Ligament retractor

Abstract

The retractor assembly includes a retractor removably coupled to a retractor handle. The retractor includes a handle connection structure, a retractor shaft, and an arcuate projection having convex retractor and cutting shield surfaces. The retractor handle includes a handle portion and a retractor connection structure. The retractor may be positioned lateral to the medial collateral ligament of the knee joint to retract the medial collateral ligament away from the tibial plateau of the knee joint and protect the medial collateral ligament during a tibial plateau resection procedure.

Description

Technical Field

[0001] The present disclosure relates to surgical instruments, systems, and methods. More specifically, the present disclosure relates to improved surgical instruments, systems, and methods for incising ligaments to facilitate surgical procedures such as knee arthroplasty.

Background Art

[0002] Arthroplasty is a surgical procedure in which one or more joint surfaces of a joint are replaced with artificial joint surfaces. Such arthroplasty has become increasingly common, particularly for the knee joint. Knee arthroplasty may include implanting a tibial prosthesis to replace the joint surface of the tibia. This may be performed with or without replacement of the joint surfaces of the femur and / or patella.

[0003] To successfully perform knee arthroplasty, it is important to protect certain ligaments of the knee joint from accidental damage during osteotomy performed during the knee arthroplasty procedure. For example, performing a tibial plateau resection surgery, particularly when the surgeon blindly approaches the medial collateral ligament from the outside with a saw blade during the tibial plateau resection surgery, may carry an increased risk of accidentally damaging or cutting the medial collateral ligament.

Summary of the Invention

Problems to be Solved by the Invention

[0004] Therefore, surgical instruments, systems, and methods that can reduce or eliminate the risk of accidentally damaging or cutting ligaments during surgery would be desirable.

Means for Solving the Problems

[0005] Summary The various surgical instruments, systems, and methods of this disclosure have been developed in accordance with the current state of the art, and in particular in response to problems and needs in the art that have not yet been fully addressed by currently available surgical instruments, systems, and methods. The surgical instruments, systems, and methods of this disclosure may offer a reduced risk of accidental ligament damage or severance during bone resection surgery.

[0006] According to some embodiments, a retractor assembly may include a retractor and a retractor handle. The retractor may include a retractor shaft, a handle connection structure, and a retractor member. The retractor member may be located at the distal end of the retractor shaft and may include a proximal end coupled to the distal end of the retractor shaft, a distal end projecting laterally away from a first longitudinal axis, and an arched projection having an upper surface, a lower surface, a retractor surface extending midway between the upper and lower surfaces and including a convex curved portion, and a cutting shield surface extending midway between the upper and lower surfaces and located on the opposite side of the retractor surface. The retractor handle may be configured to be detachably coupled to the retractor and may include a handle portion, a handle shaft coupled to the handle portion, and a retractor connection structure coupled to the handle shaft. The retractor connection structure may be configured to be detachably coupled to the handle connection structure to detachably couple the retractor handle to the retractor.

[0007] In some embodiments of the retractor assembly, the retractor member may also include a guide projection coupled to the cutting shield surface and projecting toward a first longitudinal axis. The guide projection may include an upper surface, a lower surface, and an opening formed through the guide projection between the upper and lower surfaces. The opening may be shaped to receive at least a portion of the femoral condyle in order to position the retractor member relative to the tibial plateau.

[0008] In some embodiments of the retractor assembly, the retractor shaft may also include a first shaft portion extending along a first longitudinal axis, a second shaft portion extending along a second longitudinal axis, and a third shaft portion extending along a third longitudinal axis. The second shaft portion may be intermediate between the first and third shaft portions, and the third shaft portion may be offset from the first shaft portion.

[0009] In some embodiments of the retractor assembly, the handle connection structure may be coupled to a third shaft portion.

[0010] In some embodiments of the retractor assembly, the retractor connection structure may include a locking structure configured to secure the retractor handle to the retractor by engaging with a handle connection structure.

[0011] In some embodiments of the retractor assembly, the handle connection structure may include a hex wrench and a retaining slot formed in the hex wrench.

[0012] In some embodiments of the retractor assembly, the locking structure may include a locking sleeve, a hexagonal socket disposed within the locking sleeve, and one or more ball stoppers at least partially disposed within the internal space of the hexagonal socket. The hexagonal socket may be configured to accept a hex wrench, and one or more ball stoppers may be configured to engage with retaining slots formed in the hex wrench, thereby securing the retractor handle to the retractor.

[0013] According to some embodiments, the retractor may include a retractor shaft, a retractor member, and a guide projection. The retractor member may be located at the distal end of the retractor shaft and may include an arched projection having a proximal end coupled to the distal end of the retractor shaft, a distal end projecting laterally away from a first longitudinal axis, an upper surface, a lower surface, a retractor surface extending midway between the upper and lower surfaces and having a convex curved surface, and a cutting shield surface located opposite the retractor surface and extending midway between the upper and lower surfaces. The guide projection may be coupled to the cutting shield surface and may project toward the first longitudinal axis. The guide projection may include an upper surface, a lower surface, and an opening formed through the guide projection between the upper and lower surfaces. The opening may be shaped to receive at least a portion of the femoral condyle in order to position the retractor member relative to the tibial plateau.

[0014] In some embodiments of the retractor, the upper and lower surfaces of the guide projection may be configured to taper toward each other as they advance from the proximal end of the arc projection toward the distal end of the arc projection.

[0015] In some embodiments of the retractor, the guide projection may also include an outer edge between the upper and lower surfaces.

[0016] In some embodiments of the retractor, the outer edge may include a convex surface.

[0017] In some embodiments of the retractor, the distal end of the arcuate projection may include a first tip, a second tip, and a recess intermediate between the first and second tips. The first tip, the second tip, and at least one of the recess may be shaped to guide the medial collateral ligament toward the surface of the retractor when the retractor member is inserted into the knee joint.

[0018] In some embodiments, the retractor may also include a handle connection structure located at the proximal end of the retractor shaft.

