Device and method for cutting tendons near the biceps

Abstract

A method for severing a terminal portion of a long head of the biceps (LHB) tendon from a biceps muscle, the method comprising the steps of: attaching a tenotomy device having a cutter to the tendon; moving the tenotomy device distally relative to the shoulder and along the tendon toward the biceps muscle; abutting the tenotomy device against the biceps muscle, thereby aligning a cutter position associated with a distal end of the tenotomy device with a cutting position on the tendon adjacent the biceps muscle; and using the cutter to cut the tendon at the cutting position.

Description

[Technical Field]

[0001] This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 416,410, filed October 14, 2022, the contents of which are incorporated herein by reference in their entirety.

[0002] The present invention, in some embodiments thereof, relates to devices and methods for tenotomy, and more particularly, but not exclusively, for the severing of the long head of the biceps brachii (LHB) tendon. [Background technology]

[0003] Surgery to sever the long head of the biceps tendon is typically performed with the intent of using the severed tendon to treat rotator cuff tears and similar conditions. In some cases, the entire tendon is removed for application elsewhere. In other cases, one end of the tendon is severed, leaving the partially attached tendon for application elsewhere around the shoulder. Summary of the Invention

[0004] Below is a non-exhaustive list including some example embodiments of the present invention. The present invention also includes embodiments including fewer than all of the features in an example, and embodiments that use features from more than one example, even if not explicitly listed below.

[0005] Example 1 1. A method for severing a terminal portion of a long head of the biceps (LHB) tendon from a biceps muscle, the method comprising the steps of: attaching a tenotomy device to the long head of the biceps tendon; moving the tenotomy device distally along the tendon toward the biceps muscle; abutting the tenotomy device against the biceps muscle, thereby aligning a cutter position associated with a distal end of the tenotomy device with a cutting position on the tendon adjacent the biceps muscle; and using the cutter to cut the tendon at the cutting position.

[0006] Example 2 The method according to example 1, further comprising clamping the tendon after attachment.

[0007] Example 3 The method according to either Example 1 or Example 2, wherein the cutting is performed by relative rotation of a cutter located at the distal tip of the tendon cutting device.

[0008] Example 4 The method according to any one of Examples 1 to 3, wherein the cutting is performed by moving a cutter located near the distal tip of the tendon cutting device at a predetermined angle relative to the tendon.

[0009] Example 5 3. The method according to example 2, wherein the fixation is performed after pressing a first release handle associated with the tenotomy device.

[0010] Example 6 A method according to example 3, wherein the relative rotation is performed after pressing a second release handle associated with the tendon cutting device.

[0011] Example 7 A method according to example 4, wherein the movement is performed by pushing a handle associated with the tenotomy device.

[0012] Example 8 The method according to any one of Examples 1 to 1, wherein the cutting is performed by moving a cutter located near the distal tip of the tendon cutting device at a right angle to the tendon.

[0013] Example 9 The method according to any one of Examples 1-8, wherein the cutter is embodied as a mechanically deployable knife.

[0014] Example 10 1. A device for severing the terminal end of a long head of the biceps brachii (LHB) tendon, the device comprising: an elongated body attachable to the tendon, the elongated body including a tip at a distal end of the body, the tip being in the form of a channel for receiving the tendon, the elongated body adapted to stop movement when the distal end of the tip abuts a thickened portion of the biceps brachii muscle; and a cutter associated with the body and located a predetermined distance from the distal end of the tip.

[0015] Example 11 A device according to example 10, wherein the deployable cutter is realized as a cutting tool at the tip.

[0016] Example 12 A device according to any one of Examples 10 and 11, wherein the deployable cutter is positioned 1 to 5 mm before the distal end of the tip and adapted to cut the tendon at an angle other than 90 degrees relative to the tendon.

[0017] Example 13 The device according to any one of Examples 10 to 12, further comprising a fixation bar for holding the tendon near the tip.

[0018] Example 14 A device according to any one of Examples 10 to 11 and Example 13, wherein the deployable cutter is positioned 1 to 5 mm before the distal end of the tip and adapted to cut the tendon at a 90 degree angle relative to the tendon.

[0019] Example 15 1. A method for severing a distal end of a long head of biceps (LHB) tendon from a biceps muscle, the method comprising the steps of: attaching a tenotomy device to the long head of biceps tendon; moving the tenotomy device distally along the tendon toward the biceps muscle; holding the tendon adjacent to the biceps muscle; and pulling the tendon away from the biceps muscle until the tendon is separated from the biceps muscle.

[0020] Example 16 16. The method according to example 15, wherein the traction step is performed near the shoulder.

[0021] Example 17 The method according to any one of Examples 15 or 16, further comprising the step of separating the tendon from the associated bone prior to the traction step.

[0022] Example 18 The method according to any one of Examples 15 to 17, further comprising the step of isolating at least one ligament associated with the tendon.

[0023] Example 19 The device according to any one of Examples 10-14, wherein the cutter is deployable.

[0024] Example 20 The device according to any one of Examples 10 to 14 and Example 19, wherein the predetermined distance is between 1 mm and 5 mm.

[0025] Example 21 1. A method of severing the long head of the biceps tendon, comprising: attaching a biceps cutter onto the long head of the biceps tendon through an anterolateral shoulder arthroscopic portal; closing an opening in the biceps cutter; sliding the biceps cutter distally over the tendon toward the biceps muscle; stopping the sliding of the tendon cutter when the tendon cutter abuts the proximal biceps muscle; retracting the biceps cutter slightly posteriorly to avoid severing the muscle's own muscle-tendon junction; using the cutter to cut the tendon at a cutting position, wherein the cut is made by relative rotation at an oblique angle or a right angle; and withdrawing the biceps cutter and the severed long head of the biceps tendon through the anterolateral portal.

[0026] Example 22 1. A method for cutting the long head of the biceps tendon, comprising: attaching a biceps cutter over the long head of the biceps tendon through an anterolateral shoulder arthroscopic portal; closing an opening in the biceps cutter; sliding the biceps cutter proximally toward the labrum, preferably under arthroscopic supervision; stopping the sliding when the biceps cutter abuts against the labrum; completing a flush or oblique cut of the long head of the biceps tendon, the cut being made as close to the labrum as possible; and withdrawing the biceps cutting cutter and the severed long head of the biceps tendon through the anterolateral portal.

[0027] Example 23 1. A method of severing a distal portion of the long head of the biceps brachii (LHB) tendon from the biceps brachii muscle, comprising: a. attaching a tendon cutting device having a cutter to a tendon; b. moving the tenotomy device distally relative to the shoulder along the tendon toward the biceps; c. applying the tenotomy device to the biceps muscle, thereby aligning a cutter position associated with a distal end of the tenotomy device with a cut position on the tendon adjacent the biceps muscle; d. Cutting the tendon at the cutting location using a cutter; A method comprising:

[0028] Example 24 The method according to example 23, further comprising securing the tendon in a tenotomy device after attachment.

[0029] Example 25 The method according to any one of Examples 23 and 24, wherein the attachment comprises securing the tendon in a tenotomy device after attachment.

[0030] Example 26 The method according to any one of Examples 23 to 25, wherein the fixation comprises fixating the tendon within a fixation channel of the tenotomy device.

[0031] Example 27 The method according to any one of Examples 23 to 26, wherein the cutting is performed by relative rotation of the cutters.

[0032] Example 28 A method according to any one of Examples 23 to 27, wherein the tendon cutting device includes an inner part and an outer part that are rotatable relative to each other, the inner part being positioned radially inward relative to the outer part, and the cutter being positioned on the inner part.

[0033] Example 29 A method according to any one of Examples 23 to 27, wherein the tendon cutting device includes an inner part and an outer part that are rotatable relative to each other, the inner part being positioned radially inward relative to the outer part, and the cutter being positioned on the outer part.

[0034] Example 30 A method according to any one of Examples 23 to 27, wherein the cutter is fixed within the tendon cutting device and the cutting is performed by rotating a rotatable part of the tendon cutting device relative to the cutter.

[0035] Example 31 A method according to example 30, wherein the tendon cutting device includes an inner part and an outer part that are rotatable relative to each other, the inner part being positioned radially inward relative to the outer part, and the cutter being positioned on the inner part.

[0036] Example 32 A method according to example 30, wherein the tendon cutting device includes an inner portion and an outer portion rotatable relative to each other, the inner portion being positioned radially inward relative to the outer portion, and the cutter being positioned on the outer portion.

[0037] Example 33 The method according to any one of Examples 23 to 32, wherein the cutting is performed by moving the cutter at an angle relative to the tendon.

[0038] Example 34 The method of example 33, wherein the predetermined angle is 90 degrees.

[0039] Example 35 The method of example 33, wherein the predetermined angle is an angle other than 90 degrees.

[0040] Example 36 A method according to any one of Examples 23 to 26, wherein the cutter is defined in a fixed part of the tendon cutting device, and cutting is performed by moving a movable part of the tendon cutting device axially toward the cutter, the movable part forcibly pressing the tendon against the cutter.

[0041] Example 37 A method according to example 36, wherein the fixed part is positioned radially outward relative to the movable part.

[0042] Example 38 A method according to example 36, wherein the fixed part is positioned radially inward relative to the movable part.

[0043] Example 39 The method according to any one of Examples 24 to 38, wherein the fixation is performed after or simultaneously with pressing a first release handle associated with the tenotomy device.

[0044] Example 40 The method according to any one of Examples 27 to 35, wherein the relative rotation occurs after or simultaneously with pressing a second release handle associated with the tenotomy device.

[0045] Example 41 The method according to any one of Examples 33 to 35, wherein the movement is performed by pushing a handle associated with the tenotomy device.

[0046] Example 42 The method according to any one of Examples 23 to 26, wherein the cutter is a mechanically deployable knife.

[0047] Example 43 A method according to any one of Examples 23 to 42, wherein the attaching step includes attaching a tenotomy device to the tendon through an anterolateral shoulder arthroscopic portal, the moving step includes sliding the tenotomy device over the tendon in a distal direction relative to the shoulder, the sliding step being stopped when the biceps cutter abuts the biceps, and the cutting step is by relative rotation at an oblique angle or a right angle to the longitudinal axis of the tendon, and the method includes pulling the tenotomy device and cut tendon out of the anterolateral shoulder arthroscopic portal.

[0048] Example 44 44. The method according to Example 43, further comprising, after the stopping step, a step of moving the tenotomy device proximally relative to the shoulder to a distance that ensures that the muscle-tendon junction of the biceps brachii muscle is not severed by the tenotomy device.

[0049] Example 45 The method according to any one of Examples 23 and 42 to 43, further comprising, after the attaching step, a step of closing the opening of the tendon cutting device to fix the cutting position within the biceps cutter.

