Combined flip cutter and drill

A flip cutter and drill instrument and method of antegrade drilling and retrograde cutting using such an instrument. The flip cutter and drill instrument is provided with a drill which has a multi-blade configuration and which engages an inner tube or inner member of the instrument to articulate between at least a first “straight” position (for example, about parallel to the longitudinal axis of the instrument) when the instrument is in the drilling mode, and at least a second “flip” position (for example, a non-parallel position relative to the longitudinal axis of the instrument) when the instrument is in the cutting mode.

FIELD OF THE INVENTION

The present invention relates to arthroscopic surgical methods and instruments and, more specifically, to a combined cutting and drilling instrument and methods of retrograde repairs and reconstructions.

BACKGROUND OF THE INVENTION

During arthroscopic surgery, a small incision is made in the skin covering the arthroscopic site or joint so that surgical instruments may be placed in the joint and manipulated through arthroscopic visualization. As only a very small incision is made during arthroscopic surgery, it is often difficult to handle instruments within the joint capsule, where visibility and access to the structures of the joint capsule is minimal. It is also difficult to manipulate instruments during the formation of a recipient site socket (for example, a femoral or tibial tunnel) during reconstructive surgery, with minimal bone loss and reduced intraarticular bone fragmentation of tunnel rims.

Accordingly, a need exists for a surgical drilling/cutting instrument that is configured to allow improved handling of the instrument within a joint capsule, for example the knee capsule, during ACL reconstruction. A need also exists for a surgical cutter that is stable during knee arthroscopy during the cutting mode, and that also provides drilling of femoral and tibial sockets or tunnels.

SUMMARY OF THE INVENTION

The present invention provides a combined flip cutter and drill instrument that is designed to function in both a drilling mode and a cutting mode. The flip cutter and drill of the present invention is provided with a cutting member with multiple cutting edges which engages the shaft of the instrument to articulate between at least a first “straight” position (for example, about parallel to the longitudinal axis of the instrument) and at least a second “flip” position (for example, a non-parallel position relative to the longitudinal axis of the instrument).

The combined flip cutter and drill of the present invention may be employed in a regular manner (when in the drilling mode, for example), or in a retrograde manner (when in the cutting mode, for example) to form a recipient socket (to accommodate an osteochondral transplant, or to allow retrograde fixation of a graft within two sockets, for example).

These and other features and advantages of the invention will be more apparent from the following detailed description that is provided in connection with the accompanying drawings and illustrated exemplary embodiments of the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The following description is provided to enable any person skilled in the art to make and use the invention and sets forth the best modes contemplated by the inventors of carrying out their invention. Various modifications, however, will remain readily apparent to those skilled in the art.

The present invention provides a combined flip cutter and drill instrument that is designed to function in either a drilling mode or a cutting mode. The flip cutter and drill of the present invention is provided with a drill which has a conical, multi-blade configuration and which engages the shaft of the instrument to articulate between at least a first “straight” position (for example, about parallel to the longitudinal axis of the instrument) and at least a second “flip” position (for example, a non-parallel position relative to the longitudinal axis of the instrument).

The flip cutter and drill of the present invention may be employed in a regular manner (when in the drilling mode or “straight” position, for example), or in a retrograde manner (when in the cutting mode or “flip” position for example) to form a recipient socket (to accommodate an osteochondral transplant, or to allow retrograde fixation of a graft within two sockets, for example).

Referring now to the drawings, where like elements are designated by like reference numerals,FIGS. 1-8illustrate various components of a combined flip cutter and drill100of the present invention. The flip cutter and drill100of the present invention is similar to the flip retrograde cuffing instrument100of U.S. Pat. No. 8,652,139 (the disclosure of which is incorporated in its entirety herewith) but differs in that blade5of the flip retrograde cutter100is replaced by a drill or cutter50which is conical with a plurality of edges52(FIGS. 2 and 4) and/or has a plurality of blades with sharp cutting edges52(FIGS. 6-8), as described in more detail below, to allow drilling both in a regular manner (in an antegrade manner) and in a retrograde manner.

The flip cutter and drill100includes a cannulated elongated body10having a distal end12and a proximal end13, as shown inFIGS. 1, 5A and 5B. The body10of the flip cutter and drill100includes a cannulated shaft or outer tube11provided at its distal end12. The outer tube11houses an inner tube or inner member17(as shown in more detail inFIG. 8, for example) provided with a drill50having a plurality of cutting edges52(as shown inFIG. 2, for example). Details of specific exemplary embodiments of the drill50of the flip cutter and drill100are illustrated inFIGS. 2, 4 and 6-8; however, the invention contemplates other shapes and geometries for the drill50.

