A surgical device configured for tendon detachment and excision.

Abstract

The present disclosure relates to a surgical device configured for the release and resection of harvested tendons that can be used in a variety of orthopedic surgical procedures, such as ACL, PCL, and UCL reconstruction.

Description

[Background technology]

[0001] Tendons are generally harvested for use in orthopedic procedures. Specifically, the tendon may be an autologous graft harvested from the patient's hamstring tendon, quadriceps tendon, or other area of ​​the body. The harvested tendon may be used in ligament reconstruction surgery, such as anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and ulnar collateral ligament (UCL) reconstruction. [Overview of the Initiative]

[0002] This disclosure relates to a surgical device configured for tendon dissection and excision. The harvested tendon can be used in various orthopedic procedures such as ACL, PCL, and UCL reconstruction.

[0003] An exemplary surgical apparatus according to the present disclosure includes, among other things, a shaft and an insert adjacent to the distal end of the shaft. The insert provides a stripping tube. The stripping tube includes a window that allows a portion of a tendon to enter the insert. Furthermore, the insert includes a notch proximal to the window and is configured so that a portion of the tendon extends through the notch and exits the insert. The inner diameter of the stripping tube is circular in cross-section, and the stripping tube is centered on the central axis of the shaft. Furthermore, the stripping tube is positioned around the central axis, thereby providing a continuous loop around the central axis. The outer diameter of the stripping tube is tapered adjacent to the distal edge of the stripping tube, so that the outer diameter of the stripping tube gradually decreases toward the distal edge of the stripping tube. The surgical apparatus also includes a cutter that is movable distally to cut the tendon, thereby separating a portion of the tendon extending through the notch from the rest of the tendon by trapping the portion between the distal edge of the cutter and the proximal edge of the stripping tube. The outer diameter of the cutter is tapered adjacent to the distal edge, so that the outer diameter of the cutter gradually decreases toward the distal edge of the cutter. Furthermore, the cutter includes a recess adjacent to the distal edge of the cutter and defined by an inner diameter, which is tapered, so that the inner diameter defining the recess gradually decreases as it moves from the distal edge of the cutter toward the proximal edge.

[0004] A surgical apparatus according to another exemplary aspect of the present disclosure includes, among other things, a shaft and an insert adjacent to the distal end of the shaft. The insert provides a stripping tube, which includes a window that allows a portion of a tendon to enter the insert. The insert also includes a notch proximal to the window and is configured such that a portion of the tendon extends through the notch and exits the insert. The inner diameter of the stripping tube is circular in cross-section, and the stripping tube is centered on the central axis of the shaft. Furthermore, the outer diameter of the stripping tube is tapered adjacent to the distal edge of the stripping tube, so that the outer diameter of the stripping tube gradually decreases toward the distal edge of the stripping tube. The surgical apparatus further includes a cutter that is movable distally for cutting a tendon, thereby separating the portion of the tendon extending through the notch from the rest of the tendon by sandwiching the portion of the tendon between the distal edge of the cutter and the proximal edge of the stripping tube.

[0005] A surgical apparatus according to yet another exemplary aspect of the present disclosure includes, among other things, a shaft and an insert adjacent to the distal end of the shaft. The insert provides a stripping tube, which includes a window that allows a portion of a tendon to enter the insert. The insert also includes a notch proximal to the window and is configured such that a portion of the tendon extends through the notch and exits the insert. The inner diameter of the stripping tube is circular in cross-section, and the stripping tube provides a continuous loop about the central axis of the shaft. The surgical apparatus further includes a cutter that is movable distally to cut the tendon, thereby separating the portion of the tendon extending through the notch from the rest of the tendon by sandwiching the portion of the tendon between the distal edge of the cutter and the proximal edge of the stripping tube. The outer diameter of the cutter is tapered adjacent to the distal edge, so that the outer diameter of the cutter gradually decreases toward the distal edge of the cutter. Furthermore, the cutter includes a recess adjacent to its distal edge and defined by its inner diameter, which is tapered, so that the inner diameter defining the recess gradually decreases as it moves from the distal edge of the cutter towards the proximal edge. [Brief explanation of the drawing]

[0006] [Figure 1] This is a side view of the first example surgical apparatus. [Figure 2] Figure 1 is a partial perspective view of the surgical apparatus, and in particular, it shows the cutter in an intermediate position between the stationary position and the fully extended position. [Figure 3] Figure 1 is a partial lateral perspective view of the surgical apparatus, and in particular illustrates the details of the stripping tube. [Figure 4] Figure 1 is a partial perspective view of the surgical apparatus, and in particular, shows the cutter in its fully extended position. [Figure 5] Figure 1 is a partial lateral perspective view of the surgical apparatus, illustrating the details of the cutter in particular. [Figure 6] Figure 1 is a partial top perspective view of the surgical apparatus, illustrating in particular the details of the stripping tube and the adjacent notch. [Figure 7] Figure 1 is a side view of the surgical apparatus with a portion of the handle removed for easier reference. In Figure 7, the locking assembly is engaged. [Figure 8] Figure 1 is a side view of the surgical apparatus with a portion of the handle removed for easier reference. In Figure 8, the locking assembly is disengaged. [Figure 9] Figure 1 is a side view of the surgical apparatus, with a portion of the handle removed for easier reference. In Figure 9, the stripping tube is in contact with the tendon, and the cutter is in a stationary position. [Figure 10] Figure 1 is a side view of the surgical apparatus, with a portion of the handle removed for easier reference. In Figure 10, the cutter has advanced to an intermediate distal position from its resting position. [Figure 11] Figure 1 is a side view of the surgical apparatus, with a portion of the handle removed for easier reference. In Figure 11, the cutter is advanced distally to its fully extended position and a portion of the tendon is cut. [Figure 12] Partial top view of a second exemplary surgical device. [Figure 13] Side view of a third exemplary surgical device. [Figure 14] Side view of the handle and shaft of the surgical device of FIG. 13. [Figure 15] Top view of the handle and shaft of the surgical device of FIG. 13. [Figure 16] End view of the handle of the surgical device of FIG. 13. [Figure 17] Cross-sectional view taken along line 17-17 from FIG. 16. [Figure 18] Rear perspective view of the stripping tube insert of the surgical device of FIG. 13. [Figure 19] End view of the stripping tube insert. [Figure 20] Top view of the stripping tube insert. [Figure 21] Enlarged view of a portion of the stripping tube insert. [Figure 22] Side view of the rod and guide of the surgical device of FIG. 13. [Figure 23] Cross-sectional view taken along line 23-23 from FIG. 22. [Figure 24] Side view of the rod and guide of FIG. 22 having a cap attached adjacent to the end of the guide. [Figure 25] Side view of the rod and guide of FIG. 22 having a cap removed from the guide. DETAILED DESCRIPTION OF THE INVENTION

