Digital tensioner control system for surgical tensioning

Abstract

A digital tensioner control system is disclosed. Stain gauge sensors detect a resistance value generated during the tensioning procedure. A digital tensioner controller automatically converts the resistance value as detected by the strain gauge sensors during the tensioning procedure as the surgeon adjusts the tension level to a corresponding voltage value. The voltage value is adjusted as the surgeon adjusts the tension level. The digital tensioner controller automatically determines a load value that corresponds to the voltage value as the surgeon adjusts the tension value based on a calibration that associates the load value with the corresponding voltage value. The load value is adjusted as the surgeon adjusts the tension level. The digital tensioner controller instructs a display to automatically display the load value as generated during the tensioning procedure as the surgeon adjusts the tension level applied to the graft when performing the tensioning procedure.

Description

DIGITAL TENSIONER CONTROL SYSTEM FOR SURGICAL TENSIONINGBACKGROUNDField of Disclosure

[0001] The present disclosure generally relates to tensioning devices and specifically to a digital tensioner control system for a tensioning procedure executed by a surgeon.Related Art

[0002] Conventional tensioning devices that are implemented by surgeons to execute tensioning procedures on a graft of a patient are mechanical devices that require the surgeon to manually adjust the tension applied to the graft by the tensioning device based on the feel of the surgeon. The surgeon adjusts the conventional tensioning device to adjust the tension applied to the tension based on the feel that the conventional tensioning devices provides to the surgeon. The surgeon compresses the conventional tensioning device when the feel provided by the conventional tensioning device triggers the surgeon to tighten the conventional tensioning device. The surgeon loosens the conventional tensioning device when the feel provided by the conventional tensioning device triggers the surgeon to loosen the conventional tensioning device.

[0003] However, conventional tensioning devices provide no feedback to the surgeon as to the actual tension that is being applied to the graft by the conventional tensioning device. The conventional tensioning devices do not provide a measurement of the Newton level that is being applied to graft by the conventional tensioning device. As a result, the surgeon fails to have a point of reference as to the amount of tension applied to the graft that has changed each time the surgeon adjusts the tension applied by the conventional tensioning device. The surgeon simply relies on feel generated from experience as to the appropriate adjustment in tensioning to be applied by the conventional tensioning device to the graft. Thus, customized adjustment of the tension applied to the graft are not applied based on feedback of the actual tension level provided to the surgeon to supplement the feel and experience of the surgeon.1115636-0001276888094vlBRIEF DESCRIPTION OF THE DRAWINGS / FIGURES

[0004] Embodiments of the present disclosure are described with reference to the accompanying drawings. In the drawings, like reference numerals indicate identical or functionally similar elements. Additionally, the left most digit(s) of a reference number typically identifies the drawing in which the reference number first appears.

[0005] FIG. 1 illustrates a block diagram of a digital tensioner control system that may determine a tension value applied by a digital tensioner to a graft of a patient during a tensioning procedure as a surgeon adjusts a tension level when performing the tensioning procedure;

[0006] FIG. 2 illustrates a block diagram of a digital tensioner control system that may display a tension level value and a flexion angle value based on signals generated by a strain gauge configuration as a cieating mechanism is applied;

[0007] FIG. 3 illustrates a block diagram of a digital tensioner control system that may apply a tension level to sutures based on the tightening knobs;

[0008] FIG. 4A illustrates a block diagram of a digital tensioner control system in which a strain gauge configuration is incorporated into a digital tensioner to generate tension level values;

[0009] FIG. 4B illustrates a block diagram of an example embodiment of a strain gauge configuration;

[0010] FIG. 4C illustrates a block diagram of an example embodiment of a strain gauge configuration that includes a full-bridge type III circuit diagram;

[0011] FIG. 5 illustrates a block diagram of a digital tensioner control system that may determine a tension value applied by a digital tensioner to a graft of a patient during a tensioning procedure as a surgeon adjusts a tension level when performing the tensioning procedure; and

[0012] FIG. 6 illustrates a graphical display of the tension level values relative to the flexion angle values of different grafts as tensioning levels are applied to each graft during the tensioning procedure.2115636-0001276888094vlDETAILED DESCRIPTION OF THE PRESENT DISCLOSURE

[0013] The following Detailed Description refers to accompanying drawings to illustrate exemplary embodiments consistent with the present disclosure. References in the Detailed Description to “one exemplary embodiment,” an “exemplary embodiment,” an “example exemplary embodiment,” etc., indicate the exemplary embodiment described may include a particular feature, structure, or characteristic, but every exemplary embodiment may not necessarily include the particular feature, structure, or characteristic. Moreover, such phrases are not necessarily referring to the same exemplary embodiment. Further, when a particular feature, structure, or characteristic may be described in connection with an exemplary embodiment, it is within the knowledge of those skilled in the art(s) to effect such feature, structure, or characteristic in connection with other exemplary embodiments whether or not explicitly described.

[0014] The exemplary embodiments described herein are provided for illustrative purposes, and are not limiting. Other exemplary embodiments are possible, and modifications may be made to the exemplary embodiments within the spirit and scope of the present disclosure. Therefore, the Detailed Description is not meant to limit the present disclosure. Rather, the scope of the present disclosure is defined only in accordance with the following claims and their equivalents.

[0015] Embodiments of the present disclosure may be implemented in hardware, firmware, software, or any combination thereof. Embodiments of the present disclosure may also be implemented as instructions applied by a machine-readable medium, which may be read and executed by one or more processors. A machine-readable medium may include any mechanism for storing or transmitting information in a form readable by a machine (e.g., a computing device). For example, a machine-readable medium may include read only memory (“ROM”), random access memory (“RAM”), magnetic disk storage media, optical storage media, flash memory devices, electrical optical, acoustical or other forms of propagated signals (e.g., carrier waves, infrared signals, digital signals, etc.), and others. Further firmware, software routines, and instructions may be described herein as performing certain actions. However, it should be appreciated that such descriptions are merely for convenience and that such actions in fact result from computing devices, processors, controllers, or other devices executing the firmware, software, routines, instructions, etc.3115636-0001276888094vl

[0016] For purposes of this discussion, each of the various components discussed may be considered a module, and the term “module” shall be understood to include at least one software, firmware, and hardware (such as one or more circuit, microchip, or device, or any combination thereof), and any combination thereof. In addition, it will be understood that each module may include one, or more than one, component within an actual device, and each component that forms a part of the described module may function either cooperatively or independently from any other component forming a part of the module. Conversely, multiple modules described herein may represent a single component within an actual device. Further, components within a module may be in a single device or distributed among multiple devices in a wired or wireless manner.

[0017] The following Detailed Description of the exemplary embodiments will so fully reveal the general nature of the present disclosure that others can, by applying knowledge of those skilled in the relevant art(s), readily modify and / or adapt for various applications such exemplary embodiments, without undue experimentation, without departing from the spirit and scope of the present disclosure. Therefore, such adaptations and modifications are intended to be within the meaning and plurality of equivalents of the exemplary embodiments based upon the teaching and guidance presented herein. It is to be understood that the phraseology or terminology herein for the purpose of description and not of limitation, such that the terminology or phraseology of the present specification is to be interpreted by those skilled in the relevant art(s) in light of the teachings herein.SYSTEM OVERVIEW

[0018] FIG. 1 illustrates a block diagram of a digital tensioner control system that may automatically determine a tension value applied by a digital tensioner 110 to a graft of a patient procedure as a surgeon adjusts a tension level when performing the tensioning procedure. A digital tensioner control system configuration 100 includes a digital tensioner 110 that may apply tension to the graft of a patient during a tensioning procedure in which the surgeon adjusts the tension that the digital tensioner 110 applies to the graft thereby enabling the tension in the graft to be maintained throughout the range of motion that the graft is subjected. The tensioning procedure is soft tissue reconstruction in which the surgeon replaces soft tissue via a graft and then applies tension to the soft tissue to limit laxity in the soft tissue during a range4115636-0001276888094vlof motion. The graft includes the soft tissue that the surgeon positions on the patient and then applies tension to the graft to have the appropriate tension applied to the graft to limit laxity in the graft during the range of motion. For example, the graft may be a ligament replacement in which the surgeon is replacing the ligament of the patient with a new ligament and then applies tension to the ligament to have the appropriate tension applied to the ligament to limit laxity in the ligament during the range of motion.

[0019] A digital tensioner controller 120 may automatically determine a load value that corresponds to the tension applied by the digital tensioner 110 to the graft as adjusted by the surgeon and then instructs a display positioned on the digital tensioner 110, such as a user interface 185 and / or a remote user interface 150 that is remote from the digital tensioner 110, in executing the display of the load value. For simplicity for discussion purposes, user interface 185 may be referred going forward in the discussion relative to the displaying data to the surgeon, such as the load value but remote user interface 150. However, user interface 185 may be interchanged with remote user interface 150 in also displaying such data to surgeon and / or additional users in the discussion going forward. Further, user interface 185 and remote user interface 150 may be interchanged with displaying data to the surgeon and / or additional users simultaneously in which the same data is displayed by each and / or different data is displayed by each.

[0020] In doing so, the surgeon may receive feedback in real-time based on the load value displayed to the surgeon via the user interface 185 as to tension that the surgeon is applying to the graft as the surgeon cycles through the different levels of tension applied by the digital tensioner 110 to the graft. For example, the surgeon may initially set the digital tensioner 110 to apply 50N of tension to the graft. The digital tensioner controller 120 may then in real-time display to the surgeon the 50N of tension applied to the graft and then display in real-time the tension applied to the graft by the digital tensioner 110 each time the surgeon adjusts the tension applied to the graft. Real-time is the period of time in which the digital tensioner 110 is currently applying a specific tension level to the graft and then the tension level displayed changes as the digital tensioner 110 changes the tension level applied to the graft.

[0021] As a result, the surgeon may not only have the feel of the tension that is applied to the graft but also a visual depiction of the actual tension level applied to the graft and the change in that actual tension level as the surgeon adjusts the tension that is applied to the graft5115636-0001276888094vlby the digital tensioner 110. Conventionally, the surgeon refines the feel of the tension level applied to the graft as to what the appropriate tension applied to the graft should be to limit laxity during the range of motion of the graft as gained by years of experience in which the surgeon. Each tensioning procedure that the surgeon has executed provides the surgeon with additional insight as to the feel of the appropriate tension applied to the graft to limit laxity based on adjusting the tension via a conventional tensioner. Each time the surgeon adjusts the tension via the conventional tensioner enables the surgeon to feel the tension and / or elasticity of the graft and the surgeon then adjusts the tension accordingly based on that feel gained through experience.

[0022] Rather than limit the surgeon to the feel gained by experience of the surgeon in performing tensioning procedures, digital tensioner controller 120 may also provide the visual feedback to the surgeon based on the actual tension level applied to the graft by the digital tensioner 110. As the surgeon applies their feel of the tension that is applied to the graft by the digital tensioner 110 as displayed to the surgeon by the digital tensioner controller 120 in which the surgeon is feeling the laxity and / or the tension in the graft as the surgeon adjusts the tension applied to the graft by the digital tensioner 110, the surgeon is also able to supplement that feel with the display of the tension applied to the graft by the digital tensioner 110 as the tension is adjusted.

[0023] For example, the surgeon may initially set the tension applied to the graft by the digital tensioner 110 at 50N. As the surgeon cycles the range of motion of the graft, the surgeon may visibly identify the tension applied to the graft by the digital tensioner 110 as the surgeon cycles through the range of motion. In such an example, the surgeon may then identify that the 50N displayed to the surgeon by digital tensioner controller 120 decreases as the surgeon cycles through the range of motion of the graft thereby indicating to the surgeon that the graft is losing tension. The surgeon may then immediately identify laxity in the graft at that specific point in the range of motion of the graft and adjust the tension applied to the graft by the digital tensioner 110 based on the visual feedback of the decrease in tension from 50N as displayed by digital tensioner controller 120.

[0024] In doing so, the surgeon is not limited to the visual feedback provided by the digital tensioner controller 120 as displayed via the user interface 185 as the surgeon executes the tensioning procedure of the graft in which the digital tensioner controller 120 displays the6115636-0001276888094vltension to the surgeon as the surgeon cycles through the range of motion of the graft to complete the tensioning procedure. The digital tensioner controller 120 may also accumulate all of the tensioning data collected by the digital tensioner controller 120 such that the tensioning data may be reviewed by the surgeon after completion of the tensioning procedure. Tensioning data is data that is captured by the digital tensioner controller 120 during the execution of the tensioning procedure in which the surgeon is adjusting the tension applied to the graft and cycling through the range of motion of the graft throughout the execution of the tensioning procedure. Tensioning data may include tension, load, resistance, voltage, acceleration, angle of the graft, force, orientation, angular velocity, and / or any other type of tensioning data that may be captured by the digital tensioner controller 120 from the tensioning procedure that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0025] The surgeon may then revert back to the tensioning data captured by the digital tensioner controller 120 to obtain visual feedback as to the tension level set by the surgeon throughout the tensioning procedure and how the tension level deviated for each point of the cycling through the range of motion of the graft throughout the tensioning procedure. In doing so, the surgeon may have executed several iterations of adjusting the tension level throughout the cycling of the range of motion until the appropriate tension level was reached to prevent laxity through the range of motion. The surgeon may then be able to refine the approach in executing tensioning procedures in reducing iterations of adjusting the tension level applied to the graft as the surgeon may determine a tension level to apply to the graft at the outset of the tensioning procedure that reaches the appropriate tension level with less iterations in adjusting the tension applied to the graft while increasing the effectiveness of the tensioning procedure for the patient.

