Surgery – Instruments – Suture – ligature – elastic band or clip applier
Reexamination Certificate
1999-09-21
2003-10-07
Woo, Julian W. (Department: 3731)
Surgery
Instruments
Suture, ligature, elastic band or clip applier
C606S139000
Reexamination Certificate
active
06629984
ABSTRACT:
FIELD OF THE INVENTION
The present invention relates to medical devices for performing surgery and a surgical repair kit containing the same. More particularly, the present invention is directed to a surgical repair kit useful for performing arthroscopic meniscal repairs and other surgical procedures.
BACKGROUND OF THE INVENTION
Menisci are tough rubbery “C” shaped cartilage cushions that are attached by ligaments to the top plateau of the tibia. They prevent the surfaces of the tibia and femur from grinding against each other and act as shock absorbers in the knee.
Menisci are also located in the shoulder, generally known as labrum.
Meniscal tears are a common problem, especially among amateur and professional athletes. The most common meniscus injury occurs in the knee. Each year, tens of thousands of people suffer meniscal tears, particularly in or at the site of one or both knees. If these tears are not repaired, there may be a progressive deterioration of the cartilage, leading to the painful rubbing and wearing of bones which had previously been covered by cartilage. This, in turn, leads to inflammatory synovitis, arthritis and other debilitating ailments. Consequently, at least 30,000 to 40,000 meniscal excisions or repairs are performed to the knee and shoulder each year.
Men and women between the ages of 18 and 45 experience the majority of meniscal tears, usually during athletic activity, such as when twisting, cutting, pivoting, decelerating or when being tackled. When torn, the meniscus may have a longitudinal, horizontal or radial (“parrot beak”) tear.
The damaged meniscus may be diagnosed with the assistance or use of magnetic resonance imaging (MRI) and/or an arthroscopic examination. Arthroscopy enables a surgeon to look into the joint using a miniature video camera. In many cases, torn fragments of the meniscus are removed arthroscopically. In other cases, a small tear at the periphery of the meniscus, with a very swollen knee joint, may be treated by draining the joint, temporarily restricting the use of the knee, and slowly having the patient begin rehabilitative exercises.
However, in still other cases, the tears in the meniscus do require surgical repair, normally by sewing the torn sections of the meniscus together. The use of the arthroscope greatly aids in the surgical repair of the meniscus by allowing the surgeon to better visualize the small areas between which the torn meniscus lies. The arthroscope enables the surgeon to visualize the interior of the joint and to perform surgery through small puncture holes without having to open the joint as has been done in the past.
A number of surgical tools have been developed to assist in suturing. In some cases these tools have been developed for use in arthroscopic and/or endoscopic surgery.
In addition to the foregoing, many surgical procedures are currently performed on the shoulder.
More particularly, a group of four muscles around the shoulder joint is called the rotator muscles of the shoulder. The tendonous portion of the muscles that insert into the bony tuberosities of the humeral head is known as the rotator cuff. The rotator cuff is frequently torn at or close to its bony insertion due to trauma or due to degenerative changes associated with aging. Weakness and pain are indications for the surgical repair of rotator cuffs. The surgical procedure consists of re-attachment of the rotator to its bony bed.
Another type of tear in the shoulder that requires attention relates to instability of the shoulder joint after the shoulder has been previously dislocated. The instability is the result of tearing of the joint capsule and its labrum (a fibrocartilaginous structure) from the anterior aspect of the glenoid. This deficiency is commonly known as a Bankart lesion. One method to correct the instability associated with a Bankart lesion is to re-attach the torn capsule and labrum to bone on the anterior aspect of the glenoid.
Both of the above procedures involve re-attaching soft tissues to bone. The arthroscope enables the surgeon to visualize the interior of the joint and to perform surgery through small puncture holes without having to open the joint as has been done in the past. Improvements in instrumentation and in suture anchors have made it possible for surgeons skilled in arthroscopy to perform the above surgical procedures arthroscopically.
The basic steps in arthroscopic rotator cuff repairs and arthroscopic Bankart repairs involve embedding a suture anchor into a bony bed, passing a suture through the soft tissue and tying the soft tissue to the suture anchor, thus coapting the torn tissue to the bony bed. At other times torn or lax tissues are repaired or tightened by passing sutures through two points in the soft tissue, and then tying the sutures together.
U.S. Pat. No. 2,808,055 (Thayer) discloses a surgical stitching instrument which accommodates a bobbin of suture material and includes means to feed the suture material to a needle. A slidable thread-moving member is provided for advancing the suture material through the needle.
U.S. Pat. No. 3,476,114 (Shannon et al.) discloses a ligating implement comprising an elongated instrument through which a ligature passes to form a loop at one end with a disc. The disc provides a means whereby the loop may be drawn tight about a severed vessel or the like.
U.S. Pat. No. 3,476,115 (Graeff et al.) discloses a ligating implement as in Shannon et al., and includes severing means to prevent overstressing of the locking disc during tightening of the noose.
U.S. Pat. No. 4,493,323 (Albright et al.) discloses a suturing device and a method for its use in arthroscopic surgery. The suturing device comprises an elongated tube and plunger which are used to hold and advance a pair of needles united by a length of suture material.
U.S. Pat. No. 4,641,652 (Hutterer et al.) discloses an applicator for tying sewing threads which comprises a helical tubular coil connected to a shaft having an axial passage. A catcher loop is extendable through the shaft to catch a sewing thread inserted manually into the coil passage.
U.S. Pat. No. 4,935,027 (Yoon) discloses surgical instruments and methods for effecting suturing of tissue controlled from a position remote from the suture site. The invention provides for the continuous feeding of suture material through opposed forcep jaw members between which the tissue segments are interposed.
U.S. Pat. No. 5,112,308 (Olsen et al.) discloses a medical device for and a method of endoscopic surgery.
The device includes a dilator having a tapered end and a central passage which accommodates a guidewire for directing the dilator. This device does not include any means whereby the guidewire may be secured to the dilator or otherwise manipulated in conjunction therewith.
U.S. Pat. No. 4,779,616 (Johnson) discloses a method for snagging an end of a surgical suture during arthroscopic surgery, comprising deploying a distal end of a cylindrical cannula adjacent to the end of the suture within the body and passing a resilient loop through the cannula to snag the suture.
U.S. Pat. Nos. 4,890,615, 4,923,461 and 4,957,498 (Caspari et al.) disclose a suturing instrument and method of use in arthroscopic surgery. The suturing instrument includes a hollow needle for penetrating tissue to be sutured within the body while the tissue is clamped between relatively movable jaws and a suture feed mechanism for feeding suture material through the hollow needle. The jaws can be opened and the suturing instrument withdrawn from the body, pulling the free end segment of the suture material with the instrument.
SUMMARY OF THE INVENTION
It is an object of the present invention to provide a surgical repair kit. In particular, it is an object of the present invention to provide a surgical repair kit which is particularly suited for the repair of torn menisci.
It is another object of the present invention to provide a suture passer having means for positioning of the suture.
It is another object of the present invention to provide a parallel needle guide to
Pandiscio & Pandiscio
Woo Julian W.
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