateau and a point in the region between the condyles of the femur. The distal end of the instrument is intended to be inserted into the intra-articular space and has an anchoring tip (3) designed to be placed at the femoral point and located on the axis of an alignment and guidance member (4) so that it defines therewith the axis (X-X) of the tunnel to be bored. The instrument is shaped in such a way that it may be arthroscopically inserted into the joint and adjusted therein.
Description
INSTRUMENT CHIRURGICAL DE VISEESURGICAL INSTRUMENT OF SIGHT
La présente invention concerne un instrument chirurgical de visée, et plus particulièrement un instrument de visée arthroscopique pour aligner et guider un outil de perçage destiné à réaliser à travers un tibia un tunnel dont 1 ' axe passe par deux points de l'articulation du genou, à savoir un point du plateau tibial et un point de la région située entre les condyles du fémur.The present invention relates to a surgical sighting instrument, and more particularly to an arthroscopic sighting instrument for aligning and guiding a drilling tool intended to make a tunnel through a tibia, the axis of which passes through two points of the knee joint, namely a point on the tibial plateau and a point in the region between the condyles of the femur.
En chirurgie orthopédique de l'articulation du genou, pour le remplacement du ligament croisé antérieur, il faut percer dans l'os du tibia et dans l'os du fémur un tunnel servant de logement d'ancrage au ligament de remplacement.In orthopedic surgery of the knee joint, for the replacement of the anterior cruciate ligament, it is necessary to pierce in the tibia bone and in the femur bone a tunnel serving as an anchoring housing for the replacement ligament.
Pour un placement isométrique de ce ligament de remplacement, il faut que chaque tunnel débouche en un point déterminé, respectivement du plateau tibial et de la zone intercondylienne du fémur. Ces points peuvent être déterminés par le chirurgien, avant l'intervention, par exemple par radiographie ou par toute autre méthode connue (voir par exemple les documents EP-B-0 162 027 et EP-A-0 408416), ou encore pendant l'intervention, par observation arthroscopique directe.For an isometric placement of this replacement ligament, each tunnel must emerge at a determined point, respectively of the tibial plateau and the intercondylar region of the femur. These points can be determined by the surgeon, before the intervention, for example by radiography or by any other known method (see for example documents EP-B-0 162 027 and EP-A-0 408416), or even during the intervention, by direct arthroscopic observation.
Un problème qui se pose au chirurgien lors d'une telle opération, est de percer le tunnel dans le tibia de façon à ce qu'il débouche au premier point déterminé, du plateau tibial, et que son axe passe également par le second point déterminé du fémur.A problem which arises for the surgeon during such an operation is to pierce the tunnel in the tibia so that it emerges at the first determined point, of the tibial plateau, and that its axis also passes through the second determined point. of the femur.
En effet, lorsque ces conditions sont réalisées, le tunnel dans le tibia et le tunnel dans le fémur sont parfaitement alignés, en plus de déboucher aux points voulus, dans l'articulation.When these conditions are met, the tunnel in the tibia and the tunnel in the femur are perfectly aligned, in addition to opening at the desired points, in the joint.
Cet alignement est important car dans les techniques de ligamentoplastie endoscopique prévoyant l'alignement des tunnels tibial et fémoral, on commence le plus souvent par le forage tibial, et on profite ensuite du tunnel tibial pour insérer les instruments de forage destinés à creuser le tunnel
fémoral; si l'axe du tunnel tibial est inadéquat, il peut être difficile d'atteindre ensuite par ce tunnel le point fémoral d'où doit partir le tunnel fémoral, si l'on utilise des techniques prévoyant la réalisation des tunnels par visée distincte au tibia et au fémur (réalisation du tunnel fémoral de dehors en dedans), l'alignement des axes n'est plus aussi impérieux, pour autant que les points d'arrivée des tunnels au tibia et au fémur soient corrects; cependant, comme l'insertion de la greffe se fait dans la majorité des cas par traction de celle-ci à travers les deux tunnels, une désaxation importante entre les tunnels peut rendre cette traction parfois très difficile. D'autre part, lorsque le chirurgien travaille par voie arthroscopique, en perçant les tunnels à partir du tibia, leur alignement est bien sûr atteint automatiquement, mais leur axe ne passe pas nécessairement par les points voulus, préalablement déterminés. Selon l'invention, on se propose dès lors de fournir un instrument de visée arthroscopique qui permet au chirurgien de réaliser en une seule visée un tunnel tibial dont l'axe passe rigoureusement par les points tibial et fémoral prédéterminés sur base de radiographies préopératoires.This alignment is important because in the techniques of endoscopic ligamentoplasty providing for the alignment of the tibial and femoral tunnels, we most often start with tibial drilling, and then take advantage of the tibial tunnel to insert the drilling instruments intended to dig the tunnel. femoral; if the axis of the tibial tunnel is inadequate, it can then be difficult to reach the femoral point from which the femoral tunnel must start via this tunnel, if techniques are used which provide for the construction of tunnels with a separate aim at the tibia and at the femur (realization of the femoral tunnel from outside to inside), the alignment of the axes is no longer as imperative, provided that the points of arrival of the tunnels at the tibia and at the femur are correct; however, since the insertion of the graft is done in the majority of cases by pulling it through the two tunnels, a significant offset between the tunnels can sometimes make this traction very difficult. On the other hand, when the surgeon works arthroscopically, by piercing the tunnels from the tibia, their alignment is of course achieved automatically, but their axis does not necessarily pass through the desired points, previously determined. According to the invention, it is therefore proposed to provide an arthroscopic sighting instrument which allows the surgeon to produce in a single sighting a tibial tunnel whose axis passes strictly through the tibial and femoral points predetermined on the basis of preoperative radiographs.
