JP2024514290A - ligament retractor - Google Patents

Abstract

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

Description

TECHNICAL FIELD This disclosure relates to surgical instruments, systems, and methods. More specifically, the present disclosure relates to improved surgical instruments, systems, and methods for retracting ligaments to facilitate surgical procedures such as knee arthroplasty.

Arthroplasty is a surgical procedure in which one or more articular surfaces of a joint are replaced with an artificial articular surface. Such plasty procedures are becoming increasingly popular, especially for the knee joint. Knee arthroplasty may include implanting a tibial prosthesis to replace the articular surface of the tibia. This may or may not be performed with replacement of the femoral and/or patellar articular surfaces.

For a successful knee arthroplasty, it is important to protect certain ligaments of the knee joint from accidental damage during the bone removal surgery performed during the knee arthroplasty procedure. For example, performing a tibial plateau resection surgery may inadvertently injure the medial collateral ligament, especially if the surgeon blindly approaches the medial collateral ligament from the lateral side with a saw blade during the tibial plateau resection surgery. There may be an increased risk of injury or amputation.

Therefore, surgical instruments, systems, and methods that can reduce or eliminate the risk of accidentally injuring or severing ligaments during surgical procedures would be desirable.

SUMMARY The various surgical instruments, systems, and methods of the present disclosure are not yet fully resolved by, in particular, currently available surgical instruments, systems, and methods according to the current state of the art. Developed in response to problems and needs in the field. The surgical instruments, systems, and methods of the present disclosure may provide a reduced risk of accidentally damaging or severing ligaments during osteotomy surgery.

According to some embodiments, a retractor assembly may include a retractor and a retractor handle. The retractor may include a retractor shaft, a handle connection structure, and a retractor member. A retractor member may be disposed at a distal end of the retractor shaft, with a proximal end coupled to the distal end of the retractor shaft and a distal end projecting laterally away from the first longitudinal axis. an end, an upper surface, a lower surface, a retractor surface extending intermediate the upper surface and the lower surface and including a convex curve, and a cutting shield surface disposed opposite the retractor surface extending intermediate the upper surface and the lower surface. , and may include an arcuate projection having . The retractor handle may be configured to removably couple to the retractor and may include a handle portion, a handle shaft coupled to the handle portion, and a retractor connection structure coupled to the handle shaft. The retractor connection structure may be configured to removably couple with the handle connection structure to removably couple the retractor handle to the retractor.

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

In some embodiments of the retractor assembly, the retractor shaft also includes a first shaft portion extending along a first longitudinal axis and a second shaft portion extending along a second longitudinal axis. and a third shaft portion extending along a third longitudinal axis. The second shaft portion may be intermediate the first shaft portion and the third shaft portion, and the third shaft portion may be offset from the first shaft portion.

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

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

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

In some embodiments of the retractor assembly, the locking structure includes a locking sleeve, a hexagonal socket disposed within the locking sleeve, and one or more balls disposed at least partially within the interior space of the hexagonal socket. and a detent. The hex socket may be configured to receive an hex wrench, and the one or more ball detents may be configured to engage a retention slot formed in the hex wrench to secure the retractor handle to the retractor. .

According to some embodiments, the retractor may include a retractor shaft, a retractor member, and a guide projection. The retractor member may be disposed at the distal end of the retractor shaft and may include an arcuate projection having a proximal end coupled to the distal end of the retractor shaft, a distal end projecting laterally away from the first longitudinal axis, an upper surface, a lower surface, a retractor surface extending intermediate the upper and lower surfaces and having a convexly curved surface, and a cutting shield surface disposed opposite the retractor surface and extending intermediate the upper and lower surfaces. The guide projection may be coupled to the cutting shield surface and may project toward the first longitudinal axis. The guide projection may include an upper surface, a lower surface, and an opening formed therethrough between the upper and lower surfaces. The opening may be shaped to receive at least a portion of the femoral condyle therein for positioning the retractor member relative to the tibial plateau.

In some embodiments of the retractor, the upper and lower surfaces of the guide protrusion can be configured to taper toward one another as they progress from the proximal end of the arcuate protrusion toward the distal end of the arcuate protrusion.

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

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

In some embodiments of the retractor, the distal end of the arcuate portion may include a first tip, a second tip, and a recess intermediate the first tip and the second tip. At least one of the first tip, the second tip, and the recess is shaped to guide the medial collateral ligament toward the retractor surface when the retractor member is inserted into the knee joint. It can be said that

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

In some embodiments, the retractor shaft also includes a first shaft portion extending along a first longitudinal axis, a second shaft portion extending along a second longitudinal axis, and a third shaft portion extending along a second longitudinal axis. and a third shaft portion extending along the longitudinal axis of the shaft. The second shaft portion may be disposed between the first shaft portion and the third shaft portion, and the third shaft portion may be offset from the first shaft portion.

According to some embodiments, a method of retracting a medial collateral ligament using an assembly including a retractor and a retractor handle is provided. In some embodiments, the retractor may include a handle connection structure, a convex retractor surface, and an arcuate projection having a cutting shield surface. In some embodiments, the retractor handle may include a retractor connection structure configured to engage with the handle connection structure to removably couple the retractor handle to the retractor. The method may include coupling the retractor handle to the retractor by engaging the retractor connection structure with the handle connection structure, inserting the retractor into an incision at a surgical site proximal to the knee joint, manipulating the retractor relative to the knee joint, and positioning the retractor lateral to the medial collateral ligament of the knee joint.

