U.S. patent application number 16/297838 was filed with the patent office on 2019-09-05 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, Ronen Raz, Moti Sholev.
Application Number | 20190269416 16/297838 |
Document ID | / |
Family ID | 51399242 |
Filed Date | 2019-09-05 |
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United States Patent
Application |
20190269416 |
Kind Code |
A1 |
Sholev; Moti ; et
al. |
September 5, 2019 |
ARTHROSCOPIC SURGICAL DEVICE
Abstract
An arthroscopic bone tunneling and suturing device including a
bone-engaging needle driving assembly including a bone-engaging
needle and being adapted for arthroscopic insertion into engagement
with a patient's bone at a first bone location through an
arthroscopic incision and for driving the needle forwardly along a
generally arcuate tunneling path through the bone at least to a
second bone location and a bone-engaging pin driving assembly
arranged for operative engagement with the bone-engaging needle
driving assembly and being adapted for arthroscopic insertion into
engagement with a patient's bone at a third bone location through
the arthroscopic incision.
Inventors: |
Sholev; Moti; (Amikam,
IL) ; Meloul; Raphael; (Ceasarea, IL) ; Raz;
Ronen; (Magal, IL) ; Harari; Boaz; (Haifa,
IL) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
MININVASIVE LTD. |
Magal |
|
IL |
|
|
Assignee: |
MININVASIVE LTD.
Magal
IL
|
Family ID: |
51399242 |
Appl. No.: |
16/297838 |
Filed: |
March 11, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14370884 |
Jul 7, 2014 |
10231740 |
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PCT/IL13/50030 |
Jan 15, 2013 |
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16297838 |
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61584267 |
Jan 8, 2012 |
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61636751 |
Apr 23, 2012 |
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61714813 |
Oct 17, 2012 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/0469 20130101;
A61B 2017/00367 20130101; A61B 17/1604 20130101; A61B 17/8861
20130101; A61B 17/0482 20130101; A61B 17/1642 20130101; A61B
2017/06052 20130101; A61B 2017/0472 20130101; A61B 2017/06042
20130101; A61B 2017/06104 20130101; A61B 2017/061 20130101; A61B
17/06004 20130101; A61B 2017/00407 20130101; A61B 2090/0811
20160201; A61B 2017/0608 20130101; A61B 2017/2923 20130101 |
International
Class: |
A61B 17/16 20060101
A61B017/16; A61B 17/04 20060101 A61B017/04; A61B 17/88 20060101
A61B017/88 |
Foreign Application Data
Date |
Code |
Application Number |
Aug 23, 2012 |
IL |
PCT/IL2012/000318 |
Aug 23, 2012 |
IL |
PCT/IL2012/000319 |
Claims
1-14. (canceled)
15. A method for tunneling through a bone during arthroscopic
surgery, the method comprising: providing a bone-engaging pin
driving assembly and a bone-engaging needle driving assembly, said
bone-engaging needle driving assembly including a bone-engaging
needle, said needle having an arcuate shape, adapted for
arthroscopic insertion into engagement with said bone at a first
bone location through an arthroscopic incision and for being driven
forwardly through said bone at least to a second bone location;
operatively engaging said bone-engaging pin driving assembly with
said bone-engaging needle driving assembly; inserting said
bone-engaging needle driving assembly through said arthroscopic
incision into engagement with said bone at said first bone
location; inserting said bone-engaging pin driving assembly through
said arthroscopic incision into engagement with said bone at a
third bone location; tunneling through said bone with said
bone-engaging pin driving assembly along a generally linear
tunneling path from said third bone location to said second bone
location; and driving said needle, from said first bone location at
least to said second bone location, with said bone-engaging needle
driving assembly, thereby tunneling through said bone with said
bone-engaging needle and forming a generally arcuate tunnel from
said first bone location at least to said second bone location.
16. A method for tunneling through a bone during arthroscopic
surgery according to claim 15 and also comprising: mounting a
suture on said bone-engaging pin driving assembly prior to said
operatively engaging said bone-engaging pin driving assembly with
said bone-engaging needle driving assembly; and subsequent to said
driving, engaging said suture with said needle at said second bone
location.
17. A method for tunneling through a bone during arthroscopic
surgery according to claim 16 and also comprising, subsequent to
said engaging, retracting said needle, in engagement with said
suture, through said tunnel.
18. A method for tunneling through a bone during arthroscopic
surgery according to claim 17 and further comprising, subsequent to
said retracting said needle, retracting said bone-engaging pin
driving assembly from engagement with said bone.
19. A method for tunneling through a bone during arthroscopic
surgery according to claim 18 and also comprising, subsequent to
said retracting said bone-engaging pin driving assembly: partially
re-extending said needle; and disengaging said suture from said
needle.
20. A method for tunneling through a bone during arthroscopic
surgery according to claim 16 wherein said operatively engaging
also comprises: aligning said bone-engaging pin driving assembly
with said bone-engaging needle driving assembly so that said needle
can engage said suture at said second bone location; and
subsequently axially and rotationally locking said bone-engaging
pin driving assembly to said bone-engaging needle driving assembly.
