# US 2019/0167259 A1 · Instruments and methods for complete plantar plate repairs

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- Number: US 2019/0167259 A1
- Document ID: US20190167259A1
- Status: Published application
- Kind: A1
- Application number: 16/270,949
- Filed: 2019-02-08
- Published: 2019-06-06
- Earliest claimed: 2012-01-06
- Assignees: Arthrex, Inc.
- Applicants: Arthrex, Inc.
- Inventors: Michael J. Coughlin; Lowell F. Weil, Jr.; Paul S. Shurnas; Jesse G. Moore; William Michael Karnes
- Web page: https://patentgrep.com/patent/US20190167259A1

## CPC

- A61B 17/025: {Joint distractors}
- A61B 17/0206: {with antagonistic arms as supports for retractor elements}
- A61B 17/0483: {Hand-held instruments for holding sutures (A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30)}
- A61B 17/0485: {Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet}
- A61B 17/2909: {Handles}
- A61B 17/8866: {for gripping or pushing bones, e.g. approximators (joint distractors A61B17/025)}
- A61B 90/06: {Measuring instruments not otherwise provided for}
- A61F 2/0811: {Fixation devices for tendons or ligaments}
- A61B 17/0469: {Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery}
- A61B 17/151: {for corrective osteotomy}
- A61B 17/1686: {for the hand or wrist}
- A61B 2017/0023: {disposable}
- A61B 2017/06076: {helically or spirally coiled}
- A61B 2017/061: {hollow or tubular}
- A61B 2090/061: {for measuring dimensions, e.g. length}
- A61F 2/4225: {for feet, e.g. toes}
- A61F 2002/4233: {for metatarso-phalangeal joints, i.e. MTP joints}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- 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)

## Abstract

Surgical repair systems and techniques for plantar plate repairs. The surgical repair systems and methods reconstruct the plantar plate through a dorsal incision. The surgical repair system embodies a variety of instruments that provide visualization and access to the plantar plate using suture to complete the repair. The repair system may include some or all of the following instruments: a metatarsal head pusher employed in open surgical space, to move the “capital fragment” in a controlled manner; a suture retriever instrument and a suture retriever funnel (sleeve); a suture passer such as a Mini Scorpion DX and accompanying needle, or a variety of shaped Micro Suture Lassos; a measuring guide; and a small joint distractor.

## Claims

### Claim 1

A method of plantar plate repair, comprising:
performing a longitudinal incision to expose a metatarsophalangeal joint;
distracting the metatarsophalangeal joint to expose a plantar plate,
wherein distracting the metatarsophalangeal joint includes spreading a distractor to move a first k-wire that is positioned in a metatarsal bone and a second k-wire that is positioned within a phalangeal bone away from one another, thereby exposing the plantar plate;
passing a suture through the plantar plate;
removing the distractor;
drilling a hole through the phalangeal bone;
passing the suture through the hole; and
tying a knot in the suture to complete the plantar plate repair,
wherein the distractor includes a first handle, a first arm that extends from the first handle, a second handle, a second arm that extends from the second handle, and a pivot pin extending through the first arm and the second arm,
wherein each of the first handle and the second handle includes a finger opening disposed at a proximal most end of the distractor.

### Claim 2 (depends on 1)

The method as recited in claim 1, comprising:
performing an osteotomy to the metatarsal bone prior to distracting the metatarsophalangeal joint.

### Claim 3 (depends on 2)

The method as recited in claim 2, comprising:
pushing a capital fragment of the metatarsal bone in a direction away from the metatarsophalangeal joint.

### Claim 4 (depends on 2)

The method as recited in claim 2, comprising:
fixating the osteotomy with at least one fixation device.

### Claim 5 (depends on 4)

The method as recited in claim 4, wherein the at least one fixation device is a screw.

### Claim 6 (depends on 1)

The method as recited in claim 1, comprising:
passing a second suture through the plantar plate.

### Claim 7 (depends on 1)

The method as recited in claim 1, wherein the first-wire and the second k-wire are positioned within passages formed through the distractor.

### Claim 8 (depends on 7)

The method as recited in claim 7, wherein the passages are formed through housings of the distractor.

### Claim 9 (depends on 8)

The method as recited in claim 8, wherein the first k-wire and the second k-wire are received within either proximal passages or distal passages of the housings.

### Claim 10 (depends on 8)

The method as recited in claim 8, wherein the housings are enlarged relative to the first arm and the second arm.

### Claim 11 (depends on 8)

The method as recited in claim 8, wherein the housings are disposed at distal ends of the first arm and the second arm.

### Claim 12 (depends on 1)

The method as recited in claim 1, comprising:
releasing the plantar plate from the phalangeal bone prior to passing the suture through the plantar plate.

### Claim 13 (depends on 1)

The method as recited in claim 1, wherein distracting the metatarsophalangeal joint includes:
spreading the first arm and the second arm of the distractor apart to move the metatarsal bone and the phalangeal bone apart from one another, thereby exposing the plantar plate.

### Claim 14 (depends on 1)

The method as recited in claim 1, wherein the finger opening is an oblong shaped finger opening.

### Claim 15

A method of plantar plate repair, comprising:
performing a longitudinal incision to expose a metatarsophalangeal joint;
distracting the metatarsophalangeal joint to expose a plantar plate,
wherein distracting the metatarsophalangeal joint includes spreading a distractor to move a first k-wire that is positioned in a metatarsal bone and a second k-wire that is positioned within a phalangeal bone away from one another, thereby exposing the plantar plate;
wherein the distractor includes a first handle, a first arm that extends from the first handle, a second handle, and a second arm that extends from the second handle,
wherein each of the first handle and the second handle includes a finger opening disposed at a proximal most end of the distractor and a pivot pin extending through the first arm and the second arm,
wherein each of the first arm and the second arm includes a housing that is enlarged relative to the first arm and the second arm,
wherein the first k-wire is positioned through the housing of the first arm and the second k-wire is positioned through the housing of the second arm when distracting the metatarsophalangeal joint;
passing a suture through the plantar plate;
drilling a hole through the phalangeal bone;
passing the suture through the hole; and
tying a knot in the suture to complete the plantar plate repair.

### Claim 16 (depends on 15)

The method as recited in claim 15, wherein the first k-wire is positioned in the metatarsal bone before positioning the second k-wire in the phalangeal bone.

### Claim 17 (depends on 15)

The method as recited in claim 15, wherein the first k-wire is positioned in the metatarsal bone after positioning the second k-wire in the phalangeal bone.

### Claim 18 (depends on 1)

The method as recited in claim 1, wherein the first k-wire is positioned in the metatarsal bone before positioning the second k-wire in the phalangeal bone.

### Claim 19 (depends on 1)

The method as recited in claim 1, wherein the first k-wire is positioned in the metatarsal bone after positioning the second k-wire in the phalangeal bone.