U.S. patent application number 16/268833 was filed with the patent office on 2019-08-01 for arthroscopic surgical device.
This patent application is currently assigned to MININVASIVE LTD.. The applicant listed for this patent is MININVASIVE LTD.. Invention is credited to Boaz HARARI, Raphael MELOUL, Arnon MOUSAIUF, Ronen RAZ, Mordechai SHOLEV.
Application Number | 20190231345 16/268833 |
Document ID | / |
Family ID | 51579392 |
Filed Date | 2019-08-01 |
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United States Patent
Application |
20190231345 |
Kind Code |
A1 |
SHOLEV; Mordechai ; et
al. |
August 1, 2019 |
ARTHROSCOPIC SURGICAL DEVICE
Abstract
An arthroscopic bone channel forming and suturing method
including forming a first generally straight channel in a bone,
forming a second generally straight channel in the bone, the second
generally straight channel not intersecting the first generally
straight channel, inserting a curved needle into the first
generally straight channel, inserting a suture through the second
generally straight channel in the bone to a suture pick-up
location, manipulating the curved needle to form a curved junction
between the first generally straight channel and the second
generally straight channel; and pulling the suture by the curved
needle from the suture pick-up location through the junction and
though the first generally straight channel.
Inventors: |
SHOLEV; Mordechai; (Amikam,
IL) ; MELOUL; Raphael; (Caesarea, IL) ;
MOUSAIUF; Arnon; (Atlit, IL) ; HARARI; Boaz;
(Haifa, IL) ; RAZ; Ronen; (Magal, IL) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
MININVASIVE LTD. |
Magal |
|
IL |
|
|
Assignee: |
MININVASIVE LTD.
Magal
IL
|
Family ID: |
51579392 |
Appl. No.: |
16/268833 |
Filed: |
February 6, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14766490 |
Aug 7, 2015 |
10206672 |
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PCT/IL2014/050299 |
Mar 18, 2014 |
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16268833 |
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61802958 |
Mar 18, 2013 |
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61887561 |
Oct 7, 2013 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/0469 20130101;
A61B 17/06066 20130101; A61B 17/0482 20130101; A61B 2017/00353
20130101; A61B 17/062 20130101; A61B 2090/0811 20160201; A61B
17/06166 20130101; A61B 17/1604 20130101; A61B 17/0485 20130101;
A61B 2017/00349 20130101; A61B 17/1615 20130101 |
International
Class: |
A61B 17/04 20060101
A61B017/04; A61B 17/062 20060101 A61B017/062; A61B 17/06 20060101
A61B017/06; A61B 17/16 20060101 A61B017/16 |
Claims
1. An arthroscopic bone channel forming and suturing method
comprising: forming a first generally straight channel in a bone;
inserting a curved needle into said first generally straight
channel; forming a second generally straight channel in said bone,
said second generally straight channel not intersecting said first
generally straight channel; inserting a suture through said second
generally straight channel in said bone to a suture pick-up
location; manipulating said curved needle to form a curved junction
between said first generally straight channel and said second
generally straight channel; and pulling said suture by said curved
needle from said suture pick-up location through said junction and
though said first generally straight channel.
2. An arthroscopic bone channel forming and suturing method
according to claim 1 and wherein said inserting said suture
comprises locating a folded over end of said suture at said suture
pick-up location.
3. An arthroscopic bone channel forming and suturing method
according to claim 1 and wherein free ends of said suture extend
outside of said second channel.
4. An arthroscopic bone channel forming and suturing method
according to claim 1 and wherein said second generally straight
channel is substantially longer than said first generally straight
channel.
5. An arthroscopic bone channel forming and suturing method
according to claim 1 and wherein said curved needle has a radius of
curvature which is generally equal to or greater than a length of
said first generally straight channel.
6. An arthroscopic bone channel forming and suturing method
according to claim 1 and wherein the geometry of said curved needle
and the geometry of said first generally straight channel are such
that said curved needle can pass through said first generally
straight channel without changing the configuration of said first
generally straight channel to add curvature thereto.
7. An arthroscopic bone channel forming and suturing method
according to claim 6 and wherein said geometry of said curved
needle includes its width and its inner and outer radii of
curvature and wherein said geometry of said first generally
straight channel includes its width and its length.
8-9. (canceled)
10. An arthroscopic bone channel forming and suturing method
comprising: forming a first channel in a bone; inserting a curved
needle into said first channel; forming a second channel in said
bone by using a straight drill extending through a straight working
channel; removing said drill from said working channel; inserting a
suture through said working channel extending through said second
channel in said bone to a suture pick-up location; and pulling said
suture by said curved needle from said suture pick-up location
though said first channel.
11. An arthroscopic bone channel forming and suturing method
according to claim 10 and also comprising forming a single incision
in a patient's body for insertion and removal of said curved needle
and said drill.
12. An arthroscopic bone channel forming and suturing method
according to claim 11 and wherein: said inserting a suture
comprises locating a folded over portion of said suture at said
suture pick-up location; and free ends of said suture remain
outside of said incision.
13. An arthroscopic bone channel forming and suturing method
according to claim 10 and wherein said second channel is
substantially longer than said first channel.
14. An arthroscopic bone channel forming and suturing method
according to claim 10 and wherein said curved needle has a radius
of curvature which is generally equal to or greater than a length
of said first channel.
15. An arthroscopic bone channel forming and suturing method
according to claim 10 and wherein the geometry of said curved
needle and the geometry of said first channel are such that said
curved needle can pass through said first channel without changing
the configuration of said first channel to add curvature
thereto.
16. An arthroscopic bone channel forming and suturing method
according to claim 15 and wherein said geometry of said curved
needle includes its width and its inner and outer radii of
curvature and wherein said geometry of said first channel includes
its width and its length.
17-23. (canceled)
Description
REFERENCE TO RELATED APPLICATIONS
[0001] Reference is made to the following U.S. Provisional Patent
Application which are believed to be related to the present
application, the contents of which are hereby incorporated by
reference herein and priority of which is hereby claimed under 37
CFR 1.78(a)(4) and (5)(i):
[0002] U.S. Provisional Patent Application Ser. No. 61/802,958,
entitled "Arthroscopic Surgical Device" and filed Mar. 18,
2013.
[0003] U.S. Provisional Patent Application Ser. No. 61/887,561,
entitled "Arthroscopic Surgical Device" and filed Oct. 7, 2013.