[0007] The present disclosure relates to a surgical device configured to perform tendon stripping and excision. The harvested tendon can be used in various orthopedic procedures such as ACL, PCL, and UCL reconstructions.

[0008] A surgical device according to an exemplary aspect of the present disclosure includes, among other things, a shaft and an insert adjacent to the distal end of the shaft. The insert provides a stripping tube. The stripping tube includes a window that allows a portion of the tendon to enter the insert. Further, the insert includes a notch proximal to the window and is configured such that a portion of the tendon extends through the notch and exits the insert. The inner diameter of the stripping tube has a circular cross-section and the stripping tube is centered about the central axis of the shaft. Further, the stripping tube is disposed about the central axis, whereby the stripping tube provides a continuous ring about the central axis. The outer diameter of the stripping tube is tapered adjacent to the distal edge of the stripping tube, whereby the outer diameter of the stripping tube gradually decreases toward the distal edge of the stripping tube. The surgical device also includes a cutter movable distally to cut the tendon, whereby a portion of the tendon extending through the notch is separated from the remaining portion of the tendon by sandwiching a portion of the tendon between the distal edge of the cutter and the proximal edge of the stripping tube. The outer diameter of the cutter is tapered adjacent to the distal edge, whereby the outer diameter of the cutter gradually decreases toward the distal edge of the cutter. Further, the cutter includes a recess adjacent to the distal edge of the cutter and defined by an inner diameter that is tapered such that the inner diameter defining the recess gradually decreases while moving proximally from the distal edge of the cutter.

[0009] A surgical apparatus according to another exemplary aspect of the present disclosure includes, among other things, a shaft and an insert adjacent to the distal end of the shaft. The insert provides a stripping tube, which includes a window that allows a portion of a tendon to enter the insert. The insert also includes a notch proximal to the window and is configured such that a portion of the tendon extends through the notch and exits the insert. The inner diameter of the stripping tube is circular in cross-section, and the stripping tube is centered on the central axis of the shaft. Furthermore, the outer diameter of the stripping tube is tapered adjacent to the distal edge of the stripping tube, so that the outer diameter of the stripping tube gradually decreases toward the distal edge of the stripping tube. The surgical apparatus further includes a cutter that is movable distally for cutting a tendon, thereby separating the portion of the tendon extending through the notch from the rest of the tendon by sandwiching the portion of the tendon between the distal edge of the cutter and the proximal edge of the stripping tube.

[0010] A surgical apparatus according to yet another exemplary aspect of the present disclosure includes, among other things, a shaft and an insert adjacent to the distal end of the shaft. The insert provides a stripping tube, which includes a window that allows a portion of a tendon to enter the insert. The insert also includes a notch proximal to the window and is configured such that a portion of the tendon extends through the notch and exits the insert. The inner diameter of the stripping tube is circular in cross-section, and the stripping tube provides a continuous loop about the central axis of the shaft. The surgical apparatus further includes a cutter that is movable distally to cut the tendon, thereby separating the portion of the tendon extending through the notch from the rest of the tendon by sandwiching the portion of the tendon between the distal edge of the cutter and the proximal edge of the stripping tube. The outer diameter of the cutter is tapered adjacent to the distal edge, so that the outer diameter of the cutter gradually decreases toward the distal edge of the cutter. Furthermore, the cutter includes a recess adjacent to its distal edge and defined by its inner diameter, which is tapered, so that the inner diameter defining the recess gradually decreases as it moves from the distal edge of the cutter towards the proximal edge.

[0011] In further embodiments, the cutter is centered on a central axis.

[0012] In a further embodiment, the distal edge of the stripping tube is provided with multiple serrations.

[0013] In a further embodiment, the outer diameter of the stripping tube is tapered adjacent to the proximal edge of the stripping tube, so that the outer diameter of the stripping tube gradually decreases toward the proximal edge of the stripping tube.

[0014] In a further embodiment, the shaft protrudes from the handle, the insert is mounted adjacent to the distal end of the shaft, and the shaft, insert, and handle together define a through hole extending along the central axis from the proximal end of the handle to the distal edge of the insert, and the cutter is movable within the through hole.

[0015] In further embodiments, the through hole exhibits a variable diameter along the central axis.

[0016] In a further embodiment, the cutter is provided by a rod, the rod is connected to a guide, the guide includes a projection, the handle includes a helical slot that receives the projection, and the projection and the helical slot interact such that movement of the rod and guide along a central axis results in rotation of the rod and guide about the central axis.

[0017] In a further embodiment, the projection is one of a plurality of projections spaced apart from each other around the outer surface of the guide, the helical slot is one of a plurality of helical slots, and each helical slot receives a corresponding projection.

[0018] In a further embodiment, the cap is attached to the guide adjacent to the proximal end of the guide, the cap is positioned proximal to the handle, and the cap is configured to rotate relative to the guide.

[0019] In further embodiments, the outer contour of the end section of the handle has a substantially square cross-section with rounded corners.

[0020] In a further embodiment, the outer diameter of the insert is configured to prevent rotation and axial movement of the insert relative to the shaft.