In some embodiments, the method may also include retracting the medial collateral ligament away from the tibial plateau of the knee joint using the convex retractor surface.

In some embodiments, the method also includes retracting at least a portion of the tibial plateau with a bone saw while retracting the medial collateral ligament away from the tibial plateau to prevent injury to the medial collateral ligament with the bone saw. The step of excising may be included.

In some embodiments, the method also includes resecting at least a portion of the tibial plateau of the knee joint with a bone saw while the cutting shield surface prevents the bone saw from damaging the medial collateral ligament. may be included.

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

In some embodiments of the method, in the locked position, the retractor connection structure may engage the handle connection structure to lock the retractor handle to the retractor, and in the unlocked position, the retractor connection structure may engage the handle connection structure to lock the retractor handle to the retractor. The retractor handle may be unlocked from the retractor by being disengaged from the connecting structure.

These and other features and advantages of the present disclosure will be more fully apparent from the following description and appended claims, or by practice of the apparatus, systems, and methods described below. Can be learned.
BRIEF DESCRIPTION OF THE DRAWINGS Exemplary embodiments of the disclosure will be more fully apparent from the following description and appended claims, taken in conjunction with the accompanying drawings. With the understanding that these drawings depict exemplary embodiments only and are therefore not to be considered as limiting the scope of the appended claims, the exemplary embodiments of the present disclosure are illustrated in the accompanying drawings. Through use it will be explained with further specificity and detail.

1 is a perspective view of a retractor, according to an embodiment of the present disclosure; FIG. 1B is another perspective view of the retractor of FIG. 1A; FIG. FIG. 1B is a top view of the retractor of FIG. 1B is a bottom view of the retractor of FIG. 1A; FIG. 1B is a left side view of the retractor of FIG. 1A; FIG. 1B is a right side view of the retractor of FIG. 1A; FIG. 1B is a top perspective view of the distal end of the retractor of FIG. 1A; FIG. 1B is a bottom perspective view of the distal end of the retractor of FIG. 1A; FIG. 1B is a left side view of the distal end of the retractor of FIG. 1A; FIG. FIG. 3 is a perspective view of a guide rod, according to an embodiment of the present disclosure. 2B is another perspective view of the guide rod of FIG. 2A; FIG. 2B is a bottom perspective view of the distal end of the guide rod of FIG. 2A; FIG. 2B is another bottom perspective view of the distal end of the guide rod of FIG. 2A; FIG. FIG. 2B is a bottom perspective view of the distal end of the guide rod of FIG. 2A with an alternative hook member configuration. FIG. 2F is another bottom perspective view of the distal end of the guide rod of FIG. 2E. 2B is a bottom perspective view of the distal end of the guide rod of FIG. 2A having an alternative shape and hook member design; FIG. 2H is another bottom perspective view of the distal end of the guide rod of FIG. 2H; FIG. 2B is a perspective view of the distal end of the retractor of FIG. 1A and the guide rod of FIG. 2A before assembly; FIG. 4 is a top perspective view of the distal end of the retractor and guide rod shown in FIG. 3 after assembly. FIG. 4 is a bottom perspective view of the distal end of the retractor and guide rod shown in FIG. 3 after assembly; FIG. 6 is a perspective view of the entire assembly of FIGS. 4 and 5; FIG. 7 is a perspective view of the assembly of FIG. 6 inserted into a knee joint during surgery; FIG. 1B is a perspective view of the retractor of FIG. 1A relative to a tibia, cutting guide, and bone saw during a tibial plateau resection procedure; FIG. 1 is a flowchart of a method of retracting a medial collateral ligament using an assembly during a knee arthroplasty procedure. 1 is a flowchart of a method for retracting the medial collateral ligament using a retractor during a knee arthroplasty procedure. FIG. 7 is a top perspective view of a retractor according to another embodiment of the present disclosure. FIG. 11B is a bottom perspective view of the retractor of FIG. 11A. FIG. 11B is a top view of the retractor of FIG. 11A. FIG. 11B is a bottom view of the retractor of FIG. 11A. FIG. 11B is a left side view of the retractor of FIG. 11A. FIG. 11B is a right side view of the retractor of FIG. 11A. FIG. 11B is a proximal end view of the retractor of FIG. 11A. FIG. 11B is a distal end view of the retractor of FIG. 11A. FIG. 2 is a perspective view of a handle according to an embodiment of the present disclosure. 12A is another perspective view of the handle of FIG. 12A. FIG. 12B is a side view of the handle of FIG. 12A. FIG. FIG. 12B is a distal end view of the handle of FIG. 12A. FIG. 11B is a perspective view of the retractor of FIG. 11A inserted into a knee joint during a surgical procedure. FIG. 14 is another perspective view of FIG. 13 with the femur removed; 1 is a flowchart of a method for retracting a medial collateral ligament using a retractor assembly during a knee arthroplasty procedure.

It is to be understood that the drawings are for the purpose of illustrating the concepts of the present disclosure and may not be drawn to scale. Furthermore, the drawings depict exemplary embodiments and do not represent limitations on the scope of the disclosure.
DETAILED DESCRIPTION Exemplary embodiments of the present disclosure are best understood by reference to the drawings, where like parts are designated with like numerals throughout. It will be readily appreciated that the components of the present disclosure, as generally described herein and illustrated in the figures, may be arranged and designed in a wide variety of different configurations. . Accordingly, the following more detailed description of the embodiments of the apparatus, systems, and methods depicted in the figures may be helpful in understanding the present disclosure as claimed in this application or in other applications claiming priority to this application. are not intended to limit the scope of the disclosure and are merely representative of exemplary embodiments of the present disclosure.

