A compression and / or traction sensing arthroscopic knot pusher apparatus

Abstract

The invention generally relates to a compression and / or traction sensing arthroscopic knot pusher apparatus. The apparatus includes a hollow casing having a circular end and an elongated end, a trigger coupled with a pressure indicating means, a slot for displaying the pressure, a hook coupled to the trigger, protruding from a slit, a spring attached to the trigger, an anti-slip gripper for holding the knot pusher apparatus, a needle mounted on the elongated end of the hollow casing has a threaded end and a pointed end with an aperture for allowing the suture to be positioned. The trigger is coupled to a pressure sensing arrangement. The pressure sensing arrangement is selected from a mechanical based arrangement, a fluid based arrangement, and a digital based arrangement. Alternatively the pressure sensing arrangement is a spring based arrangement.

Description

[0001] A COMPRESSION AND / OR TRACTION SENSING ARTHROSCOPIC KNOT PUSHER APPARATUS

[0002] FIELD OF THE INVENTION

[0003] The invention generally relates to an apparatus to facilitate the tying of surgical sutures in arthroscopic surgeries. In particular, the invention discloses a compression and / or traction sensing arthroscopic knot pusher apparatus.

[0004] BACKGROUND OF THE INVENTION

[0005] Arthroscopic surgery or a keyhole surgery is a minimal invasive procedure performed on a joint, using an arthroscope. Arthroscopic surgeries around the shoulder are one of the commonly performed procedures. The procedure requires a camera to be introduced through a key hole for visualization of damages. The visualization helps identify the damage or tear in the ligaments and tendons for repair. A knot pusher is generally employed to place sutures and tie a knot to repair the damages. The knot pusher drives the knot from the outside of the ligament and / or the tendon to the inside of the ligament and / or the tendon. There is a need to insert the knot in a controlled way to avoid excess pressure while repairing the soft tissues. The excess pressure exerted while placing the knot can lead to impairment of the circulation of the tissues. The impaired circulation can lead to healing deficiencies and failure of the procedure. There are devices available in the art for pushing of the knot into the soft tissue during suturing.

[0006] One such device disclosed in Patent Application “US8939999B2” titled “Suture tensioning device” provides a device which functions as a knot pusher and a suture tensioner. The device indicates the relative amount of the tension being applied by the operator on the suture. There is a need for the operator to adjust the tension based on the indicator. Therefore, the tension applied is subjective and prone to error. Another knot pusher device disclosed in Patent Application “US11678873B2” titled “Arthroscopic knot pusher and suture cutter” functions as a knot pusher and a suture cutter for an arthroscopic knee surgery. The device has a single control that can both lock the suture and cut the suture once the knot is pushed. However, the apparatus is not capable of providing feedback on the force applied during suturing.

[0007] Therefore, there is a need in the art for a device for continuous monitoring of pressure while suturing, specifically during arthroscopic surgery for placing the suture into deep layers of the soft tissue.

[0008] SUMMARY

[0009] The invention overcomes the drawbacks of the prior art by providing a continuous pressure sensing arthroscopic knot pusher apparatus. One aspect of the invention discloses a continuous pressure sensing knot pusher apparatus. The apparatus includes a hollow casing having a circular end and an elongated end. A trigger coupled with a pressure sensing arrangement is positioned proximal to the circular end. The elongated end of the hollow casing houses a hook coupled to a resilient means. The hook is capable of executing a linear motion by means of a slit. A needle is operably coupled to the trigger through a resilient means. The needle is mounted on the elongated end of the hollow casing. The needle has a threaded end and a pointed end with an aperture for allowing the suture to be positioned. The push of the trigger, initiates the movement of the needle. The pressure sensing arrangement allows the operator to regulate the extent of the pressure that is tolerable to the soft tissue being sutured / repaired. The pressure sensing arrangement enables determination of compression and / or traction during repair of a soft tissue.

[0010] The pressure sensing arrangement is selected from a mechanical based arrangement, a fluid based arrangement and a digital based arrangement.

[0011] In one aspect of the invention, the pressure sensing arrangement is a mechanical based arrangement. The arrangement includes a flexible strip provided with a gradient of preset colours, as an indicative scale to determine and adjust the pressure continuously while repairing the soft tissue. The pushing of trigger results in the curvilinear motion of the flexible strip, wherein visibility of a certain colour on a slot indicates the threshold of pressure allowed.

[0012] In another aspect of the invention, the pressure sensing arrangement is a fluid based arrangement. The arrangement includes a suction plunger housed within a semicircular channel containing pressure indicating fluid. The fluid traverses through the semicircular channel up until a slot provided on the circular end when a pressure is applied. The fluid based arrangement is alternatively provided with a silicon tube filled with a liquid. The depression of the trigger thrusts the liquid filed in the silicon tube to move along a semicircular path to be visualized through the slot provided on the outer surface of the circular end of the hollow casing.