On connaît par le document EP-B-0162027 un instrument pour aligner et guider une mèche destinée à percer un tunnel à travers le tibia et le fémur comprenant, à une extrémité, un premier élément de guidage prévu pour être inséré entre les condyles du fémur et, à une seconde extrémité, un deuxième élément de guidage en ligne avec le premier, restant à l'extérieur de l'articulation. Les deux éléments de guidage alignés sont reliés par un corps en L, de façon à pouvoir contourner le bord du plateau tibial, et le premier élément de guidage est pourvu d'une pointe destinée à être plantée dans le plateau tibial, pour former point fixe autour duquel 1 ' instrument peut pivoter autour
d'un axe vertical et d'un axe horizontal. Par construction, l'axe d'alignement des deux éléments de guidage alignés fait avec une branche du corps en L un angle prédéfini de sorte que, lorsque ladite branche du L est horizontale, l'axe d'alignement, et donc l'angle de pénétration de la mèche dans le tibia, soit correct. Un niveau peut être prévu pour contrôler l'horizontalité de la branche horizontale.Document EP-B-0162027 discloses an instrument for aligning and guiding a drill bit intended to pierce a tunnel through the tibia and the femur comprising, at one end, a first guide element intended to be inserted between the condyles of the femur and, at a second end, a second guide element in line with the first, remaining outside the joint. The two aligned guide elements are connected by an L-shaped body, so as to be able to circumvent the edge of the tibial plateau, and the first guide element is provided with a point intended to be planted in the tibial plateau, to form a fixed point. around which the instrument can rotate around a vertical axis and a horizontal axis. By construction, the alignment axis of the two aligned guide elements makes a predefined angle with a branch of the L-shaped body so that, when said branch of L is horizontal, the alignment axis, and therefore the angle penetration of the drill bit into the tibia, is correct. A level can be provided to control the horizontality of the horizontal branch.
Le premier élément de guidage, situé à l'extrémité distale de l'instrument et devant être inséré dans l'articulation, présente une longueur prédéfinie de 31 mm, correspondant à une longueur standard ou théorique du ligament croisé, et un inconvénient de cet instrument, est l'encombrement de cette partie distale, qui nécessite d'ouvrir largement l'articulation (arthrotomie), avec le traumatisme que cela entraîne, et qui rend également délicat le positionnement de l'instrument à l'intérieur de 1 'articulation.The first guide element, located at the distal end of the instrument and to be inserted into the joint, has a predefined length of 31 mm, corresponding to a standard or theoretical length of the cruciate ligament, and a drawback of this instrument , is the size of this distal part, which requires wide opening of the joint (arthrotomy), with the trauma that this causes, and which also makes it difficult to position the instrument inside the joint.
Ainsi, si l'instrument positionné par rapport au point tibial prédéterminé peut légèrement pivoter autour de l'axe longitudinal de son bras horizontal, ou encore dans le plan horizontal jusqu'à ce que son extrémité bute contre le condyle, il ne peut par contre pratiquement pas pivoter dans le plan vertical parce que le bras horizontal vient alors buter contre le plateau tibial. Il en résulte que le chirurgien ne peut pas - ou très difficilement - placer l'instrument suivant un angle autre que l'angle préétabli, pour tenir compte des particularités anatomiques du patient. Le chirurgien est de même tenu par la longueur prédéfinie de 31 mm, qui ne permet pas de tenir compte des variations individuelles. Le bon positionnement de l'instrument nécessite d'ailleurs le plus souvent l'utilisation d'un amplificateur de brillance durant l'intervention, ce qui alourdit de façon sensible le geste opératoire.Thus, if the instrument positioned with respect to the predetermined tibial point can pivot slightly around the longitudinal axis of its horizontal arm, or even in the horizontal plane until its end abuts the condyle, it cannot however practically not pivot in the vertical plane because the horizontal arm then abuts against the tibial plateau. It follows that the surgeon cannot - or very difficult - place the instrument at an angle other than the preset angle, to take account of the anatomical particularities of the patient. The surgeon is likewise bound by the predefined length of 31 mm, which does not allow individual variations to be taken into account. The correct positioning of the instrument moreover often requires the use of an image intensifier during the intervention, which significantly increases the operating gesture.
