Apparatus for performing an open wedge, high tibial osteotomy
An apparatus and method for performing an open wedge osteotomy. The apparatus includes devices for forming an open wedge osteotomy in bone, including a keyed-wedge implant. The method includes the steps of forming a cut in a bone, forming a keyhole in the bone surface at the proximal end of the cut, and positioning a keyed wedge-shaped implant into the cut formed into the bone.
1. Apparatus for performing an open wedge, high tibial osteotomy, comprising:
a cutting apparatus for forming an osteotomy cut in a tibia, the cutting apparatus comprising:
a) targeting apparatus configured for identifying (1) a cutting plane through the tibia and (2) a boundary line within the tibia for limiting a cut made along the cutting plane, the targeting apparatus including a drill guide arranged to locate the boundary line parallel to an anterior-posterior slope of the tibia and parallel to a sagittal plane of a patient,
b) a positioning guide configured for attachment to the tibia so as to establish the cutting plane and the boundary line relative to the tibia,
c) a cutting guide configured for attachment to the positioning guide to align a cutting slot with the cutting plane,
d) a keyhole drill guide, separate from the cutting guide, for attachment to the positioning guide, the keyhole drill guide further including at least one internally arranged hole adapted to receive a milling device for forming at least one keyhole at the antero-medial surface of and within the tibia, and
e) attachment and alignment members to align and removably attach the cutting guide and keyhole drill guide to the positioning guide, wherein the alignment members arrange a cross-sectional area of the at least one internally arranged hole to extend beyond a cut formed through the slot, such that keyhole surfaces are formed within the tibia and extend transversely into the tibia adjacent to and in communication with the osteotomy cut.
2. Apparatus according to claim 1 wherein the drill guide of the targeting apparatus is configured to receive a drill to form an oversized hole along the boundary line, whereby to minimize occurrence of stress risers within the tibia when bone on either side of the cut is moved apart so as to form a wedge-like opening in the tibia.
3. Apparatus according to claim 1 wherein the targeting apparatus further comprises an apex pin for disposition along the boundary line, wherein the apex pin provides a positive cutting stop at the boundary line for limiting cutting along the cutting plane.
4. Apparatus according to claim 3 wherein the apex pin comprises a flat at the positive cutting stop.
5. Apparatus according to claim 3 wherein the apex pin is necked down at the positive cutting stop.
6. Apparatus according to claim 1 wherein the targeting apparatus is configured so that a cutting approach is in a generally antero-medial direction.
7. Apparatus according to claim 1 wherein the targeting apparatus further comprises a slope guide for determining the anterior-posterior slope of the tibia whereby to determine a location of the boundary line.
8. Apparatus according to claim 7 wherein the slope guide comprises an elongated body having a non-circular cross-section.
9. Apparatus according to claim 1 wherein the targeting apparatus further comprises an alignment mechanism for determining a coronal plane and hence the sagittal plane, whereby to determine a location of the boundary line.
10. Apparatus according to claim 1 wherein the cutting guide is configured so that a cutting approach is in a generally antero-medial direction.
11. Apparatus according to claim 1 wherein the apparatus further comprises a jack for opening the cut made along the cutting plane so as to form a wedge-like opening within a bone.
12. Apparatus according to claim 11 wherein the jack is configured for mounting on the apex pin.
13. A system comprising the apparatus of claim 1 and a wedge-shaped implant for disposition in a wedge-shaped opening created in the tibia when the cut made along the cutting plane is opened.
14. A system according to claim 13 wherein the wedge-shaped implant comprises a plurality of components.
15. A system according to claim 13 wherein a top view of the wedge-shaped implant comprises a U-shaped construction.
16. A system according to claim 13 wherein the wedge-shaped implant includes at least one key for disposition in the at least one keyhole disposed within the tibia.