Breaking instruments and systems for surgical interventions

Abstract

The present invention relates to a breaking instrument for surgical interventions and a breaking system comprising a breaking instrument and a breaking motion generator, which is intended for the field of traumatology, in particular for the creation of bone tunnels suitable for the proper anatomical reconstruction of tendons and ligaments, for example in interventions for reinserting the supraspinatus tendon of the rotator cuff of the shoulder joint or for reconstructing the anterior cruciate ligament (ACL) of the knee joint.

Description

[Technical Field]

[0001] The present invention relates to a breaking instrument for surgical interventions and a breaking system comprising a breaking instrument and a breaking motion generator, which is intended for the field of traumatology, in particular for the creation of bone tunnels suitable for the proper anatomical reconstruction of tendons and ligaments, for example in interventions for reinserting the supraspinatus tendon of the rotator cuff of the shoulder joint or for reconstructing the anterior cruciate ligament (ACL) of the knee joint. [Background technology]

[0002] One of the most common injuries in the field of traumatology is the rupture of joint tendons and ligaments.

[0003] The most common tendon rupture is that of the rotator cuff of the shoulder, primarily the supraspinatus tendon. This injury is the leading cause of shoulder instability and is present in 20.7% of the general population, with prevalence increasing with age (Yamamoto et al., "Prevalence and Risk Factors for Rotator Cuff Tears in the General Population," J Shoulder Elbow Surg. 2010.1.19(1):116-20).

[0004] Screws threaded into the humeral head are often used during supraspinatus tendon reconstruction surgery. These screws carry sutures or suture bands that are passed through the damaged end of the tendon to tension, reduce, and secure the tendon to its original insertion site.

[0005] A problem that often hinders the success of reconstruction is that the screws carrying the sutures only provide superficial compression to the ends of the tendon, an area that is further reduced by the screw itself at the tendon's original insertion site, thereby hindering the healing process. If the tendon does not heal, the surgery will be insufficient, as it aims not only to reduce the tendon within the bone, but also to promote the tendon-bone healing process for proper reconstruction of the damaged tendon (Castagna et al., 2018, Arthroscopic Transosseous Rotator Cuff Repair).

[0006] The solution to this problem requires minimally invasive surgery to create angled bone tunnels for threading sutures and carving bone housings along the original anatomical insertion area for the damaged ends of the tendon and / or for the insertion of reinforcing tissue for use in repair, which cannot be done with flexible breaking instruments currently available in the art.

[0007] These breaking instruments have a flexible shaft and a curved or angled track, such as that disclosed in U.S. Patent No. 6,053,922, which describes a flexible breaking instrument intended for reaming the medullary canal of a bone, or that described in U.S. Patent No. 6,322,565, which is intended for creating a channel for the blood supply to the femoral head. These flexible breaking instruments, and other similar instruments in the art, allow for the creation of curved or angled bone tunnels by moving in a specific crushing direction from a first position to a second position.

[0008] However, if one attempts to use these breaking instruments in a second position in a direction different from the initial crushing direction, the instruments become cumbersome because in this second position the breaking elements lack the rigidity necessary to carve bone, which is necessary in the tendon repair or reconstruction surgery mentioned above.

[0009] With regard to ligaments, rupture of the knee cruciate ligaments, primarily the anterior cruciate ligament (ACL), occurs in patients of all ages and stands out as the most common rupture.

[0010] In most cases, patients suffering from an ACL tear must undergo a surgical procedure that consists of removing the damaged ACL and replacing it with an implant, the ends of which are placed and secured into the respective tibial and femoral bone tunnels.

[0011] As with tendons, to achieve anatomic ACL reconstruction, a system must be provided that can restore the original insertion area. Unfortunately, with current technology, 80% of patients develop osteoarthritis within 15-20 years postoperatively.

[0012] Solutions are currently known in the art that describe arthroscopic guides capable of forming two or more consecutive bone tunnels that are subsequently attached by dilators to successfully restore the original anatomical bony insertion of the ACL. For example, U.S. Patent Application Publication No. 2019 / 0192278 describes an arthroscopic guide capable of forming three consecutive bone tunnels that are subsequently attached by dilators.

[0013] However, the first problem associated with this type of multi-tunnel fracture system is that the tibia cannot be accessed "inside-out," making it impossible to perform an "all-in" cruciate ligament reconstruction technique. The second problem is that accessing the lateral femoral condyle through the medial portal makes it impossible to create a femoral tunnel that is sufficiently transverse, resulting in the loss of torsional integrity of the original ACL. The consequences of failing to fully restore the torsional biomechanics of the original ACL are widely documented in the literature: rotational instability of the knee joint and medium-term degenerative arthritis.

[0014] The solution to this problem requires carving a bone housing along the original anatomical insertion area to form a bone tunnel for passing the suture and for inserting an implant to be used to reconstruct the damaged ligament, which is not possible with the flexible breaking instruments of the art described above.

[0015] Document WO2008 / 096363A2 describes a bone drill for creating two diameter bone tunnels.

[0016] Therefore, in view of these issues, there is a need to provide a breaking instrument that, when used in minimally invasive surgery, can carve a bone housing along the original anatomical insertion area of ​​the tendons and ligaments being reconstructed. Summary of the Invention

[0017] The present invention proposes a solution to the aforementioned problems by means of a breaking instrument for surgical intervention according to claim 1 and a breaking system for surgical intervention according to claims 17 and 18. The dependent claims define preferred embodiments of the invention.

[0018] The present invention provides a breaking instrument for minimally invasive surgical interventions for creating bone tunnels suitable for proper anatomical reconstruction of tendons and ligaments, the breaking instrument comprising: a longitudinal body, a main body oriented along a first longitudinal axis; a distal tip attached to the main body, the distal tip including an opening oriented along at least one second longitudinal axis, the distal tip forming a ramp with respect to the main body; Equipped with the first longitudinal axis and the at least one second longitudinal axis form an angle α greater than 0 degrees with respect to each other, and the first longitudinal axis and the at least one second longitudinal axis are contained in a first sagittal plane; a longitudinal body; a break assembly, A breaking element comprising a first breaking axis and configured to receive and perform a breaking movement about the first breaking axis and to receive and perform a linear movement along a longitudinal body from a first position to at least one second position and vice versa, When the breaking element is in the first position, the breaking element is oriented within the main body along a first longitudinal axis; a breaking element, when the breaking element is in a second position, oriented according to at least one second longitudinal axis and protruding at least partially through the opening in the distal tip; a motion transfer element comprising a proximal portion, a flexible or articulated distal portion, and a second break-away shaft, the motion transfer element being rigidly attached to the break-away element by the flexible or articulated distal portion; receiving and executing a breaking motion about a second breaking axis and transmitting the breaking motion to the breaking element; receiving and performing linear motion moving along the longitudinal body and transmitting the linear motion to the breaking element; a motion transfer element configured to: a break assembly comprising: at least one stiffening means configured to provide stiffness to the breaking assembly when the breaking element is in a second position protruding at least partially through the opening in the distal tip; and Equipped with The stiffening means comprises a tubular element having a proximal portion and a distal portion, the tubular element comprising: sized and configured to move along the longitudinal body; sized and configured to at least partially receive therein a flexible or articulating distal portion of the motion transfer element; the breaking element is configured to orient the distal portion according to a first longitudinal axis when in the first position; The breaking element is configured to orient the distal portion according to at least one second longitudinal axis when in the at least one second position.

[0019] The breaking instrument of the present invention can form bone tunnels suitable for anatomical reconstruction of damaged tendons and / or ligaments. In particular, the instrument can form elongated, e.g., straight, curved, or angled bone tunnels with intra-articular exit openings resembling the original anatomical insertion area, allowing the tendon or ligament being reconstructed to be accommodated at a bone depth sufficient to ensure its regeneration. This achieves restoration favorable for osseointegration.

[0020] Throughout this specification, tendon shall be understood to mean a band of connective tissue configured to attach muscle to bone, and ligament shall be understood to mean a band of connective tissue configured to attach bones to one another.

[0021] Throughout this specification, the proximal end of an element of an instrument (or system) shall be understood to mean the end closer to the subject who will be using the instrument. In contrast, the distal end of an element of an instrument (or system) shall be understood to mean the end further away from the subject who will be using the instrument. Preferably, the subject or user is a physician, veterinarian, or medical or veterinary professional.

[0022] First, the device comprises a longitudinal body. "Longitudinal" shall be understood to mean that the main body is made or arranged in its long direction. The longitudinal body is preferably tubular, i.e., a hollow body generally open at both ends. In other embodiments, the longitudinal body is formed as a concave channel or conduit.

[0023] This longitudinal body is a main body oriented according to a first longitudinal axis; a distal tip attached to the main body, the distal tip comprising at least one opening oriented according to a second longitudinal axis; Equipped with.

[0024] The tip is preferably a small, straight or curved ramp-forming portion relative to the main body, the angle of the ramp being given by the angle formed between the first longitudinal axis along which the main body is oriented and at least one second longitudinal axis along which the opening in the tip is oriented.

[0025] Throughout this specification, the phrase "a distal tip attached to a main body" shall be understood to mean that the distal tip and the main body are in contact to form an integral, longitudinal body. The contact may be complete, such that the distal tip is fully secured to the main body to form an integral assembly, or the distal tip may be in partial contact with the main body via an attachment means such as a hinge or ratchet system.

[0026] Throughout this specification, "at least one second longitudinal axis" shall be understood to mean one or more longitudinal axes, depending on whether the tip can form one or more different angles with the main body. In particular, when the tip is fully attached to the main body, the first and second longitudinal axes form a particular angle α with respect to each other that is equal to or greater than 0 degrees. In contrast, when contact between the elements is partial, the attachment means allows the tip to be positioned in a number of different positions such that the first longitudinal axis forms a different angle α with each second longitudinal axis, each of which is equal to or greater than 0 degrees.

[0027] The first longitudinal axis and at least one second longitudinal axis are contained in a first sagittal plane. Throughout this specification, "sagittal plane" shall be understood to mean a plane that is perpendicular to the ground and that divides a body or element into left and right halves. This term is commonly used in the field of anatomy.

[0028] Second, the instrument includes a break assembly, the assembly including a break element and a motion transmission element attached to one another.

[0029] Throughout this specification, "breaking element" shall be understood to mean any type of element capable of breaking, crushing, cutting, reaming, abrading, compressing or perforating biological tissue, in particular bone tissue.

[0030] In particular examples, the breaking element is a mill, a breaking mill, a bit, a blade, a scraper, a file, a vibratory breaking element, or a reciprocating breaking and / or compression element.

[0031] In another particular example, the fracture element is a compression mill that induces bone compaction, which is important for early loading, and can shorten the rehabilitation time required to return to pre-injury activity levels.

[0032] In another more specific example, the breaking element is: have a frustoconical shape with a proximal diameter greater than the distal diameter; -Has a cylindrical shape A mixed element, the proximal segment is a compression segment and the distal segment is a fracture segment; · Having a distal cross section that corresponds to a circular, elliptical, polygonal, trilobal, or any other geometric shape.

[0033] The breaking element has a first breaking axis, e.g., a rotation axis about which the element rotates or a vibration axis about which the element performs a vibration motion. The element is configured to receive and perform a breaking motion, which is understood to be a motion that can be performed by the breaking element so that the element can break human tissue, preferably bone. Examples of breaking motions include rotational and / or reciprocating and / or vibration motions performed about the first breaking axis. Additionally, the breaking element is configured to receive and perform a linear motion along the longitudinal body (particularly along the interior of the longitudinal body if it is tubular) from a first position to at least one second position and vice versa. Throughout this specification, "at least one second position" shall be understood to mean one or more positions to which the breaking element can be positioned based on the position of the distal tip, depending on whether the tip can form one or more different angles with the main body, as described above.

[0034] The breaking element exits through the opening in the distal tip in a sagittal plane that includes the first longitudinal axis and at least one second longitudinal axis.

[0035] Throughout this specification, rotation or rotational movement shall be understood to mean a movement in which the breaking element makes a constant rotation of 360 degrees. Rotational reciprocating movement shall be understood to mean a movement in which the breaking element moves linearly and alternately in rotation in the proximal-distal and distal-proximal direction, preferably with alternating rotational forward and backward movements of 180 degrees. Oscillating or oscillatory movement shall be understood to mean a movement in which the breaking element moves between two end positions with a periodic movement in which it oscillates about a stable equilibrium position.

[0036] In the first position, the breaking element is oriented along the first longitudinal axis, i.e., the breaking element remains housed within the main body. In the second position, the breaking element is oriented along the second longitudinal axis or one of the second longitudinal axes, i.e., the breaking element protrudes at least partially through the opening in the distal tip toward the exterior of the instrument. In this second position, the breaking element is oriented along the second longitudinal axis when the distal tip and the main body form an integral assembly. When the distal tip is attached to the main body by an attachment element that can position the distal tip in a plurality of different angular positions (such that for each of the plurality of angular positions, at least one second longitudinal axis forms a different angle α with the first longitudinal axis), the breaking element is oriented along one of the second longitudinal axes.

[0037] As a result of this second position in which the breaking element is oriented, an angled bone tunnel can be carved that is formed by two consecutive segments that are angled relative to each other by an angle α. Even more advantageously, the angle α can be predetermined with the same instrument depending on the application (medical or veterinary), the particular operation to be performed, and the anatomy of the patient itself.

[0038] To enable the breaking element to be positioned in said first and second positions, the breaking assembly further comprises a motion transfer element. This motion transfer element comprises a second breaking axis for performing the breaking motion and two parts or portions: a proximal portion, which may be both rigid and flexible, and a flexible or articulating distal portion. Both portions may form an integral assembly or may be attached by attachment means, for example, screws. The motion transfer element is preferably an elongated cylinder, the proximal portion having a larger diameter cross section than the flexible or articulating distal portion.

[0039] The motion transfer element is attached to the breakable element, and in particular the distal end of the flexible or articulating distal portion is rigidly attached to the proximal end of the breakable element.

[0040] This motion transmission element is receiving a breaking movement, such as a rotational or vibration movement, and performing said breaking movement about a second breaking axis; -transferring the breaking movement to the breaking element; - receiving and carrying out linear motions, such that the linear motions travel along the longitudinal body (in particular along the interior of the longitudinal body if it is tubular); - transmitting a linear motion to the breaking element, causing the breaking element to move from a first position to a second position (and from the second position to the first position when the motion transmission stops); The device is configured to:

[0041] In one example, the flexibility of the motion transfer element is due to the braided configuration of the element. In another example, the flexibility of the motion transfer element is due to a tubular configuration with cuts and / or openings in the element. In another example, the flexibility of the motion transfer element is due to the element comprising a superelastic nitinol braided core and an outer polymer layer.

[0042] As a result of the motion transmission element being flexible or articulated, when it performs a linear movement in the proximal-distal direction, the flexible or articulated distal portion is at the distal tip of the longitudinal body and acquires a curved shape, whereby the breaking element attached to said flexible or articulated portion at least partially protrudes or projects through the opening at the distal tip towards the outside of the instrument and is oriented according to the second longitudinal axis or one of the second longitudinal axes.

[0043] This flexibility exists only in the sagittal plane. In contrast, in other planes, this flexible or articulated portion of the motion transfer element acquires rigidity as a result of a third component of the instrument. This component, the so-called stiffening means, is configured to impart stiffness to the break assembly, and in particular to the aforementioned flexible or articulated distal portion of the motion transfer element, in all planes other than the first sagittal plane when the break element is in at least one second position.

[0044] This rigidity is essential so that, in use, the instrument has sufficient force to break bone and thus be able to carve a bone tunnel of the desired shape.

[0045] The stiffening means comprises a tubular element having a proximal portion and a distal portion, the tubular element comprising: sized and configured to move along the longitudinal body; sized and configured to at least partially receive therein a flexible or articulating distal portion of the motion transfer element; the breaking element is configured to orient the distal portion according to a first longitudinal axis when in the first position; The breaking element is configured to orient the distal portion according to at least one second longitudinal axis when in the at least one second position.

[0046] The stiffening means comprises a tubular element, i.e. tubular or tubular in shape, attached to and housing the flexible or articulated portion of the motion-transmitting element, while the tubular element is housed within the longitudinal body and has dimensions suitable for being able to move along said longitudinal body (in particular along the interior of the longitudinal body if it is tubular), since this movement is possible because the tubular element houses the motion-transmitting element therein, i.e. when the motion-transmitting element moves linearly in the proximal-distal direction, the tubular element moves together with it.

[0047] Before the movement is performed, i.e., when the breaking element is in a first position, the two portions of the tubular element are oriented according to a first longitudinal axis as they are disposed within the main body. Once the movement is performed, i.e., when the breaking element is in a second position, only the proximal portion of the tubular element remains oriented according to the first longitudinal axis (i.e., it is still within the main body), while the distal portion of the tubular element is oriented according to the second longitudinal axis or one of the second longitudinal axes (i.e., this distal portion is disposed at the distal tip of the instrument and acquires a curved shape).

[0048] In a first use example, a breaking instrument, not yet activated, is introduced into a linear bone tunnel having a single pre-carved segment (along the first longitudinal axis). Once introduced, the breaking instrument is activated such that the motion-transmitting element receives the breaking motion and linear motion, transmits it to the breaking element, moves it from a first position to a second position, and simultaneously executes the breaking motion. Thus, the breaking element at least partially protrudes through the opening at the tip of the instrument and carves a second segment of the bone tunnel along the second longitudinal axis.

[0049] At this point, with the instrument still activated, the user can rotate the instrument from left to right and / or vice versa, causing the breaking element to break the bone and thus carve an enlarged intra-articular exit opening into the bone tunnel that has a shape similar to that of the original anatomical insertion area of ​​the tendon to be repaired. For example, an elongated intra-articular exit opening having a funnel and / or rectangular shape can be carved for the reinsertion of the repaired supraspinatus tendon.

[0050] Movement from left to right and / or vice versa should be understood to mean a movement made relative to a first sagittal plane of an instrument initially placed in a straight bone tunnel having a single segment.

[0051] Advantageously, such anatomic expansion created with the instrumentation is highly favorable for tissue healing, meaning that the surgery is effective and the results are long-lasting.

[0052] In the specific example of repairing a torn supraspinatus tendon of the rotator cuff, the intra-articular exit opening of the bone tunnel formed must be such as to allow for insertion of the end of the torn tendon, measuring between 4 mm and 5 mm in thickness and between 20 mm and 25 mm in width at the level of the rotator cuff.

