Abstract:
An arthroscopic surgical device for tunneling through hard tissue including an arcuate tunneling needle driver and a bone engagement element, the arcuate needle driver and the bone engagement element being joined together to provide a joined needle driver and bone engagement element having at least two different operative orientations including an arthroscopic operative orientation wherein the joined arcuate needle driver and bone engagement element has a trans-incision insertion cross-sectional footprint and a tunneling operative orientation suitable for tunneling, wherein the joined arcuate needle driver and bone engagement element has a tunneling cross-sectional footprint which is substantially greater than the insertion cross-sectional footprint.

Description:
REFERENCE TO RELATED APPLICATIONS 
     Reference is made to the following U.S. Provisional Patent Applications which are believed to be related to the present application, the contents of which are hereby incorporated by reference herein and priority of which is hereby claimed under 37 CFR 1.78(a)(4) and (5)(i): 
     U.S. Provisional Patent Application Ser. No. 61/636,751, entitled “Circular Bone Tunneling Device Employing a Stabilizing Element” and filed Apr. 23, 2012; 
     U.S. Provisional Patent Application Ser. No. 61/584,267, entitled “Circular Bone Tunneling Device” and filed Jan. 8, 2012; and 
     U.S. Provisional Patent Application Ser. No. 61/526,717, entitled “Circular Bone Tunneling Device” and filed Aug. 24, 2011. 
     Reference is also made to Published PCT Patent Application No. WO 2012/007941, entitled “Circular Bone Tunneling Device” and filed Jul. 11, 2011, the contents of which are hereby incorporated by reference herein. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates generally to arthroscopic surgical devices and more particularly to arthroscopic bone tunneling devices. 
     BACKGROUND OF THE INVENTION 
     Various types of arthroscopic surgical instruments are known for various applications including orthopedic surgery. 
     SUMMARY OF THE INVENTION 
     The present invention provides an arthroscopic surgical device for tunneling through hard tissue. 
     There is thus provided in accordance with a preferred embodiment of the present invention an arthroscopic surgical device for tunneling through hard tissue including an arcuate tunneling needle driver and a bone engagement element, the arcuate needle driver and the bone engagement element being joined together to provide a joined needle driver and bone engagement element having at least two different operative orientations including an arthroscopic operative orientation wherein the joined arcuate needle driver and bone engagement element has a trans-incision insertion cross-sectional footprint and a tunneling operative orientation suitable for tunneling, wherein the joined arcuate needle driver and bone engagement element has a tunneling cross-sectional footprint which is substantially greater than the insertion cross-sectional footprint. 
     There is also provided in accordance with another preferred embodiment of the present invention an arthroscopic surgical device for tunneling through hard tissue including an at least partially flexible arcuate tunneling needle driver and a bone engagement element, the at least partially flexible arcuate tunneling needle driver including a needle pushing element which is capable of assuming an arcuate orientation during needle driving operation thereof. 
     Preferably, the at least partially flexible arcuate needle driver and the bone engagement element are joined together to provide a joined arcuate needle driver and bone engagement element, the joined arcuate needle driver and bone engagement element having at least two different operative orientations including an arthroscopic operative orientation wherein the joined arcuate needle driver and bone engagement element has a trans-incision insertion cross-sectional footprint and a tunneling operative orientation suitable for tunneling, wherein the joined arcuate needle driver and bone engagement element has a tunneling cross-sectional footprint which is substantially greater than the insertion cross-sectional footprint. 
     Preferably, the trans-incision insertion cross-sectional footprint is suitable for arthroscopic insertion and the tunneling cross-sectional footprint is not suitable for arthroscopic insertion. 
     In accordance with a preferred embodiment of the present invention the bone engagement element is a rotatable bone engagement element. 
     In accordance with a preferred embodiment of the present invention the arthroscopic surgical device for tunneling through hard tissue also includes a bone engaging pin driving assembly including an elongate bone engaging pin. Additionally, the bone engaging pin includes a tapered screw threading. 
     Preferably, the arcuate tunneling needle driver includes a hand-engageable ratchet handle arranged for reciprocal motion about an axis and a selectable direction ratchet gear shaft. 
     In accordance with a preferred embodiment of the present invention the arthroscopic surgical device for tunneling through hard tissue also includes an arcuate tunneling needle. 
     Preferably, the arcuate tunneling needle driver includes a flexible needle driving strip and a generally rigid flexible needle driving strip driving shaft, mounted at a rear end of flexible needle driving strip. 
     In accordance with a preferred embodiment of the present invention the arthroscopic surgical device for tunneling through hard tissue also includes an arcuate needle storage and guiding portion, formed with an arcuate bore. Additionally or alternatively, the arthroscopic surgical device for tunneling through hard tissue also includes a bone engagement element positioning assembly including a finger-engageable release trigger, finger engageable bone engagement element advancement knobs and a hollow bone engagement element driving shaft. 
