The present disclosure relates to a dual-blade cutting apparatus for cutting tendons and, more particularly, for making a preliminary cut along a tendon using a dual-blade cutting apparatus.
Most people can go through the majority of their life without ever caring or knowing how complicated a structure the knee that helps them walk is. However, the knee remains a fragile mechanical structure that is readily susceptible to damage. While medical advances have made repairing the knee possible, repair of certain types of injuries results in other long term effects. To assist the reader in appreciating the elegance of the present disclosure,
For the purposes of the present disclosure, and as illustrated, the knee may be composed of the quadriceps muscles 100, the femur 102, the articular cartilage 104, the lateral condyle 106, the posterior cruciate ligament 108, the anterior cruciate ligament (ACL) 110, the lateral collateral ligament 112, the fibula 114, the tibia 116, the patellar tendon 118, the meniscus 120, the medial collateral ligament 122, the patella 124 (shown slightly displaced to the side—it normally rests in the center of the knee), and the quadriceps tendon 126. Of particular interest for the purposes of the present disclosure is the ACL 110 and what is done to repair the ACL 110.
ACL tears are common in athletes and are usually season-ending injuries. The ACL 110 cannot heal—it must be surgically reconstructed. The reconstruction requires replacement tissue. The most common tissue used is a central slip of the patient's own patellar tendon 118. In practice, the patellar tendon 118 has proven to be generally effective, but the size of the graft that can be used is limited to the size of the patient's own patellar tendon 118. As a rule of thumb, only a third of the patellar tendon 118 may be harvested as a graft. Thus, a doctor will measure the width of the patellar tendon 118, divide by three, and take the middle third of the patellar tendon 118. Such harvested grafts are rarely more than ten millimeters (10 mm) wide and may be smaller. Taking this tissue from a person's patellar tendon 118 also causes significant pain and discomfort in the post-operative healing period, which may last up to a year, and up to twenty (20) percent of these patients are left with chronic anterior knee pain.
Some doctors recommend and use other graft sources, such as cadaver grafts, but cadaver grafts have a higher failure rate. Additionally, there is a non-zero chance of disease transmission or rejection by the patient's immune system. As a final drawback, cadaver grafts are usually quite expensive and may not be covered by some insurance companies.
Other doctors use hamstring tendons (e.g., the distal semitendinosus tendon) because the scar created during harvesting is relatively small and there is less pain during the rehabilitation, but again, the hamstring tendon has its own collection of disadvantages. The disadvantages include the fact that once the graft is taken, a patient's hamstring will never recover to its previous strength. Further, all hamstring reconstructions stretch and are looser than the original ACL 110. This loosening is particularly problematic in younger female athletes.
Another alternative graft source is the quadriceps tendon 126. The quadriceps tendon 126 is larger and stronger than either the patellar tendon 118 or the hamstring tendon. The quadriceps tendon 126 is likewise stiffer and less prone to stretching or plastic deformation. However, the qualities that make the quadriceps tendon 126 attractive also contribute to the difficulty in harvesting a graft from the quadriceps tendon 126. Existing surgical implements require a large incision up the longitudinal axis of the femur 102 on the front or ventral/anterior side of the thigh to cut down to the level of the quadriceps tendon 126, resulting in a large post-operative scar. Additionally, the quadriceps tendon 126 has a consistency similar to the proverbial shoe leather, making it difficult to cut. However, an ACL 110 repaired with grafts from the quadriceps tendon 126 generally results in almost no anterior knee pain postoperatively over the short or long term and patients recover quicker.
U.S. Pat. Nos. 8,894,672; 8,894,675; 8,894,676; 9,044,260; 9,107,700; and 9,474,535 along with U.S. patent application Ser. No. 17/323,736 provide a number of devices designed to create a graft from the quadriceps tendon 126 as well as a number of secondary cutting implements to trim the distal end of the graft. Additionally, the '315 application introduced the concept of a dual-blade cutting device. While these devices perform admirably, there remains a desire to afford a surgeon more flexibility in approaching the preparation of a tendon for tendon harvesting.
The present disclosure provides a dual-blade tendon cutting apparatus. Exemplary aspects of the present disclosure relate to a cutting implement that comprises an attachment with two parallel blades that are adjustably spaced apart from one another and may be selectively inserted and removed from a handle device. The distance between the blades determines a lateral size of a graft being taken from the quadriceps tendon. By providing the dual blades in an adjustable and removable attachment, the surgeon has the freedom to reuse the handle portion after suitable sterilization while providing freedom to select a desired distance between blades to make a desired graft harvest. This approach reduces waste relative to the '315 cartridge approach and still provides desired cutting flexibility.
In this regard, in one aspect, a cutting assembly is disclosed. The cutting assembly comprises a handle having a longitudinal axis and a vertical axis. The handle comprises a body delimiting a receptacle along a portion of the longitudinal axis, a lock screw, and a set screw. The cutting assembly also comprises a blade attachment removably positioned in the receptacle and secured in the receptacle by the lock screw. The blade attachment comprises a stationary blade. The blade attachment also comprises a movable blade parallel to the stationary blade. The blade attachment also comprises a slider bar sandwiched between the stationary blade and the movable blade and configured to move the movable blade relative to the stationary blade based on position. The slider bar is selectively fixed in position by the set screw.
In another aspect, a blade attachment is disclosed. The blade attachment comprises a stationary blade. The blade attachment also comprises a movable blade parallel to the stationary blade. The blade attachment also comprises a slider bar sandwiched between the stationary blade and the movable blade and configured to move the movable blade relative to the stationary blade based on position.
Those skilled in the art will appreciate the scope of the disclosure and realize additional aspects thereof after reading the following detailed description in association with the accompanying drawings.