[0013] In one another aspect of the invention, the pressure sensing arrangement is a digital based arrangement. The arrangement includes a pressure sensor coupled to the trigger, and a graded scale positioned adjacent to the slit as an indicative of position of the hook. The graded scale is provided with gradations or markings. The pressure sensor determines the pressure applied and the pressure is indicated as a readings displayed through the slot. The position of the hook parallel to a particular marking on the graded scale also determines the pressure applied.

[0014] An alternate aspect of the invention discloses a continuous pressure sensing knot pusher apparatus. The apparatus includes a hollow casing having a circular end and an elongated end. A trigger coupled with a pressure sensing arrangement is positioned proximal to the circular end. The elongated end of the hollow casing is provided with a second graded scale having readings or markings. The second graded scale is positioned adjacent to a slit. The slit enables linear motion of the hook. The position of the hook also determines the pressure applied. The pressure is determined based on the alignment of the hook with respect to the readings or markings on the second graded scale. The pressure sensing arrangement enables determination of compression and / or traction at a desired soft tissue during repair. The pressure sensing arrangement includes an outer sleeve having a first end and a second end. The first end of the outer sleeve is mounted on the elongated end of the hollow casing. The outer sleeve is provided with a first graded scale proximal to the second end of the outer sleeve to determine the extent of pressure applied. The outer sleeve houses a rod connected to the hook. The rod is coupled to a second spring configured for sensing the pressure. The outer sleeve is contoured to enable linear motion of the rod by compressing the second spring. The compression of the second spring to a maximum threshold is facilitated by a disc trijunction. The disc trijunction intersects with the rod. The second end of the outer sleeve is provided with an aperture. The aperture is provided to hold the suture knot. The pressure suffered by the second spring is displayed by the first graded scale. The pressure sensing arrangement enables determination of a compression and / or a traction during repair of a damaged soft tissue.

[0015] BRIEF DESCRIPTION OF DRAWINGS

[0016] So that the manner in which the recited features of the invention can be understood in detail, some of the embodiments are illustrated in the appended drawings. It is to be noted, however, that the appended drawings illustrate only typical embodiments of this invention and are therefore not to be considered limiting of its scope, for the invention may admit to other equally effective embodiments.

[0017] FIG. 1 shows a continuous pressure sensing knot pusher apparatus having a mechanical pressure sensing arrangement, according to an embodiment of the invention.

[0018] FIG. 2 shows a front view of the knot pusher apparatus, according to an embodiment of the invention. FIG. 3a represents the functioning of the trigger and the flexible strip of the knot pusher apparatus during a disengaged position, according to an embodiment of the invention.

[0019] FIG. 3b represents the functioning of the trigger and the flexible strip of the knot pusher apparatus during an engaged position, according to an embodiment of the invention.

[0020] FIG. 4 shows a continuous pressure sensing knot pusher apparatus having a fluid based pressure sensing arrangement, according to an embodiment of the invention.

[0021] FIG. 5 shows a continuous pressure sensing knot pusher apparatus having a spring pressure sensing arrangement, according to an embodiment of the invention.

[0022] FIG. 6 shows a continuous pressure sensing knot pusher apparatus having a digital pressure sensing arrangement, according to an embodiment of the invention.

[0023] DETALED DESCRIPTION OF THE INVENTION

[0024] The definitions, terms and terminology adopted in the disclosure have their usual meaning and interpretations, unless otherwise specified.

[0025] The terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting of the invention. As used herein, the singular forms “a,” “an,” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. Furthermore, the use of the terms a, an, etc. does not denote a limitation of quantity, but rather denotes the presence of at least one of the referenced items. It will be further understood that the terms “comprises” and / or “comprising,” or “includes” and / or “including” when used in this specification, specify the presence of stated features, regions, integers, steps, operations, elements, and / or components, but do not preclude the presence or addition of one or more other features, regions, integers, steps, operations, elements, components, and / or groups thereof. It will be further understood that for the purposes of this disclosure, “at least one of” will be interpreted to mean any combination of the enumerated elements following the respective language, including combination of multiples of the enumerated elements.

[0026] Unless otherwise defined, all terms used herein have the same meaning as commonly understood by one of ordinary skills in the art to which this invention belongs. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the relevant art and the present disclosure, and will not be interpreted in an idealized or overly formal sense unless expressly so defined herein. Throughout the drawings and the detailed description, unless otherwise described, the same drawing reference numerals are understood to refer to the same elements, features, and structures. The relative size and depiction of these elements may be exaggerated for clarity, illustration, and convenience.