Description
REFERENCE TO RELATED APPLICATIONS
[0001] Reference is made to the following U.S. Provisional patent
applications 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. 61/584,267,
entitled "Circular Bone Tunneling Device" and filed Jan. 8,
2012;
[0003] U.S. Provisional Patent Application Ser. No. 61/636,751,
entitled "Circular Bone Tunneling Device Employing a Stabilizing
Element" and filed Apr. 23, 2012; and
[0004] U.S. Provisional Patent Application Ser. No. 61/714,813,
entitled "Arthroscopic Surgical Device" and filed Oct. 17,
2012.
[0005] Reference is also made to the following PCT Patent
Applications 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)(1) and (2)(i):
[0006] PCT Patent Application No. PCT/IL2012/000318, entitled
"Arthroscopic Surgical Device" and filed Aug. 23, 2012, the
contents of which are hereby incorporated by reference herein;
and
[0007] PCT Patent Application No. PCT/IL2012/000319, entitled
"Circular Bone Tunneling Device Employing a Stabilizing Element"
and filed Aug. 23, 2012, the contents of which are hereby
incorporated by reference herein.
[0008] Reference is also made to:
[0009] Published PCT Patent Application No. WO 2012/007941,
entitled "Circular Bone Tunneling Device" and filed Jul. 11, 2011,
the contents of which are hereby incorporated by reference herein;
and
[0010] U.S. Provisional Patent Application Ser. No. 61/526,717,
entitled "Circular Bone Tunneling Device" and filed Aug. 24, 2011,
the contents of which are hereby incorporated by reference
herein.
FIELD OF THE INVENTION
[0011] The present invention relates generally to arthroscopic
surgical devices and more particularly to arthroscopic bone
tunneling devices.
BACKGROUND OF THE INVENTION
[0012] Various types of arthroscopic surgical instruments are known
for various applications including orthopedic surgery.
SUMMARY OF THE INVENTION
[0013] The present invention seeks to provide an improved
arthroscopic bone tunneling and suturing device.
[0014] There is thus provided in accordance with a preferred
embodiment of the present invention an arthroscopic bone tunneling
and suturing device including a bone-engaging needle driving
assembly including a bone-engaging needle and being adapted for
arthroscopic insertion into engagement with a patient's bone at a
first bone location through an arthroscopic incision and for
driving the needle forwardly along a generally arcuate tunneling
path through the bone at least to a second bone location and a
bone-engaging pin driving assembly arranged for operative
engagement with the bone-engaging needle driving assembly and being
adapted for arthroscopic insertion into engagement with a patient's
bone at a third bone location through the arthroscopic
incision.
[0015] Preferably, the bone-engaging pin driving assembly is
adapted for mounting a suture thereon and positioning the suture so
that it can be engaged by the needle at the second bone location.
Additionally, the bone-engaging needle driving assembly is also
adapted for retracting the needle, in engagement with the suture,
back along the arcuate tunneling path through the bone from the
second bone location.
[0016] In accordance with a preferred embodiment of the present
invention the bone-engaging pin driving assembly includes at least
one bone tunneling pin which is operative to tunnel through the
bone along a generally linear tunneling path from the third
location to the second location at which the generally linear
tunneling path intersects the generally arcuate tunneling path,
thereby positioning the suture so that it can be engaged by the
needle at the second bone location.
[0017] Preferably, the bone-engaging pin driving assembly is
separate from the bone-engaging needle driving assembly and is
selectably engageable therewith and disengageable therefrom.
[0018] In accordance with a preferred embodiment of the present
invention the bone engaging pin driving assembly includes an inner
pin and an outer, hollow pin in which the inner pin is slidably
disposed. Additionally, the outer hollow pin is formed with a
pointed tip and with a throughgoing aperture.
[0019] Preferably, a suture extends between the inner pin and the
outer pin, the suture being looped about the inner pin interiorly
of the outer pin so as to be engageable by the needle through the
throughgoing aperture. Additionally or alternatively, the
bone-engaging pin driving assembly also includes a base assembly
including a forward portion and a rearward portion, the inner pin
being coupled to the rearward portion and the outer pin being
coupled to the forward portion.
[0020] In accordance with preferred embodiment of the present
invention the outer hollow pin is also formed with a throughgoing
side wall slot for accommodating part of the suture. Additionally,
the suture is wound around a forward end of the inner pin and
between the forward end of the inner pin and the pointed tip and
extends between the inner pin and the outer pin and partially lies
in the throughgoing slot on both sides of the inner pin.
[0021] Preferably, the base assembly selectably lockable to a
housing which encloses part of the bone-engaging needle driving
assembly. Additionally or alternatively, the forward portion and
the rearward portion of the base assembly are selectably lockable
to each other and axially slidable with respect to each other,
thereby to provide limited retractability of the inner pin with
respect to the outer pin.
[0022] In accordance with a preferred embodiment of the present
invention the bone-engaging needle driving assembly includes a
flexible needle driving strip which drives the bone engaging needle
along the arcuate tunneling path through the bone.