Enfin, les études théoriques montrent que l'isométrie cherchée dépend essentiellement de la position du point
d'insertion au fémur, où une petite erreur a des conséquences importantes sur l'isométrie, alors que la même erreur au point d'insertion au tibia n'aura que peu ou pas de conséquence sur l'isométrie. Or, l'instrument selon EP- B-0162027 est positionné le plus précisément par rapport au point d'insertion tibial (pointe plantée dans le plateau tibial), tandis que le point d'insertion fémoral est atteint par approximation (longueur et inclinaison sur l'horizontale prédéfinies de l'extrémité distale) à partir de celui-ci, de sorte que le risque d'erreur est minimal au tibia et maximal au fémur.Finally, theoretical studies show that the isometry sought depends essentially on the position of the point insertion at the femur, where a small error has significant consequences on the isometry, while the same error at the point of insertion at the tibia will have little or no consequence on the isometry. However, the instrument according to EP-B-0162027 is positioned most precisely with respect to the tibial insertion point (point planted in the tibial plateau), while the femoral insertion point is reached by approximation (length and inclination on the predefined horizontal of the distal end) from it, so that the risk of error is minimal at the tibia and maximum at the femur.
Selon l'invention, on se propose de fournir un instrument perfectionné, permettant de résoudre les problèmes ci-dessus. Un but de 1 ' invention est donc de fournir un instrument chirurgical de visée, pour aligner et guider une mèche destinée à percer à travers un tibia un tunnel dont l'axe passe par deux points prédéfinis de l'articulation du genou, à savoir un point du plateau tibial et un point de la région située entre les condyles du fémur, instrument comprenant, à son extrémité distale prévue pour être insérée dans l'espace intra-articulaire, un premier organe, présentant une pointe d'ancrage provisoire dans l'os, pour positionner l'instrument par rapport à l'un desdits points prédéfinis, un moyen de positionnement de l'instrument par rapport au second desdits points prédéfinis, un second organe, creux, d'alignement et de guidage de la mèche, aligné avec ledit premier organe, et définissant avec lui l'axe du tunnel à forer, un bras plan, angulaire, reliant le premier et le second organes, et une poignée, ledit instrument étant caractérisé en ce que ladite pointe d'ancrage prévue à ladite extrémité distale de l'instrument, est disposée dans l'axe dudit organe d'alignement et de guidage de la mèche, et définit avec celui-ci l'axe du tunnel à forer.According to the invention, it is proposed to provide an improved instrument, making it possible to solve the above problems. An object of one invention is therefore to provide a surgical sighting instrument for aligning and guiding a drill bit intended to pierce through a tibia a tunnel whose axis passes through two predefined points of the knee joint, namely a point of the tibial plateau and a point of the region located between the condyles of the femur, instrument comprising, at its distal end intended to be inserted into the intra-articular space, a first organ, having a temporary anchoring point in the bone, for positioning the instrument relative to one of said predefined points, a means for positioning the instrument relative to the second of said predefined points, a second hollow member, for aligning and guiding the drill bit, aligned with said first member, and defining with it the axis of the tunnel to be drilled, a planar, angular arm, connecting the first and second members, and a handle, said instrument being characterized in that said tip of an provided at said distal end of the instrument, is arranged in the axis of said drill alignment and guide member, and defines therewith the axis of the tunnel to be drilled.
Selon d'autres caractéristiques de l'invention: ledit moyen de positionnement comprend l'arête
terminale du bras, à la jonction du bras et de la pointe; il comprend un renflement, à la jonction entre l'extrémité distale du bras et la pointe; - ladite poignée est prévue sur l'organe d'alignement et de guidage, et est centrée sur ledit axe; l'axe de la poignée est situé dans le plan du bras.According to other characteristics of the invention: said positioning means comprises the edge end of the arm, at the junction of the arm and the point; it includes a bulge, at the junction between the distal end of the arm and the tip; - Said handle is provided on the alignment and guide member, and is centered on said axis; the axis of the handle is located in the plane of the arm.
D'autres aspects, caractéristiques et avantages de 1 ' invention apparaîtront de la description détaillée qui suit, et des dessins annexés sur lesquels:Other aspects, characteristics and advantages of the invention will appear from the detailed description which follows, and from the appended drawings in which:
Les figures 1 et 2 sont des vues de profil de variantes d'un instrument de visée arthroscopique selon l'invention,FIGS. 1 and 2 are side views of variants of an arthroscopic sighting instrument according to the invention,
La figure 2a est une vue en coupe suivant II-II à la figure 2, La figure 3 est une vue en bout du mode de réalisation de la figure 2,FIG. 2a is a sectional view along II-II in FIG. 2, FIG. 3 is an end view of the embodiment of FIG. 2,
La figure 4 est une vue schématique, de côté, de l'instrument de l'invention en position dans l'articulation du genou, et La figure 5 est une vue schématique, de face, de l'instrument dans la même position qu'à la figure 4.Figure 4 is a schematic side view of the instrument of the invention in position in the knee joint, and Figure 5 is a schematic front view of the instrument in the same position as in Figure 4.