[0019] In some embodiments, the retractor shaft may also include a first shaft portion extending along a first longitudinal axis, a second shaft portion extending along a second longitudinal axis, and a third shaft portion extending along a third longitudinal axis. The second shaft portion may be positioned between the first and third shaft portions, and the third shaft portion may be offset from the first shaft portion.

[0020] According to several embodiments, a method is provided for dehiscence of the medial collateral ligament using an assembly including a retractor and a retractor handle. In some embodiments, the retractor may include a handle connection structure and an arched projection having a convex retractor surface and a cutting shield surface. In some embodiments, the retractor handle may include a retractor connection structure configured to engage with the handle connection structure, thereby removably coupling the retractor handle to the retractor. The method may include the steps of coupling the retractor handle to the retractor by engaging the retractor connection structure with the handle connection structure, inserting the retractor into an incision in a surgical site proximal to the knee joint, manipulating the retractor relative to the knee joint, and positioning the retractor lateral to the medial collateral ligament of the knee joint.

[0021] In some embodiments, the method may also include the step of using a convex retractor surface to retract the medial collateral ligament away from the tibial plateau of the knee joint.

[0022] In some embodiments, the method may also include the step of excising at least a portion of the tibial plateau with a bone saw while opening the medial collateral ligament away from the tibial plateau to prevent damage to the medial collateral ligament by the bone saw.

[0023] In some embodiments, the method may also include the step of using a bone saw to excise at least a portion of the tibial plateau of the knee joint, while a cutting shield surface prevents the bone saw from damaging the medial collateral ligament.

[0024] In some embodiments, the method may also include moving the trocar connection structure between a locked position and an unlocked position to removably couple the trocar handle to the trocar.

[0025] In some embodiments of the method, in the locked position, the trocar connection structure may engage with the handle connection structure to lock the trocar handle to the trocar, and in the unlocked position, the trocar connection structure may be disengaged from the handle connection structure to unlock the trocar handle from the trocar.

[0026] These and other features and advantages of the present disclosure will become more fully apparent from the following description and the appended claims, or may be learned by the practice of the devices, systems, and methods described below. Brief Description of the Drawings Exemplary embodiments of the present disclosure will become more fully apparent from the following description and the appended claims, taken in conjunction with the accompanying drawings. It is to be understood that these drawings show only exemplary embodiments and are not to be considered as limiting the scope of the appended claims, and that the exemplary embodiments of the present disclosure will be described with greater specificity and detail through the use of the accompanying drawings.

Brief Description of the Drawings

[0027] [Figure 1A] FIG. 1A is a perspective view of a trocar according to an embodiment of the present disclosure. [Figure 1B] FIG. 1B is another perspective view of the trocar of FIG. 1A. [Figure 1C] FIG. 1C is a top view of the trocar of FIG. 1A. [Figure 1D] FIG. 1D is a bottom view of the trocar of FIG. 1A. [Figure 1E] FIG. 1E is a left side view of the trocar of FIG. 1A. [Figure 1F] FIG. 1F is a right side view of the trocar of FIG. 1A. [Figure 1G] FIG. 1G is a top perspective view of the distal end of the trocar of FIG. 1A. [Figure 1H]Figure 1A is a bottom view perspective of the distal end of the retractor. [Figure 1I] Figure 1A is a left side view of the distal end of the retractor. [Figure 2A] This is a perspective view of a guide rod according to one embodiment of the present disclosure. [Figure 2B] This is another perspective view of the guide rod in Figure 2A. [Figure 2C] Figure 2A is a bottom perspective view of the distal end of the guide rod. [Figure 2D] This is another bottom perspective view of the distal end of the guide rod in Figure 2A. [Figure 2E] This is a bottom perspective view of the distal end of the guide rod shown in Figure 2A, which has a different hook member shape. [Figure 2F] Figure 2E is another bottom perspective view of the distal end of the guide rod. [Figure 2G] This is a bottom perspective view of the distal end of the guide rod shown in Figure 2A, which has a different shape and hook member design. [Figure 2H] Figure 2H is another bottom perspective view of the distal end of the guide rod. [Figure 3] Figure 1A shows a perspective view of the distal end of the retractor, and Figure 2A shows the distal end of the guide rod, before assembly. [Figure 4] Figure 3 is a top perspective view of the distal end of the retractor and guide rod after assembly. [Figure 5] Figure 3 shows a bottom perspective view of the distal end of the retractor and guide rod after assembly. [Figure 6] Figures 4 and 5 show perspective views of the entire assembly. [Figure 7] Figure 6 is a perspective view of the assembly inserted into the knee joint during surgery. [Figure 8] Figure 1A shows a perspective view of the retractor relative to the tibia, cutting guide, and bone saw during a tibial plateau resection procedure. [Figure 9] This is a flowchart illustrating the method of opening the medial collateral ligament using an assembly during knee arthroplasty. [Figure 10]This is a flowchart illustrating the procedure for opening the medial collateral ligament using a retractor during knee arthroplasty. [Figure 11A] This is a top perspective view of a retractor according to another embodiment of the present disclosure. [Figure 11B] Figure 11A is a bottom perspective view of the retractor. [Figure 11C] Figure 11A is a top view of the retractor. [Figure 11D] Figure 11A is a bottom view of the retractor. [Figure 11E] Figure 11A is a left side view of the retractor. [Figure 11F] Figure 11A is a right side view of the retractor. [Figure 11G] Figure 11A is a proximal end view of the retractor. [Figure 11H] Figure 11A is a distal end view of the retractor. [Figure 12A] This is a perspective view of a handle according to one embodiment of the present disclosure. [Figure 12B] Figure 12A is another perspective view of the handle. [Figure 12C] Figure 12A is a side view of the handle. [Figure 12D] Figure 12A is a distal end view of the handle. [Figure 13] Figure 11A is a perspective view of the retractor inserted into the knee joint during surgery. [Figure 14] Another perspective view, Figure 13, with the femur removed. [Figure 15] This is a flowchart illustrating the procedure for opening the medial collateral ligament using a retractor assembly during knee arthroplasty. [Modes for carrying out the invention]

[0028] It should be understood that the drawings are intended to illustrate the concepts of this disclosure and may not be drawn to a specific scale. Furthermore, the drawings illustrate exemplary embodiments and do not constitute a limitation to the scope of this disclosure. Detailed explanation The exemplary embodiments of this disclosure will be best understood by reference to the drawings, and similar parts throughout the drawings are indicated by the same numbering. It will be readily apparent that the components of this disclosure may be arranged and designed in a wide variety of different configurations, as generally described herein and as shown in the drawings. Accordingly, the following more detailed descriptions of embodiments of apparatus, systems, and methods shown in the drawings are not intended to limit the scope of this disclosure as claimed in this application or in other applications claiming priority to this application, but are merely representative of exemplary embodiments of this disclosure.