[0050] Example 46 1. A device for severing a distal portion of the long head of the biceps brachii (LHB) tendon from the biceps brachii muscle, comprising: a. an elongated body attachable to a tendon, the elongated body including a tip and a cutter at a distal end of the body, the tip being shaped like a channel for receiving a portion of the tendon and adapted to move along the tendon and to stop moving when a distal end of the tip abuts a thickened portion of the biceps brachii muscle; b. A device wherein the cutter location is positioned relative to the body at a predetermined distance from the distal end of the tip, and the cutter is configured to sever the tendon at the cutter location.

[0051] Example 47 47. The device according to example 46, wherein the device includes a cutting tool at its tip.

[0052] Example 48 A device according to any one of Examples 46 and 47, wherein the cutter position is at a distance of about 1 mm to about 5 mm from the distal end of the tip.

[0053] Example 49 The method according to any one of Examples 46 to 48, wherein the cutter is adapted to cut the tendon at a predetermined angle relative to the tendon.

[0054] Example 50 The method according to example 49, wherein the predetermined angle is 90 degrees.

[0055] Example 51 The method according to example 49, wherein the predetermined angle is an angle other than 90 degrees.

[0056] Example 52 An apparatus according to any one of Examples 46 to 51, comprising a fixed part and a movable part, wherein the cutter is defined in the fixed part and the movable part is configured to move in the direction of the cutter and to forcibly press the tendon against the cutter.

[0057] Example 53 53. The device according to embodiment 52, wherein the fixed part is located radially outward relative to the movable part.

[0058] Example 54 53. The device according to embodiment 52, wherein the fixed part is located radially inward relative to the movable part.

[0059] Example 55 The device according to any one of Examples 46 to 54, wherein the movable part is configured to perform one of axial movement and rotation.

[0060] Example 56 A device according to any one of Examples 46 to 51, wherein the device includes a fixed part and a movable part, the cutter is defined in the movable part, the movable part is configured to move toward the fixed part, and is configured to forcibly press the tendon against the fixed part.

[0061] Example 57 57. The device according to embodiment 56, wherein the fixed part is located radially outward relative to the movable part.

[0062] Example 58 57. The device according to embodiment 56, wherein the fixed part is located radially inward relative to the movable part.

[0063] Example 59 The device according to any one of Examples 56 to 58, wherein the movable part is configured to perform one of axial movement and rotation.

[0064] Example 60 A device according to any one of Examples 46 to 51, further comprising a fixation bar for holding the tendon within the channel.

[0065] Example 61 A device according to any one of Examples 46 to 51, wherein the channel is sized and shaped to secure the tendon within the device.

[0066] Example 62 A device according to any one of Examples 46 to 51 and Examples 60 to 61, comprising a safety device having a first orientation to prevent activation of the device and a second orientation to allow activation of the device.

[0067] Example 63 63. The device according to example 62, wherein the safety device is configured to geometrically interlock with a portion of the device when in the first orientation.

[0068] Example 64 A device according to any one of Examples 46-51 and 60-63, wherein the cutter is deployable.

[0069] Example 65 The device according to any one of Examples 46-51 and 60-63, wherein the cutter is rotatable.

[0070] Example 66 A device according to any one of Examples 46 to 51 and Examples 60 to 63, wherein the device includes a rotatable portion configured to force the tendon against the cutter.

[0071] Example 67 The device according to any one of Examples 46 to 66, wherein the predetermined distance is between about 1 mm and about 5 mm.

[0072] Example 68 1. A method of severing or tearing a distal portion of the long head of the biceps brachii (LHB) tendon from the biceps brachii muscle, comprising: a. attaching the long head of the biceps tendon to a tenotomy or rupture device; b. moving the tendon cutting or rupturing device distally relative to the shoulder along the tendon toward the biceps; c. holding the tendon adjacent the biceps with a tenotomy or rupture device; d. traction of the tendon away from the biceps muscle such that the tendon is separated from the biceps muscle; A method comprising:

[0073] Example 69 The method of Example 68, wherein the holding step is performed by a distal portion of the tendon cutting or rupturing device, and a blade of the tendon cutting or rupturing device is positioned adjacent to the distal portion of the tendon cutting or rupturing device.

[0074] Example 70 The method of any one of Examples 68 or 69, wherein the pulling step includes pulling the tendon toward a blade of the tendon cutting or rupturing device.

[0075] Example 71 The method according to any one of Examples 68 to 71, wherein the traction step is performed near the shoulder.

[0076] Example 72 The method according to any one of Examples 68 to 71, further comprising the step of separating the tendon from the associated bone prior to traction.

[0077] Example 73 The method according to any one of Examples 68 to 73, further comprising the step of separating at least one ligament associated with the tendon from the shoulder.

[0078] Example 74 1. A method for severing the long head of the biceps tendon, comprising: a. placing a biceps cutter over the tendon through an anterolateral shoulder arthroscopic portal; b. sliding the biceps cutter toward the labrum; c. stopping the sliding when the biceps cutter abuts against the labrum; d. cutting the tendon flush or obliquely at the location of the tendon cut adjacent to the labrum; e. withdrawing the biceps cutter and the cut ends of the severed tendon through the anterolateral portal; A method comprising:

[0079] Example 75 The method according to example 74, further comprising, after the sliding step, closing the opening of the biceps cutter to fix the cutting position within the biceps cutter.

[0080] Example 76 A method according to either one of Examples 74 or 75, wherein the sliding step is performed under arthroscopic supervision.

[0081] Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of embodiments of the present invention, exemplary methods and / or materials are described below. In case of conflict, the present specification, including definitions, will control. Furthermore, the materials, methods, and examples are illustrative only and are not intended to be necessarily limiting.

[0082] Some embodiments of the present invention are described below with reference to flowchart illustrations and / or block diagrams of methods, apparatus (systems), and products according to embodiments of the invention. The present invention, in some embodiments, may be practiced using one or more of the elements or steps described herein. It will be understood that the present invention is applicable to other tendons, ligaments, muscles, or other body parts, but is described herein in accordance with its application to the long head of the biceps brachii tendon for clarity purposes only.

[0083] Some embodiments of the present invention are described herein, by way of example only, with reference to the accompanying drawings. Referring now specifically to the drawings in detail, it is emphasized that the particulars shown are by way of example and for purposes of illustrative discussion of embodiments of the invention. In this regard, the description taken together with the drawings will make apparent to those skilled in the art how embodiments of the present invention may be carried out. Similar elements may have the same numbers increased by multiples of 100. [Brief explanation of the drawings]

[0084] [Figure 1] 1 is a flowchart of an exemplary method of tendon cutting using a tendon cutting device, according to some embodiments of the present invention. [Figure 2] 1 is a flowchart of an exemplary method according to some embodiments of the present invention. [Figure 3] 1 is a perspective view of an exemplary biceps long head tenotomy device, according to some embodiments of the present invention. [Figure 4] 4 is a perspective view of the tenotomy device of FIG. 3 mounted on the long head of the biceps tendon, according to some embodiments of the present invention. [Figure 5] 4 is a perspective view of the tenotomy device of FIG. 3 with a tendon secured thereto, according to some embodiments of the present invention. [Figure 6] 4 is a perspective view of the tenotomy device of FIG. 3 abutting against a biceps muscle, according to some embodiments of the present invention. [Figure 7]4 is a partial view of the tendon cutting device of FIG. 3 showing the cutter prior to tendon cutting, according to some embodiments of the present invention. [Figure 8] 4 is a partial view of the tendon cutting device of FIG. 3 showing the cutter cutting the tendon, according to some embodiments of the present invention. [Figure 9] 4 is a partial view of the tendon cutting device of FIG. 3 showing the tendon after it has been cut by the tendon cutting device, according to some embodiments of the present invention. [Figure 10] 10A-10C are partial views of an alternative exemplary embodiment of a tendon cutting device having a deployable cutter, according to some embodiments of the present invention. [Figure 11] 11 is a perspective view of the tendon cutting device of FIG. 10 including an exemplary button for deploying the cutter, according to some embodiments of the present invention. [Figure 12] 11 is a partial view of the tendon cutting device of FIG. 10 with the cutters fully deployed and the tendon cut, according to some embodiments of the present invention. [Figure 13] 11 is a partial view of the tendon cutting device of FIG. 10 showing an exemplary mechanism for deploying the cutters, according to some embodiments of the present invention. [Figure 14] 11 is a partial view of the device of FIG. 10 showing a portion of an exemplary mechanism for deploying the cutter via an activation button, according to some embodiments of the present invention. [Figure 15] 1 is a side view of an exemplary tenotomy device, according to some embodiments of the present invention. FIG. [Figure 16] 16 is a partial perspective view of the tenotomy device of FIG. 15 with the channel in an open state, according to some embodiments of the present invention. [Figure 17] 16 is a partial view of the tenotomy device of FIG. 15 with the channel in a closed state, according to some embodiments of the present invention. [Figure 18] 16 is a partial view of the apparatus of FIG. 15 showing an exemplary actuation pin of the cutter, according to some embodiments of the present invention. [Figure 19] 16 is a partial view of the device of FIG. 15 showing an exemplary mechanism for deploying the cutter, according to some embodiments of the present invention. [Figure 20]FIG. 16 is a partial view of the device of FIG. 15 showing the cutter after deployment, according to some embodiments of the present invention. [Figure 21] FIG. 1 illustrates a side view of an exemplary cutter tool, according to some embodiments of the present invention. [Figure 22] FIG. 1 illustrates a side view of an exemplary tendon grabber, according to some embodiments of the present invention. [Figure 23] 10 is a flowchart of an alternative exemplary method of tendon cutting using a tenostomy device, according to some embodiments of the present invention. [Figure 24] 10 is a flowchart of an alternative exemplary method of tendon cutting using a tenostomy device, according to some embodiments of the present invention. [Figure 25A] 1 is an exploded view of an exemplary tenotomy device, according to some embodiments of the present invention. [Figure 25B] FIG. 25B is a partial enlarged view of the tenotomy device of FIG. 25A, according to some embodiments of the present invention. [Figure 25C] FIG. 25B is a side view of the cutting device of FIG. 25A shown in an initial operating orientation. [Figure 25D] FIG. 25B is a side view of the cutting device of FIG. 25A shown in an initial operating orientation with the tendon already attached. [Figure 25E] FIG. 25B is a side view of the tenotomy device of FIG. 25A after tendon severing, according to some embodiments of the present invention. [Figure 25F] FIG. 25F is a partial enlarged perspective view of the device of FIG. 25E, according to some embodiments of the present invention. [Figure 26A] 1 is a perspective view of an exemplary tenotomy device, according to some embodiments of the present invention. FIG. [Figure 26B] FIG. 26B is a partial enlarged view of the tenotomy device shown in FIG. 26A, according to some embodiments of the present invention. [Figure 26C] FIG. 26B is a side view of the tenotomy device of FIG. 26A shown in an initial operating orientation with the tendon already attached. [Figure 26D] FIG. 26B is a side view of the tenotomy device of FIG. 26A shown after tendon severing, according to some embodiments of the present invention. [Figure 26E]FIG. 26E is a partial enlarged view of the device of FIG. 26D, according to some embodiments of the present invention. [Figure 27A] 1A-1C are side views of an exemplary tenotomy device having an actuation lever, according to some embodiments of the present invention. [Figure 27B] FIG. 27B is an exploded view of the tenotomy device of FIG. 27A, according to some embodiments of the present invention. [Figure 27C] FIG. 27B is a side view of the tenotomy device of FIG. 27A with a tendon attached, according to some embodiments of the present invention. [Figure 27D] FIG. 27D is a side view of the tenotomy device of FIG. 27C after tendon severing, according to some embodiments of the present invention. [Figure 28A] 1 is an exploded view of an exemplary tenotomy device having an activation button, according to some embodiments of the present invention. [Figure 28B] FIG. 28B is a side view of the tenotomy device of FIG. 28A, according to some embodiments of the present invention. [Figure 28C] FIG. 27C is a side view of the tenotomy device of FIG. 27B in an initial operating orientation and with a tendon attached to the device, according to some embodiments of the present invention. [Figure 28D] FIG. 28D is a side view of the tenotomy device of FIG. 28C after releasing the safety, according to some embodiments of the present invention. [Figure 28E] FIG. 28D is a side view of the tenotomy device of FIG. 28C after tendon severing, according to some embodiments of the present invention. [Figure 28F] FIG. 28F is a partial enlarged view of the tenotomy device of FIG. 28E, according to some embodiments of the present invention. [Figure 29A] FIG. 1 is an exploded view of a tenostomy device, according to some embodiments of the present invention. [Figure 29B] FIG. 29B is a side view of the tenotomy device of FIG. 29A, according to some embodiments of the present invention. [Figure 29C] FIG. 29C is a side view of the tenotomy device of FIG. 29B with a tendon attached, according to some embodiments of the present invention. [Figure 29D] FIG. 29D is a side view of the tenotomy device of FIG. 29C after releasing the safety, according to some embodiments of the present invention. [Figure 29E]FIG. 29D is a side view of the tenotomy device of FIG. 29C after tendon severing, according to some embodiments of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0085] The present invention, in some embodiments thereof, relates to tendon severing, and more particularly, but not exclusively, to methods and devices for biceps long head tenotomy. (Overview)