[0023] There is also provided in accordance with another preferred
embodiment of the present invention a method for tunneling through
a bone during arthroscopic surgery, the method including providing
a bone-engaging pin driving assembly and a bone-engaging needle
driving assembly, the bone-engaging needle driving assembly
including a bone-engaging needle adapted for arthroscopic insertion
into engagement with a patient's bone at a first bone location
through an arthroscopic incision and for being driven forwardly
along a generally arcuate tunneling path through the bone at least
to a second bone location, operatively engaging the bone-engaging
pin driving assembly with the bone-engaging needle driving
assembly, inserting the bone-engaging needle driving assembly
through the arthroscopic incision into engagement with the bone at
the first bone location, inserting the bone-engaging pin driving
assembly through the arthroscopic incision into engagement with a
patient's bone at a third bone location, tunneling through the bone
with the bone-engaging pin driving assembly along a generally
linear tunneling path from the third bone location to the second
bone location and driving the needle, along the generally arcuate
tunneling path from the first bone location at least to the second
bone location, with the bone-engaging needle driving assembly,
thereby tunneling through the bone with the bone-engaging needle
along the generally arcuate tunneling path from the first bone
location at least to the second bone location.
[0024] Preferably, the method for tunneling through a bone during
arthroscopic surgery also includes mounting a suture on the
bone-engaging pin driving assembly prior to the operatively
engaging the bone-engaging pin driving assembly with the
bone-engaging needle driving assembly and subsequent to the
driving, engaging the suture with the needle at the second bone
location.
[0025] In accordance with a preferred embodiment of the present
invention the method for tunneling through a bone during
arthroscopic surgery also includes subsequent to the engaging,
retracting the needle, in engagement with the suture, along the
generally arcuate tunneling path.
[0026] Preferably, the method for tunneling through a bone during
arthroscopic surgery further includes, subsequent to the retracting
the needle, retracting the bone-engaging pin driving assembly from
engagement with the bone.
[0027] In accordance with a preferred embodiment of the present
invention the method for tunneling through a bone during
arthroscopic surgery also includes, subsequent to the retracting
the bone-engaging pin driving assembly, partially re-extending the
needle and disengaging the suture from the needle.
[0028] Preferably, the operatively engaging also includes aligning
the bone-engaging pin driving assembly with the bone-engaging
needle driving assembly so that the needle can engage the suture at
the second bone location and subsequently axially and rotationally
locking the bone-engaging pin driving assembly to the bone-engaging
needle driving assembly.
BRIEF DESCRIPTION OF THE DRAWINGS
[0029] The present invention will be understood and appreciated
from the following detailed description, taken in conjunction with
the drawings in which:
[0030] FIGS. 1A & 1B 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 first operative orientation;
[0031] FIGS. 2A & 2B are simplified pictorial illustrations of
an arthroscopic surgical device constructed and operative in
accordance with a preferred embodiment the present invention,
showing opposite views in a second operative orientation;
[0032] 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 third operative orientation;
[0033] 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 in a fourth operative orientation;
[0034] 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 fifth operative orientation;
[0035] 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 sixth operative orientation;
[0036] 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 seventh operative orientation;
[0037] 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 an eighth operative orientation;
[0038] 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 a ninth operative orientation;
[0039] 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 tenth operative orientation;
[0040] 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 an eleventh operative orientation;
[0041] 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 a twelfth operative orientation;
[0042] FIG. 13 is a simplified exploded view illustration of the
arthroscopic surgical device of FIGS. 1A-12B in the first operative
orientation;
[0043] FIGS. 14A and 14B are simplified exploded view illustrations
of a portion of the arthroscopic surgical device of FIGS. 1A-13,
showing opposite views;
[0044] FIG. 14C is a simplified partially assembled view of the
portion of the arthroscopic surgical device of FIGS. 14A and
14B;
[0045] FIGS. 15A and 15B are simplified illustrations of another
portion of the arthroscopic surgical device of FIGS. 1A-13, showing
opposite views;
[0046] FIGS. 16A and 16B are simplified exploded view illustrations
of the portion of the arthroscopic surgical device of FIGS. 1A-13,
showing opposite views;
[0047] FIGS. 17A and 17B are simplified illustrations of part of
the portion of the arthroscopic surgical device of FIGS. 16A &
16B, showing opposite views;
[0048] FIGS. 18A and 18B are simplified assembled view
illustrations of a portion of the arthroscopic surgical device of
FIGS. 1A-17B, showing opposite views;
[0049] FIG. 19 is a simplified exploded view illustration of the
portion of the arthroscopic surgical device of FIGS. 18A and
18B;
[0050] FIGS. 20A, 20B, 20C & 20D are simplified pictorial
illustrations showing various configurations of a top of the
portion of the arthroscopic surgical device shown in FIGS. 18A, 18B
and 19;
[0051] FIG. 21 is a simplified cross-sectional illustration taken
along lines XXI-XXI in FIG. 18A;
[0052] FIG. 22 is a simplified cross-sectional illustration taken
along lines XXII-XXII in FIG. 21;
[0053] FIGS. 23A, 23B and 23C are simplified cross-sectional
illustrations taken along lines A-A, B-B and C-C in FIG. 18A;
[0054] FIGS. 24A and 24B are simplified exploded view illustrations
of the portion of the arthroscopic surgical device shown in FIGS.
