Patent Publication Number: US-2021177493-A1

Title: Arthroscopic devices and methods

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of provisional application No. 62/357,786 (Attorney Docket No. 41879-726.101), filed on Jul. 1, 2016, the full disclosure of which is incorporated herein by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to arthroscopic surgical devices by which anatomical tissues in knee joints, hip joints and the like may be ablated, cut and/or removed from a joint. More specifically, this invention relates to electrosurgical probes that can be articulated with a motor drive in an arthroscopy handpiece. 
     Arthroscopic joint and other procedures, such as hip treatments, subacromial decompression, treatment of the acromioclavicular joints, often require a number of different tools having different functions and structures. In order to reduce the cost and inventory burdens associated with using a large array of tools in a single procedure. “resposable” tools having a disposable working end and a reusable handpiece have been proposed. The handpiece will be designed to work with a large number of different tool types having different functions and “working ends” so that the cost and inventory of necessary tools can be reduced. 
     While the use of resposable tools holds great promise, a successful resposable tool system requires that one type of handpiece be compatible with as many types of tools and working ends as possible. For example, many handpieces will have motor drives with a rotating drive shaft. Such motor drives need to be compatible not only with rotating end effectors, such as drills, shavers, grinders, and the like, they should also be compatible with non-rotating end effectors. 
     Of particular interest to the present invention, it would be desirable to provide tools and working ends having articulating end effectors which can be driven by a motorized handpiece having a rotatable drive element. Arthroscopic probes having an articulating working end allow physicians to reach targeted tissues which would otherwise be difficult to access. The need thus exists for improved and alternative articulating arthroscopic devices that that can ablate and extract soft tissue rapidly and also be compatible with rotating drive elements. At least some of these objectives will be met by the inventions described and claimed herein. 
     2. Description of the Background Art 
     Arthroscopic tissue ablation and extraction devices are described in the following commonly owned patents and published applications: U.S. Pat. Nos. 9,603,656; 9,585,675; 9,592,085; 9,277,954; 9,204,918; and 8,323,280; and U.S. Patent Publication Nos. US 2016/0346036; US 2016/0157916; and US 2016/0113706, the full disclosures of which are incorporated herein by reference. 
     SUMMARY OF THE INVENTION 
     The present invention provides arthroscopic and other minimally invasive tools and tool systems. The tool systems include motorized handpieces and detachable tools, where the detachable tools are usually intended for only a single use by a single patient (often being referred to as disposable tools) and the motorized handpieces are usually intended to be reused in multiple procedures for multiple patients (often being referred to as “resposable”). The motorized handpieces will provide a rotating drive element or drive shaft which is configured to engage or mate with a rotatable coupling in or on the tool. The rotatable coupling, in turn, will be configured to convert the rotary motion of the drive shaft or driver into an articulating motion within a distal region of the tool. In this way, the “resposable” handpiece can be used with conventional rotary and other tools as well as with the particular tools of the present invention which have articulating regions as described in detail below. 
     In a first specific aspect, the present invention comprises a device intended for use with a motorized handpiece having a rotating driver. The device comprises a shaft having a proximal end and an articulating distal region. A hub is attached to the proximal end of the shaft, and the hub is adapted for or configured to detachably connect to the motorized handpiece. A rotatable drive coupling on or within the hub is configured to detachably engage the rotating driver when the hub is connected to the handpiece. In this way, rotation of the drive coupling by the driver causes the articulating distal region of the shaft to articulate. 
     In particular embodiments, the shaft of the device comprises outer and inner concentric or coaxial sleeves, where a proximal end of the outer sleeve is fixed in or to the hub and a proximal portion of the inner sleeve is axially movably or translatably mounted in an interior bore of the outer sleeve in response to rotation of the driver. Usually, the shaft will have at least one distal component that maintains the distal ends of the outer and inner sleeves in a fixed relationship. i.e., the distal component fixedly couples the two ends together. Typically, a threaded collar on a proximal end of the inner sleeve threadably engages the drive coupling to longitudinally drive the threaded collar as the rotatable drive coupling is rotated by the rotating driver of the handpiece. 
     In an alternative embodiment, the rotatable drive coupling can rotate in a first direction relative to a first collar fixed to a proximal end of the inner sleeve and rotation of the drive coupling rotates a pin thereon to engage against an engaging surface of the first collar to longitudinally drive the first collar to articulate the distal region of the shaft. 
     In still further embodiments, a reciprocatable electrode is disposed at a distal tip of the articulating distal region of the shaft and is carried by a third concentric sleeve having a distal end and a proximal end. The distal end of the third sleeve is attached to the reciprocatable electrode and proximal end is attached to the drive coupling. The rotatable drive coupling is configured to rotate in a second direction and rotation of the drive coupling and pin in the second direction against a cam surface on the first collar longitudinally drives the third sleeve to reciprocate the reciprocatable electrode. 