[0021] Figure 1 illustrates an embodiment of the surgical apparatus 20. The surgical apparatus 20 includes a handle 22 and a shaft 24 projecting distally from the handle 22. The “distal” and “proximal” directions are labeled throughout the various figures for illustrative purposes only. In this embodiment, the shaft 24 includes a stripping tube 26 adjacent to its distal end. The stripping tube 26 is configured to detach tendons. The surgical apparatus 20 includes a cutter 28 (Figure 2) that is movable distally toward the stripping tube 26 to cut tendons. Details of the surgical apparatus 20, including the stripping tube 26 and the cutter 28, are described below.

[0022] Referring to Figure 3, the shaft 24 comprises a substantially cylindrical body which may be made of a metallic material. In this embodiment, the shaft 24 is substantially cylindrical, but the shaft 24 can exhibit different cross-sectional shapes, including substantially square or rectangular. The shaft 24 extends along axis A1, which is the central longitudinal axis of the shaft 24. Adjacent to the distal end 32 of the shaft 24, the shaft 24 includes a notch 34 on its upper surface 36 (i.e., top surface). The notch 34 allows the tendon to pass through it and defines the structure of the stripping tube 26, as will be discussed below.

[0023] The stripping tube 26 is part of the shaft 24 and, in this embodiment, extends entirely around the axis A1. The stripping tube 26 includes a distal edge 38 and a proximal edge 40. In this embodiment, the distal edge 38 occupies the same space as the distal end 32 of the shaft 24. The proximal edge 40 of the stripping tube 26 is defined by the distal boundary of the notch 34. The inner diameter D1 of the stripping tube 26 intersects the axis A1 such that the inner diameter D1 of the stripping tube 26 has a substantially circular cross-section. In this way, the stripping tube 26 includes a window that allows a portion of the tendon to pass through it.

[0024] The distal edge 38 of the stripping tube 26 is configured to detach a portion of the tendon from the adjacent tissue. In this embodiment, the stripping tube 26 is tapered adjacent to the distal edge 38. Specifically, the outer diameter D2 of the stripping tube 26 gradually decreases in diameter throughout the tapered section 42. The tapered section 42 extends axially from the distal edge 38 to a location 44 proximal to the distal edge 38. In one embodiment, the tapered section 42 is positioned such that the distal edge 38 is an acute-angled edge and the distal edge 38 is tapered to an acute-angled tip. In other embodiments, the distal edge 38 may be rounded or obtuse, while still having the ability to detach the tendon. Furthermore, in this embodiment, the tapered section 42 extends around the axis A1, while in other embodiments, the tapered section 42 may extend only partially around the axis A1.

[0025] To increase the ability of the stripping tube 26 to detach tendons, the stripping tube 26 may include one or more serrations adjacent to the distal edge 38. In this embodiment, the stripping tube 26 includes four serrations 46A-46D. The serrations 46A-46D are equally spaced apart from each other with respect to axis A1. In this embodiment, the serrations 46A-46D are notches extending proximal to the distal edge 38. The present disclosure is not limited to any particular number or arrangement of serrations.

[0026] A substantially circular inner diameter D1 allows for the harvesting of a substantially cylindrical tendon, which enables the harvesting of a appropriately sized cylindrical tendon without the need to approximate a cylindrical shape using numerous linear excisions. In this regard, the stripping tube 26 exhibits a substantially circular inner diameter D1 along its entire length. Furthermore, the inner diameter D1 may be selected to correspond to the desired diameter of the harvested tendon. For example, the inner diameter D1 may be 7 mm, 10 mm, or 12 mm, but this disclosure is not limited to these specific dimensions. A surgeon may have a number of surgical instruments 20 at their disposal, each having a stripping tube 26 with a different inner diameter D1. A surgeon may select a surgical instrument 20 having an appropriately sized inner diameter D1 for use in a particular procedure. In this way, the stripping tube 26 also functions as a sizing tube.

[0027] The cutter 28 is movable distally toward the stripping tube 26 for cutting or excising tendons. In this embodiment, the cutter 28 comprises a substantially cylindrical body positioned around axis A1 and disposed within the shaft 24. The cutter 28 may be made of a metallic material. Like the shaft 24, the cutter 28 may also have a different cross-sectional shape, such as a substantially square or rectangular cross-section. This disclosure is not limited to a substantially cylindrical shaft 24 and cutter 28. The cutter 28 has an outer diameter D3 that is substantially the same as the inner diameter D1 of the stripping tube 26. In this embodiment, the outer diameter D3 is slightly smaller than the inner diameter D1 to allow the cutter 28 to move relative to the shaft 24.

[0028] The cutter 28 is selectively movable within the shaft 24 under the force of the trigger and one or more biasing elements, which is discussed below. The cutter 28 is movable from a neutral resting position to a fully extended position. The resting position is shown in Figures 1 and 3, where the entire cutter is proximal to the notch 34. Figures 4 and 5 illustrate the cutter 28 in the fully extended position, where the cutter 28 has moved distally to the resting position, and the distal edge 50 of the cutter 28 is distal to the notch 34. For reference, Figure 2 illustrates the cutter 28 in an intermediate position between the resting position and the fully extended position.

[0029] To increase the ability of the cutter 28 to sever tendons, the cutter 28 is tapered adjacent to its distal edge 50. In this embodiment, the outer diameter D3 of the cutter 28 is substantially constant along the length of the cutter 28, and the cutter 28 includes a recess 52 (Figure 5) adjacent to the distal edge 50. The recess 52 tapers as it extends proximally from the distal edge 50. Specifically, the recess 52 is defined by an inner diameter D4 that gradually decreases from the distal edge 50 as it moves proximally. Thus, the recess 52 is substantially frustoconical in shape, but the disclosure is not limited to frustoconical recesses and extends to other shapes such as rounded or square recesses. The recess 52 may have an acute, rounded, or obtuse distal edge 50. In any case, the recess 52 is configured such that the distal edge 50 effectively excises tendons. Although not shown in this embodiment, the cutter 28 may include one or more saw teeth adjacent to the distal edge 50, similar to the saw teeth 46A to 46D.