     Preferably, the arthroscopic surgical device for tunneling through hard tissue also includes a needle and suture mounting assembly. 
     In accordance with a preferred embodiment of the present invention the arthroscopic surgical device for tunneling through hard tissue also includes a bone suture insertion assembly including a looped suture and a tensionable resilient elongate element connected to the looped suture for selectable tensioning of the looped suture. 
     There is further provided in accordance with yet another preferred embodiment of the present invention a bone suture insertion assembly for use with an arthroscopic surgical device for tunneling through hard tissue, the assembly including a looped suture and a tensionable resilient elongate element connected to the looped suture for selectable tensioning of the looped suture. 
     There is even further provided in accordance with still another embodiment of the present invention an arthroscopic surgical method for tunneling through hard tissue including providing an arthroscopic surgical device including an arcuate tunneling needle, an arcuate tunneling needle driver and a rotatable bone engagement element, joining the arcuate tunneling needle driver and the rotatable bone engagement element to provide a joined needle driver and bone engagement element having multiple different operative orientations, mounting a suture mounting assembly, including a suture, onto the arthroscopic surgical device, inserting a forward portion of the arthroscopic surgical device through an incision such that the forward portion engages the hard tissue, extending the arcuate tunneling needle through the hard tissue, engaging a forward end of the suture with the arcuate tunneling needle and retracting the arcuate tunneling needle through the hard tissue, thereby pulling the suture through the hard tissue. 
     Preferably, the multiple different operative orientations include at least an arthroscopic operative orientation wherein the joined arcuate needle driver and bone engagement element has a trans-incision insertion cross-sectional footprint and a tunneling operative orientation suitable for tunneling, wherein the joined arcuate needle driver and bone engagement element has a tunneling cross-sectional footprint which is substantially greater than the insertion cross-sectional footprint. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention will be understood and appreciated from the following detailed description, taken in conjunction with the drawings in which: 
         FIGS. 1A &amp; 1B  are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in a first operative orientation; 
         FIGS. 2A &amp; 2B  are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in a second operative orientation; 
         FIGS. 3A &amp; 3B  are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in a third operative orientation; 
         FIGS. 4A &amp; 4B  are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in a fourth operative orientation; 
         FIGS. 5A &amp; 5B  are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in a fifth operative orientation; 
         FIGS. 6A &amp; 6B  are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in a sixth operative orientation; 
         FIGS. 7A &amp; 7B  are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in a seventh operative orientation; 
         FIGS. 8A &amp; 8B  are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in an eighth operative orientation; 
         FIGS. 9A &amp; 9B  are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in a ninth operative orientation; 
         FIGS. 10A &amp; 10B  are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in a tenth operative orientation; 
         FIGS. 11A &amp; 11B  are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in an eleventh operative orientation; 
         FIG. 12  is a simplified exploded view illustration of the arthroscopic surgical device of  FIGS. 1A-11B  in the first operative orientation; 
         FIGS. 13A and 13B  are simplified exploded view illustrations of a portion of the arthroscopic surgical device of  FIGS. 1A-12 , showing opposite views; 
         FIG. 13C  is a simplified partially assembled view of the portion of the arthroscopic surgical device of  FIGS. 13A and 13B ; 
         FIGS. 14A and 14B  are simplified illustrations of another portion of the arthroscopic surgical device of  FIGS. 1A-12 , showing opposite views; 
         FIGS. 15A and 15B  are simplified exploded view illustrations of the portion of the arthroscopic surgical device of  FIGS. 14A &amp; 14B , showing opposite views; 
         FIGS. 16A and 16B  are simplified illustrations of part of the portion of the arthroscopic surgical device of  FIGS. 14A-15B , showing opposite views; 
         FIGS. 17A and 17B  are respective exploded and assembled views of part of the portion of the arthroscopic surgical device of  FIGS. 14A &amp; 14B ; 
         FIG. 17C  is a sectional illustration of the part of the portion of the arthroscopic surgical device of  FIGS. 17A &amp; 17B , taken along line XVIIC-XVIIC in  FIG. 17B ; 
         FIG. 18A  is a pictorial illustration of another part of the portion of the arthroscopic surgical device of  FIGS. 14A &amp; 14B ; 
         FIG. 18B  is a sectional illustration of the part of the portion of the arthroscopic surgical device shown in  FIG. 18A , taken along line XVIIIB-XVIIIB in  FIG. 18A ; 
         FIGS. 19A, 19B and 19C  are simplified illustrations of one alternative functionality for mounting of a suture on a resilient loop which is in turn mounted on a forward portion of the arthroscopic surgical device of  FIGS. 1A-12 ; 
         FIGS. 20A, 20B and 20C  are simplified illustrations of another alternative functionality for mounting of a suture on a resilient loop which is in turn mounted on a forward portion of the arthroscopic surgical device of  FIGS. 1A-12 ; 
         FIGS. 21A, 21B, 21C, 21D, 21E, 21F, 21G, 21H, 21I, 21J, 21K, 21L, 21M and 21N  are respective simplified illustrations of displacement of various part of the arthroscopic surgical device of  FIGS. 1A-20C  during operation thereof; and 
         FIGS. 22A, 22B, 22C, 22D, 22E, 22F, 22G, 22H, 22I, 22J, 22K, 22L, 22M and 22N  are simplified illustrations of operation of the arthroscopic surgical device of  FIGS. 1A-21N  in a clinical context. 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     Reference is now made to  FIGS. 1A &amp; 1B , which are simplified pictorial illustrations of an arthroscopic surgical device constructed and operative in accordance with a preferred embodiment of the present invention, showing opposite views in a first operative orientation, and to  FIG. 12 , which is a simplified exploded view illustration of the arthroscopic surgical device of  FIGS. 1A-11B . 