En se reportant au dessin, et plus particulièrement aux figures 1 et 2, l'instrument de l'invention, désigné globalement par la référence 1, se compose d'un corps constitué d'un bras plat 2 formé en pointe 3 à une extrémité (extrémité distale) et muni d'un organe 4 d'alignement et de guidage à son autre extrémité (extrémité proximale) .Referring to the drawing, and more particularly to Figures 1 and 2, the instrument of the invention, generally designated by the reference 1, consists of a body consisting of a flat arm 2 formed at a point 3 at one end (distal end) and provided with an alignment and guiding member 4 at its other end (proximal end).
L'organe 4 d'alignement et de guidage est creux, et est prévu pour guider une broche pour percer un tunnel dans le tibia. Il est d'autre part pourvu à sa périphérie extérieure d'éléments en saillie 5, pour servir de poignée lorsque l'instrument est manipulé par le chirurgien.The alignment and guiding member 4 is hollow, and is intended to guide a spindle to pierce a tunnel in the tibia. It is also provided at its outer periphery with projecting elements 5, to serve as a handle when the instrument is manipulated by the surgeon.
Le mode de réalisation de la figure 2, se distingue de celui de la figure 1, d'une part en ce que le bras 2 comprend des segments rectilignes à la figure 2, au lieu de présenter une courbure continue comme à la figure 1 ;
d'autre part, l'arête terminale du bras, à la jonction entre la pointe 3 et le bras 2 est rectiligne à la figure 1 (en 6), tandis qu'elle présente un bossage ou renflement 7 - dont la fonction sera expliquée ci-après - à la figure 2.The embodiment of Figure 2 differs from that of Figure 1, on the one hand in that the arm 2 comprises rectilinear segments in Figure 2, instead of having a continuous curvature as in Figure 1; on the other hand, the end edge of the arm, at the junction between the tip 3 and the arm 2 is rectilinear in Figure 1 (in 6), while it has a boss or bulge 7 - the function of which will be explained below - in Figure 2.
L'extrémité distale du bras 2 se raccorde à la pointe 3 suivant un angle β. Cet angle est tel que, lorsque l'instrument est en position dans l'articulation, avec la pointe inclinée suivant l'angle α prédéfini, la partie terminale du bras soit encore au moins légèrement écartée du plateau tibial (figure 4).The distal end of the arm 2 is connected to the tip 3 at an angle β. This angle is such that, when the instrument is in position in the joint, with the tip inclined according to the predefined angle α, the end part of the arm is still at least slightly spaced from the tibial plateau (Figure 4).
Bien que l'on ne soit pas limité à ces valeurs particulières, on a constaté selon l'invention qu'un angle β de 40° à 50°, convenait bien, avec un angle préféré de l'ordre de 46°.Although it is not limited to these particular values, it has been found according to the invention that an angle β from 40 ° to 50 °, is suitable, with a preferred angle of the order of 46 °.
Un bras 2 à segments rectilignes selon la figure 2 est préféré parce que les zones de raccordement entre les segments rectilignes peuvent servir de repère au chirurgien, quant à la profondeur d'insertion de l'instrument dans l'articulation.An arm 2 with rectilinear segments according to FIG. 2 is preferred because the areas of connection between the rectilinear segments can serve as a guide for the surgeon, as to the depth of insertion of the instrument into the joint.
Comme on l'a indiqué ci-dessus, les points d'ancrage du ligament de remplacement, qui sont constitués par le débouché des tunnels, sont situés respectivement à la partie postérieure de la joue interne du condyle fémoral externe (point "a") et sur le plateau tibial (point "b"), entre les deux saillies du massif spinal.As indicated above, the anchor points of the replacement ligament, which are formed by the opening of the tunnels, are located respectively at the posterior part of the internal cheek of the external femoral condyle (point "a") and on the tibial plateau (point "b"), between the two projections of the spinal massif.
En vue de l'opération de ligamentoplastie, le point d'insertion "a" dans le fémur, et le point d'insertion "b" dans le plateau tibial, déterminés préalablement par radiographie ou analogue, sont localisés à l'aide de repères anatomiques, tandis que le chirurgien détermine également l'angle α formé par la projection dans un plan vertical, de l'axe X-X passant par les point "a" et "b", par rapport à la diaphyse tibiale "c" . De manière générale, cet angle se situe dans l'intervalle entre 50° et 70°.For the ligamentoplasty operation, the insertion point "a" in the femur, and the insertion point "b" in the tibial plateau, determined beforehand by radiography or the like, are located using landmarks anatomical, while the surgeon also determines the angle α formed by the projection into a vertical plane, of the axis XX passing through the points "a" and "b", with respect to the tibial shaft "c". Generally, this angle is in the range between 50 ° and 70 °.