18A, 18B and 19, showing opposite views;
[0055] FIGS. 25A & 25B are simplified illustrations of steps in
the assembly of the portion of the arthroscopic surgical device
shown in FIGS. 18A, 18B and 19;
[0056] FIGS. 26A & 26B are simplified pictorial illustrations
of parts of the portion of the arthroscopic surgical device shown
in FIGS. 18A, 18B and 19;
[0057] FIG. 27 is a simplified side view illustration taken along
the direction indicated by an arrow XXVII in FIG. 26A;
[0058] FIG. 28 is a simplified sectional illustration taken along
the lines XXVIII-XXVIII in FIG. 27;
[0059] FIG. 29 is a simplified sectional illustration taken along
the lines XXIX-XXIX in FIG. 28;
[0060] FIGS. 30A, 30B, 30C, 30D, 30E, 30F, 30G, 30H, 30I, 30J, 30K,
30L, 30M and 30N are respective simplified illustrations of details
of the operation of the arthroscopic surgical device of FIGS.
1A-29; and
[0061] FIGS. 31A, 31B, 31C, 31D, 31E, 31F, 31G, 31H, 31I, 31J, 31K,
31L, 31M and 31N are simplified illustrations of operation of the
arthroscopic surgical device of FIGS. 1A-30N in a clinical
context.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
[0062] Reference is now made to FIGS. 1A & 1B, which 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
first operative orientation and to various additional drawings
which are specifically referenced in parentheses hereinbelow.
[0063] As seen in FIGS. 1A & 1B, 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.
[0064] The multiple action driving assembly 106 preferably includes
a bone-engaging pin driving assembly 120 and a bone-engaging needle
driving assembly 122. Bone-engaging pin driving assembly 120
preferably includes a base assembly 124 including a rearward
portion 126 and a forward portion 128. An inner, solid pin 130
(FIG. 21) is fixedly mounted onto rearward portion 126 and an
outer, hollow pin 132 is fixedly mounted onto forward portion
128.
[0065] A rearward knurled locking knob 136 is mounted onto rearward
portion 126 and selectably locks rearward portion 126 to forward
portion 128. A forward knurled locking knob 138 is mounted onto
forward portion 128 and selectably locks forward portion 128 to the
left housing element handle portion 112.
[0066] Outer hollow pin 132 is preferably formed with a pointed tip
140 and with a throughgoing top to bottom aperture 142. A suture
144 preferably extends between the inner pin 130 (FIG. 21) and the
outer pin 132, being looped about the inner pin 130 (FIG. 21)
interiorly of the outer pin 132 so as to be engageable through
aperture 142.
[0067] The multiple action driving assembly 106 preferably includes
a hand-engageable ratchet handle 150 which is arranged for
reciprocal motion about an axis 152 (FIG. 13). A selectable
direction ratchet shaft 156 (FIG. 13) 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.
[0068] A visible mechanical indicator 170 is preferably arranged on
the top of respective housing portions 102 and 104. Indicator 170
preferably provides a visible indication of the extent that arcuate
tunneling needle 162 is displaced from its fully retracted position
shown in FIGS. 1A & 1B. Arcuate tunneling needle 162 is adapted
to selectably engage suture 144 at suture engagement groove 164 via
aperture 142 in outer pin 132.
[0069] Reference is now made to FIGS. 2A & 2B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A & 1B, showing opposite views in a second
operative orientation. It is seen that in the second operative
orientation, which preferably takes place following insertion of a
forward portion of the bone-engaging needle driving assembly 122
through an arthroscopic incision, as described hereinbelow in
detail with reference to FIG. 31B, the bone-engaging pin driving
assembly 120 is inserted through the housing so that tip 140
extends to the surface of the bone, as described hereinbelow in
detail with reference to FIG. 31B.
[0070] Reference is now made to FIGS. 3A & 3B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-2B in a third operative orientation. It is seen
that bone-engaging pin driving assembly 120 is fully extended,
typically by hammering on the rearward portion 126, as described
hereinbelow in detail with reference to FIG. 31C.
[0071] Reference is now made to FIGS. 4A & 4B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-3B in a fourth operative orientation. It is seen
that, following unlocking of rearward portion 126 from the forward
portion 128 by rotation of knurled knob 136, rearward portion 126
is retracted axially relative to forward portion 128 thereby
retracting inner pin 130 (FIG. 21) relative to outer pin 132.
[0072] Reference is now made to FIGS. 5A & 5B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-4B in a fifth operative orientation. It is seen
that arcuate tunneling needle 162 is partially extended, as
indicated by indicator 170. This extension is produced by rotation
of hand-engageable ratchet handle 150 about axis 152 (FIG. 13) when
knobs 160 are in the upper position in slots 158.
[0073] Reference is now made to FIGS. 6A & 6B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-5B in a sixth operative orientation. It is seen
that arcuate tunneling needle 162 is fully extended through
aperture 142 in outer pin 132, as indicated by indicator 170 and in
response to reciprocal rotation of hand-engageable ratchet handle
150 about axis 152 when knobs 160 are in the upper position in
slots 158.
