Articular motion surgical instrument

Abstract

Various articulating instruments for driving fasteners or other surgical instruments are disclosed. The articulating instrument may be removably connected to a handpiece that includes a motor. The articulating instrument may include a torque transmission mechanism that includes a first shaft that extends through the lumen of the elongate outer housing. The first shaft may transmit torque from the motor to an articulating torque transmission unit. The articulating torque transmission unit may transmit torque to a bit that engages a fastener. The articulating instrument may include an orientation mechanism that is separate from the torque transmission mechanism. The orientation mechanism may have one or more controllers for rotating the articulating movement unit and the driver head adapter about one or more axes.

Description

Technical Field

[0001] This application claims the benefit of priority of U.S. Patent Application No. 63 / 354,656, filed Jun. 22, 2022, the entire disclosure of which is incorporated herein by reference. Additionally, any application for which a foreign or domestic priority claim is identified in an application data sheet filed herewith is incorporated herein by reference under 37 CFR 1.57.

Background Art

[0002] The present disclosure relates to an articulating instrument for the placement of fasteners in medical procedures, such as an instrument for placing screws in endoscopic surgery.

[0003] Surgical instruments play an important role in medical procedures, such as orthopedic surgery, where accurate and effective fixation of bone and / or appliances (e.g., plates) is essential. The process of inserting screws into bone has conventionally been performed manually using a hand-held screwdriver. This method requires skill and accuracy on the part of the surgeon, especially in endoscopic surgery and in the application of manual force. Dependence on manual force can pose challenges, such as when high-density bone or complex anatomical structures are involved. Additionally, there is a significant risk of human error, including incorrect placement or improper fixation of screws, appliances, and / or bone.

Summary of the Invention

[0004] Electric surgical screwdrivers represent a significant advancement in the field of surgical instruments. An electric screwdriver may include an electrical system that enables a surgeon to more efficiently drive a screw into bone. However, these instruments may lack control, stability, and accuracy while operating in a narrow space or at a particular angle. Additionally, certain electric screwdrivers may be inconvenient or impossible to operate at a particular angle and / or reach a particular anatomical structure. For example, certain electric screwdrivers may be inserted into a patient in one direction (e.g., generally parallel to the longitudinal axis of the instrument) and may not be able to drive a screw in a different direction (e.g., generally perpendicular to the longitudinal axis of the instrument). Some electric screwdrivers are fixed at the angle at which the screw is driven (e.g., relative to the handle of the instrument). This can limit or eliminate the ability of the instrument to adapt the driving angle to compensate for the peculiarities of the body's structure during a medical procedure. The present disclosure relates to an articulating instrument that addresses one or more of the foregoing concerns, or other concerns.

[0005] The present disclosure describes an arthrokinematic surgical driver for securing screws, plates, or other medical implants to a patient during a surgical procedure. The surgical driver can be an electric or non-electric (e.g., motor-driven or non-motor-driven) screw driver for securing a screw within a patient's bone, tendon, or muscle. The surgical driver can have an adjustable head that rotates about two axes that can be spaced apart and / or oriented in different directions. In some embodiments, the adjustable head can tilt up and down about a short axis (e.g., a transverse axis) of the surgical driver and rotate about a long axis (e.g., a longitudinal axis) of the surgical driver. In some implementations, the surgical driver can have an adjustable head that is a turret that rotates freely about a short axis of the surgical driver. Advantageously, the surgical driver can operate (e.g., transmit torque from a motor to a bit) when the adjustable head is in any orientation. Thus, a user can easily drive and / or fasten a medical implant (e.g., a screw) after positioning the adjustable head in a desired orientation independent of the orientation of the grip of the driver. In some implementations, the arthrokinematic surgical driver enables a user to easily reach a wide range of positions and configurations (e.g., place fasteners) during a medical procedure.

[0006] In some embodiments, the orientation of the adjustable head is controlled via two control elements such as two knobs. The first control knob rotates or tilts the adjustable head around the short axis of the surgical driver, and the second control knob rotates the adjustable head around the long axis of the surgical driver. Each control knob actuates the shaft of the surgical driver. In some variations, the first control knob actuates a first shaft connected to a gear assembly configured to rotate or tilt the adjustable head. The second control knob rotates a second shaft directly connected to the adjustable head. The control knobs enable the user to easily manipulate the surgical driver to a desired position when the surgical driver is within a limited area. The surgical driver can be used to perform minimally invasive or orthopedic surgeries such as craniofacial surgery, hand or foot surgery, and spinal surgery. Thus, the arthrokinematic surgical driver provides an efficient, safe, and accurate instrument for medical professionals or other users to fix implants.

[0007] In some aspects, the techniques (also referred to as techniques) described herein relate to arthrokinematic surgical instruments. The arthrokinematic instrument includes a long outer housing including a proximal end, a distal end, a lumen, and a longitudinal axis. The long outer housing is configured to engage a handpiece including a motor. The arthrokinematic instrument includes a torque transmission mechanism including a first shaft extending through the lumen of the long outer housing, and an articulating torque transmission unit having a first end and a second end. The first end is coupled to the distal portion of the first shaft. The articulating torque transmission unit has a first bevel gear, a second bevel gear, and a third bevel gear. The first bevel gear can be fixedly coupled to the first shaft. The second bevel gear can be coupled to a gear support shaft. The third bevel gear is removably engagable with a bit and can be configured to rotate the bit around a bit axis. The torque transmission mechanism can be configured to transmit torque from the motor to the bit. Rotating the long outer housing can be configured to rotate the torque transmission mechanism around the longitudinal axis.

[0008] The joint movement instrument includes an orientation mechanism that can be separated from the torque transmission mechanism. The orientation mechanism includes a second shaft that extends through the lumen of the elongated outer housing, and the first shaft and the second shaft are concentric. The orientation mechanism includes a fourth bevel gear and a fifth bevel gear. The fourth bevel gear can be fixedly coupled to the second shaft. The fifth bevel gear can be coupled to the driver head adapter. The orientation mechanism can include a controller connected to the proximal portion of the second shaft. The controller can be configured to rotate the second shaft. Rotation of the second shaft can rotate the driver head adapter about an axis. The transverse axis can be substantially perpendicular to the longitudinal axis.

[0009] In some aspects, the techniques described herein relate to a joint movement surgical instrument in which the second bevel gear can be a double-sided bevel gear.

[0010] In some aspects, the techniques described herein relate to a joint movement surgical instrument in which the bit axis is non-coplanar with the longitudinal axis.

[0011] In some aspects, the techniques described herein relate to a joint movement surgical instrument in which the second bevel gear is between the longitudinal axis and the bit axis.

[0012] In some aspects, the techniques described herein relate to a joint movement surgical instrument in which the bit is a bone drill bit.

[0013] In some embodiments, the techniques described herein relate to an articulating instrument configured to facilitate the placement of a surgical instrument, such as a fastener (e.g., a screw) or a drill bit, during a medical procedure. The articulating instrument can include a long outer housing that includes a proximal end, a distal end, a lumen, and a longitudinal axis. The long outer housing can be configured to engage a handpiece that includes a motor. The articulating instrument can include a torque transmission mechanism. The torque transmission mechanism can include a first shaft that extends through the lumen of the long outer housing. The torque transmission mechanism can include an articulating torque transmission unit that has a first end and a second end. The first end can be coupled to the distal portion of the first shaft. A driver head adapter can be disposed at the second end of the articulating torque transmission unit.

[0014] The driver head adapter can be configured to removably engage a bit and rotate the bit about the bit axis. The bit can be configured to engage a surgical instrument, such as a fastener (e.g., a screw) or a drill bit. The torque transmission mechanism can be configured to transmit torque from the motor to the driver head adapter and the bit. Rotating the long outer housing can be configured to rotate the torque transmission mechanism about the longitudinal axis.

[0015] The articulating instrument can include an orientation mechanism that is separate from the torque transmission mechanism. The orientation mechanism can include a second shaft that extends through the lumen of the long outer housing. The orientation mechanism can include a controller that is connected to the proximal portion of the second shaft. The controller can be configured to rotate the second shaft. The driver head adapter can be connected to the distal portion of the second shaft. Rotation of the second shaft can rotate the driver head adapter about an axis. The axis can be substantially perpendicular to the longitudinal axis.

[0016] In some aspects, the techniques described herein relate to an articulating instrument where the orientation mechanism includes a first bevel gear and a second bevel gear. The first bevel gear can be fixedly coupled to a second shaft. The second bevel gear can be coupled to a driver head adapter.

[0017] In some aspects, the techniques described herein relate to an articulating instrument configured such that the driver head adapter rotates about a transverse axis between approximately 0° and approximately 360°.

[0018] In some aspects, the techniques described herein relate to an articulating instrument configured such that the driver head adapter completes a plurality of rotations about a transverse axis.

[0019] In some aspects, the techniques described herein relate to an articulating instrument where the articulating torque transmission unit includes a first bevel gear, a second bevel gear, and a third bevel gear. The first bevel gear can be fixedly coupled to a first shaft. The second bevel gear can be coupled to a gear support shaft. The third bevel gear can be removably coupled to a bit.

[0020] In some aspects, the techniques described herein relate to an articulating instrument that includes a lumen configured such that the driver head adapter receives a shaft of the bit. The driver head adapter can be coupled to the shaft of the bit via a quick release mechanism.

[0021] In some aspects, the techniques described herein relate to an articulating instrument configured such that the elongate outer housing rotates about a longitudinal axis relative to the controller between approximately 0° and approximately 360°.

[0022] In some aspects, the techniques described herein relate to an articulating instrument configured such that the elongate outer housing completes a plurality of rotations about a longitudinal axis relative to the controller.

[0023] In some aspects, the techniques described herein relate to an articulating exercise device in which the controller includes a wheel and rotation of the wheel rotates a second shaft.

[0024] In some aspects, the techniques described herein relate to an articulating exercise device in which the controller includes a locking clutch that locks rotation of the second shaft.

[0025] In some aspects, the techniques described herein relate to an articulating exercise device in which an elongate outer housing is connected to the wheel and rotation of the wheel rotates the elongate outer housing.