     As seen in  FIGS. 1A, 1B and 12 , an arthroscopic surgical device  100  according to a preferred embodiment of the present invention includes a housing portion, preferably formed of right and left housing elements  102  and  104 , and a multiple action driving assembly  106 . The housing portion includes a handle portion, which is defined by respective right and left housing element handle portions  112  and  114 , respectively. 
     The multiple action driving assembly  106  preferably includes a bone-engaging pin driving assembly  120  preferably including a knurled knob  122  and an elongate bone-engaging pin  124 , extending forwardly therefrom, having a pointed forward end  126  which may be formed with a tapered screw threading  128 . 
     The multiple action driving assembly  106  preferably includes a hand-engageable ratchet handle  130  which is arranged for reciprocal motion about an axis  132  defined by a shaft  134 . A selectable direction ratchet gear shaft  135  extends through slots  136  in respective right and left housing element handle portions  112  and  114 , and terminates in knobs  146 , whose positions in slots  136  govern the direction of motion of an arthroscopic arcuate tunneling needle  148  having a suture engagement groove  149 , which is fully described hereinbelow with reference to  FIGS. 15A and 15B . 
     The multiple action driving assembly  106  also preferably includes a bone engagement element positioning assembly  150 , including a finger-engageable release trigger  152 , finger engageable bone engagement element advancement knobs  154 , a hollow bone engagement element driving shaft  156  and a rotatable bone engagement element  158 , pivotably mounted onto a transverse pin  160  ( FIG. 17A ) mounted onto a forward end  162  ( FIG. 22C ) of driving shaft  156  for pivotable displacement about an axis  164  ( FIG. 17A ) defined by pin  160 . Hollow bone engagement element driving shaft  156  and rotatable bone engagement element  158  are shown in their respective fully retracted orientations in  FIGS. 1A, 1B and 12 . 
     Disposed forwardly of housing elements  102  and  104  is a needle and suture mounting assembly  170  including a suture  172 , which removably engages, at a forward end  174  thereof, a groove  176  in rotatable bone engagement element  158  and is mounted, at a rearward end thereof, via a resilient suture mounting element  182  and a suture mounting adaptor  183  onto a groove  184  in a mounting base  185 , which is fixedly mounted onto housing portions  102  and  104 . 
     A finger-engageable suture mounting adaptor release lever  186  is mounted onto housing portions  102  and  104  via a pin  187  and is operative when depressed to cause suture mounting adaptor  183  to disengage from groove  184  and thus from engagement with mounting base  185 . 
     First and second visible mechanical indictors  190  and  192  are preferably arranged on the top of respective housing portions  102  and  104 . Indicator  190  preferably provides a visible indication of the extent that arcuate tunneling needle  148  is displaced from its fully retracted position shown in  FIGS. 1A &amp; 1B . Indicator  192  preferably provides a visible indication of the extent that hollow bone engagement element driving shaft  156  and rotatable bone engagement element  158  are displaced forwardly with respect to their fully retracted positions shown in  FIGS. 1A &amp; 1B . 
     Reference is now made to  FIGS. 2A &amp; 2B , which are simplified pictorial illustrations of the arthroscopic surgical device of  FIGS. 1A-1B and 12 , showing opposite views in a second operative orientation. It is seen that in the second operative orientation, which preferably takes place following insertion of the device through an arthroscopic incision, as described hereinbelow in detail with reference to  FIG. 22B , the hollow bone engagement element driving shaft  156  and the rotatable bone engagement element  158  are extended relative to their fully retracted positions shown in  FIGS. 1A &amp; 1B , as indicated by indicator  192 . 
     Reference is now made to  FIGS. 3A &amp; 3B , which are simplified pictorial illustrations of the arthroscopic surgical device of  FIGS. 1A-2B and 12  in a third operative orientation. It is seen that hollow bone engagement element driving shaft  156  and the rotatable bone engagement element  158  are further extended, as indicated by indicator  192 , and that rotatable bone engagement element  158  is partially rotated relative to its position shown in  FIGS. 2A &amp; 2B . This rotation of the rotatable bone engagement element  158  is initially produced by forward linear displacement of bone-engaging pin driving assembly  120 , preferably including knurled knob  122  and elongate bone-engaging pin  124 , through hollow bone engagement element driving shaft  156 , such that forward end  126  engages rotatable bone engagement element  158  and causes it to pivot about axis  164 . 
