US-20260124000-A1 - REAL-TIME SUPPORT SYSTEM FOR PERFORMING AT LEAST ONE BONE TUNNEL BY ARTHROSCOPY

US20260124000A1US 20260124000 A1US20260124000 A1US 20260124000A1US-20260124000-A1

Abstract

A system for assisting in real time in the production of at least one bone tunnel by arthroscopy in a joint of a patient, including an imaging device able to acquire two-dimensional images of portions of the joint of the patient, a first monitoring device and a programmable device.

Inventors

Christian Lutz
Bertrand SONNERY-COTTET
Pierre Imbert
Yvon GAUTIER
ROMAIN BENOIT

Assignees

AREAS

Dates

Publication Date: 20260507
Application Date: 20231023
Priority Date: 20221024

Claims (20)

1 - 14 . (canceled)
15 . A system for assisting with a production of at least one bone tunnel by arthroscopy in a joint of a patient using a surgical piercing instrument, the system comprising an imaging device or a measuring device, a monitoring device and a programmable device, said programmable device adapted to: obtain a preoperative three-dimensional anatomical model specific to the patient, said preoperative three-dimensional anatomical model comprising a representation of at least one portion of interest of the joint of the patient and a representation of anatomical structures of interest, acquire monitoring information of a current position and orientation of the surgical piercing instrument I P (t) during a manipulation of said surgical piercing instrument using the monitoring device; determine a peroperative partial three-dimensional anatomical model comprising a representation of the at least one portion of interest of the joint, by: acquiring, using the imaging device, a stream of peroperative two-dimensional images comprising said at least one portion of interest of the joint, and acquiring monitoring information of the current position and orientation D I (t) of the imaging device using the monitoring device; wherein said peroperative partial three-dimensional anatomical model is obtained from the stream of peroperative two-dimensional images and said monitoring information of the current position and orientation D I (t), or acquiring, using the measuring device, a cloud of points representative of the at least one portion of interest of the joint, and acquiring monitoring information of the current position and orientation of said measuring device; wherein said peroperative partial three-dimensional anatomical model is obtained from said cloud of points; register the preoperative three-dimensional anatomical model on the peroperative partial three-dimensional anatomical model; and calculate, based on at least information obtained with the registering of the preoperative three-dimensional anatomical model, and of the current position and orientation Ip(t) of the surgical piercing instrument: a current zone L of localization, in a current peroperative two-dimensional image I(t), of a piercing end of the surgical piercing instrument, a first projection P A comprising a current estimation of a zone of localization of a first orifice of a bone tunnel to be produced, and a second projection P B comprising a current estimation of a zone of localization of a second orifice of a bone tunnel to be produced.
16 . The system according to claim 15 , wherein the programmable device is further adapted to calculate at least one of: in the first projection P A , first projections of a first part of the representation of the anatomical structures of interest during an operation phase, or in the second projection P B , second projections of a second part of the representation of the anatomical structures of interest.
17 . The system according to claim 16 , wherein the anatomical structures of interest comprise bone reliefs, cartilaginous boundaries, and tendinous or ligamentous structures.
18 . The system according to claim 16 , further comprising a visualization unit and further adapted to display on the visualization unit: a superimposition of the current peroperative two-dimensional image I(t) and of the current zone L of localization of the piercing end of the surgical piercing instrument, a first superimposition of the first projection P A and of the first projections of the first part of the representation of the anatomical structures of interest, and a second superimposition of the second projection P B and of the second projections of the second part of the representation of the anatomical structures of interest.
19 . The system according to claim 15 , further adapted to, before obtaining the preoperative three-dimensional anatomical model, obtain and store a plurality of preoperative two-dimensional images comprising the portion of interest of the joint.
20 . The system according to claim 18 , further adapted to calculate at least one of a first intersection between the current estimation of the zone of localization of the first orifice with the first projections of the first part of the representation of the anatomical structure of interest or a second intersection between the current estimation of the zone of localization of the second orifice with the second projections of the second part of the representation of the anatomical structures of interest.
