Implants/Procedures Related to Tibial Tuberosity Advancement

Abstract

A tibial tuberosity advancement (TTA) system is configured to maintaining a tuberosity in an advanced position relative to a tibial body. The TTA system includes an implant, a spacer, and a spacer fixation member.

What is claimed: 
     
         1 . A TTA system configured to maintain a tuberosity in an advanced position relative to a tibial body, the advanced position being spaced cranially with respect to a first position when the tuberosity is integral with the tibial body, the TTA system comprising:
 an implant that includes an implant body, the implant body defining a proximal end portion that is configured to support the tuberosity in the advanced position, a distal end portion that is configured to be attached to the tibial body, and an intermediate implant portion that extends between the proximal end portion and distal end portion, the intermediate portion shaped so as to space the proximal end portion cranially with respect to the distal end portion a distance sufficient so as to maintain the tuberosity in the advanced position;   a spacer configured and sized to fit at least partially within a gap disposed between the tuberosity and the tibial body when the distal end portion and the proximal end portion are attached to the tibial body and the tuberosity, respectively, the spacer including a spacer body, the spacer defining a slot that extends through the spacer body; and   a spacer fixation member that includes a first end portion configured to be attached to the tuberosity, a second end portion that is configured to be attached to the tibial body, and an intermediate fixation portion extending between the first end and the second end, the intermediate fixation portion configured and sized to be at least partially received in the slot so as to couple the spacer fixation member to the spacer.   
     
     
         2 . The TTA system according to  claim 1 , wherein the proximal end portion defines a plurality of fastener holes each configured to receive a fastener so as to attach the distal end portion to the tibial body. 
     
     
         3 . The TTA system according to  claim 1 , wherein the distal end portion defines a plurality of fastener holes each configured to receive a fastener so as to attach the proximal end portion to the tuberosity. 
     
     
         4 . The TTA system according to  claim 1 , wherein the first end portion defines at least one fastener hole that is configured to receive a fastener so as to attach the first end portion to the tuberosity. 
     
     
         5 . The TTA system according to  claim 1 , wherein the second end portion defines at least one fastener hole that is configured to receive a fastener so as to attach the second end portion to the tibial body. 
     
     
         6 . The TTA system according to  claim 1 , wherein the slot is a first slot, and the spacer defines a plurality of second slots that extend into the spacer body so as to permit bone growth when the spacer is disposed in the gap. 
     
     
         7 . The TTA system according to  claim 6 , wherein spacer body is elongate along a longitudinal direction, and the second slots are each angled relative to the longitudinal direction. 
     
     
         8 . The TTA system according to  claim 1 , wherein the first end portion is angularly offset relative to the second end portion. 
     
     
         9 . The TTA system according to  claim 1 , wherein the spacer includes a plurality of resilient tines, each of the resilient tines configured to be moved toward one another when the spacer is disposed in the gap such that at least a portion of the spacer conforms to a shape of the gap. 
     
     
         10 . The TTA system according to  claim 9 , wherein the spacer includes a spacer body, the spacer defines at least one first fastener hole that is configured to receive a fastener, the at least one fastener hole extends into the spacer body, the intermediate fixation portion defines at least one second fastener hole, and the fastener is configured to be inserted through the at least one second fastener hole and into the at least one fastener hole to couple the spacer fixation member to the spacer. 
     
     
         11 . The TTA system according to  claim 9 , wherein the spacer includes a spacer body that defines an upper surface and an opposed lower surface, and the lower surface defines a substantially concave shape to facilitate movement of the resilient tines toward each other when the spacer is disposed in the gap. 
     
     
         12 . The TTA system according to  claim 1 , wherein the proximal end portion is elongate along a first axis and the distal end portion is elongate along a second axis and the first axis and the second are angularly offset with respect to each other. 
     