[0026] In some aspects, the techniques described herein relate to an articulating instrument configured to facilitate the placement of a surgical instrument, such as a fastener (e.g., a screw) or a drill bit, during a medical procedure. The articulating instrument can include a multi-component elongate outer housing that includes an upper portion, a lower portion, a proximal end, a distal end, a lumen, and a longitudinal axis. In certain implementations, the multi-component elongate outer housing can be configured to engage a handpiece that includes a motor. The articulating instrument can include a torque transmission mechanism that includes a first shaft that extends through the lumen of the multi-component elongate outer housing. The torque transmission mechanism can include an articulating torque transmission unit that has a first end and a second end. The first end can be coupled to the distal portion of the first shaft. The torque transmission mechanism can include a driver head adapter that is disposed at the second end of the articulating torque transmission unit. The driver head adapter can be configured to removably engage a bit and rotate the bit about the bit axis. The bit can be configured to engage a surgical instrument, such as a fastener (e.g., a screw) or a drill bit. The torque transmission mechanism can include a controller. The controller can be configured to move (e.g., rotate) the articulating torque transmission unit, such as about a transverse axis. The transverse axis can be substantially perpendicular to the longitudinal axis. The controller can be configured to move the articulating torque transmission unit, such as by advancing and / or retracting the upper portion of the multi-component elongate outer housing. The torque transmission mechanism can be configured to transmit torque from a motor to the driver head adapter and the bit. The above description describes a multi-component elongate outer housing, but certain implementations include a single and / or non-multi-component elongate outer housing.

[0027] In some aspects, the techniques described herein relate to an articulating exercise device in which the joint torque transmission unit includes first, second, third, and fourth bevel gears. The first bevel gear can be fixedly coupled to a first shaft. The second bevel gear can be coupled to a first gear support shaft. The third bevel gear can be coupled to a second gear support shaft. The fourth bevel gear can be removably coupled to a bit.

[0028] In some aspects, the techniques described herein relate to an articulating exercise device in which the second bevel gear includes a set of second bevel gears. The third bevel gear can include a set (e.g., a plurality) of third bevel gears.

[0029] In some aspects, the techniques described herein relate to an articulating exercise device in which the controller is configured to rotate the joint torque transmission unit by advancing or retracting a lower portion of a multi-piece elongate outer housing.

[0030] In some aspects, the techniques described herein relate to an articulating exercise device in which rotating the multi-piece elongate outer housing is configured to rotate a torque transmission mechanism about a longitudinal axis.

[0031] In some embodiments, the techniques described herein relate to an arthroscopic screw driver adapter. The adapter can include a proximal end having a body configured to removably connect to a rotary driver and / or a drive output (e.g., a drive shaft). The proximal end can be configured to connect to an electric or non-electric driver, such as a driver having an electric motor or a driver having a manually rotatable handle. The arthroscopic screw driver adapter can include a distal end having a driver head adapter. The driver head adapter can be configured to articulate and rotate relative to the body. The driver head adapter can be configured to removably receive a driver head engagable with a surgical instrument, such as a fastener (e.g., a screw) or a drill bit. The arthroscopic screw driver adapter can include an orientation control unit. The orientation control unit can be configured to control the articulation of the driver head adapter. The arthroscopic screw driver adapter can include a torque transmission unit. The torque transmission unit can be configured to removably connect to the drive output and / or to transmit torque from the drive output to the driver head adapter such that the driver head rotates a surgical instrument.

[0032] In some embodiments, the techniques described herein relate to a combination including an arthroscopic screw driver adapter, a surgical driver, and a driver head.

[0033] In some embodiments, the techniques described herein relate to an arthroscopic screw driver adapter in which the orientation control unit includes an arm configured to convert a lateral movement of the arm into a rotational movement of the driver head adapter.

[0034] In some aspects, the techniques described herein relate to an arthroscopic screw driver adapter in which the orientation control unit includes an arm configured to convert the rotational movement of the arm into the rotational movement of a driver head adapter.

[0035] In some aspects, the techniques described herein relate to an arthroscopic screw driver adapter in which the driver head adapter includes first and second gears. The first and second gears are configured to rotate about respective axes that are substantially parallel to each other and / or substantially perpendicular to the longitudinal axis of the arthroscopic screw driver adapter.

[0036] In some aspects, the techniques described herein relate to an arthroscopic screw driver adapter in which the orientation control unit includes a spring-biased clutch. The spring can include, for example, a coil spring, a leaf spring, or a helical spring, a wave spring, etc.

[0037] In some aspects, the techniques described herein relate to an arthroscopic screw driver adapter. The adapter can include a proximal end configured to removably connect to a surgical driver having a drive output, such as a surgical driver having an electric motor. The arthroscopic screw driver adapter can include a distal end configured to removably connect to the proximal end. The distal end can include a driver head adapter configured to be capable of articulating and rotating relative to the proximal end. The driver head adapter can be configured to removably receive a driver head engageable with a surgical instrument, such as a fastener or a drill bit. The arthroscopic screw driver adapter can include an orientation control unit configured to control the articulation of the driver head adapter. The arthroscopic screw driver adapter can include a torque transmission unit configured to removably connect to the drive output and transmit torque from the drive output to the driver head adapter such that the driver head rotates the surgical instrument.

[0038] In some aspects, the techniques described herein relate to an arthroscopic screw driver adapter in which the distal end further includes a quick release mechanism.

[0039] In some aspects, the techniques described herein relate to an arthroscopic screw driver adapter in which the quick release mechanism includes opposing first and second spring-biased buttons.

[0040] In some aspects, the techniques described herein relate to an arthroscopic screw driver adapter in which the proximal end includes first and second guide pins configured to removably interface with the quick release mechanism.

[0041] The above summary, the following detailed description, and the related drawings are not intended to limit or define the scope of protection.

Brief Description of the Drawings

[0042] Throughout the drawings, reference numbers are reused to indicate the correspondence between the elements being referenced. The drawings are provided to illustrate particular embodiments of the subject matter described herein and are not intended to limit its scope.

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DETAILED DESCRIPTION OF THE INVENTION

[0043] In surgical procedures, driving a screw into bone or drilling a hole using a drill bit can be difficult due to the location and / or orientation of the bone, surrounding anatomical structures (e.g., muscles, ligaments, tendons, blood vessels, nerves, etc.), the shape and condition of the bone, etc. In certain surgical procedures, access to the desired insertion location and / or angle for a screw on the bone may be restricted. Retracting or repositioning the fastening device to adjust the insertion location and / or angle can be time-consuming, cause trauma to the patient, and / or be inconvenient or impractical (such as when the direct access path of the fastening device is blocked by other anatomical structures).

[0044] A fastening device having an extension with a flexible or elastic portion can be useful for navigating the driver head within a patient's body. However, the flexible or elastic portion may not efficiently transmit sufficient torque to insert a screw into the cortical bone, among other problems.

[0045] A fastening instrument having a rigid and / or non-flexible and / or inelastic extension that can change direction can help navigate the driver head within a patient's body while also efficiently transmitting torque. In some embodiments, such an extension can include an articulating component configured to articulate at multiple angles about multiple axes. This can allow the fastening instrument to adjust (e.g., bend or pivot) to access narrow spaces, reduce the frequency with which the user needs to readjust their position, and / or provide a desired orientation of the fastening instrument. It can be beneficial for the fastening instrument to be able to maintain sufficient torque output to perform the intended function (e.g., insert a fixation screw into bone) at the same time. In some embodiments, the extension comprises an adapter configured to connect (e.g., removably) to the fastening instrument, such as an existing power driver.

[0046] It may be beneficial to have an extension having an articulating component with an outer profile comparable to that of a standard non-articulating fastening instrument. A smaller outer profile can reduce the need for a larger access portal (e.g., trocar) and / or allow a fastening instrument having an articulating component to access spaces that are normally accessible by a standard non-articulating fastening instrument.

[0047] In some implementations, a gear assembly (e.g., bevel gear or planetary gear) can provide an improved overall range for an articulating component, such as an articulating driver head. It may be desirable to use gears and gear mechanisms that fit within the available space while maintaining sufficient torque output to perform the original function. Any type of gear (e.g., spur gear, helical gear, worm gear, internal gear, etc.) can be used in any type of gear assembly described herein.

[0048] Some embodiments of an articulating instrument for endoscopic placement of a fastener that provide one or more of the above advantages, or other advantages, are disclosed herein. Some embodiments of the articulating instrument can be used with a fastener driver bit, drill bit, and the like.

[0049] Any of the structures, materials, steps, or other features disclosed above, or elsewhere in this specification, can be used in any of the embodiments of the present disclosure. Any structure, material, step, or other feature of any embodiment can be combined with any structure, material, step, or other feature of other embodiments to form further embodiments that are part of the present disclosure.

[0050] The various features and advantages of the disclosed technology will become more fully apparent from the following description of some specific embodiments shown in the figures. These embodiments are intended to illustrate the principles of the present disclosure. However, the present disclosure should not be limited to the embodiments shown. The features of the illustrated embodiments can be modified, combined, deleted, and / or replaced as will be apparent to those skilled in the art in view of the principles disclosed herein. The features, structures, or steps disclosed herein are neither essential nor indispensable.

[0051] Articulating exercise device having a torque transmission unit (Figs. 1 - 17) FIG. 1 and FIGS. 2A show a front perspective view and a side view, respectively, of one embodiment of a fastening system 150 including an articulating instrument 100 and a handpiece 106. FIGS. 2B and 2C show a front cross-sectional view and a side cross-sectional view, respectively, of the fastening system 150. FIGS. 3 and 4 show a front view and a rear view, respectively, of the fastening system 150. The fastening system 150 can be configured to facilitate the placement of a surgical instrument such as a fastener (e.g., a screw) or a drill bit during a medical procedure such as an endoscopic surgical procedure. As shown, the articulating instrument 100 can have a longitudinal axis L.

[0052] The joint exercise device 100 can include a body coupling assembly 102 and a fastening device 104. The body coupling assembly 102 can have a proximal end and a distal end. The distal end can be the end closest to the handpiece 106, and the proximal end can be the end farthest from the handpiece 106. In some embodiments, the proximal end of the body coupling assembly 102 can have a stabilizing ring 130 that surrounds the distal end of the handpiece 106 (e.g., the end to which the body coupling assembly 102 is attached). In some embodiments, the stabilizing ring 130 can be coupled to the body coupling assembly 102 by forming a friction fit with the handpiece 106. Alternatively, the stabilizing ring 130 can have a magnet, a latch, a clamp, and / or any other coupling mechanism described herein that couples with a corresponding mechanism on the handpiece 106.

[0053] As shown, the body coupling assembly 102 can have one or more arms 132 (e.g., two arms 132). In some embodiments, the arms 132 can connect the proximal and distal sections of the body coupling assembly 102 while forming an open central region. The open central region can provide space for one or more control wheels 118, 120 and one or more shafts (e.g., an internal shaft 114 and / or an output shaft 128). Advantageously, the arms 132 increase the stability and functionality of the body coupling assembly 102 while reducing the weight and size of the body coupling assembly 102. In some embodiments, the body coupling assembly 102 includes a bridge 134 that connects the arms 132 at the center of the body coupling assembly 102 and forms two or more open central regions.