[0027] Various embodiments of the invention disclose a pressure sensing arthroscopic knot pusher apparatus. The pressure sensing arrangement enables determination of a compression and / or a traction during repair of a damaged soft tissue. The pressure sensing arrangement is selected from a mechanical based arrangement, a fluid based arrangement and a digital based arrangement.

[0028] The apparatus includes a hollow casing having a circular end and an elongated end. The circular end is provided with a outer surface and an inner surface. The inner surface is configured to house a trigger. The trigger is coupled with a pressure sensing arrangement positioned proximal to the circular end. The elongated end of the hollow casing is provided with a needle. The needle has a threaded end and a pointed end with an aperture for positioning the suture. The needle is operably coupled to the trigger through a resilient means. The push of the trigger initiates the movement of the needle. The pressure sensing arrangement enables determination of the compression and I or the traction during repair of a damaged soft tissue.

[0029] The pressure sensing arrangement is selected from a mechanical based arrangement, a fluid based arrangement and a digital based arrangement. The pressure sensing arrangement aids in regulating the extent of the push of the trigger. Thereby allowing a regulated pressure to be applied on the needle to allow an optimum suture knot, thus, providing a continuous compression sensing arthroscopic knot pusher apparatus. The apparatus alternatively determines the traction withstanding capability of the soft tissue during repair of the damaged soft tissue. The apparatus described briefly herein above, shall be explained hereinafter as exemplary embodiments of the invention.

[0030] FIG. 1 shows a continuous pressure sensing knot pusher apparatus having a mechanical pressure sensing arrangement, according to an embodiment of the invention. The apparatus (100) includes a hollow casing (1). The hollow casing (1) has a circular end (1a) and an elongated end (1b). The hollow casing (1) is provided with a pair of an anti-slip gripper (15) for holding the knot pusher apparatus (100). The circular end (1a) is provided with an outer surface (2a) and an inner surface (2b). The inner surface (2b) is configured to house a trigger (3). The trigger (3) is coupled with a pressure sensing arrangement. In one example of the invention, the pressure sensing arrangement includes a flexible strip (9). The flexible strip (9) is capable of shifting its position based on an engaged or a disengaged position of the trigger (3). The flexible strip (9) is provided with a gradient of preset colours. Each of the preset colours acts as a determinant of extent of pressure applied by the operator. The outer surface of the circular end (1a) is provided with a slot (11) for enabling visualization of the preset colour. The trigger (3) is provided with a hook (5) protruding from a slit (not shown). The hook (5) provided for holding a looped end of a suture. The hook (5) is capable of executing a linear motion along the slit (not shown) provided on the elongated end (1b) of the hollow casing (1). The linear motion of the hook (5) is enabled by a resilient means. In one example, the resilient means is a spring (7). The action of the spring (7) is dependent on the pressure applied on the trigger (3), thus providing haptic feedback of the pressure applied by the operator on the suture knot. A needle (17) is mounted downstream of the resilient means and proximal to the elongated end (1b). The needle (17) has a threaded end (17a) and a pointed end (17b). The threaded end (17a) is configured to be detachably mounted to the trigger (3) via the resilient means. The pointed end (17b) is provided with a projection having an aperture (19). The aperture (19) is provided for holding a suture knot while a free end of the suture is held by the operator.

[0031] Fig. 2 shows the front view of the knot pusher apparatus, according to an embodiment of the invention. The apparatus (200) includes the hollow casing (1) having the circular end (1a) and the elongated end (1 b). The hollow casing (1) is provided with the anti-slip gripper (15) for holding the knot pusher apparatus. The trigger (3) is coupled with the flexible strip (9), as shown in FIG. 1 , capable of executing a curvilinear motion along an axis within the hollow casing (1). The elongated end (1b) of the hollow casing (1) is provided with the needle (17) mounted downstream of the hook through resilient means. The threaded end (17a) is configured to be detachably mounted to the trigger (3) through the spring (7). The pointed end (17b) is provided with the aperture (19) for positioning of the suture knot. The position of the flexible strip (9) shifts based on an engaged or a disengaged position of the trigger (3). The flexible strip (9) is provided with a gradient of preset colours. Each of the preset colour acts as a determinant of pressure applied by the operator. The slot (11) provided on the outer surface (2a) of the circular end (1a) enables visualization of the preset colour. The trigger (3) is provided with the hook (5) capable of executing a linear motion along a slit (13) provided on the elongated end (1 b) of the hollow casing (1). The linear motion of the hook (5) along the slit (13) is enabled by the spring (7). The action of the spring (7) is dependent on the pressure applied on the trigger (3), thus providing haptic feedback of pressure applied by the operator. The slot (11) further functions as a feedback unit to the operator for providing visual and auditory feedback on the pressure or force or tension applied while placing the suture. The auditory feedback is enabled by adding a mechanical system (not shown) that translates curvilinear motion of the flexible strip into a clicking sound.