[0030] When the tendon is detached, the removed portion of the tendon exits the shaft 24 through the notch 34. To cut the removed portion of the tendon, the user moves the cutter 28 distally toward the proximal edge 40 of the stripping tube 26. The tendon is cut by being sandwiched and excised between the proximal edge 40 of the stripping tube 26 and the distal edge 50 of the cutter 28. In one embodiment, the proximal edge 40 of the stripping tube 26 is tapered to increase the ease of excising the tendon. As shown in Figure 6, the stripping tube 26 may include a tapered section 54 that begins at a distal location 56 of the proximal edge 40. The outer diameter D2 of the stripping tube 26 gradually decreases throughout the tapered section 54 that moves proximal from location 56 toward the proximal edge 40. The proximal edge 40 may be acute, rounded, or obtuse. In the illustrated embodiment, both the proximal margin 40 and the distal margin 50 are tapered, but in other embodiments, only one of the proximal margin 40 or the distal margin 50 is tapered.

[0031] Referring to Figure 7, an exemplary arrangement of the handle 22 is described here. Specifically, an exemplary arrangement configured to cause movement of the cutter 28 relative to the stripping tube 26 is described. This disclosure is not limited to surgical apparatus including the specific arrangement in Figure 7.

[0032] In Figure 7, the outer cover of the handle 22 is partially removed for ease of reference. The handle 22 includes a grip 58 and a trigger 60 rotatable relative to the grip about an axis A2 adjacent to the lower portion (i.e., bottom) of the grip 58. The “downward” and “upward” directions are labeled in Figure 7 for illustrative purposes only. Axis A2 is perpendicular to axis A1 in this embodiment. The trigger 60 is located proximal to the grip 58, and the handle 22 is positioned such that the trigger 60 is placed between the user's thumb and index finger when the user grasps the grip 58.

[0033] The trigger 60 is mechanically connected to the cutter 28 by a projection 62 that protrudes upward (i.e., upward) from the rest of the trigger 60. In this way, the rotation of the trigger 60 about axis A2 is converted into axial movement of the cutter 28 along axis A1.

[0034] In Figure 7, the cutter 28 is in a stationary position with its distal edge 50 proximal to the notch 34. One or more biasing elements may bias the cutter 28 and / or the trigger 60 toward the stationary position. For example, the handle 22 may include one or more biasing elements that force the cutter 28 in the proximal direction, and the handle may also include one or more biasing elements that force the trigger 60 to rotate in a first direction R1, which in this embodiment is clockwise, about axis A2.

[0035] To move the cutter 28 distally toward its fully extended position, the user applies force to the trigger 60 to overcome the bias toward the cutter 28 and / or the trigger 60 toward its resting position. To activate the trigger 60, the user applies distal force to the trigger 60, rotating the trigger 60 in a second direction R2 opposite to the first direction R1, which ultimately causes distal movement of the cutter 28. Since applying distal force to the trigger 60 is translated into distal movement of the cutter 28, the deployment of the cutter 28 is intuitive to the user.

[0036] In aspects of this disclosure, unintended deployment of the cutter 28 is prevented by a locking assembly 64. The locking assembly 64 includes a tab 66 that is movable upward and downward in and out of a slot 68 formed within the cutter 28. In Figure 7, the locking assembly 64 is engaged, meaning the tab 66 is in the slot 68, which prevents axial movement of the cutter 28 and holds the cutter 28 in a stationary position. In Figure 8, the tab 66 is moved downward compared to Figure 7, for example by the user applying a downward force to the tab 66, thereby disengaging the locking assembly 64. In Figure 8, the tab 66 is not in the slot 68, and therefore the tab 66 does not prevent axial movement of the cutter 28. This disclosure is not limited to surgical devices having a locking assembly.

[0037] Returning to Figure 7, in another aspect of the present disclosure, the surgical apparatus 20 is arranged to rotate about axis A1 as the cutter 28 moves along axis A1. Rotating the cutter 28 relative to the stripping tube 26 may increase the ease of cutting the tendon. In one embodiment, to rotate the cutter 28, the surgical apparatus 20 includes a pin 70 supported by a shaft 24 and projecting perpendicular to axis A1. The cutter 28 includes at least one helical slot 72 formed therein. The helical slot 72 is shown by dashed lines in Figure 7 and also extends helically along axis A1. The pin 70 is arranged to project into the helical slot 72. The interaction between the pin 70 and the helical slot 72 causes the cutter 28 to rotate about axis A1 as the cutter 28 moves axially along axis A1. While the cutter 28 does not necessarily need to rotate in all embodiments, as mentioned, rotation can increase the ease of cutting. Furthermore, the disclosure naturally extends to configurations in which the cutter 28 is fixed and the stripping tube 26 rotates about axis A1 as the stripping tube 26 moves axially relative to the cutter 28. Although only one pin 70 and helical slot 72 are shown in Figure 7, the shaft 24 and cutter 28 may, of course, include additional pins and helical slots, respectively.

[0038] Referring to Figures 9 to 11, an illustrative method of use is described here. In Figure 9, the surgical device 20 makes contact with the tendon 74 and begins to detach the tendon. In this embodiment, when detaching the tendon 74, the cutter 28 is in a stationary position and the locking assembly 64 is engaged. Thereafter, the tab 66 prevents undesirable movement of the cutter 28, which could otherwise prematurely sever the tendon.

[0039] In Figure 9, the user dissects the tendon 74 by bringing the distal edge 38 of the stripping tube 26 into contact with the tendon 74 and advancing the surgical instrument 20 distally along the tendon 74. A portion of the tendon 74 enters the stripping tube 26 and becomes partially separated from the rest of the tendon 74. The partially separated portion of the tendon is labeled with reference numeral 76. The portion 76 has a substantially cylindrical cross-section thanks to the substantially circular cross-section of the stripping tube 26.