[0004] Reference is also made to the following PCT Patent
Applications and U.S. Provisional Applications which are believed
to be related to the present application, the contents of which are
hereby incorporated by reference herein:
[0005] PCT Patent Application No. PCT/IL2013/050030, entitled
"Arthroscopic Surgical Device" and filed Jan. 15, 2013;
[0006] PCT Patent Application No. PCT/IL2012/00031.8, entitled
"Arthroscopic Surgical Device" and filed Aug. 23, 2012;
[0007] PCT Patent Application No. PCT/IL2012/000319, entitled
"Circular Bone Tunneling Device Employing a Stabilizing Element"
and filed Aug. 23, 2012;
[0008] Published PCT Patent Application No. WO 2012/007941,
entitled "Circular Bone Tunneling Device" and filed Jul. 11,
2011;
[0009] U.S. Provisional Patent Application Ser. No. 61/636,751,
entitled "Circular Bone Tunneling Device Employing a Stabilizing
Element" and filed Apr. 23, 2012;
[0010] U.S. Provisional Patent Application Ser. No. 61/526,717,
entitled "Circular Bone Tunneling Device" and filed Aug. 24,
2011;
[0011] U.S. Provisional Patent Application Ser. No. 61/714,81 3,
entitled "Arthroscopic Surgical Device" and filed Oct. 17, 2012;
and
[0012] U.S. Provisional Patent Application Ser. No. 61/584,267,
entitled "Circular Bone Tunneling Device" and filed Jan. 8,
2012.
FIELD OF THE INVENTION
[0013] The present invention relates generally to arthroscopic
surgical devices and more particularly to arthroscopic bone
tunneling devices.
BACKGROUND OF THE INVENTION
[0014] Various types of arthroscopic surgical instruments are known
for various applications including orthopedic surgery.
SUMMARY OF THE INVENTION
[0015] It is appreciated that the terms `tunnel` and `channel` are
used interchangeably in the description of the present invention
and refer to a hollow bore, such as a cylindrically circular hollow
bore, formed in a bone. It is also appreciated that the terms
`tunneling` and `channeling` are used interchangeably in the
description of the present invention and refer to a method of
forming a hollow bore, such as a cylindrically circular hollow
bore, in a bone.
[0016] It is further appreciated that the term "suture" as used
throughout the description of the present invention refers to any
suitable suture and also refers to a transfer wire which is used to
pull a suture through the bone. Typically, a transfer wire is used
with the system and method of the present invention and is formed
of Nitinol. Typically, a transfer wire used with the system and
method of the present invention is folded over to form a loop at
one end.
[0017] The present invention seeks to provide an improved
arthroscopic bone tunneling and suturing device.
[0018] There is thus provided in accordance with a preferred
embodiment of the present invention an arthroscopic bone channel
forming and suturing method including forming a first generally
straight channel in a bone, inserting a curved needle into the
first generally straight channel, forming a second generally
straight channel in the bone, the second generally straight channel
not intersecting the first generally straight channel, inserting a
suture through the second generally straight channel in the bone to
a suture pick-up location, manipulating the curved needle to form a
curved junction between the first generally straight channel and
the second generally straight channel and pulling the suture by the
curved needle from the suture pick-up location through the junction
and though the first generally straight channel.
[0019] Preferably, the inserting the suture includes locating a
folded over end of the suture at the suture pick-up location.
Additionally or alternatively, free ends of the suture extend
outside of the second channel.
[0020] In accordance with a preferred embodiment of the present
invention the second generally straight channel is substantially
longer than the first generally straight channel.
[0021] Preferably, the curved needle has a radius of curvature
which is generally equal to or greater than a length of the first
generally straight channel. Additionally or alternatively, the
geometry of the curved needle and the geometry of the first
generally straight channel are such that the curved needle can pass
through the first generally straight channel without changing the
configuration of the first generally straight channel to add
curvature thereto. Additionally, the geometry of the curved needle
includes its width and its inner and outer radii of curvature and
wherein the geometry of the first generally straight channel
includes its width and its length.
[0022] There is also provided in accordance with another preferred
embodiment of the present invention an arthroscopic bone channel
forming and suturing system including a punch configured to form a
first generally straight channel in a bone, a drill configured to
form a second generally straight channel in the bone, the second
generally straight channel not intersecting the first generally
straight channel, a curved needle configured to be insertable into
the first generally straight channel, a needle driving assembly
configured to manipulate the curved needle to form a curved
junction between the first generally straight channel and the
second generally straight channel and a suture assembly configured
to insert a suture to a suture pick-up location via the second
generally straight channel in the bone, the curved needle being
configured to pull the suture from the suture pick up location and
through the junction and the first generally straight channel.
[0023] Preferably, the curved needle has a radius of curvature
which is generally equal to or greater than a length of the first
generally straight channel.
[0024] There is further provided in accordance with yet another
preferred embodiment of the present invention an arthroscopic bone
channel forming and suturing method including forming a first
channel in a bone, inserting a curved needle into the first
channel, forming a second channel in the bone by using a straight
drill extending through a straight working channel, removing the
drill from the working channel, inserting a suture through the
working channel extending through the second channel in the bone to
a suture pick-up location and pulling the suture by the curved
needle from the suture pick-up location though the first
channel.
[0025] Preferably, the method also includes forming a single
incision in a patient's body for insertion and removal of the
curved needle and the drill. Additionally, the inserting a suture
includes locating a folded over portion of the suture at the suture
pick-up location and free ends of the suture remain outside of the
incision.
[0026] In accordance with a preferred embodiment of the present
invention the second channel is substantially longer than the first
channel.
[0027] Preferably, the curved needle has a radius of curvature
which is generally equal to or greater than a length of the first
channel. Additionally or alternatively, the geometry of the curved
needle and the geometry of the first channel are such that the
curved needle can pass through the first channel without changing
the configuration of the first channel to add curvature thereto.
Additionally, the geometry of the curved needle includes its width
and its inner and outer radii of curvature and wherein the geometry
of the first channel includes its width and its length.
[0028] There is even further provided in accordance with still
another preferred embodiment of the present invention an
arthroscopic bone channeling and suturing system including a punch
configured to form a first channel in a bone, a straight drill
extending through a straight working channel and being adapted to
form a second channel and to insert the working channel in the
straight channel in the bone, a needle driving assembly configured
to insert a tunneling needle into the first channel and a suture
assembly configured to insert a suture through the working channel
and through the second channel in the bone to a suture pick-up
location, the needle driving assembly being configured to retract
the tunneling needle together with the suture from the suture
pick-up location though the first channel.
[0029] Preferably, the drill is removable from the working channel
to allow insertion of the suture assembly into the working channel.
Additionally or alternatively, the drill is formed with a drill bit
configuration at a forward end thereof.