[0032] The depression of the trigger (3) from a disengaged position, initiates the action of the knot pusher apparatus. The depression of the trigger (3) results in compression of the spring (7). The compression of the spring (7) causes the needle (17) to execute a linear motion of the hook (5) along the slit (13). The action of the spring (7) is dependent on the pressure applied on the trigger (3), thus providing haptic feedback of pressure applied by the operator. The haptic feedback is enabled due to the counterforce exhibited by the spring (7) based on the pressure applied by the operator. The depression of the trigger (3) also sets off a curvilinear motion of the flexible strip (9). The extent of motion of the flexible strip (9) is directly proportional to the extent of the depression of the trigger (3). The movement of the flexible strip (9) allows revelation of the preset colour through the slot (11).

[0033] Fig. 3a represents the functioning of the trigger and the flexible strip during a disengaged position, according to an embodiment of the invention. Initially, the knot pusher apparatus (300) is in a resting state and the trigger is in the disengaged position. The color indicative of zero pressure is displayed in the slot (11) as seen in Fig 3a. Fig. 3b represents the functioning of the trigger and the flexible strip during an engaged position, according to an embodiment of the invention. Depression of the trigger (3), sets the knot pusher apparatus (300) in action and compresses the spring (7), thereby pushing the needle (17) down for placing the suture knot in the soft tissue. The downward motion of the needle (17) also sets off a curvilinear motion of the flexible strip (9). The movement of the flexible strip (9), results in change in display of the preset color, on the flexible strip as shown in Fig 3b. The change in the display of the color is an indication of the changing pressure exerted with tightening of the suture knot, thereby continuously providing a visualization of the change in pressure, to the person operating the apparatus. The visualization of the colour through the slot (11) indicates the threshold of pressure allowable for enabling the knot, thereby providing a visual clue to the operator to arrest further depression of the trigger (3) and tightening of the suture knot. The pressure sensing arrangement described herein above assists in determining compression and traction during an arthroscopic surgery.

[0034] Continuous compression sensing while suturing is achieved due to the pressure sensing arrangement of the knot pusher apparatus (100). In one example, the compression threshold of a suture is determined during an arthroscopic surgery. It is essential to evaluate the right compression on the suture to prevent re-tears of a damaged tendon and circulatory impairment. A low compression leads to non-healing of the damage while a high compression result in tearing of the tendon and damage of the soft tissues. An optimum compression is exerted on the suture to pull the tendon to its original position. The arthroscopic surgery involves repairing a tear between a tendon and a bone or tendon-to-tendon by placing a suture knot through a knot pusher apparatus (100). An arthroscope is used to visualise a damaged region. In case the repair involves stretching the tendon to an original position, the traction necessary to stretch the tendon is determined. The traction sensing mechanism is described in detail in the next section. Once the traction is determined, the position of an anchor for suturing the tendon to the bone is established. Subsequently, a suture knot is created before pushing the knot to affix to the tendon. A looped end of the suture is held by the hook (5). The engaging of the trigger (3) results in placing of the suture knot. Once the knot is delivered through the aperture (19) of the needle (17), a free end of the suture is pulled by the operator to tighten the knot. The compression applied on the suture is continuously monitored. The action on the trigger (3) further enables a linear motion of the hook (5) carrying the looped end of the suture by means of the spring (7). The compression of the spring (7) is directly dependent on the linear motion of the hook (5). The depression of the trigger (3) sets the curvilinear motion of the flexible strip (9) and the color determines the extent of compression applied, thus indicating the compression applied while tightening suture.

[0035] The knot pusher apparatus (100) alternatively functions as a traction sensing apparatus. In one example, while repairing a damage or tear to a rotating cuff, it is essential to determine the position of an anchor. The anchor position can be established only after identifying the tolerance level of a damaged tendon for stretching before fixing to the rotating cuff. The tolerance level of the tendon for stretching the tissues to suture them to a bone is determined by the traction sensing feature of the knot pusher apparatus (100). Different tissues have different threshold to withstand the traction pressure. Therefore, optimum traction required to ensure medialization of footprint, without causing tissue re-tears and circulation impairments is determined based on the tissue being repaired.

[0036] A looped end of the suture is held by the hook (5) of the knot pusher apparatus (100), while a free end of the suture is tied to the tendon. The knot pusher apparatus (100) is held parallel to the tissue or tendon. The knot pusher apparatus (100) is pulled away from the tendon, which results in setting a linear motion of the hook (5) due to the compression of the spring (7). The said action results in setting in a curvilinear motion of the flexible strip (9), thus determining the traction applied on the tendon to reposition the tissue for affixing it to the bone. The traction sensing feature of the knot pusher apparatus (100) ensures tension free repair and also the non-recurrence of tendon re-tear and repair failure.