     In other specific embodiments, the at least one distal component at the distal end of the shaft is a ceramic member and carries at least one electrode, typically carrying at least a first polarity electrode and a distal region of the shaft comprises a second polarity electrode. In other specific embodiments, the articulating region of the shaft comprises a series of slots in the outer and/or inner sleeves. For example, slots in the outer sleeve may be radially offset from slots in the inner sleeve. By adjusting the degree of radial offset, the direction of deflection of the articulating distal region can be adjusted. In still other specific embodiments, an insulation layer may be disposed between the outer and inner sleeves, and first and second electrical contacts may be provided in the hub to connect respectively to first and second polarity electrodes on the shaft to provide for delivery of radio frequency (RF) current to the electrode(s). 
     The motorized handpiece will typically comprise a motor within a housing of the handpiece, and the housing will usually have one or more actuators for effecting various functions of the handpiece. In one example, an actuator on an outer surface of the handpiece provides for manually activating the motor to bend the articulating region. In another example, an actuator on an outer surface of the handpiece provides for controlling delivery of RF current to the first and second polarity electrodes. 
     In still further examples, the inner sleeve of the shaft may have an interior passageway extending to an open termination in a distal region of the shaft. The interior passageway is typically adapted to be connected to a negative pressure source in order to provide for aspiration through the tool and the handpiece when the handpiece is connected to the negative pressure source. 
     In a second specific aspect, an arthroscopy system comprises a motorized handpiece having a motor-driven driver or drive shaft. The system further comprises a probe having both (a) a proximal hub adapted for detachable connection to the motorized handpiece and (b) a probe shaft having an articulating distal region. A rotatable drive coupling disposed within the hub is adapted for coupling to the motor-driven driver or drive shaft, where rotation of the drive coupling by the driver will cause articulation of the articulating distal region. 
     In specific embodiments of the arthroscopy system, the shaft comprises outer and inner concentric sleeves, where a proximal end of the outer sleeve is fixed in or on the hub and a proximal end of the inner sleeve is fixed in the rotatable drive coupling. A proximal portion of the inner sleeve is typically axially or longitudinally moveable in an interior bore of the outer sleeve so that relative axial translation of the sleeves will cause articulation of the distal region. A ceramic member is typically used to connect the distal ends of the outer and inner sleeves, and first and/or second polarity electrodes may be carried on the ceramic member. An insulation layer may be disposed between the inner and outer sleeves, and electrical contacts on the handpiece are typically adapted for coupling with cooperating or corresponding electrical contacts in the hub to allow for energizing the first and second polarity electrodes. 
     The arthroscopy system may further comprise a reciprocatable electrode at a distal tip of the articulating distal region of the shaft carried by a third concentric sleeve having a distal end and a proximal end. The distal end is attached to the reciprocatable electrode, and the proximal end is driven by the rotatable drive coupling to longitudinally drive the third sleeve to reciprocate the reciprocatable electrode. 
     In a third specific aspect, the present invention provides an arthroscopy system comprising a motorized handpiece having a motor and a motor actuator button. A probe having a hub connected to a shaft having an articulating region is detachably connectible to the motorized handpiece. In particular, a hub is adapted for detachable connection to the motorized handpiece where a motor within the handpiece is configured to articulate the articulating region of the probe shaft. The actuator button and motor are configured or adapted to continuously articulate the articulating region when pressure is applied to the button to cause deformation of the articulating region between a linear shape or configuration and a fully articulated shape or configuration, or a release of pressure on the actuator button will stop such continuous articulation. 
     In a fourth aspect, an arthroscopy system comprises a motorized handpiece having a motor and a motor actuator button. A probe having a hub connected to a shaft has an articulating distal region. The hub is adapted for detachable connection to the motorized handpiece, and the motor and motor actuator button are configured to articulate the articulating region of the probe shaft such that pressure on the actuator button articulates the articulating region between a linear shape and a fully articulated shape. 
     In a fifth aspect of the present invention, an arthroscopy system comprises a motorized handpiece having a motor and a motor actuator button. A probe having a hub connected to a shaft has an articulating distal region. The hub is adapted for detachable connection to the motorized handpiece, and the motor and motor actuator button are configured to articulate the articulating region of the probe shaft such that pressure and release of pressure on the actuator button articulates the articulating region a selected number of degrees from a linear shape or configuration to a fully articulated shape or configuration. 