[0029] This specification employs standard medical directions, reference planes, and descriptive terminology. For example, anterior means toward the front of the body. Posterior means toward the rear of the body. Superior, or cranial, means toward the head. Inferior, or caudal, means toward the feet. Medial means toward the midline of the body. Lateral means away from the midline of the body. Axial means toward the central axis of the body. Dorsal axis means away from the central axis of the body. Ipsilateral means the same side of the body. Contralateral means the opposite side of the body. The sagittal plane divides the body into right and left halves. The median sagittal plane divides the body into bilaterally symmetrical right and left halves. The coronal plane divides the body into anterior and posterior halves. The transverse plane divides the body into upper and lower halves. These descriptive terms may apply to living or inanimate objects.

[0030] Figures 1A-1I show various diagrams of a retractor 100 according to one embodiment of the present disclosure. The retractor 100 may include a proximal end 101, a distal end 102, a retractor handle 110 at the proximal end 101, and a retractor member 120 at the distal end 102 that can be coupled to the retractor handle 110.

[0031] The retractor handle 110 extends, or may extend substantially along, the first longitudinal axis 112, as shown in Figure 1A. However, it will be understood that the retractor handle 110 or a portion of the retractor handle 110 may or may not extend linearly along the first longitudinal axis 112. For example, the phrase "substantially along the axis" may include linear or curved members that may or may not maintain proximity to the axis.

[0032] The retractor member 120 may generally include an arched projection, or an arched projection 130, and a retractor connecting structure (for example, as a non-limiting example, a guide projection 150 having a mounting opening 160, which will be described in more detail below).

[0033] As defined herein, the term “approximately arc-shaped” means having a curved shape, an arc shape, or an “arc-shaped” shape. The term “approximately arc-shaped” may include not only curved shapes mathematically defined by a single radius along a given curved shape, but also curved shapes mathematically defined by multiple radii along a given curved shape. However, it will also be understood that the term “approximately arc-shaped” may or may not include curved shapes defined by one or more precise mathematical formulas. Furthermore, “approximately arc-shaped” may include not only curved shapes extending along a curved path, but also shapes that constitute a series of straight-line segments that are combined to define curves or curved shapes on a larger scale. Thus, for example, a geodesic dome may be said to have a spherical curvature, even if the sphere is defined by planar segments.

[0034] The arched projection 130 may project laterally away from the first longitudinal axis 112. The arched projection 130 may include a proximal end 131 (which may be coupled to the retractor handle 110 and / or to a notch 140 formed between the retractor handle 110 and the retractor member 120), a distal end 132, an upper surface 133, and a lower surface 134. The arched projection 130 may also include a retractor surface 135 extending midway between the upper surface 133 and the lower surface 134. In some embodiments, the retractor surface 135 may have a convex curved surface. The arched projection 130 may further include a cutting shield surface 136 on the opposite side of the retractor surface 135, extending midway between the upper surface 133 and the lower surface 134. In some embodiments, the cutting shield surface 136 may have a concave curved surface.

[0035] The distal end 132 of the arched projection 130 may include a pointed tip 137. Near the pointed tip 137, the distal end 132 of the arched projection 130 may also include a lower concave curve 138 and a lower convex curve 139, which may be formed on the lower surface 134 of the arched projection 130, as shown in Figures 1E, 1F, and 1I. Each of the pointed tip 137, the concave curve 138, and / or the convex curve 139 may help to facilitate the manipulation of the distal end 102 of the retractor 100 within the tight knee joint during surgery. Furthermore, in some embodiments, as can be seen in Figure 1I, both the retractor surface 135 and the cutting shield surface 136 of the arched projection 130 can reduce in height as they advance from the proximal end 131 to the distal end 132 of the arched projection 130, further assisting the operation of the distal end 102 of the retractor 100 within a tight knee joint.

[0036] In some embodiments, the retractor coupling structure may include a guide projection 150. The guide projection 150 may be coupled to the cutting shield surface 136 of the arch projection 130 and may project toward the first longitudinal axis 112. The guide projection 150 may be configured to rest on the tibial plateau during the knee arthroplasty procedure to help position the retractor 100 properly during tibial plateau resection, as will be described in more detail below. The guide projection 150 may also include a mounting opening 160 formed within or through the guide projection 150. The mounting opening 160 may also include a chamfered surface 162, as will be described in more detail below.

[0037] Figures 2A–2H show various diagrams of the guide rod 200 according to embodiments of the present disclosure. The guide rod 200 may include a guide rod handle 210 and an elongated member 220 which may be coupled to the guide rod handle 210 and / or may be integrally formed with the guide rod handle 210. The elongated member 220 may include a rod coupling structure (e.g., a hook member 230, which will be described in more detail below as a non-limiting example) which may be coupled to the proximal end or rod proximal end 222 and the distal end of the elongated member 220 or the rod distal end 221. The guide rod handle 210 and / or the elongated member 220 may extend or substantially extend along a second longitudinal axis 212, as shown in Figure 2A.

[0038] In some embodiments, the rod coupling structure of the guide rod 200 may be configured to engage with the retractor coupling structure of the retractor 100 in order to pivotably couple the guide rod 200 to the retractor 100 to form the assembly 10, as will be described in more detail below with respect to Figures 3-6.