[0037] According to another embodiment of the invention, the knot pusher apparatus is provided with an alternate pressure sensing arrangement. FIG. 4 shows a continuous pressure sensing knot pusher apparatus having a fluid based pressure sensing arrangement, according to an embodiment of the invention. The apparatus (400) includes a hollow casing (1). The hollow casing (1) has a circular end (1a) and an elongated end (1b). The circular end having an outer surface (2a) is provided with a slot (11) for visualization of the pressure; and an inner surface (2b) is configured to house a trigger (3). The hollow casing (1) is provided with a pair of anti-slip gripper (15) for holding the knot pusher apparatus (400). The trigger (3) is coupled to a pressure sensing arrangement. The pressure sensing arrangement is a fluid based pressure sensing arrangement. The arrangement includes a plunger (not shown) and a semi circular channel (21) containing a fluid. The plunger (not shown) is coupled with the trigger (3). The plunger (not shown) is housed within the semicircular channel (21) containing the fluid. The semicircular channel (21) is housed within the inner surface (2b) of the circular end (1a). A pressure applied on the trigger (3), pushes the plunger (not shown) down, forcing the fluid to traverse through the semicircular channel (21). The fluid traversing through the semi circular channel (21) is visualized in the slot (11). The slot (11) is provided with plurality of gradations to determine the pressure applied, along with a highlighted gradation to indicate maximum pressure allowed. The trigger (3) is provided with a hook (5) protruding from a slit (not shown). The hook (5) is capable of executing a linear motion along the slit (not shown) provided on the elongated end (1b) of the hollow casing (1). The linear motion of the hook (5) is enabled by a spring (7). The action of the spring (7) is dependent on the pressure applied on the trigger (3), thus providing haptic feedback of pressure applied by the operator. A needle (17) is mounted downstream of the spring (7) and proximal to the elongated end (1b). The needle (17) has a threaded end (17a) and a pointed end (17b). The threaded end (17a) is configured to be detachably mounted to the trigger (3) through the spring (7). The pointed end (17b) with a projection having an aperture (19) is provided for allowing the suture to be positioned.

[0038] The plunger described herein above can be either a suction plunger or an arch plunger. In one example, the plunger is a suction plunger. Initially, the knot pusher apparatus is in a resting state and the trigger (3) is in the disengaged position. There is no display of fluid for visualizations in the slot (11). Depression of the trigger (3) sets the knot pusher apparatus in action. The depression of the trigger (3), compresses the spring (7), thereby pushes the needle (17) down for placing the suture knot in the tissue. The compression of the spring (7) causes the needle (17) to execute a linear motion of the hook (5) along the slit (not shown). The downward motion of the needle (17) is coupled with the compression of the suction plunger (not shown). The movement of the suction plunger (not shown) forces the fluid in the semicircular channel (21) to rise. The amount of fluid that moves within the semicircular channel (21) is directly proportional to the pressure applied on the trigger (3). Gradations provided on the slot (11) of the outer surface (2a) of the circular end (1a) enable visualization of the pressure. The arrival of the fluid, at the highlighted gradation, is an indication of the threshold of pressure exerted on the trigger (3) and cautions the operator to regulate the depression of the trigger (3), thereby enabling trauma-free knot of the suture, at the desired location.

[0039] Continuous compression and traction sensing while suturing is enabled by the fluid based pressure sensing arrangement as disclosed in the above described embodiment of the knot pusher apparatus (400). In another example, rupture to an Achilles tendon is surgically repaired. An arthroscope is used to visualize the damaged tendon.

[0040] Since, the repair involves stretching the tendon to an original position or at least to a closest proximity to attach the torn tendon together. The traction necessary to stretch the tendon is determined. The traction sensing mechanism involves tying a suture knot onto the damaged tendon. A looped end of the suture is held by the hook (5) of the knot pusher apparatus (400). The knot pusher apparatus (400) is held parallel to the tendon. The knot pusher apparatus (400) is pulled away from the tendon to determine the extent of traction exhibited by the tendon. The pulling of the knot pusher apparatus (400) results in setting a linear motion of the hook (5) due to the compression of the spring (7). Thereby resulting in displacement of the fluid in the semicircular channel (21), displaying the traction applied through the slot (11) provided. Thus, measuring the maximal threshold of traction the tendon withholds.