     Reference is now made to  FIGS. 4A &amp; 4B , which are simplified pictorial illustrations of the arthroscopic surgical device of  FIGS. 1A-3B and 12  in a fourth operative orientation. It is seen that the rotatable bone engagement element  158  is now further extended and fully rotated by approximately 90 degrees relative to its position shown in  FIGS. 2A &amp; 2B . It is seen that bone engagement pin  124  is further extended by the further forward linear displacement of knob  122  relative to housing portions  102  and  104 . This rotation of the rotatable bone engagement element  158  is produced by further forward linear displacement of bone-engaging pin driving assembly  120  and by the tension applied by resilient suture mounting element  182  to suture  172 , which engages rotatable bone engagement element  158 . 
     Reference is now made to  FIGS. 5A &amp; 5B , which are simplified pictorial illustrations of the arthroscopic surgical device of  FIGS. 1A-4B and 12  in a fifth operative orientation. It is seen that the hollow bone engagement element driving shaft  156  and the rotatable bone engagement element  158  are both yet further extended. It is also seen that bone engagement pin  124  is further extended to its maximum extent as indicated by the position of knob  122  relative to housing portions  102  and  104 . 
     Reference is now made to  FIGS. 6A &amp; 6B , which are simplified pictorial illustrations of the arthroscopic surgical device of  FIGS. 1A-5B and 12  in a sixth operative orientation. It is seen that the rotatable bone engagement element  158  and the bone engagement pin  124  remain in their maximum extended positions, as shown in  FIGS. 5A &amp; 5B , and that arcuate tunneling needle  148  is partially extended, as indicated by indicator  190 . 
     Reference is now made to  FIGS. 7A &amp; 7B , which are simplified pictorial illustrations of the arthroscopic surgical device of  FIGS. 1A-6B and 12  in a seventh operative orientation. It is seen that the rotatable bone engagement element  158  and the bone engagement pin  124  remain in their maximum extended positions, as shown in  FIGS. 5A &amp; 5B , and that arcuate tunneling needle  148  is nearly fully extended, as indicated by indicator  190 . 
     Reference is now made to  FIGS. 8A &amp; 8B , which are simplified pictorial illustrations of the arthroscopic surgical device of  FIGS. 1A-7B and 12  in an eighth operative orientation. It is seen that the rotatable bone engagement element  158  and the bone engagement pin  124  remain in their maximum extended positions, as shown in  FIGS. 5A &amp; 5B , and that arcuate tunneling needle  148  is fully extended, as indicated by indicator  190 . It is seen that the forward end  174  of suture  172  is now engaged in suture engagement groove  149  of needle  148 . 
     Reference is now made to  FIGS. 9A &amp; 9B , which are simplified pictorial illustrations of the arthroscopic surgical device of  FIGS. 1A-8B and 12  in a ninth operative orientation. It is seen that the positions of knobs  146  in slots  136  are shifted downwardly, in order to provide retraction of needle  148  in response to ratchet operation. The rotatable bone engagement element  158  and the bone engagement pin  124  remain in their maximum extended positions, as shown in  FIGS. 5A &amp; 5B , and arcuate tunneling needle  148  is partially retracted, as indicated by indicator  190 , in engagement with the forward end of suture  172 , thus drawing the suture  172  backwards along with retraction of the needle  148  along an arcuate path earlier defined through the bone by the arcuate tunneling operation of needle  148 . 
     Reference is now made to  FIGS. 10A &amp; 10B , which are simplified pictorial illustrations of the arthroscopic surgical device of  FIGS. 1A-9B and 12  in a tenth operative orientation. The rotatable bone engagement element  158  and the bone engagement pin  124  remain in their maximum extended positions, as shown in  FIGS. 5A &amp; 5B , and arcuate tunneling needle  148  is fully retracted as indicated by indicator  190 , in engagement with the forward end of suture  172 , thus drawing the suture backwards along an arcuate path along with full retraction of the needle  148 . 
     Reference is now made to  FIGS. 11A &amp; 11B , which are simplified pictorial illustrations of the arthroscopic surgical device of  FIGS. 1A-10B and 12  in an eleventh operative orientation. The rotatable bone engagement element  158  and the bone engagement pin  124  have been fully retracted and arcuate tunneling needle  148  is now partially extended in order to permit manual disengagement of the forward end  174  of suture  172  from groove  149  of needle  148 . It is noted that the positions of knobs  146  in slots  136  are shifted upwardly, in order to provide extension of needle  148  in response to ratchet operation. The orientations of the various elements are shown by indicators  190  and  192 . 
