Surgical instrument for meniscectomy and method of using the same

Claim 2

A surgical instrument comprising: a flexible cutting blade having a cutting edge, means for advancing the cutting blade with said cutting edge constituting the leading edge of the moving blade to perform a surgical cutting action, and guide means, having separate spaced projecting portions respectively insertable in at least two spaced openings of the knee that extend along the periphery of the posterior meniscus, for guiding said flexible cutting blade along a path substantially at the periphery of the posterior portion of the meniscus.

Claim 3

A surgical instrument as defined in claim 1 in which the last-named means comprises curved grooved guide means for guiding said flexible cutting blade in a path within the posterior meniscus at the periphery of the base portion of the meniscus that is adjacent to the synovia and coronary ligaments.

Claim 4

A surgical instrument as defined in claim 2 in which said curved grooved guide means comprises: two separate grooved guides separately insertable after surgical detachment of the anterior portion of the meniscus one of which guides is insertable intra-articularly above the posterior portion of the meniscus to be detached and the other of which guides is insertable intra-articularly below the posterior portion of the meniscus to be detached, and means for securing said two guides together in fixed relation to each other after they have been inserted into the posterior compartment of the knee joint.

Claim 7

A surgical instrument for detaching a greater part of the posterior portion of the meniscus from its support comprising: a flexible elongated cutting blade having a cutting edge at one end and having two longitudingal side edges, first blade guiding means for insertion below the meniscus and between the tibia and coronary ligaments that attach to the base of the meniscus comprising a curved grooved guide and an elongated handle therefor, said handle and said blade guide being in substantialy the same plane, second blade guiding means for insertion intra-articularly into the synovial pocket above the meniscus, and between the femur and the adjacent synovia comprising a curved grooved blade guide and an elongated handle therefor, said handle and said grooved blade guide being in substantially the same plane, said first and second blade guiding means being separate from each other to permit them to be separately inserted into the knee, said curved grooved blade guides each having substantially the same size and curvature, and when held in complementary positions, said guides defining complementary grooves, that receive said two side edges respectively, for guiding a flexible cutting blade along a predefined path adjacent the periphery of the posterior portion of the meniscal base, a frame having an elongated portion for supporting both of said handles, means for securing said handles to said elongated portion of said frame for insuring that said curved grooved guides assume the aforesaid complementary positions so that their respective grooves will guide a flexible cutting blade, said frame having a change in direction adjacent the base of said grooved guides when they are mounted on the frame, to provide an extended portion of the frame which extends in a direction away from and generally aligned with those ends of said grooves which are closest to the handles, and driving means mounted on said extended portion of the frame for driving said blade with said cutting edge at the forward end of the moving blade and said side edges moving along said grooves respectively so that said blade will follow the curvature of said grooved guides and detach a meniscus accordingly.

Claim 8

A surgical instrument for detaching a greater part of the posterior portion of the meniscus from its support comprising: a flexible elongated cutting blade having a cutting edge at one end and having two longitudingal side edges, first blade guiding means for insertion below the meniscus and between the tibia and coronary ligaments that attach to the base of the meniscus comprising a curved grooved guide and an elongated handle therefor, said handle and said blade guide being in substantialy the same plane, second blade guiding means for insertion intra-articularly into the synovial pocket above the meniscus, and between the femur and the adjacent synovia comprising a curved grooved blade guide and an elongated handle therefor, said handle and said grooved blade guide being in substantially the same plane, said first and second blade guiding means being separate from each other to permit them to be separately inserted into the knee, said curved grooved blade guides each having substantially the same size and curvature, and when held in complementary positions, said guides defining complementary grooves, that receive said two side edges respectively, for guiding a flexible cutting blade along a predefined path adjacent the periphery of the posterior portion of the meniscal base, a frame having an elongated portion for supporting both of said handles, means for securing said handles to said elongated portion of said frame for insuring that said curved grooved guides assume the aforesaid complementary positions so that their respective grooves will guide a flexible cutting blade, said frame having a change in direction adjacent the base of said grooved guides when they are mounted on the frame, to provide an extended portion of the frame which extends in a direction away from and generally aligned with those ends of said grooves which are closest to the handles, and driving means mounted on said extended portion of the frame for driving said blade with said cutting edge at the forward end of the moving blade and said side edges moving along said grooves respectively so that said blade will follow the curvature of said grooved guides and detach a meniscus accordingly.