[0026] For example, the surgeon may initiate with a tension level of 50N applied to a specific graft of a specific patient of age, demographic, activity level, and so on. However, the surgeon may then have to adjust the tension applied during the tensioning procedure several times before identifying the appropriate tension level to limit laxity when cycling through the range of motion. In such an example, the surgeon may then analyze each tension level adjusted by the surgeon during the tensioning procedure and decrease the tension level at each point during the cycling of the range of motion. The surgeon may then obtain the visual feedback7115636-0001276888094vlto initiate the tensioning procedure with a tension level that is 80N instead of 50N for a patient with a similar graft, age, demographic, activity level and so on. As a result, the surgeon may initiate the tensioning procedure with 80N for the next tensioning procedure that the surgeon performs thereby eliminating iterations of levels of tension that the surgeon went through in previous tensioning procedures and improving efficiency of the surgeon and effectiveness in the outcome of the procedure for the patient. Thus, the surgeon may compound the feedback received from feel, visual feedback displayed in real-time, and then analysis of past tensioning procedures to improve the efficiency and effectiveness in future tensioning procedures.

[0027] Further, the digital tensioner controller 120 may recommend to the surgeon the tension level to initiate the tensioning procedure but to also adjust the tension level throughout the tensioning procedure. The digital tensioner controller 120 may recommend to the surgeon the tension level to initiate and then adjust during the tensioning procedure based on the tensioning data collected by the digital tensioner controller 120 in past tensioning procedures. The digital controller 120 may analyze the tensioning data of past tensioning procedures as well as associate the tensioning data with past tensioning procedures to patient data. Patient data is data that is associated to each patient that undergoes the tensioning procedure. Patient data may include but is not limited to type of graft, type of tensioning procedure, demographic, age, gender, activity level and / or any other type of patient data that may impact the tensioning procedure and the outcome of the tensioning procedure as specific to the patient that may be captured from the tensioning procedure by the digital tensioner controller 120 that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0028] For example, the patient may be an eighteen year old active male that participates in active sports and is receiving a ligament replacement. Digital tensioner controller 120 may recommend to the surgeon the initial setpoint tension level to initiate the tensioning procedure based on the past tensioning procedures executed with patients that are eighteen years old, male, and participating in active sports with a similar ligament replacement. In doing so, the digital tensioner controller 120 may recommend to the surgeon as the surgeon executes the tensioning procedure the initial setpoint tension level to initiate the tensioning procedure and then recommended levels of tension for the surgeon to adjust to throughout the cycling of the range of motion based on the past tensioning procedures executed on past patients with similar8115636-0001276888094vlpatient data thereby increasing the efficiency of the tensioning procedure executed by the surgeon as well as the effectiveness in the outcome of the tensioning procedure for the patient.

[0029] Thus, each tensioning procedure that is executed continues to streamline feedback provided to the surgeon based on past levels of tension at each point of cycling through the range of motion for each patient and associates such tensioning data with the patient data thereby streamlining the efficiency in which the surgeon completes the tensioning procedure as well as optimizing the effectiveness for the patient after completing the tensioning procedure. The tensioning procedure may include any type of soft tissue reconstruction procedure that the surgeon applied tension to the soft tissue such as but not limited to knee reconstruction, shoulder reconstruction, ligament replacement, ACL replacement, and / or any other type of tensioning procedure in which tension is applied to a soft tissue via soft tissue reconstruction procedure that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure. The graft may be include any type of soft tissue replacement that surgeon positions on the patient and applies tension such a ligament, tendon, ACL, and / or any other type of soft tissue that is applied to the patient and tension is applied to that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0030] The digital tensioner controller 120 may be a device that is capable of electronically communicating with other devices. Examples of the digital tensioner controller 120 may include a mobile telephone, a smartphone, a workstation, a portable computing device, other computing devices such as a laptop, or a desktop computer, cluster of computers, set-top box, and / or any other suitable electronic device that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0031] In an embodiment, multiple modules may be implemented on the same computing device. Such a computing device may include software, firmware, hardware or a combination thereof. Software may include one or more applications on an operating system. Hardware can include, but is not limited to, a processor, a memory, and / or graphical user interface display.

[0032] As discussed above, FIG. 1 illustrates a block diagram of a digital tensioner control system 100 that may determine a tension value applied by a digital tensioner 110 to a graft of a patient during a tensioning procedure as a surgeon adjusts a tension level when performing9115636-0001276888094vlthe tensioning procedure. A plurality of strain gauge sensors 130 positioned in a strain gauge configuration 220 may detect a resistance value generated during the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner 110 applied to the graft. The resistance value is adjusted as the surgeon adjusts the tension level. FIG. 2 illustrates a block diagram of a digital tensioner control system 200 that may via display via user interface 210 a tension level value and flexion angle value based on signals generated by a strain gauge configuration 220 as a cieating mechanism 230 is implemented to apply tension to the graft by the digital tensioner 110. The digital tensioner control system 200 shares many similar features with the digital tensioner control system 100; therefore only the differences between the digital tensioner control system 200 and the digital tensioner control system 100 are to be discussed in further detail.

[0033] The strain gauge configuration 220 may be positioned in the digital tensioner 110 in which the strain gauge configuration 220 includes a plurality of strain gauges arranged in the strain gauge configuration 220 such that each of the strain gauges included in the strain gauge configuration 220 change in resistance based on the tension level applied by the digital tensioner 110 to the graft. As surgeon adjusts the tension level applied to the graft via the digital tensioner 110, the graft is strained or displaced based on the tension level applied to the graft as the surgeon cycles through the range of motion. The surgeon stretches the strain gauge configuration 220 or compresses the strain gauge configuration 220 in adjusting the tension level applied to the graft by the digital tensioner 110 as the graft is strained or displaced during the tensioning procedure.

[0034] In doing so, the strain gauge configuration 220 detects a resistance value that is generated as the surgeon adjusts the tension level applied to the graft. The resistance value detected by the strain gauge configuration 220 changes as the surgeon adjusts the tension level applied to the graft in that the strain gauge configuration 220 is stretched and / or compressed based on the adjustment of the tension level by the surgeon and applied by the digital tensioner 110. As a result, the resistance value detected by the strain gauge configuration 220 corresponds to the tension level applied by the digital tensioner 110 as the strain gauge configuration 220 is stretched and / or compressed as the tension level is adjusted by the surgeon.10115636-0001276888094vl

[0035] A digital tensioner controller 120 may automatically convert the resistance value as detected by the plurality of strain gauge sensors 130 generated during the tensioning procedure as the surgeon adjusts the tension level to a corresponding voltage value. As the strain gauge configuration 220 detects the resistance value based on the tension level applied to the graft by the digital tensioner 110, the signal generated by strain gauge configuration 220 may be amplified and the resistance value detected by the stain gauge configuration 220 may be converted to a voltage value by the digital tensioner controller 120. The voltage value that is converted from the resistance value detected by the strain gauge configuration 220 may then be measured thereby enabling the voltage value to correspond to the tension level applied by the digital tensioner 110 to the graft as the tension level is adjusted by the surgeon. As a result, the voltage value increases and / or decreases as the tension level applied by the digital tensioner controller 120 increases and / or decreases.

[0036] The digital tensioner controller 120 may automatically determine a load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon adjusts the tension value based on a calibration that associates the load value with the corresponding voltage value. The load value is adjusted as the surgeon adjusts the tension level. Digital tensioner controller 120 may convert the voltage value as generated from the strain gauge configuration 220 during the tensioning procedure as the surgeon adjusts the tension value based on a calibration that associates the load value with the voltage value in a linear relationship. The calibration of the digital tensioner 110 enables a linear relationship to be established between the voltage value generated from strain gauge configuration 220 and a corresponding load value in which as the voltage value increases and / or decreases as the tension level applied to the graft increases and / or decreases the corresponding load value also increases and / or decreases based on the linear relationship between voltage value and the load value in calibration.

[0037] The digital tensioner controller 120 may instruct by the user interface 185 to automatically display the load value as generated during the procedure as the surgeon adjusts the tension level applied to the graft when performing the tensioning procedure. As the surgeon adjusts the tension level applied to the graft by the digital tensioner 110, the strain gauge configuration 220 is stretched and / or compressed thereby generating a resistance value that is then converted to a voltage value from which a corresponding load value is determined. The11115636-0001276888094vlload value is then displayed by the user interface 185 in a manner such that the surgeon may easily recognize the tension level that is applied to the graft in real-time as the load value is a value that corresponds to the tension level and is easily discerned by the surgeon. For example, the user interface 185 may display the load level in Newtons in which the load level displayed by the user interface 185 increases and / or decreases in Newtons so that the surgeon may easily discern the tension level applied to the graft during the tensioning procedure.

[0038] The user interface 185 may be positioned on the digital tensioner 110. The user interface 185 may be positioned independent from the digital tensioner 110 such as a monitor positioned in the operating room. The remote user interface 150 may be positioned remote from the digital tensioner 110 and / or the operating room. The remote user interface 150 may be displayed on a communications device via an APP. The user interface 185 and / or remote user interface 150 may be positioned in any combination of quantities and locations and via APPs that that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0039] The digital tensioner controller 120 may automatically convert the resistance value as detected by the plurality of strain gauge sensors 130 generated during the tensioner procedure as the surgeon stretches the strain gauge configuration 220 when adjusting the tension level of the digital tensioner 110 applied to the graft to the corresponding voltage level. The voltage level is adjusted as the surgeon stretches the strain gauge configuration 220 when adjusting the tension level of the digital tensioner 110. The digital tensioner controller 120 may automatically determine the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon stretches the strain gauge configuration 220 when adjusting the tension level of the digital tensioner 110 as the load value based on the calibration that associates the load value with the corresponding voltage value. The load value is adjusted as the surgeon stretches the strain gauge configuration 220 when adjusting the tension level of the digital tensioner 110. The digital tensioner controller 120 may instruct the user interface 185 to automatically display the load value as generated during the tensioning procedure as the surgeon stretches the strain gauge configuration 220 when adjusting the tension level.

[0040] The digital tensioner controller 120 may automatically convert the resistance value as detected by the plurality of strain gauge sensors 130 during the tensioner procedure as the12115636-0001276888094vlsurgeon compresses the strain gauge configuration 220 when adjusting the tension level of the digital tensioner 110 applied to the graft to the corresponding voltage level. The voltage level is adjusted as the surgeon compresses the strain gauge configuration 220 when adjusting the tension level of the digital tensioner 110. The digital tensioner controller 120 may automatically determine the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon compresses the strain gauge configuration 220 when adjusting the tension level of the digital tensioner 110 as the load value based on the calibration that associates the load value with the corresponding voltage value. The load value is adjusted as the surgeon compresses the strain gauge configuration 220 when adjusting the tension level of the digital tensioner 110. The digital tensioner controller 120 may instruct the user interface 185 to automatically display the load value as generated during the tensioning procedure as the surgeon compresses the strain gauge configuration 220 when adjusting the tension level of the digital tensioner 110.

[0041] The digital tensioner controller 120 may apply a plurality of loads to the strain gauge configuration 220 to determine each load value of each corresponding load to the strain gauge configuration 220 that generates each corresponding voltage value when each load is applied to the strain gauge configuration 220. The digital tensioner controller 120 may determine when a linear relationship is generated between each load value of each corresponding load applied to the strain gauge configuration 220 and each corresponding voltage value that is generated when each load is applied to the strain gauge configuration 220. The digital tensioner controller 120 may calibrate the strain gauge configuration 220 based on the linear relationship between each load value and each corresponding voltage value that is generated when each load is applied to the strain gauge configuration 220. The digital tensioner controller 120 may generate the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon adjusts the tension value based on the calibration that associates the load value with the corresponding voltage value.