[0053] These specific measurement ranges provided in this use case must be adapted based on the end application in which the breaking tool is used.

[0054] In a second use example, the breaking instrument of the present invention allows a breaking element to be introduced into a linear bone tunnel at a first position where the breaking element is oriented according to a first longitudinal axis, and then the breaking element can be linearly advanced to a second position where the breaking element is oriented according to at least one second longitudinal axis, allowing a user to carve and / or back-carve an enlarged intra-articular exit opening into the bone tunnel having a shape similar to that of the original anatomical insertion area of ​​the ligament to be restored. For example, an elongated intra-articular exit opening having a funnel shape and / or a rectangular shape can be carved and / or back-carved for ACL reconstruction.

[0055] In the specific example of ACL reconstruction, the intra-articular exit opening of the bone tunnel created must be such as to allow for the insertion of fibrous material, measuring between 2 mm and 4 mm in thickness and between 12 mm and 18 mm in width.

[0056] These specific measurement ranges provided in the second use example must be adapted based on the end use in which the breaking device is to be used.

[0057] In general use, the disruption instrument is suitable for disrupting any connective tissue and / or cartilage and / or bone tissue in human or veterinary medicine.

[0058] In a particular example of use, the breaking instrument is suitable for forming and / or carving out any kind of tunnel in surgical interventions for the reconstruction of any connective and / or cartilage and / or bone tissue in medicine or veterinary medicine.

[0059] In another more specific use, the disruption instrument is suitable for efficiently disrupting and removing tissue from an intervertebral disc to create a space of a selected shape and size during a minimally invasive vertebral discectomy.

[0060] In one embodiment, the breaking device is disposable.

[0061] In a specific embodiment, the breaking instrument comprises a suction line connectable to an external suction device for removing the broken tissue. In this embodiment, both the breaking element and the motion transmission shaft are cannulated, and the breaking element comprises a distal suction window for aspirating bone powder simultaneously with carving the bone. In an even more specific embodiment, the external suction device comprises a vacuum system.

[0062] In certain embodiments, the distal tip comprises: - as a solid extension of the main body; or by a mounting element configured to position the tip at a plurality of angular positions such that, for each of the plurality of angular positions, at least one second longitudinal axis forms a different angle α with the first longitudinal axis; It is attached to the main body.

[0063] As mentioned above, the distal tip and main body meet to form an integral, longitudinal body.

[0064] The contact can be complete, with the distal tip being fully secured to the main body, ie, the distal tip being an extension of the main body, and the two forming an integral assembly.

[0065] Advantageously, this type of integrated configuration is easy to manufacture and maintain.

[0066] In contrast, the distal tip can be in partial contact with the main body via an attachment means, such as a hinge, that further allows the tip to be positioned in multiple angular positions, each orienting the tip according to a different second longitudinal axis that forms a different angle α with the first longitudinal axis.

[0067] Advantageously, this type of configuration makes the instrument very versatile, allowing the bone tunnel angle to be adapted to different applications, types of surgery, and patient anatomy.

[0068] In certain embodiments, the first breaking element comprises: - the axis of rotation about which the breaking element rotates, or an oscillating shaft on which the breaking element undergoes an oscillatory movement; is.

[0069] In certain embodiments, the tubular element further comprises at least one elongated notch disposed in the distal portion that forms at least one angle β with the first sagittal plane that is greater than 0 degrees and less than or equal to 90 degrees; each of the at least one elongated incision separates two distinct segments of the distal portion of the tubular body; When the breaking element is in at least one second position, the total separation between the segments of the tubular body is substantially zero.

[0070] Furthermore, the tubular element comprises at least one elongated cut. Throughout this specification, "cut" shall be understood to mean any cut, opening, or recess in a surface or solid that does not completely divide it. Furthermore, "elongated cut" shall be understood to mean a cut that is significantly longer than it is wide.

[0071] The incisions are disposed on the tubular element at the top of the distal portion and form an angle β greater than 0 degrees and less than or equal to 90 degrees with respect to the first sagittal plane, which angle β can be the same for all incisions, if there are one or more incisions, or can be different for all incisions.

[0072] Each of these notches separates the top of the distal portion into two distinct segments spaced a specific distance apart when the distal portion is located in the main body (i.e., when the breaking element is in the first position). The separation defined by each notch can be the same or different, provided that the sum of the separations of all notches is substantially zero when the distal portion of the tubular element is located at the distal tip of the instrument (i.e., when the breaking element is in the second position).

[0073] In other words, in the first case the notch remains open, while in the second case the notch is substantially closed. In that sense, when the notch is substantially closed, the distance between the segments is reduced to substantially zero, and it is understood that there is a certain tolerance that must be taken into account.

[0074] It will be appreciated that the incisions are closed when their curved and / or angled edges (in other words, the walls of successive segments) come into contact with each other due to the actual curved position assumed by the tubular element, which can thus provide stiffness to the flexible or articulating distal portion of the motion transmitting element in all planes except the first sagittal plane where said flexible portion assumes a curved shape.

[0075] In one example, the incisions have a trapezoidal shape, and / or a winding shape, and / or a sinusoidal shape, and / or any other shape, provided that they are arranged at an angle β (or several angles β) relative to the first sagittal plane of the breaking instrument.

[0076] In a preferred embodiment, the tubular element is a bushing comprising a modular system of interconnected sections forming a winding in a single sagittal plane.

[0077] In one embodiment, the tubular element further comprises at least one second elongated cut arranged in the lower part of its distal portion, the effect of which is in contrast to the effect of the upper cut, i.e. when the breaking element is in the at least one second position, the at least one second cut opens in such a way that the distance between the segments which it separates in the lower part of the distal portion of the tubular element increases.

[0078] In an alternative embodiment, the tubular element comprises a tube of superelastic nitinol, with or without slits, and an outer polymer layer.

[0079] In certain embodiments, the longitudinal body further comprises at least one distal longitudinal groove and the tubular element further comprises at least one first protrusion; the at least one distal longitudinal groove has a distal limit and a proximal limit; the at least one distal longitudinal groove is dimensioned to receive the at least one first protrusion and configured to cooperate with said first protrusion to guide the tubular element in the direction of the sagittal plane when the breaking element moves from the first position to the at least one second position and vice versa; the at least one first protrusion is dimensioned to pass through the at least one distal longitudinal groove, cooperates with said distal longitudinal groove, and is configured to move along the distal longitudinal groove when the breaking element moves from the first position to the at least one second position and vice versa; the at least one first protrusion abuts a distal limit of the at least one distal longitudinal groove when the breaking element is in the at least one second position;

[0080] In this embodiment, the tubular element comprises one or more protrusions configured to cooperate with one or more corresponding longitudinal grooves located in the longitudinal body. Throughout this specification, a "protrusion" shall be understood to mean a part or portion of the tubular element protruding from said element, and a "groove" shall be understood to mean an elongated channel opening inside the longitudinal body, in particular in the sagittal plane.

[0081] The projections extend through the grooves and cooperate with the grooves to guide the tubular element in the sagittal direction. Because the tubular element is connected to the motion transfer element, which is connected to the break element, when the motion transfer element moves from the first position to the second position, the tubular element moves in the sagittal direction until it abuts the distal limit of the groove. The distal limit is understood to mean the end or terminus of the groove farthest from the user. Advantageously, this projection-groove cooperation prevents the tubular element from rotating on itself or moving in an undesirable manner that would prevent the break assembly from being properly positioned and oriented. If this were to occur, the break element would not be able to be positioned in a second position to carve the second segment of the bone tunnel, nor would it be rigid enough to carve the enlarged intra-articular exit opening.

[0082] In certain embodiments, the breaking tool further comprises at least one first attachment and / or coupling means configured to attach or couple the motion transmission element to the breaking motion generating device.

[0083] The breaking tool can be coupled to a breaking motion generating device, for example a drilling device, which generates a rotational motion, from which the tool, in particular the motion transmission element, receives the breaking motion and then transmits it to the breaking element.

[0084] In anticipation of the possibility that there may be many different types of breaking motion generating devices, the present embodiment contemplates an option for the tool to include one or more attachment and / or coupling means configured to attach or couple a motion transmission element to one or more such devices.

[0085] Advantageously, the device also has great versatility and can be coupled to any commercially available breaking motion generating device.

[0086] In certain embodiments, the breaking apparatus further comprises a support at least partially surrounding the motion transmission element and a second attachment and / or coupling means configured to attach or couple the support to the breaking motion generating device.

[0087] In this embodiment, the tool comprises a support, understood to be a body that partially surrounds the motion transfer element and makes the tool easier to grip. Optionally, this body may be further attached or coupled to the breaking motion generating device by one or more second attachment and / or coupling means.

[0088] In anticipation of the possibility that there may be many different types of breaking motion generating devices, the present embodiment contemplates the option of an apparatus comprising one or more secondary attachment and / or coupling means configured to attach or couple the support to one or more such devices.

[0089] Advantageously, the device also has great versatility and can be coupled to any commercially available breaking motion generating device.

[0090] In certain embodiments, the instrument further comprises a break guide configured to guide the longitudinal body from the original position to the at least one target position, the break guide comprising: at least one tubular guide, a longitudinal conduit having a proximal end and a distal end, the longitudinal conduit including a distal appendage at the distal end; a striking edge, an extension of the longitudinal conduit at the proximal end; Equipped with the longitudinal conduit is configured to receive the longitudinal body therein; the at least one tubular guide is oriented according to a first longitudinal guide axis; the striking edge is configured to receive a striking force in the direction of the first longitudinal guide axis; at least one tubular guide; a guide arch, a proximal arch portion comprising a first coupling means configured to securely couple and uncouple the proximal arch portion to the tubular guide at a plurality of different locations along the first longitudinal guide axis; a distal arch portion having a distal tip oriented according to a second longitudinal guide axis; a second coupling means configured to couple the distal arch portion to the proximal arch portion at a plurality of different positions, for each of which the first longitudinal guide axis and the at least one second longitudinal guide axis form a different angle α2 with respect to one another; Equipped with The first longitudinal guide axis and the at least one second longitudinal guide axis are contained in a second sagittal plane. Guide arch and Equipped with.

[0091] In this embodiment, the instrument is configured to guide the longitudinal body from an original position, i.e., a position where the longitudinal body begins to penetrate a first segment of a bone tunnel carved with a conventional breaking element (e.g., a bit or mill), to at least one target position, in particular a position where the longitudinal body is correctly positioned so that the breaking element moves from the first position to a second position, thereby carving a second bone tunnel segment and forming an enlarged intra-articular exit opening.

[0092] Advantageously, the use of a fracture guide allows for increased accuracy in placement of the longitudinal body to complete the engraving of the angled bone tunnel at the anatomical target location, as well as to improve the actual utility of the instrument.

[0093] First, the breaking guide comprises at least one tubular guide, said guide comprising the following elements: A longitudinal conduit, preferably tubular, having a proximal end and a distal end. The conduit is dimensioned so that the longitudinal body can be accommodated therein. Furthermore, the distal end comprises a distal appendage (e.g., a peripheral recess), understood to be a distal end portion, an extension of the longitudinal conduit, the cross-section of which has a smaller diameter than the diameter of the remainder of the longitudinal conduit. In certain embodiments, this peripheral recess comprises a polyhedral surface. - striking edge, extension of the longitudinal conduit at its proximal end. Striking edge is understood to mean the part that is attached to the end of the longitudinal conduit at its proximal end.

[0094] The guide is oriented according to the aforementioned first longitudinal guide axis, which will coincide with the first longitudinal axis along which the main body of the longitudinal body is oriented when inserted into the break guide.

[0095] The distal appendage, once chiseled, is sized and configured to be inserted into the first segment of the bone tunnel, with a diameter that allows for insertion into the first segment of the bone tunnel with a certain amount of clamping force while preventing insertion of the remainder of the longitudinal conduit into the bone tunnel. The outer diameter of the appendage is preferably substantially equal to or slightly smaller than the diameter of the first segment of the bone tunnel.

[0096] To introduce the appendage into the first segment of the bone tunnel, the user must exert a certain striking force on the proximal end of the striking edge in the direction of the first longitudinal guide axis, which force can be applied, for example, by means of a hammer.

[0097] The proximal end of the striking edge is preferably substantially flat.

[0098] Advantageously, the force applied to the striking edge ensures play-free penetration of the appendage in the first segment of the bone tunnel, which allows the guide to remain in a stable position, thereby increasing the accuracy of positioning of the longitudinal body for engraving the second segment of the bone tunnel at the anatomical target location as well as improving the actual usability of the instrument.

[0099] Second, the break guide comprises a guide arch. Thus, the curved element should be understood to comprise a proximal arch portion comprising a first attachment means capable of securely attaching the proximal arch portion to the tubular guide at a plurality of different locations along the tubular guide. The guide arch further comprises a distal arch portion terminating in a distal tip and a second attachment means capable of attaching the distal arch portion to the proximal arch portion at a plurality of different locations.

[0100] The distal tip of the arch is oriented according to a second longitudinal guide axis that forms an angle α2 with the first longitudinal guide axis. The second longitudinal guide axis varies depending on where the proximal and distal portions of the guide arch are joined, so that the angle α2 varies depending on the joint. Both longitudinal guide axes are further contained in a second sagittal plane.

[0101] The distal tip of the distal portion is preferably configured to be introduced into a patient's body, thereby securing the fracture guide. In one example, the distal portion has an elliptical, cylindrical, or annular configuration, and optionally, the distal tip is sharp.

[0102] By anchoring the distal tip within the patient, a more stable guide position can be achieved, thereby increasing the accuracy of placement of the longitudinal body for carving the second segment of the bone tunnel at the anatomical target location, as well as improving the actual utility of the instrument.

[0103] Furthermore, the first coupling means is configured to securely couple and decouple the proximal arch portion to the tubular guide at a plurality of different locations along the guide. Advantageously, the first coupling means allows for easy decoupling of the guide arch from the guide, facilitating removal of the guide arch once the longitudinal body has been inserted into the guide.

[0104] A second coupling means between the proximal and distal arch portions allows the guide to accommodate a user-predetermined cutting direction for the first segment of the angled bone tunnel based on user preference and the anatomy of each patient, as described above, which is accomplished using a conventional breaking element such as a bit.

[0105] To widen the intra-articular outlet opening of the second segment of the bone tunnel, preferably into a funnel or fan shape, the user must rotate the longitudinal body from left to right and / or vice versa, activating the breaking movement of the breaking element when the breaking element is in the second position. Thus, the first sagittal plane forms a constant, variable angle with respect to the second sagittal plane. In certain embodiments, the widening of the intra-articular outlet opening is generated in one or more planes representing curved surfaces that intersect the second sagittal plane.

[0106] In certain embodiments, the at least one tubular guide further comprises a bore comprising a first portion and a second portion, and the main body of the longitudinal body comprises at least one second protrusion; the first portion of the bore is sized and configured to receive and guide the second protrusion from a proximal position to the second portion when the longitudinal body of the breaking instrument is inserted into and moves along the interior of the at least one tubular guide of the breaking guide; The second portion is sized and configured to abut the second protrusion when the first sagittal plane of the breaking instrument is rotated by an angle γ about the second sagittal plane of the breaking guide.

[0107] In this embodiment, the present invention contemplates holes in the guide and protrusions on the main body of the longitudinal body, the purpose of which is to limit the degree of rotation between the second sagittal plane and the first sagittal plane, i.e., to achieve a maximum angle of rotation of the longitudinal body from left to right or vice versa when the longitudinal body is housed within the break guide.

[0108] The bore comprises two attached portions, the first portion being sized and configured to receive and guide the second protrusion of the main body from a proximal position, i.e., the point at which the portion receives the second protrusion, to a position at which the protrusion passes through the second portion of the bore.

[0109] Once the projection is within the second portion, it slides along the second portion of the bore until it abuts the end or limit of the second portion. This sliding occurs by rotating the longitudinal body from left to right and vice versa as it is received within the break guide. Thus, the bore collectively can limit the angle that the first sagittal plane can form with the second sagittal plane. Advantageously, this increases the usefulness and accuracy of the break instrument when forming an enlarged intra-articular exit opening in the second segment of the bone tunnel.

[0110] In one example, the first portion of the hole is an elongated portion parallel to the second sagittal plane, and the second portion of the hole is an elongated portion of a length shorter than the length of the first portion and aligned perpendicular to the second sagittal plane, with both portions forming a "T" with respect to each other.

[0111] In another example, the first portion is also elongated and oriented parallel to the second sagittal plane, while the second portion has a square, triangular, or funnel shape. More specifically, the second portion has a constant or decreasing cross-section from its distal end to its proximal end. Alternatively, the second portion comprises two portions, the first portion having a constant cross-section and the second portion having a decreasing cross-section (from the distal end to the proximal end of the second portion).

[0112] As a result of the second portion of the hole, the user can retract the longitudinal body distally-proximally to widen the intra-articular outlet opening in another plane parallel to the first formed plane. Obviously, in this new widening, the user must continue to rotate the longitudinal body from left to right so that the first sagittal plane rotates relative to the second sagittal plane.

[0113] In an alternative embodiment, the at least one tubular guide further comprises at least one longitudinal hole, and the main body of the longitudinal body comprises at least one second protrusion; The at least one longitudinal bore is sized and configured to receive and guide the at least one second protrusion from a proximal position to a distal position and vice versa.

[0114] In this embodiment, the tubular guide includes at least one aperture formed by a single longitudinal portion that cooperates with a second projection on the main body to guide the main body from a proximal position (when the break guide receives the longitudinal body) to a distal position (when the second projection abuts the distal end of the longitudinal aperture).

[0115] Advantageously, the longitudinal bore allows for guiding the longitudinal body of the breaking instrument while recutting the bone tunnel in at least one first recutting direction. Another advantage is that the engagement between the longitudinal bore of the tubular guide and the second protrusion allows for controlling the relative positions of both sagittal planes with respect to each other, thereby increasing the reliability of the breaking instrument.

[0116] In certain embodiments, the break guide comprises a plurality of tubular guides, each of which -hole dimensions, and / or - the shape of the holes, and / or the dimensions of the first part of the hole, and / or the shape of the first part of the hole, and / or the dimensions of the second part of the hole, and / or the shape of the second part of the hole are different from each other.

[0117] In this embodiment, it is contemplated that the instrument may have one or more tubular guides with holes of different sizes and shapes, thus providing different options for enlarging the intra-articular exit opening to different sizes and depths, i.e., more or less limiting the angle of rotation of the first sagittal plane relative to the second sagittal plane, and more or less limiting the distance the user can retract the longitudinal body to create more fracture surfaces.