[0030] In accordance with a preferred embodiment of the present
invention the suture assembly includes a pair of forward arms and
the suture looped over the pair of forward arms.
[0031] In accordance with a preferred embodiment of the present
invention the needle driving assembly is configured to drive the
tunneling needle through the bone from the first channel to the
suture pick-up location.
[0032] Preferably, the tunneling needle includes a suture
engagement groove configured to retain the suture and pull the
suture from the suture pick-up location through the first channel.
Additionally, the arthroscopic bone channeling and suturing device
also includes a suture tensioning assembly and the suture is
configured to slide into engagement with the suture engagement
groove by tension provided by the tensioning assembly.
BRIEF DESCRIPTION OF THE DRAWINGS
[0033] The present invention will be understood and appreciated
from the following detailed description, taken in conjunction with
the drawings in which:
[0034] FIGS. 1A & 1B are simplified pictorial illustrations of
an arthroscopic surgical assembly constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views;
[0035] FIGS. 2A & 2B are simplified pictorial illustrations of
an arthroscopic surgical device forming part of the arthroscopic
surgical assembly of FIGS. 1A & 1B, constructed and operative
in accordance with a preferred embodiment the present invention,
showing opposite views in a first operative orientation;
[0036] FIGS. 3A & 3B are simplified pictorial illustrations of
an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a second operative orientation;
[0037] FIGS. 4A & 4B are simplified pictorial illustrations of
an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views third operative orientation;
[0038] FIGS. 5A & 5B are simplified pictorial illustrations of
an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a fourth operative orientation;
[0039] FIGS. 6A & 6B are simplified pictorial illustrations of
an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a fifth operative orientation;
[0040] FIGS. 7A & 7B are simplified pictorial illustrations of
an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a sixth operative orientation;
[0041] FIGS. 8A & 8B are simplified pictorial illustrations of
an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a seventh operative orientation;
[0042] FIGS. 9A & 9B are simplified pictorial illustrations of
an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in an eighth operative orientation;
[0043] FIGS. 10A & 10B are simplified pictorial illustrations
of an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a ninth operative orientation;
[0044] FIGS. 11A & 11B are simplified pictorial illustrations
of an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a tenth operative orientation;
[0045] FIGS. 12A & 12B are simplified pictorial illustrations
of an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in an eleventh operative orientation;
[0046] FIGS. 13A & 13B are simplified pictorial illustrations
of an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a twelfth operative orientation;
[0047] FIGS. 14A & 14B are simplified pictorial illustrations
of an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in an thirteenth operative orientation;
[0048] FIGS. 15A & 15B are simplified pictorial illustrations
of an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a fourteenth operative orientation;
[0049] FIGS. 16A & 16B are simplified pictorial illustrations
of an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a fifteenth operative orientation;
[0050] FIGS. 17A & 17B are simplified pictorial illustrations
of an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a sixteenth operative orientation;
[0051] FIGS. 18A & 18B are simplified pictorial illustrations
of an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment of the present invention,
showing opposite views in a seventeenth operative orientation;
[0052] FIGS. 19A and 19B are respectively a simplified partially
exploded view illustration of part of the arthroscopic surgical
device of FIGS. 1A-18B in the first operative orientation and a
fully exploded view illustration of a portion of the part of the
device shown in FIG. 19A;
[0053] FIG. 19C is a simplified illustration of another part of the
arthroscopic surgical device of FIGS. 1A-19B;
[0054] FIGS. 19D and 19E are simplified illustrations, from two
different perspectives, of another part of the arthroscopic
surgical device of FIGS. 1A-19B;
[0055] FIG. 19F is a simplified sectional view of a portion of the
arthroscopic surgical device of FIGS. 1A-19B.
[0056] FIGS. 20A and 20B are simplified exploded view illustrations
of a portion of the arthroscopic surgical device of FIGS. 1A-19F,
showing opposite views;
[0057] FIG. 20C is a simplified partially assembled view of the
portion of the arthroscopic surgical device of FIGS. 20A and
20B;
[0058] FIGS. 20D and 20E are simplified illustrations of the
apparatus of FIGS. 20A-20C in two different operative
orientations;
[0059] FIGS. 21A and 21B are simplified illustrations of another
portion of the arthroscopic surgical device of FIGS. 1A-19C,
showing opposite views;
[0060] FIGS. 22A and 22B are simplified exploded view illustrations
of the portion of the arthroscopic surgical device of FIGS. 21A
& 21B, showing opposite views;
[0061] FIGS. 23A and 23B are simplified illustrations of part of
the portion of the arthroscopic surgical device of FIGS. 21A &
21B;
[0062] FIGS. 24A and 24B are simplified assembled view
illustrations of a drill portion of the arthroscopic surgical
device of FIGS. 1A-19C, showing opposite views;
[0063] FIGS. 25A and 25B are simplified assembled view
illustrations of a suture cartridge portion of the arthroscopic
surgical device of FIGS. 1A-24B, showing opposite views;
[0064] FIG. 25C is a simplified exploded view illustration of the
suture cartridge portion of the arthroscopic surgical device shown
in FIGS. 25A and 25B;
[0065] FIG. 25D is a simplified side view illustration of the
suture cartridge portion of the arthroscopic surgical device shown
in FIGS. 25A-25C;
[0066] FIGS. 26A and 26B are simplified assembled view
illustrations of a working channel portion of the arthroscopic
surgical device of FIGS. 1A-25D, showing opposite views;
[0067] FIG. 26C is a simplified exploded view illustration of the
working channel portion of the arthroscopic surgical device shown
in FIGS. 26A and 26B;
[0068] FIGS. 27A, 27B, 27C, 27D, 27E, 27F, 27G, 27H, 27I, 27J, 27K,
27L, 27M, 27N, 27O, 27P, 27Q and 27R are respective simplified
illustrations of details of the operation of the arthroscopic
surgical device of FIGS. 1A-26C; and
[0069] FIGS. 28A, 28B, 28C, 28D, 28E, 28F, 28G, 28H, 28I, 28J, 28K,
28L, 28M, 28N, 28O, 28P, 28Q, 28R, 28S, 28T, 28U, 28V, 28W and 28X
are simplified illustrations of operation of the arthroscopic
surgical device of FIGS. 1A-27R in a clinical context.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
[0070] It is appreciated that the terms `tunnel` and `channel` are
used interchangeably in the description of the present invention
and refer to a hollow bore, such as a cylindrically circular hollow
bore, formed in a bone. It is also appreciated that the terms
`tunneling` and `channeling` are used interchangeably in the
description of the present invention and refer to a method of
forming a hollow bore, such as a cylindrically circular hollow
bore, in a bone.