[0039] Specific illustrative structures of retractor coupling structures and rod coupling structures are shown herein, but it will be understood that these are merely illustrative structures given for illustrative purposes only. Accordingly, any suitable shapes, forms, structures, features, etc. that can engage with each other to form a retractor coupling structure and / or a corresponding rod coupling structure for pivotably coupling the guide rod 200 to the retractor 100 are contemplated herein without departing from the spirit or scope of this disclosure.

[0040] In some embodiments, the rod coupling structure may include a hook member 230. The hook member 230 may project laterally away from the elongated member 220 and / or the second longitudinal axis 212. The hook member 230 may be shaped to be received within a mounting opening 160 formed in the guide projection 150 of the retractor 100 in order to pivotably connect the guide rod 200 to the retractor 100. The hook member 230 may take any suitable shape in order to pivotably connect the guide rod 200 to the retractor 100. Figures 2C–2H show three non-limiting examples of hook members 230 having different shapes that can be configured to pivotably connect the guide rod 200 to the retractor 100. However, it will also be understood that any number of different shapes of hook members that can pivotally connect the guide rod 200 to the retractor 100 are assumed herein. The hook member 230 may include a first side surface 231, a second side surface 232, a top surface 233, a distal hook surface 234, a proximal hook surface 235, and a hook member tip 236.

[0041] In some embodiments, the proximal hook surface 235 may extend around the proximal end 237 of the hook member 230 from a first side surface 231 to a second side surface 232.

[0042] In some embodiments, at least a portion of the proximal hook surface 235 may extend at a first angle toward the guide rod handle 210 or the rod proximal end 222. The shape and / or angle of the proximal hook surface 235 may be selected to facilitate the pivotable coupling of the guide rod 200 to the retractor 100.

[0043] In some embodiments, the tip portion 236 of the hook member may extend or project toward the proximal end 222 of the rod, above at least a portion of the proximal hook surface 235.

[0044] In some embodiments, at least a portion of the proximal hook surface 235 may include a cam surface configured to interact with a surface associated with the mounting opening 160.

[0045] In some embodiments, at least a portion of the proximal hook surface 235 may be concave.

[0046] In some embodiments, at least a portion of the proximal hook surface 235 may be convex.

[0047] In some embodiments, at least a portion of the distal hook surface 234 may extend toward the guide rod handle 210 or the rod proximal end 222 at a second angle, or substantially so.

[0048] In some embodiments, the shape of the distal hook surface 234 on the distal end 238 of the hook member 230, and / or the second angle, may be selected to engage with the chamfered surface 162 of the mounting opening 160 in order to facilitate the disengagement of the guide rod from the retractor 100 when a sufficiently large distally directed force is applied to the guide rod 200 relative to the retractor 100.

[0049] In some embodiments, the first side surface 231 and the second side surface 232 may both be angled toward the upper surface 233 of the hook member 230.

[0050] Figure 3 is a perspective view of the distal ends of the retractor 100 and guide rod 200 before they are assembled together. The surgeon can assemble the retractor 100 and guide rod 200 together by inserting the hook member 230 into the attachment opening 160 in the direction of the arrow 240 shown in Figure 3.

[0051] Figures 4-6 show various perspective views of the retractor 100 and guide rod 200 after they have been assembled together to form assembly 10. As previously stated, the guide rod 200 can be detached from the retractor 100 by applying a sufficiently large distal force to the guide rod 200. This will result in the distal hook surface 234 (which may be angled as previously stated) engaging with a chamfered surface 162 surrounding the mounting opening 160 (which may also be angled in a complementary manner to the distal hook surface 234) to detach the guide rod 200 from the retractor 100.

[0052] Figure 7 is a perspective view of assembly 10 inserted into knee joint 300 during surgery. Knee joint 300 may include tibia 400, femur 500, and medial collateral ligament 600. A guide rod 200, pivotably coupled to the retractor 100, helps prevent the distal end of the retractor 100 from being accidentally positioned medially to the medial collateral ligament 600 during insertion by the surgeon. Rather, the guide rod 200 helps ensure that during insertion, the distal end of the retractor 100 will be positioned lateral to the medial collateral ligament 600. Once the distal end of the retractor 100 is properly positioned lateral to the medial collateral ligament 600, the guide rod 200 can be detached from the retractor 100 (as described above) and removed from knee joint 300.

[0053] Figure 8 is a perspective view of the retractor 100, tibia 401, cutting guide 700 engaged with the tibia 401, and bone saw 800 in preparation for a tibial plateau resection procedure. The retractor 100 may be used by the surgeon during the resection procedure to open the medial collateral ligament of the knee joint (not shown in Figure 8) away from the tibial plateau. The cutting shield surface 136 of the retractor 100 may also function as a mechanical stopper for the blade of the bone saw 800, further protecting the medial collateral ligament from accidental injury or cut during the tibial plateau resection procedure.

[0054] Figure 9 is a flowchart of a method 900 for dehiscence of the medial collateral ligament using assembly 10 during knee arthroplasty. Assembly 10 may include a retractor 100 having a retractor coupling structure, and a guide rod 200 having a rod coupling structure configured to engage with the retractor coupling structure and pivotably connect the guide rod 200 to the retractor 100.

[0055] Method 900 may begin in step 910, in which the guide rod 200 can be rotatably coupled to the retractor 100 by engaging the rod coupling structure with the retractor coupling structure to form the assembly 10. In some embodiments, this can be achieved by inserting the hook member 230 of the guide rod 200 into a mounting opening 160 formed at the distal end of the retractor 100.

[0056] Once the guide rod 200 is coupled to the retractor 100, the method 900 may proceed to step 920, in which the assembly 10 can be inserted into an incision (not shown) at a surgical site proximal to the knee joint.

[0057] Once the assembly 10 is inserted into the incision, the method 900 may proceed to step 930, in which the assembly 10 can be manipulated relative to the knee joint to position the assembly 10 lateral to the medial collateral ligament of the knee joint. The guide rod 200 coupled to the retractor 100 can ensure that the retractor 100 does not reach the medial collateral ligament, as described above.