[0041] Once the traction is determined, the extent of repositioning of the torn or damaged tendon for suturing is established. Subsequently, a suture knot is created before pushing the knot to affix to the tendon. The compression applied on the suture is continuously monitored throughout the surgery. The engaging of the trigger (3) results in placing of the suture knot. Once the knot is delivered through the aperture (19) of the needle (17), a free end of the suture is pulled to tighten the knot. The compression applied while tightening the knot is indicated by the knot pusher apparatus (400). The action on the trigger (3) enables a linear motion of the hook (5) carrying a looped end of the suture by means of the spring (7). The compression of the spring (7) is directly dependent on the linear motion of the hook (5). The depression of the trigger (3) causes downward movement of the needle (17) for placing the suture knot. The downward movement of the needle (17) also enables the compression of the suction plunger forcing the fluid in the semicircular channel (21) to rise. The fluid that traverses in the semicircular channel (21) is indicative of the compression applied while tightening the suture knot.

[0042] In another example of the invention, the semicircular channel and the plunger (not shown) is replaced with a silicon tube filled with a liquid, wherein the depression of the trigger thrusts the liquid filed in the silicon tube to move along a semicircular path to be visualized through the slot provided on the outer end of the circular end of the hollow casing.

[0043] In yet another embodiment of the invention, the knot pusher apparatus is provided with a continuous spring pressure sensing arrangement. FIG. 5 shows a continuous pressure sensing knot pusher apparatus having a spring pressure sensing arrangement, according to an embodiment of the invention. The continuous spring pressure sensing arrangement of the knot pusher apparatus (500) includes a hollow casing (1). The hollow casing (1) has a circular end (1a) and an elongated end (1b). The hollow casing (1) is provided with an anti-slip gripper (15) for holding the knot pusher apparatus (500). The circular end (1a) of the hollow casing (1) is provide with a trigger (3). The trigger is coupled to a pressure sensing arrangement. The elongated end (1b) of the hollow casing (1) is provided with a second graded scale (41) having reading or markings. The second graded scale (41) is positioned adjacent to a slit (13). The slit (13) enables linear motion of a hook (5) by means of a first spring (7). The position of the hook (5) also determines the pressure applied. The pressure is determined based on the alignment of the hook (5) across the readings or markings on the second graded scale (41). The pressure sensing arrangement enables determination of compression and / or traction during repair of a damaged soft tissue. The pressure sensing arrangement includes an outer sleeve (31) having a first end (31a) and a second end (31b). The first end (31a) of the outer sleeve (31) is mounted on the elongated end (1b) of the hollow casing (1). The outer sleeve (31) is provided with a first graded scale (35) proximal to the second end (31b) of the outer sleeve (31) to determine the extent of pressure applied. The outer sleeve (31) houses a rod (37) connected to the hook (5). The rod (37) is coupled to a second spring (33). The second spring (33) is configured for sensing the pressure. The outer sleeve (31) is contoured to enable linear motion of the rod (37) by compressing the second spring (33). The compression of the second spring (33) to a maximum threshold is facilitated by a disc trijunction (39). The disc trijunction (39) intersects with the rod (37). The second end (31b) of the outer sleeve (31) is provided with an aperture (19). The aperture (19) is provided to hold a suture knot. The pressure suffered by the second spring (33) is displayed by the first graded scale (35). The pressure sensing arrangement enables determination of a compression and / or a traction during repair of a damaged soft tissue. When the pressure is applied on the trigger (3), the rod (37) housed within the outer sleeve (31) compresses the second spring (33). The compression applied on the second spring (33) is directly proportional to the tension or pressure applied on the suture while tightening the suture knot. The compression is indicative of the pressure applied which is indicated by the first graded scale (35), thus functioning as a feedback unit. A haptic sensory feedback is rendered due to the counter force exerted by the second spring (33). The pressure or tension applied is visualised as a color or a relative value to the operator on the first graded scale (35). Since the knot pusher apparatus (500) is spring driven, the haptic feedback is displayed in a linear mechanism, thereby providing a continuous spring pressure sensing knot pusher apparatus (500).

[0044] Continuous compression and traction sensing while suturing is enabled by the spring arrangement as disclosed in the above described embodiment of the knot pusher apparatus (500). In yet another example, a labral repair surgery is done to reverse the damage to the labrum. The surgery involves attaching the labrum to a shoulder socket. An arthroscope is used to visualize the torn labrum. The repair involves reattaching the labrum to the shoulder socket. The cartilage (labrum) is stretched to an original position or at least to a closest proximity to attach to the shoulder socket. The traction necessary to stretch the cartilage is determined. The traction sensing mechanism involves tying a suture knot onto the torn cartilage. A looped end of the suture is held by the hook (5) of the knot pusher apparatus. The knot pusher apparatus (500) is held parallel to the cartilage. The knot pusher apparatus (500) is pulled away from the cartilage to determine the traction withstanding capability of the cartilage while repositioning the torn labrum. The pulling of the knot pusher apparatus (500) results in setting a linear motion of the hook (5) due to the compression of the first spring (7), thereby, resulting in a linear movement of the rod (35). The linear movement is enabled due to the downward movement of the disc trijunction (39). The downward movement of the disc trijunction (39) is rendered due to the compression of the second spring (33). The compression of the second spring (33) is directly proportional to the traction applied on the cartilage. The traction applied is visualized by means of the first graded scale (35). The positioning of the hook (5) aligning with the gradation on the second graded scale (41) indicates the traction applied. Thus, measuring the maximal thresholds of traction the tendon withholds.