Claim 9

A surgical instrument as defined in claim 5 in which said change of direction is sufficiently small that the extended portion of the frame and said driving means does not substantially interfere with the ability of the surgeon to observe the operation as it proceeds and so that room is allowed for traction on the initially detached anterior meniscus.

Claim 10

A surgical instrument as defined in claim 6 in which the grooved blade guides have the curvature of that peripheral portion of a meniscus which is designated A in FIG. 8 of the drawing.

Claim 11

A surgical instrument as defined in claim 6 in which the grooved blade guides have the shape of that posterior portion of the periphery of a meniscus in which the surgical cutting action is desired.

Claim 12

A surgical instrument as defined in claim 5 in which said change of direction is an angle on the order of 100°-115°.

Claim 13

A surgical instrument as defined in claim 9 in which the grooved blade guides have the curvature of that portion of a meniscus which is designated A in FIG. 8 of the drawing.

Claim 14

A surgical instrument as defined in claim 9 in which the grooved blade guides have the shape of that posterior portion of the periphery of a meniscus along which a surgical cutting action is desired.

Claim 15

A surgical instrument as defined in claim 5 in which the grooved blade guides have the curvature of that peripheral portion of a meniscus which is designated A in FIG. 8 of the drawing.

Claim 16

A surgical instrument as defined in claim 5 in which the blade guides have the shape of that posterior portion of the periphery of a meniscus in which a surgical cutting action is desired.

Claim 17

A surgical instrument as defined in claim 5, in which the angle between each said guide and its complementary handle is such that the guide may be inserted in a space adjacent the meniscus to position the guide along the periphery of a portion of the meniscus.

Claim 18

A surgical instrument for detaching a portion of the meniscus from its support comprising: first and second curved blade guides each having substantially the same curvature as the other, first and second separate elongated handles for said first and second curved blade guides, respectively, each of said guides extending from one end of its elongated handle, being in substantially the same plane as said elongated handle, and including means for guiding a flexible blade along a curved path, a frame, a thin flexible cutting blade, means for attaching said handles to each other, means for attaching said handles to said frame to position the guides to receive said blade and guide it along said curved path, and means carried by said frame for driving said flexible blade in said curved blade guides so that said blade follows a path conforming to the curvature of said blade guides.

Claim 19

A surgical instrument for detaching a portion of the meniscus from its support comprising: first and second curved blade guides each having substantially the same curvature as the other, first and second separate elongated handles for said first and second curved blade guides, respectively, each of said guides extending from one end of its elongated handle, being in substantially the same plane as said elongated handle, and including means for guiding a flexible blade along a curved path, a frame, a thin flexible cutting blade, means for attaching said handles to each other, means for attaching said handles to said frame to position the guides to receive said blade and guide it along said curved path, and means carried by said frame for driving said flexible blade in said curved blade guides so that said blade follows a path conforming to the curvature of said blade guides.

Claim 20

A surgical instrument for detaching a portion of the meniscus from its support as defined in claim 15 in which said curvature substantially conforms to the outer periphery of the posterior portion of a meniscus.

Claim 21

A surgical instrument for detaching a portion of the meniscus from its support as defined in claim 15 in which said curvature substantially conforms to the outer periphery of that posterior portion of a meniscus that is adjacent to the synovia and coronary ligaments.

Claim 22

A surgical instrument for detaching a portion of the meniscus from its support as defined in claim 15 in which said curvature substantially conforms to the outer periphery of that portion of a meniscus which is designated by the letter "A" in FIG. 8 of the drawings.