[0058] Alternatively, or in addition, if the assembly 10 is positioned lateral to the medical collateral ligament, the method 900 may proceed to step 940, in which the guide rod 200 can be detached from the retractor 100 by applying a distal force to the guide rod 200 relative to the retractor 100, as described above. The detached guide rod 200 may then be removed from the knee joint in step 950.

[0059] Once the guide rod 200 is detached from the retractor 100 and removed from the knee joint, the method 900 may proceed to step 960, in which a surgeon may use the retractor 100 to retract the medial collateral ligament away from the tibial plateau of the knee joint.

[0060] Alternatively, or in addition thereto, method 900 may proceed to step 970, in which a portion of the tibial plateau may be resected with a bone saw while the medial collateral ligament is opened away from the tibia, and method 900 may then terminate.

[0061] In this way, the medial collateral ligament can be protected from damage by the bone saw during the resection procedure. The retractor 100 can protect the medial collateral ligament in at least two ways, the methods including (1) an incision that increases the separation distance between the bone saw blade and the medial collateral ligament, and thus reduces the possibility of damaging the medial collateral ligament, and (2) the cutting shield surface 136 of the retractor 100 can directly protect the medial collateral ligament from the bone saw blade to prevent the bone saw blade from damaging the medial collateral ligament. Thus, the cutting shield surface 136 can be useful in all cases where the separation distance achieved by the incision may or may not be sufficient to keep the medial collateral ligament away from the bone saw blade.

[0062] Figure 10 is a flowchart of a method 1000 for dehiscence of the medial collateral ligament of the knee joint using a retractor 100. In some embodiments, the retractor 100 may include an arched projection having a convex retractor surface 135 and a concave cutting shield surface 136.

[0063] Method 1000 may begin with step 1010, in which a retractor 100 can be inserted into an incision (not shown) at the surgical site proximal to the knee joint.

[0064] Once the retractor 100 is inserted into the incision, the method 1000 may proceed to step 1020, in which the retractor 100 can be manipulated relative to the knee joint to position the retractor 100 lateral to the medial collateral ligament.

[0065] Once the retractor 100 is positioned lateral to the medial collateral ligament, the method 1000 may proceed to step 1030, in which a surgeon may use the retractor surface 135 of the retractor 100 to retract the medial collateral ligament away from the tibial plateau of the knee joint.

[0066] Alternatively, or in addition thereto, method 1000 may proceed to step 1040, in which a portion of the tibial plateau may be resected with the osteosaw while the medial collateral ligament is opened away from the tibia, in order to prevent the osteosaw from damaging the medial collateral ligament.

[0067] Alternatively, or in addition thereto, method 1000 may proceed to step 1050 in which a portion of the tibial plateau can be excised with a bone saw, while the cutting shield surface 136 of the retractor 100 directly prevents the bone saw from damaging the medial collateral ligament, and method 1000 may then end.

[0068] Therefore, as previously stated, the medial collateral ligament can be protected from bone saw damage during the resection procedure. The retractor 100 can protect the medial collateral ligament, (1) increasing the separation distance between the bone saw blade and the medial collateral ligament, and thus reducing the possibility of damaging the medial collateral ligament, and (2) The cutting shield surface 136 of the retractor 100 may directly protect the medial collateral ligament from the bone saw blade to prevent the bone saw blade from damaging the medial collateral ligament.

[0069] Figures 11A–11H show various diagrams of the retractor 1100 according to another embodiment of the present disclosure. The retractor 1100 may include a proximal end 1101, a distal end 1102, a retractor shaft or shaft 1110, a handle connection structure 1114 at the proximal end 1101 of the retractor 1100, and a retractor member 1120 at the distal end 1102 of the retractor 1100.

[0070] In some embodiments, the shaft 1110 may include a first shaft portion 1111, a second shaft portion 1112, and a third shaft portion 1113. In this way, the third shaft portion 1113 is offset from the first shaft portion 1111, which may provide the surgeon with special clearance and working space, as will be described in more detail below. The first shaft portion 1111 may extend or substantially extend along a first longitudinal axis 1121, the second shaft portion 1112 may extend or substantially extend along a second longitudinal axis 1122, and the third shaft portion 1113 may extend or substantially extend along a third longitudinal axis 1123. However, any portion of the shaft 1110 may or may not extend linearly along a particular longitudinal axis and may include straight or curved members that can or may not maintain proximity to a particular longitudinal axis.

[0071] In some embodiments, the handle connection structure 1114 may be coupled to and / or extend proximal from the third shaft portion 1113.

[0072] In some embodiments, the handle connection structure 1114 may be configured to be detachably coupled to the handle, as will be described in more detail below with respect to Figures 12A-12D.

[0073] In some embodiments, the handle connection structure 1114 may include a hex wrench 1116 having a retaining slot 1117 formed therein. However, it will be understood that the handle connection structure 1114 may include any conceivable shape or configuration for connecting a handle to the handle connection structure 1114.

[0074] In some embodiments, the retractor 1100 may include an integrally formed handle (not shown) instead of the handle connection structure 1114.

[0075] In some embodiments, the retractor member 1120 may include a substantially arched projection, or an arched projection 1130, and a guide projection 1150.

[0076] The arched projection 1130 may project laterally away from the first longitudinal axis 1121. The arched projection 1130 may include a proximal end 1131 (which may be coupled to the first shaft portion 1111), a distal end 1132, an upper surface 1133, and a lower surface 1134.

[0077] In some embodiments, the upper surface 1133 and the lower surface 1134 may taper toward each other as they advance from the proximal end 1131 of the arched projection 1130 toward the distal end 1132 of the arched projection 1130, as shown in Figure 11H.

[0078] The arched projection 1130 may also include a retractor surface 1135 (see Figures 11E and 11H) extending midway between the upper surface 1133 and the lower surface 1134. The retractor surface 1135 may have a convex curve. The arched projection 1130 may further include a cutting shield surface 1136 on the opposite side of the retractor surface 1135, which may extend midway between the upper surface 1133 and the lower surface 1134. In some embodiments, the cutting shield surface 1136 may have a concave curve.