[0074] Reference is now made to FIGS. 7A & 7B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-6B in an seventh operative orientation. It is
seen that suture 144 is manually retracted so that it engages
arcuate tunneling needle 162 at suture engagement groove 164 via
aperture 142 in outer pin 132. Preferably prior to retraction of
suture 144, knobs 160 are lowered to their lower position in slots
158.
[0075] Reference is now made to FIGS. 8A & 8B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-7B in an eighth operative orientation. It is
seen that arcuate tunneling needle 162 is partially retracted in
response to reciprocal rotation of hand-engageable ratchet handle
150 about axis 152 when knobs 160 are in the lower position in
slots 158 and while suture 144 is engaged with needle 162 at suture
engagement groove 164 thereof.
[0076] Reference is now made to FIGS. 9A & 9B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-8B in a ninth operative orientation. It is seen
that arcuate tunneling needle 162 is further retracted, as
indicated by indicator 170, thereby pulling suture 144 therewith
out through aperture 142 of outer pin 132, thus drawing the suture
144 backwards along with retraction of the needle 162 along an
arcuate path earlier defined through the bone by the arcuate
tunneling operation of needle 162. This retraction of needle 162
results from further reciprocal rotation of hand-engageable ratchet
handle 150 about axis 152 when knobs 160 are in the lower position
in slots 158.
[0077] Reference is now made to FIGS. 10A & 10B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-9B in a tenth operative orientation. Arcuate
tunneling needle 162 is fully retracted as indicated by indicator
170, in engagement with the forward looped end of suture 144, thus
drawing the suture backwards along an arcuate path along with full
retraction of the needle 162.
[0078] Reference is now made to FIGS. 11A & 11B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-10B in an eleventh operative orientation. It is
seen that bone-engaging pin driving assembly 120 is retracted after
unlocking assembly 120 from handle portion 112 by rotation of
knurled knob 138.
[0079] Reference is now made to FIGS. 12A & 12B, which are
simplified pictorial illustrations of the arthroscopic surgical
device of FIGS. 1A-11B in an twelfth operative orientation. It is
seen that arcuate tunneling needle 162 is now partially extended in
order to permit manual disengagement of the looped forward end of
suture 144 from suture engagement groove 164 of needle 162. It is
noted that the positions of knobs 160 in slots 158 were previously
shifted upwardly, in order to provide extension of needle 162 in
response to ratchet operation. The orientations of the needle 162
is shown by indicator 170.
[0080] Reference is now made to FIGS. 13-17B and initially
specifically to FIG. 13 and to FIGS. 14A and 14B, which are
simplified exploded view illustrations of a portion of the
arthroscopic surgical device of FIGS. 1A-12, showing opposite
views, and to FIG. 14C, which is a simplified partially assembled
view, all of which show details of some elements of multiple action
driving assembly 106.
[0081] 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.
[0082] Connection element 222 includes an elongate protrusion 228,
which moves reciprocally in a slot 230 formed in housing portion
102.
[0083] Connection element 220 includes a side extending shaft 240
which includes 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.
[0084] 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.
[0085] 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 170.
[0086] 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.
[0087] 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.
[0088] A pointed corner 293 of connection element 220 selectably
engages lower linear toothed ratchet rack 287 of element 285.
[0089] Reference is now made specifically to FIGS. 15A-17B, 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.
[0090] Bone-engaging needle driving assembly 122 includes a static
forward portion 300, including a mounting base 302, which extends
forwardly of a forward end of the housing, which is fixed to an
extension shaft 304 extending axially inwardly thereof and
forwardly therefrom. Fixed to extension shaft 304 and extending
forwardly thereof, there is preferably formed an arcuate needle
storage and guiding portion 306.
[0091] Mounting base 302 is generally configured as a hollow
cylinder to accommodate part of extension shaft 304 therewithin and
is formed with matching side apertures 308 which accommodate
mounting pins 310 (FIG. 13), which serve to mount the mounting base
302 onto housing portions 102 and 104, as seen in FIG. 13.
[0092] Extension shaft 304 is preferably formed of two identical
side by side pieces 311. Side pieces 311 together define two
mutually spaced axial mounting bores extending therethrough, which
bores are designated by reference numerals 312 and 314. Bore 312
slidably accommodates hollow pin 132 and has a generally round
cross-section.
[0093] Bore 314 slidably accommodates parts of a flexible arcuate
needle driving assembly, which preferably includes a flexible
needle driving strip 318, 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 318,
preferably as shown in enlargements A & B in FIG. 15A. This
mounting is preferably by means of engagement of a protrusion 319
formed adjacent the forward end of rigid flexible needle driving
strip driving shaft 280 with a corresponding aperture 320 formed
adjacent a rearward end of flexible needle driving strip 318.
[0094] As seen in enlargement A of FIG. 15A, bore 314 has a
generally circular cross sectional central portion 322 to
accommodate shaft 280, from which portion extend a pair of
symmetrical side cut outs 324 to accommodate the side edges of
strip 318.
[0095] As seen particularly in enlargement D of FIG. 15A, forward
of extension shaft 304, there is preferably formed an arcuate
needle storage and guiding portion 350, which is formed with an
arcuate bore 352 including a portion 354 having a generally
rectangular cross section, which slidably accommodates needle 162.
