Elbow reconstruction instruments

Abstract

Instrumentation for elbow reconstruction, specifically, for repairs of the ulnar collateral ligament (UCL). The instrumentation provides for precise formation of sockets and tunnels along with easy suture/graft passage while accommodating all forms of elbow UCL reconstruction techniques. A V-drill guide is provided with a handle and two drill sleeves having intersecting trajectories for creating an intersecting V-shaped bone tunnel in the ulna. An adjustable humeral guide has an adjustable arm with an arc shape, and a peg and a block extending from each end of the adjustable arm. The peg is shaped to fit within an already-formed humeral socket. The block allows a drill to pass through and form other tunnels which intersect with the originally-formed tunnel at various positions.

What is claimed is: 
     
         1 . A surgical instrument for ulnar collateral ligament reconstruction, comprising:
 an elongated substantially rigid member with a longitudinal axis, a proximal end and a distal end;   a handle located at the proximal end of the elongated member; and   two drill sleeves located at the distal end of the elongated member, the drill sleeves being symmetrically disposed relative to the longitudinal axis of the member and a mirror image of each other, the drill sleeves being non-parallel to the longitudinal axis of the elongated member and forming a structure with a V shaped configuration so that trajectories of the two drill sleeves form an angle of about 50 to about 75 degrees, a distal end of each of the drill sleeves being provided with teeth for gripping bone, and each drill sleeve having a lumen for receiving a drill, obturator, or a pin.   
     
     
         2 . The surgical instrument of  claim 1 , wherein the drill sleeves are positioned on the ulna and a drill is inserted through each sleeve to each drill a tunnel through ulna and form a resulting intersecting bone tunnel. 
     
     
         3 . The surgical instrument of  claim 2 , wherein the drill has a drill stop to limit the depth drilled. 
     
     
         4 . The surgical instrument of  claim 2 , wherein the resulting intersecting bone tunnel has a V-shaped configuration. 
     
     
         5 . The surgical instrument of  claim 4 , wherein openings of the resulting intersecting bone tunnel define a bone bridge on the bone cortex, the bone bridge having a length between the openings of about 5.5 mm to about 7.5 mm. 
     
     
         6 . A V-drill guide for ulnar collateral ligament reconstruction, comprising:
 a handle having a longitudinal axis, a proximal end and a distal; and   two drill sleeves located at the distal end of the handle, wherein the drill sleeves are symmetrically disposed relative to the longitudinal axis of the handle and a mirror image of each other, the drill sleeves being non-parallel to the longitudinal axis of the handle so that each of the drill sleeves forms a first angle with the longitudinal axis of the handle, and wherein the drill sleeves are non-parallel relative to each other and are oriented so that they form a second angle between them.   
     
     
         7 . The V-drill guide of  claim 6 , wherein the first angle is of about 30 to about 45 degrees. 
     
     
         8 . The V-drill guide of  claim 6 , wherein the second angle is of about 50 to about 75 degrees. 
     
     
         9 . An offset guide for forming a through tunnel through the ulna, comprising:
 a cannulated tube extending from a handle, the cannulated tube forming an angle of about ninety degrees with the handle; and   a platform extending from the cannulated tube, the platform forming an angle of about ninety degrees with the cannulated tube, the platform having a generally rectangular configuration and being provided with a bore to allow the cannulated tube to pass therethrough, the platform further including a prong for placement against bone cortex and on the sublime tubercle of the ulna, the prong being about parallel to the cannulated tube.   
     
     
         10 . The offset guide of  claim 9 , wherein the platform extends away from the prong to place the cannulated tube a set distance from the articulating surface of ulna/humerus joint, over the sublime tubercle of the ulna. 
     
     
         11 . The offset guide of  claim 10 , wherein the cannulated tube is sized to allow a drill pin to pass therethrough and drill a tunnel in the ulna at the set distance from the sublime tubercle of the ulna. 
     
     
         12 . An adjustable humeral guide for forming at least one intersecting tunnel through the humerus, comprising:
 an adjustable arm having a proximal end and a distal end, and an arc-shaped configuration;   a peg extending from the distal end of the adjustable arm, the peg being configured and sized to fit within a first humeral tunnel; and   a block extending from the proximal end of the adjustable arm, the block being provided with a bore to allow a drill to pass therethrough and to form at least one second humeral tunnel within the humerus, the at least one second humeral tunnel intersecting the first humeral tunnel at different angles.   
     
     
         13 . The adjustable humeral guide of  claim 12 , wherein the block is configured to pivot and slide relative to the peg, covering various angles relative to the peg. 
     
     
         14 . The adjustable humeral guide of  claim 12 , wherein the block is configured to form a plurality of humeral tunnels within the humerus, each of the plurality of humeral tunnels intersecting the first humeral tunnel at an angle. 
     
     
         15 . The adjustable humeral guide of  claim 12 , wherein the block is configured to form a second humeral tunnel within the humerus, the second humeral tunnel intersecting the first humeral tunnel at a first angle, and a third humeral tunnel, the third humeral tunnel intersecting the first humeral tunnel at a second angle. 
     
     
         16 . A kit for ulnar collateral ligament reconstruction, comprising:
 a V-drill guide for forming an intersecting V-shaped bone tunnel in the ulna, the V-drill guide comprising a handle having a longitudinal axis, a proximal end and a distal end; and two drill sleeves located at the distal end of the handle, wherein the drill sleeves are symmetrically disposed relative to the longitudinal axis of the handle and a mirror image of each other and having intersecting trajectories, the drill sleeves being non-parallel relative to each other and forming an angle of about 50 to about 75 degrees between them;   an adjustable humeral guide for forming a socket or tunnel through the humerus, the adjustable humeral guide comprising an adjustable arm having a proximal end and a distal end, and an arc-shaped configuration; a peg extending from the distal end of the adjustable arm, the peg being configured and sized to fit within a previously-formed socket or tunnel; and a block extending from the proximal end of the adjustable arm, the block being provided with a bore to allow a drill to pass therethrough and to form at least one second socket or tunnel within the humerus, the at least one second socket or tunnel intersecting the previously-formed socket or tunnel at different angles; and   a drill sized to pass through both the two drill sleeves of the V-drill guide and through the bore of the block of the adjustable humeral guide, to form the intersecting V-shaped bone tunnel in the ulna and the at least one second socket or tunnel in the humerus.   
     
     
         17 . The kit of  claim 16 , further comprising an obturator, a reamer, a skid, a wire loop and a suture passing instrument.