21 . The system according to claim 20 , further adapted, when the first intersection or the second intersection comprises a portion of the first projections of the first part of the representation of the anatomical structures of interest or a portion of the second projections of the second part of the representation of the anatomical structures of interest respectively, to display an information message on the first superimposition or the second superimposition respectively.
22 . The system according to claim 18 , further adapted to, after a production of a first bone tunnel in the joint of the patient, calculate a three-dimensional representation of the first bone tunnel and calculate, on the first projection P A and the second projection P B a current projection of a first and a second two-dimensional view of said three-dimensional representation of the first bone tunnel respectively.
23 . The system according to claim 22 , further adapted to display, on the first projection P A , the first two-dimensional view and, on the second projection P B , the second two-dimensional view.
24 . The system according to claim 22 , further adapted to calculate at least one of a first intersection between the current estimation of the zone of localization of the first orifice and the first two-dimensional view or a second intersection between the current estimation of the zone of localization of the second orifice and the second two-dimensional view.
25 . The system according to claim 24 , further adapted, when the first intersection or the second intersection comprises at least one portion of the first two-dimensional view or at least one portion of the second two-dimensional view respectively, to display an information message on the first superimposition or the second superimposition respectively.
26 . A computer-implemented method for assisting with a production of at least one bone tunnel by arthroscopy in a joint of a patient using a surgical piercing instrument, said method comprising: obtaining a preoperative three-dimensional anatomical model specific to the patient, said preoperative three-dimensional anatomical model comprising a representation of at least one portion of interest of the joint of the patient and a representation of anatomical structures of interest, acquiring monitoring information of a current position and orientation of the surgical piercing instrument I P (t) during a manipulation of said surgical piercing instrument using a monitoring device; determining a peroperative partial three-dimensional anatomical model, comprising a representation of said at least one portion of interest of the joint, by: acquiring, using an imaging device, a stream of peroperative two-dimensional images comprising said at least one portion of interest of the joint, and acquiring monitoring information of the current position and orientation D I (t) of the imaging device using the monitoring device; wherein said peroperative partial three-dimensional anatomical model is obtained from the stream of peroperative two-dimensional images and said monitoring information of the current position and orientation D I (t), or acquiring, using a measuring device, a cloud of points representative of the at least one portion of interest of the joint, and acquiring monitoring information of the current position and orientation of said measuring device; wherein said peroperative partial three-dimensional anatomical model is obtained from said cloud of points, registering the preoperative three-dimensional anatomical model on the peroperative partial three-dimensional anatomical model; and calculate, information obtained with the registering of the preoperative three-dimensional anatomical model, and of the current position and orientation Ip(t) of the surgical piercing instrument: a current zone L of localization, in a current peroperative two-dimensional image I(t), of a piercing end of the surgical piercing instrument, a first projection P A comprising a current estimation of a zone of localization of a first orifice of a bone tunnel to be produced, and a second projection P B comprising a current estimation of a zone of localization of a second orifice of a bone tunnel to be produced.
27 . A non-transitory computer-readable medium on which a computer program product comprising instructions to execute the steps of the method according to claim 26 is recorded.
28 . A computer program product including instructions for implementing the method of claim 26 , when the computer program product is executed by a processor.
29 . The system of claim 15 , wherein the measuring device is mounted on a robotic arm.
30 . The system of claim 15 , wherein acquiring monitoring information of the current position and orientation of the surgical piercing instrument I P (t) and the current position and orientation DI(t) of the imaging device is performed at least in part by triangulation.
31 . The system of claim 15 , wherein the peroperative two-dimensional images of the stream of peroperative two-dimensional images are monocular images.
32 . The system of claim 15 , wherein the peroperative partial three-dimensional anatomical model obtained from the stream of the peroperative two-dimensional images is obtained in substantially real time.
33 . The method of claim 26 , further comprising calculating at least one of: in the first projection P A , first projections of a first part of the representation of the anatomical structures of interest during an operation phase, or in the second projection P B , second projections of a second part of the representation of the anatomical structures of interest.