     Reference is now further made to  FIG. 12  and additionally made to  FIGS. 13A and 13B , which are simplified exploded view illustrations of a portion of the arthroscopic surgical device of  FIGS. 1A-12 , showing opposite views, and to  FIG. 13C , which is a simplified partially assembled view, all of which show details of some elements of multiple action driving assembly  106 . 
     It is seen that ratchet handle  130  is typically formed with a lower aperture  210  which accommodates shaft  134  and is formed with a slot  212 . A pin  214  is slidably movable in slot  212 , such that reciprocal arcuate motion of slot  212  is translated into reciprocal planar forward and rearward motion perpendicular to a longitudinal axis  216  of pin  214 . First and second reciprocal motion connection elements  220  and  222  are fixed to pin  214  at respective apertures  224  and  226  and move together therewith in reciprocal forward and rearward linear motion in response to rotational motion of ratchet handle  130 . 
     Connection element  222  includes an elongate protrusion  228 , which moves reciprocally in a slot  230  formed in housing portion  102 . 
     Connection element  220  includes a side extending shaft  240  which includes a circumferential groove  244  onto which is mounted one end of a tension spring  248 . An opposite end of tension spring  248  is mounted in a circumferential groove  250  formed in shaft  135 . Shaft  135  extends through an aperture  254  formed in a toggle element  256 , which communicates with a hollow shaft portion  258  of toggle element  256 . Shaft  135  extends through slots  136  formed on respective housing portions  102  and  104 . 
     A double rack linear toothed element  270  is provided with an upper linear toothed ratchet rack  272  and a lower linear toothed gear rack  274 . A pointed corner  275  of connection element  220  selectably engages upper linear toothed rack  272 . Double rack linear toothed element  270  is preferably formed with a slot  276  which engages an elongate axial protrusion  277  formed in housing element  102 . 
     An inward recessed portion  278  adjacent an inner end of a generally rigid flexible needle driving strip driving shaft  280  is fixedly mounted onto double rack linear toothed element  270  by means of a mounting element  282  which is typically bolted onto element  270 . An indicator finger  284  is formed on mounting element  282  and forms part of indicator  190 . 
     A second double rack linear toothed element  285  is provided with an upper linear toothed gear rack  286  and a lower linear toothed ratchet rack  287 . Double rack linear toothed element  285  is preferably formed with a slot  288  which engages an elongate axial protrusion  289  formed in housing element  102 . 
     A gear  290 , having a gear shaft  291 , engages lower linear toothed gear rack  274  of element  270  and also simultaneously engages upper linear toothed gear rack  286  of element  285 . Gear shaft  291  preferably is mounted at its opposite ends in apertures  292  in respective housing elements  102  and  104 . 
     A pointed corner  293  of connection element  220  selectably engages lower linear toothed ratchet rack  287  of element  285 . 
     It is seen that trigger  152  forms part of a selectable release element  294 , which forms part of assembly  150  and includes a engagement protrusion  295  and collar  296  through which extends gear shaft  291 . Selectable release element  294  is pivotable about the axis of gear shaft  291  and includes a protrusion  297  which serves as a seat for one end of a compression spring  298 , whose other end is seated in a spring seat  299  formed in housing portion  102 . 
     A linear gear rack element  300  is preferably driven along an linear travel path by a gear  301 , having a gear shaft  302 , which extends through respective housing portions  102  and  104  into fixed engagement with knobs  154 . Gear  301  is normally prevented from clockwise rotation by engagement therewith by engagement protrusion  295  of selectable release element  294 . A mounting assembly  303  is fixed to linear gear rack element  300  and is operative to fixedly mount a rearward end of hollow bone engagement element driving shaft  156  onto element  300  for linear movement therewith. An indicator finger  304  is also preferably fixedly mounted onto mounting assembly  303  and forms part of indicator  192 . 
     Preferably, mounting assembly  303  is formed with a pair of oppositely directed elongate protrusions  305  which engage corresponding grooves  306  formed in housing portions  102  and  104 . 
     Reference is now made to  FIGS. 14A-16B , which illustrate needle and suture mounting assembly  170 . The needle and suture mounting assembly  170  includes linear gear rack element  300 , which is preferably driven along an elongate travel path by gear  301  responsive to rotation of either of knobs  154 . 
     Suture mounting adaptor  183  is seated on mounting base  185 , a rearward end of which is, in turn, fixed to a forward end of the housing. Mounting base  185  surrounds a rearward end of an extension shaft  310  formed of two identical side by side pieces  311  which together define two mutually spaced axial mounting bores extending therethrough, which bores are designated by reference numerals  312  and  314 . Bore  312  slidably accommodates hollow bone engagement element driving shaft  156  and has a generally round cross-section. 
     Bore  314  slidably accommodates parts of a flexible arcuate needle driving assembly, which preferably includes a flexible needle driving strip  318 , preferably formed of spring steel, and generally rigid flexible needle driving strip driving shaft  280 , which is mounted at the rear of flexible needle driving strip  318 , preferably as shown in enlargement A in  FIG. 14B . As seen in enlargement B in  FIG. 14B , bore  314  has a generally circular cross sectional portion  322  to accommodate shaft  280  from which extend a pair of symmetrical side cut outs  324  to accommodate the side edges of strip  318 . 