[0054] In some embodiments, the fastening tool 104 may extend from the distal end of the body coupling assembly 102. The fastening tool 104 may be a screwdriver, an Allen wrench, a hex bar wrench, or any other type of fastening driver or device. As shown, the articulating instrument 100 can have x, y, and z axes. The articulating instrument 100, and its individual components, can be made of metal (such as aluminum, steel, titanium, or iron) or non-metal (such as rigid plastic). In some variations, the components of the articulating instrument 100 can be made of composite materials such as carbon fiber reinforced resin.

[0055] In some embodiments, the articulating instrument 100 may include one or more control wheels 118, 120. The one or more control wheels 118, 120 can be digital and / or analog. The first control wheel 118 and the second control wheel 120 may be the same size or different sizes. For example, in some implementations, the diameter of the first control wheel 118 may be 30 mm, and the diameter of the second control wheel 120 may be 20 mm. The diameter of the wheels may vary according to different requirements and user preferences. For example, one or more of the wheels 118, 120 can have a diameter of 1 mm, 5 mm, 10 mm, 15 mm, greater than 40 mm, or any diameter therebetween. In some embodiments, the one or more control wheels 118, 120 can be coaxially arranged along the z-axis. For example, the first control wheel 118 may be arranged at the center of the body coupling assembly 102, and the second control wheel 120 may be arranged at the distal end of the body coupling assembly 102. In some embodiments, the one or more control wheels 118, 120 can be arranged on the handpiece 106 or the fastening tool 104. In some embodiments, the one or more control wheels 118, 120 may be on two or more different axes (e.g., a first z-axis and a second z-axis offset from the first z-axis).

[0056] The fastening tool 104 can include a driver head adapter 700. In various embodiments, the driver head adapter 700 can pivot, articulate, move, rotate, and / or reposition with respect to the handpiece 106. For example, the articulation tool 100 can have a multi-component (e.g., two-component shaft) 122 configured to rotate the driver head adapter 700 about the x-axis (e.g., an axis substantially perpendicular to the longitudinal axis of the articulation tool 100), as described in more detail below. Thus, the multi-component shaft 122 advantageously enables the user to have more control over the driver head adapter 700 and can provide a wider range of positions for the driver head adapter 700 during operation.

[0057] The multi-component shaft 122 can include a first portion (which can be the lower shaft portion 124) and a second portion (which can be the upper shaft portion 126). In some embodiments, the upper shaft portion 126 moves independently of the lower shaft portion 124. For example, the upper shaft portion 126 can move axially (e.g., translate) along the z-axis (e.g., the longitudinal axis of the tool 100), such as towards or away from the handpiece 106. In some embodiments, the lower shaft portion 124 can move axially (e.g., along the z-axis), such as towards or away from the handpiece 106. In some embodiments, the position of the upper shaft portion 126 relative to the position of the lower shaft portion 124 determines the inclination of the driver head adapter 700. For example, in some implementations, the user can adjust the driver head adapter 700 downward (e.g., tilt or pivot) by advancing the upper shaft portion 126 and adjust the driver head adapter 700 upward (e.g., tilt or pivot) by retracting the upper shaft portion 126. In some variations, the user can tilt the driver head adapter 700 upward by advancing the lower shaft portion 124 and tilt the driver head adapter 700 downward by retracting the lower shaft portion 124.

[0058] In some implementations, one or both of the first and second portions rotate relative to each other and / or relative to the grip of the instrument 100, etc. For example, in certain variations, rotating the first (or alternatively the second) portion in the first rotational direction can adjust the driver head adapter 700 downward (e.g., tilt or pivot) by advancing the first (or alternatively the second) portion, and rotating the first (or alternatively the second) portion in the second rotational direction can adjust the driver head adapter 700 upward (e.g., tilt or pivot) by retracting the first (or alternatively the second) portion. A portion of the driver head adapter 700 can be threadably connected to the first and / or second portions, for example, to enable movement (e.g., pivoting) of the driver head adapter 700.

[0059] In some embodiments, the user can adjust the position of the upper shaft portion 126 and / or the lower shaft portion 124 via one or more control wheels 118, 120 on the handpiece 106. For example, rotating the control wheel 118 in a first direction (e.g., clockwise) can advance the upper shaft portion 126 forward (e.g., away from the handpiece 106) while the lower shaft portion 124 remains stationary. Similarly, rotating the control wheel 118 in a second direction (e.g., counterclockwise) can retract the upper shaft portion 126 toward the handpiece 106. In some embodiments, one or more control wheels 118 control the lower shaft portion 124 or both components of the multi-component shaft 122. For example, rotating the control wheel 120 clockwise can advance the upper shaft portion 126 while simultaneously retracting the lower shaft portion 124.

[0060] In certain implementations, the position of the driver head adapter 700 is adjustable and / or rotatable about the z-axis in response to the actuation of one or more control wheels 118, 120. For example, in certain embodiments, the user can rotate the fastening tool 104 relative to the handpiece 106 by turning the control wheel 120. In some embodiments, the instrument 100 is configured to allow the user to tilt the driver head adapter 700 and rotate the fastening tool 104 (e.g., sequentially or simultaneously). For example, the control wheel 118 may be used to tilt the driver head adapter 700, and the control wheel 120 may be used to rotate the fastening tool 104. In certain implementations, such as those shown in FIG. 1, the driver head adapter 700 includes a knuckle joint and / or can articulate as a knuckle.

[0061] In some embodiments, the position of the driver head adapter 700 can be adjusted via one or more operator control units 110. For example, in some embodiments, one or more operator control units 110 may be used to tilt and / or rotate the driver head adapter 700. In some embodiments, the fastening system 150 includes one or more articulating motors that can be used to position the driver head adapter 700. In some implementations, a portion of the multi-component shaft 122 moves forward or backward in response to the user actuating (e.g., pressing) one or more operator control units 110 (such as buttons, switches, levers, arms, etc.). In certain implementations, one or more operator control units 110 can be used to rotate the fastening tool 104 relative to the handpiece 106. The operator control unit 110 may be, for example, a tactile and / or electrostatic button.

[0062] In some embodiments, the handpiece 106 can include features for improving user control by assisting the user in gripping and / or orienting the handpiece 106 and / or the articulating exercise device 100. For example, the handpiece 106 can include fins 112 that enable the user to easily and securely grip the handpiece 106. The fins 112 can comprise a pistol grip. In some variations, the device 100 comprises a pen-style grip.

[0063] Figures 5 and 6 respectively show top and bottom views of the fastening system 150. In some embodiments, the articulating exercise device 100 can be removably connected to the handpiece 106, such as by a body coupling assembly 102. The removability of the body coupling assembly 102 advantageously enables the user to quickly switch between different fastening tools 104 (e.g., from a screwdriver to a hex bar wrench, from a fastening tool of one length to a fastening tool of a different length, etc.) or to quickly replace a damaged fastening tool 104. In some embodiments, the body coupling assembly 102 is slidably engaged with and / or attached to the handpiece 106. For example, the body coupling assembly 102 can be configured to slide on and / or away from the distal end of the handpiece 106 along a direction substantially parallel to the longitudinal axis L (e.g., the z-axis).

[0064] In various embodiments, when the body coupling assembly 102 is attached to the handpiece 106, the instrument 100 is securely and firmly attached to the handpiece 106. The body coupling assembly 102 can include one or more mating mechanisms designed to engage corresponding one or more mating mechanisms of the handpiece 106. The mating mechanisms can include, for example, complementary grooves, tabs, and / or slots that securely engage with each other. In some embodiments, the body coupling assembly 102 is connected to the handpiece 106 by a friction fit. In certain implementations, the body coupling assembly 102 and / or the handpiece 106 can include one or more fastening mechanisms such as clamps, friction fits, quick releases, detents, and / or snaps that can be easily engaged or disengaged to facilitate the assembly and / or disassembly of the articulating instrument 100 to the handpiece 106. In some embodiments, the articulating instrument 100 may be permanently connected to the handpiece 106.

[0065] Figures 7, 8, and 9 respectively show a perspective view, a side view, and a top view of one embodiment of the driver head adapter 700 of the articulating instrument 100. In some embodiments, the driver head adapter 700 is at the distal end of the fastening instrument 104. The driver head adapter 700 can be configured to removably receive a driver head 116 (e.g., a bit or other medical instrument). In some implementations, the driver head can engage matingly with fasteners such as bone screws, bone fixation pins, surgical anchors, and / or surgical staples. In some implementations, the driver head can mate with a drill bit, a bone drill bit, a debulker, or other cutting or piercing instrument. In some positions, such as when the driver head adapter 700 is facing downward, the longitudinal axis of the driver head 116 can intersect the longitudinal axis L of the articulating instrument 100.

[0066] In some embodiments, the handpiece 106 can include one or more drive motors (not shown), a power source 108 (e.g., a battery), and / or other features. The one or more drive motors may be electric. In some embodiments, the driver head adapter 700 and the driver head 116 can receive torque from one or more drive motors housed in the handpiece 106. For example, the articulation instrument 100 can transmit torque from one or more motors to the driver head adapter 700 via an inner shaft 114 (see FIGS. 2B, 2C, and 11) of the fastening instrument 104 that can be directly or indirectly coupled to the output drive shaft 128 (see FIG. 2C) of the motor. In certain embodiments, the shaft 114 is received in a connector unit 136 that couples the shaft 114 and the drive shaft 128 on the other side of rotation and torque transmission. In some embodiments, the motor is controlled by one or more operator control units 110. For example, a first button may drive the motor and the driver head 116 clockwise, and a second button may drive the motor and the driver head 116 counterclockwise. In certain implementations, there may be one or more buttons that control the speed and / or amount of torque transmitted from the motor to the driver head 116.

[0067] In certain implementations, the driver head 116 is configured to be manually operated. For example, the user may use the control wheel 120 to rotate the driver head 116. In some embodiments, the articulation exercise device 100 uses a gear system (not shown) to amplify or reduce the torque received at the control wheel 120 before transmitting the torque received from the user to the driver head 116. In some embodiments, the torque received at the control wheel 120 is transmitted directly to the driver head 116. In some embodiments, the user may rotate all or a portion of the handpiece 106 to rotate the driver head 116. For example, in some embodiments, the user may rotate the handpiece 106 while holding the body coupling assembly 102 in a stationary state to rotate the driver head 116. It should be understood that the handpiece 106 can take on a variety of different shapes and sizes. For example, in some embodiments, the handpiece 106 is cylindrical with tapered ends (see handpiece 4100 of FIG. 41). In some variations, the handpiece 106 can have a square, elliptical, or hexagonal cross-section. In some cases, the handpiece 106 does not have fins 112 or compartments for batteries or motors. In some embodiments, this torque from any type of driver, motor, or pump can be transmitted to the driver head 116 by either the articulation exercise device and gear system described herein.