Standard medical directions, reference points, and descriptive terminology are employed throughout this specification. For example, forward means towards the front of the body. Posterior means towards the back of the body. Upwards or cephalad means towards the head. Inferior or caudal means towards the feet. Medial means towards the midline of the body. Lateral means away from the midline of the body. Axial direction means toward the central axis of the body. Abaxial direction means away from the central axis of the body. Ipsilateral means the same side of the body. Contralateral means the opposite side of the body. The sagittal plane divides the body into right and left parts. The midsagittal plane divides the body into symmetrical right and left halves. The coronal plane divides the body into anterior and posterior parts. The transverse section divides the body into upper and lower parts. These descriptive terms may be applied to living or inanimate objects.

1A-1I illustrate various views of a retractor 100 according to one embodiment of the present disclosure. Retractor 100 may include a proximal end 101 , a distal end 102 , a retractor handle 110 at proximal end 101 , and a retractor member 120 at distal end 102 that may be coupled to retractor handle 110 .

Retractor handle 110 may extend or substantially extend along first longitudinal axis 112, as shown in FIG. 1A. However, it will be appreciated that retractor handle 110 or a portion of retractor handle 110 may or may not extend in a straight line along first longitudinal axis 112. For example, the phrase "extending generally along an axis" can include straight or curved members that may or may not maintain proximity to the axis.

Retractor member 120 generally includes an arcuate projection or arcuate projection 130 and a retractor coupling structure, such as, by way of non-limiting example, guide projection 150 having an attachment opening 160. , which will be explained in more detail below).

As defined herein, the term "substantially arcuate" means having a curved shape, an arcuate shape, an "arcuate" shape, and the like. The term "substantially arcuate" refers to curved shapes that are mathematically defined by a single radius along a given curved shape, as well as curved shapes that are mathematically defined by multiple radii along a given curved shape. It may also include curved shapes. However, it will also be understood that the term "substantially arcuate" may or may not include a curved shape defined by one or more precise mathematical formulas. Additionally, "substantially arcuate" may include not only curved shapes that extend along a curved path, but also shapes that constitute a series of straight segments that combine to define larger scale curvatures or curved shapes. Thus, for example, a geodesic dome may be said to have a spherical curvature, even though the sphere is defined by planar segments.

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

The distal end 132 of the arcuate lobe 130 may include a pointed tip 137. Proximal to the pointed tip 137, the distal end 132 of the arcuate lobe 130 may also include a lower concave curvature 138 and a lower convex curvature 139 that may be formed on the underside 134 of the arcuate lobe 130, as shown in Figures 1E, 1F, and 1I. Each of the pointed tip 137, concave curvature 138, and/or convex curvature 139 may help to facilitate manipulation of the distal end 102 of the retractor 100 within the tight knee joint during surgery. Additionally, in some embodiments, as can be seen in FIG. 1I, the retractor surface 135 and the cut shield surface 136 of the arcuate lobe 130 may both decrease in height as they progress from the proximal end 131 of the arcuate lobe 130 toward the distal end 132 of the arcuate lobe 130, further aiding in the manipulation of the distal end 102 of the retractor 100 within the tight knee joint.

In some embodiments, the retractor coupling structure may include a guiding projection 150. Guide projection 150 may be coupled to cutting shield surface 136 of arcuate projection 130 and may project toward first longitudinal axis 112. Guide projection 150 is configured to rest on top of the tibial plateau during a knee arthroplasty procedure to assist in properly positioning retractor 100 during tibial plateau resection, as described in more detail below. may be configured. Guide projection 150 may also include a mounting opening 160 formed within or through guide projection 150 . Attachment opening 160 may also include a chamfered surface 162, as described in further detail below.

2A-2H show various views of guide rod 200, according to embodiments of the present disclosure. Guide rod 200 may include a guide rod handle 210 and an elongate member 220 that may be coupled to and/or integrally formed with guide rod handle 210. Elongate member 220 includes a proximal end or rod proximal end 222 and a rod coupling structure (e.g., by way of non-limiting example, the following: hook members 230, etc.), which will be described in more detail in . Guide rod handle 210 and/or elongate member 220 may extend or substantially extend along second longitudinal axis 212, as shown in FIG. 2A.

In some embodiments, the rod coupling structure of guide rod 200 pivotably couples guide rod 200 to retractor 100 to connect assembly 10, as described in more detail below with respect to FIGS. 3-6. The retractor 100 may be configured to engage a retractor coupling structure of the retractor 100 to form a retractor 100 .

Although specific example structures of retractor coupling structures and rod coupling structures are shown herein, it will be understood that these are merely exemplary structures provided for illustration purposes only. Accordingly, any suitable shape, configuration that may engage one another to form a retractor coupling structure and/or a corresponding rod coupling structure for pivotally coupling guide rod 200 to retractor 100 , structures, features, and the like are contemplated herein without departing from the spirit or scope of this disclosure.

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

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

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

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

In some embodiments, at least a portion of proximal hook surface 235 may include a cam surface configured to interact with a surface associated with attachment aperture 160.

In some embodiments, at least a portion of proximal hook surface 235 can be concave.

In some embodiments, at least a portion of proximal hook surface 235 can be convex.

In some embodiments, at least a portion of distal hook surface 234 may extend toward guide rod handle 210 or rod proximal end 222 at a second angle or approximately.