[0118] Advantageously, the instrument is also versatile, allowing the dimensions of the final carved bone tunnel to be adapted to the particular application, the particular type of surgery, and the patient's anatomy.

[0119] In certain embodiments, the distal appendage comprises: Trilobed tip, or Two tips, or chamfered recesses, or ·Polyhedral surface Equipped with.

[0120] In this embodiment, different types of distal appendages are provided, although there may be other types that fall within the context of the present invention.

[0121] In certain embodiments, the breaking motion is a rotational motion and the breaking instrument comprises: receiving rotational motion from a rotational motion generating device; - converting rotary motion into linear and / or reciprocating motion; - transmitting a linear and / or reciprocating motion to a motion-transmitting element, which in turn transmits a linear and / or reciprocating motion to the breaking element to move the breaking element from a first position to at least one second position; - stopping the linear and / or reciprocating motion when the rotational motion is stopped and moving the breaking element from at least one second position to the first position; The method further comprises converting means configured to:

[0122] To allow the breaking element to receive the breaking and linear motions necessary to protrude through the opening in the distal tip and break bone, this embodiment contemplates that the instrument further includes a motion transmission and conversion means. The motion transmission and conversion means preferably receives the breaking motion from the breaking motion generator and converts it into linear motion. Additionally, the motion transmission and conversion means transmits the linear motion to the motion transmission element, which then transmits it to the breaking element, moving the breaking element from the first position to at least one second position. When the linear motion stops, i.e., when the motion transmission and conversion means stops receiving the breaking motion from the generator, the motion transmission and conversion means moves the breaking element from the at least one second position to the first position, i.e., retracts it into the longitudinal body.

[0123] Advantageously, when the breaking motion generator is activated, the instrument according to this embodiment allows the breaking motion to be performed while the breaking element moves linearly, and when the breaking motion generator is released, the breaking element retracts and the breaking motion stops being performed.

[0124] In an embodiment, the breaking motion generating device is a drilling device and the motion transmission and conversion means comprises: a first longitudinal rotational motion transmission element coupleable to a motion transmission shaft of the drilling device, the first longitudinal element being configured to receive a rotational motion from the drilling device and to perform said rotational motion; - a second longitudinal rotational motion transfer element attached to a proximal portion of the motion transfer element and configured to receive rotational motion from the first longitudinal element and to perform said rotational motion and linear motion; a brake actuator connected to the second longitudinal element and configured to exert a force on the second longitudinal element to prevent rotation; a return spring configured to exert a linear return force on the second longitudinal element; a helical sliding connection configured to connect the first longitudinal element to the second longitudinal element; Equipped with The spiral sliding connection is a longitudinal coupling portion attached to the first longitudinal element, the longitudinal coupling portion having a first thread on an outer surface thereof; a longitudinal coupling conduit attached to the second longitudinal element, the longitudinal coupling conduit having a second thread on its inner surface; Equipped with The first thread of the longitudinal coupling portion and the second thread of the longitudinal coupling conduit are configured to cooperate with each other to cause linear movement of the longitudinal coupling conduit relative to the longitudinal coupling portion when the longitudinal coupling conduit undergoes rotational movement and the longitudinal coupling portion rotates at a slower speed than the longitudinal coupling conduit, and the thread direction of the helical sliding coupling is opposite to the direction of rotational movement of the drilling device.

[0125] Throughout this specification, a brake actuator shall be understood to mean a brake that applies a holding force to the second longitudinal element so as to partially slow down the rotation of said second longitudinal element.

[0126] Throughout this specification, a helical sliding connection shall be understood to mean a spindle mechanism comprising a longitudinal portion having an external thread, e.g. a screw, and a longitudinal conduit having an internal thread, e.g. a nut, which is configured to move the conduit linearly relative to the portion when the portion rotates and the conduit is partially prevented from rotating. In the context of the present invention, "partially prevented from rotating the conduit" shall be understood to mean that the conduit rotates at a slower speed than the portion due to the operation of the brake actuator.

[0127] Throughout this specification, a return spring is understood to mean a helical or spiral elastic part that is arranged so that when it is deformed by pressure or stretching, it can use its force to return to its natural shape. In the context of the present invention, the force of the return spring is used to return the second longitudinal element to a proximal stop position. The return spring and the second longitudinal element are preferably coaxial, and the return spring has a distal end attached in a fixed position to another element of the instrument and a proximal end attached to the distal end of the second longitudinal element.

[0128] When the drilling device is in an inactive state, i.e., when the motion transmission element is not receiving rotational motion, the force of the return spring is greater than the force for holding the brake actuator rotation, so that the second longitudinal element is in the proximal stop position and the breaking element is in the first position.

[0129] When the drilling device is operating, it provides a rotational motion to the first longitudinal element, which, as a result of the sliding coupling, provides the same rotational motion to the second longitudinal element. At this point, the brake actuator decelerates the second longitudinal element, reducing its rotational speed relative to that of the first longitudinal element. When the brake's rotational holding force becomes greater than the linear return force of the spring, the component of the helical coupling, acting as a spindle screw, linearly advances the second longitudinal element relative to the first longitudinal element. This linear advancement occurs because the thread direction of the helical sliding coupling is opposite to the direction of the rotational motion received and transmitted by the first longitudinal element coupled to the motion transmission shaft of the drilling device.

[0130] It should be noted that in a conventional spindle, the conduit (or nut) is completely resistant to rotation, so the conduit should not rotate at all but only move linearly. In contrast, operation of the helical sliding coupling of the present invention requires that the rotation of the conduit be partially restrained by the brake actuator, since this rotation, which corresponds to the breaking motion, must be transmitted to the second longitudinal element and to the motion-transmitting element of the tool. The second longitudinal element and motion-transmitting element move further linearly due to the operation of the helical sliding coupling.

[0131] The return spring is gradually compressed during forward movement, and its force increases until a point is reached where the forces of both the spring and the brake actuator are again equal, at which point the second longitudinal element is in a distal position and the breaking element is simultaneously in at least one second position protruding through the opening in the distal tip.

[0132] When the activity of the drilling device stops, since there is no rotational movement at all, the return spring force again becomes greater than the force holding the brake actuator in rotation, and in this case the second longitudinal element returns to the proximal stop position as a result of the linear return force action of the spring and the breaking element retracts.

[0133] Optionally, to speed up the process, the brake actuator includes a pressure spring pad that provides a non-zero initial rotational holding force.

[0134] During use of the instrument, as the breaking element progressively protrudes, the bone it strikes exerts a progressively greater holding force which is further transmitted to the second longitudinal element, which complements the force exerted by the brake actuator, so that the greater the resistance of the bone, the greater the forward force that must be exerted to cause the break.

[0135] Advantageously, this motion transmission and conversion means allows the rotation and movement of the breaking element to be activated simultaneously by the same push button of the drilling device to which the breaking tool is coupled, increasing the usability and accuracy of the breaking tool.

[0136] In an alternative embodiment, the breaking motion generating device is a drilling device and the motion transmission and conversion means comprises: a male-female sliding connection, a primary rotor coupleable to a motion transmission shaft of the drilling device, the primary rotor configured to receive and perform rotational motion from the drilling device; a secondary rotor slidably coupled to the primary rotor at a proximal end and attached to the proximal portion of the motion transmitting element at a distal end, the secondary rotor further comprising grooves or depressions having a sinusoidal shape on an outer surface thereof, the secondary rotor configured to move linearly in both directions relative to the primary rotor as a result of the sliding coupling; a male-female sliding coupling comprising: a return spring configured to exert a return force on the secondary rotor; a manual activation control connected to the fixed plunger, the manual activation control being configured so that the fixed plunger passes through a groove or recess in the secondary rotor; Equipped with the secondary rotor receives and performs rotational motion from the primary rotor, and upon activation of the control, the fixed plunger penetrates the groove or recess, causing the secondary rotor to perform a linear back and forth reciprocating motion relative to the primary rotor; the secondary rotor transmits the linear back-and-forth reciprocating motion in combination with the rotational motion to the motion transmission element, and the motion transmission element transmits the linear back-and-forth reciprocating motion in combination with the rotational motion to the breaking element; When the fixed plunger is removed from the groove or recess by releasing the control, the secondary rotor is forced by the return spring to perform a return movement in the distal-proximal direction.

[0137] Throughout this specification, a "manual activation control" shall be understood to mean an actuator that can be activated and deactivated at will by a user. This manual activation control radially moves the fixed plunger from a first position where the plunger is spaced from the sinusoidal grooves or recesses in the secondary rotor to a second position where the fixed plunger penetrates the sinusoidal grooves or recesses in the secondary rotor, and vice versa. The activation control mechanism is preferably a thrust mechanism with a spring.

[0138] Throughout this specification, "sliding connection" shall be understood to mean a male-female connection with a primary rotor understood to be a longitudinal male rod and a secondary rotor understood to be a longitudinal female conduit. This connection between both rotors is a sliding connection, i.e. the secondary rotor can slide or move linearly in both directions relative to the primary rotor.

[0139] On the one hand, the primary rotor can be coupled to a transmission shaft of the drilling device and receive the rotational motion therefrom, and on the other hand, as a result of the coupling between the rotors, the primary rotor transmits said rotational motion to the secondary rotor, and finally, the secondary rotor, which is attached at its distal end to a motion-transmitting element, also transmits said rotational motion to the motion-transmitting element, which in turn transmits said motion to the breaking element.

[0140] The secondary rotor further includes a sinusoidal groove or recess in its outer surface configured to receive and cooperate with a fixed plunger of the actuation control.

[0141] When the assembly is operating but the manual control has not yet been activated, i.e., the perforating device is operating and transmitting rotational motion to the primary rotor, but the fixed plunger has not yet penetrated the sinusoidal grooves or recesses in the secondary rotor, the breaking element is in the first position (within the main body of the instrument) because the force of the return spring urges the secondary rotor to the proximal stop position, so that the breaking element is in the first position within the main body of the instrument.

[0142] When the user decides to activate the manual control, the fixed plunger penetrates the recess or groove in the secondary rotor. This penetration causes the secondary rotor to rotate and reciprocate linearly relative to the primary rotor as a result of the sliding engagement between the two. At the same time, because the secondary rotor is attached to the proximal portion of the motion-transmitting element, the secondary rotor transmits not only rotational motion but also reciprocating motion to the motion-transmitting element, which in turn transmits both motions to the breaking element. At this point, the breaking element simultaneously rotates about the first breaking axis and reciprocates, the reciprocating motion comprising two successive motions. 1. Forward movement from a first position to a second position, where the breaking element protrudes through an opening in the distal tip. 2. A retraction movement from the second position to a new position in which the breaking element is retracted and housed within the distal tip.

[0143] The distance traveled by these back and forth instrument elements is effected by the actual shape of the sinusoidal grooves or recesses.

[0144] When the assembly is no longer activated, i.e., the perforation device is deactivated and the manual control is released, the rotor stops rotating and reciprocating, and the return spring force urges the secondary rotor to the proximal stop position, as described above, and the breaking element returns to its first position, once again located within the main body.

[0145] The return spring and secondary rotor are preferably coaxial.

[0146] In an alternative embodiment, the breaking motion generating device is a drilling device and the motion transmission and conversion means comprises: a male-female sliding connection, a primary rotor coupleable to a motion transmission shaft of the drilling device, the primary rotor configured to receive and perform rotational motion from the drilling device; a secondary rotor slidably coupled to the primary rotor at a proximal end, the secondary rotor configured to move linearly in both directions relative to the primary rotor as a result of the sliding coupling, the secondary rotor comprising a rotary pressure generator; a male-female sliding coupling comprising: a return spring configured to exert a return force on the secondary rotor; a fluid compartment comprising a first chamber, a second chamber, and a fluid, the first chamber and the second chamber are in fluid communication, and a fluid is disposed within the chambers; a rotary pressure generating device immersed in the fluid and positioned between the first chamber and the second chamber; a secondary rotor attached to a proximal portion of the motion transmitting element; and Equipped with when the secondary rotor receives the rotational motion from the primary rotor and performs the rotational motion, the rotary pressure generating device receives the rotational motion and generates a thrust force greater than the return force of the return spring, causing the fluid to flow from the first chamber into the second chamber; Fluid flow causes linear motion of the secondary rotor in the proximal-distal direction, The secondary rotor transfers linear motion, in combination with the rotational motion, to the motion transfer element, and the motion transfer element transfers linear motion, in combination with the rotational motion, to the breaking element; When the secondary rotor stops receiving rotational motion from the primary rotor, it is forced by the return spring to perform linear motion in the distal-proximal direction.

[0147] As in the previous embodiment, in this specification "sliding connection" shall be understood to mean a male-female connection with a primary rotor understood to be a longitudinal male rod and a secondary rotor understood to be a longitudinal female conduit. This connection between both rotors is a sliding connection, i.e. the secondary rotor can slide or move linearly in both directions relative to the primary rotor.

[0148] In this embodiment, on the one hand, the primary rotor can be coupled to a transmission shaft of the drilling device and can receive rotational motion therefrom. Furthermore, as a result of the coupling between the rotors, the primary rotor transmits said rotational motion to the secondary rotor. The secondary rotor, which comprises a rotary pressure generating device, transmits the rotational motion to said device. Finally, the secondary rotor also transmits said rotational motion to the motion transmitting element, which transmits said motion to the breaking element.

[0149] When the assembly is in operation, i.e., when the drilling device is operating and transmitting rotational motion to the primary rotor, the rotational motion is transmitted from the primary rotor to the secondary rotor, which transmits the rotational motion to a rotary pressure generating device, preferably a propeller or turbine. This device is immersed in the fluid in the fluid compartment, generating a thrust force greater than the thrust force of the return spring, causing fluid to flow between both chambers of the fluid compartment, and as a result of the linear sliding connection between both rotors, the secondary rotor with the rotary pressure generating device advances from a first proximal position to a second distal position.

[0150] In that sense, in the context of this particular embodiment, the linear sliding coupling has a dual function: 1. transmitting rotational motion from a drilling device to a rotary pressure generating device via a primary rotor and a secondary rotor; and 2. To allow linear motion of the secondary rotor relative to the primary rotor.

[0151] In this sense, as the secondary rotor and the rotary pressure generator advance in the proximal-distal direction, this linear motion is transferred to the motion-transfer element, which in turn transfers it to the breaking element. Thus, the breaking element is transitioned from a first position located within the main body to a second position partially protruding through the opening at the distal tip. At the same time, as a result of this motion transfer, the breaking element exhibits a rotational motion about the first breaking axis (perforation device - primary rotor - secondary rotor - motion-transfer element - breaking element).

[0152] When the assembly is not actuated, i.e., when the drill is in an inactive state, the force of the return spring urges the secondary rotor in a distal-proximal direction to a proximal stop position where the breaking element is again in the first position.

[0153] The return spring and secondary rotor are preferably coaxial.

[0154] Advantageously, this motion transmission and conversion means allows the rotation and movement of the breaking element to be activated simultaneously by the same push button of the drilling device to which the breaking tool is coupled, increasing the usability and accuracy of the breaking tool.

[0155] Additionally, the present invention provides a breakage system for minimally invasive surgical intervention, the breakage system comprising: a breaking movement generating device configured to generate and execute a breaking movement; - at least one breaking tool according to the first aspect of the invention, which can be coupled to the breaking motion generator by at least one motion transmission element; Equipped with.

[0156] In this case, the invention contemplates not only the breaking tool but also said tool in combination with a breaking motion generating device.

[0157] In one embodiment, the breaking instrument of the system is disposable. In another alternative or additional embodiment, at least a portion of the breaking motion generating device is disposable.

[0158] The advantages mentioned above for the instrument also apply to this system.

[0159] Alternatively, the present invention provides a breakage system for minimally invasive surgical intervention, the breakage system comprising: a breaking and linear and / or reciprocating motion generating device configured to generate and execute breaking and linear and / or reciprocating motions; at least one breaking tool according to the first aspect of the invention, which tool does not comprise a motion transmission and conversion means and is connectable to a breaking motion and a linear and / or reciprocating motion generating device by at least a motion transmission element; and Equipped with The breaking motion and linear and / or reciprocating motion generating device is further configured to transmit the breaking motion and linear and / or reciprocating motion to the motion transmitting element.

[0160] In this embodiment, the present invention contemplates not only the breaking instrument, but also the instrument in combination with a breaking motion and a linear and / or reciprocating motion generating device.

[0161] In order for the breaking element of the instrument to receive the breaking and linear motions necessary to protrude through the opening in the distal tip and break bone, the system contemplates that the breaking and linear and / or reciprocating motion generator provides both motions to the motion transfer element of the instrument, which then transfers them to the breaking element, moving it from a first position to at least one second position. When the breaking and linear and / or reciprocating motion generator stops operating, the motion transfer element stops receiving the breaking and linear and / or reciprocating motions, causing the breaking element to move from the at least one second position to the first position, i.e., retract into the main body.

[0162] Advantageously, when the breaking motion and linear and / or reciprocating motion generator are activated, the system allows the breaking element to move linearly and simultaneously perform the breaking motion, and when the breaking motion and linear and / or reciprocating motion generator are released, the breaking element retracts and stops performing the breaking motion.

[0163] Additionally, the advantages discussed above for breaking instruments without motion transmission and conversion means also apply to this system.

[0164] In one embodiment, the breaking instrument of the system is disposable. In another alternative or additional embodiment, at least a portion of the breaking motion and linear and / or reciprocating motion generating device are disposable.

[0165] In certain embodiments, the breaking motion and linear and / or reciprocating motion generating device comprises mechanical and / or electronic and / or electromagnetic means.

[0166] This embodiment describes different types of means integrated into the breaking motion and linear and / or reciprocating motion generating device, although other types of means are included in the context of the present invention.

[0167] In this embodiment, the breakage system of the present invention is an all-in-one system.

[0168] In certain embodiments, all breaking systems of the present invention further comprise adjustable control means for controlling the depth of advancement of the breaking element, configured to adjust the depth of advancement of the breaking element as it transitions from the first position to at least one second position. Advantageously, controlling the depth of advancement allows the user to adapt the instrument to each patient's anatomy.

[0169] In a particular example, the breaking motion and linear motion generating device comprises electromagnetic means and the adjustable control means for controlling the depth of the forward motion comprises an electronic card that can be configured to control the linear forward motion of the breaking element.