[0086] An aspect of some embodiments of the present invention relates to devices and methods for cutting the long head of the biceps tendon near the biceps muscle. Biological terms such as shoulder, tendon, ligament, biceps muscle, and long head of biceps tendon may have meanings commonly understood in the medical field. In some embodiments, the device allows the long head of the biceps tendon to be precisely cut near the biceps muscle, allowing the maximum length of the cut tendon to be used in a medical procedure. In some embodiments, the device advances along the long head of the biceps tendon until the distal end of the device abuts the biceps muscle. In some embodiments, abutting the biceps muscle allows the tendon to be cut within a few millimeters of the beginning of the biceps muscle. In some embodiments, the resulting cut tendon is as long as possible, maximizing its contribution to rotator cuff and other treatments for which such partially severed tendons are typically usable. In some embodiments, the user can additionally or alternatively cut the second end of the tendon at the shoulder. Alternatively, according to some embodiments, the tendon cutting device and method may be used to first cut the long head of the biceps tendon near the labrum and then optionally cut the tendon near the biceps muscle, or vice versa.

[0087] An aspect of some embodiments of the present invention relates to methods and devices for cutting the long head of the biceps (LHB) tendon proximal to the biceps. In some embodiments, a method for cutting the long head of the biceps (LHB) tendon from the biceps includes attaching a tenotomy device to the long head of the biceps (LHB) tendon via either an anterolateral shoulder arthroscopic portal or a mini-open approach, optionally fixing a tenotomy location on the tendon within the tenotomy device, sliding the tenotomy device distally relative to the shoulder along the tendon toward the biceps, stopping the sliding of the tenotomy device when it abuts the biceps, thereby aligning a cutter location associated with the distal end of the tenotomy device with the tenotomy location adjacent the biceps, and using the cutter to cut the tendon at the tenotomy location.

[0088] In some embodiments, the method includes attaching a tenotomy device to the long head of the biceps tendon via either an anterolateral shoulder arthroscopic portal or a mini-open approach, optionally fixing a cutting location on the tendon within the tenotomy device, sliding the tenotomy device proximally relative to the mold and along the mold toward the labrum, stopping the sliding of the tenotomy device when it abuts the labrum, thereby aligning a cutter location associated with the proximal end of the tenotomy device with the tendon cutting location adjacent the labrum, and using the cutter to cut the tendon at the tendon cutting location.

[0089] An aspect of some embodiments of the present invention relates to a method that includes securing a tendon within a tenotomy device after installation. In some embodiments, the severing is performed by rotating a cutter located near the distal tip of the tenotomy device relative to a fixed portion of the device, or by rotating a portion of the device relative to the fixed cutter. In some embodiments, the severing is performed by deploying a cutter located near the distal tip of the tenotomy device at a predetermined angle relative to the tendon. In some embodiments, the device includes a fixed cutter, and a portion of the device is axially movable toward the cutter, the axially movable portion of which can force the tendon against the cutter. In some embodiments, the cutter is moved axially toward the fixed portion of the device, forcing the cutter against the tendon. In some embodiments, the cutter is embodied as a mechanically deployable knife.

[0090] In some embodiments, the locking is performed optionally after pressing a first release handle associated with the tenotomy device. In some embodiments, the relative rotation is performed after pressing a second release handle associated with the tenotomy device. In some embodiments, the movement is performed by pressing a handle associated with the tenotomy device.

[0091] In some embodiments, the cut is made with a cutter perpendicular to the longitudinal axis of the tendon. In some embodiments, the cut is made at an oblique angle to the longitudinal axis of the tendon. Those skilled in the art will understand that it may be desirable to cut the tendon at a particular predetermined angle depending on various factors, such as the type of treatment being performed and how the cut end of the tendon will be attached to another anatomical structure. In some embodiments, the cut can be made at a particular predetermined angle, for example, to facilitate attachment of the tendon to another anatomical structure.

[0092] One aspect of some embodiments of the present invention relates to a device for cutting the terminal end of a long head of the biceps brachii (LHB) tendon. The device includes an elongated body attachable to the tendon and including a tip at a distal end of the body. The elongated body has a channel-shaped portion for receiving the tendon, optionally adapted to secure the tendon within the device, and adapted to slide along the tendon. The body is adapted to stop movement when the distal end of the tip abuts a thickened portion of the biceps brachii muscle, and a cutter is associated with the body and positioned a predetermined distance from the distal end of the tip.

[0093] In some embodiments, the cutter is embodied as a cutting tool within the tip. In some embodiments, the predetermined distance is about 1 mm to about 5 mm (optionally about 0.5 mm to about 7 mm, optionally about 0.1 mm to about 10 mm) from the distal end of the tip, and the cutter is adapted to cut the tendon at an angle other than 90 degrees relative to the longitudinal axis of the tendon. For example, the cutter can be adapted to cut the tendon at an angle within a range selected from about 1 degree to about 30 degrees, about 30 degrees to about 50 degrees, about 50 degrees to about 70 degrees, about 70 degrees to about 89 degrees, about 91 degrees to about 110 degrees, about 110 degrees to about 130 degrees, about 130 degrees to about 150 degrees, and about 150 degrees to about 170 degrees. Alternatively, according to some embodiments, the cutter is adapted to cut the tendon at an angle of 90 degrees relative to the longitudinal axis of the tendon.

[0094] An aspect of some embodiments of the present invention relates to a device that includes a retainer bar for holding a tendon within a channel of a tenotomy device, which, according to some embodiments, can prevent the tendon from unintentionally releasing from the channel, for example, as the device is slid along the tendon toward the biceps. In some embodiments, the device includes a retainer bar for holding the tendon near its tip prior to cutting the tendon.

[0095] An aspect of some embodiments of the present invention relates to a device in which the cutter is rotatable or a portion of the device is rotatable relative to the cutter. In some embodiments, the cutter is deployable. In some embodiments, the cutter is defined in a fixed portion of the device and the portion of the device is axially movable relative to the cutter. In some embodiments, the fixed portion is disposed radially outward relative to the movable portion. In some embodiments, the fixed portion is disposed radially inward relative to the movable portion.

[0096] In some embodiments, the cutter is positioned about 1 mm to about 5 mm (optionally about 0.5 mm to about 7 mm, optionally about 0.1 mm to about 10 mm) from the distal end of the tip and is adapted to cut the tendon perpendicular to the longitudinal axis of the tendon, hi some embodiments, the cutter is adapted to cut the tendon at an oblique angle relative to the longitudinal axis of the tendon.

[0097] In some embodiments, a safety device is provided to prevent accidental or premature actuation of the device by preventing depression of the actuation lever or actuation button.

[0098] An aspect of some embodiments of the present invention relates to a method for severing a long head of the biceps (LHB) tendon from a biceps muscle, comprising: attaching a tenotomy device to the long head of the biceps tendon; moving the tenotomy device distally relative to the shoulder along the tendon toward the biceps muscle; holding the tendon near the biceps muscle; and optionally pressing the tendon against a blade of the tenotomy device to retract the tendon away from the biceps muscle until the tendon is separated from the biceps muscle. In some embodiments, the method further comprises separating the tendon from an associated bone before retracting. In some embodiments, the method further comprises separating at least one ligament associated with the tendon.

[0099] An aspect of some embodiments of the present invention relates to a method for severing the long head of the biceps tendon, the method including attaching a tenotomy device to the long head of the biceps tendon through an anterolateral shoulder arthroscopic portal, optionally closing an opening in the tenotomy device to secure the tendon within the device, sliding a biceps cutter over the tendon in a distal direction relative to the shoulder toward the biceps muscle, stopping the sliding of the tenotomy device when the device abuts the biceps muscle, retracting the biceps cutter slightly, e.g., 1 to 2 mm, posteriorly to potentially avoid severing the muscle-tendon junction of the muscle itself, severing the tendon at a cut location on the tendon using the cutter of the tenotomy device, where the cut is made by rotating at an oblique angle or a right angle relative to the longitudinal axis of the tendon, and withdrawing the tenotomy device and severed long head of the biceps tendon through the anterolateral portal.