[0068] Rotation and / or torque of the wheel 120 can be transmitted to the driver head via the internal shaft 114. For example, the control wheel 120 can be connected to an internal shaft 114 that rotates one or more gears of the gear assembly 1000 (see FIG. 10). In some embodiments, the gear assembly 1000 can be configured to rotate the driver head 116. The gear assembly 1000 is described in more detail below.

[0069] In some embodiments, the driver head adapter 700 may have a front cap 725. The cap 725 can include a rounded front plate 730 and a recess 735. The recess 735 can be configured to receive the projection 900 of the stabilizer 1005. The stabilizer 1005 can be configured to securely receive the end of the driver head 116, such as a screw driver bit. For example, the proximal end of the driver head 116 can abut against the stabilizer 1005. In some implementations, the stabilizer 1005 can assist in positioning the driver head 116 inside the driver head adapter 700 and / or can reduce unwanted movement of the driver head 116. For example, in certain variations, the stabilizer 1005 is configured to prevent or inhibit the driver head 116 from vibrating or shearing during operation of the arthroscopic instrument 100. This can reduce wear (e.g., of the arthroscopic instrument 100, the driver head 116, and / or the operator), enhance secure screw driving, and / or improve efficiency. In some embodiments, the stabilizer 1005 provides physical interference (e.g., a stop) through which a distally directed force can be applied from the handpiece through the arthroscopic instrument 100 and / or the driver head 116 into a fastener or other surgical instrument.

[0070] Figures 10A-10C show perspective views of driver head adapter 700 with the cover shown transparently to display certain internal components. As will be described in more detail below, the driver head adapter is capable of articulating, such as between the positions shown in FIGS. 10A-10C. In some embodiments, the internal components of driver head adapter 700 include torque transfer unit 1010, as will be described in more detail below. Torque transfer unit 1010 may include components for transferring torque from a motor within handpiece 106 to driver head 116. In various embodiments, torque transfer unit 1010 is configured to receive torque from internal shaft 114 that is capable of being coupled to the motor as described above. Torque transfer unit 1010 can transfer torque from internal shaft 114 to driver head 116. In various embodiments, torque transfer unit 1010 maintains the direction of the motor. For example, the driver head adapter may rotate driver head 116 in the same direction that the motor rotates internal shaft 114.

[0071] Figures 11 and 12 respectively show a perspective view and a side view of an embodiment of the internal components of the driver head adapter 700. In some implementations, the torque transmission unit 1010 includes a gear assembly 1000. In some embodiments, the gear assembly 1000 includes a plurality of bevel gears. For example, the gear assembly 1000 can include a first bevel gear 705, one or more second bevel gears 710, one or more third bevel gears 715, and a fourth bevel gear 720. The first bevel gear 705 can be fixedly coupled to the distal end of the inner shaft 114 of the fastening tool 104. Thereby, the first bevel gear 705 can receive torque from the drive motor via the inner shaft 114. In some embodiments, the first bevel gear 705 can mesh with one or more second bevel gears 710. The one or more second bevel gears 710 can mesh with one or more third bevel gears 715. The one or more third bevel gears 715 can mesh with the fourth bevel gear 720. In some embodiments, the fourth bevel gear 720 can be configured to removably engage (e.g., receive) with the driver head 116 as shown in FIG. 16. The fourth bevel gear 720 can be configured to transmit torque to the driver head 116. For example, the fourth bevel gear 720 may have a hexagonal recess 1500 (see FIG. 15) configured to receive the corresponding hexagonal portion 1600 (see FIG. 16) of the shaft of the driver head 116. The flat region of the hexagonal recess 1500 can prevent or prevent the driver head 116 from rotating independently of the fourth bevel gear 720. The recess of the fourth bevel gear 720 can be a recess of any shape configured to prevent or prevent the driver head 116 from rotating independently of the fourth bevel gear 720. Any type of gear (e.g., spur gear, helical gear, worm gear, internal gear, etc.) can be used in any type of gear assembly described herein.

[0072] Figures 13 and 14 respectively show a top view and a bottom view of the internal components of the driver head adapter 700. Advantageously, in an implementation having a plurality of second bevel gears 710 and / or a plurality of third bevel gears 715, the gear assembly 1000 divides the motor torque between the left and right sides of the gear assembly 1000 while also facilitating articulation (as described below). More specifically, the first bevel gear 705 transmits approximately half of the motor torque to the right second gear 710A and approximately half of the motor torque to the left second gear 710B. In a particular implementation, the motor torque is divided among the individual gears of a set of third bevel gears 715A, 715B. The fourth gear receives half of the motor torque from the right third gear 715A and half of the motor torque from the left third gear 715B. Thus, the fourth gear receives substantially the full motor torque (e.g., approximately half from each side of the gear assembly 1000). By dividing the motor torque between both sides of the gear assembly 1000, the forces on the bevel gears of the second set 710A, 710B and the third set 715A, 715B are reduced. Dividing the torque can, for example, enable the gear assembly 1000 to transmit high torque loads safely, reliably, and / or efficiently. In some implementations, dividing the motor torque between both sides of the gear assembly 1000 can reduce cost and / or size by allowing smaller and / or weaker bevel gears to be used for at least the second set 710A, 710B and the third set 715A, 715B of bevel gears.

[0073] Figure 15 shows a perspective view of the internal components of the driver head adapter 700 without the outer casing or driver head. As described above, the hexagonal recess 1500 is configured to securely and removably connect and transmit the driver head 116 to the driver head 116. The removable driver head 116 allows the user to quickly change between different driver heads 116. For example, the user may wish to switch to a different type of driver head 116 or replace a damaged or worn driver head.

[0074] In some embodiments, the torque transmission unit 1010 is configured to articulate as the driver head adapter 700 moves. For example, the torque transmission unit 1010 can be configured to rotate about the x-axis (the transverse axis of the fastening instrument 104). In some embodiments, the second set of bevel gears 710 is on the first pin or set of pins 1505, and the third set of bevel gears 715 is on the second pin or set of pins 1510. For example, as shown in FIG. 15, the pin 1505 can extend between the second set of bevel gears 710 to connect them, and the third set of bevel gears 715 can have a separate pin 1510. The pin or set of pins 1505, 1510 may be attached to the shell of the driver head adapter 700, and the third set of bevel gears 715 may be rotated around the first guide pin 1505 when the driver head adapter 700 is tilted. Thereby, the torque transmission unit 1010 can transmit torque from the motor to the driver head 116 while the driver head adapter 700 is tilted.

[0075] FIG. 16 shows a perspective view of the driver head 116 removed from the hexagonal recess 1500 of the fourth bevel gear 720. As described above, the driver head 116 has a corresponding hexagonal portion 1600. The articulation device 100 can be used for various types of operations such as ablation, imaging, and biopsy. Thus, in some embodiments, the driver head 116 can be an electrode or ablation device, a dedicated imaging probe, a cutting instrument, a gripper, or other type of surgical instrument.

[0076] FIG. 17 shows the distal end of the multi-component shaft 122 of the fastening instrument 104. In some embodiments, the fastening instrument 104 has an upper anchor point 1700 and a lower anchor point 1705 of the driver head adapter 700. The two anchor points 1700, 1705 allow the driver head adapter 700 to rotate about the x-axis as described above. Overall, the fastening system 150 enables a user to accurately and efficiently treat a patient undergoing a surgical procedure by providing greater control, reliability, and durability.

[0077] Articulating exercise device having a turret driver head adapter (Figs. 18 - 29) FIG. 18 shows an embodiment of a fastening system 1850 that includes an articulating instrument 1800 having a turret driver head adapter 1810 and a handpiece 1825. The articulating instrument 1800 can include a body coupling assembly 1815 and a fastening instrument 1820. The body coupling assembly 1815 can be connected to the handpiece coupling assembly 1840 using a quick release mechanism 1830 or the like. The handpiece coupling assembly 1840 can be rigidly and / or securely connected to the handpiece 1825. In some embodiments, the handpiece coupling assembly 1840 can be removably connected to the handpiece 1825 via a quick release mechanism (not shown) or any other fastening mechanism described herein. These features are described in more detail below. The articulating instrument 1800 may include any of the features of the articulating instrument 100, and vice versa.

[0078] The articulating exercise device 1800 may include one or more control units (e.g., control wheels 1805, 1835, 1910) for articulating the turret driver head adapter 1810 and / or the driver head 2405. The one or more control wheels 1805, 1835, 1910 may be digital and / or analog, and may be the same size or different sizes. For example, in some implementations, the diameter of the first control wheel 1835 may be 25 mm, the diameter of the second control wheel 1805 may be 20 mm, and the diameter of the third wheel 1910 may be 15 mm. The diameter of the wheels may vary to suit different requirements and user preferences. For example, one or more of the wheels 1805, 1835, 1910 may have a diameter of 1 mm, 5 mm, 10 mm, 15 mm, greater than 40 mm, or any diameter in between. In some embodiments, the one or more control wheels 1805, 1835, 1910 may be coaxially arranged along the z-axis. For example, the first control wheel 1835 may be disposed at the center of the body coupling assembly 1815, the second control wheel 1805 may be disposed toward the front (e.g., distal end) of the body coupling assembly 1815, and the third control wheel 1910 may be disposed at the distal end of the body coupling assembly 1815. In some embodiments, the one or more control wheels 1805, 1835, 1910 may be disposed on the handpiece 1825 or the articulating exercise device 1800. In some cases, the one or more control wheels 1805, 1835, 1910 may be on two or more different axes (e.g., a first z-axis and a second z-axis offset from the first z-axis).

[0079] For example, as will be described in more detail below, the control wheels 1805, 1835, 1910 can be configured to rotate the turret driver head adapter 1810 about multiple axes and / or provide multiple degrees of freedom (e.g., three or more axes and / or degrees of freedom). In some embodiments, the first control wheel 1835 controls the rotation of the driver head 2405, the second control wheel 1805 controls the rotation of the turret driver head adapter 1810 about the y-axis, and the third control wheel 1910 controls the rotation of the articulating instrument 1800 about the z-axis. In some embodiments, the longitudinal axis of the driver head 116 does not intersect the longitudinal axis of the articulating instrument 1800 (e.g., at all positions of the driver head). For example, in certain variations, the longitudinal axis of the driver head 116 can oscillate to define a plane that does not intersect the longitudinal axis of the articulating instrument 1800.