     Forward of extension shaft  310 , there is preferably formed an arcuate needle storage and guiding portion  350 , which is formed with an arcuate bore  352  including a rectangular portion  354 , which slidably accommodates needle  148 , from which extend a pair of symmetrical side cut outs  356  to accommodate the side edges of strip  318 . 
     As seen particularly in  FIG. 15A , it is seen that suture engagement groove  149  of arcuate needle  148  is partially defined by a partially overlying portion  357  of needle  148 . 
     It is seen that bone engagement pin  124  slidably extends through bone engagement element driving shaft  156 , which in turn slidably extends through bore  312 . 
     Reference is now made to  FIGS. 17A and 17B , which are respective exploded and assembled views of the rotatable bone engagement element  158 , which forms part of the portion of the arthroscopic surgical device of  FIGS. 14A &amp; 14B , and to  FIG. 17C , which is a sectional illustration of the rotatable bone engagement element  158 , taken along line XVIIC-XVIIC in  FIG. 17B . 
     As seen in  FIGS. 17A-17C , the rotatable bone engagement element  158  is a side-to-side symmetric element including side wall portions  402  and  404  joined by a bridging portion  406 . Each of the side wall portions  402  and  404  includes a protruding top pointed bone engaging portion  408 , a protruding bottom pointed bone engaging portion  410  and an aperture  412  for rotatably accommodating pin  160 . An arcuate slot  416  is formed in each side wall. Slots  416  together define groove  176  ( FIGS. 1A &amp; 1B ) which is partially engaged by the forward end  174  of suture  172 . An inwardly directed protrusion  418  is formed on an inner wall surface of each of side wall portions  402  and  404 . 
     A flexible bent plate  420  is preferably attached at a top portion  422  to a rear facing surface of bridging portion  406  and is arranged to have a forwardly directed bottom portion  424  normally seated between side wall portions  402  and  404  so as to partially block access to arcuate slots  416  by the forward end  174  of suture  172 . 
     Reference is now made to  FIG. 18A , which is a pictorial illustration of mounting base  185 , another part of the portion of the arthroscopic surgical device of  FIGS. 14A &amp; 14B , and to  FIG. 18B , which is a sectional illustration taken along line XVIIIB-XVIIIB in  FIG. 18A . As seen in  FIGS. 18A &amp; 18B , the mounting base  185  is a generally cylindrical element having a longitudinal bore  440  extending therethrough, which accommodates the rearward end of extension shaft  310 . 
     Reference is now made to  FIGS. 19A, 19B and 19C , which are simplified illustrations of one alternative structure and functionality for mounting of a suture on a resilient loop which is in turn mounted on a forward portion of the arthroscopic surgical device of  FIGS. 1A-12 . 
     As seen in  FIGS. 19A-19C , there is preferably provided a suture mounting assembly including suture  172 , resilient suture mounting element  182  and suture mounting adapter  183 , which is adapted for removable mounting onto mounting base  185  ( FIGS. 18A-18B ). Suture mounting element adapter  183  preferably is configured generally as a cap which is removably seated onto mounting base  185 . Suture mounting element adapter  183  preferably includes a rearward facing resilient engagement element  442  which is snap engageable with circumferential groove  184  of mounting base  185 . 
       FIG. 19A  shows the various elements prior to assembly thereof and  FIG. 19B  shows the suture  172  knotted onto the resilient suture mounting element  182 .  FIG. 19C  shows the resilient suture mount element  182 , having the suture  172  knotted thereon, retained onto hook  310  of suture mounting element adapter  183 . 
     Reference is now made to  FIGS. 20A, 20B and 20C , which are simplified illustrations of another alternative structure and functionality for mounting of a suture on a resilient loop which is in turn mounted on a forward portion of the arthroscopic surgical device of  FIGS. 1A-12 . 
     As seen in  FIGS. 20A-20C , there is preferably provided a suture mounting assembly including a endless looped suture  450 , resilient suture mounting element  182  and suture mounting adapter  183 , which is adapted for removable mounting onto mounting base  185  ( FIGS. 18A-18B ). As in the embodiment of  FIGS. 19A-19C , suture mounting element adapter  183  preferably is configured generally as a cap which is removably seated onto mounting base  185  and preferably includes a rearward facing resilient engagement element  442  which is snap engageable with circumferential groove  184  of mounting base  185 . 
       FIG. 20A  shows the various elements prior to assembly thereof and  FIG. 20B  shows the suture  450  looped over the resilient suture mounting element  182 .  FIG. 20C  shows the resilient suture mount element  182 , having the suture  450  knotted thereon, retained onto hook  310  of suture mounting element adapter  183 . 