[0100] An aspect of some embodiments of the present invention relates to a method of severing the long head of the biceps tendon, the method including attaching a tenotomy device onto the long head of the biceps through an anterolateral shoulder arthroscopic portal, optionally closing an opening in the tenotomy device, sliding the device proximally relative to the shoulder toward the labrum, optionally under arthroscopic supervision, stopping the sliding when the tenotomy device abuts the labrum, cutting the long head of the biceps tendon flush or obliquely to the longitudinal axis of the tendon, optionally with the cut made as close to the labrum as possible, and withdrawing the tenotomy device and severed long head of the biceps tendon through the anterolateral portal.

[0101] Before describing at least one embodiment of the present invention in detail, it is to be understood that the invention is not necessarily limited in its application to the details of construction and the arrangement of components and / or methods set forth in the following description and / or illustrated in the drawings and examples. The invention is capable of other embodiments and of being practiced or carried out in various ways.

[0102] 1 is a flowchart of an exemplary method 10 of tenotomy using a tenotomy device, according to some embodiments of the present invention. In some embodiments, an exemplary method 10 of severing a terminal end of a long head of biceps (LHB) tendon from a biceps muscle includes attaching a tenotomy device to the long head of biceps tendon at 12, moving the tenotomy device distally relative to the shoulder and along the tendon toward the biceps muscle at 16, abutting the tenotomy device against the biceps muscle at 18, thereby aligning a cutter position associated with the distal end of the tenotomy device with a cutting position on the tendon adjacent the biceps muscle, and severing the tendon at the cutting position using the cutter at 20. It has been found that by abutting the tenotomy device against the biceps muscle, the tendon is cut as close to the biceps muscle as possible, thereby leaving only a small portion of the tendon attached to the biceps muscle. Alternatively, according to some embodiments, if it is desired to leave a portion of the tendon attached to the biceps muscle, the device can be moved along the tendon toward the biceps muscle until it is a desired distance from the biceps muscle, at which point the tendon is severed, i.e., the desired distance from the biceps muscle.

[0103] In some embodiments, the method optionally further includes securing the tendon within the tenotomy device after attachment at 14. In some embodiments, the cut is performed by rotating 22 a cutter located at the distal end of the tenotomy device relative to a fixed portion of the device. Alternatively, in some embodiments, the cut is performed by rotating a portion of the device relative to a fixed cutter of the device. In some embodiments, the cut is performed by deploying 24 a cutter located near the distal tip of the tenotomy device at an angle relative to the tendon. In some embodiments, the cut is performed at 26 by axial movement of an outer portion of the device relative to the fixed cutter (or axial movement of the cutter relative to the fixed outer portion), or by axial movement of an inner portion of the device relative to the fixed cutter (or axial movement of the cutter relative to the fixed inner portion).

[0104] In some embodiments, locking 14 is optionally performed after depressing a first release handle associated with the tenotomy device. In some embodiments, relative rotation 22 is performed after depressing a second release handle associated with the tenotomy device. In some embodiments, cutter deployment 24 or axial movement 26 is performed by depressing a handle, button, or other actuator associated with the tenotomy device.

[0105] In some embodiments, the cut is made by a cutter perpendicular to the longitudinal axis of the tendon, in some embodiments, the cut is made by a cutter at an oblique angle to the longitudinal axis of the tendon, in some embodiments, the cutter is embodied as a mechanically deployable knife.

[0106] In some embodiments, the method is carried out by moving a tenotomy device along the long head of the biceps tendon in a direction away from the shoulder and toward the biceps. In some embodiments, the tenotomy device is inserted through a surgically prepared incision, typically around the shoulder. In some embodiments, the tenotomy device can optionally close elements over the tendon, thereby reversibly securing the tendon within the device, where the tendon resides in a groove or channel in the tenotomy device. In some embodiments, optionally, with the tendon thus secured, the user can move the tenotomy device along the tendon until the distal end of the tenotomy device abuts or otherwise impinges on an expanded portion of the biceps. In some embodiments, once the tenotomy device reaches the biceps, an associated cutter is positioned for tendon severing. In some embodiments, the distance between the distal end of the tenotomy device and the cutter is typically about 2 mm to about 5 mm. Optionally, this distance is about 1 mm to about 7 mm. Optionally, this distance is about 0.5 mm to about 10 mm. In some embodiments, positioning the cutter near the distal end of the cutting device allows for the maximum amount of tendon to be available after the tendon is cut proximal to the biceps muscle.

[0107] In some embodiments, the cutting of the tendon can be performed by a fixed cutter or a deployable cutter. In some embodiments, the cutting can be performed by a circular motion of a cutter or knife near the distal end of the tendon cutting device. In some embodiments, the cutting can additionally or alternatively be performed by a reversibly deployable knife at an angle or perpendicular to the longitudinal axis of the tendon.

[0108] 2, an exemplary method 30 for severing the terminal end of the long head of the biceps (LHB) tendon near the biceps, according to some embodiments of the present invention, is shown. The method includes attaching a tenotomy device to the long head of the biceps tendon at 32, moving the tenotomy device distally relative to the shoulder along the tendon toward the biceps at 34, holding the tendon proximal to the biceps at 38, and pulling the tendon away from the biceps, optionally against a cutter of the device, until the tendon is separated from the biceps at 40.

[0109] In some embodiments, the retraction is performed around the shoulder. In some embodiments, the method further comprises separating the tendon from an associated bone prior to retraction. In some embodiments, the method further comprises, at 36, separating at least one ligament associated with the tendon.

[0110] In some embodiments, separation of the long head of the biceps tendon from the biceps muscle is typically not performed by directly severing the tendon as described above in some embodiments. Rather, in some embodiments, the ligaments associated with the long head of the biceps muscle can be held or severed while the tendon is pulled away from the biceps muscle from the opposite side of the shoulder circumference. In some embodiments, traction on the tendon separates the long head of the biceps tendon from the biceps muscle without actively cutting the tendon.

[0111] Referring now to FIG. 3 , a perspective view of an exemplary tenotomy device is shown, according to some embodiments of the present invention. In some embodiments, the tenotomy device 300 includes a handle 305 for use by a physician / user. In some embodiments, the tenotomy device 300 includes a first movable button 310, which is used to optionally secure a tendon within the tenotomy device 300 via a locking latch 545 ( FIG. 5 ). In some embodiments, the locking latch 545 is deployed from the device 500 and extends radially around the tendon 535, thereby securing the tendon in the channel 502 within the device 300. According to some embodiments, a second movable button 315 is adapted to actuate the cutting of the tendon via relative rotational movement of a cutter (not shown). In some embodiments, the device 300 includes a handle 305 from which extends an elongated body 320. In some embodiments, the elongated body has a distal end 322 that includes a channel 325 shaped to receive a tendon (not shown). In some embodiments, the distal end of the channel 325 is the distal tip 330 of the tenotomy device 300. In some embodiments, the distal tip 330 is adapted to abut the biceps muscle (not shown), as discussed further herein.

[0112] 4, a perspective view of an exemplary tenotomy device attached to a long head of the biceps tendon is shown, according to some embodiments of the present invention. The device 400 includes a channel 402 adapted to receive a long head of the biceps tendon 435 associated with the biceps muscle 440. The distal end 404 of the channel 402, according to some embodiments, includes a first opening 430 into the elongated body 420 of the device. The proximal end 406 of the channel, according to some embodiments, includes a second opening 432 disposed on a side of the elongated body 420 of the device. According to some embodiments, the tendon 435 can be attached within the channel 402 in the device 400, extending therethrough from the proximal end 406 of the channel to the distal end 404 of the channel. In some embodiments, a potential advantage of the channel 402 is that it is configured to receive the tendon and allow the cutting device 400 to slide along the tendon as it moves toward the biceps brachii muscle 440 prior to cutting, as discussed further herein.

[0113] It should be noted that while in some figures, including Figure 4, the tendon 435 appears to be separated from the shoulder, this is for simplicity's sake only. Those skilled in the art will understand that, according to some embodiments, during operation of the tenotomy device, the tendon 435 may be connected to the biceps 440 and also attached to the shoulder, the tendon 435 may be attached to the tenotomy device 400, and the device 400 may slide or otherwise move along the tendon 435 as the tendon is attached to the biceps at a first end 442 and the shoulder at a second end (not shown).

[0114] Referring now to FIG. 5 , a perspective view of an exemplary tenotomy device 500 with a biceps long head tendon 535 secured thereto is shown, according to some embodiments of the present invention. The tenotomy device 500 includes a locking latch 545 for securing a portion of the biceps long head tendon 535. The locking latch 545 is deployable via a button 510 to secure the tendon 535 within the tenotomy device 500. In some embodiments, during a typical procedure to cut the biceps long head tendon, the physician does not have access to a camera or the like. Therefore, locking the tendon 535 to the tenotomy device 500 via the locking latch 545 is an important feature for securing / retaining the tendon 535 within the tenotomy device during the procedure. Note that, according to some embodiments, the locking latch 540 allows the tendon 535 to be secured / retained within the channel 502 while the device 500 is slidable along the tendon 535, e.g., toward the biceps 540.

[0115] Referring now to FIG. 6 , a perspective view of an exemplary tenodesis device 600 abutting a biceps muscle 640 is shown, according to some embodiments of the present invention. FIG. 6 shows the tenodesis device 600 and its attached associated anchored tendon 635 after the tenodesis device 600 has been moved toward the biceps muscle 640. In some embodiments, the distal end 630 of the tenodesis device 600 abuts an enlarged muscle portion 642 of the biceps muscle 640, thereby preventing the tenodesis device 600 from moving further distally along the tendon 635 relative to the shoulder (not shown). In some embodiments, the tenodesis device 600 is in a position to cut the tendon 635 when the enlarged portion of the biceps muscle 640 prevents the tenodesis device 600 from moving further along the tendon 635.

[0116] 7, a portion of the tenotomy device of FIG. 3 is shown, according to some embodiments of the present invention. In some embodiments, elongate body 720 (designated by reference number 320 in FIG. 3) includes a cutter or cutting blade 750 proximal to a distal end 730 of tenotomy device 700. In some embodiments, cutter 750 is purposefully positioned relative to channel 725 so as not to cut the tendon prior to positioning the tendon proximal to biceps muscle 740. According to some embodiments, this allows elongate body 720 to slide along tendon 735 without damaging the tendon.