[0080] FIG. 19 shows a top view of the body coupling assembly 1815. FIG. 20 shows a perspective view of the body coupling assembly 1815 removed from the handpiece coupling assembly 1840 and the handpiece 1825. Additionally, FIG. 21 shows a rear perspective view of the body coupling assembly 1815 removed from the handpiece coupling assembly 1840 and the handpiece 1825. As shown, in some embodiments, the body coupling assembly 1815 is removably connected to a handpiece coupling assembly 1840 (which can be connected to the handpiece 1825) via a quick release mechanism 1830.

[0081] In certain implementations, the quick release mechanism 1830 can be operated by one or more buttons 1900 (e.g., two buttons). For example, the one or more buttons 1900 can disengage the lock and enable the user to remove the body coupling assembly 1815. As shown, in some embodiments, the body coupling assembly 1815 is removed by sliding the body coupling assembly 1815 to disengage one or more guide pins 2000 from the handpiece coupling assembly 1840 or the handpiece 1825.

[0082] In certain implementations, the body coupling assembly 1815 may use any of the coupling methods described in any of the embodiments described herein. In some embodiments, the buttons 1900 are on both sides of the body coupling assembly 1815 and are pressed toward the longitudinal axis of the body coupling assembly 1815. In some variations, the quick release mechanism 1830 includes one or more detents, latches, bayonet connections, friction fits, or other connection mechanisms. For example, in some implementations, the body coupling assembly 1815 may have a spring-biased connection portion that automatically pushes a pin into the notch 2100 when the post of the handpiece coupling assembly 1840 is pushed into the mating hole 2105 of the body coupling assembly 1815. In some embodiments, when one or more of the buttons 1900 are pressed, the pin is pushed out of the notch 2100. One or more of the buttons 1900 may be spring-biased to automatically return to the locked / unpressed position. A spring 2225 (see FIG. 22) may be present between one or more of the buttons 1900. In some embodiments, one or more of the buttons 1900 have one or more guide pins 2215 and corresponding slots 2220. The one or more guide pins 2215 facilitate linear movement and ensure that the button 1900 efficiently locks and unlocks the connection between the body coupling assembly 1815 and the handpiece coupling assembly 1840. Advantageously, the quick release mechanism 1830 facilitates a secure and removable connection between the body coupling assembly 1815 and the handpiece coupling assembly 1840.

[0083] FIG. 22 shows a top partial cross-sectional view of the body coupling assembly 1815 attached to the handpiece 1825. More specifically, FIG. 22 shows a cross-section of the main housing of the body coupling assembly 1815 with the outer casing of the control wheel 1805 removed. In some embodiments, the fastening tool 1820 and / or the turret driver head adapter 1810 can pivot, articulate, move, rotate, and / or be repositioned relative to the handpiece 1825 and / or the body coupling assembly 1815. For example, the elongate outer housing 1905 of the fastening tool 1820 can rotate about the z-axis (e.g., the longitudinal axis of the fastening tool 1820). Thus, the user can rotate the elongate outer housing 1905 without rotating the body coupling assembly 1815 or the handpiece 1825, and vice versa. In some embodiments, rotating the elongate outer housing 1905 also rotates the driver head adapter 1810 about the z-axis. The body coupling assembly 1815 can include one or more controls for rotating the elongate outer housing 1905. For example, the body coupling assembly 1815 can include a control wheel 1910 fixed to the elongate outer housing 1905. Thus, the user can rotate the elongate outer housing 1905 by rotating the control wheel 1910.

[0084] In some embodiments, the control wheel 1910 has a locking clutch 2200. The locking clutch 2200 can lock the rotation of the elongate outer housing 1905 relative to the body coupling assembly 1815. As shown, the locking clutch 2200 can comprise mating (e.g., meshing) mating teeth that engage one or more locking pins 2210 (e.g., two locking pins) when locked. The locking clutch 2200 may be spring-biased or have a bias applied by a biasing member. In some embodiments, the user can disengage the locking clutch 2200 by sliding the locking clutch 2200 to a disengaged position (e.g., along the z-axis) (e.g., as shown in FIG. 22, the spring of the locking clutch 2200 is compressed and / or the mating teeth are disengaged). The spring of the locking clutch 2200 may be present within a recess of the body coupling assembly 1815 and may be coaxial with the elongate outer housing 1905. In some embodiments, when the locking clutch is in the disengaged position, the user can rotate the control wheel 1910, thereby rotating the elongate outer housing 1905. In some embodiments, the locking clutch 2200 can lock in a predetermined position. For example, the locking clutch 2200 may have locking positions at every 1°, 5°, 10°, 30°, 90°, or greater than 90°, or any number therebetween. In certain implementations, the locking clutch 2200 may be able to lock in any position.

[0085] FIG. 23 shows a side cross-sectional view of the body coupling assembly 1815. In some embodiments, the turret driver head adapter 1810 can rotate about the y-axis. The body coupling assembly 1815 can have an orientation control mechanism such as a control wheel 1805, a lever, an arm, or an electronic mechanism. In some embodiments, the orientation control mechanism is configured to rotate the turret driver head adapter 1810 about the y-axis. For example, the control wheel 1805 can be connected to an internal shaft 2300 (also referred to as a first internal shaft) that rotates one or more gears of a gear assembly 2500 (see FIG. 25). In some embodiments, the gear assembly 2500 can be configured to rotate the turret driver head adapter 1810. The gear assembly 2500 will be described in more detail below. In some embodiments, the internal shaft 2300 is between the elongate outer housing 1905 and a second internal shaft 2305, which will be described in more detail below. The elongate outer housing 1905, the internal shaft 2300, and the second internal shaft 2305 may be concentric shafts. In some embodiments, the fastening device 1820 has a plurality of lumens within the elongate outer housing 1905. Accordingly, the internal shaft 2300 and the second internal shaft 2305 may not be concentric.

[0086] In some embodiments, the control wheel 1805 for the turret driver head adapter 1810 may have a locking clutch 2205 (see FIG. 22). As shown, the locking clutch 2205 can include mating (e.g., engaging) mating teeth that mate with the elongated outer housing 1905. The locking clutch 2205 can lock the rotation of the turret driver head adapter 1810 relative to the protective bottom housing 2400 (see FIG. 24). The locking clutch 2205 may be spring-biased or biased by a biasing member. The spring of the locking clutch 2205 may be present within a circular recess of the body coupling assembly 1815 and may be coaxial with the inner shaft 2300. In some embodiments, the user can disengage the locking clutch 2205 by sliding the locking clutch 2205 to a disengaged position (e.g., along the z-axis) (e.g., the spring of the locking clutch 2200 is compressed and / or the mating teeth are disengaged). In some embodiments, when the locking clutch is in the disengaged position, the user can rotate the control wheel 1805, thereby rotating the inner shaft 2300. The control wheel 1805 may use one or more pins 2230 to connect to corresponding grooves of the inner shaft 2300. In some embodiments, the locking clutch 2205 can be locked in a predetermined position. For example, the locking clutch 2205 may have locking positions at 1°, 5°, 10°, 30°, 90°, or more than 90°, or at any number in between. In a particular implementation, the locking clutch 2205 may be able to be locked in any position. In some embodiments, the body coupling assembly 1815 may have one or more bearings 2310 to reduce or eliminate friction between two or more components (e.g., a rotating shaft and a non-rotating body).

[0087] The body coupling assembly 1815 may have a control unit for manually operating the driver head 2405. The control unit may be a control wheel 1835 that transmits the torque received from the user to the driver head (e.g., a bit). The rotation and / or torque of the wheel 1835 may be transmitted to the driver head via an internal shaft 2305. In some embodiments, the articulating instrument 1800 uses a gear system (not shown) to amplify or reduce the torque received by the control wheel 1835 before transmitting the torque received from the user to the driver head 2405. In some embodiments, the torque received by the control wheel 1835 is transmitted directly to the driver head 2405. For example, the control wheel 1835 may be connected to an internal shaft 2305 that rotates one or more gears of a gear assembly 2505 (see FIG. 25). In some embodiments, the gear assembly 2505 may be configured to rotate the driver head 2405. The gear assembly 2505 will be described in more detail below.

[0088] FIG. 24 shows an enlarged view of the turret driver head adapter 1810. In some embodiments, the turret driver head adapter 1810 is offset from the z-axis (e.g., the longitudinal axis of the fastening instrument 1820) and / or rotates about the y-axis (e.g., the transverse axis). In some embodiments, the turret driver head adapter 1810 can rotate 0° to 360° about the y-axis. In some embodiments, the turret driver head adapter 1810 can rotate freely about the y-axis (e.g., can make multiple full rotations). In various embodiments, the turret driver head adapter 1810 includes the driver head 2405. The driver head 2405 can be offset (e.g., spaced apart) from the longitudinal axis of the instrument 1800 and / or the elongated outer housing 1905. For example, the longitudinal axis of the driver head 2405 and the longitudinal axis of the instrument 100 may be non-coplanar in the z-x plane.

[0089] Figures 25 and 26 show enlarged views of certain internal components of the elongate outer housing 1905 and the turret driver head adapter 1810. As shown, the distal end of the elongate outer housing 1905 can have threads 2550 that can secure a cover 2400 (see FIG. 24). Also as shown, the internal components of the turret driver head adapter 1810 can include a plurality of articulating motion assemblies such as an articulating torque transmission unit 2510 and / or an articulating mechanism 2515. The articulating torque transmission unit 2510 and the articulating mechanism 2515 can be separate and / or can operate independently (e.g., one can operate without the operation of the other). As will be described in more detail below, in certain embodiments, the unit 2510 can control the driver head 2405 and the mechanism 2515 can control the rotational position of the driver head adapter 1810.

[0090] In some embodiments, the articulating torque transmission unit 2510 includes a gear assembly 2505 that transmits torque from a second internal shaft 2305 to a driver head 2405 (e.g., a bit, drill bit, or other medical instrument). In various embodiments, the proximal end of the second internal shaft 2305 can be coupled to a motor of the fastening system 1850. Torque can be transmitted through the shaft 2305 to the gear assembly 2505 and then to the driver head 2405. In various embodiments, the articulating torque transmission unit 2510 maintains the direction of the motor. For example, the turret driver head adapter 1810 can rotate the driver head 2405 in the same direction that the motor rotates the second internal shaft 2305.