[0042] The digital tensioner controller 120 may apply a first load and a second load to the strain gauge configuration to determine a first load value and a second load value of the first load and the second load that generates a first voltage value and a second voltage value when the first load and the second load is applied to the strain gauge configuration 220. The digital tensioner controller 120 may determine the linear relationship is generated between the first13115636-0001276888094vlload value and the first voltage value and between the second load value and the second voltage value as applied to the strain gauge configuration 220. The digital tensioner controller 120 may execute a two-point calibration to calibrate the strain gauge configuration 220 based on the linear relationship and between the second load value and the second voltage value as applied to the strain gauge configuration. The digital tensioner controller 120 may execute any type of multi-point calibration to calibrate the strain gauge configuration 220 based on a linear relationship between each corresponding load value and corresponding voltage value that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0043] The digital tensioner controller 120 may instruct the user interface 185 to automatically display the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon stretches the strain gauge configuration 220 when adjusting the tensioning level of the digital tensioner 110 based on the calibration that associates the load value with the corresponding voltage value. The load value that is automatically displayed is adjusted as the surgeon stretches the strain gauge configuration. The digital tensioner controller 120 may instruct the user interface 185 to automatically display the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon compresses the strain gauge configuration 220 when adjusting the tension level of the digital tensioner 110 based on the calibration that associates the load value with the corresponding voltage value. The load value that is automatically displayed is adjusted as the surgeon compresses the strain gauge configuration 220.

[0044] FIG. 3 illustrates a block diagram of a digital tensioner control system 300 that may apply a tension level to sutures 310 based on tightening knobs 320. As discussed above, as the surgeon adjusts the tensioning knobs 320, the tension level applied to the sutures 310 is adjusted and in doing so the strain gauge configuration 220 stretches and / or compresses. As discussed above, the strain gauge configuration 220 may then be calibrated such that the voltage value determined from the strain gauge configuration 220 maps to a load value based on a linear relationship between the voltage value and the load value determined during the calibration. The strain gauge configuration 220 may include a plurality of strain gauges. The strain gauges may be configured in the strain gauge configuration 220 in a manner such that additional influences to the accuracy of the resistance value detected by the strain gauges as14115636-0001276888094vlthe strain gauge configuration 220 stretches and / or compresses. The digital tensioner control system 300 shares many similar features with the digital tensioner control system 100 and the digital tensioner control system 200; therefore only the differences between the digital tensioner control system 300 and the digital tensioner control system 100 and the digital tensioner control system 200 are to be discussed in further detail.

[0045] The quantity of strain gauges and the configuration of the strain gauges in the strain gauge configuration my reduce the additional influences to the accuracy of the resistance value detected by the strain gauges in that as the quantity of the strain gauges included in the strain gauge configuration 220 increases, the reduction of the additional influences to the accuracy of the resistance value detected by the strain gauges. For example, the strain gauge configuration 220 may include four wire strain gauges in which four strain gauges may be configured in a manner where there is a first set of four strain gauges positioned on a first side and a second set of four strain gauges positioned on a second side totaling eight straight engages in total. However, this configuration of strain gauges and quantity of strain gauges may be any quantity of strain gauges arranged in any type of strain gauge configuration 220 to reduce the additional influences that impact the accuracy of the resistance value detected by the strain gauges that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0046] An additional influence that may impact the accuracy of the resistance values detected by the strain gauges may be the impact of the tension level applied in an axis of the digital tensioner 110 to the graft. The turning of the tightening knobs 320 by the surgeon may increase tension on the sutures 310 which may cause a compressive load on the body of the digital tensioner 110. The strain gauges may measure the compressive loads on the body of the digital tensioner 110 and transmit the signals to the digital tensioner controller 120. However, the arms of the digital tensioner 110 may bend in as the tension level is applied to the sutures 310 in that the bend in the arms of the digital tensioner impacts the resistance value detected by the strain gauges and impacts the accuracy of the detected resistance value.

[0047] The bend in the arms of the digital tensioner 110 impacts the stretching and / or compressing of the strain gauges in that the bend in the arms adjusts the resistance value detected by the strain gauges such that the resistance value does not represent the tension level applied to the sutures 310. Rather the tension level applied to the sutures 310 and the bend in15115636-0001276888094vlthe arms of the digital tensioner 110 may result in the bend of the material of the strain gauges as the tension levels are applied to the sutures 310 based on the resulting compressive loads on the body of the digital tensioner 110. The strain gauge configuration 220 in which the quantity of the strain gauges and the configuration of the strain gauges may decrease the impact of the bend in the arms of the digital tensioner 110 on the resistance value detected by the strain gauge configuration 220 thereby increasing the accuracy of the detected resistance value by the strain gauge configuration 220 and increasing the accuracy of the load value displayed to the surgeon.

[0048] An additional influence that may impact the accuracy of the resistance values detected by the strain gauges may be the impact of the temperature of the environment in which the digital tensioner 110 is located. The temperature of the environment in which the digital tensioner 110 is located may impact the material of the strain gauges in which the material of the strain gauges may expand due to the temperature of the environment in which the digital tensioner 110 is located as well as a change in temperature of the environment in which the digital tensioner 110 is located.

[0049] For example, the digital tensioner 110 is transferred from a cold room in which the digital tensioner 110 is stored to a warm room in which the tensioning procedure is to be executed may expand the material of the strain gauges. The strain gauges may measure the strain generated from that expansion of material as well as the tension level applies to the sutures 310 by the tightening knobs 320 thereby impacting the accuracy of the detected resistance value. The strain gauge configuration 220 in which the quantity of strain gauges and the configuration of the strain gauges may decrease the impact in the expansion of the material of the strain gauges generated by the temperature of the environment of the digital tensioner 110 on the resistance value detected by the strain gauge configuration 220 thereby increasing the accuracy of the detected resistance value by the strain gauge configuration 220 and increasing the accuracy of the load value displayed to the surgeon.

[0050] An additional influence that may impact the accuracy of the resistance values detected by the strain gauges may be the impact of the Poisson effect of the material in which the strain gauges are positioned. The material in which the strain gauges are positioned may expand and based on the Poisson effect the strain gauges may also expand with the material in which the strain gauges are positioned. As the material that the strain gauges are positioned, the strain gauges may also expand to a point where the strain gauges break and / or detach from16115636-0001276888094vlthe material. The strain gauge configuration 220 in which quantity of strain gauges and the configuration of the strain gauges may enable the strain gauge configuration 220 to continue to detect the resistance value by decreasing the Poisson effect of the material as the material expands and / or deflects thereby increasing the accuracy of the detected resistance value by the strain gauge configuration 220 and increasing the accuracy of the load value displayed to the surgeon.

[0051] FIG. 4A illustrates a block diagram of a digital tensioner control system 400 in which a strain gauge configuration 420 is incorporated into a digital tensioner 110 to generate tension level values as discussed in detail above. FIG. 4B illustrates a block diagram of an example embodiment of a strain gauge configuration 450. The strain gauge configuration 450 is based on a full-bridge type III configuration in which the full-bridge type III configuration measures axial strain and rejects bend strain. The strain gauge configuration 450 may be incorporated into the digital tensioner 110 as strain gauge configuration 420 in digital tensioner control system 400 in FIG. 4A. The digital tensioner control system 400, the digital tensioner control system 450, and the digital tensioner control system 480 share many similar features with the digital tensioner control system 100, the digital tensioner control system 200, and the digital tensioner control system 300; therefore only the differences between the digital tensioner control system 400, the digital tensioner control system 450, and the digital tensioner control system 480 and the digital tensioner control system 100, the digital tensioner control system 200, and the digital tensioner control system 300 are to be discussed in further detail.

[0052] The strain gauge configuration 450 depicted in FIG. 4B may include four active strain-gauge elements. Two of the active strain-gauge elements may be mounted in the direction of axial strain with one active strain-gauge elements positioned on one side of the strain specimen (top) and the other active strain-gauge element positioned on the opposite side (bottom). The other two active strain-gauge elements may act together as a Poisson gauge and a mounted transverse (perpendicular) to the principal axis of strain with one active strain-gauge element positioned on one side of the strain specimen (top) and the other active strain-gauge element mounted on the opposite side (bottom). The strain gauge configuration 450 may compensate for temperature. The strain gauge configuration 450 may reject bending strain. The strain gauge configuration 450 my compensate for the aggregate effect on the principle strain measurement due to Poisson’s ratio of the specimen material. The strain gauge17115636-0001276888094vlconfiguration 450 may compensate for load resistance. The strain gauge configuration may have sensitivity at:1000 me ~1 3mVout(1).Vgx input

[0053] The strain gauge configuration 480 depicted in FIG. 4C includes a full-bridge type III circuit diagram. The strain gauge configuration 480 may apply the full-bridge type III circuit diagram with the following equations in which:• Ri is an active strain-gauge element measuring compressive Poisson effect (-ne).• R.2 is an active strain-gauge element measuring tensile strain (+e).• R.3 is an active strain-gauge element measuring compressive Poisson effect (-ne).• R.4 is an active strain-gauge element measuring the tensile strength (+e).To convert voltage readings to strain units the following equation applies:To simulate the effect on strain of applying a shunt resistor across R3 the following equation applies:

[0054] The strain gauge configuration 420 included in digital tensioner may include any type of strain gauge configuration that measures axial strain and reduces the influence of the impact of tension on the digital tensioner, the Poisson effect, and temperature that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0055] Returning to FIG. 1, an accelerometer 140 may measure an acceleration of the graft during the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner 110 applied to the graft. The acceleration of the graft is adjusted as an angle of the graft is adjusted as the surgeon adjusts the tension level. A gyrometer 160 may measure a rotation of the graft during the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner controller 110 applied to the graft. The rotation of the graft is adjusted as the angle of the graft is adjusted as the surgeon adjusts the tension level.

[0056] The digital tensioner controller 120 may automatically determine the angle of the graft during the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner 110 applied to the graft based on the measurement of the rotation of the graft and the18115636-0001276888094vlacceleration of the graft thereby generating a rotation of an angle of the graft relative to a duration of time that the graft is rotated. The gyrometer 160 may measure the rotational speed in degrees per second and / or radians per second as the surgeon adjusts the tension level of the digital tensioner 110 and cycles through the range of motion. The accelerometer 140 may then measure acceleration and / or gravity as the surgeon adjusts the tension level of the digital tensioner and cycles through the range of motion.

[0057] The digital tensioner controller 120 may then determine the angle of the graft based on the rotational speed measured by the gyrometer 160 and the amount of time in which the graft was positioned during the range of motion. The accelerometer 160 may then provide an external reference point based measuring the direction of gravity such that angle of the graft as determined by the digital tensioner controller 120 may not drift thereby skewing the determination of the angle of the graft over time. The digital tensioner controller 120 may then instruct the user interface 185 to automatically display the angle of the graft as generated during the tensioning procedure as the surgeon adjusts the tension level applied to the graft when performing the tensioning procedure. In doing so, the surgeon may receive visual feedback as to the tension level applied to the graft relative to the angle of the graft as the surgeon executes the tensioning procedure on the graft.

[0058] The digital tensioner controller 120 may instruct the user interface 185 to automatically display the load value and the angle of the graft as generated as the surgeon cycles the graft during the tensioning procedure as the surgeon stretches the strain gauge configuration 220 when adjusting the tension level thereby enabling the surgeon to determine the load value of the graft relative to the angle of the graft as the surgeon cycles the graft when stretching the strain gauge configuration 220. The digital tensioner controller 120 may instruct the user interface 185 to automatically display the load value and the angle of the graft as generated as the surgeon cycles the graft through the range of motion during the tensioning procedure as the surgeon compresses the strain gauge configuration 220 when adjusting the tension level thereby enabling the surgeon to determine the load value of the graft relative to the angle of the graft as the surgeon cycles the graft through the range of motion when compressing the strain gauge configuration. The digital tensioner controller 120 may also instruct a remote user interface 150 to automatically display the load value and the angle of the19115636-0001276888094vlgraft as generated during the tensioning procedure as the surgeon adjusts the tension level applied to the graft when performing the tensioning procedure.

[0059] Returning to FIG. 3, the digital tensioner 110 may include a first display 330a and a second display 330b. The first display 330a may display the tension level applied by suture 340a and the second display 330b may display the tension level applied by the suture 340b. In doing so, the surgeon may receive visual feedback as to the tension level applied to suture 340a and suture 340b during the tensioning procedure. The surgeon may request to apply different tension levels to suture 340a and suture 340b when executing the tensioning procedure in which the surgeon adjusts the tension level applied to suture 340a to differ from suture 340b. The application of different tension levels to suture 340a and suture 340b and corresponding display of the differing tension levels by corresponding first display 330a and second display 330b enables the surgeon to have the flexibility in executing the tensioning procedure to apply tension to different constructs throughout the tensioning procedure.