[0071] It is further appreciated that the term "suture" as used
throughout the description of the present invention refers to any
suitable suture and also refers to a transfer wire which is used to
pull a suture through the bone. Typically, a transfer wire is used
with the system and method of the present invention and is formed
of Nitinol. Typically, a transfer wire used with the system and
method of the present invention is folded over to form a loop at
one end.
[0072] Reference is now made to FIGS. 1A & 1B, which are
simplified pictorial illustrations of an arthroscopic surgical
assembly, constructed and operative in accordance with a preferred
embodiment of the present invention, showing opposite views, and to
various additional drawings which are specifically referenced in
parentheses hereinbelow.
[0073] As seen in FIG. 1B, there is provided a bone punch 10,
preferably including a handle portion 12, an intermediate portion
14, and a forward portion 16, having a pointed tip 18. A line 20 is
preferably formed on forward portion 16 to indicate a desired
extent of bone penetration to a surgeon using the punch. A
generally concave impact surface 22 is preferably formed on a
rearward end of punch 10, for impact thereon by a surgical
hammer.
[0074] As seen in FIGS. 1A & 1B and shown specifically in FIGS.
2A & 2B, an arthroscopic surgical device 100 according to a
preferred embodiment of the present invention includes a housing
portion, preferably formed of right and left housing elements 102
and 104, and a multiple action driving assembly 106, only part of
which is seen in FIGS. 1A & 1B. The housing portion includes a
handle portion, which is defined by respective right and left
housing element handle portions 112 and 114, respectively.
[0075] The multiple action driving assembly 106 preferably includes
a bone-engaging pin insertion assembly 120, a bone-engaging needle
driving assembly 122 and a selectable attachment assembly 123.
[0076] Bone-engaging pin insertion assembly 120 preferably includes
a working channel assembly 124, which is shown and described in
detail hereinbelow with reference to FIGS. 26A-26C, and a drill
126, which is shown and described in detail hereinbelow with
reference to FIGS. 24A & 24B.
[0077] Referring now additionally to FIGS. 26A-26C, it is seen that
the working channel assembly 124 includes a main longitudinal rigid
tube 128, typically formed of stainless steel, and a hardened
forward tube 130, typically formed of hardened stainless steel,
which fits into a forward end of main rigid tube 128. Preferably,
welded onto a rear end of main tube 128 is a driving socket element
132 having formed, at a rear end thereof, a recess 134, typically
having a hexagonal cross section.
[0078] Driving socket element 132 is rotatably mounted within a
collar member 136, which is shown and described in detail
hereinbelow, with reference to FIGS. 19A & 19B, and which is
mounted onto the housing so as to have limited axial movement with
respect thereto. Driving socket element 132 is restrained against
axial movement relative to collar member 136, preferably by a pair
of retaining pins 138, which extend through transverse apertures
formed in collar member 136 and engage a groove 140 formed in
driving socket element 132.
[0079] Referring now additionally to FIGS. 24A-24B, it is seen that
drill 126 preferably comprises a solid rod 142 of circular cross
section, having a drill bit configuration at a forward end 144
thereof and being formed at a widened rear end 146 thereof with a
hexagonal cross section, such that rear end 146 is suitable for
drivable engagement with a chuck of a conventional surgical drill
(not shown).
[0080] The bone-engaging needle driving assembly 122 preferably
includes a hand-engageable ratchet handle 150 which is arranged for
reciprocal motion about an axis 152 (FIG. 19B). A selectable
direction ratchet shaft 156 (FIG. 19B) extends through slots 158 in
respective right and left housing element handle portions 112 and
114, and terminates in knobs 160, whose positions in slots 158
govern the direction of motion of an arthroscopic arcuate tunneling
needle 162 having a suture engagement groove 164 partially defined
by a needle end portion 165.
[0081] As noted above, it is appreciated that the terms `tunneling`
and `channeling` are used interchangeably in the description of the
present invention and refer to a method of forming a hollow bore,
such as a cylindrically circular hollow bore, in a bone.
[0082] A visible mechanical indicator 166 is preferably arranged on
the top of respective housing portions 102 and 104. Indicator 166
preferably provides a visible indication of the extent that arcuate
tunneling needle 162 is displaced from its fully retracted position
shown in FIGS. 2A & 2B.
[0083] A suture cartridge assembly 170 is provided for selectable
engagement with the housing and is illustrated in FIGS. 25A-25D.
Suture cartridge assembly 170 preferably includes a longitudinal
tube 172 having a specially configured forward end 174. As seen
particularly in FIG. 25C, the forward end 174 is configured to have
a pair of mutually spaced forwardly extending arms 176 which are
each formed with a suture retaining end notch 178 and a suture
retaining side notch 180. A transverse slot 182 is formed
rearwardly of arms 176 to enable a folded over suture 184 which
extends through a longitudinal bore in longitudinal tube 172 to be
looped over arms 176 at notches 178 and 180 as shown in FIG.
25A.
[0084] As noted above, it is appreciated that the term "suture" as
used throughout the description of the present invention refers to
any suitable suture and also refers to a transfer wire which is
used to pull a suture through the bone. Typically, a transfer wire
is used with the system and method of the present invention and is
formed of Nitinol.
[0085] Mounted at a rearward end 185 of tube 172, there is provided
a selectable suture tensioning assembly 186. Assembly 186 includes
an assembly housing 187 onto which is pivotably mounted a
user-operable suture release lever 188, which, in turn, operates a
pivotably mounted release element 189. Release element 189
selectably retains the assembly housing 187 against rearward axial
movement under the urging of a compression spring 190. Frictional
engagement between a screw 191, threaded into engagement with a
retaining member 192, and a transversely extending rod 193
maintains tension on the suture 184 up to a predetermined threshold
force beyond which the ends of the suture 184 become released from
assembly 186. Rod 193 engages a pair of slots 194 on opposite sides
of assembly housing 187 and extends through a transverse aperture
195 in retaining member 192.
[0086] A pivot pin 196 pivotably mounts release lever 188 onto
assembly housing 187. A pusher pin 197, mounted onto release lever
188, engages release element 189 and produces pivoted movement
thereof about a pivot pin 198, fixed to housing 187, in response to
pressing on release lever 188. A latch pin 199, fixed onto assembly
housing 187 selectably engages release element 189.
[0087] The operation of selectable suture tensioning assembly 186
may be summarized as follows. Insertion of the suture cartridge
assembly 170 into engagement with collar member 136 causes release
element 189 to be latched to collar member 136. Downward pushing on
release lever 188 produces pivotal motion of release element 189,
which pushes spring 190 rearwardly against retaining member 192.