[0040] In one embodiment, the tendon 74 may be a quadriceps tendon. However, this disclosure is not limited to any particular type of tendon. Furthermore, this disclosure may be used with other types of soft tissue and is not limited to use with tendons.

[0041] In the exemplary method, the user continues to advance the surgical instrument 20 distally until portion 76 reaches the desired graft length. The user may measure portion 76 using markings 78 on the outside of the shaft 24. The markings 78 correspond to the proximal distance of the notch 34 and may also be spaced 10 units (e.g., 50, 60, 70, 80, 90) in millimeters. Markings 78 are used in the figures and are shown in the figures with dashed lines to avoid confusion with other reference numbers considered herein. The shaft 24 does not need to include markings in all embodiments.

[0042] In Figure 10, the user is advancing the surgical apparatus 20 distally to the point where a portion 76 of the tendon 74 provides the appropriate graft length. Thus, the user disengages the locking assembly 64 by moving the tab 66 downward and begins to advance the cutter 28 distally. The user activates the trigger 60 by pressing the grip 58 and the trigger 60 together, thereby rotating the trigger 60 in direction R2 about axis A2. This rotation results in distal movement of the cutter 28 along axis A1 thanks to the mechanical connection of the projection 62 to the cutter 28. The axial movement of the cutter 28 also results in rotational movement of the cutter 28 about axis A1 thanks to the arrangement of the pin 70 and the helical slot 72.

[0043] The continuous compression causes further distal movement of the cutter 28, which then causes a portion 76 of the tendon 74 to be trapped between the distal edge 50 of the cutter 28 and the proximal edge 40 of the stripping tube 26. Finally, the portion 76 is completely severed from the rest of the tendon 74, as shown in Figure 11, with the cutter 28 in a fully extended position. Among other advantages, the surgical apparatus 20 is intuitive and allows the tendon to be harvested using fewer instruments than previous techniques.

[0044] Figure 12 is a top view of a portion of another illustrative surgical apparatus 120. Unless otherwise noted or indicated, surgical apparatus 120 corresponds to surgical apparatus 20, with a "1" prefixed to a similar part.

[0045] Unlike surgical apparatus 20, in which the cutter 28 is positioned within the circumference of the shaft 24, surgical apparatus 120 is arranged such that the cutter 128 is positioned outside the circumference of the shaft 124. The cutter 128 may be movable between a stationary position and a fully extended position in substantially the same manner as described with respect to Figures 7 to 11. The cutter 128 may rotate as it moves axially, as in the previous embodiment. Alternatively, the cutter 128 does not need to rotate.

[0046] In an additional embodiment, the stripping tube 126 is substantially the same as that of the stripping tube 26, except for the proximal edge 140. In Figure 12, the proximal edge 140 of the stripping tube 126 is not tapered. Rather, the proximal edge 140 is obtuse and includes a rounded projection 180 that protrudes proximally from the upper surface 182 of the stripping tube 126. In a variation of this embodiment, the proximal edge 140 may be tapered in generally the same way as the proximal edge 40. In yet another variation, the proximal edge 140 does not include the rounded projection 180.

[0047] The distal edge 150 of the cutter 128 is also arranged differently from that of the previous embodiment. In Figure 12, the outer diameter D3 of the cutter 128 includes a tapered section 184 that extends from the distal edge 150 to a proximal location 186 of the distal edge 150. The outer diameter D3 gradually decreases in thickness as it moves distally through the entire tapered section 184. The cutter 128 also includes at least one sawtooth 188 adjacent to the distal edge 150. In Figure 12, the cutter 128 includes only one sawtooth 188, which in this embodiment is a notch formed within the distal edge 150. The sawtooth 188 is symmetrical with respect to a plane that passes through axis A1 and bisects the surgical apparatus 120. The sawtooth 188 is aligned with projection 180 such that a common plane bisects both projection 180 and sawtooth 188. The projection 180 and the serrations 188 work together to provide effective excision of the tendon. Although only one serration 188 is shown in Figure 12, the cutter 128 may include additional serrations. Alternatively, the cutter 128 may not include any serrations at all.

[0048] Herein, we describe another example of a surgical apparatus 220. Unless otherwise stated or indicated, a surgical apparatus 220 corresponds to a similar component to a surgical apparatus 20, with the number "2" preceding it.

[0049] Figure 13 is a side view of an exemplary surgical apparatus 220. The surgical apparatus 220 includes a handle 222 and a shaft 224 projecting distally from the handle 222. Furthermore, a stripping tube 226 is adjacent to the distal end of the shaft 224. The stripping tube 226 is configured to detach tendons. The surgical apparatus 220 includes a cutter 228 that is movable distally toward the stripping tube 226 for cutting tendons.

[0050] Referring to Figures 14 to 17, the handle 222 and shaft 224 are integrally formed in this embodiment. The handle 222 and shaft 224 may be made from, for example, a metal material or another type of material such as polycarbonate. The handle 222 has an outer contour configured to be grasped by the hand of a user, such as a surgeon.

[0051] As shown in Figure 16, when viewed from the edge, the outer contour of the handle 222 is substantially square with rounded corners. The corners connect the first set of opposing surfaces 302A, 302B to the second set of opposing surfaces 304A, 304B. The first set of opposing surfaces 302A, 302B exhibits the same contour reflected around axis A3, which is the central longitudinal axis of the surgical instrument 220. The second set of opposing surfaces 304A, 304B also exhibits the same contour reflected around axis A3. Furthermore, the contour of the second set of opposing surfaces 304A, 304B differs from that of the first set of opposing surfaces 302A, 302B, which provides the user with two or more options for gripping the handle 222. The user may find a particular hand position that is more comfortable, for example, depending on personal preference and / or the relative position of the user and the patient. Furthermore, the virtually square outer contour allows for optimal torque transmission.