Une caractéristique de l'invention est que la pointe 3 de l'instrument est située sur l'axe X-X passant par le
centre de l'organe d'alignement et de guidage 4. Cette pointe permet en effet de positionner très précisément l'instrument par rapport à l'un des points (le point a) préétablis, assurant ainsi la précision de la visée. D'autre part, une pointe à l'extrémité distale permet de réduire au maximum l'encombrement de cette extrémité qui doit être insérée le plus profondément dans l'articulation, et ainsi de faciliter la manipulation de l'instrument dans l'articulation, en particulier l'insertion de l'instrument par une ouverture verticale de faible dimension (8 à 10 mm) , et le pivotement ultérieur, dans le plan vertical et dans le plan horizontal, de l'instrument planté au point d'insertion fémoral. . .A feature of the invention is that the tip 3 of the instrument is located on the axis XX passing through the center of the alignment and guiding member 4. This point makes it possible to position the instrument very precisely relative to one of the pre-established points (point a), thus ensuring the accuracy of the aiming. On the other hand, a point at the distal end makes it possible to reduce as much as possible the bulk of this end which must be inserted most deeply into the joint, and thus to facilitate the manipulation of the instrument in the joint, in particular the insertion of the instrument through a vertical opening of small dimension (8 to 10 mm), and the subsequent pivoting, in the vertical plane and in the horizontal plane, of the instrument planted at the point of femoral insertion. . .
Le bras 2 reliant les deux extrémités de l'instrument est un bras plat, plan, dont le plan médian passe par l'axe X-X. Un avantage d'un tel élément plat est qu'il se glisse plus facilement dans l'articulation, en passant par une courte incision dans la capsule articulaire; un autre avantage est qu'il permet un contrôle arthroscopique de la verticalité de l'instrument. La largeur du bras n'est pas un paramètre de l'invention; elle sera la plus faible possible, pour limiter l'encombrement, tout en étant suffisante pour lui assurer la rigidité voulue, compte tenu de son épaisseur et de la nature du matériau qui le constitue.The arm 2 connecting the two ends of the instrument is a flat, flat arm, the median plane of which passes through the axis X-X. An advantage of such a flat element is that it slides more easily into the joint, passing through a short incision in the joint capsule; another advantage is that it allows arthroscopic control of the verticality of the instrument. The width of the arm is not a parameter of the invention; it will be as small as possible, to limit the size, while being sufficient to provide it with the desired rigidity, taking into account its thickness and the nature of the material which constitutes it.
Le bras 2 est d'autre part angulé ou courbe dans le sens longitudinal, pour permettre d'insérer la pointe de l'instrument au point "a" du fémur, en partant d'une courte incision dans la capsule articulaire à la face antéro- interne du genou (schématisée en "d" à la figure 4), et en passant dans l'étroit espace situé entre le plateau tibial et le toit de l'échancrure intercondylienne du fémur. Cette courbe permet également à l' instrument de contourner le plateau tibial lorsque l'instrument est pivoté dans le plan vertical pour l'amener à l'angle α souhaité.The arm 2 is on the other hand angled or curved in the longitudinal direction, to allow the tip of the instrument to be inserted at point "a" of the femur, starting from a short incision in the articular capsule with the antero face - internal knee (shown schematically in "d" in Figure 4), and passing through the narrow space between the tibial plateau and the roof of the intercondylar notch of the femur. This curve also allows the instrument to bypass the tibial plateau when the instrument is pivoted in the vertical plane to bring it to the desired angle α.
Pour la mise en place du viseur, le chirurgien insère l'extrémité distale 3 dans l'articulation, par une courte
incision (8 à 10 mm) pratiquée à la face antéro-interne du genou, jusqu'à venir planter la pointe 3 au point d'insertion "a" dans le fémur, le point "a" ayant de préférence été déterminé préalablement par radiographie ou analogue.For positioning the viewfinder, the surgeon inserts the distal end 3 into the joint, using a short incision (8 to 10 mm) made on the anteromedial side of the knee, until the point 3 is planted at the point of insertion "a" into the femur, point "a" having preferably been determined beforehand by radiography or the like.
Au cours de cette opération, le chirurgien contrôle de manière connue la progression de l'instrument par voie endoscopique, et s'aide de repères anatomiques pour localiser visuellement le point "a" préalablement déterminé.During this operation, the surgeon monitors the progress of the instrument in a known manner endoscopically, and uses anatomical landmarks to visually locate the point "a" previously determined.