This produces retraction of tube 172 and of arms 176 and tensions
the forward folded over end of suture 184 and draws it tightly into
engagement with arcuate tunneling needle 162, which is adapted to
selectably engage suture 184 at needle-suture engagement location
located between arms 176. The free ends of the suture 184
thereafter become released from the suture tensioning assembly 186
in response to retraction of the needle 162 along its arcuate path,
which produces tensile force on the suture 184 which overcomes the
grip between rod 193 and screw 191 produced by spring 190.
[0088] It is appreciated that free ends of suture 184 remain
outside of an incision made in a patient's body before, during and
after the insertion procedure described hereinbelow with reference
to FIGS. 27A-27R and 28A-28X.
[0089] Reference is now made to FIGS. 3A & 3B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-2B in a second operative orientation. It is seen
that the transition from the first operative orientation of FIGS.
2A & 2B to the second operative orientation, which preferably
occurs following insertion of a forward portion of the
bone-engaging needle driving assembly 122 through an arthroscopic
incision, as described hereinbelow with reference to FIGS. 28E and
27B, involves shifting the position of knobs 160 from a lowered
position to a raised position in slot 158.
[0090] Reference is now made to FIGS. 4A & 4B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-3B in a third operative orientation and which
illustrate partial extension of arcuate tunneling needle 162, as
indicated by indicator 166. This extension is produced by rotation
of hand-engageable ratchet handle 150 about axis 152 (FIG. 19B)
when knobs 160 are in the upper position in slots 158. Needle 162
enters a channel earlier formed in a humerus, as will be described
hereinbelow with reference to FIGS. 27C & 28H.
[0091] Reference is now made to FIGS. 5A & 5B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-4B in a fourth operative orientation and which
show insertion of the bone-engaging pin insertion assembly 120
through the housing of the arthroscopic surgical device 100 of
FIGS. 4A & 4B so that tip 144 extends nearly to the surface of
the bone, as described hereinbelow with reference to FIGS. 27D and
28I.
[0092] Reference is now made to FIGS. 6A & 6B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-5B in a fifth operative orientation. It is seen
that the widened rear end 146 of bone-engaging pin insertion
assembly 120 is engaged by the chuck of a surgical drill 200, as
described hereinbelow in detail with reference to FIGS. 27E and
28J.
[0093] Reference is now made to FIGS. 7A & 7B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-6B in a sixth operative orientation. It is seen
that due to operation of surgical drill 200, the forward tip 144 of
the drill 126 is fully extended, as described hereinbelow in detail
with reference to FIGS. 27F and 28K. It is seen that concomitantly,
due to the operation of surgical drill 200, working channel
assembly 124, including collar member 136, has moved to its full
axially forward position with respect to the selectable attachment
assembly 123. It is noted, as will be described hereinbelow, that
collar member 136 is automatically latched to selectable attachment
assembly 123 at this stage.
[0094] Reference is now made to FIGS. 8A & 8B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-7B in a seventh operative orientation. Here it
is seen that the drill 126 is being retracted but that working
channel assembly 124 remains in its full axially forward position,
by virtue of latching of collar member 136 to selectable attachment
assembly 123.
[0095] Reference is now made to FIGS. 9A & 9B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-8B in an eighth operative orientation and
illustrate insertion of the suture cartridge assembly 170 through
the working channel assembly 124. It is noted that selectable
suture tensioning assembly 186 is automatically latched to collar
member 136.
[0096] Reference is now made to FIGS. 10A & 10B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-9B in a ninth operative orientation and which
illustrate full extension of arcuate tunneling needle 162, as
indicated by indicator 166. This extension is produced by rotation
of hand-engageable ratchet handle 150 about axis 152 (FIG. 19B)
when knobs 160 are in the upper position in slots 158.
[0097] It is seen that arcuate tunneling needle 162 extends between
mutually spaced forwardly extending arms 176 of suture cartridge
assembly 170. As noted above, each of arms 176 is formed with a
suture retaining end notch 178 and a suture retaining side notch
180. A transverse slot 182 is formed rearwardly of arms 176 to
enable a folded over suture 184 which extends through a
longitudinal bore in longitudinal tube 172 to be looped over arms
176 at notches 178 and 180 as shown in FIG. 25A. It is further seen
that suture engagement groove 164 lies below mutually spaced
forwardly extending arms 176 of suture cartridge assembly 170.
[0098] Reference is now made to FIGS. 11A & 11B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-10B in a tenth operative orientation. It is seen
that lever 188 is manually depressed, thereby unlatching suture
tensioning assembly 170 from collar member 136 and causing axially
rearward displacement of suture tensioning assembly 170 relative to
collar member 136 and concomitant axial retraction of arms 176 of
suture cartridge assembly 170 relative to working channel 124. It
is seen that suture 184 is looped around needle 162 at a location
on needle 162 lying above suture engagement groove 164.
[0099] Reference is now made to FIGS. 12A & 12B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-11B in an eleventh operative orientation. It is
seen knobs 160 are lowered to their lower position in slots
158.
[0100] Reference is now made to FIGS. 13A & 13B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-12B in a twelfth operative orientation. It is
seen that needle 162 is partially retracted so that it engages
suture 184 at suture engagement groove 164.
[0101] Reference is now made to FIGS. 14A & 14B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-13B in a thirteenth operative orientation. It is
seen that arcuate tunneling needle 162 is fully retracted, as
indicated by indicator 166, in engagement with the forward looped
end of suture 184, thus drawing the suture backwards along an
arcuate path along with full retraction of the needle 162.
[0102] Reference is now made to FIGS. 15A & 15B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-14B in a fourteenth operative orientation. It is
seen that suture cartridge assembly 170 is fully retracted and
withdrawn from the working channel assembly 124, leaving the suture
184 in the working channel assembly 124.
[0103] Reference is now made to FIGS. 16A & 16B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-15B in a fifteenth operative orientation. It is
seen that the working channel assembly 124 is partially axially
retracted by rotation of the selectable attachment assembly 123,
which forces collar member 136 axially rearwardly, thus drawing
hardened forward tube 130 rearwardly out of tight engagement with
the bone.
[0104] Reference is now made to FIGS. 17A & 17B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-16B in a sixteenth operative orientation. It is
seen that working channel assembly 124 is fully retracted and that
the positions of knobs 160 in slots 158 are shifted upwardly, in
order to provide extension of needle 162 in response to operation
of ratchet handle 150. The orientation of the needle 162 is shown
by indicator 166.