[0170] All the advantages obtained from the breaking device of the first aspect of the invention are applicable to any breaking system equipped with said breaking device.

[0171] All features and / or steps of the methods described herein (including the claims, description, and drawings) may be combined in any combination, except for such mutually exclusive feature combinations.

[0172] These and other features and advantages of the present invention will be more clearly shown on the basis of the following detailed description of preferred embodiments, given by way of illustrative and non-limiting example only, with reference to the accompanying drawings, in which: [Brief explanation of the drawings]

[0173] [Figure 1a] Figure 1a shows a different view of the breaking device. [Figure 1b] FIG. 1b shows a different view of the breaking device. [Figure 1c] FIG. 1c shows a different view of the breaking device. [Figure 1d] FIG. 1d shows a different view of the breaking device. [Figure 2a] FIG. 2a shows in detail different views of the stiffening element of the breaking device. [Figure 2b] FIG. 2b shows in detail a different view of the stiffening element of the breaking device. [Figure 2c] FIG. 2c shows in detail a different view of the stiffening element of the breaking device. [Figure 2d] FIG. 2d shows in detail a different view of the stiffening element of the breaking device. [Figure 2e] Figure 2e shows in detail different types of stiffening elements. [Figure 3a] FIG. 3a shows a breaking tool with a first embodiment of the motion transmission and conversion means comprising a mechanical spiral sliding connection. [Figure 3b] FIG. 3b shows a breaking tool with a first embodiment of the motion transmission and conversion means comprising a mechanical spiral sliding connection. [Figure 3c] FIG. 3c shows a breaking tool with a first embodiment of the motion transmission and conversion means comprising a mechanical spiral sliding connection. [Figure 4a] FIG. 4a shows a breaking tool with a second embodiment of the motion transmission and conversion means comprising a mechanical sinusoidal coupling. [Figure 4b] FIG. 4b shows a breaking tool with a second embodiment of the motion transmission and conversion means comprising a mechanical sinusoidal coupling. [Figure 4c]FIG. 4c shows a breaking tool with a second embodiment of the motion transmission and conversion means comprising a mechanical sinusoidal coupling. [Figure 4d] FIG. 4d shows a breaking tool with a second embodiment of the motion transmission and conversion means comprising a mechanical sinusoidal coupling. [Figure 4e] FIG. 4e shows a breaking tool with a second embodiment of the motion transmission and conversion means comprising a mechanical sinusoidal coupling. [Figure 4f] FIG. 4f shows a breaking tool with a second embodiment of the motion transmission and transformation means comprising a mechanical sinusoidal coupling. [Figure 4g] FIG. 4g shows a breaking tool with a second embodiment of the motion transmission and conversion means comprising a mechanical sinusoidal coupling. [Figure 5a] FIG. 5a shows a breaking tool with a third embodiment of the motion transmission and conversion means comprising a hydraulic coupling. [Figure 5b] FIG. 5b shows a breaking tool with a third embodiment of the motion transmission and conversion means comprising a hydraulic coupling. [Figure 6a] FIG. 6a shows a breaking tool according to one embodiment of the invention, where the tool comprises a breaking guide. [Figure 6b] FIG. 6b shows a breaking tool according to one embodiment of the invention, where the tool comprises a breaking guide. [Figure 7a] FIG. 7a shows in detail the breaking guide of the breaking device according to one embodiment of the present invention. [Figure 7b] FIG. 7b shows in detail the breaking guide of the breaking device according to one embodiment of the present invention. [Figure 7c] FIG. 7c shows in detail the breaking guide of the breaking device according to one embodiment of the present invention. [Figure 7d] FIG. 7d shows in detail the breaking guide of the breaking device according to one embodiment of the present invention. [Figure 7e] FIG. 7e shows in detail the breaking guide of the breaking device according to one embodiment of the present invention. [Figure 7f] FIG. 7f shows in detail the breaking guide of the breaking device according to one embodiment of the present invention. [Figure 8a] FIG. 8a shows different views of multiple tubular guides of a fracture guide of an instrument according to one embodiment of the present invention. [Figure 8b] FIG. 8b shows different views of multiple tubular guides of a fracture guide of an instrument according to one embodiment of the present invention. [Figure 9] FIG. 9 shows examples of breaking element configurations according to different embodiments of the present invention. [Figure 10a] FIG. 10a shows a breaking system for surgical intervention in which the breaking instrument is coupled to an orthopedic drill. [Figure 10b] FIG. 10b shows a breaking system for surgical intervention in which the breaking instrument is coupled to an orthopedic drill. [Figure 10c] FIG. 10c shows a breaking system for surgical intervention in which the breaking instrument is coupled to an orthopedic drill. [Figure 10d] FIG. 10d shows a breaking system for surgical intervention in which the breaking instrument is coupled to an orthopedic drill. [Figure 10e] FIG. 10e shows a breaking system for surgical intervention in which the breaking instrument is coupled to an orthopedic drill. [Figure 10f] FIG. 10f shows a breaking system for surgical intervention in which the breaking instrument is coupled to an orthopedic drill. [Figure 10g] FIG. 10g shows a breaking system for surgical intervention in which the breaking instrument is coupled to an orthopedic drill. [Figure 10h] FIG. 10h shows a breaking system for surgical intervention in which the breaking instrument is coupled to an orthopedic drill. [Figure 10i] FIG. 10i shows a breaking system for surgical intervention in which the breaking instrument is coupled to an orthopedic drill. [Figure 11a] FIG. 11a shows a breaking system for surgical intervention in which the breaking instrument is attached to an orthopedic drill. [Figure 11b] FIG. 11b shows a breaking system for surgical intervention in which the breaking instrument is attached to an orthopedic drill. [Figure 11c]FIG. 11c shows a breaking system for surgical intervention in which the breaking instrument is attached to an orthopedic drill. [Figure 12a] Figure 12a shows the cylindrical shape of the tunnel carved back by a conventional breaking tool. [Figure 12b] FIG. 12b shows the funnel-like shape of an angled bone tunnel carved by the breaking instrument of the present invention. [Figure 12c] FIG. 12c shows different shapes of straight bone tunnels carved by the breaking instrument of the present invention. [Figure 13a] FIG. 13a illustrates steps of a method for repairing a damaged supraspinatus tendon with the disruption system of the present invention. [Figure 13b] FIG. 13b illustrates steps of a method for repairing a damaged supraspinatus tendon with the disruption system of the present invention. [Figure 13c] FIG. 13c shows steps of a method for repairing a damaged supraspinatus tendon with the disruption system of the present invention. [Figure 13d] FIG. 13d shows steps of a method for repairing a damaged supraspinatus tendon with the disruption system of the present invention. [Figure 13e] FIG. 13e illustrates steps of a method for repairing a damaged supraspinatus tendon with the disruption system of the present invention. [Figure 13f] FIG. 13f shows steps of a method for repairing a damaged supraspinatus tendon with the disruption system of the present invention. [Figure 14a] FIG. 14a shows the steps of a method for reconstructing the anterior cruciate ligament of a right knee with the rupture system of the present invention. [Figure 14b] FIG. 14b shows steps of a method for reconstructing the anterior cruciate ligament of the right knee with the rupture system of the present invention. [Figure 14c] FIG. 14c shows steps of a method for reconstructing the anterior cruciate ligament of the right knee with the rupture system of the present invention. [Figure 14d] FIG. 14d shows steps of a method for reconstructing the anterior cruciate ligament of the right knee with the rupture system of the present invention. [Figure 14e] FIG. 14e shows steps of a method for reconstructing the anterior cruciate ligament of the right knee with the rupture system of the present invention. [Figure 14f] FIG. 14f shows steps of a method for reconstructing the anterior cruciate ligament of a right knee with the rupture system of the present invention. [Figure 14g] FIG. 14g shows steps of a method for reconstructing the anterior cruciate ligament of a right knee with the rupture system of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0174] 1a-1c show external perspective views of the breaking device with the breaking elements retracted (FIG. 1a), extended (FIG. 1b), and with all elements disassembled (FIG. 1c).

[0175] FIG. 1a shows a preferred embodiment of a breaking instrument (100) for surgical intervention comprising a longitudinal body (110) comprising a main body (111) and a distal tip (112) attached to the main body (111). The longitudinal body (110) is preferably tubular, as shown in FIG. 1a. In other embodiments, the longitudinal body (110) is in the shape of a concave channel or conduit. In certain embodiments, the main body (111) has a cylindrical configuration with a diameter between 3 mm and 7 mm.

[0176] Additionally, the breaking device (100) comprises a breaking element and a stiffening means, not shown in FIG. 1a.

[0177] 1b shows the same instrument, but in which it can be seen that the main body (111) is oriented according to a first longitudinal axis (101) and the opening (115) in the distal tip (112) is oriented according to a second longitudinal axis (102). In addition, it can be derived from this figure that the first longitudinal axis (101) and the at least one second longitudinal axis (102) form an angle α (which can be 0 degrees or greater) with respect to each other, and that the first longitudinal axis (101) and the second longitudinal axis (102) are contained in a first sagittal plane (103).

[0178] In a particular embodiment, the angle α between the first longitudinal axis (101) and the second longitudinal axis (102) is between 25° and 65°, and in a more particular embodiment, the angle α is 45°.

[0179] In this embodiment of Figure 1b, the distal tip (112) is rigidly attached to the main body (111) as an extension, ie the longitudinal body (110) is one piece.

[0180] In these figures, the distal tip (112) forms a curved ramp with the main body (111). In other embodiments, the ramp is straight.

[0181] Additionally, a portion of the breaker assembly (120) can be seen in Figure 1b protruding through the opening (115) in the distal tip (112).

[0182] The breaking assembly (120) of the breaking device (100) comprises: a breaking element (121) comprising a first breaking axis (121.1) and configured to receive and perform a breaking movement about the first breaking axis (121.1), to receive and perform a linear movement, and to move along the longitudinal body (110) from a first position to at least one second position and vice versa, When the breaking element (121) is in the first position, the breaking element (121) is oriented within the main body (111) according to the first longitudinal axis (101); a breaking element (121) oriented according to at least one second longitudinal axis (102) when the breaking element (121) is in a second position and protruding at least partially through an opening (115) in the distal tip (112); a motion transfer element (122) comprising a proximal portion (122.1), a flexible or articulating distal portion (122.2), and a second breaking axis (122.3), the motion transfer element (122) being rigidly attached to the breaking element (121) by the flexible or articulating distal portion (122.2); receiving and carrying out a breaking movement about a second breaking axis (122.3) and transmitting the breaking movement to the breaking element (121); receiving and carrying out a linear motion moving along the longitudinal body (110) and transmitting the linear motion to the breaking element (121); a motion transfer element (122) configured to: Equipped with.

[0183] FIG. 1a shows the breaking element (121) in a first position, ie the breaking element (121) is located inside the main body (111) and oriented according to the first longitudinal axis (101).

[0184] FIG. 1b shows the breaking element (121) in a second position, i.e., the breaking element (121) is oriented according to the second longitudinal axis (102) and at least partially protrudes from the distal tip (112) through the opening (115) in the distal tip (112).

[0185] In a particular embodiment, the breaking element (121) has a length between 10 mm and 25 mm.

[0186] FIG. 1c shows an exploded view of the same device (100) shown in FIGS. 1a and 1b.

[0187] The motion transmission element (122) comprising a proximal portion (122.1) and a flexible or articulating distal portion (122.2) as well as a second fracture axis (122.3) can be seen in detail in this FIG. 1c.

[0188] As mentioned above, the motion transfer element (122) is rigidly attached to the breaking element (121), said attachment being established by a flexible or articulating distal portion (122.2) of the motion transfer element (122).

[0189] FIG. 1c further shows a stiffening means (130) configured to provide stiffness to the flexible or articulating distal portion (122.2) of the motion transfer element (122) in all planes other than the first sagittal plane (103) when the breaking element (121) is in at least one second position (shown in FIG. 1b).

[0190] In a preferred embodiment, the breaking motion is a rotational motion, while in other embodiments the motion is an oscillatory or reciprocating motion.

[0191] In these figures, the breaking instrument (100) further comprises at least one first attachment and / or coupling means (140) configured to attach or couple the motion transfer element (122) to a breaking motion generating device (200, 200'), not shown. Furthermore, the instrument (100) comprises supports (160.1, 170.1, 180.1) partially surrounding the motion transfer element (122) and second attachment and / or coupling means (150) configured to attach or couple the supports (160.1, 170.1, 180.1) to the breaking motion generating device (200, 200').

[0192] In certain embodiments where the breaking motion is a rotational motion, the breaking instrument (100) further comprises a motion transmission and conversion means (not shown in Figures 1a-1c), which means: receiving rotational motion from a rotational motion generating device, for example a drill; - converting rotary motion into linear and / or reciprocating motion; - transmitting a linear and / or reciprocating motion to a motion-transmitting element (122), which in turn transmits a linear and / or reciprocating motion to the breaking element (121) to move the breaking element (121) from a first position to at least one second position; - stopping the linear and / or reciprocating movement when the rotational movement is stopped, and moving the breaking element (121) from at least one second position to the first position; The device is configured to:

[0193] The motion transmission and conversion means are integrated inside the supports (160.1, 170.1, 180.1).

[0194] A reference ring (116) surrounding the longitudinal body (110) is further seen in Figures 1a-1c, which ring can move along the body (110). This ring (118) is entirely optional, but is used as a reference for the user using the breaking tool (100), and in particular to inform the user of the depth of the back-mill.

[0195] Figure 1d shows an alternative embodiment of Figures 1a-1d, in which the distal tip (112) is attached to the main body (111) by an attachment element configured to position the distal tip (112) in a plurality of angular positions, whereby for each of the plurality of angular positions a different second longitudinal axis (102) is formed, each of which forms a different angle α with the first longitudinal axis (101). In this case, the distal tip (112) can be positioned in a plurality of different angular positions, and the breaking element (121) in the second position is oriented according to one of the plurality of different angular positions.

[0196] Figures 2a to 2d show different views of the stiffening element (130) in detail.

[0197] 2a and 2b are exploded perspective views showing the stiffening element (130) along with other parts of the device (100) with which it interacts.

[0198] The element (130) comprises a tubular element (131) comprising a proximal portion (131.1) and a distal portion (131.2).

[0199] The tubular element (131) surrounds the flexible or articulated distal portion (122.2) of the motion transfer element (122) and accommodates the flexible or articulated portion (122.2) therein. Furthermore, the tubular element (131) is sized to be accommodated within the longitudinal body (110) and is able to move along the interior of said body. This movement is possible because the tubular element accommodates the motion transfer element (122) therein, i.e., when the motion transfer element (122) moves linearly to cause the breaking element (121) to protrude through the opening in the distal tip (112), the tubular element (131) moves with it. In addition, the motion transmission element (122) performs a breaking movement about a second breaking axis (122.3), and the breaking element (121) also performs said breaking movement about a first breaking axis (121.1) without the tubular element (131) interfering with said breaking movement.

[0200] The difference between Figures 2a and 2b lies in the different configuration of the flexible or articulating distal portion (122.2) of the motion transmission element (122). In Figure 2a, the flexible or articulating distal portion (122.2) has a configuration with a grooved surface, while in Figure 2b, the flexible or articulating distal portion (122.2) has a braided configuration. In other embodiments, other configurations of the flexible or articulating distal portion (122.2) are feasible in the context of the present invention.

[0201] Additionally, the tubular element (131) comprises at least one elongated notch (132) located in the upper part of the distal portion (131.2) and forming an angle β greater than 0 degrees and less than or equal to 90 degrees with respect to the first sagittal plane (103), the angle β being the same for all notches (132), if there are one or more notches (132), or different for all notches (132).

[0202] Each of these notches (132) separates the upper portion of the distal portion (131.2) into two distinct segments (132.1) spaced a specific distance apart when the breaking element is in a first position. The separation defined by each notch (132) may be the same or different, provided that the sum of the separations of all notches (132) is substantially zero when the distal portion (131.2) of the tubular element (131) is located at the distal tip (112) of the instrument (i.e., when the breaking element (121) is in a second position).

[0203] In one example, the notches (132) have a trapezoidal shape, and / or a winding shape, and / or a sinusoidal shape, and / or any other shape, provided that they are arranged at an angle β (or several angles β) relative to the first sagittal plane (103).

[0204] In another example, the tubular element (131) comprises a modular system of interconnected sections that form a winding in a single sagittal plane such that when the distal portion (131.2) of the tubular element (131) is positioned at the distal tip (112) of the instrument, the sum of the separations between the sections is substantially zero.

[0205] In another example, the tubular element (131) comprises a tube of superelastic nitinol, with or without slits, and an outer polymer layer.

[0206] Figures 2c and 2d show in detail the position of the stiffening element (130) when the breaking element (121) is in the first position or the second position, respectively.

[0207] In Figure 2c, i.e., when the breaking element (121) is in a first position, the two portions (131.1, 131.2) of the tubular element (131) are positioned within the main body (110) and are therefore oriented according to the first longitudinal axis (101). In Figure 2d, i.e., when the breaking assembly (120) and the stiffening element (130) are moved, the breaking element (121) is in a second position and only the proximal portion (131.1) of the tubular element (131) remains oriented according to the first longitudinal axis (101). In other words, the proximal portion (131.1) is still positioned within the main body (110), while the flexible or articulating distal portion (131.2) of the tubular element (131) is oriented according to one of the second longitudinal axes (102) or (102). In this second case, a flexible or articulated distal portion (131.2) is placed at the distal tip (112) of the instrument (100) and acquires a curved shape.

[0208] That is, in the first case, the incisions (132) remain open, while in the second case, the incisions (132) are substantially closed, i.e., due to the actual curved position of the tubular element (131), the walls of successive segments (132.1) are in contact with each other. The tubular element (131) can thus provide stiffness to the flexible or articulating distal portion (122.2) of the motion-transmitting element (122) in all planes except the first sagittal plane (103), in which the flexible or articulating portion (122.2) acquires a curved shape. This stiffness is transferred to the breaking element (121) when the breaking element (121) is in at least one second position.

[0209] Additionally, in Figures 2c and 2d it can be seen that the longitudinal body (110) comprises a distal longitudinal groove (114) and the tubular element (131) comprises a first protrusion (133). In other examples, multiple distal longitudinal grooves (114) and multiple tubular elements (131) or multiple first protrusions (133) are possible.