[0052] Here, with reference to Figure 14, additional details of the first pair of opposing surfaces 302A and 302B are described. Starting adjacent to the proximal end 306 of the handle 222 and moving distally, surfaces 302A and 302B gradually taper toward the axis A3, thereby reducing the diameter of the handle 222 toward the axial location 308. At location 308, surfaces 302A and 302B are closest to the axis A3. Distal to location 308, surfaces 302A and 302B gradually deviate from the axis A3 to form a flared portion 310, where the handle 222 exhibits its largest diameter in this embodiment. Specifically, in the flared portion 310, surfaces 302A and 302B are slightly further away from the axis A3 than at the location adjacent to the proximal end 306 of the handle 222. At the distal end of the protruding portion 310, the handle 222 converges toward axis A3, and surfaces 302A and 302B merge into the shaft 224.

[0053] Referring to Figure 15, the second pair of opposing surfaces 304A, 304B exhibit a substantially constant diameter, starting adjacent to the proximal end 306 of the handle 222 and moving distally to an axial location 312. Location 312 is proximal to location 308. Distal to location 312, surfaces 304A, 304B gradually taper toward axis A3 and eventually merge into the shaft 224. Surfaces 304A, 304B do not deviate from axis A3 as they move distally along the length of surfaces 304A, 304B, and specifically, surfaces 304A, 304B do not exhibit a protrusion similar to the protrusion 310 in this embodiment.

[0054] Referring to Figure 17, the handle 222 and shaft 224 include a through hole 314 that extends along the entire length of the handle 222 and shaft 224. Specifically, the through hole 314 extends from the proximal end 306 of the handle 222 to the distal end 316 of the shaft 224. Adjacent to the distal end 316, the through hole 314 is configured to receive and support the stripping tube 226 relative to the shaft 224. The through hole 314 is also configured to facilitate the movement of the cutter 228 within the through hole 314. The through hole 314 has a varying diameter that is centered around axis A3 and passes through axis A3 along the length of the through hole 314. The through hole 314 has a circular cross-section along most of its length.

[0055] Starting from the distal end 316 and moving proximal, the through-hole 314 exhibits a diameter D5 along length L1. The inner surface of diameter D5 may include features such as protrusions configured to interact with corresponding features on the outer surface of the stripping tube 226 in order to prevent rotation and / or axial movement of the stripping tube 226. Exemplary features are described below for the stripping tube insert 320 that provides the stripping tube 226 in this embodiment. Proximal to length L1, the through-hole widens along length L2 to a diameter D6, which is larger than diameter D5. Along length L2, the through-hole 314 may also include features configured to interact with features on the outer surface of the stripping tube 226 in order to prevent relative rotation and / or axial movement between the stripping tube 226 and the shaft 224. Proximal to length L2, along length L3, the through-hole narrows and exhibits a diameter D7, which is smaller than diameter D6.

[0056] Starting from the proximal end 306 of the handle 222 and moving distally, within the handle 222, the through hole 314 exhibits a diameter D8 over a length L4. Within length L4, the through hole 314 also includes, in this embodiment, two helical slots 318A, 318B. The helical slots 318A, 318B extend radially outward with a diameter D8 and extend helically along axis A3. The helical slots 318A, 318B are configured to receive a pin associated with the cutter 228, and the interaction between the pin and the helical slots 318A, 318B is arranged to rotate the cutter 228 about axis A3 as the cutter 228 moves axially along axis A3. Distal to length L4, the diameter of the through hole 314 gradually decreases and merges into a diameter D7.

[0057] In this embodiment, the stripping tube 226 of the surgical apparatus 220 is not integrally formed with the shaft 224. Rather, the stripping tube 226 is provided by a separately formed structure, referred to herein as a stripping tube insert 320, which is shown in Figures 18 to 21. The stripping tube insert 320 is press-fitted to the distal end 316 of the shaft 224, or otherwise connected to the shaft 224. The stripping tube insert 320 includes a distal section 322 configured to provide the stripping tube 226 and to perform the dissection and excision of soft tissue. The stripping tube insert 320 also includes a proximal section 324 configured to fit into a through hole 314 and to hold the stripping tube insert 320 to the shaft 224 by resisting rotation and axial movement of the stripping tube insert 320 relative to the shaft 224.

[0058] Referring to Figure 19, the stripping tube insert 320 has a constant internal diameter D9 along its entire length, from its distal end 326 to its proximal end 328. In this way, the stripping tube insert 320 defines a through hole along its entire length. As shown in Figure 13, when the stripping tube insert 320 is supported against the shaft 224, the internal diameter D9 is centered on axis A3 and essentially continues the through hole 314 so that the surgical instrument 220 exhibits a through hole extending from the proximal end 306 of the handle to the distal end 326 of the stripping tube insert 320. In this embodiment, the interior of the stripping tube insert 320 has a substantially circular cross-section along its entire length.

[0059] Referring to Figure 20, the stripping tube 226 is constructed substantially the same as the stripping tube 26. The stripping tube 226 includes a distal edge 238 that occupies the same space as the distal end 326 (Figure 18), and a proximal edge 240. The proximal edge 240 of the stripping tube 226 is defined by the distal boundary of the notch 234 on the upper surface of the stripping tube insert 320. The distal edge 238 of the stripping tube 226 defines a window 330 (Figure 19) that allows a portion of the tendon to pass through it.

[0060] The distal edge 238 of the stripping tube 226 is configured to detach a portion of the tendon from the adjacent tissue. The detached portion of the tendon enters the window 330, passes through the inside of the stripping tube 226, and finally exits the surgical device 220 through the notch 234.