     In a sixth aspect, the present invention comprises an arthroscopy system including a motorized handpiece having a motor and at least one motor actuator button. A hub on a probe is adapted for a detachable connection to the motorized handpiece, and the motor and a motor actuator button are configured to articulate the articulating region of the probe shaft and to initiate or energize different modes of RF current delivery to bi-polar or other electrodes carried on the probe shaft. The RF current delivery mode may comprise an ablation wave form or a coagulation wave form for delivery of RF current to the electrodes. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various embodiments of the present invention will now be discussed with reference to the appended drawings. It should be appreciated that the drawings depict only typical embodiments of the invention and are therefore not to be considered limiting in scope. 
         FIG. 1  is a perspective view of a disposable arthroscopic RF probe that has an articulating working end with a stationary active electrode, wherein the articulating mechanism is actuated by a motor drive in an arthroscopic handpiece. 
         FIG. 2  is a perspective view of an arthroscopic handpiece with a motor drive that is used in combination with the RF probe of  FIG. 1 . 
         FIG. 3A  is a perspective view of the articulating working end of the RF probe of  FIG. 1  showing the RF electrodes. 
         FIG. 3B  is a sectional perspective view of the articulating working end  FIG. 3A . 
         FIG. 4  is a sectional view of the proximal hub of the RF probe of  FIG. 1  showing the motor driven articulation mechanism and the RF current carrying members. 
         FIG. 5  is a perspective view of another variation of an articulating RF probe that has a motor driven reciprocating active electrode. 
         FIG. 6  is a cut-away view of the articulating region and working end of the articulating RF probe of  FIG. 5 . 
         FIG. 7  is a schematic view of the mechanisms in the probe hub of  FIG. 5  that allows the motor drive of  FIG. 2  to both articulate and de-articulate the probe shaft of  FIG. 5  and also reciprocate the active electrode. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The present invention relates to arthroscopy systems and related methods of use. Several variations of the invention will now be described to provide an overall understanding of the principles of the form, function and methods of use of the devices disclosed herein. In general, the present disclosure provides for an articulating arthroscopic system that includes a single-use articulating RF probe that can be detachable coupled to a re-usable motorized handpiece. This description of the general principles of this invention is not meant to limit the inventive concepts in the appended claims. 
     Referring now to the drawings and the reference numbers marked thereon.  FIGS. 1 and 2  illustrate an arthroscopic system that is provided for treating joint tissue, wherein  FIG. 1  shows a disposable articulating probe  100  with a working end  102  that has an articulating region  105  with a distal active electrode  110 .  FIG. 2  illustrates a reusable handle or handpiece  112  with a motor drive  115  carried therein, wherein the probe  100  of  FIG. 1  is adapted for detachable coupling to the handpiece  112  of  FIG. 2 . The articulating working end  102  allows for selected articulation up to 90° or more to thus allow the physician to orient the distal electrode  110  as needed in a joint to ablate and/or smooth joint tissue, for example to treat damaged regions of an articular surface in a hip, knee, shoulder, ankle or other joint. 
     More in particular, the articulating probe  100  as shown in  FIG. 1  has a proximal hub assembly  118  that is connected to an elongate shaft  120  extending about longitudinal axis  122  to the distal working end  102 . Referring to  FIGS. 3A-3B  and  FIG. 4 , the shaft  120  comprises an outer sleeve  125  and an inner sleeve  126  slidably disposed in bore  127  of the outer sleeve  125 . The inner and outer sleeves  125  and  126  can be fabricated of a suitable metal alloy, such as stainless steel or NiTi. The wall thicknesses of the inner and outer sleeves  125 ,  126  can range from about 0.005″ to 0.010″ with the outer diameter the outer sleeve  125  ranging from about 2.0 mm to 6.0 mm. 
       FIGS. 3A-3B  show the articulating region  105  of shaft  120  in more detail. In  FIG. 3A , it can be seen that the outer sleeve  125  has a slotted region  128  that allows for its articulation.  FIG. 3B  shows that inner sleeve  126  has a similar slotted region  130  with the slots  132  in each sleeve rotationally offset from one another by 180°. In the variation of  FIGS. 1 and 3A-3B , the inner and outer slotted sleeve portions  128  and  130  can have any configuration of slot depth, angle, orientation and shape to provide a desired range of articulated shapes, torque resistance and the like. The slots can have engaging features (not shown) to engage sleeve portions on either side of the slots  132  to increase torque resistance. 