[0117] Referring now to FIG. 8 , a portion of the tenotomy device of FIG. 3 is shown with cutter 850 severing the long head of the biceps tendon adjacent to the biceps muscle 840, according to some embodiments of the present invention. According to some embodiments, device 800 includes an inner portion 860 that defines a portion of a channel 802, the inner portion 860 being rotatable relative to elongated body 820. According to some embodiments, when tendon 835 is placed within channel 802 and inner portion 860 is rotated relative to elongated body 820, the tendon is forced against cutter 850, thereby severing tendon 835. Note that the tendon can be severed at a distance of about 2 mm to about 5 mm (optionally about 1 mm to about 7 mm, optionally about 0.5 mm to about 10 mm) from the proximal (closer to the shoulder) end of biceps muscle 840. In some embodiments, the cut is actuated by a second movable button 315 ( FIG. 3 ), not shown in this figure.

[0118] Alternatively, according to some embodiments, rather than the elongate body having a fixed cutting blade and the inner portion being rotatable relative to the elongate body to press the tendon against the cutting blade, the cutting blade may be formed on the fixed inner portion and the outer portion of the elongate body may be configured to rotate relative to the inner portion of the device to press the tendon against the cutting blade.

[0119] As a further alternative, according to some embodiments, rather than the elongate body having a fixed cutting blade and a rotatable portion adapted to press the tendon against the cutting blade, the device may include a fixed portion and a rotatable cutting blade adapted to press the tendon against the fixed portion and cut it.

[0120] Referring now to Figure 9, a portion of the tenotomy device of Figure 3 is shown, illustrating a tendon after it has been severed by tenotomy device 900, according to some embodiments of the present invention. Figure 9 shows tendon 935 completely separated from biceps muscle 940 and not already attached or secured to tenotomy device 900. In some embodiments, severed tendon 935 is still attached to its second end, but as previously described herein, is shown unattached solely for ease of visualization. In some embodiments, after severing tendon 935, tenotomy device 900 can be removed from the body (not shown).

[0121] 10 , a portion of an exemplary alternative tendon cutting device 1000 is shown, according to some embodiments of the present invention. According to some embodiments, the device includes an inner portion 1060 having a channel 1025 formed therein. Alternatively, according to some embodiments, the channel 1025 may be integrally formed as part of the elongate body 1020. In some embodiments, a deployable cutter 1050 is positioned within the device 1000 outside of the channel 1025 to avoid prematurely severing the tendon. According to some embodiments, the device 1000 includes a slot 1062 through which the cutter 1050 is deployable at an angle relative to the elongate body 1020.

[0122] 11, a perspective view of the device of FIG. 10 is shown including an exemplary button 1107 for deploying a cutter (not shown in this view), according to some embodiments of the present invention. FIG. 11 shows a tendon 1135 attached to, and optionally anchored by, the tenotomy device 1100. In some embodiments, the tenotomy device 1100 has a button 1107 attached to its proximal end to deploy a cutter (not shown in this view) after the distal tip 1130 of the device contacts the biceps muscle 1140, as described herein. In some embodiments, the button 1107 has an optional cover 1108 to prevent accidental or premature deployment of the cutter from within the channel 1125 that holds the tendon 1135.

[0123] According to some embodiments, optionally, any actuators described herein, such as activation buttons, knobs, or levers, can be provided with covers to prevent accidental or premature activation of the tenotomy device.

[0124] 12, a portion of the tenotomy device of FIG. 10 is shown with the cutter 1250 fully deployed and the long head of the biceps tendon 1235 already severed from the biceps muscle 1240, in accordance with some embodiments of the present invention. FIG. 12 shows the cutter 1250 fully deployed and the corresponding button 1207 fully depressed. In some embodiments, the tendon 1235 has been separated from the biceps muscle 1240 and is no longer secured within the tenotomy device 1200.

[0125] 13, a portion of the tendon cutting device of FIG. 10 is shown, illustrating a portion of an exemplary mechanism 1355 for deploying a cutter 1350 to cut a tendon 1335, according to some embodiments of the present invention. In some embodiments, the mechanism 1355 of the device 1300 is actuated by a button (1207 in FIG. 12) to push the cutter 1350 through a slot 1362 in the channel 1325, moving the cutter at an angle relative to the tendon 1335.

[0126] 13 , according to some embodiments, because the channel 1325 is oriented at a particular angle relative to the elongate body 1320 of the device 1300, the tendon 1335, when attached to the channel 1325, is oriented at that same angle relative to the elongate body 1320. As a result, the cutter 1350 is adapted to cut the tendon at an oblique angle relative to the tendon's longitudinal axis. Optionally, if it is desired to cut the tendon 1335 at a different angle, the tendon can be moved so that it is not flush with the surface 1326 of the channel 1325. That is, the tendon can be held relative to the elongate body at an angle different from that defined by the surface 1326 of the channel 1325. This allows the cutter 1350 to be deployed to cut the tendon 1335 at a different angle, for example, at 90 degrees relative to the tendon's longitudinal axis, according to some embodiments. Similarly, with respect to other embodiments described herein, the tendon can be cut at a 90-degree or oblique angle depending on how it is held within the tendon cutting device according to some embodiments.

[0127] Referring now to FIG. 14 , a portion of an exemplary mechanism for deploying cutters via an actuation button is shown, according to some embodiments of the present invention. The button 1407 is shown in an initial position, and a cover 1408 (shown in an open position in FIG. 14 and in a closed position in FIG. 11 ) is provided to prevent accidental or premature deployment of the cutter (1350 in FIG. 13 ) when the cover is in the closed position over the button, according to some embodiments. In some embodiments, pressing the button 1407 on the tendon cutting device 1400 deploys the cutter (see 1350 in FIG. 13 ) via a series of springs, gears, and other mechanical structures 1460 to sever the tendon 1335 (FIG. 13 ). It will be appreciated by those skilled in the art that the mechanism shown and described in FIGS. 13-14 is one example of a suitable mechanism for deploying the cutter, and that other mechanisms are similarly suitable, according to some embodiments.

[0128] Note that this embodiment has one depressible button 1407 for optionally securing the tendon within the channel and cutting the tendon, as opposed to the previous embodiment described herein (FIG. 3) which has two sliding buttons.

[0129] 15, a side view of an exemplary tendon cutting device 1500 is shown, according to some embodiments of the present invention. FIG. 15 shows the exemplary tendon cutting device 1500, including a handle 1505, a rotatable first ring 1565, and a second cutting ring 1570. In some embodiments, the cutting device 1500 further includes a first shaft 1575 including a channel 1525 adapted to receive a tendon, the channel including a proximal angled surface 1626 and a distal surface 1627 ( FIG. 16 ), and the device 1500 includes a second shaft 1580 including a cutter (not shown). In some embodiments, this configuration of the device 1600 allows for perpendicular cutting of the tendon, as will be further described with respect to FIGS. 19-20 .

[0130] 16, a perspective view of a portion of an exemplary tenotomy device 1600 having a channel 1625 in an open state is shown, according to some embodiments of the present invention. In some embodiments, the channel 1625 includes an angled surface 1626 and a distal surface parallel to the longitudinal axis of the device. The channel 1625 is adapted to receive a tendon (not shown) therein. In some embodiments, the tendon can optionally be secured within the channel 1625 by rotating a rotatable first ring 1665, e.g., one full rotation, via a securing latch (1745 in FIG. 17).

[0131] Referring now to FIG. 17, a portion of an exemplary tenotomy device is shown having a channel 1725 in a closed state, according to some embodiments of the present invention. FIG. 17 shows the locking latch 1745 (without tendon) in a closed position after rotation with the first rotatable ring 1665 (FIG. 16) on the shaft. In some embodiments, a full rotation of the first rotatable ring 1665 fully deploys the locking latch 1745. In some embodiments, the locking latch 1745 can hold the tendon in place in the channel 1725 as the tenotomy device is moved toward the biceps and / or while the tendon is cut.

[0132] 18 , a portion of the tenotomy device of FIG. 15 is shown, including an exemplary actuation pin 1880 of a cutter (1950 in FIG. 19 ) within the exemplary tenotomy device 1800, according to some embodiments of the present invention. FIG. 18 illustrates the pin 1880, as well as a first position 1885 prior to cutting the tendon and a second position 1890 after cutting the tendon. In some embodiments, moving the pin 1880 from the first position 1885 to the second position 1890 deploys a cutter (2050 in FIG. 20 ) adapted to cut the long head of the biceps tendon at a 90-degree angle relative to the tendon's longitudinal axis. In some embodiments, the pin 1880 is movable only after rotation of the first rotatable ring 1865 to ensure that the locking latch 1745 is closed over the tendon within the channel 1725 (see FIG. 17 ) before deploying the cutter.

[0133] Referring now to Figure 19, there is shown a portion of the tendon cutting device of Figure 15 including an exemplary mechanism for deploying cutter 1950, according to some embodiments of the present invention. Figure 19 shows details of second shaft 1980, in which a gear system 1995 associated with a pin (see 1880 in Figure 18) deploys cutter 1950 perpendicular to the tendon within channel 1625 (Figure 16). It will be appreciated by those skilled in the art that the mechanism shown and described with respect to Figure 19 is one example of a suitable mechanism for deploying the cutter, and that other mechanisms are similarly suitable according to some embodiments.

[0134] Referring now to FIG. 20 , a portion of the device of FIG. 15 is shown after deployment of an exemplary cutter 2050, according to some embodiments of the present invention. In some embodiments, a closure or locking latch 2045 can optionally be closed over the tendon prior to deployment of the cutter 2050, thereby locking the tendon (not shown) in the channel 2025, as described herein in FIG. 17 . However, for clarity, the locking latch 2045 is shown in an open position, so that the cutter 2050 is clearly visible. In some embodiments, a mechanism, such as that included in the second shaft 2080 and described herein with respect to FIG. 19 , guides deployment of the cutter 2050 to cut the tendon at approximately 90 degrees relative to the tendon's longitudinal axis. FIG. 20 shows the cutter 2050 fully deployed, but without the tendon for clarity. In some embodiments, as described herein, opening and closing of the locking latch 2045 is controlled by a first rotating ring (1665 in FIG. 16), while deployment of the cutter 2050 is controlled by movement of a pin (1880 in FIG. 18), as previously described.

[0135] Referring now to FIG. 21 , a side view of an exemplary cutter tool 2102 according to some embodiments of the present invention is shown, which can be utilized to cut or sever a tendon, such as the long head of the biceps brachii tendon. FIG. 21 shows the cutter tool 2101, which includes a handle 2105, a metering shaft 2109 terminating in a semicircular end 2112, and optionally, a blade 2151, for example, on the radially inner portion of the semicircular end 2112 of the cutter tool 2101. In some embodiments, the cutter tool 2101 is typically inserted through an arthroscopic portal, with the end 2112 with the blade 2151 positioned under the tendon (with the blade facing the tendon), and the tool 2101 is moved along the tendon until the device is against the biceps brachii muscle and the blade 2151 is positioned adjacent to the location where the tendon will be cut. To cut or sever the tendon, the transverse ligament is manually or mechanically retracted, separating the tendon from the biceps brachii muscle.