Drill50illustrated in detail inFIGS. 2, 4 and 6-8is configured to engage the shaft or inner tube17of the instrument100and to articulate between at least first and second positions. In an exemplary embodiment, drill50engages inner tube17in a first or “straight” position (for example, about parallel to the longitudinal axis of the cutting instrument100), as shown inFIGS. 1, 2 and 6. In the “straight” configuration, instrument100functions in the antegrade drilling mode.

In an exemplary embodiment, drill50engages the shaft of the instrument in a second or “flip” position (for example, a non-parallel position relative to the longitudinal axis of the cutting instrument100), as shown inFIGS. 4, 5A, 5B, and 7. In the “flip” configuration, instrument100functions in the cutting mode (for example, retrograde cutting). The non-parallel position shown inFIGS. 4, 5 and 7is about perpendicular to the longitudinal axis of the cutting instrument100; however, the present invention contemplates embodiments wherein drill50forms any angle with the shaft (for example, an angle between about 10 to about 170 degrees relative to the longitudinal axis of the cutting instrument100, as shown inFIG. 8, for example).

In use, once the drilling/cutting instrument100is inserted into a joint, for example, a knee joint, the surgeon rotates (in the direction of arrow “A” ofFIG. 3) actuating mechanism60to pivot the cutting drill50into the “flip” configuration (i.e., into a position other than the “straight” position), wherein the cutting tip is disposed at an angle of about 90 degrees with respect to the shaft of the instrument. The surgeon may also gradually increase or decrease the angle, as desired and in accordance with the characteristics of the surgical site. Once the drill is articulated in the desired “flip” position, the drill is preferably locked in position by tightening the tube11. A drilling operation (when the instrument is in the “straight” position) or a retrograde cutting operation (when the instrument is in the “flip” position) may be subsequently carried, as desired and as known in the art.

As seen inFIGS. 5A and 5B, actuating mechanism60comprises a driver end1, a nut2, a hub3, a retainer ring7, two pins (a slotted spring pin9and a pin10), and the shaft11. The flip cutter and drill100is preferably assembled by first pressing the4shaft11into the hub3until the shaft11bottoms out. The retainer ring7is then inserted into a groove of the hub3to form a first sub-assembly. Next, the inner member17is inserted into an end of the driver end1and securely engaged using the pin10. The first sub-assembly, described above, is slid over the assembled inner member17and driver end1. Next, the drill50is slid into slot of the inner member17and securely engaged using cross pin8. The nut2is then screwed onto the other end of the driver end1. Next, the hub3is pulled back while advancing the nut2until the retainer ring7engages and the slotted spring pin9is inserted into a through hole in the driver end1to secure the driver end1against the nut2. An O-Ring20may be slid over the shaft11, having laser etches on its circumference. The O-Ring20may be used to measure depth during retrograde drilling.

The present invention may be used to form various sockets or tunnels to allow fixation of a graft (for example, a semitendonosus allograft) or to allow replacement of osteochondral cores or implants in a retrograde manner, to obviate inserting harvesters into the joint. For example, drilling/cutting instrument100of the present invention may be employed for the formation of sockets during an “all-inside ACL RetroConstruction™” for ligament repair, which may comprise, for example, the steps of: (i) drilling at least a femoral and tibial tunnel or socket using a retrograde drill technique employing the drilling/cutting instrument100ofFIGS. 1-8; (ii) providing a graft (soft tissue graft or BTB graft) in the vicinity of the sockets; and (iii) securing the graft within the femoral and tibial tunnels (sockets).

According to yet another embodiment, an exemplary method of ACL RetroConstruction™ of the present invention comprises, for example, the steps of: (i) drilling a femoral socket; (ii) drilling a tibial tunnel or socket using a retrograde drill technique employing the drilling/cutting instrument100ofFIGS. 1-8; (iii) providing a graft (soft tissue graft or BTB graft) in the vicinity of the sockets; (iv) securing the graft (soft tissue graft or BTB graft) to a continuous loop/button construct comprising a button with an oblong configuration and provided with an inside eyelet that allows the passage of the continuous loop, preferably a suture loop; (v) passing the graft with the button through the femoral tunnel; (vi) securing the button to the femoral cortex once the button exits the femoral socket; and (vii) securing the graft in the tibial tunnel or socket.

Although the present invention has been described in connection with preferred embodiments, many modifications and variations will become apparent to those skilled in the art. While preferred embodiments of the invention have been described and illustrated above, it should be understood that these are exemplary of the invention and are not to be considered as limiting. It is preferred, therefore, that the present invention be limited not by the specific disclosure herein, but only by the appended claims.