     Referring to  FIG. 3B , the distal end  135  of outer sleeve  126  and distal end  136  of inner sleeve  126  are coupled by connections to distal dielectric member  140  (described further below) to allow axial forces to be applied to inner sleeve  126  relative to outer sleeve  125  to thus articulate the articulating region  105  as is known in the art. The articulation mechanism is further described below. The notches or slots  132  in articulating regions  128  and  130  of sleeves  125  and  126 , respectively, can have a width W that is uniform along the slotted region in the working end  102  or the slots can have a varying width. Alternatively, the slot width W can differ in different portions of the sleeve to effectuate a particular curved profile when fully articulated. In other variations, the slot width W can increase or decrease along the working end to create a curve having a varying radius. Clearly, it is understood that any number of variations are within the scope of this disclosure. 
       FIG. 4  is a sectional view of hub  118  of  FIG. 1 , wherein the proximal end  142  of outer sleeve  125  is fixed in the distal end  144  of hub  118 .  FIG. 4  further shows that the proximal end  146  of inner sleeve  126  is fixed in a threaded collar  148  that is adapted to move axially in order to translate the inner sleeve  126  relative to the outer sleeve  125 . In  FIG. 4 , a drive coupling  155  is rotatable in a proximal end  156  of the hub  118 . The drive coupling  155  has a slot configuration  158  that is adapted to mate with a shaft  160  ( FIG. 2 ) of the motor drive unit  115  in handpiece  112 . The interior of the drive coupling  155  has a threaded region  162  that engages the threaded region  164  of the threaded collar  148 . Thus, it can be seen that the rotation of the drive coupling  155  will move the threaded collar  148  and inner sleeve  126  axially back and forth depending on the direction of rotation of the drive coupling  155  to articulate the working end  102  as shown in  FIG. 1 . In one variation, when the working end  102  is in a straight configuration, the drive coupling  155  can be rotated a selected amount from about 90° to 720°, or from about 90° to 360°, to thereby move the inner sleeve  126  in the proximal direction relative to the outer sleeve  125  to thus bend the working end  102  to an articulated configuration. As will be described further below, the articulation is driven by the motor drive  115  in the handpiece  102 . 
     The electrosurgical functionality of the probe  100  can be described with reference to  FIGS. 3A-3B and 4 . In  FIG. 3B , it can be seen that the inner and outer sleeves.  125  and  126 , are connected at their distal ends.  135  and  136 , to the distal dielectric member  140 . The outer and inner sleeves  125 ,  126  are used as opposing polarity electrical leads that carry RF current to and from the active electrode  110  and a return electrode  170  which comprises an outer surface of outer sleeve  125 . Therefore, the inner and outer sleeves ( 125 ,  126 ) must be spaced apart by an insulator, which at the distal end of the shaft  120  comprises the ceramic member  140 . In  FIG. 3B , it can be seen that the distal end  135  of outer sleeve  125  is mechanically locked to the ceramic member  140  by projecting portions  172   a  and  172   b  of the ceramic member  140  that are received by openings  174   a  and  174   b  in the wall of outer sleeve  125 . The inner sleeve  126  has a distal end  136  with at least two projecting elements  165   a  and  165   b  that extend through first and second bores in the ceramic member  140  with the distal tips of the projecting elements  165   a  and  165   b  welded to active electrode  110 . 
     Referring to  FIG. 3A , the ceramic member  140  can be fabricated of a technical ceramic material that has a very high hardness rating and a high fracture toughness rating, where “hardness” is measured on a Vickers scale and “fracture toughness” is measured in MPam 1/2 . Fracture toughness refers to a property which describes the ability of a material containing a flaw or crack to resist further fracture and expresses a material&#39;s resistance to brittle fracture. The occurrence of flaws is not completely avoidable in the fabrication and processing of any components. 
     In one variation, the ceramic member  140  is a form of zirconia. Zirconia-based ceramics have been widely used in dentistry and such materials were derived from structural ceramics used in aerospace and military armor. Such ceramics were modified to meet the additional requirements of biocompatibility and are doped with stabilizers to achieve high strength and fracture toughness. The types of ceramics used in the current invention have been used in dental implants, and technical details of such zirconia-based ceramics can be found in Volpato, et al., “Application of Zirconia in Dentistry: Biological. Mechanical and Optical Considerations”, Chapter 17 in  Advances in Ceramics—Electric and Magnetic Ceramics. Bioceramics, Ceramics and Environment  (2011). 
     The ceramic member  140  can be fabricated of an yttria-stabilized zirconia as is known in the field of technical ceramics, and can be provided by CoorsTek Inc., 16000 Table Mountain Pkwy., Golden, Colo. 80403 or Superior Technical Ceramics Corp., 600 Industrial Park Rd., St. Albans City, Vt. 05478. Other technical ceramics that may be used consist of magnesia-stabilized zirconia, ceria-stabilized zirconia, zirconia toughened alumina and silicon nitride. 
