# US 2016/0256293 A1 · Surgical method and instrumentation assembly for positioning an ankle prosthesis

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- Number: US 2016/0256293 A1
- Document ID: US20160256293A1
- Status: Published application
- Kind: A1
- Application number: 15/044,441
- Filed: 2016-02-16
- Published: 2016-09-08
- Earliest claimed: 2015-03-06
- Assignees: Tornier SAS
- Applicants: Tornier, Inc.
- Inventors: Richard Garret Mauldin; Yann Brunnarius; Delphine Henry
- Web page: https://patentgrep.com/patent/US20160256293A1

## CPC

- A61F 2/4606: {of wrists or ankles; of hands, e.g. fingers; of feet, e.g. toes}
- A61B 17/15: Guides therefor
- A61B 17/1739: {specially adapted for particular parts of the body}
- A61F 2/4657: {Measuring instruments used for implanting artificial joints (for surgical instruments A61B90/06)}
- A61B 17/1775: {for the foot or ankle}
- A61B 2090/376: {using X-rays, e.g. fluoroscopy}
- A61B 2090/3937: {Visible markers}
- A61B 2090/3966: {Radiopaque markers visible in an X-ray image}
- A61F 2/4202: {for ankles}
- A61F 2/4603: {for insertion or extraction of endoprosthetic joints or of accessories thereof}
- A61F 2002/30884: {Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity}
- A61F 2002/30891: {Plurality of protrusions}
- A61F 2002/30902: {laterally or radially}
- A61F 2002/4205: {Tibial components}
- A61F 2002/4207: {Talar components}
- A61F 2002/4668: {for measuring angles}
- A61F: FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS (dental prosthetics A61C)
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

This surgical ankle repair method comprises the steps of providing an instrumentation assembly for positioning an ankle prosthesis, the instrumentation assembly including a talar alignment instrument and a cutting block, the talar alignment instrument comprising a front portion and two fins extending from the ends of the front portion, said fins being adapted to be positioned in gutters extending below a tibia of a patient and around a trochlea of a talus of the patient, each fin including a reference marker, the cutting block comprising a tibial alignment structure and a recess which engages a protrusion provided on the talar alignment instrument, positioning the talar alignment instrument such that the fins are disposed in the gutters extending below the tibia and around the trochlea of the talus; aligning the talar alignment instrument so that the fins are parallel to the rotational plane of the talus, perpendicular to the rotational axis of the talus, and so that the reference markers are aligned with a longitudinal axis of the tibia; confirming alignment of the reference markers via imaging technology; mechanically attaching the talar alignment instrument to the talus; fastening the cutting block to the talar alignment instrument such that the recess engages the protrusion locked in a parallel orientation to the rotational plane of the talus; rotating the talus such that the tibial alignment structure is in a parallel alignment to the longitudinal axis of the tibia, thereby correcting any varus or valgus deformity of the talus; attaching the tibial alignment structure to the tibia; and performing a first resection of the talus and at least one resection of the tibia using the cutting block.

## Claims

### Claim 1

A surgical ankle repair method comprising the steps of:
a) providing an instrumentation assembly for positioning an ankle prosthesis, the instrumentation assembly including a talar alignment instrument and a cutting block, the talar alignment instrument comprising a front portion and two fins extending from the ends of the front portion, said fins being adapted to be positioned in gutters extending below a tibia of a patient and around a trochlea of a talus of the patient, each fin including a reference marker, the cutting block comprising a tibial alignment structure and a recess which engages a protrusion provided on the talar alignment instrument,
b) positioning the talar alignment instrument such that the fins are disposed in the gutters extending below the tibia and around the trochlea of the talus;
c) aligning the talar alignment instrument so that the fins are parallel to the rotational plane of the talus, perpendicular to the rotational axis of the talus, and so that the reference markers are aligned with a longitudinal axis of the tibia;
d) confirming alignment of the reference markers via imaging technology;
e) mechanically attaching the talar alignment instrument to the talus;
f) fastening the cutting block to the talar alignment instrument such that the recess engages the protrusion locked in a parallel orientation to the rotational plane of the talus;
g) rotating the talus such that the tibial alignment structure is in a parallel alignment to the longitudinal axis of the tibia, thereby correcting any varus or valgus deformity of the talus;
h) attaching the tibial alignment structure to the tibia; and
i) performing a first resection of the talus and at least one resection of the tibia using the cutting block.

### Claim 2 (depends on 1)

The surgical method of claim 1, wherein the imaging technology is selected from the group consisting of X-ray, CT, and MR imaging.

### Claim 3 (depends on 1)

The surgical method of claim 1, wherein the method comprises, after step i), a further step j) consisting in inserting, in at least one hole drilled in the talus at step e) for inserting screws adapted to mechanically attach the talar alignment instrument to the talus, a positioning element for positioning a cutting guide for performing a second resection of the talus.

### Claim 4 (depends on 3)

The surgical method of claim 3, wherein the at least one resection performed on the talus at step i) is a posterior chamfer, and wherein at step j) the cutting guide for performing the second resection is also positioned against the posterior chamfer.