[0079] In some embodiments, the distal end 1132 of the arched projection 1130 may include a first tip 1141 and a second tip 1142 separated by a recess 1143. At least one of the first tip 1141, the second tip 1142, and / or the recess 1143 may be tapered and / or otherwise shaped to guide the medial collateral ligament toward the retractor surface 1135 when the retractor member 1120 is inserted into the knee joint. Furthermore, at least one of the first tip 1141, the second tip 1142, and / or the recess 1143 may be tapered and / or otherwise shaped to separate tissue during insertion and / or to facilitate the manipulation of the distal end 1102 of the retractor 1100 within the tight knee joint during surgery. In some embodiments, as can be seen in Figure 11H, the retractor surface 1135 and cutting shield surface 1136 of the arched projection 1130 can both reduce height as they advance from the proximal end 1131 of the arched projection 1130 toward the distal end 1132 of the arched projection 1130, further assisting the operation of the distal end 1102 of the retractor 1100 within the tight knee joint.

[0080] The guide projection 1150 may include an upper surface 1151, a lower surface 1152, and an outer edge 1153 midway between the upper surface 1151 and the lower surface 1152. The guide projection 1150 may be configured to rest on the top of the tibial plateau during knee arthroplasty to help position the retractor 1100 properly during tibial plateau resection (see Figures 13 and 14).

[0081] In some embodiments, the guide projection 1150 may be coupled to the cutting shield surface 1136 and project toward the first longitudinal axis 1121.

[0082] In some embodiments, the outer edge 1153 of the guide projection 1150 may include a convex surface.

[0083] In some embodiments, the upper surface 1151 and the lower surface 1152 may taper toward each other as they advance from the proximal end 1131 of the arched projection 1130 toward the distal end 1132 of the arched projection 1130 (see Figure 11F). This taper may help separate tissue and / or facilitate the manipulation of the distal end 1102 of the retractor 1100 within a tight knee joint during surgery.

[0084] In some embodiments, the opening 1160 may be formed within or through the guide projection 1150.

[0085] In some embodiments, the opening 1160 may be shaped to receive at least a portion of the femoral condyle therein, and to help position, position, hold, and / or maintain the retractor member 1120 against at least one of the femoral condyle and tibial plateau of the knee joint during surgical procedures (see, for example, Figure 13).

[0086] In some embodiments, the retractor 1100 may be inserted into, positioned, and / or removed from the knee joint without the use of additional guide rods (such as the guide rod 200 described herein). However, it will also be understood that in other embodiments, the retractor 1100 may be inserted into, positioned, and / or removed from the knee joint with the use of additional guide rods, which may be coupled to the opening 1160 via suitable hook members (such as the guide rod 200 and hook member 230 described herein).

[0087] Figures 12A–12D show various diagrams of a retractor handle or handle 1200 according to one embodiment of the present disclosure. The handle 1200 may include a handle portion 1210, a handle shaft 1220, and a retractor connection structure 1230.

[0088] In some embodiments, the handle 1200 may be detachably coupled to the retractor 1100.

[0089] In some embodiments, the retractor connection structure 1230 may include a locking structure that can be configured to secure the handle 1200 to the retractor 1100.

[0090] In some embodiments, the locking structure may include a locking sleeve 1240, a hexagonal socket 1250, and one or more pins or one or more ball retainers 1260, which can be configured to lock the handle 1200 to the handle connection structure 1114 of the retractor 1100.

[0091] In some embodiments, the lock sleeve 1240 and / or one or more ball retainers 1260 may be spring-biased. For example, the lock sleeve 1240 may be spring-biased, resulting in it being pushed distally along the handle shaft 1220. Furthermore, one or more ball retainers 1260 may be spring-biased, resulting in them being pushed inward into the internal space of the hex socket 1250.

[0092] In some embodiments, the handle 1200 may be coupled to the retractor 1100 by (1) moving the locking sleeve 1240 proximal along the handle shaft 1220 to allow one or more ball retainers 1260 to retract from the internal space of the hex socket 1250, (2) inserting the hex wrench 1116 of the handle connection structure 1114 into the hex socket 1250 of the retractor connection structure 1230, and (3) releasing / moving the locking sleeve 1240 distal along the handle shaft 1220 to force one or more ball retainers 1260 to enter into retaining slots 1117 formed in the hex wrench 1116, thereby securing the handle 1200 to the retractor 1100.

[0093] In some embodiments, the handle 1200 can be detached from the retractor 1100 by (1) moving the lock sleeve 1240 proximal along the handle shaft 1220 to allow one or more ball retainers 1260 to retract from the retaining slot 1117, and (2) removing the hex wrench 1116 from the hex socket 1250 to detach the handle 1200 from the retractor 1100.

[0094] Figure 13 is a perspective view of the retractor 1100 coupled to the handle 1200 to form a retractor assembly 1700, the retractor 1100 being inserted into the knee joint 1300 during surgery. Figure 14 shows another perspective view of Figure 13, where the femur is removed to show the retractor member 1120 engaged with the tibial plateau 1450. The knee joint 1300 may include the tibia 1400, femur 1500, and medial collateral ligament 1600. As previously described herein, the form of the retractor 1100 may be helpful in the insertion of the retractor 1100 and / or may help prevent the distal end 1102 of the retractor 1100 from accidentally locating medially to the medial collateral ligament 1600 during insertion of the retractor 1100 by the surgeon. Rather, the morphology of the retractor 1100 will help ensure that, during insertion, the distal end 1102 of the retractor 1100 is positioned lateral to the medial collateral ligament 1600 by the surgeon. Once the distal end 1102 of the retractor 1100 is properly positioned lateral to the medial collateral ligament 1600, the tibial plateau can be resected with a bone saw in the same manner as shown and described in Figure 8. Thus, the retractor 1100 can be used by the surgeon during the resection procedure to retract the medial collateral ligament of the knee joint away from the tibial plateau. The cutting shield surface 1136 of the retractor 1100 can also function as a mechanical stopper against the bone saw blade, further protecting the medial collateral ligament from accidental injury or cut during the tibial plateau resection procedure.