[0060] For example, the surgeon may apply tension levels to suture 340a that is attached to a tendon on the lefthand side. The surgeon may then apply different tension levels to suture 340b that is attached to an internal brace and / or suture augmentation on the righthand side. The first display 330a may then provide visual feedback to the surgeon as to the tension level applied to the tendon but suture 340a relative to the second display 330b providing visual feedback to the surgeon as to the tension level applied to the internal brace simultaneously thereby enabling the surgeon to recognize the different tension levels applied to the tendon and the internal brace throughout the execution of the tensioning procedure.

[0061] When the surgeon is using this, the digital sensor controller 120 may convert the voltage values to a tension value based on the calibration and that is what is displayed with the right of the user interface 185 and the left of the user interface 185 as well as the display 330a and the display 330b. For example, two tension values may be displayed in the color “red” by the display 330a and the display 330b. The angle may be displayed in the color “green.” In another embodiment, the tension values may be printed on the digital tensioner 110 itself. In such an embodiment, the LEDs may be positioned to change color based on the tension value that is determined. The tension values and the angle values may also be displayed by the remote user interface via a network 180 and display as digital values. The digital tensioner 110 may include any quantity of displays to provide the corresponding visual feedback20115636-0001276888094vlgenerated during the execution of the tensioning procedure that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure. The digital tensioner 110 may display the visual feedback generated during the execution of the tensioning procedure by any type of display configuration that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure. As discussed above, the digital tensioner control system configuration 100 may include any quantity and combination of user interfaces 185 and / or remote user interfaces 150 that may display the visual feedback generated during the execution of the tensioning procedure that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.SENSOR DETECTION CONFIGURATION

[0062] FIG. 5 illustrates a block diagram of a digital tensioner control system 500 that may extract tensioning parameters that are captured intraoperatively and are associated with the tensioning procedure as the surgeon adjusts the tension level of the graft throughout the execution of the tensioning procedure. The digital tensioner control system 500 includes a digital tensioner 510 in which the surgeon implements in adjusting the tension level applied to the graft throughout the execution of the tensioning procedure. A digital tensioner computing device 520 that includes a processor 515 may then extract the tensioning parameters captured during throughout the tensioning procedure and stream tensioning parameters to a remote user interface 550 and / or user interface 585 such that the remote user interface 550 and / or user interface 585 may display the tensioning parameters to the surgeon intraoperatively as the surgeon executes the tensioning procedure.

[0063] The digital tensioning controller 520 may also store the tensioning parameters captured intraoperatively throughout the execution of the tensioning procedure in a tensioning parameter database 560. The digital tensioning controller may also stream the tensioning parameters captured intraoperatively throughout the execution the tensioning procedure as well as the tensioning parameters stored in the digital tensioner parameter database captured from past tensioning procedures to digital tensioning server 530 such that the digital tensioning server 530 may implement a neural network 540 in applying machine learning to the tensioning parameters and stored tensioning parameters. The digital tensioner control system 500 shares21115636-0001276888094vlmany similar features with the digital tensioner control system, the digital tensioner control system 200, the digital tensioner control system 300, the digital tensioner control system 400, the digital tensioner control system 450, and the digital tensioner control system 480; therefore only the differences between the digital tensioner control system 500 and the digital tensioner control system 100, the digital tensioner control system 200, the digital tensioner control system 300, the digital tensioner control system 400, the digital tensioner control system 450, and the digital tensioner control system 480 are to be discussed in further detail.

[0064] The digital tensioner computing device 520 may extract a plurality of tensioning parameters associated with a tensioning procedure as the surgeon adjusts the tension level of the digital tensioner 510 applied to the graft intraoperatively. The tensioning parameters associated with the tensioning procedure fluctuate intraoperatively as the surgeon adjusts the tension level of the digital tensioner applied to the graft. The tensioning parameters are parameters that are associated with the graft and generated throughout the tensioning procedure in which the tensioning parameters are indicative as to state of the graft throughout the tensioning procedure. For example, the tensioning parameters may include the tension level applied to the graft in which the tension level is adjusted by the surgeon throughout the execution of the tensioning procedure. The tensioning parameters may also include the flexion angle of the graft as the tension level applied to the graft is adjusted in which the flexion angle of the graft relative to the tension level applied to the graft at each flexion angle may be adjusted as the surgeon executes the tensioning procedure. The tensioning parameters may include tension level, flexion angle, laxity, displacement, and / or any other tensioning parameter that is indicative as to the state of the graft throughout the tensioning procedure that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0065] The digital tensioner computing device 520 may automatically stream the tensioning parameters associated with a tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft intraoperatively to a user interface 585 to display the tensioning parameters as the tensioning parameters fluctuate as the surgeon adjusts the tension level of the digital tensioner 510 in real-time. As discussed in detail above, conventionally the surgeon relied on feel when adjusting the tension level applied to the graft to determine the appropriate tension to apply to the graft to limit laxity in the graft when cycling22115636-0001276888094vlthroughout the range of motion. Additionally, the surgeon may rely on pre-operative data in which such data is obtained and is available to the surgeon before the surgeon initiates the tensioning procedure as well as post-operative data which is obtained and is available to the surgeon after executing the tensioning procedure.

[0066] Rather than the surgeon limited to relying on feel gained through experience in executing tensioning procedures as well as pre-operative data and post-operative data obtained through past tensioning procedures, the digital tensioner computing device 520 may extract the tensioning parameters captured intraoperatively in real-time throughout the execution of the tensioning procedure and display such tensioning parameters captured intraoperatively to the surgeon via user interface 585 in real-time. The surgeon may observe how the tensioning parameters are fluctuating throughout the execution of the tensioning procedure in real-time as displayed by the user interface 585 in a manner that also depicts the relation of each tensioning parameter that is captured as related to each other captured tensioning parameter. For example, FIG. 6 illustrates a block diagram of an example user interface configuration 600 that is displaying tensioning parameters as captured intraoperatively in real-time as the surgeon executes the tensioning procedure. In such an example, the user interface configuration depicts how the tension level in Force (N) is adjusted to each of the grafts relative to the flexion angle of each of the grafts at each point in time throughout the execution of the tensioning procedure.

[0067] In doing so, the surgeon may receive intraoperative feedback as to the integration of the tensioning parameters as the surgeon executes the tensioning procedure. As the surgeon adjusts the tension level applied to the graft, the flexion angle of the graft for each adjustment of the tension level is also displayed. For example, the surgeon may increase the tension level applied to the graft at flexion angle of the graft in which displacement in the graft increases as the flexion angle of the graft is adjusted through cycling of the range of motion at the current tension level applied to the graft. The intraoperative streaming of the tension level relative to the flexion angle of the graft by the digital tensioner computing device 520 as displayed by the user interface 520 may provide immediate visual feedback to the surgeon as to the current tension level resulting in displacement of the graft at the current flexion angle. The surgeon may then immediately adjust the tension level to decrease the displacement of the graft at the flexion angle and the digital tensioner computing device 520 may thereby stream the23115636-0001276888094vladjustment as displayed by the user interface 585 intraoperatively to provide the surgeon with visual feedback as to the adjustment of the tension level relative to the flexion angle.

[0068] The surgeon may then determine the appropriate tension level to increase and / or decrease to relative to the flexion angle of the graft as the surgeon cycles the graft through the range of motion at each tension level applied to the graft based as displayed by user interface 585 in to obtain the appropriate tension level at each flexion angle of the graft throughout the range of motion to limit laxity. As a result, the surgeon may supplement the intraoperative capturing and display of the tensioning parameters providing immediate visual feedback to the surgeon in real-time with the feel of the surgeon as well as the pre-operative and post-operative data available to the surgeon to efficiently obtain the appropriate tension level at each flexion angle of the graft throughout the range of motion to limit laxity as well as the effectiveness in the patient outcome of the tensioning procedure. Real-time is the period of time in which the digital tensioner 510 is currently applying a specific tension level to the graft at a specific flexion angle of the graft as the tension level and the flexion angle of the graft change intraoperatively thereby capturing and displaying resulting tensioning parameters intraoperatively.

[0069] The digital tensioner computing device 520 may stream the tensioning parameters associated with the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner 510 applied to the graft intraoperatively to a tensioning parameter database 560 thereby enabling the tensioning parameters to accumulate in the tensioning parameter database 560 as the tensioning parameters fluctuate as the surgeon adjusts the tension level of the digital tensioner 510 in real-time. As discussed above, the digital tensioner computing device 520 may extract the tensioning parameters captured intraoperatively throughout the execution of the tensioning procedure such that the surgeon may receive immediate visual feedback as to the tensioning parameters captured for each tension level applied to the graft at each corresponding flexion angle of the graft and the relation of such captured tensioning parameters. The digital tensioner computing device 520 may also stream the tensioning parameters captured intraoperatively as the tension level applied to the graft is adjusted as well as the flexion angle of the graft is adjusted such that the captured tensioning parameters may be stored in the tensioning parameter database 560.24115636-0001276888094vl

[0070] The tensioning parameters captured intraoperatively may then be stored in the digital tensioner parameter database 560 such that the tensioning parameters may be associated with the tensioning procedure performed and the patient in which the tensioning procedure was executed. The tensioning parameters may then provide post-operative feedback to the surgeon in which the surgeon may analyze each tensioning parameter relative to each other tensioning parameter captured intraoperatively throughout the execution of the tensioning procedure. The surgeon may be able to analyze and associate each tensioning parameter relative to each other tensioning parameter captured intraoperatively throughout the execution of the tensioning procedure to determine the efficiency and the effectiveness in the patient outcome for the tensioning procedure. As a result, the surgeon may be able to continue increase efficiency in future tensioning procedures with the post-operative feedback of the tensioning parameters captured intraoperatively and stored digital tensioner parameter database 560 as well as identify post-operative issues following the completion of the tensioning procedure that the patient may be experiencing to efficiently identify what occurred during the tensioning procedure to address the post-operative issues.

[0071] For example, a patient may be experiencing immediate issues following the tensioning procedure in post-operation. Rather than wait for the patient to have a re-rupture of the graft weeks after the completion of the tensioning procedure in which a new tensioning procedure may be executed to fix the re-rupture, the surgeon may analyze the tensioning parameters captured intraoperatively during the tensioning procedure to identify the cause of the issues experienced by the patient thereby enabling the surgeon to address such issues immediately following the tensioning procedure. In such an example, the surgeon may identify that the tension level of 50N applied to the tendon during the tensioning procedure did not appropriately limit the laxity in the tendon as well as resulted in displacement of the tendon at the tension level of 50N at the corresponding flexion angle of the tendon.

[0072] The surgeon may then identify based on the tensioning parameters of the tension level, flexion angle, laxity, and displacement of the tension at 50N as an issue and thereby efficiently rectify the issues the patient is experiencing early in post-operation to increase the effectiveness of the outcome early in post-operation rather than delaying until the patient experiences significantly increased issues in severity following post-operation such as a rerupture. As a result, the streaming of tensioning parameters as captured intraoperatively by25115636-0001276888094vlthe digital tensioner computing device 520 to the digital tensioner parameter database 560 may provide continuous improvement in the efficiency of the execution of future tensioning procedures as well as the effectiveness in the outcome of the tensioning procedure for future patients.

[0073] The digital tensioner computing device 520 automatically streams a tension value and a flexion angle value as the surgeon adjusts the digital tensioner 510 applied to the graft positioned on a joint for the duration of the tensioning procedure to the user interface 585 to display the tension value and the flexion angle value as the tension value and the flexion angle value fluctuate for the duration of the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner 510 in real-time. The digital tensioner controller may stream the tension value and the flexion angle value as the surgeon adjusts the tension level of the digital tensioner 510 applied to the graft positioned on the joint to the tensioning parameter database 560 thereby enabling the tension value and the flexion angle value to accumulate in the tensioning parameter database 560 as the tension value and the flexion angle value fluctuate for the duration of the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner 510 in real-time.

[0074] The digital tension controller 520 may stream the tension value and the flexion angle value to a remote user interface 530 as the surgeon adjusts the tension level of the digital tensioner applied to the graft positioned on the joint. The remote user interface 530 is positioned remote from the digital tensioner 510 thereby enabling the display of the tension value and the flexion angle value as the tension value and the flexion angle value fluctuate for the duration of the tensioning procedure without obstruction.

[0075] The digital tensioner computing device 520 may stream the tension value and the flexion angle value to the remote user interface 530 as the surgeon adjusts the tension level of the digital tension applied to the graft and moves the joint through a range of motion as the tension value and the flexion angle value fluctuate for the duration of the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner 510 in real-time. The digital tensioner computing device 520 may instruct the remote user interface 530 to graphically display the tension value and the flexion angle value over time for the duration of the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner 510 applied to the graft and moves the joint through the range of motion. The graphically display of the tension26115636-0001276888094vllevel value and the flexion angle value depicts how the tension value and the flexion angle value fluctuate intraoperatively for the duration of the tensioning procedure.

