Patent Publication Number: US-11660086-B2

Title: Surgical device with trigger operated needle

Description:
RELATED APPLICATION(S) 
     This application is a continuation of prior U.S. application Ser. No. 16/401,634, filed May 2, 2019, the entirety of which is incorporated by reference herein. 
    
    
     BACKGROUND 
     This disclosure relates to a surgical device with a single trigger configured to rotate and slide. The disclosure also relates to a method of repairing damaged tissue. 
     Orthopedic procedures are often performed to repair musculoskeletal injuries, such as those sustained during sporting activities. Tears in the meniscus are known to be repaired by deploying suture on either side of the tear, tensioning the suture to close the tear, and allowing it to heal. 
     SUMMARY 
     This disclosure relates to a surgical device with a single (e.g., thumb) trigger configured to rotate and slide. The disclosure also relates to a method of repairing damaged tissue. A surgical device according to an exemplary aspect of the present disclosure includes, inter alia, a handle including a bore, and a trigger configured to advance or retract a needle through the bore of the handle. The trigger is configured to rotate about a pivot axis and further configured to slide in distal and proximal directions. The device may be operated using one hand, and permits a user, such as a surgeon, to advance a needle through the device using intuitive, relatively easy thumb movements. While the device may be used in other techniques, it is particularly useful in meniscal repairs, including inside-out meniscal repairs. 
     A surgical device according to an exemplary aspect of the present disclosure includes, inter alia, a handle including a bore, and a trigger configured to advance or retract a needle through the bore of the handle. The trigger is configured to rotate about a pivot axis and further configured to slide in distal and proximal directions. 
     A method according to an exemplary aspect of the present disclosure includes, inter alia, pressing on a trigger of a surgical device such that the trigger rotates into contact with a needle and moves in a distal direction to advance a needle within a bore of a handle of the surgical device. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    illustrates an example surgical device. 
         FIG.  2    is a cross-sectional view of a portion of the surgical device. 
         FIG.  3    is an exploded, perspective view of an example trigger assembly. 
         FIG.  4    is a perspective view of the trigger assembly. 
         FIG.  5    is a cross-sectional view of the trigger assembly with a trigger in a first rotation position. 
         FIG.  6    is a cross-sectional view of the trigger assembly with the trigger in a second rotation position. 
         FIG.  7    is an end view of the trigger. 
         FIG.  8    is a partial cross-sectional view of the trigger. 
         FIG.  9    is a partial cross-sectional view of the surgical device with the trigger assembly removed for reference. 
         FIG.  10    illustrates an example construct. 
         FIG.  11    illustrates a user loading a needle into the surgical device. 
         FIG.  12    illustrates the surgical device positioned adjacent a first side of a meniscal tear. 
         FIG.  13    illustrates a first needle passing through the meniscus. 
         FIG.  14    illustrates a condition in which the first needle is fully passed through the meniscus. 
         FIG.  15    illustrates the surgical device positioned adjacent a second side of a meniscal tear. 
         FIG.  16    illustrates a condition in which a second needle has fully passed through the meniscus. 
     
    
    
     DETAILED DESCRIPTION 
     This disclosure relates to a surgical device with a single trigger (e.g., a thumb trigger) configured to rotate and slide. The disclosure also relates to a method of repairing damaged tissue. A surgical device according to an exemplary aspect of the present disclosure includes, inter alia, a handle including a bore, and a trigger configured to advance or retract a needle through the bore of the handle. The trigger is configured to rotate about a pivot axis and further configured to slide in distal and proximal directions. The device may be operated using one hand, and permits a user, such as a surgeon, to advance a needle through the device using intuitive, relatively easy thumb movements. While the device may be used in other techniques, it is particularly useful in meniscal repairs, including inside-out meniscal repairs. 
     A surgical device according to an exemplary aspect of the present disclosure includes, inter alia, a handle including a bore, and a trigger configured to advance or retract a needle through the bore of the handle. The trigger is configured to rotate about a pivot axis and further configured to slide in distal and proximal directions. 
     In a further embodiment, the trigger is configured to rotate about the pivot axis between a first rotation position and a second rotation position, and the trigger is closer to a central axis of the bore of the handle in the second rotation position. 
     In a further embodiment, an inferior surface of the trigger is configured to contact the needle when the trigger is in the second rotation position. 
     In a further embodiment, an inferior surface of the trigger includes a channel, the trigger includes an insert projecting into the channel, and the insert is configured to contact the needle when the trigger is in the second rotation position. 
     In a further embodiment, the insert is made of a metallic material. 
     In a further embodiment, the surgical device includes a trigger assembly including the trigger, a trigger housing, and a pin. The trigger is configured to rotate relative to the trigger housing about the pin. 