In some embodiments, the shape and/or second angle of the distal hook surface 234 on the distal end 238 of the hook member 230 may be selected to engage the chamfered surface 162 of the attachment opening 160 to facilitate decoupling of the guide rod from the retractor 100 when a distally directed force of sufficient magnitude is applied to the guide rod 200 relative to the retractor 100.

In some embodiments, first side 231 and second side 232 may be angled together toward top surface 233 of hook member 230.

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

4-6 show various perspective views of the retractor 100 and the guide rod 200 after they have been assembled together to form the assembly 10. As previously described, the guide rod 200 may be decoupled from the retractor 100 by applying a distally directed force of sufficient magnitude to the guide rod 200. This will cause the distal hook surface 234 (which may be angled as described above) to engage the chamfered surface 162 surrounding the attachment opening 160 (which may also be angled in a complementary manner to the distal hook surface 234) to decouple the guide rod 200 from the retractor 100.

7 is a perspective view of the assembly 10 inserted into a knee joint 300 during a surgical procedure. The knee joint 300 may include a tibia 400, a femur 500, and a medial collateral ligament 600. The guide rod 200 pivotally coupled to the retractor 100 helps prevent the distal end of the retractor 100 from being inadvertently positioned medial to the medial collateral ligament 600 during insertion by the surgeon. Rather, the guide rod 200 helps ensure that the distal end of the retractor 100 will be positioned lateral to the medial collateral ligament 600 during insertion by the surgeon. Once the distal end of the retractor 100 is properly positioned lateral to the medial collateral ligament 600, the guide rod 200 may be disconnected from the retractor 100 (as previously described) and removed from the knee joint 300.

FIG. 8 is a perspective view of retractor 100, tibia 401, cutting guide 700 engaged with tibia 401, and bone saw 800 in preparation for a tibial plateau resection procedure. Retractor 100 may be utilized by a surgeon to retract the medial collateral ligament (not shown in FIG. 8) of the knee joint away from the tibial plateau during an ablation procedure. Cutting shield surface 136 of retractor 100 may also act as a mechanical stop for the blade of bone saw 800, further protecting the medial collateral ligament from accidental injury or cutting during the tibial plateau resection procedure.

FIG. 9 is a flowchart of a method 900 for retracting the medial collateral ligament using assembly 10 during a knee arthroplasty procedure. Assembly 10 includes a retractor 100 having a retractor coupling structure and a guide rod having a rod coupling structure configured to engage the retractor coupling structure to pivotally couple a guide rod 200 to the retractor 100. 200.

Method 900 may begin at step 910 where guide rod 200 may be pivotally coupled to retractor 100 to form assembly 10 by engaging the rod coupling structure with the retractor coupling structure. In some embodiments, this may be accomplished by inserting the hook member 230 of the guide rod 200 into the attachment opening 160 formed in the distal end of the retractor 100.

Once guide rod 200 is coupled to retractor 100, method 900 may proceed to step 920, where assembly 10 may be inserted into a surgical site incision (not shown) proximal to the knee joint.

Once assembly 10 is inserted into the incision, method 900 continues to step 930, where assembly 10 may be manipulated relative to the knee joint to position assembly 10 lateral to the medial collateral ligament of the knee joint. You can move on. Guide rod 200 coupled to retractor 100 may ensure that retractor 100 does not end up medial to the medial collateral ligament, as previously described.

Alternatively, or in addition, once the assembly 10 is positioned lateral to the medical collateral ligament, the method 900 may proceed to step 940, where the guide rod 200 may be detached from the retractor 100 by applying a distally directed force to the guide rod 200 relative to the retractor 100, as previously described. The detached guide rod 200 may then be removed from the knee joint in step 950.

Once the guide rod 200 is disconnected from the retractor 100 and removed from the knee joint, the method 900 involves the surgeon utilizing the retractor 100 to retract the medial collateral ligament away from the tibial plateau of the knee joint. may proceed to step 960.

Alternatively, or in addition, method 900 may proceed to step 970, where a portion of the tibial plateau may be resected with a bone saw while the medial collateral ligament is retracted away from the tibia, and Method 900 may end.

In this way, the medial collateral ligament may be protected from damage by the bone saw during the resection procedure. Retractor 100 may protect the medial collateral ligament in at least two ways, including (1) increasing the separation distance between the bone saw blade and the medial collateral ligament, thus protecting the medial collateral ligament; (2) Cutting shield surface 136 of retractor 100 removes the medial collateral ligament from the bone saw blade to prevent the bone saw blade from damaging the medial collateral ligament. Including what can be directly protected. Thus, cutting shield surface 136 may be useful in all cases where the separation distance achieved by retraction may or may not be sufficient to move the medial collateral ligament away from the bone saw blade.

FIG. 10 is a flowchart of a method 1000 for retracting the medial collateral ligament of a knee joint using retractor 100. In some embodiments, retractor 100 may include an arcuate projection having a retractor surface 135 that is convex and a cutting shield surface 136 that is concave.

Method 1000 may begin at step 1010, where retractor 100 may be inserted into an incision (not shown) at a surgical site proximal to the knee joint.

Once the retractor 100 is inserted into the incision, the method 1000 continues to step 1020, where the retractor 100 may be manipulated relative to the knee joint to position the retractor 100 lateral to the medial collateral ligament. obtain.

Once the retractor 100 is placed lateral to the medial collateral ligament, the method 1000 allows the surgeon to utilize the retractor surface 135 of the retractor 100 to direct the medial collateral ligament away from the tibial plateau of the knee joint. The patient may proceed to step 1030, where the wound may be retracted.