[0076] The digital tensioner computing device 520 may stream a plurality of tension values and a plurality of flexion angle values generated from a plurality of digital tensioners 510 as the surgeon adjusts each tension value of each digital tension applied to each graft by each corresponding digital tensioner and moves the joint through the range of motion as each tension value and each flexion angle value fluctuate during the duration of the tensioning procedure as the surgeon adjusts the tensioning level of each corresponding digital tensioner in real-time. The digital tensioner computing device 520 may instruct the remote user interface 530 to graphically display each tension level value and each flexion angle value simultaneously over time for the duration of the tensioning procedure as the surgeon adjusts each tension level of each digital tensioner applied each graft by each corresponding digital tensioner and moves the joint through the range of motion. The graphically display of each tension level value and each flexion angle value simultaneously depicts how each tension value and each flexion angle value fluctuates relative to each other tension value and each other flexion angle value for the duration of the tensioning procedure.

[0077] The surgeon may implement several different digital tensioners 510 in executing the tensioning procedure. For example, the surgeon may implement a digital tensioner 510 to apply tension to a ligament while implementing a digital tensioner 510 to apply tension to an augmented piece while implementing a digital tensioner 510 to a brace for the ligament. The surgeon may be able to receive visual feedback with regard to the tension parameters captured intraoperatively from each of the different tensioners 510 as the surgeon executes the tensioning procedure with each of the different tensioners 510. As the surgeon adjusts the tension level applied by each digital tensioner 510 relative to the flexion angle in which each digital tensioner 510 is attached, the digital tensioner computing device 520 may simultaneously stream each of the tensioning parameters as captured intraoperatively to the user interface 585 such that the user interface 585 may display simultaneously the fluctuation in the tensioning parameters intraoperatively for each of the digital tensioners 510 relative to each other.

[0078] For example, the surgeon may implement five different digital tensioners 510 in executing an knee reconstruction surgery with multiple ligaments simultaneously. Returning27115636-0001276888094vlto FIG. 6, the example user interface configuration 600 may depict the tension level in Force (N) and the corresponding flexion angle for each of the graft 1, graft 2, graft 3, graft 4, and the augment 1. The surgeon may adjust the tension level of each of the different digital tensioners 510 applied to graft 1, graft 2, graft 3, graft 4, and the augment 1 relative to the flection angle of the corresponding ligament throughout the execution of the tensioning procedure. The digital tensioner computing device 520 may then stream the captured tensioning parameters intraoperatively of the tension level of Force (N) and flexion angle to the user interface 585 such that the fluctuation of the tensioning level relative to flexion angle for each of the digital tensioners 510 applied to each of the ligaments of graft 1, graft 2, graft 3, graft 4, and augment 1 may be displayed relative to each other such that the surgeon may receive immediate visual feedback as to the tensioning parameters of each of the digital tensioners 510 relative to each other. The digital tensioner computing device 520 may stream any type of tensioning parameters extracted intraoperatively from any quantity of digital tensioners 510 applied to any quantity of grafts and display the tensioning parameters relative to each other as captured intraoperatively that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0079] The digital tensioner computing device 520 may extract a plurality of pre-operative variable parameters associated with the tensioning procedure. The pre-operative variable parameters associated with the tensioning procedure are pre-defined by the surgeon pre- operatively to the tensioning procedure. The digital tensioner computing device 520 may stream the pre-operative variable parameters associated with the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner 510 applied to the graft intraoperatively to accumulate the pre-operative variable parameters in the tensioning parameter database 560 as the surgeon adjusts the tension level of the digital tensioner 510 in real-time.

[0080] The surgeon may have preferences in which the surgeon prefers to execute a particular tensioning procedure. For example, the surgeon may have preferences in which the surgeon prefers to execute an ACL replacement in which the surgeon prefers to execute the tunnel placement, implement specific angles, implement specific fixation techniques in so on in which the surgeon prefers to implement each time the surgeon executes an ACL replacement. Further, each tensioning procedure may have different types of aspects specific28115636-0001276888094vlto the tensioning procedure that may be implemented in future executions of the specific tensioning procedure in which such different aspects are inherent to the specific tensioning procedure. For example, the type of ligament that is being replaced in the tensioning procedure in which a type of graft that may be implemented for that type of ligament, the pre-tension levels to be applied to that type of ligament and graft, and so on may be inherent to the type of tensioning procedure that is to be executed.

[0081] As a result, the surgeon prefers to implement pre-operative variable parameters which are pre-determined before initiating the tensioning procedure that are associated with the tensioning procedure and the surgeon. The surgeon then implements the pre-operative variable parameters when executing the tensioning procedure and reacts accordingly throughout the execution of the tensioning procedure based on the implementation of the preoperative variable parameters. Further, each tensioning procedure may implement preoperative variable parameters that are inherent to the tensioning procedure and may be executed in future tensioning procedures in which such pre-operative variable parameters may apply to a first tensioning procedure but not apply to a second tensioning procedure. For example, a complicated knee replacement may have pre-operative variable parameters that are apply to the complicated knee replacement but do not apply to a simpler ligament replacement and are thus inherent to the complicated knee replacement. Thus, pre-operative variable parameters are parameters that are identified pre-operatively and are associated with the tensioning procedure that is to be executed and may be implemented at the outset of the tensioning procedure.

[0082] The digital tensioning controller 520 may extract the pre-operative variable parameters for the specific tensioning procedure as executed by the specific surgeon and then stream such pre-operative variable parameters as the surgeon executes the tensioning procedure to the tensioning parameter database 560. The pre-operative variable parameters associated with the tensioning procedure and associated with the preferences of the surgeon as well as inherent to the specific tensioning procedure being executed may be stored and accumulated in the tensioning parameter database 560. In doing so, the digital tensioner computing device 520 may pull the pre-operative variable parameters from the tensioning parameter database 560 and provide to the surgeon as the surgeon executes future specific tensioning procedures in which the surgeon has preferences for such specific tensioning29115636-0001276888094vlprocedures to be implemented as well as the specific tensioning procedures having preoperative variable parameters that are inherent to the specific tensioning procedure each time the surgeon executes the specific tensioning procedure.

[0083] Pre-operative variable parameters may include but not limited to type of ligament in MCL, ACL, PFL, and so on, type of graft in Allen graft, synthetic graft, autograft and so on, is the graft pre-tensioned, the pre-tension levels, the type of graft in hamstring, patella bone graft, and so on, description of the graft itself, tunneling, tunneling technique, retrograde, tunnel diameter, placement of the tunnel, fixation techniques, is a brace used, type of fixation used, description of the procedure, and / or any other type of pre-operative variable parameter that may be implemented in a specific tensioning procedure based on the preferences of the surgeon and / or specific to the type of tensioning procedure that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0084] The digital tensioner computing device 520 may extract a plurality of patient parameters associated with the tensioning procedure. The patient parameters associated with the tensioning procedure are associated with the patient pre-operatively to the tensioning procedure. The digital tensioner computing device 520 may stream the patient parameters associated with the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner 510 applied to the graft intraoperatively to accumulate the patient parameters in the tensioning parameter database 560 as the surgeon adjusts the tension level of the digital tensioner in real-time.

[0085] Patient parameters are parameters that are associated with each patient that undergoes a tensioning procedure. For example, a patient undergoing a ligament replacement has a specific demographic, age, gender, and / or activity level which is associated with the patient. In such an example, the patient may be an eighteen year old male that is playing competitive soccer. The patient parameters influence the execution of the tensioning procedure in that each patient has specific patient parameters that differ from other patients. For example, the execution of the tensioning procedure for the eighteen year old male that is playing competitive soccer may influence the execution of the tensioning procedure differently from an eighty year old female that gingerly walks that is undergoing the same ligament replacement as the eighteen year old male that is playing competitive soccer.30115636-0001276888094vl

[0086] The digital tensioning controller 520 may extract the patient parameters that are associated with the patient that is to undergo a specific tensioning procedure that other patients with similar patient parameters as the patient to undergo a similar tensioning procedure have had. The patient parameters associated with the patient that is to undergo the tensioning procedure may be stored and accumulated in the tensioning parameter database 560. In doing so, the digital tensioner computing device 520 may pull the patient parameters from the tensioning parameter database 560 and provide to the surgeon as the surgeon executes future tensioning procedures for patients with similar patient data undergoing similar tensioning procedures.

[0087] Patient parameters may include but is not limited to type of graft, type of tensioning procedure, demographic, age, gender, physical activity level, weight, and / or any other type of patient parameters that may impact the tensioning procedure and the outcome of the tensioning procedure as associated with the patient that may be captured from the tensioning procedure by the digital tensioner computing device 520 that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0088] The digital tensioner computing device 520 may automatically receive updated tensioning parameters, updated pre-operative variable parameters, and updated patient parameters that includes updated streamed tensioning data associated with each past tensioning procedure as trained on a neural network 540 based on machine learning as the neural network continuously updates the tensioning parameters, the updated pre-operative variable parameters, and the updated patent parameters with updated tensioning data as captured from the past tensioning procedures. As discussed in detail above, tensioning parameters, preoperative variable parameters, and patient parameters may be extracted by digital tensioner computing device 520 for each tensioning procedure executed and stored in digital tensioner parameter database 560. The digital tensioner parameter database 560 continues to accumulate tensioning parameters, pre-operative variable parameters, and patient parameters for each patient, each surgeon, each tensioning procedure that is executed.

[0089] As the tensioning parameters, pre-operative variable parameters, and the patient parameters continue to accumulate in the digital tensioner parameter database 560, the digital tensioner computing device 520 may then stream such parameters as past tensioning parameters, past pre-operative variable parameters, and past patient parameters as extracted31115636-0001276888094vlfrom each past tensioning procedure to digital tensioner server 530. Digital tensioner server 530 may then feed the past tensioning parameters, past pre-operative variable parameters, and past patient parameters as extracted from each past tensioning procedure into neural network 540. The neural network 540 may then apply machine learning to the past tensioning parameters, past pre-operative parameters, and past patient parameters from each past tensioning procedure to train on the past tensioning parameters, past pre-operative variable parameters, and past patient parameters as extracted from each past tensioning procedure.

[0090] The neural network 540 may continue to train based on machine learning for each past tensioning procedure performed with the past tensioning parameters, past pre-operative variable parameters and the past patient parameters. Each tensioning procedure completed provides additional past tensioning parameters, pre-operative variable parameters, and patient parameters for neural network 540 to train. For example, a tensioning procedure of a multiple line graft is executed on a patient that is twenty-five years old, female, and active soccer player. A 10 mm diameter graft was used on the quadracepts tendon and different fixation devices were used as well as the tensioning parameters generated from each of the cycles. The neural network 540 may accumulate such past tensioning parameters, pre-operative variable parameters, and past patient parameters and train as well with past tensioning parameters, preoperative variable parameters, and past patient parameters of each similar past tensioning procedure that was executed.

[0091] The neural network 540 may then assist the digital tensioner computing device 520 in providing the digital tensioner computing device 520 with updated tension parameters, updated pre-operative variable parameters, and updated patient parameters that have been updated based on updated streamed tensioning data associated with each past tensioning procedure as trained on by the neural network 540. The updated tension parameters, updated pre-operative variable parameters, and updated patient parameters are updated based on the learning of the neural network 540 with updated tensioning data as captured from past tensioning procedures. The digital tensioner computing device 520 continues to receive assistance from the neural network 540 based on the continuous learning from the neural network from past tensioning procedures thereby enabling the digital tensioner computing device 520 to provide current tension parameters, current pre-operative variable parameters,32115636-0001276888094vland current patient parameters to the surgeon for a current tensioning procedure to be executed by the surgeon.

[0092] In doing so, the digital tensioner computing device 520 may provide updated tension parameters, updated pre-operative parameters, and updated patient parameters for the surgeon to implement during the execution of the current tensioning procedure with increased accuracy based on the training of the neural network 540 from past tensioning procedures. For example, the surgeon determine the appropriate tension levels to apply to each corresponding flection angle for the multiple line graft tensioning procedure that is executed on the twenty- five year old, female, and active soccer player with increased accuracy based on the past tensioning parameters, past pre-operative variable parameters, and past patient parameters extracted from past similar tensioning procedures with similar patients. As a result, the digital tensioning controller 520 may continue to provide current tensioning parameters, current preoperative variable parameters and current patient parameters to the surgeon for each subsequent tensioning procedure with increased accuracy. With each tensioning procedure that is completed, the accuracy in which the digital tensioning controller 520 provides assistance to each surgeon of each subsequent tensioning procedure increases thereby increasing the efficiency of each subsequent tensioning procedure that is executed as well as increasing the effectiveness in the outcome of the procedure for the patient with the completion of each past tensioning procedure.