     
         13 . The TTA system according to  claim 1 , wherein the implant body includes a first surface configured to face the tibial body and the tuberosity, and a second surface opposite the first surface, the implant body further defining a first thickness measured from the first surface to the second surface in the proximal end portion, a second thickness measured from the first surface to the second surface in the distal end portion, and a third thickness measured from the first surface to the second surface in the intermediate implant portion, wherein the third thickness is less than at least one of the first and second thicknesses. 
     
     
         14 . The TTA system according to  claim 13 , wherein the third thickness is less than both the first and second thicknesses. 
     
     
         15 . The TTA system according to  claim 1 , wherein the implant body includes a first side surface and a second side surface opposite the first side surface, the implant body further defining a first width measured from the first side surface to the second side surface in the proximal end portion, a second width measured from the first side surface to the second side surface in the distal end portion, and a third width measured from the first side surface to the second side surface in the intermediate implant portion, wherein the first width is less than at least one of the second and third widths. 
     
     
         16 . The TTA system according to  claim 15 , wherein the first width is less than both the second and third widths. 
     
     
         17 . The TTA system according to  claim 1 , wherein the implant body includes a first surface configured to face the tibial body and the tuberosity, and a second surface opposite the first surface, the implant body further includes a scalloped portion extending out from the first surface, the scalloped portion including a peripheral side wall and a raised surface configured to face the tibial body and the tuberosity. 
     
     
         18 . The TTA system according to  claim 17 , wherein the scalloped portion is a first scalloped portion, the implant body further comprising a second scalloped portion, wherein the peripheral side walls of the first and second scalloped portions define a gap between a portion of the peripheral side walls that face each other. 
     
     
         19 . The TTA system according to  claim 1 , further comprising a TTA advancement assembly configured to advance the tuberosity from a first position to the advanced position relative to the tibial body after an osteotomy has been made between the tuberosity and the tibial body, the TTA advancement assembly comprising:
 an advancement body configured to be coupled to the tibial body; and   a distraction arm movably coupled to the advancement body, the distraction arm configured to be coupled to the tuberosity, such that the distraction arm is configured to move along with the tuberosity relative to the tibial body.   
     
     
         20 . The TTA system according to  claim 19 , wherein as the distraction arm moves relative to the advancement body, the advancement assembly provides an indication of how far the tuberosity has advanced from the first position toward the advanced position. 
     
     
         21 . The TTA system according to  claim 20 , wherein advancement assembly further comprises a displacement scale coupled to the advancement body, the displacement scale configured to provide the indication. 
     
     
         22 . The TTA system according to  claim 19 , further comprising an angular adjustment member coupled to the advancement body at an attachment location of the advancement body, wherein the angular adjustment member is configured to pivot relative to a pivot axis defined by the attachment location, the angular adjustment member including a contact member that is configured to fit in a gap defined by the osteotomy and disposed between the tuberosity and the tibial body. 
     
     
         23 . A TTA advancement assembly configured to advance a tuberosity from a first position to an advanced position relative to a tibial body after an osteotomy has been made between the advanced tuberosity and the tibial body, the advanced position being spaced cranially and proximally with respect to the first position when the tuberosity is integral with the tibial body, the TTA advancement assembly comprising:
 an advancement body that is configured to be coupled to the tibial body; and   a distraction arm movably coupled to the advancement body, the distraction arm configured to be coupled to the tuberosity, wherein the distraction arm is configured to move along with the tuberosity relative to the tibial body, such that the distraction arm moves a predetermined distance relative to the advancement body,   wherein translation of the distraction arm the predetermined distance causes the advancement assembly to provide an indication that the tuberosity has advanced from the first position to the advanced position.   
     
     
         24 . The TTA advancement assembly according to  claim 23 , further comprising a displacement scale that is configured to provide the indication that the tuberosity has advanced from the first position to the advanced position, wherein the displacement scale is coupled to the advancement body, the displacement scale is disposed substantially parallel to the distraction arm so as to measure the translation of the distraction arm when the distraction arm is moved relative to the advancement body. 
     