[0091] The gear assembly 2505 of the joint torque transmission unit 2510 may include a plurality of gears such as a first bevel gear 2520, a second bevel gear 2525, and a third bevel gear 2600. In some embodiments, the first bevel gear 2520 is fixedly coupled to the second inner shaft 2305, the second bevel gear 2525 is fixedly coupled to the gear support shaft 2605, and the third bevel gear 2600 is fixedly coupled to the output shaft 2610. The output shaft may be fixed to the driver head 2405 (e.g., a bit). In some embodiments, the shaft 2605 may be a shoulder screw for holding one or more components of the turret head adapter 1810. The gear support shaft 2605 may have a slot at the distal end (e.g., the end furthest from the corresponding gear) that can be used to tighten the shoulder screw in place during the assembly process of the articulating exercise device 1800. In some embodiments, the turret driver head adapter 1810 has one or more clevis pins with cross pins (not shown) to eliminate the risk of one or more screws loosening. Thus, the articulating exercise device 1800 can be manufactured to remain firmly assembled during operation.

[0092] In some embodiments, the first bevel gear 2520 may interact (e.g., mesh) with the second bevel gear 2525. The second bevel gear 2525 may interact (e.g., mesh) with the third bevel gear 2600. As shown in FIG. 26, the second bevel gear 2525 may comprise a double bevel gear having bevel gears on both sides. Any type of gear (e.g., spur gear, helical gear, worm gear, internal gear, etc.) may be used in any type of gear assembly described herein.

[0093] In some embodiments, the joint mechanism 2515 surrounds and / or is nested within the joint torque transmission unit 2510. For example, as described above, the inner shaft 2305 of the joint torque transmission unit 2510 can be disposed within the lumen of the inner shaft 2300 of the joint mechanism 2515. In certain implementations, the second bevel gear 2525 and the third bevel gear 2600 of the joint torque transmission unit 2510 can be disposed within the front cap 2540 of the turret driver head adapter 1810. The nesting of the joint torque transmission unit 2510 and the joint mechanism 2515 can reduce the size of the joint exercise device 1800 while maintaining high-level movement and torque transmission.

[0094] In some embodiments, the joint mechanism 2515 is an orientation mechanism configured to orient the driver head adapter 1810 in different orientations. The joint mechanism 2515 may be a gear assembly 2500. The gear assembly 2500 may include a first bevel gear 2530 and a second bevel gear 2535. The first bevel gear 2530 may be fixedly coupled to the inner shaft 2300, and the second bevel gear 2535 may be fixedly coupled to the front cap 2540 of the turret driver head adapter 1810. The first bevel gear 2530 may interact (e.g., mesh) with the second bevel gear 2535. As illustrated, in certain implementations, the first bevel gear 2530 of the mechanism 2515 has an outer diameter larger than that of the first bevel gear 2520 of the unit 2510, and / or the second bevel gear 2535 of the mechanism 2515 has an outer diameter larger than that of the second bevel gear 2525 of the unit 2510. Also as illustrated, the first bevel gears 2520, 2530 may be coaxial, and / or the second bevel gears 2525, 2535 may be coaxial. In some embodiments, the first bevel gears 2520, 2530 and the second bevel gears 2525, 2535 are configured to rotate about substantially perpendicular axes.

[0095] As described above, the articulation mechanism 2515 can be configured to rotate the turret driver head adapter 1810 about the y-axis when the corresponding internal shaft 2300 is rotated. In some embodiments, the second bevel gear 2535 has a mechanical stopper 2545 that limits the rotation of the turret driver head adapter 1810. In some embodiments, the second bevel gear 2535 does not have a mechanical stopper and / or can rotate 360° about the y-axis.

[0096] In some embodiments, the position of the turret driver head adapter 1810 can be adjusted via one or more operator control units 110. For example, the user may be able to press one or more operator control units 110 (see FIG. 20) to rotate the fastening tool 1820 about the z-axis. In certain implementations, one or more operator control units 110 can be used to rotate the turret driver head adapter 1810 about the y-axis.

[0097] FIG. 27 shows a side view of the turret driver head adapter 1810. In some embodiments, the turret driver head adapter 1810 includes a back cap 2700. The back cap 2700 protects the articulation torque transmission unit 2510 and the articulation mechanism 2515 from shock as well as debris and dust.

[0098] In some embodiments, the back cap 2700 may be a sliding lock for the driver head 2405. For example, the user may slide the back cap 2700 along the y-axis to an unlocked position (e.g., the raised position shown in FIG. 27) to unlock the driver head 2405. In certain implementations, the user may slide the back cap 2700 to a locked position (e.g., the lowered position shown in FIG. 24) to lock the driver head 2405. In some embodiments, by lowering the back cap 2700, the tab is slid into the groove 2615 of the driver head 2405. In some implementations, the back cap 2700 may use any of the coupling mechanisms described herein (e.g., friction fit, magnet, etc.). This allows the back cap 2700 to enable the driver head 2405 to be easily removed from the turret driver head adapter 1810. The quick removal of the driver head 2405 allows the user to easily change the driver head 2405 (e.g., from a screwdriver bit to a hex bar wrench) or replace a damaged driver head 2405.

[0099] FIG. 28 shows a front cross-sectional view of one embodiment of the fastening system 1850. FIG. 29 shows an enlarged cross-sectional view of one embodiment of the articulating instrument 1800. In some embodiments, as described above, the fastening instrument 1820 has three concentric shafts. For example, the fastening instrument 1820 may include a first outer shaft (e.g., the elongate outer housing 1905), a second shaft fixedly attached to the articulation mechanism 2515 (e.g., the inner shaft 2300), and a third shaft fixedly attached to the articulation torque transmission unit 2510 (e.g., the second inner shaft 2305). The concentric shafts reduce the size of the fastening instrument 1820 while allowing the user to effectively control and operate the turret driver head adapter 1810.

[0100] Figures 30 - 32 show the rounded front plate 3000 of the front cap 2540 of the turret driver head adapter 1810. In some embodiments, the rounded front plate 3000 is coupled to the front cap 2540 of the turret driver head adapter 1810 via a top lip 3005 and a bottom lip 3010 of the rounded front plate 3000. For example, the top lip 3005 can be inserted into a recess of the front cap 2540. In certain implementations, the bottom lip 3010 can be inserted into a bottom recess that is formed in part by the front cap 2540 and in part by the protective bottom housing 2400 of the turret driver head adapter 1810. As shown in Figure 32, the protective bottom housing 2400 allows the bottom lip 3010 to slide along the recess as the turret driver head adapter 1810 rotates about the y - axis. The integral rounded front plate 3000 can stabilize the driver head 2405 while allowing smooth rotation of the turret driver head adapter 1810.

[0101] Articulating exercise device having a turret driver head adapter (Figs. 33 - 40) Figure 33 shows a perspective view of one embodiment of a fastening tool 3300 that includes a turret driver head adapter 3305. The tool 3300 may include any of the features of either of the tools 100, 1800, and vice versa. For example, the tool 3300 can include a handpiece, a handpiece coupling assembly, a body coupling assembly, and a fastening tool (as described and illustrated above). For illustrative purposes, the following description and associated figures focus on a portion of the tool 3300, namely the distal end of the tool 3300 that includes the turret driver head adapter 3305.

[0102] The fastening tool 3300 may include a long outer shaft 3320, a turret driver head adapter 3305, a back cap 3310, and a driver head 3315. The fastening tool 3300 may be part of a fastening system that includes one or more control units for articulating the turret driver head adapter 3305 and / or the driver head 3315. For example, the fastening tool 3300 may be incorporated into any of the fastening systems described above. In some embodiments, the turret driver head adapter 3305 is configured to rotate about the y-axis. The fastening tool 3300 may be configured to rotate about the z-axis with respect to the handpiece of the fastening system.

[0103] Figures 34A and 34B respectively show a front view and a rear view of the turret driver head adapter 3305. In some embodiments, the turret driver head adapter 3305 includes a back cap 3310. The back cap 3310 protects the internal components of the fastening tool 3300 from impact as well as moisture, debris, and dust. In some embodiments, the back cap 3310 may be a sliding lock of the turret driver head adapter 3305. For example, the user can slide the back cap 3310 along the y-axis to an unlocked position (e.g., the raised position shown in Figure 34B) to unlock the driver head 3315. In certain implementations, the user can slide the back cap 3310 to a locked position (e.g., the lowered position shown in Figure 34A) to lock the driver head 3315. In some embodiments, by lowering the back cap 3310, a tab 4000 is slid into a groove (see 2615 in Figure 26) of the driver head 3315 to lock the driver head 3315 in a fixed position. In some implementations, the back cap 3310 may use any of the coupling mechanisms described herein (e.g., friction fit, magnet, etc.). In some embodiments, the back cap 3310 is spring-biased and automatically returns to the locked position.

[0104] In some embodiments, the turret driver head adapter 3305 has a stabilizer 3400 configured to securely receive the driver head 3315. As shown, in some embodiments, the driver head 3315 passes through the stabilizer 3400 and / or is substantially coplanar with the back of the stabilizer 3400. In some implementations, the stabilizer 3400 can assist in positioning the driver head 3315 inside the driver head adapter 3305 and / or can reduce unwanted movement of the driver head 3315.

[0105] FIGS. 35 and 36 respectively show front and rear views of the fastening device 3300 including the turret driver head adapter 3305. FIGS. 37A and 37B respectively show top and bottom views of the fastening device 3300. Similar to the articulating device 1800 described above, the fastening device 3300 can have three different shafts. For example, the fastening device 3300 can have a long outer shaft 3320 that can be used to rotate the fastening device 3300, an inner shaft 3600 that can be used to rotate the turret driver head adapter 3305 about the y-axis, and a second inner shaft 3605 that can be used to transmit torque from a motor to the driver head 3315.

[0106] FIG. 38 shows a perspective view of the internal components of the turret driver head adapter 3305 with certain cover components not shown for illustrative purposes. The internal components can include an articulating torque transmission unit 3800 and a separate articulating mechanism 3805. The unit 3800 and the mechanism 3805 can be separate and / or can operate independently (e.g., one can be operated without the operation of the other).

[0107] In some embodiments, the articulating torque transmission unit 3800 includes a gear assembly that transmits torque from the second inner shaft 3605 to a driver head 3315 (e.g., a bit, drill bit, or other medical instrument). In some embodiments, the second inner shaft 3605 can be coupled to a motor of the fastening system. The gear assembly of the articulating torque transmission unit 3800 can include a first bevel gear 3810, a second bevel gear 3815, and a third bevel gear 3820. The bevel gears may have different pitch angles, gear ratios, or tooth counts according to requirements and user preferences. For example, one or more of the gears may have a pitch angle of 0°, 5°, 10°, 20°, 50°, 70°, 90°, or greater than 90°, or any angle therebetween. In some implementations, one or more of the gears may have a tooth count of 1 mm, 2 mm, 5 mm, 10 mm, greater than 10 mm, or any length therebetween. In some embodiments, the first bevel gear 3810 is fixedly coupled to the second inner shaft 3605, the second bevel gear 3815 is fixedly coupled to a gear support shaft 3845, and the third bevel gear 3820 is removably coupled to the driver head 3315. The first bevel gear 3810 may mesh with the second bevel gear 3815, and the second bevel gear 3815 may mesh with the third bevel gear 3820. Various gear ratios can be implemented between any of the gears described herein. For example, the ratio between the first bevel gear 3810 and the second bevel gear 3815 may be 1:1, 2:1, 3:1, 4:1, 1:2, 1:3, 1:4, or any other ratio.