A pair of symmetrical side cut outs 356 extend outwardly from
portion 354 and accommodate the side edges of flexible needle
driving strip 318.
[0096] As seen particularly in FIG. 16A, it is seen that suture
engagement groove 164 of arcuate needle 162 is partially defined by
a partially overlying portion 357 of needle 162. It is also seen in
an enlargement of FIG. 16A, that the forward end of flexible needle
driving strip 318 is attached to arcuate needle 162. This
attachment is preferably by means of engagement of a protrusion 366
formed adjacent the rearward end of arcuate needle 162 with a
corresponding aperture 367 formed adjacent a forward end of
flexible needle driving strip 318.
[0097] Reference is now made to FIGS. 18A & 18B and FIG. 19,
which illustrate bone-engaging pin driving assembly 120. As noted
above, bone-engaging pin driving assembly 120 preferably includes a
base assembly 124 including a rearward portion 126 and a forward
portion 128. An inner, solid pin 130 is fixedly mounted onto
rearward portion 126 and an outer, hollow pin 132 is fixedly
mounted onto forward portion 128.
[0098] A rearward knurled locking knob 136 is mounted onto rearward
portion 126 and selectably locks rearward portion 126 to forward
portion 128. A forward knurled locking knob 138 is mounted onto
forward portion 128 and selectably locks forward portion 128 to the
left housing element handle portion 112.
[0099] Outer hollow pin 132 is preferably formed with a pointed tip
140 and with a throughgoing top to bottom aperture 142. A suture
144 preferably extends between the inner pin 130 and the outer pin
132, being looped about the inner pin 130 interiorly of the outer
pin 132 so as to be engageable through aperture 142.
[0100] As seen particularly in FIGS. 18A, 18B and 19, extending
perpendicularly to throughgoing top to bottom aperture 142 there is
formed a throughgoing side wall slot 400, which, as will be
described hereinbelow, accommodates suture 144. FIGS. 18A, 18B and
19 also illustrate a throughgoing shaft 401 which extends through a
corresponding side-to-side bore formed in rearward portion 126.
FIGS. 24A and 24B show the various elements which are assembled as
seen in FIGS. 18A, 18B and 19, but without the suture 144, for
clarity.
[0101] FIGS. 20A, 20B, 20C and 20D show various alternative
configurations of pointed tip 140. FIG. 20A shows a generally
conical tip 402 having a suture accommodating slot 404. FIG. 20B
shows a generally tapered screw threaded tip 406 having a suture
accommodating slot 408. FIG. 20C shows a generally conical drill
tip 410 having a suture accommodating slot 412. FIG. 20D shows a
generally diamond cut tip 414 having a suture accommodating slot
416.
[0102] Reference is now made to FIGS. 21-23C, which illustrate the
initial positioning of suture 144 in the bone-engaging pin driving
assembly 120.
[0103] FIG. 21 is a simplified cross-sectional illustration taken
along lines XXI-XXI in FIG. 18A and FIG. 22 is a simplified
cross-sectional illustration taken along lines XXII-XXII in FIG.
21. FIGS. 23A-23C are cross-sectional illustrations taken as
indicated in FIG. 18A. These drawings clearly illustrate the
orientation of the suture 144 with respect to pins 130 and 132 and
aperture 142 and slot 400 and show how the suture 144 is wound
around pin 130 and between the end of pin 130 and tip 140 and
partially lies in both sides of slot 400.
[0104] FIGS. 25A and 25B show assembly of the bone-engaging pin
driving assembly 120. Once the suture 144 has been wound around
inner pin 130 as seen in FIG. 25A, rearward portion 126, including
the inner pin 130 having the suture 144 wound thereon, is joined to
forward portion 128 by inserting pin 130 into pin 132 through bore
480 (FIG. 26A). The rearward portion 126 is then locked to the
forward portion 128 by operation of knob 136. Insertion of a
retaining pin 420 into rearward portion 126 serves to limit the
axial separation of the forward and rearward portions 128 and 126
respectively and thus to limit the axial retraction of pin 130
relative to pin 132. A further retaining pin 424 may be provided
for locking knob 136 against disengagement from rearward portion
126.
[0105] Reference is now made to FIGS. 26A & 26B, which are
simplified pictorial illustrations of parts of the portion of the
arthroscopic surgical device shown in FIGS. 18A, 18B and 19, FIG.
27, which is a simplified side view illustration taken along the
direction indicated by an arrow XXVII in FIG. 26A, FIG. 28, which
is a simplified sectional illustration taken along the lines
XXVIII-XXVIII in FIG. 27, and FIG. 29, which is a simplified
sectional illustration taken along the lines XXIX-XXIX in FIG.
28.
[0106] Rearward portion 126 is preferably a generally cylindrical
element 428 extending along a cylindrical axis 430 and is formed
with various bores and slots as described hereinbelow. A side slot
432 extends axially forwardly from a rear surface 434 of element
428 along approximately one third of the axial length of element
428 and terminates in a narrowed axial bore 436 which extends all
of the way to a forward surface 438 of element 428. A transverse
bore 439 communicates with bore 436 and accommodates pin 424 (FIG.