[0210] The distal longitudinal groove (114) is sized to receive the first protrusion (133) and is configured to cooperate with the first protrusion (133) to guide the first protrusion (133) in the direction of the sagittal plane (103) as indicated by the arrow in Figure 2d. The movement of the tubular element (131) occurs simultaneously with the linear movement of the breaking element (121) as the breaking element (121) moves from the first position to the second position and vice versa.

[0211] At the same time, the first protrusion (133) is sized to pass through the distal longitudinal groove (114), cooperates with the longitudinal groove (114), and is configured to move along the groove (114) when the breaking element (121) moves from the first position to the second position and vice versa.

[0212] The distal edge of the distal longitudinal groove (113) acts as a stop for the first protrusion (133) when the breaking element (121) is located in a second position, so that in this at least one second position the separation between the segments (132.1) of the tubular body (131) is substantially zero, and the breaking element (121) thereby acquires rigidity in this at least one second position.

[0213] Figure 2e shows in detail different types of stiffening elements (130).

[0214] Figures 3a-3c show an embodiment of a breaking instrument (100), in which the instrument (100) comprises a motion transmission and conversion means (160). In this embodiment, the breaking motion generating device (200, 200') is a rotational motion generating device (200, 200'), preferably a perforating device.

[0215] The motion transmission and conversion means (160) of this embodiment comprises: a first longitudinal rotary motion transmission element (161) that can be coupled to a motion transmission shaft of a drilling device (200, 200'), the first longitudinal element (161) being configured to receive a rotary motion from said drilling device (200, 200') and to perform said rotary motion; - a second longitudinal rotational motion transmission element (162) attached to the proximal portion (122.3) of the motion transmission element (122) and configured to receive rotational motion from the first longitudinal element (161) and to perform said rotational and linear motion; a brake actuator (163) connected to the second longitudinal element (162) and configured to exert a force on the second longitudinal element (162) to prevent it from rotating; a return spring (164) configured to exert a linear return force on the second longitudinal element (162); a helical sliding connection (165) configured to connect the first longitudinal element (161) to the second longitudinal element (162); Equipped with The spiral sliding connection (165) is a longitudinal coupling part (161.1) attached to the first longitudinal element (161), the longitudinal coupling part (161.1) having a first thread (161.2) on its outer surface; a longitudinal coupling conduit (162.1) attached to the second longitudinal element (162), the longitudinal coupling conduit (162.1) having a second thread (162.2) on its inner surface; Equipped with The first thread (161.2) of the longitudinal coupling portion (161.1) and the second thread (162.2) of the longitudinal coupling conduit (162.1) are configured to cooperate with each other so that when the longitudinal coupling conduit (162.1) undergoes a rotational movement and the longitudinal coupling portion (161.1) rotates at a slower speed than the longitudinal coupling conduit (162.1), a linear movement of the longitudinal coupling conduit (162.1) relative to the longitudinal coupling portion (161.1) occurs, and the thread direction of the helical sliding coupling (165) is opposite to the direction of the rotational movement of the drilling device.

[0216] Figure 3a shows an assembly diagram of the motion transmission and conversion means (160) integrated into a support (160.1). The shape and dimensions of the support (160.1) can vary. Figures 3b and 3c show side cross-sectional views of the support (160.1) so that the operation of the motion transmission and conversion means (160) of this embodiment can be observed. In particular, Figure 3b shows a situation in which the perforation device (not shown) is not activated and the second longitudinal element (162) is in a first position. Figure 3c shows a situation in which the perforation device (not shown) is activated and the second longitudinal element (162) is in a second position linearly displaced relative to the first position.

[0217] 3a shows the situation in which the drilling device is in an inactive state, i.e. the motion transmission element (122) is not accepting any rotational movement. In this case, the force of the return spring (164) is greater than the force holding the brake actuator (163) against rotation, so the second longitudinal element (162) is in the proximal stop position and the breaking element (not shown in this figure) is in the first position.

[0218] 3b shows the drilling device (200) in operation. The drilling device provides a rotational motion to the first longitudinal element (161), which, as a result of the helical sliding connection (165), provides the same rotational motion to the second longitudinal element (162). At this point, the brake actuator (163) increases the rotational retention force transmitted to the second longitudinal element (162), slowing the rotational speed of the second longitudinal element (162) relative to the rotational speed of the first longitudinal element (161). When the rotational retention force of the brake (163) becomes greater than the linear return force of the spring (164), the component of the helical sliding connection (165), acting as a spindle screw, linearly advances the second longitudinal element (162) relative to the first longitudinal element (161). This linear forward motion occurs because the thread direction of the helical sliding connection (165) is opposite to the direction of the rotational motion received and transmitted by the first longitudinal element (161) connected to the motion transmission shaft of the drilling device.

[0219] The return spring (164) is gradually compressed during forward movement, and its force increases until a point is reached where the forces of both the spring (164) and the brake actuator (163) are again equal, at which point the second longitudinal element (162) is in a distal position and simultaneously the breaking element (121) is in at least one second position protruding through the opening (115) in the distal tip (112).

[0220] When the activity of the drilling device stops, since there is no rotational movement at all, the force of the return spring (164) becomes greater again than the force holding the rotation of the brake actuator (163). In this case, the second longitudinal element (162) returns to its proximal stop position as a result of the linear return force action of the spring (164), and the breaking element (121) retracts, returning to the situation shown in Figure 3.

[0221] Optionally, to speed up the process, the brake actuator (163) includes a pressure spring pad that provides a non-zero initial rotational holding force.

[0222] Figures 4a-4g show one embodiment of a breaking tool (100) comprising a manually activated motion transmission and conversion means (170). In this embodiment, the breaking motion generating device (not shown) is a rotary motion generating device, preferably a perforating device.

[0223] The motion transmission and conversion means (170) of this embodiment includes: - a male-female sliding connection (173), a primary rotor (171) connectable to a motion transmission shaft of the drilling device (200, 200'), the primary rotor (171) being configured to receive and perform rotational motion from the drilling device (200, 200'); a secondary rotor (172) slidably coupled at a proximal end to the primary rotor (171) and attached at a distal end to the proximal portion (122.1) of the motion transmission element (122), the secondary rotor (172) further comprising grooves or depressions (172.1) having a sinusoidal shape on its outer surface, the secondary rotor (172) configured to move linearly in both directions relative to the primary rotor (171) as a result of the sliding coupling; a male-female sliding coupling (173) comprising: a return spring (174) configured to exert a return force on the secondary rotor (172); a manual activation control (175) connected to a fixed plunger (176), the manual activation control (175) being configured so that the fixed plunger (176) passes through a groove or recess (172.1) in the secondary rotor (172); Equipped with When the secondary rotor (172) receives and performs rotational motion from the primary rotor (171), activation of the control (175) causes the fixed plunger (176) to penetrate the groove or recess (172.1) and the secondary rotor (172) to perform a linear back and forth reciprocating motion relative to the primary rotor (171); The secondary rotor (172) transmits the linear back-and-forth reciprocating motion in combination with the rotational motion to the motion transmission element (122), and the motion transmission element (122) transmits the linear back-and-forth reciprocating motion in combination with the rotational motion to the breaking element (121); When the control (175) is released to remove the fixed plunger (176) from the groove or recess (172.1), the secondary rotor (172) performs a return movement in the distal-to-proximal direction, pushed by the return spring (174).

[0224] Figure 4a shows the motion transmission and conversion means (170) integrated into a support (170.1), the shape and dimensions of which may vary. Figure 4b shows an exploded view of the device of this embodiment. Figures 4c-4d show side cross-sectional views of the breaking device (100) of this embodiment, and Figures 4e-4g show side cross-sectional views of the support (170.1) of said device (100) so that the operation of the motion transmission and conversion means (170) of this embodiment can be observed.

[0225] In this embodiment, when the assembly is in operation but the manual control (175) has not yet been activated, i.e., the perforation device (200, 200′) is in operation and transmitting rotational motion to the primary rotor (171), but the fixed plunger (176) has not yet penetrated the sinusoidal grooves or recesses (172.1) of the secondary rotor (172), the breaking element (121) is in the first position (within the main body (111) of the instrument (100)) because the force of the return spring (174) urges the secondary rotor (172) toward a proximal stop position, so that the breaking element (121) is in the first position within the main body (111) of the instrument (100).

[0226] When the user decides to activate the manual control (175), the fixed plunger (176) penetrates the recess or groove (172.1) in the secondary rotor (172). This penetration causes the secondary rotor (172) to perform a linear back-and-forth reciprocating motion relative to the primary rotor (171) as a result of the sliding coupling (173), in addition to a rotational motion. At the same time, because the secondary rotor (172) is attached to the proximal portion (122.1) of the motion-transmitting element (122), the secondary rotor (172) transmits not only a rotational motion but also a reciprocating motion to the motion-transmitting element (122), which in turn transmits both motions to the breaking element (121). At this point, the breaking element (121) simultaneously performs a rotational motion about the first breaking axis and a reciprocating motion, the reciprocating motion comprising two successive motions. 1. Forward movement from a first position to a second position, where the breaking element (121) protrudes through the opening (115) in the distal tip (112). 2. A retraction movement from the second position to a new position in which the breaking element (121) is retracted and accommodated within the distal tip (115).

[0227] The distance traveled by these back and forth moving elements of the instrument (100) is effected by the actual shape of the sinusoidal grooves or recesses (172.1).

[0228] When the assembly is no longer in operation, i.e., when the perforation devices (200, 200′) are deactivated and the manual control (175) is released, the rotors (171, 172) stop rotating and reciprocating, and in this case, as described above, the force of the return spring (174) urges the secondary rotor (172) towards its proximal stop position, and the breaking element (121) returns to its first position, once again located within the main body (111).

[0229] More specifically, Figure 4c shows the situation when the perforation device (not shown) is in an inactive state, i.e. when the motion transmission element (122) is not receiving any rotational motion, in which case the force of the return spring (174) urges the secondary rotor (172) towards the proximal stop position and the breaking element (121) is in the first position.

[0230] 4d shows the situation when the perforation device (not shown) is activated and the manual activation control (175) is pressed. The perforation device provides a rotational motion to the primary rotor (171), which in turn provides the rotational motion to the secondary rotor (172). In addition, the fixed plunger (176) cooperates with the sinusoidal grooves or recesses (172.1) so that the secondary rotor (172) performs a linear back-and-forth reciprocating motion, which is transmitted, along with the rotational motion, to the motion transmission element (122), which transmits both motions to the breaking element (121).

[0231] When the fixed plunger (176) is released by manual control, the secondary rotor (172) pushed by the return spring (174) performs a return movement to the starting position, and the breaking element (121) retracts, returning to the situation shown in Figure 4c.

[0232] Figures 5a and 5b show another embodiment of the invention in which the motion transmission and conversion means (180) comprises an automatically operated hydraulic system. In this embodiment, the breaking motion generating device (not shown) is a rotary motion generating device, preferably a drilling device.

[0233] The motion transmission and conversion means (180) of this embodiment comprises: - a male-female sliding connection (183), a primary rotor (181) connectable to a motion transmission shaft of the drilling device (200, 200'), the primary rotor (181) being configured to receive and perform rotational motion from the drilling device (200, 200'); a secondary rotor (182) slidably coupled at a proximal end to the primary rotor (181), the secondary rotor (182) configured to move linearly in both directions relative to the primary rotor (181) as a result of the sliding coupling, the secondary rotor (182) comprising a rotary pressure generator (185); a male-female sliding coupling (183) comprising: a return spring (184) configured to exert a return force on the secondary rotor (182); a fluid compartment comprising a first chamber (186), a second chamber (187) and a fluid (188), The first chamber (186) and the second chamber (187) are in fluid communication, and a fluid (188) is disposed within the chambers (186, 187); a rotary pressure generating device (185) immersed in a fluid (188) and positioned between a first chamber (186) and a second chamber (187); The secondary rotor (182) is attached to the proximal portion (122.1) of the motion transmission element (122), a fluid compartment; Equipped with When the secondary rotor (182) receives the rotational motion from the primary rotor (181) and performs the rotational motion, the rotational pressure generator (185) receives the rotational motion and generates a thrust force greater than the return force of the return spring (184), causing the fluid (188) to flow from the first chamber (186) into the second chamber (187); The flow of fluid (188) causes linear motion of the secondary rotor (182) in a proximal-distal direction, The secondary rotor (182) transfers linear motion, in combination with rotational motion, to the motion transfer element (122), which transfers linear motion, in combination with rotational motion, to the breaking element (121); When the secondary rotor (182) stops receiving rotational motion from the primary rotor (181), the secondary rotor (182) is pushed by the return spring (184) to perform a linear motion in the distal-proximal direction.

[0234] Figure 5a shows this motion transmission and transformation means (180), and Figure 5b shows with arrows the rotational and linear motions received and performed by the motion transmission and transformation means (180).

[0235] When the assembly is in operation, i.e., when the drilling devices (200, 200') are operating and transmitting rotational motion to the primary rotor (181), the rotational motion is transmitted from the primary rotor (181) to the secondary rotor (182). The secondary rotor (182) then transmits the rotational motion to the rotary pressure generator (185), preferably a propeller or turbine. This device (185) is immersed in the fluid (188) of the fluid compartment, generating a thrust force greater than that of the return spring (184), causing the fluid to flow between both chambers (186, 187) of the fluid compartment, and as a result of the linear sliding connection (183) between both rotors (181, 182), the secondary rotor (182) with the rotary pressure generator (185) advances from a first proximal position to a second distal position.

[0236] In that sense, in the context of this particular embodiment, the linear sliding connection (183) has a dual function: 1. transmitting rotational motion from the drilling device (200, 200') to the rotary pressure generating device (185) via the primary rotor (181) and the secondary rotor (182); and 2. To allow linear motion of the secondary rotor (182) relative to the primary rotor (181).

[0237] In this sense, as the secondary rotor (182) and the rotational pressure generator (185) advance in the proximal-distal direction, this linear motion is transferred to the motion transfer element (122), which in turn transfers it to the breaking element (121). Thus, the breaking element (121) is transferred from a first position located inside the main body (111) to a second position partially protruding through the opening (115) of the distal tip (112). At the same time, the breaking element (121) describes a rotational motion about a first breaking axis due to the transfer of this motion (perforation device (200, 200') - primary rotor (181) - secondary rotor (182) - motion transfer element (122) - breaking element (121)).

[0238] When the assembly is not actuated, i.e., when the drill (200, 200') is in an inactive state, the force of the return spring (184) urges the secondary rotor (182) in a distal-proximal direction to a proximal stop position, where the breaking element (121) is again in the first position.

[0239] In one embodiment, the fluid is a medical hydraulic fluid, and in another even more preferred embodiment, the fluid is sterile water.

[0240] 6a-6b show an embodiment of the breaking tool (100) in which the breaking tool (100) further comprises a breaking guide (300).

[0241] The break guide (300) is configured to guide the longitudinal body (110) from an original position, i.e., a position where the longitudinal body (110) begins to penetrate a first segment of the bone tunnel, to a target position, i.e., a position where the longitudinal body (110) is correctly positioned so that the break element (121) moves from the first position to the second position, thereby engraving the second bone tunnel segment and creating an enlarged intra-articular exit opening.

[0242] Figure 6a shows the breaking instrument (100) with the breaking guide (300) when the longitudinal body (110) is not inserted into the breaking guide (300), and Figure 6b shows the breaking instrument (100) with the breaking guide (300) when the longitudinal body (110) is inserted into the breaking guide (300).

[0243] Figures 7a to 7f show the breaking guide (300) in detail.

[0244] Figure 7a shows an exploded perspective view of the break guide (300). As can be seen, the break guide (300) comprises a tubular guide (310), which is a longitudinal conduit (311) having a proximal end (311.1) and a distal end (311.2), the longitudinal conduit (311) comprising a distal appendage (311.3) at the distal end (311.2); - a striking edge (312), an extension of the longitudinal conduit (311) at its proximal end (311.1); Equipped with.

[0245] The longitudinal conduit (311) is configured to accommodate the longitudinal body (110), and the at least one tubular guide (310) is oriented according to a first longitudinal guide axis (321.1).

[0246] The striking edge (312) is configured to receive a striking force in the direction of the first longitudinal guide axis (321.1).

[0247] In this illustration, the distal appendage (311.3) is a peripheral recess. Other examples of the distal appendage (311.3) include a trilobed tip, or two tips, or a chamfered recess, or a polyhedral face.

[0248] The breaking guide (300) further comprises a guide arch (320), the guide arch (320) comprising: a proximal arch portion (321) having first coupling means (330) configured to securely couple and decouple the proximal arch portion (321) to the tubular guide (310) at a plurality of different positions along a first longitudinal guide axis (321.1); a distal arch portion (322) with a distal tip (322.2) oriented according to a second longitudinal guide axis (322.1); - second coupling means (340) configured to couple the distal arch portion (322) to the proximal arch portion (321) at a plurality of different positions, for each of which the first longitudinal guide axis (321.1) and at least one second longitudinal guide axis (322.1) form a different angle α2 with respect to each other; Equipped with.

[0249] As can be seen in FIG. 7a, both longitudinal guide axes (321.1, 322.1) are contained in the second sagittal plane (301).

[0250] Figure 7b shows an unexploded perspective view of the break guide (300). This view shows how the distal arch portion (322) is connected to the proximal arch portion (321) by the second connecting means (340) in two different positions. In these two positions, the first longitudinal guide axis (321.1) and the second longitudinal guide axis (322.1) form different angles α2 relative to each other.

[0251] Furthermore, Figure 7b shows how, as a result of the first coupling means (330), the guide arch (320) can be securely assembled onto the tubular guide (310), particularly in one of several different positions that can be arranged along the tubular guide (310). In this particular example, the first coupling means (330) of the guide arch (312) is in the form of a cylindrical clamp or clip, as can be seen in detail in Figures 7c and 7d. To assemble the guide arch (320) onto the tubular guide (310), the first coupling means (330) is opened according to the direction of the arrows, and once in the desired position, the clamp or clip is closed so that it surrounds the tubular guide (310) in a fixed position.

[0252] FIG. 7d shows by the arrows how the guide arch (320) is disassembled from the tubular guide (310), ie by opening the clamp or clip in the direction of the upward arrow.

[0253] Figure 7e details a specific embodiment in which the first coupling means (330) comprises a longitudinal ratchet. The longitudinal ratchet comprises successive wedge-shaped teeth or protrusions disposed on the tubular guide (310) and at least one complementary, also wedge-shaped tooth or protrusion on the guide arch (320) configured and dimensioned to fit between two consecutive teeth or protrusions on the tubular guide (310). In this sense, as the tubular guide (310) moves relative to the guide arch (320), the at least one complementary tooth or protrusion on the guide arch (320) moves from one position to another along the ratchet, each of which is located between two consecutive teeth or protrusions on the guide. In this sense, as a result of this first coupling means (330) of the guide arch, the proximal arch portion (321) can be securely coupled at multiple different positions along at least one tubular guide (310).