[0061] In this embodiment, to facilitate resection, the stripping tube 226 is tapered adjacent to the distal edge 238. Specifically, the outer diameter D of the stripping tube 226 is tapered. 10The diameter gradually decreases throughout the tapered section 242. The tapered section 242 extends axially from the distal edge 238 to a location 244 proximal to the distal edge 238. In one embodiment, the tapered section 242 is positioned such that the distal edge 238 is an acute-angled edge and the distal edge 238 is tapered to the acute-angled tip. Tapering the distal edge 238 allows for effective excision of the tendon while also protecting against accidental excision of adjacent soft tissues such as paratendinous tissue. In other embodiments, the distal edge 238 may be rounded or obtuse, while still retaining the ability to dissect the tendon. Furthermore, in this embodiment, the tapered section 242 extends around the entire axis A3. For this purpose, the stripping tube 226 extends continuously around axis A3, thereby defining a continuous and uninterrupted loop, as shown in Figure 19.

[0062] The stripping tube 226 also includes a tapered section 254 that begins at a distal location 256 of the proximal edge 240. Specifically, the outer diameter D of the stripping tube 226 10 The tapered section 254 gradually decreases as it moves proximal from location 256 to the proximal edge 240. The proximal edge 240 may be acute, rounded, or obtuse. The tapered section 254 facilitates the excision of the detached portion of the tendon because the detached portion of the tendon is sandwiched between the distal edge and the proximal edge 240 of the cutter 228.

[0063] Proximal to the notch 234, the external proximal section 324 of the stripping tube insert 320 includes numerous features configured to interact with the shaft 224, and specifically with the through hole 314, in order to hold the stripping tube insert 320 relative to the shaft 224. The majority of the proximal section 324 of the stripping tube insert has a diameter D 10 It exhibits the following characteristics. When moving proximal to the notch 234, the stripping tube insert 320 has a diameter D10 It includes a raised section 332 having a larger diameter. Proximal to the raised section 332, the stripping tube insert 320 has a diameter D 10 It returns with a step. When moving proximal, the stripping tube insert 320 includes a plurality of axially extending projections 334, each of which is circumferentially separated from one another with respect to the outside of the stripping tube insert 320. In one embodiment, the axially extending projections 334 are splines, and in that embodiment, they may be formed by spline rolling. The axially extending projections 334 are configured to interact and engage with corresponding features of the through-hole 314 to prevent relative rotation of the stripping tube insert 320 and the shaft 224.

[0064] Proximal to the projection 334 extending in the longitudinal direction, the stripping tube insert 320 includes a plurality of retaining features 336A to 336C that are axially separated from each other and configured to resist axial movement of the stripping tube insert 320 relative to the shaft 224. Specifically referring to retaining feature 336A, the retaining features 336A to 336C are located at a diameter D 10 An inwardly recessed channel 338, and a channel located immediately proximal to the channel 338, with a diameter D 10 A raised surface 340 protrudes radially outward, and the surface 342 tapers proximally from the raised surface 340, so that when moving proximally, the inclined surface 342 has a diameter D 10 The channel 338, the raised surface 340, and the inclined surface 342 are formed by gradually blending into the channel 338, the raised surface 340, and the inclined surface 342, which continuously extend around the entire outer circumference of the stripping tube insert 320. While specific arrangements of features configured to resist axial and rotational movement of the stripping tube insert 320 are shown and described, this disclosure extends to other such arrangements.

[0065] The stripping tube insert 320 is press-fitted into the through-hole 314 by being inserted into the through-hole 314 adjacent to the distal end 316 of the shaft 224. By forming the stripping tube insert 320 as a structure separate from the handle 222 and the shaft 224, the user may select a specific stripping tube insert 320 for use in a specific procedure. Specifically, the user may have access to kits having stripping tube inserts presenting different sizes and / or diameters D9 of different cross-sectional shapes, and the user may also select a specific stripping tube insert from the kit for use in a specific procedure to obtain a desired graft size and / or shape.

[0066] Here, the cutter 228 will be described with reference to FIGS. 22 and 23. Generally, the cutter 228 is movable within the through-hole 314 to excise a portion of the tendon protruding through the notch 234. In this embodiment, the cutter 228 is provided by a rod 344 which is depicted as broken along its length in FIGS. 22-24 for simplicity of illustration of the rod 344 which does not show its full length L5. The rod 344 has a substantially constant outer diameter D along its length L5 extending from the distal edge 250 of the rod 344 to the point where the rod 344 is attached to the guide 346. 11 As shown in FIG. 23, a portion of the rod 344 may pass into the guide 346. The diameter D 11 is such that the rod 344 can move axially within the through-hole 314 and inside the stripping tube insert 320.

[0067] The guide 346 has a diameter D 11 greater than the diameter D 12 along its length L6. The diameter D 12This corresponds to the diameter D8 of the through hole 314. This embodiment includes two sets of circumferentially spaced pins 348A and 348B, centered on the guide 346 and sized to be received within the helical slots 318A and 318B. The pins 348A and 348B interact with the helical slots 318A and 318B to convert the axial movement of the cutter 228 along axis A3 into rotation of the cutter 228 about axis A3, which increases the ease of tendon excision.

[0068] In this embodiment, the distal edge 250 of the rod 344 is tapered. Specifically, the outer diameter D of the rod 344 11 The tapered section 352 gradually decreases throughout the tapered section 352, moving distally from a location 354 proximal to the distal margin 250. The distal margin 250 may be acute, rounded, or obtuse. The tapered section 354 facilitates the excision of the detached portion of the tendon, but also reduces the undesirable excision of adjacent soft tissue.

[0069] The inner diameter of the rod 344 adjacent to the distal edge 250 is also tapered. Specifically, the rod 344 includes a recess 353 adjacent to the distal edge 250. The recess 353 has a frustoconical shape, and its inner diameter D gradually decreases as the recess 353 extends proximal to the distal edge 250. 13 The tapered section 355 has a recess 353, which includes a proximal section 357 proximal to the tapered section 355 to facilitate machining of the tapered section 355. The proximal section 357 has a diameter less than or equal to the minimum diameter of the tapered section 355. The tapered section 355 facilitates tendon resection. Together, the tapered sections 354 and 355 concentrate the resection force and increase the ease of tendon resection.