[0093] The digital tensioner computing device 520 may analyze the updated tensioning parameters, the updated pre-operative variable parameters, and the updated patient parameters as provided by the neural network 540 to determine a plurality of current tensioning parameters, a plurality of current pre-operative variable parameters, and a plurality of current patient parameters associated with a current tensioning procedure. The current tensioning parameters, the current pre-operative variable parameters, and the current patient parameters are indicative to an execution of the current tensioning procedure on a current patient. The digital tensioner computing device 520 may automatically generate a notification of the current tensioning parameters, the current pre-operative variable parameters, and current patient parameters as provided by the neural network 540 for the execution of the current tensioning procedure.33115636-0001276888094vl

[0094] The digital tensioner computing device 520 may analyze the tensioning parameters, the pre-operative variable parameters, and the patient parameters post-operatively to generate feedback relative to a completion of the tensioning procedure. The feedback is indicative to an outcome of the completed tensioning procedure for the patient. The digital tensioner computing device 520 may automatically stream the tensioning parameters, the pre-operative variable parameters, and the patient parameters based on the feedback generated post- operatively relative to the completion of the tensioning procedure to the tensioning parameter database 560 to train the neural network 540 based on machine learning on the streamed tensioning parameters, the pre-operative variable parameters, and the patient parameters based on the feedback generated post-operatively.

[0095] With each completed tensioning procedure, the digital tensioner computing device 520 may post-operatively analyze the tensioning parameters, the pre-operative variable parameters, and the patient parameters that were extracted during the execution of the tensioning procedure feedback the tensioning parameters, the pre-operative parameters, and the patient parameters to the neural network 540 such that the neural network 540 may continue to train. Thus, with each completion of each tensioning procedure, the digital tensioner computing device 520 may feedback the tensioning parameters, the pre-operative parameters, and the patient parameters to the neural network 540 such that the assistance provided with regard to tensioning parameters, pre-operative parameters, and patient parameters provided by the digital tensioner computing device 520 to each future tensioning procedure continues to increase in accuracy.

[0096] Further, the digital tensioner computing device 520 may provide additional postoperative feedback to the neural network 540 via digital tensioner server 530 based on postoperative analysis of the completed tensioning procedure. Ultimately, the tensioning procedure results in an outcome for the patient. The increased effectiveness of the outcome of the patient increases the level of success of the tensioning procedure. The post-operative analysis for the completed tensioning procedure may initiate immediately following the completion of the tensioning procedure and continue through rehabilitation and continue through each year following the completion of the tensioning procedure. Such feedback may be obtained from the surgeon and other medical professionals that evaluate the patient throughout the time period following the completion of the tensioning procedure.34115636-0001276888094vl

[0097] The digital tensioner computing device 520 may then associate such feedback with the tension parameters, pre-operative variable parameters, and the patient parameters that were captured during the tensioning procedure. In doing so, the outcome of the tensioning procedure may be linked to the tension parameters, pre-operative variable parameters, and the patient parameters that were captured during the tensioning procedure to determine the effectiveness of the outcome of the tensioning procedure based on the impact of the tension parameters, preoperative parameters, and the patient parameters captured during the tensioning procedure. The digital tensioner computing device 520 may then stream the association of the feedback generated post-operatively from the completion of the tensioning procedure with the tensioning parameters, pre-operative variable parameters, and the patient parameters captured during the tensioning procedure to the neural network 540 via digital tensioner server 530. In doing so, the neural network 540 may continue to train on the effectiveness of the tensioning parameters, pre-operative variable parameters, and the patient parameters as associated with the feedback provided in the outcome of the tensioning procedure post-operatively.

[0098] For example, a patient feedback survey mechanism may be provided to the digital tensioner computing device 520 so that the surgeon may program in a cadence of request for the patient to fill out a survey form. The patient feedback survey may have questions to identify the best engagement of the digital tensioner control system 500 to maintain simplicity for the patient. The patient may enter an answer based on a star based ranking. The digital tensioner computing device may determine a score representing the effectiveness of the outcome of the tensioning procedure. The digital tensioner computing device 520 may then determine a score representing the effectiveness of the outcome of the tensioning procedure based on the patient feedback survey executed for iterations of time following the completion of the tensioning procedure, such as post-operative, rehabilitation, six months, one year, two years, three years and so on from the completion of the tensioning procedure. The digital tensioner computing device 520 may then feedback the data extracted from the patient feedback survey into neural network 540 via digital tensioner server 530 such that the neural network 540 may continue to learn based on machine learning the association of the feedback with regard to the effectiveness in the outcome of the tensioning procedure with the tensioning parameters, pre-operative variable parameters, and the patient parameters to enable surgeons to pinpoint optimal tension level values to apply in future tensioning procedures.35115636-0001276888094vl

[0099] The feedback of the patient and the feedback of the surgeon may be provided as to the correct tension level values at the outcome of the tensioning procedure. Conventionally, the surgeons do not know the actual tension level values and rather operate on feel. Conventionally, the surgeons have no insight as to the Newton level applied to the graft. However, digital tensioner computing device 520 may synergize the feel of the surgeon with the additional insight of the actual tension level value, such as 18N. As the data is accumulated, the surgeon may be able to with an increased degree of objectivity obtain with their desired outcome in tensioning the graft. The feedback loop is provided to the neural network 540 to learn. The confirmation feedback from the surgeon and the patient may then provide confirmation that the tension level values that were implemented in the tensioning procedure as well as the tension parameters, pre-operative value parameters, and patient parameters based contributed to the effectiveness of the outcome of the tensioning procedure for the patient.

[0100] The digital tensioner computing device 520 may generate a post-operative report relative to the completion of the tensioning procedure that includes the tensioning parameters, the pre-operative variable parameters, and the patient parameters generated in real-time during the duration of the tensioning procedure to provide feedback to the surgeon. In doing so, the surgeon may be able to analyze the feedback generated in the post-operative report based on the association of the feedback generated in the post-operative report with the tensioning parameters, the pre-operative variable parameters, and the patient parameters. For example, the surgeon may be able to identify where laxity and / or displacement in the tendon occurred during the procedure and the tensioning parameters generated at those occurrences as well as associating the pre-operative variable parameters and the patient parameters with the occurrences. The digital tensioning computing device 520 may associate feedback with the tensioning parameters, pre-operative value parameters, and the patient parameters from feedback generated from any type of source that provides feedback as to the effectiveness of the tensioning procedure that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0101] Digital tensioner computing device 520 may continuously stream tensioning procedure data to digital tensioner server 530 such that digital tensioner server 530 may accumulate tensioning procedure data as stored in digital tensioner parameter database 560. In doing so, the digital tensioner server 530 may continuously accumulate tensioning procedure36115636-0001276888094vldata that is associated with the adjusting of tension levels to a graft each time a tensioning procedure is executed. The tensioning procedure data is accumulated from each tensioning procedure and analyzed to recognize different tensioning parameters, pre-operative variable parameters, and patient parameters that are generated during the execution of each tensioning procedure. Over time as the tensioning procedure data that is accumulated by digital tensioner server 530 item identification server 530 continues to increase, neural network 540 may then apply a neural network algorithm such as but not limited to a multilayer perceptron (MLP), a restricted Boltzmann Machine (RBM), a convolution neural network (CNN), and / or any other neural network algorithm that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.

[0102] Each time the tensioning procedure data is streamed to digital tensioner server 530, neural network 540 may then assist digital tensioner computing device 520 by providing digital tensioner computing device 520 with the appropriate recognition of the surgeon, the patient and the tensioning procedure to be executed on the patient by the surgeon to accurately provide the tensioning parameters, pre-operative variable parameters, and the patient parameters to the surgeon to execute the tensioning procedure. Neural network 540 may assist digital tensioning computing device 520 in learning as to the appropriate tensioning parameters, pre-operative variable parameters, and the patient parameters to be implemented by the surgeon in executing the tensioning procedure on the patient such that neural network 540 may further improve the accuracy of digital tensioning computing device 520 in automatically recognizing the surgeon, the patient, and the tensioning procedure to be executed on the patient to further enhance the execution of the tensioning procedure. Neural network 540 may provide digital tensioner controller 520 with improved accuracy in automatically recognizing the surgeon, the patient, and the tensioning procedure to be executed on the patient such that the neural network 540 may continue to learn upon the accumulation of the tensioning procedure data that is provided by digital tensioning computing device 520 and / or any computing device associated with digital tensioner control system 500 to digital tensioner computing device 520. Thus, recognition of the surgeon, the patient, and the tensioning procedure may further enhance the identification of the tensioning parameters, pre-operative variable parameters, and patient parameters to be provided to the surgeon for the execution of any tensioning procedure on any patient.37115636-0001276888094vl

[0103] Returning to FIG. 6, the example user interface configuration 600 depicts the tension levels applied to each graft through each cycle relative to the flexion angle. For example, the example user interface configuration 600 depicts a Max Force of 32N and a Min Force of 18N in the fourth cycle that lasted a duration of 3: 18:01. The example user interface configuration 600 then visually depicts the adjustment of the tension level applied to the graft relative to the flexion angle. The digital tensioner computing device 520 may determine the Max Force and the Min Force for each graft during each cycle and stream that to the user interface 585 such that the user interface 585 may provide the visual feedback to the surgeon intraoperatively of the Max Force and the Min Force for each graft during each cycle.

[0104] The surgeon in executing each cycle is attempting to decrease the difference between the Max Force and the Min Force generated during each cycle. As the surgeon cycles through the range of motion in adjusting the tension level applied by the digital tensioner 510 to the graft, the digital tensioner computing device 520 may determine the Max Force and Min Force generated during each cycle and provide that visual feedback to the surgeon. In doing so, the surgeon may then adjust the tension level applied to the digital tensioner 50 to the graft during each subsequent cycle in an attempt to continue to decrease the difference between the Max Force and the Min Force generated during each cycle. For example in FIG. 6, the digital tensioner computing device 520 determines that the Max Force applied to the graft is 32N and the Min Force applied to the graft is 18N during the fourth cycle. The surgeon may then implement that visual feedback streamed by digital tensioner computing device 520 to the user interface 585 intraoperatively such that the surgeon may adjust the tension level applied to the graft by the digital tensioner 510 in the fifth cycle to further decrease the difference between the Max Force and the Min Force in the fifth cycle.

[0105] The surgeon may then continue to adjust the tension level applied to the graft by the digital tensioner 510 in each subsequent cycle based on the visual feedback displayed by user interface 585 until the decrease in the difference between the Max Force and Min Force is obtained. Further, the display of relation of the Force to flexion angle over the duration of time for each cycle may also provide a graphical relation of the fluctuation of the Max Force and the Min Force to the surgeon. The graphical relation of the fluctuation of the Max Force and Min Force should flatten out as the difference between the Max Force and the Min force decreases thereby also providing visual feedback of the graphical relation of the fluctuation of38115636-0001276888094vlthe Max Force and the Min Force during each cycle in which the tension level is applied to the graft by the digital tensioner 510. Thus, the digital tensioner computing device 510 generates additional layers of visual feedback to the surgeon when executing the tensioning procedure which may then be incorporated into the neural network 540 for further training to assist in the execution of future tensioning procedures.

[0106] Further as depicted by the example user interface configuration 600, the digital tensioning computing device 520 may also capture video and / or voice notes intraoperatively as the surgeon executes the tensioning procedure. In doing so, the digital tensioning computing device 520 may stream the video and / or voice notes to the user interface 585 such that the user interface 585 displays the video and / or voice notes to the surgeon as depicted by the example user interface 600. The surgeon may do a post operative report for consumption by the patient audience or the surgeon themselves. The surgeon may record voice notes with a voice command and / or there may be a command prompted by the digital tensioning computing device 520 to instruct the surgeon to commensurate the recording of voice notes in which the voice notes may be transcribed and added to the surgical procedure data stored and ultimately is provided in the post-operation reports by the digital tensioning computing device 520 reports.

[0107] In an embodiment, the digital tensioning computing device 510 may receive readings from the digital tensioner 510 with regard to the flexion angle values and the tension level values and that data may be streamed into the application by a Bluetooth connection. The flexion angle values and the tension level values may be stored and may be stored for the entire tensioning procedure. The flexion angle values and the tension level values may be captured with time stamped data points. For example, the four values that include the two tension level values, the two flexion angle values, and a time stamp for each stream of data into the digital tensioner control system 500. The flexion angle value and the tension level values may be presented at any point on time on any user interface of the digital tensioner control system 500.