[0105] Reference is now made to FIGS. 18A & 18B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-17B in a seventeenth operative orientation. It
is seen that the arcuate tunneling needle 162 is now partially
extended in order to permit manual disengagement of the looped
forward end of suture 184 from suture engagement groove 164 of
needle 162.
[0106] Reference is now made to FIGS. 19A-24B and initially
specifically to FIGS. 19A & 19B and to FIGS. 20A and 20B, which
are simplified exploded view illustrations of a portion of the
arthroscopic surgical device of FIGS. 1A-18B, showing opposite
views, to FIG. 20C, which is a simplified partially assembled view,
and to FIGS. 20D and 20E, which are simplified illustrations of the
apparatus of FIGS. 20A-20C in two different operative orientations,
all of which show details of some elements of multiple action
driving assembly 106.
[0107] It is seen that ratchet handle 150 is typically formed with
a lower aperture 210, which accommodates a shaft 154, and a slot
212. A pin 214 is slidably movable in slot 212, such that
reciprocal arcuate motion of slot 212 is translated into reciprocal
planar forward and rearward motion perpendicular to a longitudinal
axis 216 of pin 214. First and second reciprocal motion connection
elements 220 and 222 are fixed to pin 214 at respective apertures
224 and 226 and move together therewith in reciprocal forward and
rearward linear motion in response to rotational motion of ratchet
handle 150.
[0108] Connection element 222 includes an elongate protrusion 228,
which moves reciprocally in a slot 230 formed in housing portion
102.
[0109] Connection element 220 includes a side extending shaft 240
which is formed with a circumferential groove 244 onto which is
mounted one end of a tension spring 248. An opposite end of tension
spring 248 is mounted in a circumferential groove 250 formed in
shaft 156. Shaft 156 extends through an aperture 254 formed in a
toggle element 256, which communicates with a hollow shaft portion
258 of toggle element 256. Shaft 156 extends through slots 158
formed on respective housing portions 102 and 104.
[0110] A double rack linear toothed element 270 is provided with an
upper linear toothed ratchet rack 272 and a lower linear toothed
gear rack 274. A pointed corner 275 of connection element 220
selectably engages upper linear toothed rack 272. Double rack
linear toothed element 270 is preferably formed with a slot 276
which engages an elongate axial protrusion 277 formed in housing
element 102.
[0111] An inward recessed portion 278 adjacent an inner end of a
generally rigid flexible needle driving strip driving shaft 280 is
fixedly mounted onto double rack linear toothed element 270 by
means of a mounting element 282, which is typically bolted onto
element 270. An indicator finger 284 is formed on mounting element
282 and forms part of indicator 166.
[0112] A second double rack linear toothed element 285 is provided
with an upper linear toothed gear rack 286 and a lower linear
toothed ratchet rack 287. Double rack linear toothed element 285 is
preferably formed with a slot 288, which engages an elongate axial
protrusion 289 formed in housing element 102.
[0113] A gear 290, having a gear shaft 291, engages lower linear
toothed gear rack 274 of element 270 and also simultaneously
engages upper linear toothed gear rack 286 of element 285. Gear
shaft 291 preferably is mounted at its opposite ends in apertures
292 in respective housing elements 102 and 104.
[0114] A pointed corner 293 of connection element 220 selectably
engages lower linear toothed ratchet rack 287 of element 285.
[0115] Reference is now made specifically to FIGS. 19A-19F and
20A-20E, which illustrate the structure of selectable attachment
assembly 123. As seen with particularity in FIGS. 19A, 19C &
19F, the selectable attachment assembly 123 comprises a winged nut
294 having a threaded bore 295 extending therealong from a first
end 296 of nut 294 to a circumferential recess 297 which is spaced
from a second end 298 of nut 294 by a non-threaded bore portion
299.
[0116] As seen in FIGS. 19A and 19D-19F, a connection element 300
is arranged for threaded engagement with threaded bore 295 of
winged nut 294. Connection element 300 includes a first generally
cylindrical portion 301 having a throughgoing axial bore 302 and a
throughgoing bottom slit 303 formed therein. A threaded generally
cylindrical collar portion 304 is located at an intermediate
location along connection element 300 forwardly of first generally
cylindrical portion 301 in the sense of FIG. 19A. A second
generally cylindrical portion 305 is located forwardly of collar
portion 304 and has a cross sectional diameter which is greater
than that of first cylindrical portion and less than that of collar
portion 304.
[0117] Forward of second generally cylindrical portion 305 there
are preferably provided a pair of spaced lugs 306 which are
separated by a vertical recess 307. Connection element 300 also
includes an aperture 308, formed in generally cylindrical portion
301, in which is seated an axial guiding pin 309.
[0118] A latch element 310 includes a forward portion 311, having a
top transverse bore 312 through which extends a transverse pin 313
for pivotable attachment of latch element 310 to connection element
300 via lugs 306. Latch element 310 also includes a rearwardly
facing latch extension portion 314 which is seated in throughgoing
bottom slit 303 and includes a depending latch protrusion 315, at a
rearward end thereof, for removable latched engagement with collar
member 136 of working channel assembly 124.
[0119] Forward portion 311 also includes a bottom transverse bore
316 which accommodates a pin 317, onto which is connected a first
end of a tension spring 318, whose opposite end is connected to a
pin 319 which is mounted at opposite ends thereof at respective
locations 320 in right and left housing elements 102 and 104.
[0120] Transverse pin 313 is mounted at opposite ends thereof at
respective locations 321 in right and left housing elements 102 and
104.
[0121] Forward portion 311 is also formed with an aperture 322 for
accommodating working channel assembly 124, which extends
therethrough.
[0122] Returning now to the description of the working channel
assembly 124 in greater detail and referring now additionally to
FIGS. 26A-26C, as mentioned above, working channel assembly 124
includes a main longitudinal rigid tube 128 and a hardened forward
tube 130. Driving socket element 132 is preferably welded onto a
rear end of main tube 128 and is rotatably mounted within collar
member 136. Driving socket element 132 is restrained against axial
movement relative to collar member 136, preferably by a pair of
retaining pins 138, which extend through transverse apertures
formed in collar member 136 and engage a groove 140 formed in
driving socket element 132.
[0123] Turning specifically to FIG. 26C, it is seen that socket
element 132 is a generally cylindrical element which has a
non-circular driving bore 134, typically of hexagonal cross
section, extending partially therethrough from a rear end 323 of
socket element 132. A narrow bore 324 extends forwardly of driving
bore 134 and extends into a broadened bore 325 which terminates at
a forward circumferential recess 326. External circumferential
recess 140 surrounds part of broadened bore 325.