Alternatively, or in addition, method 1000 may proceed to step 1040, where a portion of the tibial plateau may be resected with a bone saw while the medial collateral ligament is retracted away from the tibia to prevent the bone saw from damaging the medial collateral ligament.

Alternatively, or in addition, the method 1000 may proceed to step 1050, where a portion of the tibial plateau may be resected with a bone saw while the cutting shield surface 136 of the retractor 100 directly prevents the bone saw from damaging the medial collateral ligament, and the method 1000 may end.

Thus, as previously discussed, the medial collateral ligament may be protected from bone saw damage during the resection procedure. Retractor 100 may protect the medial collateral ligament and (1) increase the separation distance between the bone saw blade and the medial collateral ligament, thus reducing the likelihood of damaging the medial collateral ligament; Opening and
(2) includes that the cutting shield surface 136 of the retractor 100 may directly protect the medial collateral ligament from the bone saw blade to prevent the bone saw blade from damaging the medial collateral ligament;

11A-11H show various views of a retractor 1100 according to another embodiment of the present disclosure. The retractor 1100 can include a proximal end 1101, a distal end 1102, a retractor shaft or shaft 1110, a handle connection structure 1114 at the proximal end 1101 of the retractor 1100, and a retractor member 1120 at the distal end 1102 of the retractor 1100.

In some embodiments, shaft 1110 may include a first shaft portion 1111, a second shaft portion 1112, and a third shaft portion 1113. In this manner, the third shaft portion 1113 may be offset from the first shaft portion 1111 to provide extra clearance and working space for the surgeon, as will be explained in more detail below. The first shaft portion 1111 may extend or substantially extend along a first longitudinal axis 1121 and the second shaft portion 1112 may extend or substantially extend along a second longitudinal axis 1122. The third shaft portion 1113 may extend or substantially extend along the third longitudinal axis 1123. However, any portion of shaft 1110 may or may not extend linearly along a particular longitudinal axis, and may generally maintain proximity to or maintain proximity to a particular longitudinal axis. It may include straight or curved members that may not have to be straight or curved.

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

In some embodiments, the handle connection structure 1114 may be configured to removably couple with the handle, as described in more detail below with respect to FIGS. 12A-12D.

In some embodiments, the handle connection structure 1114 may include a hex wrench 1116 with a retention slot 1117 formed therein. However, it will be appreciated that handle connection structure 1114 may include any conceivable shape or configuration for coupling a handle to handle connection structure 1114.

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

In some embodiments, the retractor member 1120 may include a generally arcuate projection, or an arcuate projection 1130, and a guide projection 1150.

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

In some embodiments, the upper surface 1133 and the lower surface 1134 touch each other as they progress from the proximal end 1131 of the arcuate projection 1130 toward the distal end 1132 of the arcuate projection 1130, as shown in FIG. 11H. It can be tapered towards the end.

Arcuate projection 1130 may also include a retractor surface 1135 (see FIGS. 11E and 11H) that extends intermediate the upper surface 1133 and lower surface 1134. Retractor surface 1135 may have a convex curvature. Arcuate projection 1130 may further include a cutting shield surface 1136 that may extend intermediate upper surface 1133 and lower surface 1134 opposite retractor surface 1135. In some embodiments, cutting shield surface 1136 may have a concave curvature.

In some embodiments, the distal end 1132 of the arcuate portion 1130 may include a first tip 1141 and a second tip 1142 separated by a recess 1143. At least one of the first tip 1141, the second tip 1142, and/or the recess 1143 may be attached to the medial collateral ligament on the retractor surface 1135 when the retractor member 1120 is inserted into the knee joint. It may be tapered and/or otherwise shaped to guide towards. Additionally, at least one of the first tip 1141, the second tip 1142, and/or the recess 1143 may be used to separate tissue during insertion and/or during surgery within a tight knee joint. The distal end 1102 of the retractor 1100 may be tapered and/or otherwise shaped to help facilitate manipulation of the distal end 1102 of the retractor 1100. In some embodiments, as can be seen in FIG. 11H, the retractor surface 1135 and cutting shield surface 1136 of the arcuate portion 1130 both extend from the proximal end 1131 of the arcuate portion 1130. As one advances toward the distal end 1132 of the section 1130, the height may be reduced to further aid in maneuvering the distal end 1102 of the retractor 1100 within the tight knee joint.

The guide protrusion 1150 may include an upper surface 1151, a lower surface 1152, and an outer edge 1153 intermediate the upper surface 1151 and the lower surface 1152. The guide protrusion 1150 may be configured to rest on the top of the tibial plateau during a knee arthroplasty procedure to aid in properly positioning the retractor 1100 during tibial plateau resection (see FIGS. 13 and 14).

In some embodiments, guide protrusion 1150 may be coupled to cutting shield surface 1136 and protrude toward first longitudinal axis 1121.

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

In some embodiments, the upper surface 1151 and the lower surface 1152 may taper toward one another as they progress from the proximal end 1131 of the arcuate projection 1130 toward the distal end 1132 of the arcuate projection 1130 (see FIG. 11F). This taper may help separate tissue and/or facilitate manipulation of the distal end 1102 of the retractor 1100 within a tight knee joint during surgery.

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

In some embodiments, the opening 1160 can be shaped to receive at least a portion of the femoral condyle therein, and during a surgical procedure, at least one of the femoral condyle and tibial plateau of the knee joint. (see, eg, FIG. 13).

