Method and apparatus for altering biomechanics of the articular joints
Pathology of the human knee can arise from excessive and/or uneven loading of regions within the joint. Methods and apparatus are disclosed that enable displacement of soft tissue around the knee, without displacing or severing bone thereby altering the mechanical load distribution within the joint in a less invasive manner than previous techniques.
1. A method of treating a knee joint, the knee joint including a tibia, tibial tubercle and patellar tendon, the method comprising:
attaching a device to the tibia at a fixation site caudally of an attachment point of the patellar tendon to the tibial tubercle without penetrating the joint capsule of the knee with said device, and with the device engaging the patellar tendon between the patella and the attachment point of the patellar tendon to the tibial tubercle; and
displacing the patellar tendon from a pretreatment location with said device by a distance sufficient to alter a load on the patella or femur to achieve a therapeutic effect, said displacement occurring without relocating the attachment point of the patellar tendon to tibial tubercle, wherein said displacing comprises displacing the patellar tendon more than about 5 mm.
2. The method of claim 1 , wherein said displacing comprises displacing the patellar tendon anteriorly.
3. The method of claim 2 , wherein said displacing further comprises displacing the patellar tendon at least one of medially, laterally, cranially, or caudally.
4. The method of claim 1 , wherein said displacing comprises displacing varying the displacement of the patellar tendon with change in joint flexion angle.
5. The method of claim 1 , wherein said attaching comprises attaching the device to the medial side of the tibia.
6. The method of claim 1 , wherein said attaching comprises attaching the device the lateral side of the tibia.
7. The method of claim 1 , wherein:
the device comprises a fixation portion and a displacement portion;
said attaching comprises attaching the fixation portion of the device to the tibia such that at least a portion of the fixation portion is disposed caudally of the attachment point of the patellar tendon to tibia; and
said displacing comprises engaging the patellar tendon with the displacement portion of the device superior to the attachment point.
8. The method of claim 7 , wherein the fixation portion of the device has a longitudinal axis and the displacement portion extends transverse to the longitudinal axis.
9. The method of claim 8 , wherein said attaching comprises attaching the fixation portion of the device to the tibia with the longitudinal axis of the device extending in a cranial-caudal direction.
10. The method of claim 7 , wherein said displacing further comprises inserting the displacement portion of the device under the patellar tendon superior to the attachment point of the patellar tendon to the tibia.
11. The method of claim 7 , wherein said attaching comprises securing the fixation portion of the device to the tibia with a bone screw inserted through a hole in the fixation portion.
12. The method of claim 11 , wherein the displacement portion is free of holes for bone screws.
13. The method of claim 7 , wherein said attaching comprises attaching the fixation portion to the tibia on a lateral side of said attachment point.
14. The method of claim 7 , wherein said attaching comprises attaching the fixation portion to the tibia on a medial side of said attachment point.
15. The method in claim 7 , wherein the displacement of the patellar tendon varies as joint flexion angle changes.
16. A method of treating a knee joint, the knee joint including a tibia, tibial tubercle and patellar tendon, the method comprising:
attaching a device to the tibia at a fixation site caudally of an attachment point of the patellar tendon to the tibial tubercle without penetrating the joint capsule of the knee with said device, and with the device engaging the patellar tendon between the patella and the attachment joint of the tendon to the tibial tubercle; and
displacing the patellar tendon from a pretreatment location with said device by a distance sufficient to alter a load on the patella or femur to achieve a therapeutic effect, said displacement occurring without relocating the attachment point of the patellar tendon to tibial tubercle, wherein:
the device is substantially L-shaped;
said attaching comprises attaching the vertical portion of the L-shape at the fixation site; and
said displacing comprises engaging the patellar tendon with the base portion of the L-shape.
17. A method of treating a knee joint, the knee joint including a tibia, tibial tubercle and patellar tendon, the method comprising:
attaching a device to the tibia at a fixation site caudally of an attachment point of the patellar tendon to the tibial tubercle without penetrating the joint capsule of the knee with said device, and with the device engaging the patellar tendon between the patella and the attachment point of the patellar tendon to the tibial tubercle; and
displacing the patellar tendon from a pretreatment location with said device by a distance sufficient to alter a load on the patella or femur to achieve a therapeutic effect, said displacement occurring without relocating the attachment point of the patellar tendon to tibial tubercle, wherein:
the device comprises a fixation portion having a longitudinal axis, and a displacement portion extending transverse to the longitudinal axis; and
said attaching comprises attaching the fixation portion to the tibia at the fixation site and engaging the patellar tendon with the displacement portion superior to the attachment point of the patellar tendon to the tibia.
18. The method of claim 17 , further comprising inserting the displacement portion under the patellar tendon superior to said attachment point.
19. The method of claim 17 , wherein said attaching further comprises attaching the fixation portion to the tibia with a bone screw inserted through a hole in the fixation portion.
20. The method of claim 19 , wherein the displacement portion of the device is free of holes for bone screws.
21. The method of claim 1 , wherein the displacement alters a load between a patella and a femur.
22. The method of claim 21 , wherein patellar tendon is displaced without cutting the femur or patella.
23. A method of treating patellofemoral pain in a knee joint, the knee joint being surrounded by a capsule and comprising a femur, tibia and patella with a patellar tendon extending between the patella and an attachment point on the tibia, said method comprising:
creating an incision adjacent the knee without penetrating the knee joint capsule;
inserting a prosthesis through the incision with a portion of the prosthesis inserted under the patellar tendon between the attachment point and the patella without the prosthesis penetrating the knee joint capsule; and
attaching a second portion of the prosthesis to the tibia at a position at least in part caudally with respect to the attachment point, wherein the first and second portion of the prosthesis is configured and dimensioned such that said inserting and attaching displaces the patellar tendon by a least about 5 mm from a pretreatment location.
24. The method of claim 23 , wherein the displacement of the patellar tendon is sufficient to redistribute loading within the knee joint.
25. The method of claim 24 , wherein the displacement is sufficient to reduce force applied by the patella toward the femur.
26. The method of claim 23 , wherein said attaching further comprises securing the second portion of the prosthesis to the tibia with at least one bone screw.
27. The method of claim 26 , wherein the first portion of the prosthesis comprises a displacement portion with a smooth bearing surface substantially free of holes and the second portion of the prosthesis comprises a fixation portion including holes for receiving bone screws.