[0136] 22, a side view of an exemplary tendon grabber device 2200 is shown, according to some embodiments of the present invention. In some embodiments, a tendon can be grasped using device 2200 as shown in FIG. 22. According to some embodiments, tendon grabber device 2000 includes an axial slot 2202 and an interlocking lateral slot 2204 into which the tendon can be inserted when holding or moving the tendon relative to other anatomical structures or other devices. For example, according to some embodiments, device 2000 can be used to hold and insert a tendon into a channel of a tenotomy device, such as channel 325 of device 200 (FIG. 3).

[0137] 23 , a flowchart of an exemplary method 2300 of cutting a tendon using a tenotomy device is shown, according to some embodiments of the present invention. In some embodiments, the method 2300 includes attaching a biceps cutter to a tendon, such as the long head of the biceps tendon, through an anterolateral shoulder arthroscopic portal at 2302, optionally closing the opening of the biceps cutter to secure the tendon within the biceps cutter at 2304, sliding the biceps cutter distally relative to the shoulder over the tendon toward the biceps muscle at 2308, stopping the sliding of the tendon cutter upon abutting the proximal portion of the biceps muscle at 2310, and optionally cutting the tendon up a sufficient distance to avoid cutting the muscle-tendon junction of the muscle itself at 2312. The biceps cutter is withdrawn posteriorly, and at 2414, the cutter is used to cut the tendon at the cutting location, where the cutting is performed by rotating the inner portion of the biceps cutter relative to the cutter (or vice versa), deploying the cutter (2318), or axially moving the outer tube of the biceps cutter relative to the fixed cutter (or axially moving the inner tube relative to the fixed cutter), cutting the tendon at an oblique angle or perpendicular angle to the longitudinal axis of the tendon, and at 2322, withdrawing the biceps cutter and the severed long head of biceps tendon from the anterolateral portal.

[0138] 24 , a flowchart of an exemplary method 2400 for cutting a tendon using a tenotomy device is shown, according to some embodiments of the present invention. In some embodiments, the method 2400 can be used, for example, to cut the long head of the biceps tendon, and includes attaching a tenotomy device onto the long head of the biceps muscle through an anterolateral shoulder arthroscopic portal at 2402, optionally closing the opening of the biceps cutter at 2404, sliding the biceps cutter proximally toward the labrum at 2406, optionally under arthroscopic supervision, stopping the sliding when the biceps cutter abuts against the labrum at 2408, cutting the long head of the biceps tendon flush or obliquely at 2410, where the cut is optionally made as close to the labrum as possible, and withdrawing the biceps cutter and cut long head of the biceps muscle through the anterolateral portal at 2412.

[0139] Figure 25A is an exploded view of an exemplary tenotomy device 100, according to some embodiments of the present invention. According to some embodiments, the device 100 includes an outer shaft 102 having a proximal end 104 and a distal end 106, and a fixed inner shaft 110 having a distal end 112, some details of which are shown enlarged in Figure 25B. The inner shaft distal end 112, according to some embodiments, is formed with a first angled or curved surface 114 disposed generally at a first angle relative to the inner shaft longitudinal axis 120. According to some embodiments, a flange 130 may be formed along a portion of the inner shaft distal end 112, where the flange 130 encompasses less than 360 degrees of the inner shaft distal end 112. In some examples, as described further herein, the flange 130 can define a distal opening 116 in the inner shaft 110, and the first angled surface 114 and the flange 130 can form a passageway for the device 100 to slide along a tendon (not shown). According to some embodiments, a lateral opening 118 leading to the first angled surface 114 can be formed in the inner shaft 110 adjacent the first end 122 of the flange 130, and a second angled / curved surface 124 can be defined in the inner shaft 110 adjacent the first angled surface 114. According to some embodiments, a slightly protruding end 126 can be formed between the first angled surface 114 and the second angled surface 124, the function of which will be described below. According to some embodiments, the second angled surface 124 is disposed at approximately a second angle relative to the longitudinal axis 120, the second angle (between the second angled surface 124 and the longitudinal axis 120) being greater than the first angle (between the first angled surface 114 and the shaft longitudinal axis 120). According to some embodiments, the cutting blade 150 can be disposed on the flange 130 at a position radially outward from the first angled surface 114.

[0140] 25C-25D, the cutting device 100 is shown in an initial operating orientation according to some embodiments. A tendon 170 is mounted on the cutting device by inserting the tendon into the channel 140 through the opening 118 (best seen in FIG. 25B).

[0141] According to some embodiments, the device 100 can include a scissor-like actuator having a pair of finger grips. When the finger grips are moved toward each other (to the position shown in FIG. 25E), this causes the inner shaft 110 to move axially proximally relative to the outer shaft 102. Although not shown in this embodiment, a similar tenostomy device can alternatively be configured to be axially movable distally relative to the inner shaft.

[0142] A safety 164 may optionally be provided with device 100 to prevent accidental or premature actuation of device 100. In some embodiments, safety 164, which may optionally include a ratchet mechanism, may prevent finger grips 162 from moving toward each other until safety 164 is depressed, thereby preventing accidental or premature actuation of the device. The structure and function of actuator 160, including finger grips 162 and safety 164, are known to those skilled in the art and will not be described further herein. It should also be understood that the particular actuation and safety mechanisms described herein are exemplary only, and that any other suitable actuation mechanisms may be utilized in some embodiments.

[0143] In an initial operating orientation, as shown in FIG. 25D (and with reference to FIG. 25B ), a tendon 170, such as the long head of the biceps tendon adjacent to the biceps muscle 172, can be attached to the device 100 by inserting it through the lateral opening 118 and the distal opening 116 and alongside the second angled surface 124. According to some embodiments, the tendon then extends within the channel 140, laterally from the first angled surface 114, and out through the distal opening 116 (see FIG. 25B ). It should be noted that while the first end 174 of the tendon 170 is shown attached to the biceps muscle 172, the second end 176 of the tendon 170 can be attached to the shoulder (not shown), e.g., the labrum, or another anatomical structure of the shoulder. However, in the drawings of this and other embodiments of the tenotomy device, the shoulder and the attachment of the second end 176 of the tendon 170 to the shoulder are omitted for clarity.

[0144] Once the tendon is attached to the device 100, according to some embodiments, and as described above with respect to the embodiments of Figures 3-9, for example, the device can be slidably moved along with the tendon as it moves through the passageway 140, so that the device 100 abuts the biceps muscle 172. Once so positioned, according to some embodiments, the device 100 is actuated by moving the finger grips toward each other from the relative position of Figure 25D (before the device 100 has been moved to abut the biceps muscle 172) to the relative position of Figure 25E, thereby moving the inner shaft 110 proximally relative to the outer shaft 102.

[0145] In embodiments including safety 164, movement of the finger grips toward one another may be limited, and tendon 170 may be held between outer shaft 102 and flange 130 (FIG. 25B), which may prevent movement of tendon 170 relative to device 100 in some embodiments. Release of safety 164 requires application of pressure, allowing further movement of the finger grips toward one another.

[0146] According to some embodiments, as the finger grips are moved relative to one another, for example, from their relative position in Figure 25D toward the relative position in Figure 25E, the inner shaft 110 moves proximally relative to the outer shaft 102, causing the distal end 106 of the outer shaft to contact the tendon 170 and press the tendon against the cutting blade 150, severing the tendon. In this way, the tendon 170 can be separated or severed from the biceps muscle 172, as shown in Figures 25E-25F.

[0147] According to some embodiments, device 100 does not require a locking latch or deployable components to secure tendon 170 within passageway 140. Optionally, according to some embodiments, tendon 170 can be secured within passageway by structure of inner shaft 110, including protruding end 126 and flange 130. Such fixation of tendon 170 also fixes the cut location of tendon 170 within device 100. In some embodiments, device 100 may include alternative structure adapted to secure tendon 170 and fix the cut location of the tendon within device 100.

[0148] Those skilled in the art will understand that, optionally, any of the other embodiments described and illustrated herein may have similar structures for securing tendons therein, such as particular angled or curved surfaces of the channels, as described herein.

[0149] FIG. 26A is a perspective view of an exemplary tenotomy device 200, according to some embodiments of the present invention. FIG. 26B is a partial enlarged view of the tenotomy device 200 shown in FIG. 26A, according to some embodiments of the present invention. Device 200 is similar to device 100 (FIGS. 25A-25B) in that it includes an outer shaft and an inner shaft. However, in device 100, the outer shaft 102 is fixed, while the inner shaft 110 carries the cutting blade 150 and is axially movable relative to the fixed outer shaft 102. In contrast, in device 200, the outer shaft 202 is fixed and carries the cutting blade 250, while the inner shaft 210 is axially movable relative to the outer shaft 202. Additionally, in the embodiment of FIGS. 26A-26E, the safety (164 in FIG. 25C) has been omitted for simplicity. Optionally, the device of FIGS. 26A-26E can include a safety similar to that of FIG. 25A.

[0150] Those skilled in the art will appreciate that the various components of device 200 are similar in structure and function to those of device 100 (FIG. 25A), and therefore will not be described again in FIGS. 26A-26E.

[0151] 26C is a side view of the tendon cutting device 200 in an initial operating orientation, according to some embodiments. The tendon 170 is attached to the cutting device 200 as described herein, for example, with respect to FIG. 25D, i.e., by inserting the tendon into the channel of the device through an opening at the distal end of the device.

[0152] Figure 26D is a side view of the tenotomy device 200 after severing the tendon 170, according to some embodiments, and Figure 26E shows a close-up portion of the device 200, according to some embodiments. In Figure 26D, it can be seen that the finger grips 162 have been moved closer to each other compared to the position in Figure 26C (the initial operating orientation). The inner shaft 210, a portion of which can be seen more clearly in Figure 26E, has been moved distally relative to the outer shaft, causing the inner shaft 210 to press the tendon 170 against the cutting blades on the outer shaft 202, thereby separating the tendon 170 from the biceps muscle 172. Although not shown in this embodiment, a similar tenotomy device could alternatively be configured to be axially movable proximally relative to the inner shaft.

[0153] Figure 27A is a side view of an exemplary tenotomy device 2700, according to some embodiments of the present invention, and Figure 27B is an exploded view of the tenotomy device 2700 of Figure 27A, according to some embodiments of the present invention. The device 2700 includes a handle 2762 having an actuation lever 2760, a fixed outer shaft 2702 carrying a cutting blade, and an inner shaft 2710 that is axially movable relative to the outer shaft 2702.