Le premier point étant fixé, il faut encore orienter le viseur pour que son axe X-X passe par le point "b" du tibia, qui se situe entre les crêtes du massif spinal du plateau tibial. Pour que ceci se vérifie, il faut faire pivoter le viseur, ancré au point "a" par la pointe 3 a) d'une part dans le plan horizontal (autour d'un axe vertical passant par le point "a) , pour que son plan (le plan médian du bras 2) passe par le point "b" du plateau tibial (situé au milieu du massif spinal), comme on le voit à la figure 5; b) d'autre part dans le plan vertical (autour d'un axe horizontal passant par le point "a" ) , pour amener 1 ' axe X-X à l'angle α prédéterminé radiologiquement par rapport à la diaphyse tibiale "c". Pour l'orientation de l'étape a), le chirurgien fait pivoter l'instrument pour palper le plateau tibial à l'aide de 1 ' arête 6 ou 7 à la jonction entre le bras 2 et la pointe 3. Ce faisant, et en s 'aidant éventuellement de repères anatomiques, il peut assez facilement localiser le creux de l'espace interspinal du tibia, l'orientation de l'étape a) (orientation selon la figure 5) étant atteinte lorsque l'arête 6 ou 7 bute contre le fond dudit creux spinal.The first point being fixed, it is still necessary to orient the viewfinder so that its X-X axis passes through point "b" of the tibia, which is located between the crests of the spinal massif of the tibial plateau. For this to happen, you must rotate the viewfinder, anchored at point "a" by point 3 a) on the one hand in the horizontal plane (around a vertical axis passing through point "a), so that its plane (the median plane of arm 2) passes through point "b" of the tibial plateau (located in the middle of the spinal massif), as seen in Figure 5; b) on the other hand in the vertical plane (around a horizontal axis passing through point "a"), to bring the axis XX to the angle α radiologically predetermined with respect to the tibial diaphysis "c". For the orientation of step a), the surgeon rotates the instrument to palpate the tibial plateau using the edge 6 or 7 at the junction between the arm 2 and the tip 3. In doing so, and possibly using anatomical landmarks, it can quite easily locate the hollow of the interspinal space of the tibia, the orientation of step a) (orientation according to Figure 5) being reached when the edge 6 or 7 abuts against the bottom said spinal hollow.
Au cours de cette opération, il est important que le plan du bras soit maintenu sensiblement vertical, pour éviter une erreur angulaire dans la positionnement de l'axe X-X au cours de l'étape a). En effet, l'axe X-X de
l'instrument ne passe pas par l'arête 6 ou 7 mais au-dessus de sorte que, au cours de l'étape a), lorsque le chirurgien palpe avec l'arête 6 ou 7 le milieu du massif spinal (c'est-à-dire le fond du creux entre les arêtes spinales), l'axe ne passe précisément au-dessus de ce milieu, que lorsque le plan du bras est vertical. En cas d'écart de ce plan par rapport à la verticale, il se produira une erreur angulaire de positionnement de l'axe X-X, fonction de l'angle d'inclinaison du bras sur la verticale, et de la distance entre l'arête 6 ou 7 en contact avec le milieu du massif spinal, et l'axe X-X.During this operation, it is important that the plane of the arm is kept substantially vertical, to avoid an angular error in the positioning of the axis XX during step a). Indeed, the axis XX of the instrument does not pass through the edge 6 or 7 but above so that, during step a), when the surgeon palpates with the edge 6 or 7 the middle of the spinal mass (this is ie the bottom of the hollow between the spinal ridges), the axis passes precisely above this medium, only when the plane of the arm is vertical. If this plane deviates from the vertical, there will be an angular error in the positioning of the axis XX, a function of the angle of inclination of the arm on the vertical, and of the distance between the edge 6 or 7 in contact with the middle of the spinal massif, and the axis XX.
Tout en maintenant cette orientation, le chirurgien doit alors orienter le viseur dans le plan vertical, suivant l'étape b) (orientation selon la figure 4), pour l'amener à l'angle α prédéterminé. Ceci peut se faire à l'oeil, pour un chirurgien suffisamment exercé; mieux, le chirurgien appliquera sur la diaphyse tibiale une branche d'un goniomètre préréglé à l'angle α, et orientera alors l'axe X-X du viseur (donné par l'axe du moyen d'alignement 4, ou encore par l'axe d'une pointe carrée très effilée, insérée dans celui-ci en vue de faire un pré-trou de marquage) par comparaison avec l'autre branche du goniomètre.While maintaining this orientation, the surgeon must then orient the viewfinder in the vertical plane, according to step b) (orientation according to FIG. 4), to bring it to the predetermined angle α. This can be done by eye, for a surgeon who is sufficiently trained; better, the surgeon will apply to the tibial shaft a branch of a goniometer preset at the angle α, and will then orient the axis XX of the viewfinder (given by the axis of the alignment means 4, or even by the axis with a very tapered square tip, inserted into it in order to make a marking pre-hole) by comparison with the other branch of the goniometer.