     In a further embodiment, the pin defines the pivot axis perpendicular to a central axis of the bore of the handle. 
     In a further embodiment, the trigger housing includes a bore configured to permit the needle to move therethrough, the bore of the trigger housing coaxial with a central axis of the bore of the handle. 
     In a further embodiment, the trigger housing includes a channel extending from a superior surface of the trigger housing to the bore of the trigger housing, and a portion of the trigger is within the channel. 
     In a further embodiment, the trigger assembly includes a spring configured to bias the trigger away from a central axis of the bore of the handle. 
     In a further embodiment, the trigger assembly further includes a second pin received in a slot of the trigger, and the slot is shaped to limit the rotational movement of the trigger. 
     In a further embodiment, the entire trigger assembly is configured to slide relative to the handle in the distal and proximal directions. 
     In a further embodiment, the surgical device includes a spring configured to bias the trigger in the proximal direction. 
     In a further embodiment, the spring is a coil spring arranged about a central axis of the bore of the handle. 
     In a further embodiment, the surgical device includes a strand of suture including a first end connected to the needle and a second end connected to another needle. 
     In a further embodiment, a dimension of a superior surface of the trigger relative to a superior surface of the handle gradually increases distally. 
     In a further embodiment, the dimension of the superior surface of the trigger relative to the superior surface of the handle gradually increases distally until a tangent to the superior surface of the trigger is substantially perpendicular to a central axis of the bore. 
     A method according to an exemplary aspect of the present disclosure includes, inter alia, pressing on a trigger of a surgical device such that the trigger rotates into contact with a needle and moves in a distal direction to advance a needle within a bore of a handle of the surgical device. 
     In a further embodiment, the method includes reducing a force applied to the trigger such that the trigger rotates out of contact with the needle and moves in a proximal direction. 
     In a further embodiment, the method includes repeating the pressing and reducing steps to advance the needle through a meniscus. 
       FIG.  1    illustrates an example surgical device  10  according to the present disclosure. The surgical device  10  includes a handle  12  and a cannula  14  projecting distally (the “distal” direction is labeled in various figures for reference) from the handle  12 . The handle  12  includes a trigger  16 , which in this example is a thumb trigger. The trigger  16  is moveable in the distal and proximal directions (the “proximal” direction is labeled in various figures reference) to advance or retract a needle through the surgical device  10 . In addition to being moveable in the distal and proximal directions, the trigger  16  is also rotatable to selectively grasp a needle such that distal movement of the trigger  16  advances the needle distally, for example, as will be explained in detail below. 
       FIG.  2    is a cross-sectional view of the surgical device  10  with the cannula  14  removed for ease of reference. As shown in  FIG.  2   , the handle  12  includes a bore  18  extending along a central axis A. The bore  18  extends through the entirety of the handle  12 , and in particular extends from a proximal end  20  of the handle  12  to a distal end  22  of the handle  12 . The bore  18  is coaxial with a bore of the cannula  14  such that a needle advancing through the bore  18  is fed into the cannula  14 . The bore  18  gradually widens adjacent the proximal end  20  of the handle  12  to facilitate loading of a needle. 
     The trigger  16  will now be described in more detail with reference to  FIGS.  3 - 6   . The surgical device  10  includes a trigger assembly  24 , which is received in a recess  26  (FIG.  2 ) in the handle  12 . The trigger assembly  24  includes a trigger housing  28 , the trigger  16 , a spring  30 , a first pin  32 , and a second pin  34 . In this example, the spring  30  is a coil spring and the pins  32 ,  34  are cylindrical shafts. The trigger housing  28  includes a channel  36  extending from a superior surface of the trigger housing  28  and receiving a portion of the trigger  16 . The trigger housing  28  further includes a bore  38  coaxial with the bore  18  of the handle  12 . The channel  36  extends from the superior surface of the trigger housing  28  to the bore  38 . The trigger housing  28  also includes a recess  40  receiving at least a portion of the spring  30 . 
     The trigger  16  is configured to rotate relative to the trigger housing  28  in first and second directions D 1 , D 2  about a pivot axis P defined by the first pin  32 . The spring  30  and recess  40  are arranged at a generally opposite end of the trigger housing  28  as the pivot axis P. The trigger  16  is configured to rotate about the pivot axis P between a first rotation position ( FIG.  5   ) and a second rotation position ( FIG.  6   ). 
     In order to move from the first rotation position to the second rotation position, a user, such as a surgeon, applies force using their a thumb, for example, to a superior surface  42  of the trigger  16 , which causes the trigger  16  to rotate in direction D 1 . The force applied by the surgeon overcomes a bias force applied by the spring  30  to the trigger  16  in the second direction D 2  and generally away from the central axis A. When in the second rotation position, the trigger  16  is closer to the central axis A of the bore  18  and the bore  38 , which again are coaxial in this example. 
