Granted Patent B2

US 8,821,504 · App. 12/950,097 · Granted Sep 2, 2014

Abstract

Claims (101)

1. A method for treating joint pain comprising:

identifying a source of the pain of the joint based on an image of the joint, the image indicating the presence of a defect in the subchondral region of a bone of the joint;

locating an insufficiency fracture in the subchondral region of the joint, wherein a subchondral defect is further present near the insufficiency fracture, the subchondral defect comprising a bone marrow lesion;

evaluating the bone marrow lesion based on a location of the bone marrow lesion and a size of the bone marrow lesion from the image of the joint;

mapping an access path to a location in the subchondral region where the insufficiency fracture resides, wherein the access path preserves an articular surface of the joint; and

implanting in the bone, via the access path, a reinforcing member that stabilizes the insufficiency fracture.

2. The method of claim 1 , wherein implanting the reinforcing member comprises injecting a flowable material.

3. The method of claim 1 , wherein the flowable material comprises a bone void filler, bone substitute material, or a bone cement.

4. The method of claim 1 , wherein the flowable material stimulates bone growth.

5. The method of claim 4 , wherein the flowable material includes calcium phosphate.

6. The method of claim 2 , wherein the flowable material integrates the insufficiency fracture with surrounding bone tissue.

7. The method of claim 1 , wherein the subchondral defect further includes sclerotic bone.

8. The method of claim 1 , wherein the insufficiency fracture is a result of the subchondral defect.

9. The method of claim 1 , wherein evaluating the bone marrow lesion comprises assessing the bone marrow lesion based on its proximity to a periphery of the bone.

10. The method of claim 1 , wherein mapping the access path further includes creating access to the location of the bone marrow lesion.

11. The method of claim 10 , wherein creating access comprises measuring a location of the bone marrow lesion based on a coordinate system that originates from an anatomic landmark on the bone.

12. The method of claim 1 , wherein mapping the access further includes creating access by drilling.

13. The method of claim 11 , wherein the coordinate system corresponds to predetermined settings of an instrument guide.

14. The method of claim 7 , further including removing bone tissue and at least a portion of the sclerotic bone from the bone prior to implanting the reinforcing member.

15. The method of claim 1 , wherein the reinforcing member is an implantable device.

16. The method of claim 15 , wherein the implantable device is a bone plug.

17. The method of claim 1 , wherein the access path comprises an inferior approach into the bone towards the insufficiency fracture.

18. The method of claim 17 , wherein the inferior approach comprises an approach at an angle of about 30 to about 45 degrees.

19. The method of claim 1 , further comprising resurfacing the articular surface of the joint.

20. The method of claim 19 , further including removing the reinforcing member prior to resurfacing.

21. The method of claim 19 , further including assessing an effectiveness of the reinforcing member prior to resurfacing.

22. The method of claim 1 , wherein identifying the source of the pain of the joint based on an image of the joint comprises evaluating a magnetic resonance image of the joint.

23. The method of claim 7 , wherein identifying the source of the pain of the joint comprises identifying the bone marrow lesion based on a T2-weighted magnetic resonance image joint and identifying the sclerotic bone based on a T1-weighted magnetic resonance image of the joint.

24. An instrument for guiding a tool to a target location in a bone adjacent to a joint, comprising:

a first portion having a first guide section including a plurality of portals, each portal being configured to guide the tool therethrough to the target location;

a reference probe extending from the first portion having a tip that indicates a selected landmark on the bone; and

a handle portion coupled to the first portion and having a second guide section configured to guide the tool to the target location, the second guide section having a plurality of portals, each portal being configured to guide the tool therethrough at an acute angle with respect to the reference probe;

wherein the handle portion comprises an adjustable arm configured with a radius of curvature that provides an adjustable set of acute angles of approach to the target location.

25. The instrument of claim 24 , wherein the tool is a drill, pin, implantable device delivery tool, guidewire, bone portal, rongeur, or hammer.

26. The instrument of claim 24 , wherein the reference probe is configured to rest against an anatomical landmark on the bone adjacent to the joint.

27. The instrument of claim 24 , wherein the openings are configured to guide the tool into a subchondral region of the bone.

28. The instrument of claim 24 , wherein the instrument is a unitary body.

29. The instrument of claim 24 , wherein the handle portion is configured to be detachable from the instrument.

30. A method for treating joint pain comprising:

identifying a source of the pain of the joint based on an image of the joint, the image indicating the presence of a defect in the subchondral region of a bone of the joint;

locating an insufficiency fracture in the subchondral region of the joint, wherein a subchondral defect is further present near the insufficiency fracture, the subchondral defect comprising a bone marrow lesion;

evaluating the bone marrow lesion based on a location of the bone marrow lesion and a size of the bone marrow lesion from the image of the joint;

mapping an access path to a location in the subchondral region where the insufficiency fracture resides, wherein the access path preserves an articular surface of the joint; and

implanting in the bone, via the access path, a reinforcing member that stabilizes the insufficiency fracture;

wherein evaluating the bone marrow lesion comprises assessing the bone marrow lesion based on its proximity to a periphery of the bone.

31. A method for treating joint pain comprising:

identifying a source of the pain of the joint based on an image of the joint, the image indicating the presence of a defect in the subchondral region of a bone of the joint;

locating an insufficiency fracture in the subchondral region of the joint, wherein a subchondral defect is further present near the insufficiency fracture, the subchondral defect comprising a bone marrow lesion;

mapping an access path to a location in the subchondral region where the insufficiency fracture resides, wherein the access path preserves an articular surface of the joint; and

implanting in the bone, via the access path, a reinforcing member that stabilizes the insufficiency fracture;

wherein mapping the access path further includes creating access to the location of the bone marrow lesion.