[0045] Once the traction is determined, the extent of repositioning of the torn cartilage for reattaching the cartilage to the shoulder socket is established. Subsequently, a suture knot is created before pushing the knot to affix to the cartilage by means of the knot pusher apparatus (500). The compression applied on the suture is continuously monitored throughout the surgery. The engaging of the trigger (3) results in placing of the suture knot. Once the knot is delivered through the aperture (19), a free end of the suture is pulled to tighten the knot. The compression applied while tightening the knot is indicated by the knot pusher apparatus (500). The action on the trigger (3) enables a linear motion of the hook (5) carrying a looped end of the suture by means of the spring (7). The compression of the spring (7) is directly dependent on the linear motion of the hook (5). The depression of the trigger (3) causes downward movement of the outer sleeve (31) for placing the suture knot. The downward movement of the outer sleeve (31) is accompanied by the linear movement of the rod (37). The linear movement is enabled due to the downward movement of the disc trijunction (39), occurring as a result of compression of the second spring (33). The compression of the second spring (33) is directly proportional to the compression applied on the suture while tightening the knot. The compression applied is indicated by the first graded scale (35). The values or the reading indicate the compression applied while tightening the suture knot.

[0046] According to an alternate embodiment of the invention, the knot pusher apparatus is provided with a digital based arrangement. FIG. 6 shows a continuous pressure sensing knot pusher apparatus having a digital pressure sensing arrangement, according to an embodiment of the invention. The apparatus includes, a hollow casing (1). The hollow casing (1) has a circular end (1a) and an elongated end (1b). The hollow casing (1) is provided with an anti-slip gripper (15) for holding the knot pusher apparatus (600). The circular end (1a) is provided with a trigger (3). The trigger (3) is coupled with a digital pressure sensing arrangement. The pressure sensing arrangement includes a pressure sensor (51), and a graded scale (53). The graded scale is either provided with gradations or markings of pressure or is configured to digitally display the pressure. The pressure sensor is also connected to a slot (11) provided on the circular end (1a) for digitally displaying the pressure. The pressure sensor (51) is positioned beneath the trigger (3). The trigger (3) is coupled to a hook (5) protruding from a slit (13). The silt (13) is provided on the elongated end (1b) of the hollow casing (1). The slit (13) enables linear motion of the hook (5) by means of a spring (7). The graded scale (53) is positioned adjacent to the slit (13). The position of the hook (5) aligning with a particular making on the graded scale (53) exhibits the compression or traction applied. A needle (17) is mounted downstream of the spring (7) and proximal to the elongated end (1b) of the hollow casing (1). The needle (17) has a threaded end (17a) and a pointed end (17b). The threaded end (17a) is configured to be detachably mounted to the trigger (3) through the spring (7). The pointed end (17b) is provided with a projection for an aperture (19). The aperture (19) carries the suture knot.

[0047] The depression of the trigger (3), compresses the spring (7), thereby pushes a needle (17) down for placing the suture knot in the tissue. The compression of the spring (7) causes the needle (17) to execute a linear motion of the hook (5) along the slit (13). The position of the hook aligning with the marking or gradations on the graded scale (53) indicates the pressure or traction while operating the knot pusher apparatus (600). The engaging of the trigger (3) also activates the pressure sensor (51) to determine the pressure or compression applied while placing the suture knot.

[0048] The knot pusher described herein is operable either manually or through robotics.

[0049] The foregoing description of the invention has been set for merely to illustrate the invention and is not intended to be limiting. Since modifications of the disclosed embodiments incorporating the scope and substance of the invention may occur to a person skilled in the art, the invention should be construed to include everything within the scope of the appended claims and equivalents thereof.

Claims

WE CLAIM:

1. A continuous pressure sensing arthroscopic knot pusher apparatus, the apparatus comprising of: a hollow casing (1) having a circular end (1a) and an elongated end (1b), the circular end (1a) comprising of an outer surface (2a) and an inner surface (2b), wherein the circular end (1a) is provided with a slot (11); a trigger (3) positioned proximal to the circular end (1a), wherein the trigger (3) is coupled to a hook (5) provided on the elongated end (1b) of the hollow casing (1), the hook (5) configured for executing a linear motion; a needle (17) operably coupled to the trigger (3), the needle (17) mounted on the elongated end (1b) of the hollow casing (1), the needle having a threaded end (17a) for coupling with the trigger (3), and a pointed end (17b) with a projection having an aperture (19) for allowing the suture to be positioned; and a pressure sensing arrangement mounted between the trigger (3) and the hook (5), wherein the pressure sensing arrangement enables determination of a compression and / or a traction during repair of a damaged soft tissue.