[0154] According to some embodiments, the device 2700 can employ a mechanism whereby rotational motion of one or more components of the device is translated into linear motion of one or more other components of the device in some embodiments. For example, the device 2700 can include a mechanical component for imparting linear motion to the inner shaft 2710, as described herein. In some embodiments, the mechanical component can include, for example, a toothed element attached to the actuation lever 2760, with a corresponding recess in the inner shaft 2710, such that pressing against the actuation lever 2760 imparts axial motion to the inner shaft 2710. Mechanisms of this type are well known in the art and will not be further described here. Additionally, according to some embodiments, any mechanism for moving the inner shaft 2710 relative to the outer shaft 2702 can be utilized.

[0155] Those skilled in the art will appreciate that the described mechanism including toothed and recessed elements is merely one example of a mechanism for imparting linear motion to the inner shaft 2710. Alternatively, any other mechanism for imparting linear motion to the inner shaft 2710 of the device 2700 can be employed. Likewise, any other embodiment described and illustrated herein can employ such mechanisms to effect similar motion of device components.

[0156] FIG. 27C is a side view of the tendon cutting device of FIG. 27A, according to some embodiments of the present invention. The device 2700 is shown in an initial operating orientation, with the actuation lever 2760 facing in a first direction relative to the handle 2762, which in the illustrated embodiment is at an angle relative to the handle. The tendon 170 can be attached to the cutting device 2700 by inserting the tendon into the channel of the device through an opening at the distal end of the device, as discussed, for example, with respect to FIGS. 25C-25D. Components of the device 2700, such as the outer shaft, are similar in structure and function to those of device 200 (FIG. 26C) and will not be described further herein. Similarly, some of the actions of attaching the tendon 170 to the device 2000 and moving the device 2000 along the tendon toward the biceps 172 are similar to those described herein with respect to device 200 (FIG. 26C) and will not be described again here.

[0157] Once the tendon 170 is attached to the device 2000, the lever 2760 is movable in a second orientation relative to the handle 2762, which in the embodiment of FIG. 27D is substantially parallel to the handle. According to some embodiments, this movement of the lever 2760 from the first orientation (FIG. 27C) to the second orientation (FIG. 27D) can move the inner shaft 2710 axially toward the cutting blade 2750, thereby forcing the tendon 170 against the cutting blade 2750 and severing the tendon 170, thereby separating it from the biceps muscle 172.

[0158] According to some embodiments, instead of the tendon cutting device having a fixed outer portion including a cutting blade and an axially movable inner portion adapted to press the tendon against the cutting blade, as with any of the embodiments of Figures 27A-27D, the device may include a fixed inner portion and an axially movable outer portion including a cutting blade adapted to press against a fixed portion to cut the tendon.

[0159] Figure 28A is an exploded view of an exemplary tenotomy device 2800 having an activation button 2860, according to some embodiments of the present invention. The device 2800 includes a handle 2862 having an activation switch or button 2860, a fixed outer shaft 2802 carrying a cutting blade, an inner shaft 2810 axially movable relative to the outer shaft 2802, and an optional safety 2870, as shown in side view in Figure 28B, according to some embodiments. The inner shaft 2810 may be provided with a slot 2812 at its distal end 2814. The slot 2812 is further described in relation to Figure 28F.

[0160] Figure 28C is a side view of the tendon cutting device 2800 of Figure 28B in accordance with some embodiments of the present invention. The device 2800 is shown in an initial operating orientation, with the activation button 2860 positioned a distance from the handle 2862. The tendon 170 can be attached to the cutting device 2800 as described herein, for example, with respect to Figures 25C-25D, i.e., by inserting the tendon into the channel of the device through an opening at the distal end of the device.

[0161] Components of device 2800, such as outer shaft 2802, are similar in structure and function to those of device 200 (FIG. 26C) and will not be described further herein. Similarly, some of the actions of attaching tendon 170 to device 2800 and moving the device along the tendon toward biceps 172 are similar to those described herein with respect to device 200 (FIG. 26C) and will not be described again here.

[0162] In some embodiments, device 2800 includes a safety feature that prevents accidental or premature depression of activation button 2860, thereby preventing accidental or premature activation of device 2800. Specifically, device 2800 can include a mechanism whereby there is a geometric interlock between a component of the device, such as safety 2870, and another component of device 2800, such as activation button 2860. For example, in some embodiments, a portion 2872 of safety 2870 can optionally extend through handle 2862 and into a recess 2874 in activation button 2860. In some embodiments, in a locked configuration, safety 2870 can be prevented from moving further into or through activation button 2860. After releasing the geometric interlock, safety 2870 can move further into handle 2862 and / or the recess, thereby allowing activation button 2860 to be depressed and device 2800 to be activated.

[0163] Those skilled in the art will appreciate that the described safety device 2870 is merely one example of a safety mechanism employing a geometric interlock between components. Any other mechanism for preventing accidental or premature actuation of device 2800 may alternatively be employed. Likewise, any of the other embodiments described and illustrated herein may employ such safety mechanisms for similar purposes.

[0164] Once the tendon 170 is attached to the device 2800 and the user is ready to cut the tendon, the device can be moved along the tendon and against the biceps muscle, and then the safety 2870 can be released by pressing it toward the handle 2862. Once the safety 2870 is released, the activation button 2860 can be depressed, as shown in FIG. 28D. When the button 2860 is depressed toward the handle 2832, as shown in FIG. 28E, the inner shaft 2810 is moved axially toward the cutting blade 2850. This forces the tendon 170 against the cutting blade, cutting the tendon 170 and thereby separating it from the biceps muscle 172, as shown in FIGS. 28E-28F.

[0165] As described herein, according to some embodiments, the inner shaft 2810 is provided with a slot 2812 at the distal end 2814 of the inner shaft. It has been found that providing a slot in the inner shaft can improve the cutting action of the device 2800.

[0166] Figure 29A is an exploded view of an exemplary tenotomy device 2900 having an activation button 2960, according to some embodiments of the present invention. The device 2900, shown in side view in Figure 29B, includes a handle 2962 having an activation switch or button 2960, a fixed inner shaft 2902 carrying a cutting blade, an outer shaft 2910 that is axially movable relative to the inner shaft, and an optional safety 2970, according to some embodiments.

[0167] Figure 29C is a side view of the tendon cutting device of Figure 29B, according to some embodiments of the present invention. The device 2900 is shown in an initial operating orientation, with the activation button 2960 positioned a distance from the handle 2962. The tendon 170 can be attached to the cutting device 2900 as described herein, for example, with respect to Figures 25C-25D, i.e., by inserting the tendon into the channel of the device through an opening at the distal end of the device.

[0168] Components of device 2900, such as inner shaft 2902, are similar in structure and function to those of device 100 (FIG. 25C) and will not be described further herein. Similarly, some of the actions of attaching tendon 170 to device 2900 and moving the device along the tendon toward biceps 172 are similar to those described herein with respect to device 100 (FIG. 25C) and will not be described again here.

[0169] According to some embodiments, device 2900 includes a safety feature to prevent accidental or premature depression of activation button 2960, thereby preventing accidental or premature activation of device 2900. Specifically, device 2900 can include a mechanism whereby there is a geometric interlock between components of the device, such as safety 2970, and other components of device 2900, such as activation button 2960. Components of device 2900, including safety 2970 and outer shaft 2910, can be similar in structure and function to corresponding components of device 2800 (FIG. 28B) and will not be described again herein.

[0170] Those skilled in the art will appreciate that the illustrated safety device 2970 is merely one example of a safety mechanism employing a geometric interlock between components. Any other mechanism for preventing accidental or premature actuation of the device 2900 may alternatively be employed. Likewise, any of the other embodiments described and illustrated herein may employ such safety mechanisms for similar purposes.

[0171] According to some embodiments, once the tendon 170 is attached to the device 2900 and the user is ready to cut the tendon, the device can be moved along the tendon until the inner shaft 2902 abuts the biceps muscle, and then the safety 2970 can be released by pushing it toward the handle 2962. Once the safety 2970 is released, the activation button 2960 can be depressed, as shown in FIG. 29D. When the button 2960 is depressed toward the handle 2962, as shown in FIG. 29E, the outer shaft 2910 moves axially toward the cutting blade 2950. This forces the tendon 170 against the cutting blade 2950, ​​cutting the tendon 170 and thereby separating it from the biceps muscle 172.

[0172] According to some embodiments, instead of the tendon cutting device having a fixed portion including a cutting blade and an axially movable portion adapted to press the tendon against the cutting blade, as with any of the embodiments of Figures 25A-29F, the device may include a fixed portion and an axially movable portion including a cutting blade adapted to press against the fixed portion to cut the tendon.

[0173] Those skilled in the art will understand that many of the features described herein may be provided in additional embodiments of the present invention. For example, an embodiment having a rotatable cutter as described herein may alternatively be provided with a deployable cutter as described herein, or may alternatively be provided with a fixed cutter and an axially movable portion that presses the tendon against the fixed cutter as described herein. For example, an embodiment having an actuation lever as discussed herein may alternatively be provided with an actuation button as discussed herein, or may alternatively be provided with an actuator having a finger grip as discussed herein. Furthermore, any of the devices discussed herein may include a laterally disposed grip, such as located on the handle of the device, to facilitate grasping of the device. It is anticipated that many related tendon cutting devices will be developed during the patent lifespan that matures from this application, and the scope of the term tendon cutting device is intended to encompass all such innovations a priori. It is also understood that additional devices and methods combining elements of the above embodiments may be employed without departing from the spirit of the present invention.

[0174] The term "about" as used herein in connection with an amount or value means "within ±20%."

[0175] The terms "comprises," "comprised," "includes," "included," "has," "had," and their conjugations mean "including but not limited to."

[0176] The term "consisting of" means "including and limited to."

[0177] The term "consisting essentially of" means that the composition, method, or structure may include additional components, steps, and / or moieties, but only if the additional components, steps, and / or moieties do not materially alter the basic and novel characteristics of the claimed composition, method, or structure.

[0178] As used herein, the singular forms "a," "an," and "the" include plural references unless the context clearly dictates otherwise. For example, the term "a compound" or "at least one compound" can include multiple compounds, including mixtures thereof.