19) for retaining knob 136 (FIG. 19) in bore 436 and in slot
432.
[0107] A transverse bore 440 extends perpendicularly to axis 430
and accommodates shaft 401 (FIGS. 18A, 18B & 19).
[0108] A side slot 442 extends axially rearwardly from forward
surface 438 of element 428 along approximately two thirds of the
axial length of element 428. Side slot 442 accommodates knob
138.
[0109] A bore 450, having a generally rectangular cross section, is
formed on forward surface 438. A transverse bore 452 communicates
with bore 450 and accommodates pin 420 (FIG. 19) for limiting axial
displacement of the forward portion 128 relative to the rearward
portion 126.
[0110] Forward portion 128 is preferably a generally disk-like
cylindrical element 468 extending along cylindrical axis 430 and is
formed with various bores, slots and protrusions as described
hereinbelow. A side slot 472 extends axially forwardly from a rear
surface 474 of element 468 through to a forward surface 478 of
element 468.
[0111] A central bore 480 extends axially rearwardly from forward
surface 478 of element 468 to rear surface 474 of element 468 and
therebeyond through an axial protrusion 482, having a generally
rectangular cross section, as a side opened slot 484. A transverse
retaining slot 486, extending perpendicularly to axis 430 is
provided on a top surface of protrusion 482 and is engaged by pin
420 for limiting axial displacement of protrusion 482 within bore
450, thus limiting relative displacement of the forward and
rearward portions 128 and 126 respectively and thus limiting
retraction of pin 130 within pin 132.
[0112] A stepped, partially threaded bore 490 extends forwardly
from rear surface 474 as a threaded portion 492 and continues at a
shoulder 494 as a non-threaded bore portion 496 to forward surface
478.
[0113] A suture access slot 498 communicates with central bore 480
and allows threading of suture 144 therethrough.
[0114] Reference is now made to FIGS. 30A, 30B, 30C, 30D, 30E, 30F,
30G, 30H, 30I, 30J, 30K, 30L, 30M and 30N, which illustrate details
of the operation of the arthroscopic surgical device of FIGS.
1A-29, and to FIGS. 31A, 31B, 31C, 31D, 31E, 31F, 31G, 31H, 31I,
31J, 31K, 31L, 31M and 31N, which are simplified illustrations of
operation of the arthroscopic surgical device of FIGS. 1A-30N in a
clinical context.
[0115] As seen in FIGS. 30A and 31A, which correspond generally to
FIGS. 1A-2B, prior to insertion of the arthroscopic surgical device
100 through an arthroscopic incision in a patient, a bone-engaging
pin driving assembly 120, such as that described hereinabove with
reference to FIGS. 18A-29, is mounted onto the arthroscopic
surgical device 100.
[0116] FIG. 31A shows initial forward axial positioning of
bone-engaging pin driving assembly 120 in the arthroscopic surgical
device 100, as indicated by an arrow 500. At this stage, the tip
140 of the bone-engaging pin driving assembly 120 does not protrude
from bore 312.
[0117] FIG. 31B shows insertion of arcuate needle storage and
guiding portion 306 through an incision 501 such that a forwardmost
end 502 of arcuate needle storage and guiding portion 306 engages a
bone, here shown as a humerus.
[0118] It is seen in FIGS. 30A, 31A & 31B that the inner, solid
pin 130 and outer, hollow pin 132 are in their respective fully
retracted positions.
[0119] FIGS. 30B and 31C, which correspond generally to FIGS. 2A
& 2B, show further linear forward displacement of bone-engaging
pin driving assembly 120 in the arthroscopic surgical device 100,
as indicated by an arrow 504. This displacement is preferably
achieved by an operator manually pushing the bone-engaging pin
driving assembly 120 forwardly relative to the remainder of the
arthroscopic surgical device 100, as indicated by arrow 504, until
tip 140 engages the bone.
[0120] FIGS. 30C and 31D, which correspond generally to FIGS. 3A
& 3B, show further and maximum linear forward displacement of
bone-engaging pin driving assembly 120 in the arthroscopic surgical
device 100, as indicated by an arrow 506. This displacement may be
achieved by an operator hammering rearward portion 126 as shown
forcing tip 140 and pins 130 and 132 axially through the bone until
tip 140 reaches its forwardmost position within the bone such that
aperture 142 intersects an arcuate trajectory of needle 162 within
the bone. This forwardmost position is defined by engagement of a
forward surface 478 of forward portion 128 with a rear surface of
the housing.
[0121] Alternatively, hammering may be replaced by rotational
displacement, such as by using alternative tips 406 or 410 (FIGS.
20B & 20C), which may be driven manually or by using a power
drill.
[0122] It is also noted that the desired rotational positioning of
hollow pin 132 is achieved by lining up a marking 508 on the
forward portion 128 with a corresponding marking 510 adjacent the
rear surface of the housing. This rotational positioning is
required to ensure that aperture 142 is aligned vertically in the
sense of FIGS. 3A, 3B and 30C. At this position, the bone-engaging
pin driving assembly 120 is axially and rotationally locked in the
arthroscopic surgical device 100, by operation of knurled knob 138,
as described hereinabove with reference to FIGS. 18A-20.