In some embodiments, retractor 1100 is inserted into, positioned, and/or removed from the knee joint without the use of additional guide rods (such as guide rod 200 described herein). can be removed. However, in other embodiments, retractor 1100 may include additional guides that may be coupled to opening 1160 via a suitable hook member (such as guide rod 200 and hook member 230 described herein). It will also be appreciated that the rod may be used to be inserted into, positioned, and/or removed from the knee joint.

12A-12D show various views of a retractor handle or handle 1200, according to one embodiment of the present disclosure. Handle 1200 may include a handle portion 1210, a handle shaft 1220, and a retractor connection structure 1230.

In some embodiments, the handle 1200 may be removably connectable to the retractor 1100.

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

In some embodiments, the locking structure may include a locking sleeve 1240, a hex socket 1250, and one or more pins that may be configured to lock the handle 1200 to the handle connection structure 1114 of the retractor 1100, or One or more ball detents 1260 may be included.

In some embodiments, locking sleeve 1240 and/or one or more ball detents 1260 may be spring biased. For example, locking sleeve 1240 may be spring biased such that locking sleeve 1240 is pushed distally along handle shaft 1220. Additionally, the one or more ball detents 1260 may be spring biased such that they are pushed inwardly into the interior space of the hex socket 1250.

In some embodiments, the handle 1200 can be coupled to the retractor 1100 by (1) moving the locking sleeve 1240 proximally along the handle shaft 1220 to allow one or more ball detents 1260 to retract from the interior space of the hex socket 1250, (2) inserting the hex wrench 1116 of the handle connection structure 1114 into the hex socket 1250 of the retractor connection structure 1230, and (3) releasing/moving the locking sleeve 1240 distally along the handle shaft 1220 to force one or more ball detents 1260 into the retention slots 1117 formed in the hex wrench 1116 to secure the handle 1200 to the retractor 1100.

In some embodiments, the handle 1200 is configured to (1) move the locking sleeve 1240 proximally along the handle shaft 1220 to prevent the one or more ball detents 1260 from retracting from the retention slot 1117; and (2) detach the handle 1200 from the retractor 1100 by removing the hex wrench 1116 from the hex socket 1250 and disconnecting the handle 1200 from the retractor 1100.

FIG. 13 is a perspective view of a retractor 1100 coupled to a handle 1200 to form a retractor assembly 1700 that is inserted into a knee joint 1300 during a surgical procedure. FIG. 14 shows another perspective view of FIG. 13 with the femur removed to show retractor member 1120 engaged with tibial plateau 1450. Knee joint 1300 may include a tibia 1400, a femur 1500, and a medial collateral ligament 1600. As previously described herein, the configuration of retractor 1100 may aid in insertion of retractor 1100 and/or during insertion of retractor 1100 by a surgeon, distal end 1102 of retractor 1100 may It may help prevent accidental placement medial to the medial collateral ligament 1600. Rather, the configuration of retractor 1100 helps ensure that the distal end 1102 of retractor 1100 will be placed lateral to the medial collateral ligament 1600 by the surgeon during insertion. Dew. Once the distal end 1102 of the retractor 1100 is properly positioned lateral to the medial collateral ligament 1600, the tibial plateau may be resected with a bone saw in a manner similar to that shown and described in FIG. . Accordingly, retractor 1100 may be utilized by a surgeon to retract the medial collateral ligament of the knee joint away from the tibial plateau during an ablation procedure. The cutting shield surface 1136 of the retractor 1100 may also serve as a mechanical stop for the bone saw blade, further protecting the medial collateral ligament from accidental injury or cutting during the tibial plateau resection procedure.

FIG. 15 is a flowchart of a method 2000 for retracting the medial collateral ligament using retractor assembly 1700 during a knee arthroplasty procedure. Retractor assembly 1700 may include retractor 1100 and handle 1200. In some embodiments, the retractor 1100 includes a handle connection structure 1114, a guide projection 1150, and an arcuate projection 1130 having a retractor surface 1135, which may be convex, and a cutting shield surface 1136, which may be concave. may include. Handle 1200 may include a retractor connection structure 1230 configured to engage handle connection structure 1114 to removably couple handle 1200 to retractor 1100.

Method 2000 includes coupling handle 1200 to retractor 1100 and forming retractor assembly 1700 by engaging retractor connection structure 1230 with handle connection structure 1114, as previously described herein. It may begin at step 2010.

Once retractor handle 1200 is coupled to retractor 1100 to form retractor assembly 1700, method 2000 includes the steps of: inserting retractor 1100 into an incision (not shown) at a surgical site proximal to the knee joint. It can proceed to 2020.

Once the retractor 1100 is inserted into the incision, the method 2000 continues to step 2030, where the retractor 1100 may be manipulated relative to the knee joint to position the retractor 1100 on the lateral surface of the medial collateral ligament. obtain. In some embodiments, the guiding protrusion 1150 and/or the arcuate protrusion 1130 of the retractor 1100 guides the retractor 1100 under the medial meniscus (not shown) of the knee joint during placement of the retractor 1100 relative to the knee joint. Can cross. Further, in some embodiments, positioning the guiding projection 1150 of the retractor 1100 on the medial tibial plateau (not shown) of the knee joint may be such that the arcuate projection 1130 of the retractor 1100 It can be shown to be interposed between the medial collateral ligament and the medial tibial plateau.

Once the retractor 1100 is positioned lateral to the medial collateral ligament, the method 2000 allows the surgeon to utilize the retractor surface 1135 of the retractor 1100 to retract the medial collateral ligament away from the tibial plateau of the knee joint. If possible, proceed to step 2040.