[0108] In embodiment, the tension level values and the flexion angle values may be viewed on the digital tensioner 510 in a manner that the surgeon does not have to look at the digital tensioner 510 as during the procedure at certain times that may be difficult due to angles or whatever the surgeon is doing. In such an embodiment, the display of the tension level values and the flexion angle values may be more easily viewed via a heads-up display, such as remote39115636-0001276888094vluser interface 550. In another embodiment, the flexion angle values and the tension level values as viewed on the digital tensioner 510 may also be viewed via a mobile phone, a tablet, a PC, and / or any other device capable of displaying the streamed tensioning procedure data that will be apparent to those skilled in the relevant art(s) without departing from the spirit and scope of the disclosure.CONCLUSION

[0109] It is to be appreciated that the Detailed Description section, and not the Abstract section, is intended to be used to interpret the claims. The Abstract section may set forth one or more, but not all exemplary embodiments, of the present disclosure, and thus, is not intended to limit the present disclosure and the appended claims in any way.

[0110] The present disclosure has been described above with the aid of functional building blocks illustrating the implementation of specified functions and relationships thereof. The boundaries of these functional building blocks have been arbitrarily defined herein for the convenience of the description. Alternate boundaries may be defined so long as the specified functions and relationships thereof are appropriately performed.[OHl] It will be apparent to those skilled in the relevant art(s) the various changes in form and detail can be made without departing from the spirt and scope of the present disclosure. Thus the present disclosure should not be limited by any of the above-described exemplary embodiments, but should be defined only in accordance with the following claims and their equivalents.40115636-0001276888094vl

Claims

WHAT IS CLAIMED IS:

1. A digital tensioner control system to automatically determine a tension value applied by a digital tensioner to a graft of a patient during a tensioning procedure as a surgeon adjusts a tension level when performing the tensioning procedure, comprising: a plurality of strain gauge sensors positioned in a strain gauge configuration that is configured to a detect a resistance value generated during the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft, wherein the resistance value is adjusted as the surgeon adjusts the tension level; and a digital tensioner controller associated with the digital tensioner and comprising a processor and a memory having a plurality of instructions stored therein that, in response to execution by the processor causes the digital tensioner controller to: automatically convert the resistance value as detected by the plurality of strain gauge sensors generated during the tensioning procedure as the surgeon adjusts the tension level to a corresponding voltage value, wherein the voltage value is adjusted as the surgeon adjusts the tension level, automatically determine a load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon adjusts the tension value based on a calibration that associates the load value with the corresponding voltage value, wherein the load value is adjusted as the surgeon adjusts the tension level, and instruct a display to automatically display the load value as generated during the tensioning procedure as the surgeon adjusts the tension level applied to the graft when performing the tensioning procedure.41115636-0001276888094vl2. The digital tensioner control system of claim 1 , wherein the memory having the plurality of instructions that causes the digital tensioner controller to: automatically convert the resistance value as detected by the plurality of strain gauge sensors generated during the tensioner procedure as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner applied to the graft to the corresponding voltage level, wherein the voltage level is adjusted as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner; automatically determine the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner as the load value based on the calibration that associates the load value with the corresponding voltage value, wherein the load value is adjusted as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner; and instruct the display to automatically display the load value as generated during the tensioning procedure as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner.

3. The digital tensioner control system of claim 2, wherein the memory having the plurality of instructions that causes the digital tensioner controller to: automatically convert the resistance value as detected by the plurality of strain gauge sensors during the tensioner procedure as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner applied to the graft to the corresponding voltage level, wherein the voltage level is adjusted as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner; automatically determine the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner as the load value based on the calibration that associates the load value with the42115636-0001276888094vlcorresponding voltage value, wherein the load value is adjusted as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner; and instruct the display to automatically display the load value as generated during the tensioning procedure as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner.

4. The digital tensioner control system of claim 3, wherein the memory having the plurality of instructions causes the digital tensioner controller to: apply a plurality of loads to the strain gauge configuration to determine each load value of each corresponding load to the strain gauge configuration that generates each corresponding voltage value when each load is applied to the strain gauge configuration; determine when a linear relationship is generated between each load value of each corresponding load applied to the strain gauge configuration and each corresponding voltage value that is generated when each load is applied to the strain gauge configuration; calibrate the strain gauge configuration based on the linear relationship between each load value and each corresponding voltage value that is generated when each load is applied to strain gauge configuration; and generate the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon adjusts the tension value based on the calibration that associates the load value with the corresponding voltage value.

5. The digital tensioner control system of claim 4, wherein the memory having the plurality of instructions causes the digital tensioner controller to: apply a first load and a second load to the strain gauge configuration to determine a first load value and a second load value of the first load and the second load that generates a first voltage value and a second voltage value when the first load and the second load is applied to the strain gauge configuration;43115636-0001276888094vldetermine the linear relationship is generated between the first load value and the first voltage value and between the second load value and the second voltage value as applied to the strain gauge configuration; and execute a two-point calibration to calibrate the strain gauge configuration based on the linear relationship between the first load value and the first voltage value and between the second load value and the second voltage value as applied to the strain gauge configuration.

6. The digital tensioner control system of claim 4, wherein the memory having the plurality of instructions causes the digital tensioner controller to: instruct the display to automatically display the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner based on the calibration that associates the load value with the corresponding voltage value, wherein the load value that is automatically displayed is adjusted as the surgeon stretches the strain gauge configuration; and instruct the display to automatically display the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner based on the calibration that associates the load value with the corresponding voltage value, wherein the load value that is automatically displayed is adjusted as the surgeon compresses the strain gauge configuration.

7. The digital tensioner control system of claim 5, further comprising: an accelerometer that is configured to measure an acceleration of the graft during the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft, wherein the acceleration of the graft is adjusted as an angle of the graft is adjusted as the surgeon adjusts the tension level; and a gyrometer that is configured to measure a rotational of the graft during the tensioning procedure as the surgeon adjusts the tension level of the digital44115636-0001276888094vltensioner applied to the graft, wherein the rotation of the graft is adjusted as the angle of the graft is adjusted as the surgeon adjusts the tension level.

8. The digital tensioner control system of claim 7, wherein the memory having the plurality of instructions causes the digital tensioner controller to: automatically determine the angle of the graft during the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft based on the measurement of the rotation of the graft and the acceleration of the graft thereby generating a rotation of an angle of the graft relative to a duration of time that the graft is rotated; and instruct a display to automatically display the angle of the graft as generated during the tensioning procedure as the surgeon adjusts the tension level applied to the graft when performing the tensioning procedure.

9. The digital tensioner control system of claim 8, wherein the memory having the plurality of instructions causes the digital tensioner controller to: instruct the display to automatically display the load value and the angle of the graft as generated as the surgeon cycles the graft during the tensioning procedure as the surgeon stretches the strain gauge configuration when adjusting the tension level thereby enabling the surgeon to determine the load value of the graft relative to the angle of the graft as the surgeon cycles the graft when stretching the strain gauge configuration; and instruct the display to automatically display the load value and the angle of the graft as generated as the surgeon cycles the graft during the tensioning procedure as the surgeon compresses the strain gauge configuration when adjusting the tension level thereby enabling the surgeon to determine the load value of the graft relative to the angle of the graft as the surgeon cycles the graft when compressing the strain gauge configuration.45115636-0001276888094vl10. The digital tensioner control system of claim 9, wherein the memory having the plurality of instructions causes the digital tensioner controller to: instruct a remote display to automatically display the load value and the angle of the graft as generated during the tensioning procedure as the surgeon adjusts the tension level applied to the graft when performing the tensioning procedure.

11. A method for automatically determining a tension value applied by a digital tensioner to a graft of a patient during a tensioning procedure as a surgeon adjusts a tension level when performing the tensioning procedure, comprising: detecting a resistance value generated during the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft, wherein the resistance value is adjusted as the surgeon adjusts the tension level; automatically converting the resistance value as detected by a plurality of strain gauge sensors generated during the tensioning procedure as the surgeon adjusts the tension level to a corresponding voltage value, wherein the voltage value is adjusted as the surgeon adjusts the tension level; automatically determining a load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon adjusts the tension value based on a calibration that associates the load value with the corresponding voltage value, wherein the load value is adjusted as the surgeon adjusts the tension level; and instructing a display to automatically display the load value as generated during the tensioning procedure as the surgeon adjusts the tension level applied to the graft when performing the tensioning procedure.

12. The method of claim 11, further comprising: automatically converting the resistance value as detected by the plurality of strain gauge sensors generated during the tensioner procedure as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner applied to the graft to the corresponding voltage level, wherein46115636-0001276888094vlthe voltage level is adjusted as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner; automatically determining the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner as the load value based on the calibration that associates the load value with the corresponding voltage value, wherein the load value is adjusted as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner; and instructing the display to automatically display the load value as generated during the tensioning procedure as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner.

13. The method of claim 12, further comprising: automatically converting the resistance value as detected by the plurality of strain gauge sensors during the tensioner procedure as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner applied to the graft to the corresponding voltage level, wherein the voltage level is adjusted as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner; automatically determining the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner as the load value based on the calibration that associates the load value with the corresponding voltage value, wherein the load value is adjusted as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner; and instructing the display to automatically display the load value as generated during the tensioning procedure as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner.47115636-0001276888094vl14. The method of claim 13, further comprising: applying a plurality of loads to the strain gauge configuration to determine each load value of each corresponding load to the strain gauge configuration that generates each corresponding voltage value when each load is applied to the strain gauge configuration; determining when a linear relationship is generated between each load value of each corresponding load applied to the strain gauge configuration and each corresponding voltage value that is generated when each load is applied to the strain gauge configuration; calibrating the strain gauge configuration based on the linear relationship between each load value and each corresponding voltage value that is generated when each load is applied to the strain gauge configuration; and generating the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon adjusts the tension value based on the calibration that associates the load value with the corresponding voltage value.

15. The method of claim 14, further comprising: applying a first load and a second load to the strain gauge configuration to determine a first load value and a second load value of the first load and the second load that generates a first voltage value and a second voltage value when the first land the second load is applied to the strain gauge configuration; determining the linear relationship that is generated between the first load value and the second voltage value and between the second load value and the second voltage value as applied to the strain gauge configuration; and executing a two-point calibration to calibrate the strain gauge configuration based on the linear relationship between the first load value and the first voltage value and between the second load value and the second voltage value as applied to the strain gauge configuration.48115636-0001276888094vl16. The method of claim 14, further comprising: instructing the display to automatically display the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon stretches the strain gauge configuration when adjusting the tension level of the digital tensioner based on the calibration that associates the load value with the corresponding voltage value, wherein the load value that is automatically displayed is adjusted as the surgeon stretches the strain gauge configuration; and instructing the display to automatically display the load value that corresponds to the voltage value as generated during the tensioning procedure as the surgeon compresses the strain gauge configuration when adjusting the tension level of the digital tensioner based on the calibration that associates the load value with the corresponding voltage value, wherein the load value that is automatically displayed is adjusted as the surgeon compresses the strain gauge configuration.

17. The method of claim 15, further comprising: measuring an acceleration of the graft during the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft, wherein the acceleration of the graft is adjusted as an angle of the graft is adjusted as the surgeon adjusts the tension level; and measuring a rotation of the graft during the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft, wherein the rotation of the graft is adjusted as the angle of the graft is adjusted as the surgeon adjusts the tension level.

18. The method of claim 17, further comprising: automatically determining the angle of the graft during the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft based on the measurement of the rotation of the graft and the acceleration49115636-0001276888094vlof the graft thereby generating a rotation of an angle of the graft relative to a duration of time that the graft is rotated; and instructing a display to automatically display the angle of the graft as generated during the tensioning procedure as the surgeon adjusts the tension level applied to the graft when performing the tensioning procedure.

19. The method of claim 18, further comprising: instructing the display to automatically display the load value and the angle of the graft as generated as the surgeon cycles the graft during the tensioning procedure as the surgeon stretches the strain gauge configuration when adjusting the tension level thereby enabling the surgeon to determine the load value of the graft relative to the angle of the graft as the surgeon cycles the graft when stretching the strain gauge configuration; and instructing the display to automatically display the load value and the angle of the graft as generated as the surgeon cycles the graft during the tensioning procedure as the surgeon compresses the strain gauge configuration when adjusting the tension level thereby enabling the surgeon to determine the load value of the graft relative to the angle of the graft as the surgeon cycles the graft when compressing the strain gauge configuration.

20. The method of claim 19, further comprising: instructing a remote display to automatically display the load value and the angle of the graft as generated during the tensioning procedure as the surgeon adjusts the tension level applied to the graft when performing the tensioning procedure.