       FIG. 3B  further shows a thin wall insulator sleeve  175  in phantom view around the exterior of inner sleeve  126  to provide electrical insulation between the outer sleeve  125  and the inner sleeve  126 . The insulator sleeve  175  can comprise a flexible temperature resistant material such as parylene. PFTE, PEEK or the like. The outer sleeve  125  can have a flexible thin-wall sheath  180  as shown in phantom view in  FIG. 3A  of a suitable polymer surrounding the articulating region  105  of the shaft assembly  120 . In this variation, the return electrode  170  comprised a surface portion of outer sleeve  125  proximal from the articulating region  105  ( FIG. 3A ). 
     The components of hub  118  and cooperating handpiece that provide electrical pathways for delivering RF current to and from the probe working end  105  can now be described. As can be seen in  FIGS. 1 and 4 , the proximal hub  118  of probe  100  is configured with projecting elements  182  that cooperate with a J-lock grooves in the handpiece  102  ( FIG. 2 ) for detachably locking the hub assembly  118  into the receiving passageway  185  of the handpiece  112 . 
     In  FIG. 4 , it can be seen that a first spring-loaded electrical contacts  205 A and  205 B are disposed on opposing sides of hub  118  and are adapted to engage a corresponding metal electrical contact (not shown) in the receiving passageway  185  of handpiece  112 . The probe hub  118  can be inserted into the receiving passageway  185  in handpiece  112  in either and “up” or “down” position, so the electrical contacts  205 A and  205 B are provided on both sides of the hub to provide contact with a corresponding electrical contact in the handpiece no matter the hub orientation. The spring-loaded electrical contacts  205 A and  205 B then extend inwardly in hub  118  to contact the rotating threaded coupling  148  that is a metal and is conductively fixed to proximal end  146  of inner sleeve  126 . Thus, RF current can be carried through the threaded coupling  148  to the inner sleeve  126  and the active electrode  110  ( FIG. 3B ). 
       FIG. 4  shows a second spring-loaded electrical contact  210  in hub  118  that is configured to engage another electrical contact (not shown) in the receiving passageway  185  of handpiece  112  ( FIG. 2 ). Electrical contact  210  extends inward in the hub  118  to contact the metal core  202  that is fixedly coupled to the proximal end  142  of outer sleeve  125 , wherein a portion of the outer sleeve  126  is exposed and comprises the return electrode  170  as described above and illustrated in  FIGS. 3A-3B . Inward of metal core  202  in the hub  118  is insulative plastic block  208  that has a bore  214  therein that allows for axial movement of the inner sleeve  126  to thereby articulate the working end  102 . 
     Now turning to operation of the system.  FIG. 2  shows that the handpiece  112  is operatively coupled by electrical cable  184  to a controller  185  and RF source  190 . The controller  185  is adapted to control all operations of the motor drive  115  as well as RF functions. Actuator buttons  186   a .  186   b ,  186   c  and a joystick  188  are provided on the handpiece  112  to actuate certain functions of the probe  100 . In one variation, the joystick  188  is operatively coupled to the controller  185  to activate the motor drive  115  wherein pushing the joystick  188  forward activates the motor drive in a first rotational direction which in turn engages and rotates the drive coupling  155  in hub  118  to thereby articulate the working end  102  of the probe as shown in  FIG. 1 . In this variation, pushing on the joystick  188  can progressively move the working end between the linear configuration and the fully articulated configuration as indicated in  FIG. 1 . By releasing pressure on the joystick  188 , the motor drive  115  would be de-activated and the working end  102  would remain articulated in any intermediate position between the linear configuration and fully articulated configuration of  FIG. 1 . 
     In another variation, the joystick  188  and a controller algorithm could operate so that a single push on the joystick  188  would articulate the working end  102  from the linear configuration to the fully articulated configuration of  FIG. 1 . Alternatively, a single touch of the joystick  188  could articulate the working end a predetermined number of degrees, wherein 2 to 10 touches of the joystick  188  would articulate the working end  102  from the linear configuration to the fully articulated configuration. 
     In another variation, the joystick  188  can be pressed backwards to activate rotation of the motor drive  115  in the opposite rotational direction to thereby articulate the working end  102  in the opposite direction compared to the articulation direction shown in  FIG. 1 . 
     Still referring to  FIG. 2 , one of the actuator buttons  186   a .  186   b  or  186   c  on the handpiece  112  can be operatively coupled to the controller  185  and RF source  190  to energize the RF electrodes  110  and  170 . In another variation, one of the actuator buttons,  186   a ,  186   b  or  186   c  is coupled to the controller  185  and the RF source  190  to select a particular mode or RF waveform, for example (1) an RF waveform for ablation or (2) an RF waveform for coagulation as is known in the art. 