[0124] Collar member 136 includes a generally cylindrical back
portion 327 having a bore 328 which is intersected by pins 138
extending through transverse apertures 329 in cylindrical back
portion 327. A narrow bore 330 extends forwardly of bore 328 and
communicates with a recess 332. Cylindrical back portion 327 is
also formed with an axial bottom groove 334 having side lobes 336
and communicating with a transverse aperture 337.
[0125] Forward of back portion 327 is a generally cylindrical
forward portion 338 having an axial slot 340 which extends
partially into cylindrical back portion 327 as shown at reference
numeral 342. Axial guiding pin 309 of connection element 300
engages axial slot 340 to ensure proper rotational alignment of
working channel assembly 124 and to ensure proper alignment of
suture cartridge assembly 170.
[0126] The assembly of socket element 132 inside collar member 136
and the mounting therein of main longitudinal rigid tube 128 is
shown in an enlarged sectional portion of FIG. 26A.
[0127] Reference is now made specifically to FIGS. 21A-24B, which
illustrate bone-engaging needle driving assembly 122. The
bone-engaging needle driving assembly 122 includes linear gear rack
element 270, which is preferably driven along an elongate travel
path responsive to reciprocal motion of ratchet handle 150.
[0128] Bone-engaging needle driving assembly 122 includes a static
forward portion 400, including a mounting base 402, which extends
forwardly of a forward end of the housing, which is fixed to an
extension shaft 404 extending axially inwardly thereof and
forwardly therefrom. Fixed to extension shaft 404 and extending
forwardly thereof, there is preferably formed an arcuate needle
storage and guiding portion 406.
[0129] Mounting base 402 is generally configured as a hollow
cylinder to accommodate part of extension shaft 404 therewithin and
is formed with matching side apertures 408 which accommodate
mounting pins 410 (FIG. 19B), which serve to mount the mounting
base 402 onto housing portions 102 and 104, as seen in FIG.
19B.
[0130] Extension shaft 404 is preferably formed of two side by side
pieces 411. Side pieces 411 together define two mutually spaced
axial mounting bores extending therethrough, which bores are
designated by reference numerals 412 and 414. Bore 412 slidably
accommodates working channel assembly 124 and has a generally round
cross-section.
[0131] Bore 414 slidably accommodates parts of a flexible arcuate
needle driving assembly, which preferably includes a flexible
needle driving strip 418, preferably formed of spring steel, and
generally rigid flexible needle driving strip driving shaft 280,
which is mounted at the rear of flexible needle driving strip 418,
preferably as shown in enlargements A & B in FIG. 21A. This
mounting is preferably by means of engagement of a protrusion 419
formed adjacent the forward end of rigid flexible needle driving
strip driving shaft 280 with a corresponding aperture 420 formed
adjacent a rearward end of flexible needle driving strip 418.
[0132] As seen in enlargement A of FIG. 21A, bore 414 has a
generally circular cross sectional central portion 422 to
accommodate shaft 280, from which portion extend a pair of
symmetrical side cut outs 424 to accommodate the side edges of
strip 418.
[0133] As seen particularly in enlargement D of FIG. 21A, forward
of extension shaft 404, there is preferably formed an arcuate
needle storage and guiding portion 450, which is formed with an
arcuate bore 452 including a portion 454 having a generally
rectangular cross section, which slidably accommodates needle 162.
A pair of symmetrical side cut outs 456 extend outwardly from
portion 454 and accommodate the side edges of flexible needle
driving strip 418.
[0134] It is also seen in an enlargement of FIG. 22A, that the
forward end of flexible needle driving strip 418 is attached to
arcuate needle 162. This attachment is preferably by means of
engagement of a protrusion 466 formed adjacent the rearward end of
arcuate needle 162 with a corresponding aperture 467 formed
adjacent a forward end of flexible needle driving strip 418.
[0135] Reference is now made to FIGS. 27A, 27B, 27C, 27D, 27E, 27F,
27G, 27H, 27I, 27J, 27K, 27L, 27M, 27N, 27O, 27P, 27Q and 27R,
which illustrate details of the operation of the arthroscopic
surgical device of FIGS. 1A-26C, and to FIGS. 28A, 28B, 28C, 28D,
28E, 28F, 28G, 28H, 28I, 28J, 28K, 28L, 28M, 28N, 28O, 28P, 28Q,
28R, 28S, 28T, 28U, 28V, 28W and 28X, which are simplified
illustrations of operation of the arthroscopic surgical device of
FIGS. 1A-27R in a clinical context.
[0136] Reference is initially made to FIGS. 28A-28D, which show an
initial step of using punch 10 (FIG. 1B) to form a channel 499 in a
bone, such as a humerus. A surgeon positions punch 10 opposite an
appropriate arthroscopic incision 500 in a patient, as shown in
FIGS. 28A and 28B. As seen in FIG. 28C, using a surgical hammer
which impacts on impact surface 22 of punch 10, the surgeon forces
the forward portion 16 of the punch 10 into the humerus up to line
20. The punch is then withdrawn from the patient, leaving channel
499 in the humerus, as shown in FIG. 28D. FIG. 28E illustrates
initial insertion of the arthroscopic surgical device of FIGS. 2A
& 2B, in a first operative orientation, as shown in FIG. 27A,
through an arthroscopic incision 501 adjacent to incision 500.
[0137] Reference is now made to FIGS. 27B and 28F which illustrate
shifting of knobs 160 in slots 158 to their upward positions.
[0138] Reference is now made to FIG. 27C and FIG. 28G, which
correspond to FIGS. 4A & 4B and show extending of the needle
162, by squeezing of handle 150 as indicated by an arrow 502 and
positioning of the extended forward portion of needle 162 in
channel 499 in the humerus. FIG. 28H shows the forward portion of
needle 162 fully inserted in channel 499.
[0139] As seen in FIG. 28C, needle 162 preferably has a radius of
curvature which is generally equal to or greater than a length of
channel 499. Additionally, it is appreciated that the geometry of
needle 162, including its width and inner and outer radii of
curvature, and the geometry of channel 499, including its length
and width, are such that needle 162 can pass through channel 499
without changing the configuration of channel 499 to add curvature
thereto.
[0140] Reference is now made to FIGS. 27D and 28I, which show drill
126, such as that described hereinabove with reference to FIGS. 20A
& 20B, being mounted onto the arthroscopic surgical device 100
and being initially positioned, as indicated by an arrow 503, to a
position wherein the tip 144 touches the outside surface of the
humerus.