21. A digital tensioner control system to automatically determine a tension value applied by a digital tensioner to a graft of a patient during a tensioning procedure as a surgeon adjusts a tension level when performing the tensioning procedure, comprising: at least one processor;50115636-0001276888094vla memory coupled with the at least one processor, the memory including instructions that when executed by the at least one processor cause the at least one processor to: extract a plurality of tensioning parameters associated with a tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft in intraoperatively, wherein the tensioning parameters associated with the tensioning procedure fluctuate intraoperatively as the surgeon adjusts the tension level of the digital tensioner applied to the graft, automatically stream the tensioning parameters associated with a tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft intraoperatively to a display to display the tensioning parameters as the tensioning parameters fluctuate as the surgeon adjusts the tension level of the digital tensioner in real-time, and stream the tensioning parameters associated with the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft intraoperatively to a tensioning parameter database thereby enabling the tensioning parameters to accumulate in the tensioning parameter database as the tensioning parameters fluctuate as the surgeon adjusts the tension level of the digital tensioner in real-time.

22. The digital tensioner control system of claim 21, wherein the processor is further configured to: extract a tension value and flexion angle value as the surgeon adjusts the tension level of the digital tensioner applied to a graft positioned on a joint for a duration of the tensioning procedure, wherein the tension value and the flexion angle value fluctuate intraoperatively as the surgeon adjusts the tension level of the digital tensioner applied to the graft for the duration of the tensioning procedure; automatically stream the tension value and the flexion angle value as the surgeon adjusts the digital tensioner applied to the graft positioned on the joint for the duration of the tensioning procedure to the display to display the tension value and the flexion angle value as the tension value and the flexion angle value fluctuate51115636-0001276888094vlfor the duration of the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner in real-time; and stream the tension value and the flexion angle value as the surgeon adjusts the tension level of the digital tensioner applied to the graft positioned on the joint to the tensioning parameter database thereby enabling the tension value and the flexion angle value to accumulate in the tensioning parameter database as the tension value and the flexion angle value fluctuate for the duration of the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner in realtime.

23. The digital tensioner control system of claim 22, wherein the processor is further configured to: stream the tension value and the flexion angle value to a remote display as the surgeon adjusts the tension level of the digital tensioner applied to the graft positioned on the joint, wherein the remote display is positioned remote from the digital tensioner thereby enabling the display of the tension value and the flexion angle value as the tension value and the flexion angle value fluctuate for the duration of the tensioning procedure without obstruction.

24. The digital tensioner control system of claim 23, wherein the processor is further configured to: stream the tension value and the flexion angle value to the remote display as the surgeon adjusts the tension level of the digital tensioner applied to the graft and moves the joint through a range of motion as the tension value and the flexion angle value fluctuate for the duration of the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner in real-time; and instruct the remote display to graphically display the tension value and the flexion angle value over time for the duration of the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft and moves the joint through the range of motion, wherein the graphically display of the tension level value and the flexion angle value depicts how the tension value and52115636-0001276888094vlthe flexion angle value fluctuate intraoperatively for the duration of the tensioning procedure.

25. The digital tensioner control system of claim 24, wherein the processor is further configured to: stream a plurality of tension values and a plurality of flexion angle values generated from a plurality of digital tensioners as the surgeon adjusts each tension value of each digital tensioner applied to each graft by each corresponding digital tensioner and moves the joint through the range of motion as each tension value and each flexion angle value fluctuate during the duration of the tensioning procedure as the surgeon adjusts the tensioning level of each corresponding digital tensioner in real-time; and instruct the remote display to graphically display each tension level value and each flexion angle value simultaneously over time for the duration of the tensioning procedure as the surgeon adjusts each tension level of each digital tensioner applied to each graft by each corresponding digital tensioner and moves the joint through the range of motion, wherein the graphically display of each tension level value and each flexion angle value simultaneously depicts how each tension value and each flexion angle value fluctuate relative to each other tension value and each other flexion angle value for the duration of the tensioning procedure.

26. The digital tensioner control system of claim 25, wherein the processor is further configured to: extract a plurality of pre-operative variable parameters associated with the tensioning procedure, wherein the pre-operative variable parameters associated with the tensioning procedure are pre-defined by the surgeon pre-operatively to the tensioning procedure; and stream the pre-operative variable parameters associated with the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft intraoperatively to accumulate the pre-operative variable parameters in the53115636-0001276888094vltensioning parameter database as the surgeon adjusts the tension level of the digital tensioner in real-time.

27. The digital tensioner control system of claim 26, wherein the processor is further configured to: extract a plurality of patient parameters associated with the tensioning procedure, wherein the patient parameters associated with the tensioning procedure are associated with the patient pre-operatively to the tensioning procedure; and stream the patient parameters associated with the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft intraoperatively to accumulate the patient parameters in the tensioning parameter database as the surgeon adjusts the tension level of the digital tensioner in real-time.

28. The digital tensioner control system of claim 27, wherein the processor is further configured to: automatically receive updated tensioning parameters, updated pre-operative variable parameters, and updated patient parameters that includes updated streamed tensioning data associated with each past tensioning procedure as trained on a neural network based on machine learning as the neural network continuously updates the updated tensioning parameters, the updated pre-operative variable parameters, and the updated patent parameters with updated tensioning data as captured from past tensioning procedures; analyze the updated tensioning parameters, the updated pre-operative variable parameters, and the updated patient parameters as provided by the neural network to determine a plurality of current tensioning parameters, the plurality of current pre-operative variable parameters, and plurality of current patient parameters associated with a current tensioning procedure, wherein the current tensioning parameters, the current pre-operative variable parameters, and the current patient parameters are indicative to an execution of the current tensioning procedure on a current patient; and54115636-0001276888094vlautomatically generate a notification of the current tensioning parameters, the current pre-operative variable parameters, and the current patient parameters as provided by the neural network for the execution of the current tensioning procedure.

29. The digital tensioner control system of claim 28, wherein the processor is further configured to: analyze the tensioning parameters, the pre-operative variable parameters, and the patient parameters post-operatively to generate feedback relative to a completion of the tensioning procedure, wherein the feedback is indicative to an outcome of the completed tensioning procedure for the patient; and automatically stream the tensioning parameters, the pre-operative variable parameters and the patient parameters based on the feedback generated post- operatively relative to the completion of the tensioning procedure to the tensioning parameter database to train the neural network based on machine learning on the streamed tensioning parameters, the pre-operative variable parameters, and the patient parameters based on the feedback generated post-operatively.

30. The digital tensioner control system of claim 9, wherein the memory having the plurality of instructions causes the digital tensioner controller to: generate a post-operative report relative to the completion of the tensioning procedure that includes the tensioning parameters, the pre-operative variable parameters and the patient parameters generated in real-time during the duration of the tensioning procedure to provide feedback to the surgeon.

31. A method for automatically determining a tension value applied by a digital tensioner to a graft of a patient during a tensioning procedure as a surgeon adjusts a tension level when performing the tensioning procedure, comprising: extracting a plurality of tensioning parameters associated with a tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft intraoperatively, wherein the tensioning parameters associated with the55115636-0001276888094vltensioning procedure fluctuate intraoperatively as the surgeon adjusts the tension level of the digital tensioner applied to the graft; automatically streaming the tensioning parameters associated with a tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft intraoperatively to a display to display the tensioning parameters as the tensioning parameters fluctuate as the surgeon adjusts the tension level of the digital tensioner in real-time; and streaming the tensioning parameters associated with the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft intraoperatively to a tensioning parameter database thereby enabling the tensioning parameters to accumulate in the tensioning parameter database as the tensioning parameters fluctuate as the surgeon adjusts the tension level of the digital tensioner in real-time.

32. The method of claim 31, further comprising: extracting a tension value and flexion angle value as the surgeon adjusts the tension level of the digital tensioner applied to the graft positioned on a joint for a duration of the tensioning procedure, wherein the tension value and the flexion angle value fluctuate intraoperatively as the surgeon adjusts the tension level of the digital tensioner applied to the graft for the duration of the tensioning procedure; automatically streaming the tension value and the fluctuation angle value as the surgeon adjusts the digital tensioner applied to the graft positioned on the joint for the duration of the tensioning procedure to the display to display the tension value and the flexion angle value as the tension value and the flexion angle value fluctuate for the duration of the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner in real-time; and streaming the tension value and the flexion angle value as the surgeon adjusts the tension level of the digital tensioner applied to the graft positioned on the joint to the tensioning parameter database thereby enabling the tension value and the flexion angle value to accumulate in the tensioning parameter database as the tension value and the flexion angle value fluctuate for the duration of the56115636-0001276888094vltensioning procedure as the surgeon adjusts the tension level of the digital tensioner in real-time.

33. The method of claim 32, further comprising: streaming the tension value and the flexion angle value to a remote display as the surgeon adjusts the tension level of the digital tensioner applied to the graft positioned on the joint, wherein the remote display is positioned remote from the digital tensioner display thereby enabling the display of the tension value and the flexion angel value as the tension value and the flexion angle value fluctuate for the duration of the tensioning procedure without obstruction.

34. The method of claim 33, further comprising: streaming the tension value and the flexion angle value to the remote display as the surgeon adjusts the tension level of the digital tensioner applied to the graft and moves the joint through a range of motion as the tension value and the flexion angle value fluctuate for the duration of the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner in real-time; and instructing the remote display to graphically display the tension value and the flexion angle value over time for the duration of the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft and moves the joint through the range of motion, wherein the graphically display of the tension value and the flexion angle value depicts how the tension value and the flexion angle value fluctuate intraoperatively for the duration of the tensioning procedure.

35. The method of claim 34, further comprising: streaming a plurality of tension values and a plurality of flexion angles generated from a plurality of digital tensioners as the surgeon adjusts each tension value of each digital tension applied to each graft by each corresponding digital tensioner and moves the joint through the range of motion as each tension value and each flexion angle value fluctuate during the duration of the tensioning57115636-0001276888094vlprocedure as the surgeon adjusts the tensioning level of each corresponding digital tensioner in real-time; and instructing the remote display to graphically display each tension level value and each flexion angle value simultaneously over time for the duration of the tensioning procedure as the surgeon adjusts each tension level of each digital tension applied to each graft by each corresponding digital tensioner and moves the joint through the range of motion, wherein the graphically display of each tension level value and each flexion angle value simultaneously depicts how each tension value and each flexion angle value fluctuate relative to each other tension value and each other flexion angle value for the duration of the tensioning procedure.

36. The method of claim 35, further comprising: extracting a plurality of pre-operative variable parameters associated with the tensioning procedure, wherein the pre-operative variable parameters associated with the tensioning procedure are pre-defined by the surgeon pre-operatively to the tensioning procedure; and streaming the pre-operative variable parameters associated with the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft intraoperatively to accumulate the pre-operative variable parameters in the tensioning parameter database as the surgeon adjusts the tension level of the digital tensioner in real-time.

37. The method of claim 36, further comprising: extracting a plurality of patient parameters associated with the tensioning procedure, wherein the patient parameters associated with the tensioning procedure are associated with the patent pre-operatively to the tensioning procedure; and streaming the patient parameters associated with the tensioning procedure as the surgeon adjusts the tension level of the digital tensioner applied to the graft58115636-0001276888094vlintraoperatively to accumulate the patent parameters in the tensioning parameter database as the surgeon adjusts the tension level of the digital tensioner in real-time.

38. The method of claim 37, further comprising: automatically receiving updated tensioning parameters, updated preoperative variable parameters, and updated patient parameters that includes updated streamed tensioning data associated with each past tensioning procedure as trained on a neural network based on machine learning as the neural network continuously updates the updated tensioning parameters, the updated pre-operative variable parameters, and the updated patent parameters with updated tensioning data as captured from past tensioning procedures; analyzing the updated tensioning parameters, the updated pre-operative variable parameters, and the updated patient parameters as provided by the neural network to determine a plurality of current tensioning parameters, the plurality of current pre-operative variable parameters, and the plurality of current patient parameters associated with a current tensioning procedure, wherein the current tensioning parameters, the current pre-operative variable parameters, and the current patient parameters are indicative to an execution of the current tensioning procedure on a current patient; and automatically generating a notification of the current tensioning parameters, the current pre-operative variable parameters, and the current patient parameters as provided by the neural network for the execution of the current tensioning procedure.

39. The method of claim 38, further comprising: analyzing the tensioning parameters, the pre-operative variable parameters, and the patient parameters post-operatively to generate feedback relative to a completion of the tensioning procedure, wherein the feedback is indicative to an outcome of the completed tensioning procedure for the patient; and automatically streaming the tensioning parameters, the pre-operative variable parameters, and the patient parameters based on the feedback generated59115636-0001276888094vlpost-operatively relative to the completion of the tensioning procedure to the tensioning parameter database to train the neural network based on machine learning on the streamed tensioning parameters, the pre-operative variable parameters, and the patient parameters based on the feedback generated post- operatively.

40. The method of claim 39, further comprising: generating a post-operative report relative to the completion of the tensioning procedure that includes the tensioning parameters, the pre-operative variable parameters, and the patient parameters generated in real-time during the duration of the tensioning procedure to provide feedback to the surgeon.60115636-0001276888094vl

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