     In another variation, referring to  FIG. 2 , the handpiece  112  has a display  195  (e.g., an LCD screen) that displays an image or other indicator of the articulated shape of the working end  102 , as the motor drive articulates the working end. Such a display would be useful as the working end may not always be visible in an arthroscopic procedure, such as during insertion and withdrawal, and it would be important to provide the physician with an indication of the articulated shape of the working end  102 . 
     In another variation, referring to  FIGS. 2 and 3A-3B , the distal ceramic member  140  can have an aspiration port  230  therein that is connected to passageway  232  in the inner sleeve  126  that communicates through hub  118  and handpiece  112  with negative pressure source  220  ( FIG. 2 ). In the embodiment shown in  FIGS. 3A-3B , the aspiration port  230  extends through the electrode  110 , but it should be appreciated that any number of ports can be provided in the working end in or near the active electrode  110 . 
     In the embodiment of working end  102  shown in  FIGS. 3A-3B , the active electrode  110  is disposed at the distal end of the ceramic member  140 , but it should be appreciated that the active electrode  110  can have any suitable shape and configuration. For example, the active electrode can be on the side of the ceramic member  140  or can be configured as a ring electrode around the circumference of the ceramic member  140 . Further, the active electrode can comprise a plurality spaced apart wire-like electrode elements that are known to be effective in rapidly forming and maintaining RF plasma for tissue ablation. In another variation, the active electrode can comprise a hook or blade electrode extends distally from the ceramic member  140 . In still another variation, such a hook or blade electrode can be extendable and retractable from the ceramic member  140 . In another variation, the electrode can be a motor-driven rotational cutting sleeve as is known in the art that can be coupled to negative pressure source  220  for cutting and extracting tissue. Such a cutting sleeve would have a flexible section to cooperate with the articulating section  105  of the working end  102 . 
     Now turning to  FIGS. 5-6 , another variation of articulating probe  400  is shown that again has a hub  404  and elongate shaft  410  with longitudinal axis  412  that carries a distal electrosurgical working end  415 . In this variation, an active electrode  420  is motor driven and is carried by the working end  415  and is adapted to reciprocate relative to a ceramic body or housing  422  wherein in the previous embodiment  100  of  FIGS. 1 and 3A-3B , the active electrode  110  was fixed and stationary in the working end  102 . In the variation of  FIGS. 5-6 , the working end  415  is of the type described in co-pending U.S. patent application Ser. No. 15/410,723 filed Jan. 19, 2017 titled ARTHROSCOPIC DEVICES AND METHODS (Atty. Docket No. 41879-713.201) in which the active electrode  420  reciprocates in a window  428  in the ceramic housing  422  carried at the distal end of the articulating region  440  of shaft  410 . In the variation of  FIG. 5 , as in the previous embodiment, first and second concentric slotted sleeves.  445  and  448  respectively, are used to provide the articulating region  440  of the probe. In the variation of  FIGS. 5-6 , a third sleeve or member  450  is carried within an interior passageway  454  of the second sleeve  448  which is configured for reciprocation and extends through the shaft  410  and carries the active electrode  420 . It should be appreciated that the third sleeve  450  in such an embodiment also can be configured for rotation or rotational oscillation or a combination of rotation and reciprocation. 
     The variation of  FIG. 5  again is adapted for detachable coupling to the handpiece  112  and motor drive  115  of  FIG. 2 . The hub  404  of the probe  400  of  FIG. 5  again has identical features as the previous embodiment of  FIG. 1  including electrical contacts for coupling to the handpiece  112 . 
     As can be understood from  FIG. 2 , the handpiece  112  and motor drive  115  essentially provide only two different operating outputs, which are first to rotate in clockwise direction and second to rotate in a counter-clockwise direction. In the previous embodiment of  FIGS. 1-3 , the motor drive  115  was adapted to rotate in a first direction to articulate the distal articulating region  105  (see  FIGS. 1 and 3A ) and then rotate in the opposite or second direction to de-articulate the articulating region  105  to return the shaft to a linear shape. 
     However, the probe of  FIG. 5  requires three functions which are (i) to articulate the working end, (ii) to de-articulate the working end; and (iii) to reciprocate the active electrode  420 . 
       FIG. 7  is a cut-away and exploded schematic view of the mechanisms in the interior of the hub  404  ( FIG. 5 ) that provide the three functions listed above. The motor drive  115  of  FIG. 2  when rotated in a first direction in cooperation with a distal compression spring  455  can articulate and de-articulate the working end. Then, the motor drive  115  can be rotated in the second or opposite rotational direction to reciprocate the active electrode  420  in the distal housing  422  as will be described in further detail below. 