[0254] Figure 7f shows in detail a particular embodiment of the interconnection between the main body (111) of the longitudinal body (110) and the tubular guide (310).

[0255] In this embodiment, the tubular guide (310) further comprises a hole (314), which comprises a first portion (314.1) and a second portion (314.2) attached to each other as can be seen in the figure. Similarly, the main body (111) of the longitudinal body (110) comprises a second protrusion (113).

[0256] The first portion (314.1) of the bore (324) is sized and configured to receive and guide the second protrusion (113) from a proximal position where the second protrusion (113) is introduced into the first portion (314.1) to a distal position where the second protrusion (113) is introduced into the second portion (314.2) as the longitudinal body (110) of the breaking instrument (100) is inserted into and moves along the interior of the tubular guide (310) of the breaking guide (300).

[0257] The second portion (314.2) is sized and configured to abut the second protrusion (113) when the first sagittal plane (103) of the breaking instrument (100) is rotated by an angle γ relative to the second sagittal plane (301) of the breaking guide (300).

[0258] In this sense, when the second protrusion 113 is positioned within the second portion 314.2, the second protrusion slides along the second portion 314.2 of the bore 314 in a direction perpendicular to the second sagittal plane 301 until it abuts an end or limit of the second portion 314.2. This sliding occurs as the longitudinal body 110 rotates from left to right and vice versa as it is received within the break guide 300. In this sense, the bore 314 as a whole can limit the angle that the first sagittal plane 103 can form with the second sagittal plane 301.

[0259] In this example, the first portion (314.1) of the hole (314) is an elongated portion parallel to the second sagittal plane (301), and the second portion (314.2) of the hole (314) is a quadrilateral portion, both portions forming a "T" together.

[0260] As described throughout this specification, the widening of the intra-articular outlet opening occurs in a plane perpendicular to the second sagittal plane (301). As a result of the second portion (314.2) of the hole (314) in this embodiment, the user can retract the longitudinal body (110) distally-proximally to widen the intra-articular outlet opening in the other plane parallel to the plane in which the tunnel was originally formed. Obviously, in this new widening, the user must continue to rotate the longitudinal body (110) from left to right so that the first sagittal plane rotates relative to the second sagittal plane.

[0261] In certain embodiments, the tubular guide (310) comprises a single longitudinal bore (314), the main body (111) of the longitudinal body (110) comprises at least one second protrusion (113), and the longitudinal bore (314) is sized and configured to receive and guide the at least one second protrusion (113) from a proximal position to a distal position and vice versa.

[0262] 8a-8b show top and perspective views of several tubular guides 310, all of whose holes 314 vary in shape and / or size. For example, a tubular guide 310 with a single hole and several tubular guides 310 with holes 314 having first and second portions 314.1 and 314.2 of different shapes and sizes are shown.

[0263] FIG. 9 shows different examples of the configuration of the breaking element (121).

[0264] 10a-10i show a breaking system (400) for surgical intervention comprising a breaking motion generator (200) and a breaking instrument (100) according to any of the previously described embodiments.

[0265] The breaking motion generating device (200), in this case a drilling device (200), is configured to generate and execute a breaking motion, in this particular example a rotational motion, and is also configured to transfer the breaking motion to the motion transfer element (122).

[0266] In particular, Figure 10a shows a side view of the system (400) with the tool (100) decoupled from the break motion generator (200).

[0267] In particular, Figure 10b shows a side view of the system (400) with the tool (100) coupled to the breaking motion generator (200) in an inactivated state.

[0268] Figure 10c shows a side view of the system (400) with the arrow indicating that the breaking motion generator (200) has been activated (arrow pointing to the drill trigger), which causes rotational and forward motion of the breaking assembly (120) and positions the breaking element (121) in a second position protruding through the opening (115) in the distal tip (112).

[0269] The breaking tool (100) of Figures 10d-10f can be coupled to the breaking motion generator (200) by means of the motion transmission element (122). To that end, the breaking tool (100) comprises first attachment and / or coupling means (140), shown in detail in Figure 10f, configured to couple the motion transmission element (122) to the breaking motion generator (200).

[0270] The breaking device (100) of Figures 10g-10i can be coupled to the breaking motion generating device (200) by the motion transfer element (122) and by the supports (160.1, 170.1, 180.1) as a result of the first and second attachment and / or coupling means (140, 150). The assembly of the first and second attachment and / or coupling means (140, 150) is shown in detail in Figure 6i, which is configured to couple the motion transfer element (122) and the supports (160.1, 170.1, 180.1) to the breaking motion generating device (200).

[0271] 11a-11c show a breaking system (500) for surgical intervention, a breaking motion generator and linear reciprocating motion generator (200') configured to generate and execute a breaking motion and to generate and execute a linear or reciprocating motion; a breaking tool (100) without means for transmitting and converting motion; Equipped with The breaking motion and linear or reciprocating motion generating device (200') is further configured to transmit the breaking motion and linear or reciprocating motion to the motion transmitting element (122). The breaking system (500) is shown.

[0272] In this example, the breaking tool (100) is further attached to the breaking motion and linear or reciprocating motion generating device (200') by a first attachment and / or coupling means (140) and a second attachment and / or coupling means (150).

[0273] In the particular example of Figures 11a-11c, the breaking and linear motion generating device (200') comprises mechanical and / or electromagnetic and / or electronic means for generating breaking and linear or reciprocating motion, which are activated simultaneously by one and the same push button.

[0274] In particular, Figure 11a shows a side view of the system (500).

[0275] FIG. 11b shows a cross-sectional view of the system (500) with the breaking element (121) in a first position.

[0276] 11c shows a cross-sectional view of the system (500) with the breaking element (121) in a second position. Additionally, the drilling device (200′) is actuated (arrow pointing to the drill trigger), causing rotational and forward movement of the breaking assembly (120), with the breaking element (121) positioned in a second position protruding through the opening in the distal tip (112), and performing simultaneous rotational and reciprocal movements, as indicated by the arrow.

[0277] In any of the systems (400, 500) described in this application, the first sagittal plane of the breaking instrument (100) can maintain a fixed position relative to the sagittal plane of the breaking motion generating device.

[0278] In a specific embodiment not shown, the first sagittal plane (103) of the breaking instrument (100) can be rotated between a plurality of positions, for each of which the first sagittal plane (103) of the breaking instrument (100) rotates relative to the sagittal plane of the breaking motion generating device (200, 200').

[0279] Advantageously, rotation of the first sagittal plane (103) of the breaking instrument (100) relative to the sagittal plane of the breaking motion generating device (200, 200') allows the sagittal plane of the breaking motion generating device (200, 200') to be maintained in a fixed position and only the breaking instrument (100) to be rotated, which promotes the usability and accuracy of the breaking instrument (100).

[0280] In certain embodiments, the rupture system (400, 500) comprises a disposable rupture instrument (100).

[0281] In another particular embodiment, the breaking system (400, 500) comprises a breaking instrument (100) and a breaking motion generating device (200, 200') that are disposable, except for the motor and battery of the breaking motion generating device (200, 200').

[0282] FIG. 12a shows the state of the art of bone tunnel back-milling with a breaking tool having a single axis of rotation coinciding with the breaking axis, which results in only a cylindrical widening of the first bone tunnel.

[0283] FIG. 12b shows an angled bone tunnel formed and reamed by the breaking instrument of the present invention.

[0284] FIG. 12c shows a different example for widening a straight bone tunnel with a breaking instrument of the present invention.

[0285] A first example of a surgical procedure performed with the rupture system of the present invention, specifically to repair the supraspinatus tendon of the shoulder joint.

[0286] In a second aspect, which complements the first aspect, the present invention provides a first method for carving an angled bone tunnel with an enlarged intra-articular exit opening in a human or animal body during connective tissue repair, the method being shown in the flow chart of Figure 13a.

[0287] The method includes the following steps: a) forming a first straight segment (1) of an angled bone tunnel in a bone to be carved, the first straight segment (1) having an entrance opening in the outer cortex of the bone; b) providing a breaking system (400, 500) comprising the breaking device (100) of the present invention; c) introducing the longitudinal body (110) of the breaking instrument into the first straight segment (1) and positioning the distal tip (112) in the distal segment of the first segment of the bone tunnel and orienting the second longitudinal axis in the desired direction; d) actuating the breaking system (400, 500) by manually or automatically advancing the breaking element (121) from the first position to the second position, thereby carving, during its movement, a second linear segment (2) of the angled bone tunnel at an angle α relative to the first linear segment (1) of the bone tunnel and with an exit opening in the inner bone cortex; e) rotating the main body (111) of the breaking instrument left and right, thereby widening the intra-articular exit opening of the angled bone tunnel by the desired angle with the breaking element (121); f) deactivating the breaking device and returning the breaking element (121) to the first position manually or automatically; g) Removing the breaking instrument from the angled bone tunnel (1-2-3) that has been widened by the breaking instrument of the present invention.

[0288] In this embodiment, step a) is carried out with any instrument capable of carving a straight bone tunnel into bone, for example a bit or mill coupled to a surgical drill.

[0289] In certain embodiments, the connective tissue being repaired is the supraspinatus tendon of the shoulder joint.

[0290] Figure 13b shows in detail the different segments of the bone tunnel carved into the greater tuberosity of the humerus. 1) Side and front views of the first straight segment of the bone tunnel (1). 2) Side and front views of the first straight segment (1) and the second straight segment (2) of the bone tunnel. 3) Side, front and perspective views of a complete bone tunnel with the intra-articular exit opening (2-3) widened with any of the systems of the present invention.

[0291] FIG. 13c shows a more preferred specific embodiment, where the breaking system (400, 500) used in the method comprises a breaking tool (100) comprising a breaking guide (300).

[0292] In an embodiment of this method, steps b) and c) comprise the following substeps: b1) inserting the distal tip (322.2) of the distal portion (322) of the guide arch (320) of the fracture guide (300) into the patient's body and positioning said distal tip (322.2) approximately in the center of the original insertion footprint; b2) with the guide arch (320) parallel to the coronal plane, positioning the distal end of the tubular guide (310) of the fracture guide (300) on the outer cortex of the bone to be carved, approximately at a distance of between about 15 mm and 25 mm from the greater tuberosity; b3) engraving a first straight segment of an angled bone tunnel using a laser depth marked bit; b4) removing the bit and applying a striking force to the striking edge (312) of the tubular guide (310) so that the distal appendage (311.3) of the tubular guide (310) penetrates the first segment (1) of the bone tunnel; b5) introducing the longitudinal body (110) of the breaking tool (100) into the longitudinal channel (311) of the tubular guide (310); b6) Decoupling the guide arch (320) from the tubular guide (310).

[0293] In step b2), a tubular guide (310) is preferably selected whose locating holes (314) must have a length that is compatible with the patient's anatomy.

[0294] Additionally, step e) of the method includes the following substeps using a breaking tool (100) equipped with a breaking guide (300): e) activating the breaking system (400, 500) and, with the longitudinal body (110) of the breaking instrument (100) inserted into the longitudinal conduit (311), rotating the longitudinal body (110) left and right relative to the second sagittal plane (303), thereby widening the exit opening of the second bone tunnel (2) into a fan-shaped or funnel-shaped shape (3).

[0295] In even more specific embodiments, left and right rotation of the longitudinal body (110) relative to the second sagittal plane (303) is limited by interaction between the hole (314) in the tubular guide (300) and the first protrusion (113) on the longitudinal body (110).

[0296] In another embodiment, the method further comprises the substep of retracting the longitudinal body (110) in a distal-proximal direction and / or advancing the longitudinal body (110) a certain distance in a proximal-distal direction while the system (400) is activated, and rotating the longitudinal body (110) left and right relative to the second sagittal plane (303), thereby widening the exit opening (2) of the second bone tunnel into a fan-like or funnel-like shape (3) in one or more planes parallel to the plane initially formed in step e).

[0297] FIG. 13d shows a musculoskeletal view of a bone tunnel (1-2-3) carved with one of the systems (400, 500) of the present invention and the insertion of a graft to repair the supraspinatus tendon in the shoulder joint.

[0298] In the specific example of repairing a torn supraspinatus tendon of the rotator cuff, the dimensions of the intra-articular exit opening of the created bone tunnel must be such as to allow for the insertion of the end of the torn tendon, measuring between 4 mm and 5 mm in thickness and between 20 mm and 25 mm in width at the level of the rotator chord. However, these specific measurement ranges provided in the foregoing example must be adapted based on the respective anatomical structure and the end use for which the breaking instrument will be used, which, in general, is suitable for breaking any connective tissue and / or cartilage and / or bone tissue in human or veterinary medicine.

[0299] Once the angled bone tunnel has been created and the intra-articular exit opening has been widened into a fan or funnel shape using one of the inventive breaker systems (400, 500), the end of the supraspinatus tendon to be repaired is sutured, and a suture band is passed through the widened, angled bone tunnel (1-2-3), e.g., with a curved suture threader. The lower left portion of Figure 13d shows the tendon end already passing through the anatomically widened bone tunnel opening and the suture band emerging from the bone tunnel. The lower right portion of Figure 13d shows the suture band (20) held by a cortical multi-suture fixation device (10), which may be, for example, that described in U.S. Pat. No. 5,630,824 or European Patent No. 3,141,216.

[0300] Figure 13e shows a perspective view of the same method shown in the middle and bottom views of Figure 13d. In particular, this figure illustrates repair of a partial supraspinatus tendon rupture through an enlarged angled bone tunnel (1-2-3) using a suture band (20) formed with one of the inventive fracture systems (400, 500) and threading the tendon end through an anatomically enlarged bone tunnel opening. The lower right portion of the figure shows the suture band (20) held by a cortical multi-suture fixation device (10), which may be, for example, that described in U.S. Pat. No. 5,630,824 or European Patent No. 3,141,216.

[0301] Figure 13f shows an overview of the steps of a method for repairing a complete rupture of the supraspinatus tendon. The method involves the creation of an angled bone tunnel (1-2-3) reamed by one of the inventive rupture systems (400, 500) and the use of expander tissue (30) and a suture band (20) that threads the end of the reinforcing tissue (30) through the opening of the anatomically reamed bone tunnel. The lower right portion of Figure 13f shows the suture band (20) held by a cortical multi-suture anchoring device (10), which may be, for example, that described in U.S. Pat. No. 5,630,824 or European Patent No. 3,141,216.

[0302] In certain embodiments, the reinforcement tissue (30) is decellularized dermal tissue. In another specific embodiment, the reinforcement tissue (30) comprises biodegradable biopolymer fibers. In another specific embodiment, the reinforcement tissue (30) comprises a bioabsorbable poly(lactic-co-glycolic acid) (PLGA) aligned microfiber scaffold.

[0303] Considering that failure rates of up to 68% have been reported in complete ruptures of the supraspinatus tendon (Jost B, Pfirrmann CWA, Gerber C. Clinical outcomes after structural failure of rotator cuff repair. J Bone Joint Surg Am 2000;82:304-14.), the goal in all cases is to achieve revascularization of the tendon ends through osseointegration of the reinforcing tissue (30).

[0304] A second example of a surgical procedure performed with the disruption system of the present invention, specifically to repair the anterior cruciate ligament of the knee joint.

[0305] In a third aspect, also complementary to the first aspect, the present invention provides a second method for carving and / or back-carving an anatomical bone tunnel in a human or animal body during connective tissue repair, which method is shown in the flow chart of Figure 14a.

[0306] The method includes the following steps: a) forming a straight bone tunnel (4, 4') having an entrance opening in the outer cortex of the bone to be carved and an exit opening in the inner cortex of said bone; b) providing a breaking system (400, 500) comprising the breaking device (100) of the present invention; c) introducing the main body (111) of the breaking instrument (100) into the straight tunnel with the distal tip (112) positioned within the distal segment of the bone tunnel and orienting the second longitudinal axis (102) in the first direction; d) activating the breaking system by manually or automatically advancing the breaking element (121) from the first position to the second position, thereby engraving the first widening segment (5, 5') during its movement; e) retracting the breaking instrument and back-cutting the first widened segment (5, 5') of the bone tunnel the desired distance; f) (optionally) repositioning the distal tip (112) within the distal segment of the bone tunnel and orienting the second longitudinal axis (102) in a second direction, the first direction and the second direction forming an angle α greater than 0 degrees with respect to each other; g) (optionally) activating a breaking tool to carve a second widening segment (6,6') of the straight bone tunnel (4,4'); h) (optionally) retracting the breaking instrument and back-cutting the second widening segment (6, 6') of the bone tunnel a desired distance; i) returning the breaking element (121) to the first position where the first longitudinal axis (101) and the second longitudinal axis (102) are coaxial and disengaging the breaking system (400, 500); j) Removing the breaking instrument (100) from the anatomically reamed bone tunnel.

[0307] Throughout this specification, "recarving back" should be understood to mean the action of returning a breaking element from a first distal position within the bone tunnel to a second proximal position within the bone tunnel, which action widens the bone tunnel segment through which the breaking element has been moved.

[0308] Steps d), e), and f) are optional, and in certain embodiments, a single widening segment is carved. This particular embodiment is specifically indicated for anatomical reconstruction of the ACL using a single folded semitendinosus graft comprising three branches with two free ends and two bent ends.

[0309] In a particular embodiment, the connective tissue on which the above-described method is performed is the cruciate ligaments of the knee joint.

[0310] In certain embodiments, a user performing the method with a breaking tool can use a reference ring (116) that is disposed around and movable along the longitudinal body (110) to determine the depth of the backcut.

[0311] In certain embodiments, the user performs the method using a breaking tool (100) of the present invention that includes a breaking guide (300). In more particular embodiments, the tool (100) includes a reference ring (116) that is disposed around and movable along the longitudinal body (110) to provide a guide for determining the depth of the backcut.

[0312] More specifically, while reaming a straight bone tunnel for an ACL, the user places the reference ring (116) in contact with the proximal end of the first coupling means (322) of the guide arch (320) of the fracture guide (300) as the distal tip (112) protrudes through and reams the intra-articular opening of the straight bone tunnel. The user then rotates the fracture instrument including the tubular guide (310) to the desired position to begin backcutting, whereby the distance the reference ring moves away from the proximal end of the first coupling means (322) indicates to the user the depth of the backcut.