[0108] In some embodiments, the articulation mechanism 3805 surrounds the articulating torque transmission unit 3800. For example, as described above, the second inner shaft 3605 of the articulating torque transmission unit 3800 can be disposed within the lumen of the inner shaft 3600 of the articulation mechanism 3805. In certain implementations, the second bevel gear 3815 and the third bevel gear 3820 of the articulating torque transmission unit 3800 can be disposed within the front cap 3855 of the turret driver head adapter 3305.

[0109] In some embodiments, the articulation mechanism 3805 may be a gear assembly. The gear assembly may include a first bevel gear 3825 and a second bevel gear 3830. The first bevel gear 3825 may be fixedly coupled to the inner shaft 3600, and the second bevel gear 3830 may be fixedly coupled to the front cap 3855 of the turret driver head adapter 3305. The first bevel gear 3825 may mesh with the second bevel gear 3830. As described above, the articulation mechanism 3805 may be configured to rotate the turret driver head adapter 3305 about the y-axis of the fastening tool 3300 when the corresponding inner shaft 3600 is rotated. In some embodiments, the second bevel gear 3830 may be rotatable 360° about the y-axis. In some embodiments, the turret driver head adapter 3305 may be rotatable multiple times about the y-axis.

[0110] Similar to the foregoing embodiments, the position of the turret driver head adapter 3305 may be adjusted via one or more operator controls or control wheels. For example, the user may be able to press one or more operator controls to rotate the fastening tool 3300 about the z-axis. In certain implementations, one or more operator controls or control wheels may be used to rotate the turret driver head adapter 3305 about the y-axis.

[0111] In some embodiments, the fastening tool 3300 includes one or more washers 3835, 3840. The one or more washers 3835, 3840 may be made of a low-friction material such as a polymer. The one or more washers 3835, 3840 can reduce the area of metal-to-metal contact and / or improve the durability and reliability of the fastening tool 3300. The one or more washers 3835, 3840 can reduce vibration and protect internal components from moisture, dust, and debris.

[0112] Figures 39 and 40 respectively show a front view and a rear view of an embodiment of the internal components of the turret driver head adapter 3305. In some embodiments, long gears are used in the articulating torque transmission unit 3800 and / or the articulating mechanism 3805. For example, the second bevel gear 3815 of the articulating mechanism 3805 may be a high-capacity gear having larger teeth (e.g., increasing the tooth thickness and depth), enhanced material strength (e.g., improved heat treatment), and precision manufacturing. The high-capacity gear can handle heavy loads and transmit large torques while reducing wear, tearing, and noise. For example, the second bevel gear 3815 may have a larger diameter, an increased contact ratio, and / or wider teeth compared to conventional gears. Thus, the high-capacity gear can transmit a larger amount of torque without shearing. Note that any of the gears disclosed herein may be high-capacity gears.

[0113] In some embodiments, the second bevel gear 3815 may be a double-sided bevel gear. Advantageously, the double-sided gear 3815 may have higher strength compared to two separate bevel gears connected by a shaft. For example, the double-sided gear 3815 may have more material at the tooth roots to resist bending. In some embodiments, wear and tearing increase the friction between the various components of the articulating torque transmission unit 3800, so a larger torque may be required. To extend the life of the fastening tool 3300, the second bevel gear 3815 may have larger teeth at the input end to safely receive and transmit a large amount of torque. Thus, the second bevel gear 3815 can reduce the possibility that the gears 3810 and 3815 experience coupling problems.

[0114] In some embodiments, the double-sided gear 3815 may be easier to manufacture than other gears (e.g., two separate but connected bevel gears). For example, the manufacture of the second bevel gear 3815 may not require the time adjustment or alignment of two opposing surfaces because it is integral. In some embodiments, the second bevel gear 3815 may have a smaller inner diameter than other gears because of its integral structure that can reduce friction between the gear 3815 and the gear support shaft 3845.

[0115] For example, in some implementations, the teeth at the proximal end of the second bevel gear 3815 (e.g., the teeth that mesh with the first bevel gear 3810) may have a different number of teeth, pitch angle, thickness, and / or contact ratio than the teeth at the distal end of the second bevel gear 3815 (e.g., the teeth that mesh with the third bevel gear 3820). Thus, the double-sided bevel gear may be able to provide different mechanical advantages on both sides of the teeth while reducing the overall weight of the gear (e.g., compared to two bevel gears connected by a shaft). Any of the gears disclosed herein may be a double-sided bevel gear.

[0116] Figure 41 shows an embodiment of a fastening system 4150 that includes a handpiece 4105. The handpiece 4105 can include a handle, which can be cylindrical or other shapes. In some embodiments, the user may rotate all or a portion of the handpiece 4105 around the longitudinal axis of the articulating instrument 4100 to rotate the driver head 116. For example, in some embodiments, the user may rotate the handpiece 4105 while holding the body coupling assembly 102 stationary to rotate the driver head 116. In some embodiments, the handpiece 4105 and the body coupling assembly 102 may be coupled via bearings, slides, or bushings that allow independent rotational movement between components. The handpiece 4105 can take on a variety of different shapes and sizes. In some embodiments, the handpiece 4105 is cylindrical and / or tapers at both ends. In some cases, the handpiece 106 does not have fins 112 or compartments for the battery and motor. The handpiece 4105 can be used with any embodiment of the articulating instrument described herein.

[0117] Specific terms Conditional language, such as "can", "could", "might", "may", "e.g.", etc., used herein is generally intended to convey that a particular embodiment includes a particular feature, element, and / or step, but other embodiments do not, unless specifically stated otherwise or understood otherwise in the context in which it is used. Thus, such conditional language is not generally intended to imply that a feature, element, and / or step is required in any way for one or more embodiments, or that these features, elements, and / or steps are necessarily included in, or are to be performed in, any particular embodiment, whether or not the author's input or intervention is present, or to imply any logic for determining whether these features, elements, and / or steps are included in, or are to be performed in, any particular embodiment.

[0118] Connective language such as the phrase "at least one of X, Y, and Z" is generally understood, in the context in which it is used, unless specifically stated otherwise, to convey that an item, term, etc. can be any of X, Y, or Z. Thus, such connective language is not generally intended to imply that a particular embodiment requires the presence of at least one of each of X, at least one of Y, and at least one of Z.

[0119] Terms such as "comprising", "including", "having", etc. are synonyms and are used inclusively in an open-ended manner, without excluding additional elements, features, acts, operations, etc. Also, the term "or", when used, for example, to connect a list of elements, is used in an inclusive sense (not an exclusive sense) such that the term "or" means one, some, or all of the elements in the list. The term "and / or" means that "and" applies in some embodiments and "or" applies in some embodiments. Thus, A, B, and / or C corresponds to A, B, and C as described in one sentence, and A, B, or C as described in another sentence. The term "and / or" is used to avoid unnecessary redundancy.

[0120] As used herein, the terms "approximately," "about," and "substantially" represent an amount close to the stated amount that still performs the desired function or achieves the desired result. For example, in some embodiments, the terms "approximately," "about," and "substantially" may refer to an amount within 10% of the stated amount, as the context may indicate. The term "generally" as used herein primarily represents a value, amount, or characteristic that includes or tends towards a particular value, amount, or characteristic. As an example, in certain embodiments, the term "substantially parallel" can refer to something that deviates by 20 degrees or less from exact parallel, and the term "substantially perpendicular" can refer to something that deviates by 20 degrees or less from exact perpendicular, as the context may indicate.

[0121] Overview The present disclosure has presented specific embodiments, examples, and variations of joint exercise devices, systems, and methods. These joint exercise devices, systems, and methods enable a user to easily reach a wide range of positions and configurations during a medical procedure (e.g., place a fastener) by, for example, using multiple control units and shafts to change the orientation of the joint exercise device. The present disclosure extends beyond the specifically disclosed embodiments, examples, and variations to other alternative embodiments and / or uses of the invention, as well as obvious modifications and equivalents thereof. Additionally, while several variations have been shown and described in detail, other modifications within the scope of the present disclosure will be readily apparent to those skilled in the art based on the present disclosure. Also, while specific examples have been described in the context of attachments for surgical instruments, the various inventions disclosed herein are not limited to use in surgical instruments. In fact, the various inventions disclosed herein are contemplated for use in a variety of other types of medical devices and other medical environments. Any of the apparatuses, systems, or methods described herein may include any of the features disclosed in U.S. Patent No. 11,259,855, which is hereby incorporated by reference in its entirety.

[0122] Some embodiments have been described in connection with the accompanying drawings. The figures are drawn to scale, but such scales should not be limiting since dimensions and ratios other than those shown are contemplated and are within the scope of the present disclosure. Distances, angles, etc. are merely illustrative and do not necessarily have an exact relationship to the actual dimensions and layout of the devices shown. Components may be added, removed, and / or rearranged. Additionally, the disclosure herein of any particular features, aspects, methods, properties, characteristics, qualities, attributes, elements, etc. related to the various embodiments may be used in all other embodiments described herein. Moreover, it will be recognized that any method described herein may be practiced using any device suitable for the recited steps.

[0123] Specific features described in the context of separate implementations may also be implemented in combination in a single implementation. Conversely, various features described in the context of a single implementation may also be implemented separately in multiple implementations or in any suitable sub - combination. Also, features may be described as acting in a particular combination, but one or more features from the claimed combination may, in some cases, be deleted from the combination, and the combination may be claimed as any sub - combination or variation of a sub - combination.

[0124] Any part of a step, process, structure, and / or apparatus disclosed or illustrated in an embodiment, flowchart, or example of the present disclosure can be combined with or used with (or instead of) any other part of a step, process, structure, and / or apparatus disclosed or illustrated in different embodiments. The embodiments and examples disclosed herein are not separate and are not intended to be separated from each other. Combinations, variations, and other implementations of the disclosed features are within the scope of the present disclosure.

[0125] Any of the components or steps can be adjusted or modified. Other or additional steps can be used. None of the elements or steps described herein are essential or indispensable. Also, operations may be depicted in the drawings or described herein in a particular order, but such operations need not be performed in the particular order or sequence shown, and not all such operations need to be performed to achieve the desired result. Other operations not shown or described can be incorporated into the described operations. For example, one or more additional operations can be performed before, after, simultaneously with, or between any of the described operations. Further, the operations may be rearranged or reordered in other implementations. Also, the separation of the various system components in the above-described implementations should not be understood to require such separation in all implementations, and it should be understood that the described components and systems can generally be integrated together into a single product or packaged into multiple products.