     Referring to  FIGS. 6-7 , it can be understood that the shaft  410  and working end  415  that provide the articulating function comprise a first or outer sleeve  445  and the second concentric inner sleeve  448 . The first sleeve  445  is fixed in distal hub body  458  that carries hub core  460 . The first sleeve  445  has a slotted distal portion  462  as shown in  FIGS. 5-6 . 
     Referring to  FIG. 7 , the second sleeve  448  is adapted to move axially in the bore  464  of the first sleeve  445  and hub core  460 . The second sleeve  448  also has a slotted distal portion  466  and a distal termination that is welded at weld  470  to the first or outer sleeve  445  (see  FIG. 6 ) to provide articulation as described previously. The second sleeve  448  is fixed to a distal collar  475  that carries a transverse pin  476  that is adapted to move in an arcuate slot  477  in hub core  460  to thereby move the collar  475  axially relative to the first or outer sleeve  445 . The proximal end  478  of the second sleeve  448  is also fixed to an intermediate collar  480  described further below. The third or innermost sleeve  450  which carries the active electrode  420  ( FIG. 6 ) is fixed to a proximal collar  485  which is adapted to move back and forth axially relative to the first and second sleeves.  445  and  448 , respectively. 
     Finally,  FIG. 7  shows a drive coupling  490  in schematic view that is adapted to freely rotate without axial movement in a circumferential groove in a proximal end  492  of the hub  404  (see  FIG. 5 ). The freely rotating drive coupling  490  in  FIG. 7  is shown moved proximally away from the proximal collar  485 . 
     Now describing the dual rotational mechanisms of  FIG. 7  carried with the hub  404  in more detail, it can be seen that rotation of the drive coupling  490  in the first direction indicated by dashed arrows AA, will move the second sleeve  448  in the distal direction relative to the first sleeve  445  to thereby articulate the articulating region  440 . In more detail, the controller and motor drive  115  can be configured to rotate the drive coupling  490  in the first direction at a slow speed and only a predetermined number of degrees. The controller  185  ( FIG. 2 ) receives signals from Hall sensors that senses magnets in the drive coupling  490  to determine the rotational position of the drive coupling  490 , as described in co-pending and commonly owned U.S. patent application Ser. No. 15/495,620 filed Apr. 24, 2017 titled ARTHROSCOPIC DEVICES AND METHODS. In this variation, the controller  185  again can initially determine the rotational position of the drive coupling  490  and then rotate the drive coupling as needed to any desired position. 
     Referring now to  FIG. 6 , it can be seen that the drive coupling  490  carries an extension member  495  that extends axially and which interfaces with the cam surface  500  of the proximal collar  485 . As the drive coupling  490  rotates in the first direction, the extension member  495  moves along the cam surface  500  until it interfaces with the vertical surface  505 . After the extension member  495  interfaces with the vertical surface  505 , further rotation of the extension member  495  in the first direction then rotates the proximal collar  485 . As can be seen in  FIG. 7 , the proximal collar  485  has an axially extending portion  508  that slidably engages a notch  510  in the intermediate collar  480 . Further, the intermediate collar  480  is fixed to the second sleeve  448  and the assembly then when rotated also moves axially as the transverse pin  476  moves in the arcuate slot  477  in the hub core  460 . From  FIG. 7 , it thus can be understood that rotation of the intermediate collar  480  causes the movement of transverse pin  476  in arcuate slot  477  to thereby push the second sleeve  448  axially in the distal direction which articulates the probe. 
     In the lower right portion of  FIG. 7 , the arcuate slot  477  in bore  515  of hub core  460  is shown in a flattened plane which illustrates the shape of slot  477  as the pin  476  moves within the surface of bore  515  in the hub core  460 . It can be understood that rotation of distal collar  475  and transverse pin  476  can move along the arcuate slot  477  from an initial pin position X wherein the probe is not articulated to a second pin position Y wherein the probe is partly articulated to a third pin position Z wherein the probe is fully articulated. The arcuate slot  477  can have flat portions  520   a  and  520   b  with optional detents  522   a  and  522   b  where the pin  476  can rest to maintain the articulating region  440  in a particular articulated configuration. It should be appreciated that there may be several different flattened areas in the arcuate slot  477  to provide multiple degrees of articulation. As can be understood from  FIG. 7 , the distal compression spring  455  is adapted to urge the second sleeve  448  in the proximal direction relative to the first sleeve  445  to straighten the articulated working end and the flattened slot portions  520   a  and  520   b  prevent the spring from moving to pin along a slope in the slot  477 . In  FIG. 7 , the maximum axial movement of the second sleeve  445  relative to stationary first sleeve  445  is indicated at extension distance DD which is the maximum axial movement of pin  476  pin slot  477 . 