     Rotational movement of the trigger  16  relative to the trigger housing  28  is governed in part by a slot  44 . The slot  44  is shaped so as to limit rotation of the trigger  16  in the directions D 1 , D 2 . In particular, the second pin  34  extends in a direction parallel to the pivot axis P through the slot  44 . Contact between the pin  34  and the ends of the slot  44  restrict rotational movement of the trigger  16 . 
     When in the second rotation position, the trigger  16  is configured to contact a needle within the bore  38  and hold the needle against the bore  38  such that distal or proximal movement of the trigger assembly  24  results in corresponding distal or proximal movement of the needle. An inferior surface  46  of the trigger  16  is configured to facilitate contact with the needle when the trigger is in the second rotation position. With specific reference to  FIGS.  7  and  8   , the inferior surface of the trigger  16  includes a channel  48  aligned with the central axis A and configured to guide a needle relative to the trigger  16 . The channel  48  helps guide a needle within the bore  38 . Further, the channel  48  is formed such that it is substantially flat and extends substantially parallel to the central axis A when the trigger  16  is in the second rotation position. 
     An insert  50  ( FIG.  8   ) within the trigger  16  projects into the channel  48  and is configured to contact a needle when the trigger  16  is in the second rotation position. In the example of  FIG.  8   , the insert  50  projects into the channel  48  but not beyond the inferior surface  46 . This arrangement permits the insert  50  to contact a needle before the remainder of the trigger  16 . The channel  48  is not required in all examples. 
     The insert  50  may be made of a material corresponding to the material of the needle. The insert  50  may also be made of a material different than the remainder of the trigger  16 . In an example, the trigger  16  is made of a polymer material, and the insert  50  is made of a metallic material. Making the insert  50  of a metallic material increases the friction between the trigger  16  and the needle, which in turn increases the ease of advancing or retracting the needle. 
     In addition to the trigger assembly  24 , the handle  12  includes a quick-connect fitting  52  adjacent the distal end  22  thereof. The quick connect fitting  52 , which is shown in FIGS.  2  and  9 , is configured to connect the cannula  14  to the handle  12  relatively quickly, by hand, and without the use of a tool. The quick connect fitting  52  includes a bore  53  ( FIG.  2   ) coaxial with the bore  18  and allows a needle, for example, to pass therethrough. The quick connect fitting  52  permits a surgeon to conveniently select or change the cannula  14 . 
     The quick connect fitting  52  in this example includes a shaft  54  (perhaps best seen in  FIG.  2   ) projecting proximally toward the recess  26 . A spring  56  is arranged about the shaft  54 . The spring  56  is a coil spring and is arranged about the central axis A, in this example. The spring  56  is also in contact with the trigger assembly  24  and is configured to bias the trigger assembly  24  proximally. To this end, the entire trigger assembly  24  is configured to slide distally and proximally within the recess  26 . The recess  26  is sized and shaped to limit the extent to which the trigger assembly  24  slides relative to the handle  12 . 
     The surgical device  10  allows a surgeon to advance or retract surgical needles, such as meniscal repair needles, using one hand, and in particular using a smooth, intuitive thumb movement. When the surgeon grasps the handle  12 , the surgeon&#39;s fingers rest comfortably adjacent a finger rest  58  ( FIG.  2   ) on an inferior portion of the handle  12 . In one example, the surgeon&#39;s index finger is distal of the finger rest  58  with the middle, ring, and pinky fingers proximal of the finger rest  58 . The surgeon&#39;s thumb comfortably rests adjacent the trigger  16 . 
     In order to advance a needle through the surgical device  10 , the surgeon presses the trigger  16  down which pivots the trigger  16  into the second rotation position into contact with a needle, and then, while continuing to press the trigger  16  down, the surgeon slides the thumb actuator distally to advance the needle distally. The arrangement of the trigger  16  allows the surgeon to advance the needle by pressing down and forward in a single fluid movement. The surgeon then reduces the force applied to the trigger  16  by lifting their thumb off the trigger  16  or reducing the pressure they apply to the trigger  16 , which causes the trigger  16  to disengage the needle under the force of spring  30  and slide proximally under the force of spring  56 . The process is repeated to continue advancing the needle. 