     Reference is now made to  FIGS. 21A, 21B, 21C, 21D, 21E, 21F, 21G, 21H, 21I, 21J, 21K, 21L, 21M and 21N , which illustrate details of the operation of the arthroscopic surgical device of  FIGS. 1A-20C , and to  FIGS. 22A, 22B, 23C, 23D, 23E, 23F, 23G, 22H, 22I, 22J, 22K, 22L, 22M and 22N , which are simplified illustrations of operation of the arthroscopic surgical device of  FIGS. 1A-21N  in a clinical context. 
     As seen in  FIGS. 21A and 22A , which correspond generally to  FIGS. 1A &amp; 1B , prior to insertion of the arthroscopic surgical device  100  through an arthroscopic incision  500  in a patient, a suture mounting assembly  170 , such as that described hereinabove with reference to  FIGS. 19A-19C , is mounted onto the arthroscopic surgical device  100 , with a forward end  174  of the suture  172  being retained in slots  416  ( FIGS. 17A-17C ) defining groove  176  ( FIGS. 1A &amp; 1B ) of bone engagement element  158 . 
       FIG. 22B  shows insertion of a forward portion of arcuate needle storage and guiding portion  350  through incision  500  such that a forwardmost end  502  of arcuate needle storage and guiding portion  350  engages a bone, here shown as a humerus. 
     It is seen in  FIGS. 21A, 22A &amp; 22B  that the bone engagement pin  124  and a hollow bone engagement element driving shaft  156  are in their fully retracted positions and that knobs  146  are in their upward positions in slots  136 . As seen in  FIG. 22B , indicator  190  shows full retraction of flexible needle driving strip driving shaft  280  and of arcuate tunneling needle  148  and indicator  192  shows full retraction of hollow bone engagement element driving shaft  156  and of bone engagement element  158 . As further shown in  FIGS. 21A, 21B &amp; 22B , knobs  146  are positioned to their upper operative orientation in slots  136 , for forward direction driving of arcuate tunneling needle  148 . 
       FIGS. 21B and 22C , which correspond generally to  FIGS. 2A &amp; 2B , show counterclockwise rotation of knobs  154 , in the sense of  FIG. 21B , as indicated by an arrow  504  in  FIG. 21B . This counterclockwise rotation, as seen particularly in enlargement A in  FIG. 21B , produces corresponding counterclockwise rotation of gear  301 , as indicated by an arrow  506 , in engagement with linear gear rack element  300 , driving linear gear rack element  300  forwardly in the sense of  FIG. 21B , as indicated by an arrow  507 . 
     As noted above with reference to  FIGS. 12-13C , mounting assembly  303  fixes hollow bone engagement element driving shaft  156  onto element  300  for linear movement therewith. Thus, forward motion of linear gear rack element  300  produces corresponding forward extension of hollow bone engagement element driving shaft  156 , as can be seen by comparing enlargement A of  FIG. 21B  with corresponding enlargement A of  FIG. 21A . 
     Enlargements B in  FIGS. 21B, 21C, 21D and 21E , which correspond generally to  FIGS. 2A-5B , show various stages in rotation of rotatable bone engagement element  158  about axis  164  and forward displacement of knurled knob  122  and elongate bone-engaging pin  124 , extending forwardly therefrom. 
       FIG. 22C , which corresponds generally to  FIGS. 4A &amp; 4B , shows extension of hollow bone engagement element driving shaft  156  and rotation of rotatable bone engagement element  158  about axis  164  defined by pin  160  into operative engagement with the bone. Indicator  190  is unchanged from its position shown in  FIG. 22B , indicating that the arcuate needle  148  remains in its fully retracted position. Indicator  192  shows the extension of hollow bone engagement element driving shaft  156  as can be seen by comparing the positions of indicator finger  304  in  FIGS. 22B and 22C  respectively. 
       FIG. 22D , which corresponds generally to  FIGS. 5A &amp; 5B , shows that the optionally threaded portion  128  at the forward end  126  of bone engagement pin  124  is fully engaged with the bone, preferably as by both linear and rotational movement thereof, as indicated by the position of knob  122  and by an arrow  510  relative to housing portions  102  and  104 . 
       FIGS. 21F and 21G  and  FIG. 22E , which correspond generally to  FIGS. 6A &amp; 6B , show partial extension of arcuate tunneling needle  148  through the bone, as indicated by indicator finger  284  of indicator  190 . 
       FIGS. 21E, 21F, 21G &amp; 21H , particularly at enlargements C thereof, show that squeezing on hand-engageable ratchet handle  130  produces rotation thereof, as indicated by an arrow  518 , about a rotational axis defined by shaft  134  and, via pin  214 , displaces first reciprocal motion connection element  220  linearly forwardly, as indicated by an arrow  520 , with pointed corner  275  of connection element  220  in engagement with upper linear toothed rack  272  of double rack linear toothed element  270 , thereby driving element  270  and flexible needle driving strip driving shaft  280  forwardly and causing arcuate needle  148 , driven thereby, to travel along an arcuate path through the portion of arcuate bore  352  having a rectangular cross section and to extend outwardly into tunneling engagement with the bone, as indicated by arrow  522 . 