[0126] The various features and processes described above may be used independently of each other or combined in various ways. All possible combinations and subcombinations are intended to fall within the scope of this disclosure. The exemplary systems and components described herein may be configured differently than described. For example, elements may be added, deleted, or rearranged compared to the disclosed exemplary embodiments.

[0127] In summary, various embodiments and examples of joint exercise devices, systems, and methods have been disclosed. While the present disclosure is in the context of these embodiments and examples, the present disclosure extends beyond the specifically disclosed embodiments to other alternative embodiments and / or other uses of the embodiments, as well as to specific modifications and equivalents. The present disclosure is clearly intended that various features and aspects of the disclosed embodiments can be combined with or replaced by each other. Accordingly, the scope of the present disclosure should not be limited by the specific disclosed embodiments described herein.

Claims

1. An arthroscopic surgical instrument, A long outer housing having a proximal end, a distal end, a lumen, and a longitudinal axis, the long outer housing being configured to engage a handpiece having a motor, the long outer housing; A torque transmission mechanism, A first shaft extending through the lumen of the long outer housing; An articulating torque transmission unit having a first end and a second end, the first end being coupled to a distal portion of the first shaft, a first bevel gear, a second bevel gear, and a third bevel gear, the first bevel gear being fixedly coupled to the first shaft, the second bevel gear being coupled to a gear support shaft, the third bevel gear being removably engaged with a bit and configured to rotate the bit about a bit axis, the articulating torque transmission unit; Comprising, The torque transmission mechanism is configured to transmit torque from the motor to the bit, and rotating the long outer housing is configured to rotate the torque transmission mechanism about the longitudinal axis, the torque transmission mechanism; An orientation mechanism separated from the torque transmission mechanism, the orientation mechanism comprising: A second shaft extending through the lumen of the long outer housing, the first shaft and the second shaft being concentric, the second shaft; A fourth bevel gear and a fifth bevel gear, the fourth bevel gear being fixedly coupled to the second shaft, the fifth bevel gear being coupled to a driver head adapter, the fourth bevel gear and the fifth bevel gear; A controller connected to a proximal portion of the second shaft, the controller being configured to rotate the second shaft, rotation of the second shaft rotating the driver head adapter about a transverse axis, the transverse axis being substantially perpendicular to the longitudinal axis, the controller; An orientation mechanism comprising; An arthroscopic surgical instrument comprising.

2. The arthroscopic surgical instrument according to claim 1, wherein the bit axis is non-coplanar with the longitudinal axis.

3. The arthroscopic surgical instrument according to claim 1 or claim 2, wherein the second bevel gear is a double-sided bevel gear and the second bevel gear is between the longitudinal axis and the bit axis.

4. The arthroscopic surgical instrument according to any one of claims 1 to 3, wherein the bit is a bone drill bit.

5. An arthroscopic instrument configured to facilitate placement of a fastener during a medical procedure, the arthroscopic instrument comprising: A long outer housing having a proximal end, a distal end, a lumen, and a longitudinal axis, the long outer housing being configured to engage a handpiece having a motor, the long outer housing, and A torque transmission mechanism, A first shaft extending through the lumen of the long outer housing, An articulating torque transmission unit having a first end and a second end, the first end being coupled to the distal portion of the first shaft, the articulating torque transmission unit, and A driver head adapter disposed at the second end of the articulating torque transmission unit, the driver head adapter being configured to removably engage a bit and rotate the bit about the bit axis, the bit being configured to engage a fastener, the driver head adapter, and Comprising, The torque transmission mechanism is configured to transmit torque from the motor to the driver head adapter and the bit, and rotating the long outer housing is configured to rotate the torque transmission mechanism about the longitudinal axis, the torque transmission mechanism, and An orientation mechanism separated from the torque transmission mechanism, the orientation mechanism comprising A second shaft extending through the lumen of the long outer housing, A controller connected to the proximal portion of the second shaft, the controller being configured to rotate the second shaft, the driver head adapter being connected to the distal portion of the second shaft, rotation of the second shaft rotating the driver head adapter about a transverse axis, the transverse axis being substantially perpendicular to the longitudinal axis, the controller, and An orientation mechanism comprising, An articulating exercise device comprising.

6. The orientation mechanism comprises a first bevel gear and a second bevel gear, the first bevel gear being fixedly coupled to the second shaft, the second bevel gear being coupled to the driver head adapter, the articulating exercise device according to claim 5.

7. The driver head adapter is configured to rotate about the transverse axis between about 0° and about 360°, the articulating exercise device according to claim 5 or claim 6.

8. The driver head adapter is configured to complete a plurality of rotations about the transverse axis, the articulating exercise device according to any one of claims 5 to 7.

9. The articulation torque transmission unit includes a first bevel gear, a second bevel gear, and a third bevel gear. The first bevel gear is fixedly coupled to a first shaft, the second bevel gear is coupled to a gear support shaft, and the third bevel gear is removably coupled to a bit. The articulation exercise device according to any one of claims 5 to 8.

10. The driver head adapter includes a lumen configured to receive the shaft of the bit, and the driver head adapter is coupled to the shaft of the bit via a quick release mechanism. The articulation exercise device according to any one of claims 5 to 9.

11. The elongated outer housing is configured to rotate about the longitudinal axis relative to the controller between approximately 0° and approximately 360°. The articulation exercise device according to any one of claims 5 to 10.

12. The elongated outer housing is configured to complete a plurality of rotations about the longitudinal axis relative to the controller. The articulation exercise device according to any one of claims 5 to 11.

13. The controller includes a wheel, and rotation of the wheel rotates a second shaft. The articulation exercise device according to any one of claims 5 to 12.

14. The controller includes a locking clutch that locks the rotation of the second shaft. The articulation exercise device according to any one of claims 5 to 13.

15. The elongated outer housing is connected to the wheel, and rotation of the wheel rotates the elongated outer housing. The articulation exercise device according to any one of claims 5 to 14.

16. An articulation exercise device configured to facilitate the placement of a fastener during a medical procedure, the articulation exercise device comprising: A multi-piece elongated outer housing having an upper portion, a lower portion, a proximal end, a distal end, a lumen, and a longitudinal axis, the multi-piece elongated outer housing being configured to engage a handpiece including a motor; the multi-piece elongated outer housing; A torque transmission mechanism, A first shaft extending through the lumen of the multi-piece elongated outer housing; An articulation torque transmission unit having a first end and a second end, the first end being coupled to the distal portion of the first shaft; the articulation torque transmission unit; A driver head adapter disposed at a second end of the joint torque transmission unit, the driver head adapter being configured to removably engage with a bit and rotate the bit about a bit axis, the bit being configured to engage with a fastener, the driver head adapter; A controller configured to rotate the joint torque transmission unit about a transverse axis, the transverse axis being substantially perpendicular to the longitudinal axis, the controller being configured to rotate the joint torque transmission unit by advancing or retracting an upper portion of the multi-piece elongated outer housing, the controller; comprising; A torque transmission mechanism configured to transmit torque from a motor to the driver head adapter and the bit, the torque transmission mechanism; An articulating exercise device comprising.

17. The articulating exercise device according to claim 16, wherein the joint torque transmission unit comprises first, second, third, and fourth bevel gears, the first bevel gear being fixedly coupled to a first shaft, the second bevel gear being coupled to a first gear support shaft, the third bevel gear being coupled to a second gear support shaft, and the fourth bevel gear being removably coupled to the bit.

18. The articulating exercise device according to claim 17, wherein the second bevel gear comprises a set of second bevel gears and the third bevel gear comprises a set of third bevel gears.

19. The articulating exercise device according to any one of claims 16 to 18, wherein the controller is configured to rotate the joint torque transmission unit by advancing or retracting a lower portion of the multi-piece elongated outer housing.

20. The articulating exercise device according to any one of claims 16 to 19, wherein rotating the multi-piece elongated outer housing is configured to rotate the torque transmission mechanism about the longitudinal axis.

21. An arthroscopic surgical screw driver adapter, a proximal end having a body configured to be removably connected to a rotary driver and a drive output, a distal end having a driver head adapter configured to articulate and rotate relative to the body, the driver head adapter being configured to removably receive a driver head engageable with a surgical fastener, the distal end; an orientation control unit configured to control the articulation of the driver head adapter; A torque transmission unit configured to removably connect to a drive output and transmit torque from the drive output to a driver head adapter so that the driver head rotates a surgical fastener, A screw driver adapter for arthroscopic surgery comprising the same.

22. A combination comprising the screw driver adapter for arthroscopic surgery according to claim 21, a surgical driver, and a driver head.

23. The screw driver adapter for arthroscopic surgery according to claim 21 or claim 22, wherein the orientation control unit comprises an arm configured to convert a lateral movement of the arm into a rotational movement of the driver head adapter.

24. The screw driver adapter for arthroscopic surgery according to any one of claims 21 to 23, wherein the orientation control unit comprises an arm configured to convert a rotational movement of the arm into a rotational movement of the driver head adapter.

25. The screw driver adapter for arthroscopic surgery according to any one of claims 21 to 24, wherein the driver head adapter comprises first and second gears that are substantially parallel to each other and rotate about respective axes that are substantially perpendicular to the longitudinal axis of the screw driver adapter for arthroscopic surgery.

26. The screw driver adapter for arthroscopic surgery according to any one of claims 21 to 25, wherein the orientation control unit comprises a spring-biased clutch.

27. A screw driver adapter for arthroscopic surgery, A proximal end configured to removably connect to a surgical driver having an electric motor and a drive output, A distal end configured to removably connect to the proximal end, the distal end comprising: A driver head adapter configured to move arthroscopically and rotate relative to the proximal end and removably receive a driver head engageable with a surgical fastener, An orientation control unit configured to control the arthroscopic movement of the driver head adapter, A torque transmission unit configured to removably connect to the drive output and transmit torque from the drive output to the driver head adapter so that the driver head rotates a surgical fastener, A distal end comprising the same, A screw driver adapter for arthroscopic surgery comprising the same.

28. The distal end further comprises a quick release mechanism, the arthroscopic screw driver adapter according to claim 27.

29. The quick release mechanism comprises opposed first and second spring-biased buttons, the arthroscopic screw driver adapter according to claim 28.

30. The proximal end comprises first and second guide pins configured to removably engage with the quick release mechanism, the arthroscopic screw driver adapter according to claim 28 or claim 29.

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