[0095] Figure 15 is a flowchart of a method 2000 for dehiscence of the medial collateral ligament using a retractor assembly 1700 during a knee arthroplasty procedure. The retractor assembly 1700 may include a retractor 1100 and a handle 1200. In some embodiments, the retractor 1100 may include a handle connection structure 1114, a guide projection 1150, and an arched projection 1130 having a retractor surface 1135 which may be convex, and a cutting shield surface 1136 which may be concave. The handle 1200 may include a retractor connection structure 1230 configured to engage with the handle connection structure 1114 to removably connect the handle 1200 to the retractor 1100.

[0096] Method 2000 may begin in step 2010, in which the handle 1200 is coupled to the retractor 1100 and the retractor connection structure 1230 is engaged with the handle connection structure 1114 to form the retractor assembly 1700, as previously described herein.

[0097] Once the retractor handle 1200 is coupled to the retractor 1100 to form the retractor assembly 1700, the method 2000 may proceed to step 2020, in which the retractor 1100 is inserted into an incision (not shown) at the surgical site proximal to the knee joint.

[0098] Once the retractor 1100 is inserted into the incision, the method 2000 may proceed to step 2030, in which the retractor 1100 can be manipulated relative to the knee joint to position the retractor 1100 on the outer surface of the medial collateral ligament. In some embodiments, the guide projection 1150 and / or arched projection 1130 of the retractor 1100 may traverse beneath the medial meniscus (not shown) of the knee joint during the positioning of the retractor 1100 relative to the knee joint. Furthermore, in some embodiments, positioning the guide projection 1150 of the retractor 1100 on the medial tibial plateau (not shown) of the knee joint may indicate that the arched projection 1130 of the retractor 1100 is interposed between the medial collateral ligament of the knee joint and the medial tibial plateau.

[0099] Once the retractor 1100 is positioned lateral to the medial collateral ligament, the method 2000 may proceed to step 2040, in which the surgeon may use the retractor surface 1135 of the retractor 1100 to retract the medial collateral ligament away from the tibial plateau of the knee joint.

[0100] Alternatively, or in addition thereto, Method 2000 may proceed to step 2050, in which a portion of the tibial plateau is excised with the bone saw while the medial collateral ligament is resected away from the tibia, and the cutting shield surface 1136 of the retractor 1100 can further prevent the bone saw from damaging the medial collateral ligament, and Method 2000 may end.

[0101] In this way, the medial collateral ligament can be protected from bone saw damage during the resection procedure. The retractor 1100 can protect the medial collateral ligament in at least two ways, the methods of which include (1) an incision that increases the separation distance between the bone saw blade and the medial collateral ligament, and thus reduces the possibility of damaging the medial collateral ligament, and (2) the cutting shield surface 1136 of the retractor 1100 being able to directly protect the medial collateral ligament from the bone saw blade to prevent the bone saw blade from damaging the medial collateral ligament. Thus, the cutting shield surface 1136 can be useful in all cases where the separation distance achieved by the incision may or may not be sufficient to separate the medial collateral ligament from the bone saw blade.

[0102] Any method disclosed herein may include one or more steps or operations for performing the described method. One or more steps or operations of a method may be omitted from any of the methods disclosed herein. Furthermore, any of the steps or operations of a method may be interchangeable with one another. In other words, the order and / or use of any particular steps or operations may be changed unless a specific order of steps or operations is required for proper operation of the embodiment.

[0103] It will also be understood that any of the ligament retraction devices, components, assemblies, systems, and / or methods described herein can be combined and linked in any number of combinations without departing from the spirit or scope of this disclosure. For example, the retractor 100 of Figures 1A–1I and / or the retractor 1100 of Figures 11A–11I may be used with a guide rod 200 including any embodiment of the hook member 230 shown in Figures 2C–2H. In another non-limiting example, for example, the hook member 230 may be coupled to a guide projection 150 (instead of the guide rod 200), and the mounting opening 160 may be formed in the guide rod 200 (instead of the guide projection 150). In another non-limiting example, for example, a handle 1200 may be used with the retractor 100 and / or a retractor handle 110 may be used with the retractor 1100. As another non-limiting example, the guide projections 150 and 1150 may be used in conjunction with either of the retractors 100, 1100 disclosed herein.

[0104] The term “exemplary” is used herein to mean “provided as an example, case, or illustration.” Any embodiment described herein as “exemplary” should not necessarily be construed as being preferable or advantageous over other embodiments. Various aspects of the embodiments are shown in the drawings, which are not necessarily drawn to a certain scale unless otherwise indicated.

[0105] Throughout this specification, any reference to “one embodiment” or “that embodiment” means that a particular feature, structure, or characteristic described in relation to that embodiment is included in at least one embodiment. Therefore, not all quotations or variations thereof referenced throughout this specification necessarily refer to the same embodiment.

[0106] Similarly, in the above description of embodiments, it should be understood that, for the purpose of streamlining the disclosure, various features are often combined into a single embodiment, figure, or description thereof. However, this method of disclosure should not be interpreted as reflecting an intention that any claim requires more features than those explicitly described in that claim. Rather, as reflected in the following claims, the embodiments of the invention consist of fewer combinations of features than all the features of any single aforementioned disclosed embodiment combined. Consequently, the claims following this detailed description are explicitly incorporated into this detailed description, and each claim is valid on its own as a separate embodiment. This disclosure includes all substitutions of independent claims with their dependent claims.

[0107] The use of the term “first” in the claims with respect to a feature or element does not necessarily imply the presence of a second or additional such feature or element. Elements enumerated in means-plus-function form are intended to be interpreted in accordance with § 112(6) of the United States Patent Act. It will be apparent to those skilled in the art that modifications can be made to the details of the embodiments described herein without departing from the underlying principles.

[0108] The terms “connected,” “joined,” “engaged,” and “communicate” refer to any form of interaction between two or more entities, including mechanical, electrical, magnetic, electromagnetic, fluid, and thermal interactions. Two components can be functionally joined to each other even if they are not in direct contact with each other. The term “contacting” refers to units that are in direct physical contact with each other, although the units do not necessarily have to be mounted together. The term “fluid communication” refers to two structures that are connected so that fluid in one structure can pass through the other. The term “substantially equal” may mean that the relative dispersion from each other is within approximately ±10%.