Alternatively, or in addition, method 2000 includes retracting a portion of the tibial plateau while the medial collateral ligament is retracted away from the tibia to prevent the bone saw from damaging the medial collateral ligament. The bone saw may be excised and the cutting shield surface 1136 of the retractor 1100 may proceed to step 2050, where the bone saw may further prevent the bone saw from damaging the medial collateral ligament, and the method 2000 may end.

In this way, the medial collateral ligament may be protected from damage by the bone saw during the resection procedure. The retractor 1100 may protect the medial collateral ligament in at least two ways, including (1) retraction, which increases the separation distance between the bone saw blade and the medial collateral ligament, thus reducing the chance of damaging the medial collateral ligament, and (2) the cutting shield surface 1136 of the retractor 1100 may directly protect the medial collateral ligament from the bone saw blade to prevent the bone saw blade from damaging the medial collateral ligament. Thus, the cutting shield surface 1136 may be useful in all cases where the separation distance achieved by retraction may or may not be sufficient to move the medial collateral ligament away from the bone saw blade.

Any method disclosed herein may include one or more steps or actions for carrying out the described method. One or more method steps or actions may be omitted from any of the methods disclosed herein. Additionally, any of the method steps or actions may be interchanged with one another. In other words, unless a specific order of steps or actions is required for proper operation of an embodiment, the order and/or use of specific steps or actions may be modified.

Any of the ligament retraction devices, components, assemblies, systems, and/or methods described herein may be combined in any number of combinations without departing from the spirit or scope of this disclosure, and It will be understood that it may also be linked. For example, the retractor 100 of FIGS. 1A-1I, and/or the retractor 1100 of FIGS. Can be used with. As another non-limiting example, for example, hook member 230 may be coupled to guide protrusion 150 (instead of guide rod 200), and attachment opening 160 may be coupled to guide protrusion 150 (instead of guide protrusion 150). 200. As another non-limiting example, handle 1200 may be utilized with retractor 100 and/or retractor handle 110 may be utilized with retractor 1100, for example. As another non-limiting example, guide projections 150 and 1150 may be utilized with any of the retractors 100, 1100 disclosed herein.

The word "exemplary" is used herein to mean "serving as an example, instance, or illustration." Any embodiment described herein as "exemplary" is not necessarily to be construed as preferred or advantageous over other embodiments. Various aspects of the embodiments are illustrated in the drawings, which are not necessarily drawn to scale unless otherwise indicated.

References throughout this specification to "an embodiment" or "the embodiment" refer to references to "an embodiment" or "the embodiment" in which the particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. means to be Therefore, the quotations or variations thereof cited throughout this specification are not necessarily all referring to the same embodiment.

Similarly, in the above description of embodiments, it should be understood that various features are often grouped together in a single embodiment, figure, or description thereof for the purpose of streamlining the disclosure. This method of disclosure, however, is not to be interpreted as reflecting an intention that any claim requires more features than are expressly recited in the claim. Rather, as the following claims reflect, inventive aspects lie in combinations of fewer features than all of the features of any single foregoing disclosed embodiment. Thus, the claims following this detailed description are hereby expressly incorporated into this detailed description, with each claim standing on its own as a separate embodiment. This disclosure includes all substitutions of independent claims with dependent claims thereof.

In the claims, the mention of the term "first" in reference to a feature or element does not necessarily imply the presence of a second or additional such feature or element. Elements listed in means-plus-function format are intended to be construed in accordance with 35 U.S.C. 112(6). It will be apparent to those skilled in the art that changes may be made in the details of the embodiments described above without departing from the underlying principles described herein.

The terms "connected," "coupled," "engaged," and "communicating" include mechanical, electrical, magnetic, electromagnetic, fluidic, and thermal interactions. , refers to any form of interaction between two or more entities. Two components may be functionally coupled to each other even though they are not in direct contact with each other. The term "abutting" refers to units that are in direct physical contact with each other, although the units are not necessarily attached together. The phrase "fluid communication" refers to two structures connected such that fluid in one structure can pass to the other structure. The phrase "substantially equal" can mean that the relative variances from each other are within about ±10%.

Although particular embodiments and applications of the present disclosure have been illustrated and described, it should be understood that the appended claims are not limited to the precise configuration and components disclosed herein. It is. Various modifications, changes, and variations may be made in the arrangement, operation, and details of the devices, systems, and methods disclosed herein that will be apparent to those skilled in the art.

Claims (20)

