Methods and instruments for subchondral treatment of osteoarthritis in a small joint

Abstract

Devices, instruments and associated methods for the subchondral treatment of osteoarthritis in small joints are provided. In addition, a method for treating joint pain in small joints is provided. These small joints may be ankle, elbow or wrist joints. The methods may target one of many different access points having trajectories with a common focal point at or near the small joint. The instruments may limit access to areas within or near the small joint by providing predefined entry paths that avoid damage to surrounding tissues.

What is claimed is: 
     
         1 . A method for treating joint pain, the method comprising:
 identifying a subchondral defect in a subchondral region of a bone of a joint;   providing a guide instrument having portals representing predefined trajectories for accessing an internal area of the bone, wherein at least one or more of the trajectory paths intersects at a focal point;   selecting a subchondral access path to a location near the subchondral defect;   selecting a portal of the guide instrument corresponding to the selected subchondral access path; and   treating the subchondral defect, via the selected portal of the guide instrument, while preserving the articular surface of the bone.   
     
     
         2 . The method of  claim 1 , wherein the subchondral defect is a bone marrow lesion, bone marrow edema or insufficiency fracture. 
     
     
         3 . The method of  claim 1 , wherein the joint is a small joint selected from the group consisting of ankle joint, elbow joint, wrist joint, and shoulder joint. 
     
     
         4 . The method of  claim 3 , wherein the joint is an ankle joint, and the bone is a talus, calcaneous, or tibial bone. 
     
     
         5 . The method of  claim 1 , wherein treating the subchondral defect comprises injecting in the bone, via the selected subchondral access path, a bone hardening material. 
     
     
         6 . The method of  claim 5 , wherein the bone hardening material comprises a bone cement, bone void filler, or bone substitute material. 
     
     
         7 . The method of  claim 1 , wherein treating the subchondral defect comprises implanting a reinforcing member that stabilizes the subchondral defect. 
     
     
         8 . A guide instrument for delivering an instrument to a subchondral region of a joint, the instrument comprising:
 a guide frame comprising at least one opening for receiving a fixation element;   a detachable alignment bar connectable to the guide frame; and   a guide ring comprising a plurality of openings for receiving therethrough an instrument or tool to the subchondral region of the joint, wherein each opening provides a predefined trajectory path into the subchondral region, at least one or more of the trajectory paths intersecting at a focal point.   
     
     
         9 . The guide instrument of  claim 8 , wherein the alignment bar includes a notched arm and the guide frame includes a notched tab for detachably receiving the notched arm. 
     
     
         10 . The guide instrument of  claim 8 , wherein the guide ring includes a notched arm and the guide frame includes a notched tab for detachably receiving the guide ring. 
     
     
         11 . The guide instrument of  claim 8 , wherein the fixation element comprises a fixation pin. 
     
     
         12 . The guide instrument of  claim 8 , wherein the guide frame comprises a plurality of openings. 
     
     
         13 . The guide instrument of  claim 12 , wherein one of he openings is configured as an elongate slot. 
     
     
         14 . The guide instrument of  claim 12 , further being configured for use with an ankle joint. 
     
     
         15 . A guide instrument for delivering an instrument to a subchondral region of a joint, the instrument comprising:
 a main body having a generally wedge shape with a first end extending into a first flange and a second end extending into a second flange, each of said first and second flanges having one or more openings for receiving an instrument for insertion into the subchondral region of the joint to be treated;   wherein the openings of the first flange are elongated slots.   
     
     
         16 . The guide instrument of  claim 15 , further including visual markers on the main body. 
     
     
         17 . The guide instrument of  claim 15 , further including a projection from a corner of the main body, the projection extending into a third flange, the third flange further including one or more openings. 
     
     
         18 . The guide instrument of  claim 5 , further being formed of a radiolucent material. 
     
     
         19 . The guide instrument of  claim 18 , wherein the visual markers are formed of radiopaque material. 
     
     
         20 . The guide instrument of  claim 15 , further being configured for use with an ankle joint.