[0313] FIG. 14b shows the steps of the above method performed on the tibia: 1. Time point 1 shows a straight bone tunnel (4) formed by a breaking instrument, such as a drill, with an entrance opening at the outer cortex of the bone to be carved and an exit opening at the inner cortex of said bone. 2. Point 2 shows how the longitudinal body (110) of the breaking instrument (100) is introduced through the straight bone tunnel (4) with the breaking system (500) released. 3. Time point 3 shows how the breaking instrument (100) is rotated to orient the second longitudinal axis (102) in a first direction and activate the breaking system (400, 500), with the breaking element (121) extending through the distal tip (112) of the instrument (100). 4. Point 4 shows how the breaking instrument (100) is retracted a certain distance along the straight bone tunnel (4) to carve out the first widening segment (5) of the straight bone tunnel (4), after which the breaking system (400, 500) is released and the longitudinal body (110) is reintroduced into the end of the straight bone tunnel (4). 5. Time point 5 shows how the breaking instrument (100) is rotated to orient the second longitudinal axis (102) in a second direction, the first direction and the second direction forming an angle of approximately 45 degrees relative to one another, and in addition, at this point, a restart of the system (500) is shown to extend the breaking element (121) through the distal tip (112) of the instrument (100). 6. Finally, time point 6 shows how the breaking instrument (100) is retracted a certain distance along the straight bone tunnel (4) to carve out a second widening segment (6) of the straight bone tunnel (4).

[0314] After these operations, the breaking system (400, 500) is released, the breaking element (121) is retracted, and finally the breaking instrument (100) is removed from the straight bone tunnel (4) having the first and second widening segments (5, 6).

[0315] FIG. 14c shows in detail a straight bone tunnel (4) with first and second widening segments (5, 6) carved into the tibia. 1) Perspective view of a straight bone tunnel (4). 2) Perspective view of a straight bone tunnel (4) with a first widened segment (5) carved by the breaking instrument of the present invention. 3) Perspective view of a straight bone tunnel (4) with first and second widened segments (5, 6) carved with a breaking instrument of the present invention.

[0316] FIG. 14d shows the steps of the above method performed on the femur: - Point 1 shows a straight bone tunnel (4) formed by a breaking instrument, such as a drill, having an entrance opening in the outer cortex of the bone to be carved and an exit opening in the inner cortex of said bone, and further shows how the longitudinal body (110) of the breaking instrument (100) is introduced through the straight bone tunnel (4') with the breaking system (400, 500) released. - Time point 2 shows how the breaking instrument (100) is rotated to orient the second longitudinal axis (102) in the first direction. -Times 3 and 4 show the activation of the breaking system (400, 500), with the breaking element (121) extending through the distal tip (112) of the instrument (100) and carving back the first widening segment (5') of the straight tunnel (4'). - Time point 5 shows the release of the breaking system (400, 500) and subsequent rotation, which attempts to orient the second longitudinal axis (102) of the instrument (100) in a second direction, the first direction and the second direction forming an angle of 180 degrees relative to each other. -Times 6 and 7 show the restart of the system (400, 500) to extend the breaking element (121) through the distal tip (112) of the instrument (100) and re-cut the second widening segment (6') of the straight bone tunnel (4'). - After these actions, the breaking system (400, 500) is released, the breaking element (121) retracts to the second position and finally the instrument is removed, leaving behind a carved straight bone tunnel (4') with first and second widening segments (5', 6'), as shown at time 8 in Figure 14d.

[0317] Figure 14e shows in detail the straight bone tunnel (4') with first and second widening segments (5, 6) carved into the femur. 1) Perspective view of a straight bone tunnel (4). 2) Perspective view of a straight bone tunnel (4) with a first widening segment (5) carved with the system (500) of the present invention. 3) Perspective view of a straight bone tunnel (4) with first and second widening segments (5', 6') carved with the system (400, 500) of the present invention.

[0318] In the specific example of reconstructing the anterior cruciate ligament, the intra-articular exit opening of the created bone tunnel must be such as to allow for the insertion of fibrous material, which in the Caucasian population generally measures between 2 mm and 4 mm in thickness and between 12 mm and 18 mm in width. However, these specific measurement ranges provided in the preceding example must be adapted in human and veterinary medicine based on the specific anatomy of other populations, the specific anatomy of a particular patient, and the type of implant and / or technique used and / or the end use for which the disruption device will be used.

[0319] Figure 14f shows an overall view of the steps of a method for reconstructing the anterior cruciate ligament (ACL) of a right knee. In particular, step 1) shows an overall view of the joint with the bone tunnel anatomically reamed by the breaking instrument of the present invention. Step 2) shows the introduction of a suture band into the tibial tunnel, drawing both branches of the quartered semitendinosus graft into the tibial tunnel. Step 3) shows the suture band at the femoral end of the implant being introduced into the femoral tunnel. Step 4) shows the anatomical twisting of the implant achieved in restoring the C-shaped insertion footprint of the original ACL.

[0320] FIG. 14g shows an overview of the steps of a method for reconstructing the anterior cruciate ligament (ACL) of a right knee. In particular, step 1) shows a general view of the joint with the femoral tunnel anatomically widened by the breaking instrument of the present invention and a conventional cylindrical tibial tunnel. Steps 2) and 3) show the introduction of the semitendinosus-gracilis implant into the joint. Step 4) shows the anatomical twisting of the implant, achieved in this case by holding both ends of the implant with cortical fixation devices (10) such as those described in EP 3141216 and EP 3897455.

[0321] In an exemplary embodiment, preferred as "Embodiment 1," a breaking instrument (100) for minimally invasive surgical intervention is presented, the breaking instrument (100) comprising: a longitudinal body (110), a main body (111) oriented according to a first longitudinal axis (101); a distal tip (112) attached to a main body (111) with an opening (115) oriented according to at least one second longitudinal axis (102), the distal tip (112) forming a ramp with respect to the main body (111); Equipped with the first longitudinal axis (101) and the at least one second longitudinal axis (102) form an angle α greater than 0 degrees with respect to each other, and the first longitudinal axis (101) and the at least one second longitudinal axis (102) are contained in a first sagittal plane (103); a longitudinal body (110); a breaking assembly (120), a breaking element (121) comprising a first breaking axis (121.1) and configured to receive and perform a breaking movement about the first breaking axis (121.1) and to receive and perform a linear movement along the longitudinal body (110) from a first position to at least one second position and vice versa, When the breaking element (121) is in the first position, the breaking element (121) is oriented within the main body (111) according to the first longitudinal axis (101); a breaking element (121) oriented according to at least one second longitudinal axis (102) when the breaking element (121) is in a second position and protruding at least partially through an opening (115) in the distal tip (112); a motion transfer element (122) comprising a proximal portion (122.1), a flexible or articulating distal portion (122.2), and a second break-off shaft (122.3), the motion transfer element (122) being rigidly attached to the break-off element (121) by the flexible or articulating distal portion (122.2); receiving and carrying out a breaking movement about a second breaking axis (122.3) and transmitting the breaking movement to the breaking element (121); receiving and carrying out a linear motion moving along the longitudinal body (110) and transmitting the linear motion to the breaking element (121); a motion transfer element (122) configured to: a break assembly (120) comprising: at least one stiffening means (130) configured to provide stiffness to the breaking assembly (120) when the breaking element (121) is in a second position protruding at least partially through the opening (115) of the distal tip (112); Equipped with.

[0322] [Embodiment 2] The breaking instrument (100) according to the aforementioned "embodiment", wherein the distal tip (112) is - as an extension of said main body (111), or - by a mounting element configured to position the tip (112) in a plurality of angular positions such that, for each of said plurality of angular positions, at least one second longitudinal axis (102) forms a different angle α with the first longitudinal axis (101); A breaking device (100) attached to the main body (111).

[0323] [Embodiment 3] The breaking instrument (100) according to the aforementioned "embodiment", wherein the stiffening means (130) comprises a tubular element (131) having a proximal portion (131.1) and a distal portion (131.2), the tubular element (131) comprising: sized and configured to move along the longitudinal body (110); sized and configured to at least partially accommodate therein a flexible or articulating distal portion (122.1) of the motion transmission element (122); configured to orient the distal portion (131.2) according to the first longitudinal axis (101) when the breaking element (121) is in the first position; configured to orient the distal portion (131.2) according to at least one second longitudinal axis (102) when the breaking element (121) is in at least one second position; Breaking device (100).

[0324] [Embodiment 4] The breaking instrument (100) according to the aforementioned "embodiment", wherein the tubular element (131) further comprises at least one elongated notch (132) disposed in the distal portion (131.2) that forms at least one angle β with the first sagittal plane (103) that is greater than 0 degrees and less than or equal to 90 degrees; - each of the at least one elongated notch (132) separates two different segments (132.1) of the distal part (131.2) of the tubular body (131); - when the breaking element (121) is in at least one second position, the sum of the separations between the segments (132.1) of the tubular body (131) is substantially zero; Breaking device (100).

[0325] [Embodiment 5] A breaking instrument (100) according to either "embodiment 3 or 4", wherein the longitudinal body (110) further comprises at least one distal longitudinal groove (114), and the tubular element (131) further comprises at least one first protrusion (133); - at least one distal longitudinal groove (114) has a distal limit and a proximal limit; the at least one distal longitudinal groove (114) is dimensioned to receive the at least one first protrusion (133) and configured to cooperate with said first protrusion (133) to guide the tubular element (131) in the direction of the sagittal plane (103) when the breaking element (121) moves from a first position to at least one second position and vice versa; the at least one first protrusion (133) is dimensioned to pass through the at least one distal longitudinal groove (114), cooperates with said distal longitudinal groove (114), and is configured to move along the distal longitudinal groove (114) when the breaking element (121) moves from a first position to at least one second position and vice versa; the at least one first protrusion (133) abuts the distal limit of the at least one distal longitudinal groove (114) when the breaking element (121) is in the at least one second position; Breaking device (100).

[0326] [Embodiment 6] A breaking tool (100) according to any of the above-mentioned "embodiments", further comprising at least one first attachment and / or coupling means (140) configured to attach or couple the motion transmission element (122) to the breaking motion generating device (200, 200').

[0327] [Embodiment 7] A breaking tool (100) according to any of the aforementioned "embodiments", further comprising a support (160.1, 170.1, 180.1) at least partially surrounding the motion transmission element (122), and a second attachment and / or coupling means (150) configured to attach or couple the support (160.1, 170.1, 180.1) to a breaking motion generating device (200, 200').

[0328] [Embodiment 8] The breaking instrument (100) according to any of the foregoing "embodiments," further comprising a breaking guide (300) configured to guide the longitudinal body (110) from an original position to at least one target position, the breaking guide (300) comprising: at least one tubular guide (310), a longitudinal conduit (311) having a proximal end (311.1) and a distal end (311.2), the longitudinal conduit (311) including a distal appendage (311.3) at the distal end (311.2); a striking edge (312), an extension of the longitudinal conduit (311) at the proximal end (311.1); Equipped with The longitudinal conduit (311) is configured to receive the longitudinal body (110) therein; At least one tubular guide (310) is oriented according to a first longitudinal guide axis (321.1); The striking edge (312) is configured to receive a striking force in the direction of the first longitudinal guide axis (321.1); At least one tubular guide (310); - a guide arch (320), a proximal arch portion (321) comprising first coupling means (330) configured to securely couple and decouple the proximal arch portion (321) to the tubular guide (310) at a plurality of different locations along a first longitudinal guide axis (321.1); a distal arch portion (322) having a distal tip (322.2) oriented according to a second longitudinal guide axis (322.1); a second coupling means (340) configured to couple the distal arch portion (322) to the proximal arch portion (321) at a plurality of different positions, for each of which the first longitudinal guide axis (321.1) and at least one second longitudinal guide axis (322.1) form a different angle α2 with respect to one another; Equipped with the first longitudinal guide axis (321.1) and at least one second longitudinal guide axis (322.1) are contained in a second sagittal plane (301); Guide arch (320), Equipped with Breaking device (100).

[0329] [Embodiment 9] A breaking instrument (100) according to the aforementioned "embodiment", the at least one tubular guide (310) further comprises a hole (314) comprising a first portion (314.1) and a second portion (314.2); the main body (111) of the longitudinal body (110) comprises at least one second protrusion (113); the first portion (314.1) of the hole (314) is sized and configured to receive and guide the second protrusion (113) from a proximal position to the second portion (314.2) when the longitudinal body (110) of the breaking instrument (100) is inserted into and moves along the interior of the at least one tubular guide (310) of the breaking guide (300); the second portion (314.2) is sized and configured to abut the second protrusion (113) when the first sagittal plane (103) of the breaking instrument (100) is rotated by an angle γ about the second sagittal plane (301) of the breaking guide (300); Breaking device (100).

[0330] A breaking instrument (100) according to "Embodiment 10" or "Embodiment 8", The at least one tubular guide (310) further comprises at least one longitudinal hole (314), and the main body (111) of the longitudinal body (110) comprises at least one second protrusion (113); the at least one longitudinal bore (314) is sized and configured to receive and guide the at least one second protrusion (113) from a proximal position to a distal position and vice versa; Breaking device (100).

[0331] [Embodiment 11] In the breaking instrument (100) according to "embodiment 9 or 10," the breaking guide (300) comprises a plurality of tubular guides (320), and each of the tubular guides (320) the dimensions of the holes (314), and / or the shape of the holes (314), and / or the dimensions of the first portion (314.1) of the hole (314), and / or the shape of the first part (314.1) of the hole (314), and / or the dimensions of the second portion (314.2) of the hole (314), and / or the shape of the second part (314.2) of the hole (314); are different from each other, Breaking device (100).

[0332] [Embodiment 12] The breaking instrument (100) according to any one of "embodiments 8 to 11," wherein the distal appendage (311.3) is Trilobed tip, or Two tips, or chamfered recesses, or ·Polyhedral surface Equipped with Breaking device (100).

[0333] [Embodiment 13] A breaking tool (100) according to any of the aforementioned "embodiments," wherein the breaking motion is a rotational motion, and the breaking tool (100) - receiving a rotational motion from a rotational motion generating device (200, 200'); - converting rotary motion into linear and / or reciprocating motion; - transmitting a linear and / or reciprocating motion to a motion-transmitting element (122), which in turn transmits a linear and / or reciprocating motion to the breaking element (121) to move the breaking element (121) from a first position to at least one second position; - stopping the linear and / or reciprocating movement when the rotational movement is stopped, and moving the breaking element (121) from at least one second position to the first position; and further comprising a conversion means (160, 170, 180) configured to perform Breaking device (100).

[0334] [Embodiment 14] In the breaking instrument (100) according to the aforementioned "embodiment," the breaking motion generating device (200, 200') is a perforating device (200, 200'), and the motion transmission and conversion means (160) is a first longitudinal rotary motion transmission element (161) that can be coupled to a motion transmission shaft of a drilling device (200, 200'), the first longitudinal element (161) being configured to receive a rotary motion from said drilling device (200, 200') and to perform said rotary motion; - a second longitudinal rotational motion transmission element (162) attached to the proximal portion (122.1) of the motion transmission element (122) and configured to receive rotational motion from the first longitudinal element (161) and to perform said rotational and linear motion; a brake actuator (163) connected to the second longitudinal element (162) and configured to exert a force on the second longitudinal element (162) to prevent it from rotating; a return spring (164) configured to exert a linear return force on the second longitudinal element (162); a helical sliding connection (165) configured to connect the first longitudinal element (161) to the second longitudinal element (162); Equipped with The spiral sliding connection (165) is a longitudinal coupling part (161.1) attached to the first longitudinal element (161), the longitudinal coupling part (161.1) having a first thread (161.2) on its outer surface; a longitudinal coupling conduit (162.1) attached to the second longitudinal element (162), the longitudinal coupling conduit (162.1) having a second thread (162.2) on its inner surface; Equipped with the first thread (161.2) of the longitudinal coupling portion (161.1) and the second thread (162.2) of the longitudinal coupling conduit (162.1) are configured to cooperate with one another to cause a linear movement of the longitudinal coupling conduit (162.1) relative to the longitudinal coupling portion (161.1) when the longitudinal coupling conduit (162.1) undergoes a rotational movement and the longitudinal coupling portion (161.1) rotates at a slower speed than the longitudinal coupling conduit (162.1), and the thread direction of the helical sliding coupling (165) is opposite to the direction of the rotational movement of the drilling device; Breaking device (100).

[0335] [Embodiment 15] A breaking tool (100) according to "embodiment 13," wherein the breaking motion generating device (200, 200') is a punching device (200, 200'), and the motion transmission and conversion means (170) is - a male-female sliding connection (173), a primary rotor (171) connectable to a motion transmission shaft of the drilling device (200, 200'), the primary rotor (171) being configured to receive and perform rotational motion from the drilling device (200, 200'); a secondary rotor (172) slidably coupled at a proximal end to the primary rotor (171) and attached at a distal end to the proximal portion (122.1) of the motion transmission element (122), the secondary rotor (172) further comprising grooves or depressions (172.1) having a sinusoidal shape on its outer surface, the secondary rotor (172) configured to move linearly in both directions relative to the primary rotor (171) as a result of the sliding coupling; a male-female sliding coupling (173) comprising: a return spring (174) configured to exert a return force on the secondary rotor (172); a manual activation control (175) connected to a fixed plunger (176), the manual activation control (175) being configured so that the fixed plunger (176) passes through a groove or recess (172.1) in the secondary rotor (172); Equipped with When the secondary rotor (172) receives and performs rotational motion from the primary rotor (171), activation of the control (175) causes the fixed plunger (176) to penetrate the groove or recess (172.1) and the secondary rotor (172) to perform a linear back and forth reciprocating motion relative to the primary rotor (171); The secondary rotor (172) transmits the linear back-and-forth reciprocating motion in combination with the rotational motion to the motion transmission element (122), and the motion transmission element (122) transmits the linear back-and-forth reciprocating motion in combination with the rotational motion to the breaking element (121); When the fixed plunger (176) is removed from the groove or recess (172.1) by releasing the control (175), the secondary rotor (172) performs a return movement in the distal-proximal direction, pushed by the return spring (174). Breaking device (100).