32. A method for treating joint pain comprising:

identifying a source of the pain of the joint based on an image of the joint, the image indicating the presence of a defect in the subchondral region of a bone of the joint;

locating an insufficiency fracture in the subchondral region of the joint, wherein a subchondral defect is further present near the insufficiency fracture, the subchondral defect comprising a bone marrow lesion;

mapping an access path to a location in the subchondral region where the insufficiency fracture resides, wherein the access path preserves an articular surface of the joint; and

implanting in the bone, via the access path, a reinforcing member that stabilizes the insufficiency fracture;

wherein mapping the access path further includes creating access to the location of the bone marrow lesion; and further wherein creating access comprises measuring a location of the bone marrow lesion based on a coordinate system that originates from an anatomic landmark on the bone.

33. A method for treating joint pain comprising:

identifying a source of the pain of the joint based on an image of the joint, the image indicating the presence of a defect in the subchondral region of a bone of the joint;

locating an insufficiency fracture in the subchondral region of the joint, wherein a subchondral defect is further present near the insufficiency fracture, the subchondral defect comprising a bone marrow lesion;

mapping an access path to a location in the subchondral region where the insufficiency fracture resides, wherein the access path preserves an articular surface of the joint; and

implanting in the bone, via the access path, a reinforcing member that stabilizes the insufficiency fracture;

wherein mapping the access path further includes creating access to the location of the bone marrow lesion; and further wherein creating access comprises measuring a location of the bone marrow lesion based on a coordinate system that originates from an anatomic landmark on the bone, the coordinate system corresponding to predetermined settings of an instrument guide.

34. A method for treating joint pain comprising:

identifying a source of the pain of the joint based on an image of the joint, the image indicating the presence of a defect in the subchondral region of a bone of the joint;

locating an insufficiency fracture in the subchondral region of the joint, wherein the subchondral defect further includes sclerotic bone;

mapping an access path to a location in the subchondral region where the insufficiency fracture resides, wherein the access path preserves an articular surface of the joint;

implanting in the bone, via the access path, a reinforcing member that stabilizes the insufficiency fracture; and

further including removing bone tissue and at least a portion of the sclerotic bone from the bone prior to implanting the reinforcing member.

35. A method for treating joint pain comprising:

identifying a source of the pain of the joint based on an image of the joint, the image indicating the presence of a defect in the subchondral region of a bone of the joint;

locating an insufficiency fracture in the subchondral region of the joint;

mapping an access path to a location in the subchondral region where the insufficiency fracture resides, wherein the access path preserves an articular surface of the joint;

implanting in the bone, via the access path, a reinforcing member that stabilizes the insufficiency fracture; and

further comprising resurfacing the articular surface of the joint.

36. A method for treating joint pain comprising:

identifying a source of the pain of the joint based on an image of the joint, the image indicating the presence of a defect in the subchondral region of a bone of the joint;

locating an insufficiency fracture in the subchondral region of the joint;

mapping an access path to a location in the subchondral region where the insufficiency fracture resides, wherein the access path preserves an articular surface of the joint;

implanting in the bone, via the access path, a reinforcing member that stabilizes the insufficiency fracture; and

further comprising resurfacing the articular surface of the joint, wherein the reinforcing member is removed prior to resurfacing.

37. A method for treating joint pain comprising:

identifying a source of the pain of the joint based on an image of the joint, the image indicating the presence of a defect in the subchondral region of a bone of the joint;

locating an insufficiency fracture in the subchondral region of the joint;

mapping an access path to a location in the subchondral region where the insufficiency fracture resides, wherein the access path preserves an articular surface of the joint;

implanting in the bone, via the access path, a reinforcing member that stabilizes the insufficiency fracture;

assessing an effectiveness of the reinforcing member; and

resurfacing the articular surface of the joint.

38. A method for treating joint pain comprising:

identifying a source of the pain of the joint based on an image of the joint, the image indicating the presence of a defect in the subchondral region of a bone of the joint;

locating an insufficiency fracture in the subchondral region of the joint, wherein a subchondral defect is further present near the insufficiency fracture, the subchondral defect including sclerotic bone;

mapping an access path to a location in the subchondral region where the insufficiency fracture resides, wherein the access path preserves an articular surface of the joint; and

implanting in the bone, via the access path, a reinforcing member that stabilizes the insufficiency fracture;

wherein identifying the source of the pain of the joint comprises identifying the bone marrow lesion based on a T2-weighted magnetic resonance image joint and identifying the sclerotic bone based on a T1-weighted magnetic resonance image of the joint.

39. An instrument for guiding a tool to a target location in a bone adjacent to a joint, comprising:

a first portion having a first guide section including a plurality of portals, each portal being configured to guide the tool therethrough to the target location;

a reference probe extending from the first portion having a tip that indicates a selected landmark on the bone; and

a handle portion coupled to the first portion and having a second guide section configured to guide the tool to the target location, the second guide section having a plurality of portals, each portal being configured to guide the tool therethrough at an acute angle with respect to the reference probe;

wherein the handle portion comprises an adjustable arm that provides an adjustable set of angles of approach to the target location.

40. The instrument of claim 24 , wherein the first guide section is configured to guide the tool at an angle substantially parallel to the reference probe.

41. The instrument of claim 39 , wherein the first guide section is configured to guide the tool at an angle substantially parallel to the reference probe.

Assignments (11)