2. The apparatus as claimed in claim 1, wherein the pressure sensing arrangement is selected from a mechanical based pressure sensing arrangement, a fluid based pressure sensing arrangement and a digital based pressure sensing arrangement.

3. The apparatus as claimed in claim 1, wherein the mechanical sensing arrangement comprises of a flexible strip (9) coupled to the trigger (3), the flexible strip (9) is capable of executing a curvilinear motion along an axis within the hollow casing (1), wherein the flexible strip (9) is provided with a gradient of preset colours forvisualization through the slot (11), the visibility of a certain colour indicates the compression or traction allowable.

4. The apparatus as claimed in claim 1, wherein the fluid based pressure sensing arrangement comprises a suction plunger housed within a semicircular channel (21) containing pressure indicating fluids, wherein the fluids traverse through the semicircular channel (21) up until the slot (11) provided on the circular end (1a) for displaying the pressure applied.

5. The apparatus as claimed in claim 1, wherein the digital based pressure sensing arrangement comprises of a pressure sensor (51) configured to digitally display the pressure on the slot (11); and a graded scale (53) positioned adjacent to a slit (13) provided with gradations or markings, wherein the pressure applied is alternatively visualized by locating the position of the hook (5) aligning with the gradations on the graded scale (53).

6. The apparatus as claimed in claim 1, wherein the hook (5) facilitates looping of the suture.

7. The apparatus as claimed in claim 1, wherein the linear motion of the hook is enabled by a resilient means, wherein the resilient means is a spring (7).

8. The apparatus as claimed in claim 1, wherein the spring (7) counter forces the pressure applied while operating the trigger (3) providing a haptic feedback to the operator.

9. The apparatus as claimed in claim 1, wherein the hollow casing (1) is provided with a pair of anti-slip gripper (15) for holding the knot pusher apparatus.

10. The apparatus as claimed in claim 1 , wherein the slot (11) further functions as a feedback unit to the operator for providing visual and auditory feedback on the pressure or force or tension applied while placing the suture.

11. The apparatus as claimed in claim 1 , wherein the auditory feedback is enabled by adding a mechanical system that translates curvilinear motion of the flexible strip into a clicking sound.

12. A continuous pressure sensing arthroscopic knot pusher apparatus, the apparatus comprising of: a hollow casing (1) having a circular end (1a) and an elongated end (1b), wherein the hollow casing (1) is provided with a pair of anti-slip gripper (15) for holding the knot pusher apparatus; a trigger (3) positioned proximal to the circular end (1a), wherein the trigger (3) is coupled to a hook (5) provided on the elongated end (1b) of the hollow casing (1), the hook (5) configured for executing a linear motion through a first spring (7); and a pressure sensing arrangement comprising of an outer sleeve (31) having a first end (31a) and a second end (31b), the outer sleeve (31) provided with a first graded scale (35) proximal to the second end (31b) to determine the extent of pressure applied; a rod (37) mounted within the outer sleeve (31) and connected to the hook (5); a second spring (33) coupled to the rod (37) and configured for sensing the pressure; an aperture (19) provide at the second end (31b) of the outer sleeve (31), wherein the pressure suffered by the second spring (33) is displayed by the first graded scale (35); and a second graded scale (41) positioned adjacent to a slit (13), the second graded scale (41) provided with readings or markings for determining the pressure; wherein the pressure is visualized based on the positionof the hook (5) with respect to the second graded scale (41), wherein the pressure sensing arrangement enables determination of a compression and / or a traction during repair of a damaged soft tissue.

13. The apparatus as claimed in claim 12, wherein the first end (31a) of the outer sleeve (31) is mounted on the elongated end (1b) of the hollow casing (1).

14. The apparatus as claimed in claim 12, wherein the outer sleeve (31) is contoured to enable linear motion of the sliding rod (37) by compressing the second spring (33).

15. The apparatus as claimed in claim 12, wherein the compression of the second spring (33) to a maximum threshold is facilitated by a disc trijunction (39), wherein the disc trijunction (39) intersects with the rod (37).

16. The apparatus as claimed in claim 12, wherein the first spring (7) counter forces the pressure applied while operating the trigger (3), providing a haptic feedback to the operator.

17. The apparatus as claimed in claim 12, wherein the first graded scale (35) and second graded scale (41) further functions as a feedback unit to the operator for providing visual feedback of the pressure applied.

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