     A number of repeated thumb movements may be required to fully advance a needle through the surgical device  10 . The trigger  16  is suited to accommodate such movements. In particular, the superior surface  42  is wider than the remainder of the trigger  16  and projects above a superior surface of the handle  12 . Specifically, in the first rotation position, as in  FIG.  2   , the superior surface  42  projects a height H above a superior surface  60  of the handle  12 . Moving distally, the height H is substantially constant along a length of the trigger  16 , except that, approaching a distal end portion of the trigger  16 , the superior surface  42  curves away from the handle  12 . In a particular example, the superior surface  42  adjacent a distal end portion of the trigger  16  is defined by a radius R having an origin O superior to the handle  12 . The origin O extends perpendicular to the central axis A. The dimension H continually increases and follows the radius R, until a tangent T to the superior surface  42  is substantially normal to the central axis A. The arrangement of the superior surface  42  of the trigger  16  is particularly suited to a surgeon pressing the trigger  16  both distally and in the rotational direction D 1 . 
       FIG.  10    illustrates an example construct  62  configured to be used with the surgical device  10 . The construct  62 , in this example, includes a strand of suture  64  with a first end  66  connected to a first needle  68  and a second end  70  connected to a second needle  72 . The first and second needles  68 ,  72  are configured to be advanced or retracted through the surgical device  10 . The needles  68 ,  72  are metallic meniscal repair needles in this example. 
     The strand of suture  64  is provided by one of the following example types of suture: FiberWire®, TigerWire®, or FiberChain® suture, which are each available from Arthrex, Inc. It should be understood, however, that any type of suture may be used, including cored or coreless sutures. In another embodiment, the strand of suture  64  is flat suture, such as FiberTape® or SutureTape® suture, which are also available from Arthrex, Inc. The strand of suture  64  may also be a monofilament suture having barbs, as mentioned above. Further, the strand of suture  64  could include any soft, flexible strand of material, and is not limited to suture. 
     An example method of use will now be described. In  FIG.  11   , a surgeon grasps the surgical device  10  with one hand and loads the first needle  68  into the surgical device  10  by inserting it into the bore  18  at the proximal end  20  of the surgical device  10 . 
     With reference to  FIG.  12   , the surgeon navigates the surgical device  10  within a joint space  74 , such as a joint cavity in a knee, namely a cavity between a femur and a tibia. While a knee joint is illustrated, it should be understood that this disclosure extends to other joints. As illustrated in  FIG.  12   , there is a tear  76  in a meniscus  78 . The meniscus includes  78  a medial surface  78 M, or interior surface, and a lateral surface  78 L, or exterior surface. The surgical device  10  is used to advance the needles  68 ,  72  through the meniscus  78  adjacent the tear  76 , to deploy the suture  64  adjacent the tear  78  such that a surgeon can close the tear  78  and allow it to heal. 
     In  FIG.  13   , with the cannula  14  placed adjacent the tear  76 , the surgeon advances the first needle  68  through the meniscus  78  by pressing on the trigger  16  with his or her thumb, thereby causing the trigger  16  to rotate in direction D 1  and move distally, and then releasing the pressure applied to the trigger  16  to allow the trigger  16  to rotate back in direction D 2  and move proximally under the force of springs  30 ,  56 . The surgeon repeats the pressing and releasing steps a number of times. Each time, the trigger  16  advances the first needle  68  further through the bore  18  until it exits the cannula  14  and penetrates through the meniscus  78 . Once the first needle  68  projects sufficiently through the meniscus  78 , the surgeon may pull the first needle  68  completely through the meniscus  78  using a tool, for example. 
       FIG.  14    is representative of a condition where the first needle  68  has passed completely through the meniscus  78  such that the suture  64  passes through the meniscus  78  adjacent the tear  76 . The surgeon then moves the surgical device  10  to another side of the tear  76 , as shown in  FIG.  15   , and then surgeon loads the second needle  72  into the surgical device  10  and advances it through the meniscus  78  using trigger  16  according to the same process as described above. The surgeon then tensions both ends of the suture  64  to close the tear  76 , as shown in  FIG.  16   . The surgeon may then use the suture  64  to tie a knot such that the knot abuts the lateral surface  78 L. The process described relative to  FIGS.  11 - 16    may be referred to as an inside out meniscal repair. The surgical device  10  may be used in other procedures, for example, and is not limited to use relative to the meniscus or the knee. 
     It should be understood that terms such as “lateral,” “medial,” “distal,” “proximal,” “superior,” and “inferior” are used above consistent with the way those terms are used in the art. Further, these terms have been used herein for purposes of explanation, and should not be considered otherwise limiting. Terms such as “generally,” “substantially,” and “about” are not intended to be boundaryless terms, and should be interpreted consistent with the way one skilled in the art would interpret those terms. 
     Although the different examples have the specific components shown in the illustrations, embodiments of this disclosure are not limited to those particular combinations. It is possible to use some of the components or features from one of the examples in combination with features or components from another one of the examples. 
     One of ordinary skill in this art would understand that the above-described embodiments are exemplary and non-limiting. That is, modifications of this disclosure would come within the scope of the claims. Accordingly, the following claims should be studied to determine their true scope and content.