     As also can be seen in  FIG. 7 , the distal spring  455  can have a proximal end  526  fixed in the intermediate collar  480  and a distal end  528  fixed in the hub core  460  so the spring resists compression and also resists rotation. Thus, the distal spring  455  is adapted to urge the articulated region  440  of the probe ( FIG. 5 ) toward a linear configuration. Again referring to the diagram of the lower right portion of  FIG. 7 , it can be understood that motor driven rotation of the collar  475  and pin  476  to position ZZ will then cause the pin  476  to move into the return portion  532  of arcuate slot  477  and thereafter return to the initial position X under the force of the distal spring  455 . 
     Now turning to the reciprocation mechanism provided by the mechanisms shown in  FIG. 7 , it can be described how rotation of the drive collar  490  in the second direction indicated by the solid arrow BB will reciprocate the third sleeve  450  relative to the working end  415  in any articulated position to thereby reciprocate the active electrode  420  (see  FIGS. 5-6 ). It should be appreciated that a distal portion  535  of the third sleeve  450  ( FIG. 6 ) can be slotted in multiple orientations to thereby function as a flexible drive shaft within the passageway through the interior of the first and second sleeves,  445  and  448 , when either straight or articulated. 
     In  FIG. 7 , it can be seen that rotation of the drive coupling  490  in the second direction (solid arrow BB) causes the extension pin  495  to ride along the cam surface  500  to thus move the proximal collar  485  distally until the extension pin  495  rotates over the vertical surface  505  which then allows the proximal collar  485  to move in the proximal direction under the force of proximal spring  540 . Thus.  FIG. 7  illustrates that the stroke of reciprocation indicated at CC is equivalent to the height of the vertical surface  505 . The proximal spring  540  which resists compression is positioned between the proximal collar  485  and the intermediate collar  480  and urges the proximal collar in the proximal direction at all times. 
     Thus, it can be understood how the controller  185  by using the motor drive  115  can both articulate the working end of the probe  400  and reciprocate an active electrode  420  ( FIG. 5 ) in the working end  415  during any degree of articulation of the working end. 
     Still referring to  FIG. 7 , the RF source  190  is shown schematically with a first electrical lead  160  coupled to a spring contact  162  that engages the proximal collar  485  which is a conductive metal and thus conducts RF current to the third sleeve  450  and the active electrode  420  at the working end. The second lead  172  from the RF source  190  extends to the distal hub  458  and is connected to the first sleeve  445  which comprises the return electrode as described previously. It should be appreciated each of the sleeves  445 ,  448  and  450  may have thin insulative coatings (not shown in  FIG. 7 ) to thus insulate the RF current paths to the working end  415 . 
     Although particular embodiments of the present invention have been described above in detail, it will be understood that this description is merely for purposes of illustration and the above description of the invention is not exhaustive. Specific features of the invention are shown in some drawings and not in others, and this is for convenience only and any feature may be combined with another in accordance with the invention. A number of variations and alternatives will be apparent to one having ordinary skills in the art. Such alternatives and variations are intended to be included within the scope of the claims. Particular features that are presented in dependent claims can be combined and fall within the scope of the invention. The invention also encompasses embodiments as if dependent claims were alternatively written in a multiple dependent claim format with reference to other independent claims. 
     Other variations are within the spirit of the present invention. Thus, while the invention is susceptible to various modifications and alternative constructions, certain illustrated embodiments thereof are shown in the drawings and have been described above in detail. It should be understood, however, that there is no intention to limit the invention to the specific form or forms disclosed, but on the contrary, the intention is to cover all modifications, alternative constructions, and equivalents falling within the spirit and scope of the invention, as defined in the appended claims. 
     The use of the terms “a” and “an” and “the” and similar referents in the context of describing the invention (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. The terms “comprising,” “having,” “including,” and “containing” are to be construed as open-ended terms (i.e., meaning “including, but not limited to,”) unless otherwise noted. The term “connected” is to be construed as partly or wholly contained within, attached to, or joined together, even if there is something intervening. Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., “such as”) provided herein, is intended merely to better illuminate embodiments of the invention and does not pose a limitation on the scope of the invention unless otherwise claimed. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the invention. 
     Preferred embodiments of this invention are described herein, including the best mode known to the inventors for carrying out the invention. Variations of those preferred embodiments may become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventors expect skilled artisans to employ such variations as appropriate, and the inventors intend for the invention to be practiced otherwise than as specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contradicted by context. 
     All references, including publications, patent applications, and patents, cited herein are hereby incorporated by reference to the same extent as if each reference were individually and specifically indicated to be incorporated by reference and were set forth in its entirety herein.