La pointe carrée est ensuite remplacée par un guide- broche qui permet d'insérer une broche à travers le tibia. L'instrument est ensuite retiré, de même que la broche de perçage, et le chirurgien insère ensuite à la main une broche légèrement plus fine, qui servira de guide à la mèche canulée destinée à percer le tunnel. Le tunnel tibial sert ultérieurement de moyen d'accès pour ensuite forer le tunnel fémoral (tunnel borgne). Pour ce faire, le chirurgien introduit une broche par le tunnel tibial et pénètre dans le fémur au niveau de l'orifice créé par la pointe du viseur. Cette broche sert ensuite de guide à la mèche canulée destinée à percer le tunnel fémoral.The square point is then replaced by a spindle guide which allows a pin to be inserted through the tibia. The instrument is then removed, as is the piercing pin, and the surgeon then manually inserts a slightly thinner pin, which will serve as a guide for the cannulated drill bit intended to pierce the tunnel. The tibial tunnel is later used as a means of access and then drilling the femoral tunnel (blind tunnel). To do this, the surgeon introduces a pin through the tibial tunnel and enters the femur at the level of the orifice created by the point of the viewfinder. This pin then serves as a guide for the cannulated drill bit intended to pierce the femoral tunnel.
Le positionnement de la poignée 5, 5 sur l'axe X-X facilite la manipulation du viseur, en particulier parce
que les mouvements d'orientation sont plus instinctifs, et qu'un mouvement involontaire de pivotement du plan du viseur autour de la poignée ne produit qu'une rotation de l'axe sur lui-même, et non un changement d'orientation, comme par exemple dans le viseur selon EP-0 162 027.The positioning of the handle 5, 5 on the axis XX facilitates the manipulation of the viewfinder, in particular because that the orientation movements are more instinctive, and that an involuntary pivoting movement of the viewfinder plane around the handle only produces a rotation of the axis on itself, and not a change of orientation, as for example in the viewfinder according to EP-0 162 027.
De même, une poignée dans le plan du bras, comme sur le dessin, facilite la manipulation puisque le chirurgien a ainsi conscience de la position du plan du bras.Likewise, a handle in the plane of the arm, as in the drawing, facilitates the manipulation since the surgeon is thus aware of the position of the plane of the arm.
La longueur de la pointe 3 n'est pas un paramètre critique de l'invention, toutefois, elle sera suffisante pour permettre d'obtenir un ancrage ferme de la pointe dans le fémur (avec généralement une pénétration de 3 à 5 mm), tout en permettant encore au chirurgien d'effectuer l'étape de palpation du creux interspinal du tibia, mentionnée ci- dessus. Selon l'invention, une longueur de pointe de 20 à 30 mm convient, mesurée sur l'axe X-X entre l'extrémité de la pointe et le bord interne du bras 2The length of the tip 3 is not a critical parameter of the invention, however, it will be sufficient to allow a firm anchoring of the tip in the femur (with generally a penetration of 3 to 5 mm), all still allowing the surgeon to carry out the palpation step of the interspinal hollow of the tibia, mentioned above. According to the invention, a tip length of 20 to 30 mm is suitable, measured on the axis X-X between the end of the tip and the internal edge of the arm 2
Bien entendu, l'invention n'est pas limitée aux modes de réalisation représentés et décrits, qui n'ont été choisis qu'à titre d'exemple.
Of course, the invention is not limited to the embodiments shown and described, which have been chosen only by way of example.
Claims
1. Instrument chirurgical (1) de visée, pour aligner et guider un outil de perçage destiné à réaliser à travers un tibia un tunnel dont 1 ' axe passe par deux points prédéfinis de l'articulation du genou, à savoir un point du plateau tibial et un point de la région située entre les condyles du fémur, instrument comprenant à son extrémité distale prévue pour être insérée dans l'espace intra-articulaire, un premier organe, présentant une pointe d'ancrage (3) provisoire dans l'os, pour positionner l'instrument par rapport à 1 'un desdits points prédéfinis, un moyen de positionnement de l'instrument par rapport au second desdits points prédéfinis, un second organe (4), creux, d'alignement et de guidage de l'outil de perçage, aligné avec ledit premier organe, et définissant avec lui l'axe (X-X) du tunnel à forer, un bras (2) plan, angulaire, reliant le premier et le second organes, et une poignée (5), caractérisé en ce que ladite pointe d'ancrage (3) prévue à ladite extrémité distale de l'instrument, est disposée dans l'axe dudit organe (4) d'alignement et de guidage, et définit avec celui-ci l'axe (X-X) du tunnel à forer.1. Surgical instrument (1) for aiming, for aligning and guiding a drilling tool intended to make a tunnel through a tibia, the axis of which passes through two predefined points of the knee joint, namely a point of the tibial plateau and a point of the region situated between the condyles of the femur, instrument comprising at its distal end intended to be inserted in the intra-articular space, a first organ, having a temporary anchoring point (3) in the bone, for positioning the instrument relative to one of said predefined points, means for positioning the instrument relative to the second of said predefined points, a second hollow member (4) for aligning and guiding the tool drilling, aligned with said first member, and defining therewith the axis (XX) of the tunnel to be drilled, a planar, angular arm (2) connecting the first and second members, and a handle (5), characterized in what said anchor point (3) provided at said distal end of the instrument, is arranged in the axis of said member (4) for alignment and guiding, and defines therewith the axis (X-X) of the tunnel to be drilled.