### Claim 5 (depends on 4)

The surgical method of claim 4, wherein the method comprises, after step j), a further step k) consisting in positioning, on the surface of the second resection, a cutting guide for performing a third resection of the talus, which forms with the second resection an anterior chamfer.

### Claim 6 (depends on 1)

The surgical method of claim 1, wherein the talar alignment instrument is used to align a second cutting guide for performing a second resection of the talus.

### Claim 7 (depends on 6)

The surgical method of claim 6, wherein the second cutting guide remains on the talus surface, the talar alignment instrument is removed and a third cutting guide is placed on the second cutting guide to perform a third resection of the talus which forms with the second resection an anterior chamfer.

### Claim 8 (depends on 1)

The surgical method of claim 1, wherein at least one hole drilled in the talus at step e) for inserting screws adapted to mechanically attach the talar alignment instrument to the talus is used for drilling a hole destined to receive an anchoring peg of a talus implant.

### Claim 9 (depends on 1)

The surgical method of claim 1, wherein the talar alignment instrument is mechanically attached to the talus using at least two screws.

### Claim 10 (depends on 1)

The surgical method of claim 1, wherein the reference markers of the fins mark a direction perpendicular to the fins.

### Claim 11

A surgical ankle replacement method comprising the steps of:
a) placing a talar alignment instrument on the talus,
b) positioning the talar alignment instrument on the talus,
c) aligning a reference marker provided on the talar alignment instrument,
d) mechanically attaching the talar alignment instrument to the talus,
e) fastening a cutting block to the talar alignment instrument,
f) locking a relative position of the cutting block and the tibia,
g) performing, using the cutting block, at least one resection of a lower surface of the tibia and at least one resection of a top surface of the talus.

### Claim 12 (depends on 11)

The surgical ankle replacement method of claim 11, wherein at step b) the talar alignment instrument is positioned relative to a rotational plane of the talus and to a rotational axis of the talus.

### Claim 13 (depends on 11)

The surgical ankle replacement method of claim 11, wherein at step c) the reference marker allows matching of the instrument's axis and radii to the talus's radii and axis.

### Claim 14

A surgical instrumentation assembly for positioning an ankle prosthesis, the ankle prosthesis including a tibia implant and a talus implant, wherein the instrumentation assembly comprises:
a talar alignment instrument adapted to be placed on a talus of a patient, and relative to the rotational plane of the talus, and centered on the rotational axis of the talus, and perpendicular to the rotational plane of the talus and mechanically attached to the talus,
a cutting block adapted to be fastened to the talar alignment instrument and locked with respect to a tibia of the patient.

### Claim 15 (depends on 14)

The surgical instrumentation assembly of claim 14, wherein the talar alignment instrument comprises a front portion and two fins extending from the ends of the front portion, said fins being adapted to be positioned in gutters extending below the tibia and around a trochlea of the talus.

### Claim 16 (depends on 15)

The surgical instrumentation assembly of claim 15, wherein the front portion comprises holes for inserting screws for mechanically attaching the talar alignment instrument to the talus.

### Claim 17 (depends on 15)

The surgical instrumentation assembly of claim 15, wherein the front portion comprises a protruding portion adapted to be received in a recess of the cutting block, the recess and the protruding portion being configured to prevent relative displacement of the talar alignment instrument and the cutting block, and locking parallel to the rotational plane of the talus.

### Claim 18 (depends on 17)

The surgical instrumentation assembly of claim 17, wherein the recess and the protruding portion are complementary shaped.

### Claim 19 (depends on 15)

The surgical instrumentation assembly of claim 15, wherein the fins of the talar alignment instrument are provided with reference markers adapted to mark a direction perpendicular to the fins, and adapted to be aligned with the longitudinal axis of the tibia, and aligned to the rotational axis of the talus.

### Claim 20 (depends on 19)

The surgical instrumentation assembly of claim 19, wherein the reference markers are elongated slots.

### Claim 21 (depends on 14)

The surgical instrumentation assembly of claim 14, wherein the cutting block comprises a tibial alignment structure adapted to be aligned with the longitudinal axis of the tibia and mechanically attached to the tibia.

### Claim 22 (depends on 14)

The surgical instrumentation assembly of claim 14, wherein the cutting block is configured to permit the cutting of at least one surface or hole on the top surface of the talus and cutting of at least one surface or hole in the distal portion of the tibia.

### Claim 23 (depends on 22)

The surgical instrumentation assembly of claim 22, wherein the assembly further comprises one or several cutting guides configured to permit the cutting of additional surfaces or holes on the top surface of the talus, and wherein said cutting guides are adapted to be positioned against prior cut surfaces or holes.

### Claim 24 (depends on 23)

The surgical instrumentation assembly of claim 23, wherein at least one of the cutting guides for cutting additional surfaces or holes comprises at least one positioning shape adapted to be positioned against a screw inserted in a hole previously drilled in the talus for inserting a screw for mechanically attaching the talar alignment instrument to the talus.

### Claim 25 (depends on 23)

The surgical instrumentation assembly of claim 23, wherein at least one of the cutting guides for the cutting additional surfaces comprises of at least one positioning shape adapted to be positioned against the talar alignment instrument attached to the talus.