[0109] While specific embodiments and applications of this disclosure have been illustrated and described, it should be understood that the appended claims are not limited to the exact configurations and components disclosed herein. Various modifications, changes, and variations that will be apparent to those skilled in the art may be made to the arrangement, operation, and details of the apparatus, systems, and methods disclosed herein.

Claims

1. A retractor assembly, wherein the retractor assembly is A retractor, wherein the retractor is A retractor shaft, the retractor shaft having a proximal end and a distal end, and at least a portion of the retractor shaft extending along a first longitudinal axis, A handle connection structure positioned at the proximal end of the retractor shaft, A retractor member positioned at the distal end of the retractor shaft, wherein the retractor member is An arch-shaped projection, wherein the arch-shaped projection is The proximal end of the retractor shaft is connected to the distal end, A distal end that protrudes laterally away from the first longitudinal axis, Top surface and, The bottom and, A retractor surface extending between the upper surface and the lower surface, wherein the retractor surface includes a convex curved surface, The arc-shaped projection includes a cutting shield surface, which is located on the opposite side of the retractor surface and extends between the upper and lower surfaces, A guide projection is coupled to the cutting shield surface and protrudes toward the first longitudinal axis, wherein the guide projection is Top surface and, The bottom and, It includes an opening formed between the upper surface and the lower surface through the guide projection, The retractor includes the retractor member, which includes the guide projection, the opening of which is shaped to receive at least a portion of the femoral condyle in order to position the retractor member relative to the tibial plateau, and A retractor handle configured to be detachably coupled to the retractor, wherein the retractor handle is The handle part, The handle shaft connected to the aforementioned handle portion, It includes a retractor connection structure coupled to the handle shaft, A retractor assembly characterized in that the retractor connection structure is configured to be detachably coupled with the handle connection structure, and includes a retractor handle that detachably connects the retractor handle to the retractor.

2. The retractor assembly according to claim 1, wherein the retractor shaft further comprises A first shaft portion extending along the first longitudinal axis, A second shaft portion extending along the second longitudinal axis, Including a third shaft portion extending along a third longitudinal axis, The retractor assembly is characterized in that the second shaft portion is located midway between the first shaft portion and the third shaft portion, and the third shaft portion is offset from the first shaft portion.

3. A retractor assembly according to claim 2, wherein the handle connection structure is coupled to the third shaft portion.

4. A retractor assembly according to claim 1, wherein the retractor connection structure includes a locking structure configured to fix the retractor handle to the retractor by engaging with the handle connection structure.

5. The retractor assembly according to claim 4, wherein the handle connection structure is A hex wrench and A retractor assembly characterized by including a retaining slot formed in the hexagonal wrench.

6. The retractor assembly according to claim 5, wherein the locking structure is Lock sleeve and A hexagonal socket is placed inside the aforementioned lock sleeve, The hexagonal socket includes at least one or more ball stoppers that are partially positioned within its internal space, A retractor assembly characterized in that the hexagonal socket is configured to receive the hexagonal wrench, and the one or more ball retainers are configured to engage with the retaining slots formed in the hexagonal wrench to secure the retractor handle to the retractor.

7. A retractor assembly according to Claim 1, wherein the distal end of the arc-shaped projection includes a recess formed at its tip, and the recess is shaped to help separate tissue when the retractor is inserted into the knee joint.

8. A retractor, wherein the retractor is A retractor shaft, wherein the retractor shaft is The proximal end and Including the distal end, At least a portion of the retractor shaft extends along the first longitudinal axis, A retractor member positioned at the distal end of the retractor shaft, wherein the retractor member is An arch-shaped projection, wherein the arch-shaped projection is The proximal end of the retractor shaft is connected to the distal end, A distal end that protrudes laterally away from the first longitudinal axis, Top surface and, The bottom and, A retractor surface extending between the upper surface and the lower surface, wherein the retractor surface includes a convex curvature, A cutting shield surface located on the opposite side of the retractor surface, the cutting shield surface includes the cutting shield surface extending between the upper surface and the lower surface, and the retractor member includes the arch-shaped projection, A guide projection is coupled to the cutting shield surface and protrudes toward the first longitudinal axis, wherein the guide projection is Top surface and, The bottom and, It includes an opening formed between the upper surface and the lower surface through the guide projection, The retractor is characterized in that the opening includes a guide projection, which is shaped to receive at least a portion of the femoral condyle in order to position the retractor member with respect to the tibial plateau.

9. A wound retractor according to claim 8, characterized in that the upper surface and the lower surface of the guide projection are configured to taper toward each other when moving from the proximal end of the arc-shaped projection toward the distal end of the arc-shaped projection.

10. A wound retractor according to claim 8, wherein the guide projection further includes an outer edge midway between the upper surface and the lower surface.

11. A retractor according to claim 10, wherein the outer edge includes a convex surface.

12. The retractor according to claim 8, wherein the distal end of the arc-shaped projection is further, The first tip and, The second tip and Including a recess located between the first tip and the second tip, A retractor characterized in that at least one of the first tip, the second tip, and the recess is shaped to guide the medial collateral ligament toward the surface of the retractor when the retractor member is inserted into the knee joint.

13. A retractor according to claim 8, further comprising a handle connection structure disposed at the proximal end of the retractor shaft.

14. The retractor according to claim 8, wherein the retractor shaft is A first shaft portion extending along the first longitudinal axis, A second shaft portion extending along the second longitudinal axis, Including a third shaft portion extending along a third longitudinal axis, The retractor is characterized in that the second shaft portion is located midway between the first shaft portion and the third shaft portion, and the third shaft portion is offset from the first shaft portion.

15. A retractor according to claim 8, wherein the distal end of the arc-shaped projection includes a recess formed at its tip, and the recess is shaped to help separate tissue when the retractor is inserted into the knee joint.

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