       FIG. 21G  shows retraction of handle  130 , as indicated by an arrow  530 , under urging of spring  248  whereby pointed corner  275  is operationally disengaged from rack  272  of double rack linear toothed element  270 , such that one or more subsequent squeeze on handle  130 , as indicated by an arrow  526 , produces further linear forward motion of double rack linear toothed element  270  and consequent further arcuate extension travel of needle  148 , as seen in  FIG. 21H . 
     It is appreciated that simultaneous engagement of gear  290  with lower linear toothed gear rack  274  of element  270  and upper linear toothed gear rack  286  of element  285  produces rearward linear motion of element  285  corresponding to forward linear motion of element  270 . 
       FIGS. 21H and 22F , which correspond generally to  FIGS. 7A &amp; 7B , show further arcuate extension of arcuate tunnel needle  148 , as indicated by an arrow  534 , through the bone, driven by further squeezing of handle  130 , as well as initial engagement of a forward end of needle  148  with flexible bent plate  420  of the bone engagement element  158 . 
       FIGS. 21I &amp; 22G , which correspond generally to  FIGS. 8A &amp; 8B , show nearly complete extension of arcuate tunnel needle  148  in engagement with flexible bent plate  420  and bending back of flexible bent plate  420  so as to disengage bottom portion  424  thereof from the forward end  174  of suture  172 . It is noted that forward end  174  of suture  172  does not move further into suture engagement groove  149  of needle  148  because it is blocked by a partially overlying portion  357  of needle  148  which partially defines groove  149  of needle  148 . 
       FIG. 22H , which corresponds generally to  FIGS. 8A &amp; 8B , shows complete extension of arcuate tunnel needle  148 . It is noted that the forward end of suture  172  moves into groove  149  of needle  148 , by the resilient action of resilient suture mounting element  182 , and is engaged by needle  148 . The complete extension of arcuate tunnel needle  148  is indicated by indicator finger  284  of indicator  190 . 
       FIGS. 21J, 22I and 22J , which correspond generally to  FIGS. 9A &amp; 9B , show initial retraction of arcuate tunnel needle  148 , as indicated by arrows  535 , following repositioning of knobs  146 , as indicated by an arrow  536 , which produces reverse driving of the ratchet assembly operated by squeezing handle  130 . It is noted that the needle  148  carries with it the suture  172 . 
     Repositioning of knobs  146  causes repositioning of connection element  220 , as indicated by an arrow  538 , causing pointed corner  293  of connection element  220  to engage lower linear toothed ratchet rack  287  of element  285 , as seen in  FIG. 21J , such that squeezing of handle  130 , as indicated by an arrow  539 , causes element  285  to be moved linearly forward. It is appreciated that simultaneous engagement of gear  290  with lower linear toothed gear rack  274  of element  270  and upper linear toothed gear rack  286  of element  285  produces rearward linear motion of element  270  in response to forward linear motion of element  285 . 
       FIG. 22K , which corresponds generally to  FIGS. 10A &amp; 10B , shows further retraction of arcuate tunnel needle  148 . It is noted that the needle  148  continues to draw the suture  172  with it. 
       FIGS. 21K and 22L , which correspond generally to  FIGS. 11A and 11B , show retraction of arcuate tunnel needle  148  entirely out of the bone. It is noted that the needle  148  continues to draw the suture  172  therewith. 
       FIG. 21L  shows rearward pivot displacement of finger-engageable release trigger  152 , as indicated by an arrow  540 , against the urging of compression spring  298 , and simultaneous clockwise rotation of knob  154 . Rearward pivot displacement of release trigger  152  causes selectable release element  294  to rotate counterclockwise, as indicated by arrow  541 , about the axis of gear shaft  291 , thereby producing disengagement of engagement protrusion  295  of element  294  from gear  301 , thus enabling gear  301  to be rotated by knob  154  in a clockwise direction, as indicated by an arrow  542 , which in turn produces retraction of hollow bone engagement element driving shaft  156 . 
       FIG. 21M  shows full retraction of bone engagement pin  124 . 
       FIG. 22M  shows full removal of the arthroscopic surgical device from the patient&#39;s body via the arthroscopic incision  500 , with the suture  172  extending through the bone. 
       FIG. 21N  shows slight extension of the needle  148  to enable manual disengagement of the suture  172  from groove  149  therein. This extension is produced by upward repositioning of knobs  146  in slots  136  and squeezing of handle  130 . 
       FIG. 22N  shows manual release of the forward part  174  of suture  172  from suture engagement groove  149  of needle  148 . 
     It will be appreciated by persons skilled in the art that the present invention is not limited by what has been particularly shown and described hereinabove. Rather the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove as well as modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not in the prior art.