[0141] FIGS. 27E and 28J, which correspond generally to FIGS. 6A
& 6B, show attachment of surgical drill 200 to widened rear end
146 of drill 126.
[0142] FIGS. 27F and 28K, which correspond generally to FIGS. 7A
& 7B, show linear forward displacement of drill 126 and working
channel assembly 124 of bone-engaging pin insertion assembly 120 in
the arthroscopic surgical device 100, as indicated by an arrow 504.
This displacement is preferably achieved by operation of the
surgical drill 200 in operative engagement with widened rear end
146 of drill 126. As seen in FIG. 28K, the tip 144 of drill 126 is
in its most forward position and tube 130 is in its most forward
position.
[0143] FIGS. 27G and 28L, which correspond generally to FIGS. 8A
& 8B, show retraction of the drill 126, as indicated by an
arrow 505, while leaving the tube 130 in its most forward
position.
[0144] As seen in FIG. 28L, a channel formed in the humerus by
drill 126 is preferably longer, and more preferably, substantially
longer, than channel 499 formed in the humerus by punch 10. It is
also seen in FIG. 28L that the channel formed in the humerus by
drill 126 does not intersect channel 499.
[0145] Additionally, it is appreciated that the channel formed in
the humerus by drill 126 and channel 499 formed in the humerus by
punch 10 are not parallel channels. Preferably, an angle formed
between the channel formed in the humerus by drill 126 and an
extension of channel 499 formed in the humerus by punch 10 is
generally a right angle or an acute angle greater than
45.degree..
[0146] Reference is now made to FIGS. 27H and 28M, which correspond
generally to FIGS. 9A and 9B and which show insertion of the suture
cartridge assembly 170, including suture 184, in engagement with
the working channel assembly 124, such that arms 176 of suture
cartridge assembly 170 extend forwardly of a forward edge of tube
130.
[0147] Reference is now made to FIGS. 27I and 28N, which correspond
generally to FIGS. 10A & 10B and show full extension of arcuate
tunneling needle 162 through the bone, as indicated by indicator
finger 284 of indicator 166. This full extension is produced by
squeezing of handle 150, as indicated by an arrow 506. It is seen
that this squeezing of hand-engageable ratchet handle 150 produces
rotation thereof, as indicated by arrow 506, about a rotational
axis defined by shaft 154 and, via pin 214, displaces first
reciprocal motion connection element 220 linearly forwardly, as
indicated by an arrow 520, with pointed corner 275 of connection
element 220 in engagement with upper linear toothed rack 272 of
double rack linear toothed element 270, thereby driving element 270
and needle driving strip driving shaft 280 forwardly and causing
arcuate needle 162, driven thereby, to travel along an arcuate path
through the portion 454 of arcuate bore 452 having a rectangular
cross section and to extend outwardly into tunneling engagement
with the bone, as indicated by an arrow 522.
[0148] As seen in FIG. 28N, movement of needle 162 forms a curved
junction between channel 499 and the channel formed by drill
126.
[0149] It is seen that suture engagement groove 164 of arcuate
needle 162, which is partially defined by end portion 165, extends
between arms 176 rearward of a forward end of suture 184.
[0150] Reference is now made to FIGS. 27J and 28O, which correspond
generally to FIGS. 11A & 11B and show partial retraction of the
suture cartridge assembly 170 relative to the working channel
assembly 124, as indicated by an arrow 530, in response to manual
depression of a user-operable suture release lever 188. This
retraction causes the forward folded over end of suture 184 to
press rearwardly against needle 162.
[0151] FIGS. 27K and 28P, which correspond generally to FIGS. 12A
& 12B, show downward repositioning of knob 160, as indicated by
an arrow 532.
[0152] FIGS. 27L and 28Q, which correspond generally to FIGS. 13A
& 13B, show arcuate retraction of arcuate tunneling needle 162,
as indicated by an arrow 534, through the bone, driven by further
squeezing of handle 150 as indicated by an arrow 535. The forward
folded over end of suture 184 is seen to be in engagement with
groove 164 of needle 162, and to be retained therein by end portion
165 of needle 162, such that retraction of the needle 162 pulls the
suture 184 together with it along the arcuate travel path of the
needle 162.
[0153] FIGS. 27M & 28R, which correspond generally to FIGS. 14A
& 14B, show full retraction of arcuate tunneling needle 162 in
engagement with suture 184, thereby pulling suture 184 through the
arcuate passageway being traversed by arcuate needle 162. This
retraction is provided by further squeezing of handle 150, as
indicated by arrow 535. The complete retraction of arcuate
tunneling needle 162 is indicated by indicator finger 284 of
indicator 166. At this stage, suture 184, in doubled-over
configuration, extends entirely through the bone along the arcuate
path tunneled by needle 162 through the curved junction formed in
the bone by needle 162 and through channel 499. At this stage, the
suture 184 is securely retained in engagement with groove 164 of
needle 162.
[0154] FIGS. 27N and 28S, which correspond generally to FIGS. 15A
& 15B, show the arthroscopic surgical device of FIGS. 1A-26C
following complete removal and disengagement of the suture
cartridge assembly 170 and disengagement of the free ends of the
suture 184 therefrom.
[0155] FIGS. 27O and 28T, which correspond generally to FIGS. 16A
& 16B, show partial retraction of tube 130 produced by rotation
of winged nut 294.
[0156] FIGS. 27P and 28U, which correspond generally to FIGS. 17A
& 17B, show complete retraction of tube 130.
[0157] FIG. 28V shows removal of the arthroscopic surgical device
from the body from the patient through incision 501, leaving the
suture 184 extending through the bone.
[0158] FIGS. 27Q and 28W show upward repositioning of knob 160, as
indicated by an arrow 536.
[0159] FIGS. 27R and 28X, which correspond generally to FIGS. 18A
& 18B, show detachment of the suture 184 from arcuate tunneling
needle 162 following extension thereof in response to further
squeezing of handle 150, as indicated by an arrow 538.
[0160] It is appreciated that following detachment of folded over
portion of suture 184 from needle 162 free ends of suture 184 are
pulled through working channel assembly 124. As noted above, it is
appreciated that free ends of suture 184 remain outside of incision
501 before, during and after the insertion procedure described
above with reference to FIGS. 27A-27R and 28A-28X.
[0161] It will be appreciated by persons skilled in the art that
the present invention is not limited by what has been particularly
shown and described hereinabove. Rather the scope of the present
invention includes both combinations and subcombinations of the
various features described hereinabove as well as modifications
thereof which would occur to persons skilled in the art upon
reading the foregoing description and which are not in the prior
art.
* * * * *