Description

FIELD OF THE INVENTION The present invention relates to assistance in surgery by arthroscopy. More particularly, the invention relates to a system for real-time assistance in producing at least one bone tunnel in a joint of a patient during surgery. STATE OF THE ART Ligament reconstruction surgeries of the knee are operations that consist in replacing one or more ligaments of the knee joint, connecting the femur to the tibia with a strip of tendinous tissue, which will constitute the neoligament, taken from the patient (autografting) or, more rarely, taken post-mortem from donors (allografting). The surgeon will then produce a bone tunnel in the femur and a bone tunnel in the tibia and position these tunnels in the insertions of the injured ligament, and then pass the graft into these tunnels before securing it. Two major types of ligaments can be distinguished. First of all, there are intra-articular ligaments that connect the femur to the tibia by passing through the articular space of the knee, a space defined and delimited by the articular capsule. The other category of ligament relates to extra-articular ligaments, located at the periphery of the knee and that connect the knee to the tibia without passing through the articular space. Intra-articular ligaments are ligaments that are easily identifiable and individualizable. In particular they can be observed by means of an arthroscope, i.e. by introducing a mini camera into the articular space through a mini incision (arthroscopic door). In contrast, extra-articular ligaments are located at the periphery of the joint, and are “bonded” to the articular capsule. These ligaments are therefore not observable under arthroscopy and are difficult to identify and individualise. During surgery, locating these extra-articular ligaments and in particular the bone insertions thereof to reconstruct them requires the making of wide incisions and a lengthy dissection step. Some extra-articular ligaments that are very fine and bonded to the articular capsule, such as for example the anterolateral ligament or the medial femoral-patellar ligament, are almost not identifiable by dissection. Placement of bone tunnels in the native insertion of the ligaments is therefore not always possible for certain structures and in certain cases when such insertion has been altered during trauma (such as for example the femoral insertion of the anterior cruciate ligament —ACL, which is often injured during rupture of the latter). Moreover, it is often necessary, during the same operation, to position several bone tunnels. Indeed, medical imaging studies of the last years have made it possible to demonstrate that isolated rupture of the anterior cruciate ligament (ACL) is in fact rare and in the majority of cases is accompanied by a lesion of a very specific extra-articular ligament, the anterolateral ligament (ALL). Reconstruction of the ACL and of the ALL is today indicated for the majority of patients. Thus, in rare cases of serious sprain of the knee, several intra-and extra-articular ligaments are injured and must be reconstructed. Currently, mechanical sights help in the positioning of bone tunnels during a surgical operation of the knee for reconstructing intra-articular ligaments. The principle is based on the placing of a guide pin on which the tunnel will next be pierced by means of a cannulated bit. In a first so-called ‘IN OUT’ sighting technique, the femoral pin is placed from the inside towards the outside of the joint. In this technique, the exiting of the tunnel on the external part of the bone is not controlled and is susceptible to cause iatrogenic lesions. Moreover, this technique does not allow the positioning of the grafts for reconstructing the extra-articular ligaments such as the anterolateral ligament. In a second so-called ‘OUT IN’ sighting technique, the pin is placed from the outside towards the inside of the joint. This technique makes it possible to make sightings with the knee at 90 degrees of bending. For these OUT INsights, the point of entry on the outside of the bone is made percutaneously (i.e. through the skin) and the zone is selected after palpation of the bone relief (here, the lateral epicondyle). Positioning this entry point by palpation therefore remains unreliable and unreproducible. There are moreover computer-aided sighting systems providing supplementary information to the surgeon by using in real time an imaging technique, such as radioscopy, during the operation and projecting points acquired by means of a sensor onto the knee of the patient in real time on this imaging. However, radioscopy during surgery is an irradiant process. Also, this sighting system only takes into account the positioning of the intra-articular tunnels and allows neither a precise positioning of the extra-articular orifice nor achieving the precise positioning of the extra-articular grafts. There is thus in the prior art no system making it possible to meet the new