[0070] As shown in Figures 24 and 25, the cap 356 is attached to the guide 346 proximal to the guide 346 via a number of flexible tabs 358 on the guide 346. The cap 356 interacts with the flexible tabs 358 such that the flexible tabs 358 restrict the axial movement of the cap 356, but allow rotation of the cap 356 relative to the guide 346. As shown in Figure 13, when assembled, the cap 356 is proximal to the handle 222.

[0071] To move the cutter 228, the user may grasp the handle 222 with one hand and the cap 356 with the other. The user may apply force to the cap 356 to move the rod 344 and guide 346 axially along axis A3. When this force is applied, the guide 346 and rod 344 rotate about axis A3 by the helical slots 318A, 318B and pins 348A, 348B. However, since the cap 356 is rotatable relative to the rod 344 and guide 346, the rotation of the rod 344 and guide 346 is not transmitted to the cap 356. Therefore, the user is not forced to adjust their grip on the cap 356 when moving the cutter 228. This may be particularly beneficial because the user typically wears latex gloves that are prone to tearing when exposed to excessive friction.

[0072] Various features of the surgical apparatus 220 may be combined with features of the surgical apparatus 20, unless such features are not compatible. For example, although serrations are not shown on the surgical apparatus 220, the serrations 46A to 46D of the surgical apparatus 20 can be incorporated into the surgical apparatus 220. Furthermore, the surgical apparatus 220 may include markings similar to those of the marking 78.

[0073] The surgical apparatus 220 is used to dissect tendons in substantially the same manner as the surgical apparatus 20, except that, instead of a trigger, the cutter 228 is moved distally when the user applies force to the cap 356, as shown in Figures 10 and 11. Another exception is that, as shown in Figure 9, the cutter 228, including the rod 344, guide 346, and cap 356, may be detached from the stripping tube insert 320, handle 222, and shaft 224 when the tendon is dissected. The cutter 228 may then be inserted into the through-hole 314 when excision is desired. Thus, the surgical apparatus 220 is a substantially two-part system that prevents accidental and / or premature deployment of the cutter 228.

[0074] Naturally, terms such as “distal,” “proximal,” “upper,” and “lower” are used herein for illustrative purposes only and should not be considered to be limiting in any other way. Terms such as “generally,” “substantially,” “about,” and “slightly” are not intended to be unbounded terms and should be interpreted in a manner consistent with how a person skilled in the art would interpret them.

[0075] Different embodiments may have specific components as shown in the illustrations, but embodiments of this disclosure are not limited to any particular combination thereof. It is possible to use some components or features from one embodiment in combination with features or components from another embodiment. In addition, the various figures accompanying this disclosure are not necessarily to scale, and some features may be exaggerated or minimized to illustrate certain details of a particular component or arrangement.

[0076] Those skilled in the art will understand that the embodiments described above are illustrative and non-limiting; that is, modifications to the present disclosure will fall within the scope of the claims. Consequently, the following claims should be considered to determine their true scope and content.

Claims

1. Surgical device, The shaft and An insert adjacent to the distal end of the shaft, wherein the insert provides a stripping tube, the stripping tube includes a window allowing a portion of a tendon to enter the insert, the insert includes a notch proximal to the window, and the portion of the tendon extends through the notch to exit the insert, the inner diameter of the stripping tube has a circular cross-section, and the stripping tube provides a continuous ring around the central axis of the shaft, A cutter that is movable distally to sever the tendon, wherein the portion of the tendon extending through the notch is separated from the rest of the tendon by clamping the portion of the tendon between the distal edge of the cutter and the proximal edge of the stripping tube, the outer diameter of the cutter is tapered adjacent to the distal edge, so that the outer diameter of the cutter gradually decreases toward the distal edge of the cutter, and the cutter includes a recess adjacent to the distal edge of the cutter and defined by an inner diameter, the inner diameter defining the recess is tapered, so that the inner diameter defining the recess gradually decreases toward the distal edge of the cutter as it moves proximally, Equipped with, The aforementioned shaft protrudes from the handle, The insert is attached adjacent to the distal end of the shaft, The shaft, the insert, and the handle together define a through hole that extends along the central axis from the proximal end of the handle to the distal edge of the insert. A surgical device in which the cutter is movable within the through hole.

2. The surgical apparatus according to claim 1, wherein the cutter is centered on the central axis.

3. The surgical apparatus according to claim 1, wherein the distal edge of the stripping tube includes a plurality of serrations.

4. The surgical apparatus according to claim 1, wherein the outer diameter of the stripping tube is tapered adjacent to the proximal edge of the stripping tube, so that the outer diameter of the stripping tube gradually decreases toward the proximal edge of the stripping tube.

5. The surgical apparatus according to claim 1, wherein the through hole exhibits a variable diameter along the central axis.

6. The cutter is provided by a rod, The aforementioned rod is connected to the guide, The guide includes a projection, The handle includes a helical slot for receiving the projection, The surgical apparatus according to claim 1, wherein the projection and the helical slot interact such that the movement of the rod and guide along the central axis results in the rotation of the rod and the guide about the central axis.

7. The aforementioned projection is one of a plurality of projections spaced apart from each other with respect to the outer surface of the guide. The aforementioned helical slot is one of a plurality of helical slots, and The surgical apparatus according to claim 6, wherein each helical slot receives a corresponding one of the projections.

8. The cap is attached to the guide adjacent to the proximal end of the guide, The cap is positioned near the handle, and The surgical apparatus according to claim 6, wherein the cap is configured to rotate relative to the guide.

9. The surgical apparatus according to claim 1, wherein the outer contour of the end section of the handle has a square cross-section with rounded corners when viewed in the direction of the central axis.

10. The surgical apparatus according to claim 1, wherein the outer diameter of the insert is configured to prevent rotation and axial movement of the insert relative to the shaft.

11. The surgical apparatus according to claim 1, wherein the stripping tube defines a continuous and uninterrupted loop.

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