[0336] [Embodiment 16] A breaking tool (100) according to "embodiment 13," wherein the breaking motion generating device (200, 200') is a punching device (200, 200'), and the motion transmission and conversion means (180) comprises: - a male-female sliding connection (183), a primary rotor (181) connectable to a motion transmission shaft of the drilling device (200, 200'), the primary rotor (181) being configured to receive and perform rotational motion from the drilling device (200, 200'); a secondary rotor (182) slidably coupled at a proximal end to the primary rotor (181), the secondary rotor (182) configured to move linearly in both directions relative to the primary rotor (181) as a result of the sliding coupling, the secondary rotor (182) comprising a rotary pressure generator (185); a male-female sliding coupling (183) comprising: a return spring (184) configured to exert a return force on the secondary rotor (182); a fluid compartment comprising a first chamber (186), a second chamber (187) and a fluid (188), The first chamber (186) and the second chamber (187) are in fluid communication, and a fluid (188) is disposed within the chambers (186, 187); a rotary pressure generating device (185) immersed in a fluid (188) and positioned between a first chamber (186) and a second chamber (187); The secondary rotor (182) is attached to the proximal portion (122.1) of the motion transmission element (122), a fluid compartment; Equipped with When the secondary rotor (182) receives the rotational motion from the primary rotor (181) and performs the rotational motion, the rotational pressure generator (185) receives the rotational motion and generates a thrust force greater than the return force of the return spring (184), causing the fluid (188) to flow from the first chamber (186) into the second chamber (187); The flow of fluid (188) causes linear motion of the secondary rotor (182) in a proximal-distal direction, The secondary rotor (182) transfers linear motion, in combination with rotational motion, to the motion transfer element (122), which transfers linear motion, in combination with rotational motion, to the breaking element (121); When the secondary rotor (182) stops receiving rotational motion from the primary rotor (181), the secondary rotor (182) is pushed by the return spring (184) to perform a linear motion in the distal-proximal direction. Breaking device (100).

[0337] [Embodiment 17] A fracture system (400) for minimally invasive surgical intervention, the fracture system (400) comprising: a breaking movement generating device (200, 200') configured to generate and execute a breaking movement; - at least one breaking tool (100) according to any of the previous "embodiments", which can be coupled to a breaking motion generator (200, 200') by at least a motion transmission element (122); Equipped with The breaking motion generating device (200, 200′) is further configured to transmit the breaking motion to the motion transmission element (122). Breaking system (400).

[0338] [Embodiment 18] A fracture system (500) for minimally invasive surgical intervention, the fracture system (500) comprising: a breaking and linear and / or reciprocating motion generating device (200') configured to generate and execute breaking and linear and / or reciprocating motions; - at least one breaking tool (100) according to any of the first to twelfth embodiments, which can be coupled to a breaking motion and a linear and / or reciprocating motion generating device (200') by at least a motion transmission element (122); Equipped with The breaking motion and linear and / or reciprocating motion generating device (200') is further configured to transmit the breaking motion and linear and / or reciprocating motion to the motion transmitting element (122); Breaking system (500).

[0339] [Embodiment 19] A breaking system (500) according to the above-mentioned "embodiment", wherein the breaking motion and linear and / or reciprocating motion generating device (200') comprises mechanical and / or electronic and / or electromagnetic means.

Claims

1. A fracture device (100) for minimally invasive surgical intervention to create a bone tunnel suitable for proper anatomical reconstruction of tendons and ligaments, - The longitudinal body (110), A main body (111) oriented according to a first longitudinal axis (101), A distal tip portion (112) attached to the main body (111) having an opening (115) oriented according to at least one second longitudinal axis (102), wherein the distal tip portion (112) forms an incline relative to the main body (111), Equipped with, The first longitudinal axis (101) and the at least one second longitudinal axis (102) form an angle α greater than 0 degrees with respect to each other, and the first longitudinal axis (101) and the at least one second longitudinal axis (102) are included in the first sagittal plane (103). The longitudinal main body (110) and - A fractured assembly (120), A fracture element (121) is provided with a first fracture axis (121.1) and is configured to receive and execute a fracture motion about the first fracture axis (121.1), and to receive and execute a linear motion moving along the longitudinal body (110) from a first position to at least one second position and in reverse, When the breaking element (121) is in the first position, the breaking element (121) is oriented within the main body (111) according to the first longitudinal axis (101), When the fracture element (121) is in the second position, the fracture element (121) is oriented according to the at least one second longitudinal axis (102) and at least partially protrudes through the opening (115) of the distal tip (112), A motion transmission element (122) comprising a proximal portion (122.1), a flexible or articulated distal portion (122.2), and a second fracture axis (122.3), wherein the motion transmission element (122) is firmly attached to the fracture element (121) by the flexible or articulated distal portion (122.2), The system receives and executes the fracture motion centered on the second fracture axis (122.3), and transmits the fracture motion to the fracture element (121). The linear motion moving along the longitudinal body (110) is received and executed, and the linear motion is transmitted to the breaking element (121), A motion transmission element (122) is configured to perform the following: A fracture assembly (120) comprising, - When the fracture element (121) is in the second position, at least partially protruding through the opening (115) of the distal tip (112), at least one stiffening means (130) configured to provide stiffness to the fracture assembly (120), Equipped with, The rigidity-imparting means (130) comprises a tubular element (131), the tubular element (131) comprises a proximal portion (131.1) and a distal portion (131.2), and the tubular element (131) is Dimensioned and configured to move along the longitudinal body (110), The dimensions and configuration are such that the flexible or articulated distal portion (122.1) of the motion transmission element (122) is at least partially housed therein. When the fracture element (121) is in the first position, it is configured to orient the distal portion (131.2) according to the first longitudinal axis (101), When the fracture element (121) is in the at least one second position, it is configured to orient the distal portion (131.2) according to the at least one second longitudinal axis (102). Breaking tool (100).

2. The distal tip portion (112) is - As an extension of the main body (111), firmly, or - By mounting elements configured to position the tip portion (112) at each of the plurality of angular positions such that the at least one second longitudinal axis (102) forms an angle α different from the first longitudinal axis (101), The main body (111) is attached to the above The breaking device (100) according to claim 1.

3. The first fracture element (121.1) is - The breaking element (121) rotates on a rotating shaft, or The fracture element (121) is the vibration axis through which it performs vibrational motion. The breaking device (100) according to claim 1.

4. The tubular element (131) further comprises at least one elongated notch (132) located in the distal portion (131.2) that forms at least one angle β greater than 0 degrees and less than or equal to 90 degrees with respect to the first sagittal plane (103), - Each of the at least one elongated notch (132) separates two different segments (132.1) of the distal portion (131.2) of the tubular body (131), - When the breaking element (121) is in the at least one second position, the sum of the separations between the segments (132.1) of the tubular body (131) is substantially zero. The breaking device (100) according to claim 1.

5. The longitudinal body (110) further comprises at least one distal longitudinal groove (114), and the tubular element (131) further comprises at least one first projection (133), - The at least one distal longitudinal groove (114) has a distal limit and a proximal limit, - The at least one distal longitudinal groove (114) is sized to receive the at least one first projection (133) and is configured to cooperate with the first projection (133) to guide the tubular element (131) in the direction of the sagittal plane (103) as the breaking element (121) moves from the first position to the at least one second position and vice versa. - The at least one first projection (133) is sized to penetrate the at least one distal longitudinal groove (114) and is configured to cooperate with the distal longitudinal groove (114) and move along the distal longitudinal groove (114) when the breaking element (121) moves from the first position to the at least one second position and vice versa. - The at least one first projection (133) abuts against the distal limit of the at least one distal longitudinal groove (114) when the breaking element (121) is in the at least one second position. The breaking device (100) according to claim 1.

6. The breaking device (100) according to claim 1, further comprising at least one first attachment and / or coupling means (140) configured to attach or couple the motion transmission element (122) to a breaking motion generating device (200, 200').

7. The breaking device (100) according to claim 1, further comprising a support (160.1, 170.1, 180.1) that at least partially surrounds the motion transmission element (122), and a second attachment and / or coupling means (150) configured to attach or couple the support (160.1, 170.1, 180.1) to a breaking motion generating device (200, 200').

8. The system further comprises a fracture guide (300) configured to guide the longitudinal body (110) from its original position to at least one target position, and the fracture guide (300) - At least one tubular guide (310), A longitudinal conduit (311) having a proximal end (311.1) and a distal end (311.2), wherein the longitudinal conduit (311) includes a distal appendage (311.3) at the distal end (311.2), The striking edge (312), the extension of the longitudinal conduit (311) at the proximal end (311.1), Equipped with, The longitudinal conduit (311) is configured to house the longitudinal body (110) within it. The at least one tubular guide (310) is oriented according to a first longitudinal guide axis (321.1), The striking edge (312) is configured to receive the striking force in the direction of the first longitudinal guide axis (321.1). At least one tubular guide (310) and - Guide arch (320), A proximal arch portion (321) comprising a first coupling means (330) configured to securely connect and disconnect the proximal arch portion (321) to the tubular guide (310) at a plurality of different positions along the first longitudinal guide axis (321.1), The distal arch portion (322) comprises a distal tip portion (322.2) oriented according to a second longitudinal guide axis (322.1), A second coupling means (340) configured to connect the distal arch portion (322) to the proximal arch portion (321) at multiple different positions, wherein, for each of the positions, the first longitudinal guide axis (321.1) and the at least one second longitudinal guide axis (322.1) form different angles α2 with respect to each other; Equipped with, The first longitudinal guide axis (321.1) and the at least one second longitudinal guide axis (322.1) are included in the second sagittal plane (301). Guide arch (320) and Equipped with, The breaking device (100) according to claim 1.

9. The at least one tubular guide (310) further comprises a hole (314) having a first portion (314.1) and a second portion (314.2), and the main body (111) of the longitudinal body (110) comprises at least one second projection (113), The first portion (314.1) of the hole (314) is sized and configured to receive and guide the second projection (113) from its proximal position to the second portion (314.2) when the longitudinal body (110) of the breaking tool (100) is inserted into the at least one tubular guide (310) of the breaking guide (300) and moves along the inside of the at least one tubular guide (310). The second portion (314.2) is sized and configured such that the first sagittal plane (103) of the breaking tool (100) contacts the second projection (113) when the first sagittal plane (103) of the breaking guide (300) is rotated by an angle γ about the second sagittal plane (301). The breaking element (100) according to claim 8.

10. The at least one tubular guide (310) further comprises at least one longitudinal hole (314), and the main body (111) of the longitudinal body (110) comprises at least one second projection (113), The at least one longitudinal hole (314) is sized and configured to receive and guide the at least one second projection (113) from a proximal position to a distal position and vice versa. The breaking device (100) according to claim 8.

11. The fracture guide (300) comprises a plurality of tubular guides (320), and each of the tubular guides (320) - The dimensions of the hole (314), and / or - The shape of the hole (314), and / or - The dimensions of the first portion (314.1) of the hole (314), and / or - The shape of the first portion (314.1) of the hole (314), and / or - The dimensions of the second portion (314.2) of the hole (314), and / or - The shape of the second portion (314.2) of the hole (314) They are different from each other, The breaking device (100) according to claim 9.

12. The distal appendage (311.3) is - Trilobed tip, or - Two tips, or - Chamfered recess, or ・Polyhedral surface A breaking device (100) according to claim 8, comprising:

13. The breaking motion is a rotational motion, and the breaking device (100) is - Receiving rotational motion from the rotational motion generation device (200, 200'), - Converting the rotational motion into linear motion and / or reciprocating motion, - The linear motion and / or reciprocating motion is transmitted to the motion transmission element (122), and the motion transmission element (122) transmits the linear motion and / or reciprocating motion to the breaking element (121), causing the breaking element (121) to move from the first position to the at least one second position, - When the rotational motion stops, the linear motion and / or reciprocating motion stops, and the breaking element (121) moves from the at least one second position to the first position, The breaking device (100) according to claim 1, further comprising conversion means (160, 170, 180) configured to perform the following.

14. The fracture motion generating device (200, 200') is a drilling device (200, 200'), and the motion transmission and conversion means (160) is - A first longitudinal rotational motion transmission element (161) that can be coupled to the motion transmission shaft of the drilling device (200, 200'), wherein the first longitudinal element (161) is configured to receive the rotational motion from the drilling device (200, 200') and to execute the rotational motion, - A second longitudinal rotational motion transmission element (162), which is attached to the proximal portion (122.1) of the motion transmission element (122), and is configured to receive rotational motion from the first longitudinal element (161) and to perform the rotational motion and linear motion, - A brake actuator (163) connected to the second longitudinal element (162) and configured to exert a force on the second longitudinal element (162) to maintain rotation, - A return spring (164) configured to exert a linear return force on the second longitudinal element (162), - A helical sliding coupling (165) configured to connect the first longitudinal element (161) to the second longitudinal element (162), Equipped with, The aforementioned helical sliding coupling (165) is A longitudinal coupling portion (161.1) attached to the first longitudinal element (161), the longitudinal coupling portion (161.1) having a first screw thread (161.2) on its outer surface, A longitudinal connecting conduit (162.1) attached to the second longitudinal element (162), the longitudinal connecting conduit (162.1) having a second thread (162.2) on its inner surface, Equipped with, The first thread (161.2) of the longitudinal coupling portion (161.1) and the second thread (162.2) of the longitudinal coupling conduit (162.1) are configured to cooperate with each other so that when the longitudinal coupling conduit (162.1) rotates and the longitudinal coupling portion (161.1) rotates at a slower speed than the longitudinal coupling conduit (162.1), linear motion of the longitudinal coupling conduit (162.1) occurs relative to the longitudinal coupling portion (161.1), and the direction of the threads of the helical sliding coupling (165) is opposite to the direction of the rotational motion of the drilling device. The breaking device (100) according to claim 13.

15. The fracture motion generating device (200, 200') is a drilling device (200, 200'), and the motion transmission and conversion means (170) is - A male-female sliding joint (173), A primary rotor (171) that can be coupled to the motion transmission shaft of the drilling device (200, 200'), wherein the primary rotor (171) is configured to receive rotational motion from the drilling device (200, 200') and to perform the rotational motion, A secondary rotor (172) is slidably coupled to the primary rotor (171) at its proximal end and attached to the proximal portion (122.1) of the motion transmission element (122) at its distal end, wherein the secondary rotor (172) further comprises sinusoidal grooves or recesses (172.1) on its outer surface, and the secondary rotor (172) is configured to move linearly in both directions relative to the primary rotor (171) as a result of the sliding coupling, A male-female sliding coupling (173) is provided, - A return spring (174) configured to exert a return force on the secondary rotor (172), - A manual start control (175) connected to a fixed plunger (176), wherein the manual start control (175) is configured such that the fixed plunger (176) penetrates the groove or recess (172.1) of the secondary rotor (172), Equipped with, When the secondary rotor (172) receives the rotational motion from the primary rotor (171) and performs the rotational motion, the activation of the control (175) causes the fixed plunger (176) to penetrate the groove or recess (172.1), and the secondary rotor (172) performs linear reciprocating motion relative to the primary rotor (171). The secondary rotor (172), in combination with the rotational motion, transmits the linear reciprocating motion to the motion transmission element (122), and the motion transmission element (122), in combination with the rotational motion, transmits the linear reciprocating motion to the fracture element (121). When the control (175) is released, the fixed plunger (176) is removed from the groove or recess (172.1), and the secondary rotor (172) is pushed by the return spring (174) to perform a return motion in the distal-proximal direction. The breaking device (100) according to claim 13.

16. The fracture motion generating device (200, 200') is a drilling device (200, 200'), and the motion transmission and conversion means (180) is - A male-female sliding joint (183), A primary rotor (181) that can be coupled to the motion transmission shaft of the drilling device (200, 200'), wherein the primary rotor (181) is configured to receive rotational motion from the drilling device (200, 200') and to perform the rotational motion, A secondary rotor (182) is slidably coupled to the primary rotor (181) at its proximal end, wherein the secondary rotor (182) is configured to move linearly in both directions relative to the primary rotor (181) as a result of the sliding coupling, and the secondary rotor (182) is equipped with a rotational pressure generating device (185), A male-female sliding coupling (183) is provided, - A return spring (184) configured to exert a return force on the secondary rotor (182), - A fluid compartment comprising a first chamber (186), a second chamber (187), and a fluid (188), The first chamber (186) and the second chamber (187) are in fluid communication, and the fluid (188) is disposed inside the chambers (186, 187). The rotating pressure generating device (185) is immersed in the fluid (188) and is positioned between the first chamber (186) and the second chamber (187). The secondary rotor (182) is attached to the proximal portion (122.1) of the motion transmission element (122), and has a fluid compartment. Equipped with, When the secondary rotor (182) receives rotational motion from the primary rotor (181) and performs the rotational motion, the rotational pressure generating device (185) receives the rotational motion and generates a thrust force greater than the return force of the return spring (184), causing the fluid (188) to flow from the first chamber (186) into the second chamber (187). The flow of the fluid (188) causes the secondary rotor (182) to move linearly in the proximal-distal direction. The secondary rotor (182), in combination with the rotational motion, transmits the linear motion to the motion transmission element (122), and the motion transmission element (122), in combination with the rotational motion, transmits the linear motion to the fracture element (121). When the secondary rotor (182) stops receiving the rotational motion from the primary rotor (181), the secondary rotor (182) is pushed by the return spring (184) and performs linear motion in the distal-proximal direction. The breaking device (100) according to claim 13.

17. A fracture system (400) for minimally invasive surgical intervention, - A fracture motion generating device (200, 200') configured to generate and execute fracture motion, - At least one breaking device (100) according to any one of claims 1 to 16, wherein at least one breaking device (100) is connectable to the breaking motion generating device (200, 200') by the motion transmission element (122), Equipped with, The fracture motion generating device (200, 200') is further configured to transmit the fracture motion to the motion transmission element (122). Fracture system (400).

18. A fracture system (500) for minimally invasive surgical intervention, - A fracture motion and linear motion and / or reciprocating motion generating device (200') configured to generate and execute fracture motion and linear and / or reciprocating motion, - At least one breaking device (100) according to any one of claims 1 to 12, the breaking device (100) which can be coupled to the breaking motion and linear motion and / or reciprocating motion generating device (200') by at least the motion transmission element (122), Equipped with, The fracture motion and linear motion and / or reciprocating motion generating device (200') is further configured to transmit the fracture motion and the linear motion and / or reciprocating motion to the motion transmission element (122). Fracture system (500).

19. The system (500) according to claim 18, wherein the fracture motion and linear motion and / or reciprocating motion generating device (200') comprises mechanical and / or electronic and / or electromagnetic means.

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