Claim 23

A surgical instrument comprising: cutting means; guide means for guiding said cutting means along a path substantially near the periphery of the posterior portion of a meniscus, said guide means comprising a guide element having a curvature conforming to the curvature of the periphery of the posterior portion of a meniscus and insertable in a space in a knee that is adjacent said posterior portion of a meniscus with the curvature of said element conforming to the curvature of the periphery of said posterior portion of the meniscus, and driving means for advancing said cutting means along said guide means to detach the posterior meniscus.

Claim 24

A surgical instrument comprising: cutting means; guide means for guiding said cutting means along a path substantially near the periphery of the posterior portion of a meniscus, said guide means comprising a guide element having a curvature conforming to the curvature of the periphery of the posterior portion of a meniscus and insertable in a space in a knee that is adjacent said posterior portion of a meniscus with the curvature of said element conforming to the curvature of the periphery of said posterior portion of the meniscus, and driving means for advancing said cutting means along said guide means to detach the posterior meniscus.

Claim 25

A surgical instrument as defined in claim 19 in which said guide means comprises two separate guides, each of said guides having a guiding portion of a shape substantially conforming to the periphery of the posterior portion of a meniscus, one of said guides being adapted to be inserted intra-articularly above the meniscus to a position where it extends along a path substantially conforming to the periphery of the posterior portion of a meniscus, the other of said guides being adapted to be inserted intra-articularly below the meniscus to a position where it extends along a path substantially conforming to the periphery of the posterior portion of a meniscus.

Claim 26

A surgical instrument comprising: cutting means, guide means for guiding said cutting means along a path substantially near the periphery of the posterior portion of a meniscus, in which said guide means comprises two separate guides, each of said guides having a guiding portion of a shape substantially conforming to the periphery of the posterior portion of a meniscus, one of said guides being adapted to be inserted intra-articularly above the meniscus to a position where it extends along a path substantially conforming to the periphery of the posterior portion of a meniscus, the other of said guides being adapted to be inserted intra-articularly below the meniscus to a position where it extends along a path substantially conforming to the periphery of the posterior portion of a meniscus, each said guide having a handle separate from the handle of the other guide, and driving means for advancing said cutting means along said guide means to detach the posterior meniscus.

Claim 27

A surgical instrument comprising: cutting means, guide means for guiding said cutting means along a path substantially near the periphery of the posterior portion of a meniscus, in which said guide means comprises two separate guides, each of said guides having a guiding portion of a shape substantially conforming to the periphery of the posterior portion of a meniscus, one of said guides being adapted to be inserted intra-articularly above the meniscus to a position where it extends along a path substantially conforming to the periphery of the posterior portion of a meniscus, the other of said guides being adapted to be inserted intra-articularly below the meniscus to a position where it extends along a path substantially conforming to the periphery of the posterior portion of a meniscus, each said guide having a handle separate from the handle of the other guide, and driving means for advancing said cutting means along said guide means to detach the posterior meniscus.

Claim 28

A surgical instrument as defined in claim 21 including a frame, means for rigidly attaching said handles to said frame after the guides have been inserted into the knee of a patient with one such guide above and one below the meniscus to be detached thereby securing said handles and guides in a fixed relation to each other, said frame carrying said driving means.

Claim 29

A surgical instrument as defined in claim 22 in which said frame is a bar having two portions that have an angle of about 100° between them, said driving means being carried by one of said portions, and said handles being carried by and being detachably secured to the other of said portions.

Claim 30

A surgical instrument as defined in claim 23 in which said cutting means comprises a flexible blade having a cutting edge at one end, and said guides having complementary grooves for guiding the flexible blade when said handles are secured to said frame.

Claim 31

A surgical instrument as defined in claim 22 in which said frame is a bar having two portions, said two portions being integral and having an angle between them that permits use of the instrument to perform a meniscectomy without either of the portions obscuring the surgeon's view of the operation, said driving means being carried by one of said portions, and said handles being carried by and being detachably secured to other of said portions.