[0123] Reference is now made to FIGS. 30D and 31E, which correspond
generally to FIGS. 4A and 4B and which show retraction of rod 130
relative to rod 132. This is achieved by unlocking the rearward and
forward portions 126 and 128 from each other via suitable rotation
of knurled knob 136 and pulling back rearward portion 126 axially
from forward portion 128, as indicated by an arrow 512.
[0124] It is noted that at this stage indicator 170 shows full
retraction of flexible needle driving strip driving shaft 280 and
of arcuate tunneling needle 162.
[0125] Reference is now made to FIGS. 30E and 31F, which correspond
generally to FIGS. 5A & 5B and show partial extension of
arcuate tunneling needle 162 through the bone, as indicated by
indicator finger 284 of indicator 170. This partial extension
follows upward repositioning of knob 160, as indicated by hand 1,
followed by squeezing of handle 150, as indicated by hand 2.
[0126] FIGS. 30E, 30F, 30G, which correspond generally to FIGS. 6A
& 6B, 30H, particularly at enlargements B in FIGS. 30G and 30H,
and 31G show that squeezing on hand-engageable ratchet handle 150
produces rotation thereof, as indicated by an arrow 518, 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 354 of arcuate bore 352 having a rectangular
cross section and to extend outwardly into tunneling engagement
with the bone, as indicated by arrow 522.
[0127] FIG. 30H shows retraction of handle 150, as indicated by an
arrow 530, under urging of spring 248 whereby pointed corner 275 is
operationally disengaged from rack 272 of double rack linear
toothed element 270, such that one or more subsequent squeeze on
handle 150 produces further linear forward motion of double rack
linear toothed element 270 and consequent further arcuate extension
travel of needle 162.
[0128] It is appreciated that simultaneous engagement of gear 290
with lower linear toothed gear rack 274 of element 270 and upper
linear toothed gear rack 286 of element 285 produces rearward
linear motion of element 285 corresponding to forward linear motion
of element 270.
[0129] FIGS. 30I and 31H, which correspond generally to FIGS.
7A-8B, show downward repositioning of knob 160, as indicated by an
arrow 532 and by hand 1, to provide arcuate retraction of arcuate
tunnel needle 162, as indicated by an arrow 534, through the bone,
driven by further squeezing of handle 150 as indicated by an arrow
535 and by hand 2. Prior to this retraction, the operator pulls
back on suture 144, as indicated by an arrow 536, thereby drawing
it into engagement with groove 164 in needle 162, and to be
retained therein by partially overlying portion 357 of needle 162,
such that retraction of the needle 162 pulls the suture together
with it along the arcuate travel path of the needle 162.
[0130] FIGS. 30J & 31I, which correspond generally to FIGS. 9A
& 9B, show partial retraction of arcuate tunnel needle 162 in
engagement with suture 144, thereby pulling suture 144 through the
arcuate passageway being traversed by arcuate needle 162. The
partial retraction is provided by further squeezing of handle 150,
as indicated by arrow 535. It is appreciated that that during the
retraction the operator continues to pulls back on suture 144, as
indicated by arrow 536.
[0131] FIGS. 30K and 31J, which correspond generally to FIGS. 10A
& 10B, show complete retraction of arcuate tunnel needle 162.
The complete retraction of arcuate tunnel needle 162 is indicated
by indicator finger 284 of indicator 170. At this stage, suture
144, in doubled-over configuration, extends entirely through the
bone along the arcuate path tunneled by needle 162 as described
above. The retraction is provided by further squeezing of handle
150, as indicated by arrow 535. It is appreciated that during the
retraction the operator continues to pulls back on suture 144, as
indicated by arrow 536.
[0132] FIGS. 30L and 31K show unlocking of forward portion 128 from
the housing, by manipulation of knurled knob 138 as described
hereinabove.
[0133] FIGS. 30M and 31L, which correspond generally to FIGS. 11A
& 11B, show retraction of bone-engaging pin driving assembly
120 from engagement with the bone, leaving the suture 144 extending
through the bone and still being attached to arcuate tunnel needle
162.
[0134] FIG. 31M shows removal of the arthroscopic surgical device
100 from the patient through incision 501.
[0135] FIGS. 30N and 31N, which correspond generally to FIGS. 12A
& 12B, show partial re-extension of arcuate tunnel needle 162
so that the suture 144 can be manually disengaged therefrom. This
partial re-extension is achieved by upwardly repositioning knobs
160, as indicated by hand 1, and then operating handle 150, as
indicated by hand 2. The partial re-extension is followed by manual
disengagement of suture 144, as indicated by hand 3.
[0136] Upward repositioning of knobs 160, as indicated by an arrow
538, causes repositioning of connection element 220, causing
pointed corner 275 of connection element 220 to engage upper linear
toothed ratchet rack 272 of element 270, as seen in FIG. 30E, such
that squeezing of handle 150, as indicated by an arrow 540, causes
element 270 to be moved linearly forward and thereby drive needle
driving strip driving shaft 280 forwardly and cause arcuate needle
162, driven thereby, to partially re-extend, as indicated by an
arrow 542.
[0137] 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.
* * * * *