The accompanying drawings incorporated in and forming a part of this specification illustrate several aspects of the disclosure, and together with the description serve to explain the principles of the disclosure.
The embodiments set forth below represent the necessary information to enable those skilled in the art to practice the disclosure and illustrate the best mode of practicing the disclosure. Upon reading the following description in light of the accompanying drawings, those skilled in the art will understand the concepts of the disclosure and will recognize applications of these concepts not particularly addressed herein. It should be understood that these concepts and applications fall within the scope of the disclosure and the accompanying claims.
The present disclosure provides a dual-blade tendon cutting apparatus. Exemplary aspects of the present disclosure relate to a cutting implement that comprises an attachment with two parallel blades that are adjustably spaced apart from one another and may be selectively inserted and removed from a handle device. The distance between the blades determines a lateral size of a graft being taken from the quadriceps tendon. By providing the dual blades in an adjustable and removable attachment, the surgeon has the freedom to reuse the handle portion after suitable sterilization while providing freedom to select a desired distance between blades to make a desired graft harvest. This approach reduces waste relative to the '315 cartridge approach and still provides desired cutting flexibility.
Before addressing exemplary aspects of the present disclosure,
The handle 204 includes a channel 212 and beveled edges to allow the dual-blade cutting attachment 202 to snap fit therein. The handle 204 is contoured to provide an easy grip surface and may be made from plastic or the like. In particular, the handle 204 may include a first front ridge 214 where pressure may be applied such as by a surgeon's thumb. Likewise, the handle 204 may be generally I-shaped with a wider front section 216 and rear section 218 (best seen in
Because the size of the graft may vary depending on the person, it may be appropriate to use differently-sized dual-blade cutting attachments 202. To this end, exemplary aspects of the present disclosure allow a plurality of differently-sized dual-blade cutting attachments to be placed into respective bays of a single cartridge 300 as illustrated in
The dual-blade cutting attachment 202 is further illustrated in
While the apparatus of the '315 application is useful in creating a graft of a desired size, it can lead to waste as only one out of three dual blades in the cartridge may be used before discarding the cartridge and the unused blades. Accordingly, exemplary aspects of the present disclosure provide an assembly formed from a handle and a removable blade attachment where the blade attachment has two parallel blades that are adjustably positioned relative to one another in such a manner as to change the lateral space between the blades.
The handle 600 has a general longitudinal axis 606 and a lateral axis 608. The handle 600 may be contoured along the lateral axis 608 with beveled edges 610A-610D (610D shown in
The blade attachment 602 is held in place within the receptacle 628 by a lock screw 630. It should be appreciated that the handle 600 may include a bottom swell 632 that is not necessarily directly opposite the peak 624 and has a short taper slope 634 towards the second end 626. A set screw 700 (
As better seen in
With further reference to
The movable blade 804 also includes a body 830 and an arm 832. The arm 832 extends from the body 830 along the longitudinal axis 606. The arm 832 has a lateral dimension less than the lateral dimension of the body 830. A second cutting blade 834 is secured to the arm 830 and extends further along the longitudinal axis 606. The second cutting blade 834 includes a cutting edge 836 shaped liked a scalpel or the like. The body 830 defines a groove 838 which is configured to receive the protuberances 904 of the stationary blade 802. Additionally, a top surface of the body 830 may include diagonal slots 910 that interoperate with the slider bar 806 as explained below.
With continued reference to
Positioning of the movable blade 804 relative to the stationary blade 802 is better illustrated in
Alternate views of how the lock screw 630 and the set screw 700 inter-relate to the body 808 of the stationary blade, the body 830 of the movable blade 804, and the ridges 844 of the slider bar 806 are provided in
It should be appreciated that the handle 600 may be formed from a material that is capable of being sterilized such as in an autoclave and reused while the blade attachment 602 may be made from materials designed to be disposable or single use. Further in an exemplary aspect, the cutting blades 812 and 834 may move from between 7 mm to 14 mm width (e.g., width 1002B is 7 mm and width 1002A is 14 mm).
Given the structure of the dual-blade cutting apparatus (either using the cartridge blades of the '315 application or the attachment of the present disclosure), a brief overview of one possible use is provided. Specifically, during the preparation and harvesting of a quadriceps tendon, the surgeon may, before or after preparing a bone graft of patellar material that remains attached to the tendon, use the dual-blade cutting apparatus to “score,” “shape,” or make a preliminary guide cut in the tendon. That is, the dual-blade cutting apparatus may cut a few millimeters deep from an anterior surface of the tendon towards a posterior surface, where such cut does not cut completely from the anterior to posterior surface. These preliminary cuts on the anterior surface then help act as guides to make a consistently shaped tendon (in terms of width) for a subsequent cutting device such as the V-blade of the '672 patent or the notched blade of the '736 application to perform further cutting and harvesting. In contrast, an unguided hand may provide variations in width resulting in a suboptimal graft.
While it is specifically contemplated that the dual-blade cutting apparatus may be used in the preparation and harvesting of a quadriceps tendon, usage is not so limited and other uses including surgical (e.g., other tendons or workpieces), hobby (e.g., scoring a workpiece with parallel cuts before performing a final cut), or the like are contemplated.
Those skilled in the art will recognize improvements and modifications to the embodiments of the present disclosure. All such improvements and modifications are considered within the scope of the concepts disclosed herein and the claims that follow.
The present application is related to U.S. patent application Ser. No. 16/900,315, filed Jun. 12, 2020. The '315 application claims priority to U.S. Provisional Patent Application Serial No. 62/861,623 filed on Jun. 14, 2019. The contents of both of these applications are incorporated herein by reference in their entirety.