1. A retractor assembly, comprising:
A retractor, the retractor comprising:
a retractor shaft including a proximal end and a distal end, at least a portion of the retractor shaft extending along a first longitudinal axis;
a handle connection structure disposed on a proximal end of the retractor shaft;
a retractor member disposed at a distal end of the retractor shaft, the retractor member including an arcuate projection, the arcuate projection comprising:
a proximal end coupled to the distal end of the retractor shaft;
a distal end projecting laterally away from the first longitudinal axis; and
The top surface and
The underside and
a retractor surface extending intermediate the upper surface and the lower surface, the retractor surface including a convex curved surface; and
the retractor member including a cut shield surface disposed opposite the retractor surface and extending intermediate the upper surface and the lower surface; and
a retractor handle configured to removably couple to the retractor, the retractor handle comprising:
The handle part,
a handle shaft coupled to the handle portion;
a retractor connection structure coupled to the handle shaft,
A retractor assembly comprising: a retractor handle configured to releasably couple with the handle connection structure, releasably coupling the retractor handle to the retractor. The retractor assembly of claim 1, wherein the retractor member further includes a guide protrusion coupled to the cutting shield surface and projecting toward the first longitudinal axis, the guide protrusion The department is
The top surface and
The bottom surface and
an opening formed through the guide protrusion between the upper surface and the lower surface;
The retractor assembly wherein the opening is configured to receive at least a portion of a femoral condyle therein for positioning the retractor member relative to a tibial plateau. The retractor assembly of claim 1, wherein the retractor shaft further comprises:
a first shaft portion extending along the first longitudinal axis;
a second shaft portion extending along a second longitudinal axis;
a third shaft portion extending along a third longitudinal axis;
The second shaft portion is intermediate the first shaft portion and the third shaft portion, and the third shaft portion is offset from the first shaft portion. vessel assembly. 4. The retractor assembly of claim 3, wherein the handle connection structure is coupled to the third shaft portion. The retractor assembly of claim 1, wherein the retractor connection structure includes a locking structure configured to secure the retractor handle to the retractor by engaging the handle connection structure. A retractor assembly comprising: 6. The retractor assembly of claim 5, wherein the handle connection structure comprises:
hex wrench and
A retractor assembly including a retention slot formed in the hex wrench. The retractor assembly of claim 6, wherein the locking structure comprises:
lock sleeve and
a hex socket disposed within the locking sleeve;
one or more ball detents disposed at least partially within the interior space of the hex socket;
The hex socket is configured to receive the hex wrench, and the one or more ball detents engage the retention slot formed in the hex wrench to lock the retractor handle into the retractor. A retractor assembly configured to secure to a retractor assembly. A retractor, the retractor comprising:
A retractor shaft, the retractor shaft comprising:
A proximal end;
a distal end,
at least a portion of the retractor shaft extends along a first longitudinal axis;
a retractor member disposed at a distal end of the retractor shaft, the retractor member comprising:
An arcuate projection, the arcuate projection comprising:
a proximal end coupled to the distal end of the retractor shaft;
a distal end projecting laterally away from the first longitudinal axis; and
The top surface and
The underside and
a retractor surface extending intermediate the upper surface and the lower surface, the retractor surface including a convex curvature; and
the retractor member including the arcuate projection, the retractor member including a cut shield surface disposed opposite the retractor surface, the cut shield surface extending intermediate the upper surface and the lower surface;
a guide protrusion coupled to the cutting shield surface and protruding toward the first longitudinal axis, the guide protrusion comprising:
The top surface and
The underside and
an opening formed through the guide projection between the upper surface and the lower surface;
the opening including a guide projection configured to receive at least a portion of a femoral condyle therein to position the retractor member relative to the tibial plateau. 9. The retractor of claim 8, wherein the upper surface and the lower surface of the guiding protrusion touch each other as they advance from the proximal end of the arcuate projection toward the distal end of the arcuate projection. A retractor characterized in that it is configured to taper toward the front. 9. The retractor of claim 8, wherein the guide protrusion further includes an outer edge intermediate the upper surface and the lower surface. 11. The retractor of claim 10, wherein the outer edge includes a convex surface. 9. The retractor of claim 8, wherein the distal end of the arcuate projection further comprises:
A first tip;
a second tip; and a recess intermediate the first tip and the second tip,
at least one of the first tip, the second tip, and the recess is shaped to guide the medial collateral ligament toward the retractor surface when the retractor member is inserted into a knee joint. 9. The retractor of claim 8, further comprising a handle connection structure located at the proximal end of the retractor shaft. 9. The retractor of claim 8, wherein the retractor shaft comprises:
a first shaft portion extending along the first longitudinal axis;
a second shaft portion extending along a second longitudinal axis;
a third shaft portion extending along a third longitudinal axis;
The retractor, wherein the second shaft portion is intermediate the first shaft portion and the third shaft portion, and the third shaft portion is offset from the first shaft portion. A method for retracting a medial collateral ligament using an assembly including a retractor and a retractor handle, the retractor having a handle connection structure and an arcuate retractor surface having a convex retractor surface and a cutting shield surface. a protrusion, the retractor handle includes a retractor connection structure configured to engage the handle connection structure to removably couple the retractor handle to the retractor; The method is
coupling the retractor handle to the retractor by engaging the retractor connection structure with the handle connection structure;
Inserting the retractor into an incision at a surgical site proximal to the knee joint;
manipulating the retractor with respect to the knee joint;
placing the retractor lateral to the medial collateral ligament of the knee joint. 16. The method of claim 15, further comprising:
A method comprising using the convex retractor surface to retract the medial collateral ligament away from the tibial plateau of the knee joint. 17. The method of claim 16, further comprising:
In order to prevent damage to the medial collateral ligament caused by the bone saw, the step includes resecting at least a portion of the tibial plateau with the bone saw while retracting the medial collateral ligament in a direction away from the tibial plateau. A method characterized by: 16. The method of claim 15 further comprising:
resecting at least a portion of the tibial plateau of the knee joint with the bone saw while the cutting shield surface prevents the bone saw from damaging the medial collateral ligament. 16. The method of claim 15 further comprising:
13. The method of claim 12, further comprising: moving the retractor connection structure between a locked position and an unlocked position to releasably couple the retractor handle to the retractor. 20. The method according to claim 19,
in the locked position, the retractor connection structure engages the handle connection structure to lock the retractor handle to the retractor;
In the unlocked position, the retractor connection structure is disengaged from the handle connection structure to unlock the retractor handle from the retractor.

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