[0179] Throughout this application, embodiments of the invention may be presented with reference to a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as a fixed limitation on the scope of the invention. Accordingly, the description of a range should be considered to have specifically disclosed all possible subranges, along with individual numerical values ​​within that range. For example, a description of a range such as "1 to 6" should be considered to have specifically disclosed subranges such as "1 to 3," "1 to 4," "1 to 5," "2 to 4," "2 to 6," "3 to 6," etc., along with individual numerical values ​​within that range, e.g., 1, 2, 3, 4, 5, and 6. This applies regardless of the breadth of the range.

[0180] Whenever a numerical range is given herein (e.g., "10-15," "10 to 15," or any pair of numbers joined by another such range designator), it is meant to include any number (fractional or integer) within the limits of the stated range, inclusive of the limits of that range, unless the context clearly dictates otherwise. The phrases "ranging from / across / between" a first specified number and a second specified number, and "ranging from / across / between" a first specified number "to," "up to," "until," "inclusive through" (or another such range designator) a second specified number, are used interchangeably herein and are meant to include the first specified number and the second specified number, and all fractional and integer numbers therebetween.

[0181] Unless otherwise indicated, numbers used herein and any numerical ranges based thereon are approximations within the accuracy of reasonable measurement and rounding errors as understood by one of ordinary skill in the art.

[0182] As used herein, the term "method" refers to ways, means, techniques, and procedures for accomplishing a given task, including, but not limited to, ways, means, techniques, and procedures that are known to or that can be readily developed by those skilled in the art of chemistry, pharmacology, biology, biochemistry, and medicine from known ways, means, techniques, and procedures.

[0183] As used herein, the term "treating" includes halting, substantially inhibiting, slowing or reversing the progression of a condition, substantially ameliorating the clinical or cosmetic symptoms of a condition, or substantially preventing the appearance of clinical or cosmetic symptoms of a condition.

[0184] It is understood that certain features of the invention, which are for clarity described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention that are for brevity described in the context of a single embodiment may also be provided separately or in any suitable subcombination, or as appropriate to any other described embodiment of the invention. Certain features described in the context of various embodiments are not considered essential features of those embodiments, unless the embodiment is inoperable without those elements.

[0185] All publications, patents, and patent applications mentioned in this specification are incorporated herein by reference in their entirety, as if each individual publication, patent, and patent application was specifically and individually indicated to be incorporated herein by reference. Furthermore, citation or identification of any reference in this application should not be construed as an admission that such reference is available as prior art to the present invention. To the extent used as section headings, they should not be construed as necessarily limiting. Additionally, any priority documents of this application are incorporated herein by reference in their entirety.

Claims

1. 1. A method of severing a distal portion of the long head of the biceps (LHB) tendon from the biceps, comprising: a. attaching a tendon cutting device having a cutter to the tendon; b. moving the tenotomy device distally relative to the shoulder along the tendon toward the biceps; c) applying the tenotomy device to the biceps muscle, thereby aligning a cutter position associated with a distal end of the tenotomy device with a cut location on the tendon adjacent the biceps muscle; d. severing the tendon at the cutting location using the cutter; A method comprising:

2. The method of claim 1 , further comprising securing the tendon within the tendon cutting device after the attachment.

3. The method of claim 1 , wherein the attaching comprises securing the tendon within the tendon cutting device after the attaching.

4. The method of claim 3 , wherein the fixation comprises fixating the tendon within a fixation channel of the tenotomy device.

5. The method of claim 1 , wherein the cutting is performed by relative rotation of the cutters.

6. 6. The method of claim 5, wherein the tendon cutting device includes an inner portion and an outer portion rotatable relative to one another, the inner portion being disposed radially inward relative to the outer portion, and the cutter being disposed on the inner portion.

7. 6. The method of claim 5, wherein the tendon cutting device includes an inner portion and an outer portion rotatable relative to one another, the inner portion being disposed radially inward relative to the outer portion, and the cutter being disposed on the outer portion.

8. 2. The method of claim 1, wherein the cutter is fixed within the tendon cutting device and the cutting is performed by rotating a rotatable portion of the tendon cutting device relative to the cutter.

9. 9. The method of claim 8, wherein the tendon cutting device includes an inner portion and an outer portion rotatable relative to one another, the inner portion being disposed radially inward relative to the outer portion, and the cutter being disposed on the inner portion.

10. 9. The method of claim 8, wherein the tendon cutting device includes an inner portion and an outer portion rotatable relative to one another, the inner portion being disposed radially inward relative to the outer portion, and the cutter being disposed on the outer portion.

11. The method of claim 1 , wherein the cutting is performed by moving the cutter at an angle relative to the tendon.

12. The method of claim 11 , wherein the predetermined angle is 90 degrees.

13. The method of claim 11 , wherein the predetermined angle is other than 90 degrees.

14. 2. The method of claim 1, wherein the cutter is defined in a fixed part of the tendon cutting device, and the cutting is performed by moving a movable part of the tendon cutting device axially toward the cutter, the movable part forcing the tendon against the cutter.

15. The method of claim 14 , wherein the fixed portion is located radially outward relative to the movable portion.

16. The method of claim 14 , wherein the fixed portion is located radially inward relative to the movable portion.

17. The method of claim 2 , wherein the locking is performed after or simultaneously with depressing a first release handle associated with the tenotomy device.

18. The method of claim 5 , wherein the rotation is performed after or simultaneously with depressing a second release handle associated with the tendon cutting device.

19. The method of claim 11 , wherein the movement is performed by pushing a handle associated with the tendon cutting device.

20. The method of claim 1 , wherein the cutter is a mechanically deployable knife.

21. the attaching step includes attaching a tenotomy device to the tendon through an anterolateral shoulder arthroscopic portal; the moving includes sliding the tenotomy device over the tendon in a distal direction relative to the shoulder; The sliding is stopped when the biceps cutter comes into contact with the biceps, the cutting is by relative rotation at an oblique or perpendicular angle to the longitudinal axis of the tendon; The method of claim 1 , wherein the method includes withdrawing the tenotomy device and severed tendon through the anterolateral shoulder arthroscopic portal.

22. 22. The method of claim 21, further comprising, after stopping, moving the tenotomy device proximally relative to the shoulder a distance ensuring that the tenotomy device does not sever a muscle-tendon junction of the biceps brachii.

23. 22. The method of claim 21, further comprising closing an opening in the tendon cutting device after the attaching step to fix the cutting location within the biceps cutter.

24. 1. An apparatus for severing a distal portion of the long head of the biceps (LHB) tendon from the biceps, comprising: an elongate body attachable to the tendon, the elongate body including a tip and a cutter at a distal end of the body, the tip being shaped like a channel for receiving a portion of the tendon and adapted to move along the tendon and to stop said movement when a distal end of the tip abuts a thickened portion of the biceps brachii; a cutter location is positioned relative to said body a predetermined distance from said distal end of said tip, said cutter configured to sever said tendon at said cutter location.

25. 25. The device of claim 24, wherein the device includes a cutting tool at the tip.

26. 25. The device of claim 24, wherein the cutter location is about 1 mm to about 5 mm from the distal end of the tip.

27. 25. The apparatus of claim 24, wherein the cutter is adapted to cut the tendon at a predetermined angle relative to the tendon.

28. 28. The apparatus of claim 27, wherein the predetermined angle is 90 degrees.

29. 28. The apparatus of claim 27, wherein the predetermined angle is other than 90 degrees.

30. 25. The device of claim 24, comprising a fixed portion and a movable portion, the cutter defined in the fixed portion, the movable portion configured to move toward the cutter and to force the tendon against the cutter.

31. The device of claim 30, wherein the fixed portion is located radially outward relative to the movable portion.

32. The device of claim 30, wherein the fixed portion is located radially inward relative to the movable portion.

33. 31. The apparatus of claim 30, wherein the movable portion is configured to perform one of axial movement and rotation.

34. 25. The device of claim 24, wherein the device includes a fixed portion and a movable portion, the cutter being defined in the movable portion, the movable portion being configured to move toward the fixed portion and to force the tendon against the fixed portion.

35. 35. The device of claim 34, wherein the fixed portion is located radially outward relative to the movable portion.

36. 35. The device of claim 34, wherein the fixed portion is located radially inward relative to the movable portion.

37. 35. The apparatus of claim 34, wherein the movable portion is configured to perform one of axial movement and rotation.

38. 25. The device of claim 24, further comprising a fixation bar for fixing the tendon within the channel.

39. 25. The device of claim 24, wherein the channel is sized and shaped to secure the tendon within the device.

40. 25. The device of claim 24, including a safety device having a first orientation to prevent actuation of the device and a second orientation to allow actuation of the device.

41. 41. The device of claim 40, wherein the safety device is configured to geometrically interlock with a portion of the device when in the first orientation.

42. 25. The device of claim 24, wherein the cutter is deployable.

43. 25. The apparatus of claim 24, wherein the cutter is rotatable.

44. 25. The device of claim 24, wherein the device includes a rotatable portion configured to force the tendon against the cutter.

45. 25. The apparatus of claim 24, wherein the predetermined distance is from about 1 mm to about 5 mm.

46. 1. A method for severing or tearing a distal portion of the long head of the biceps (LHB) tendon from the biceps muscle, comprising: a. attaching the long head of the biceps tendon to a tenotomy or rupture device; b. moving the tendon cutting or rupturing device distally relative to the shoulder along the tendon toward the biceps; c. holding the tendon adjacent the biceps with the tendon cutting or rupturing device; d. pulling the tendon away from the biceps muscle such that the tendon is separated from the biceps muscle; A method comprising:

47. 47. The method of claim 46, wherein the holding step is performed by a distal portion of the tendon cutting or rupturing device, and a blade of the tendon cutting or rupturing device is positioned adjacent to the distal portion of the tendon cutting or rupturing device.

48. 47. The method of claim 46, wherein the pulling step comprises pulling the tendon toward a blade of the tendon cutting or rupturing device.

49. 47. The method of claim 46, wherein the pulling step occurs near the shoulder.

50. 47. The method of claim 46, further comprising separating the tendon from the associated bone prior to the traction.

51. 47. The method of claim 46, further comprising isolating at least one ligament associated with the tendon from the shoulder.

52. 1. A method of severing the tendon of the long head of the biceps brachii, comprising: a. placing a biceps cutter over the tendon through an anterolateral shoulder arthroscopic portal; b) sliding the biceps cutter toward the labrum; c) stopping the sliding when the biceps cutter abuts against the labrum; d. cutting the tendon flush or obliquely at a cut location of the tendon adjacent the labrum; e. Pulling the biceps cutter and the cut ends of the severed tendon through the anterolateral portal; A method comprising:

53. 53. The method of claim 52, further comprising the step of closing an opening in the biceps cutter after the sliding step to fix the cutting position within the biceps cutter.

54. 53. The method of claim 52, wherein the sliding step is performed under arthroscopic supervision.

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