2. Instrument selon la revendication 1, caractérisé en ce que ledit moyen de positionnement comprend l'arête terminale (6) du bras à la jonction dudit bras (2) et de ladite pointe (3). 2. Instrument according to claim 1, characterized in that said positioning means comprises the end edge (6) of the arm at the junction of said arm (2) and said tip (3).
3. Instrument selon l'une quelconque des revendications 1 et 2, caractérisé en ce qu'il comprend un renflement (7) à la jonction du bras (2) et de la pointe (3).3. Instrument according to any one of claims 1 and 2, characterized in that it comprises a bulge (7) at the junction of the arm (2) and the tip (3).
4. Instrument selon l'une quelconque des revendications précédentes, caractérisé en ce que ladite poignée (5, 5) est prévue sur l'organe (4) d'alignement et de guidage, et est centrée sur ledit axe (X-X) .4. Instrument according to any one of the preceding claims, characterized in that said handle (5, 5) is provided on the member (4) for alignment and guidance, and is centered on said axis (X-X).
5. Instrument selon l'une quelconque des revendications précédentes, caractérisé en ce que l'axe de la poignée (5, 5) est situé dans le plan du bras (2). 5. Instrument according to any one of the claims previous, characterized in that the axis of the handle (5, 5) is located in the plane of the arm (2).
Priority Applications (4)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| PCT/BE1995/000059 WO1997000644A1 (en) | 1995-06-22 | 1995-06-22 | Surgical sighting instrument |
| CA002225383A CA2225383A1 (en) | 1995-06-22 | 1995-06-22 | Surgical aiming instrument |
| AU27088/95A AU2708895A (en) | 1995-06-22 | 1995-06-22 | Surgical sighting instrument |
| EP95922363A EP0837654A1 (en) | 1995-06-22 | 1995-06-22 | Surgical sighting instrument |
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| PCT/BE1995/000059 WO1997000644A1 (en) | 1995-06-22 | 1995-06-22 | Surgical sighting instrument |
| CA002225383A CA2225383A1 (en) | 1995-06-22 | 1995-06-22 | Surgical aiming instrument |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| WO1997000644A1 true WO1997000644A1 (en) | 1997-01-09 |
Family
ID=25662965
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| PCT/BE1995/000059 WO1997000644A1 (en) | 1995-06-22 | 1995-06-22 | Surgical sighting instrument |
Country Status (4)
| Country | Link |
|---|---|
| EP (1) | EP0837654A1 (en) |
| AU (1) | AU2708895A (en) |
| CA (1) | CA2225383A1 (en) |
| WO (1) | WO1997000644A1 (en) |
Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US4708139A (en) * | 1986-02-24 | 1987-11-24 | Dunbar Iv William H | Arthroscopic drill guide |
| EP0162027B1 (en) * | 1984-03-14 | 1989-06-07 | Magnus Odensten | A drill guiding and aligning device and a drill rod and a milling device to be used in connection therewith |
| EP0440991A1 (en) * | 1990-01-31 | 1991-08-14 | Acufex Microsurgical Inc. | Method and instruments for the reconstruction of the anterior cruciate ligament |
| WO1994000058A1 (en) * | 1992-06-19 | 1994-01-06 | Surgicraft Limited | Positioning probe for a drill jig in knee surgery |
-
1995
- 1995-06-22 AU AU27088/95A patent/AU2708895A/en not_active Abandoned
- 1995-06-22 WO PCT/BE1995/000059 patent/WO1997000644A1/en not_active Application Discontinuation
- 1995-06-22 CA CA002225383A patent/CA2225383A1/en not_active Abandoned
- 1995-06-22 EP EP95922363A patent/EP0837654A1/en not_active Withdrawn
Patent Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP0162027B1 (en) * | 1984-03-14 | 1989-06-07 | Magnus Odensten | A drill guiding and aligning device and a drill rod and a milling device to be used in connection therewith |
| US4708139A (en) * | 1986-02-24 | 1987-11-24 | Dunbar Iv William H | Arthroscopic drill guide |
| EP0440991A1 (en) * | 1990-01-31 | 1991-08-14 | Acufex Microsurgical Inc. | Method and instruments for the reconstruction of the anterior cruciate ligament |
| WO1994000058A1 (en) * | 1992-06-19 | 1994-01-06 | Surgicraft Limited | Positioning probe for a drill jig in knee surgery |
Also Published As
| Publication number | Publication date |
|---|---|
| EP0837654A1 (en) | 1998-04-29 |
| AU2708895A (en) | 1997-01-22 |
| CA2225383A1 (en) | 1997-01-09 |
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