     
         25 . The TTA advancement assembly according to  claim 23 , further comprising an angular adjustment member coupled to the advancement body at an attachment location of the advancement body, wherein the angular adjustment member is configured to pivot relative to a pivot axis defined by the attachment location, the angular adjustment member includes a contact member that is configured to fit in a gap defined by the osteotomy and disposed between the tuberosity and the tibial body such that the distraction arm is oriented at a predetermined advancement angle relative to the osteotomy. 
     
     
         26 . The TTA advancement assembly according to  claim 25 , wherein the angular adjustment member is configured to be angularly fixed relative to the advancement body. 
     
     
         27 . The TTA advancement assembly according to  claim 23 , further comprising an implant that is configured to be attached to the tuberosity and the tibial body, and the implant being configured to be coupled to the distraction arm such that movement of the distraction arm relative to the advancement body causes at least apportion of the implant to move along with the tuberosity relative to the tibial body. 
     
     
         28 . The TTA advancement assembly according to  claim 27 , further comprising a drill guide that is configured to be attached to the implant, and the distraction arm define a drill guide hole that is configured to receive the drill guide so that the drill guide is configured to be coupled to the distraction arm and the implant when the drill guide is inserted through the drill guide hole and is attached to the implant. 
     
     
         29 . The TTA advancement assembly according to  claim 23 , wherein the advancement body defines an opening configured to receive a wire such that the advancement body can be coupled to the tibial body when the wire is inserted through the opening and into the tibial body. 
     
     
         30 . The TTA advancement assembly according to  claim 23 , wherein the advancement body is configured as a jig. 
     
     
         31 . A TTA method to configured to advance a tuberosity from a first position to an advanced position relative to a tibial body after an osteotomy has been made between the advanced tuberosity and the tibial body, the advanced position being spaced cranially and proximally with respect to the first position when the tuberosity is integral with the tibial body, the method comprising:
 coupling an advancement body to the tuberosity via a distraction arm that is movably coupled to the advancement body, the distraction arm configured to move relative to the advancement body;   placing a contact member that is coupled to the advancement body in a gap formed during the osteotomy, the gap disposed between the tuberosity and the tibial body;   moving the distraction arm relative to the advancement body to move the tuberosity between the first position and the advanced position.   
     
     
         32 . A TTA advancement assembly configured to advance a tuberosity from a first position to an advanced position relative to a tibial body after an osteotomy has been made between the advanced tuberosity and the tibial body, the advanced position being spaced cranially and proximally with respect to the first position when the tuberosity is integral with the tibial body, the TTA advancement assembly comprising:
 an advancement body that is configured to be coupled to the tibial body; and   an angular adjustment member pivotally coupled to the advancement body such that the angular adjustment member is configured to pivot relative to the advancement body about a pivot axis, the angular adjustment member including a contact member that is configured to fit in a gap defined by the osteotomy, wherein the angular adjustment member is configured to be pivotally fixed relative to the advancement body such that advancement body is oriented at a predetermined advancement angle relative to the osteotomy when the contact member is disposed in the osteotomy.   
     
     
         33 . The TTA advancement assembly according to  claim 32 , further comprising a distraction arm movably coupled to the advancement body, the distraction arm configured to be coupled to the tuberosity, wherein the distraction arm is configured to translate to move along with the tuberosity relative to the tibial body, such that the distraction arm moves a predetermined distance relative to the advancement body. 
     
     
         34 . The TTA advancement assembly according to  claim 32 , wherein the angular adjustment member includes an angular scale that is configured to determine when the angular adjustment member is oriented at the predetermined advancement angle relative to the osteotomy. 
     
     
         35 . The TTA advancement assembly according to  claim 32 , wherein advancement body is configured as a jig. 
     
     
         36 . The TTA advancement assembly according to  claim 32 , wherein the contact member defines a substantially planar configuration. 
     
     
         37 . The TTA advancement assembly according to  claim 36 , wherein the contact member is configured as a blade.