Claim 36

The method as defined in claim 27 in which the following steps are carried out after the menicus is detached: retract the cutting blade about five-eighths inch, flex the knee until the angle between the thigh and leg is about 100°, advance the guides further into the joint so that their forward tips generally face the posterior meniscal insertion, again gently advance the cutting blade until resistance is encountered, retract the cutting blade completely from the guides, detach the guide handles from said second portion, and remove the two guides from the knee.

Claim 39

The method as defined in claim 29 in which the following step is performed after the meniscus is detached and before the handles are detached from the frame: retract the cutting means, place the limbs that join at the knee at an angle of about 100°, reposition the guides so that their tips face the posterior meniscal insertion, and gently advance the cutting means until resistance is encountered.

Claim 40

A surgical instrument comprising an elongated frame that has a first portion that extends for a substantial distance and a second portion at an angle to the first portion, one end of said first portion being connected to one end of said second portion, the other end of said first portion being a free end, an elongated cutting blade having a cutting edge at one end, means supporting said blade on said first portion and mounting said blade for movement along a path parallel to said first portion with the cutting edge of the blade on the end thereof farthest from the free end of said first position, first and second curved separate guides each having an elongated handle, said guides defining complementary grooves for receiving the side edges of said blade and guiding the blade as it is moved into the guides, and mounting means for detachably mounting said elongated handles to said second portion and in parallel relation thereto to position open ends of said grooves in a position to receive the cutting blade as the cutting edge moves in a direction away from the free end of said first portion.

Claim 41

A surgical instrument comprising an elongated frame that has a first portion that extends for a substantial distance and a second portion at an angle to the first portion, one end of said first portion being connected to one end of said second portion, the other end of said first portion being a free end, an elongated cutting blade having a cutting edge at one end, means supporting said blade on said first portion and mounting said blade for movement along a path parallel to said first portion with the cutting edge of the blade on the end thereof farthest from the free end of said first position, first and second curved separate guides each having an elongated handle, said guides defining complementary grooves for receiving the side edges of said blade and guiding the blade as it is moved into the guides, and mounting means for detachably mounting said elongated handles to said second portion and in parallel relation thereto to position open ends of said grooves in a position to receive the cutting blade as the cutting edge moves in a direction away from the free end of said first portion.

Claim 42

A surgical instrument as defined in claim 31 in which said curved guides have a curvature conforming to the posterior portion of a meniscus to be detached.

Claim 43

A surgical instrument as defined in claim 31 in which one of said handles includes threaded means operable to clamp said handles together.

Claim 44

A surgical instrument as defined in claim 31 in which said mounting means includes means for clamping one of said handles to said second portion.

Claim 45

A surgical instrument as defined in claim 31 in which said curved guides have a configuration conforming to the posterior portion of a meniscus to be detached, one of said handles including threaded means operable to clamp said handles together, said mounting means comprising means for clamping one of said handles to said second portion, and said angle being about 100°.

Claim 46

A surgical instrument as defined in claim 31 in which said angle is in the order of 100 to 115°.

Claim 47

A surgical instrument comprising: a flexible cutting blade having a cutting edge, means for advancing the cutting blade to perform a surgical cutting action, and guide means for guiding said flexible cutting blade along a path substantially at the periphery of the posterior portion of a meniscus, in which said guide means comprise: first and second guides each having a handle, each said guide and its handle having the shape relative to each other that is shown in conjunction with the guide and handle of FIG. 7.

Claim 48

A surgical instrument comprising: a flexible cutting blade having a cutting edge, means for advancing the cutting blade to perform a surgical cutting action, and guide means for guiding said flexible cutting blade along a path substantially at the periphery of the posterior portion of a meniscus, in which said guide means comprise: first and second guides each having a handle, each said guide and its handle having the shape relative to each other that is shown in conjunction with the guide and handle of FIG. 7.