Abstract:
An articulating hook elevator for manipulating tissue during arthroscopic procedures. The articulating hook elevator comprises a shaft, a proximal end, and a distal end provided with an articulating paddle. The hook may be actuated by a switch and can articulate into a standard tip for traditional manipulation of tissue, or into a rotated or articulated position. In this manner, effective manipulation and retraction of tissue from the surgical site without tissue collapse may be achieved, allowing a surgeon to better visualize the internal condition of the arthroscopic site and speed up the overall procedure.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of U.S. Provisional Application No. 61/014,254, filed Dec. 17, 2007, the entire disclosure of which is incorporated by reference herein. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates to arthroscopic surgical methods and instruments and, more specifically, to an articulating hook elevator for arthroscopy. 
       BACKGROUND OF THE INVENTION 
       [0003]    Arthroscopic surgery involves the insertion of an arthroscope into a joint region, such as the knee, elbow or shoulder, to allow a surgeon to view the internal condition of the joint. Examples of such arthroscopic procedures are partial meniscectomies and ligament reconstructions in the knee, shoulder acromioplasties and rotator cuff debridements, and elbow synovectomies. 
         [0004]    During arthroscopic surgery, a small incision is made in the skin covering the arthroscopic site or joint so that surgical instruments may be placed in the joint and manipulated through arthroscopic visualization. A very small incision is highly desirable as it has an obvious cosmetic advantage, and low complication rates with a very low incidence of infection. 
         [0005]    Because only a very small incision is made during arthroscopic surgery, it is often difficult to grab small regions of tissue and to subsequently apply a desired tension on the tissue within the joint capsule, either in a direction toward or away from the arthroscopic portal. In addition, it is also difficult to handle instruments within the joint capsule, where visibility and access to the structures of the joint capsule is minimal. 
         [0006]    Accordingly, a need exists for a surgical instrument that allows improved handling of instrumentation within a joint capsule, for example the elbow capsule, during athroscopic surgery. A need also exists for a surgical instrument that is stable during elbow arthroscopy and that allows the secure lifting and/or retracting orientation desired by the surgeon, without accidental slipping or shifting and with minimal soft tissue edema to the patient. 
       SUMMARY OF THE INVENTION 
       [0007]    The present invention provides an articulating hook elevator having a shaft, a proximal end, and a distal end provided with an articulating hook. The hook is configured to allow secure engagement and retraction of anatomical structures (such as neurovascular structures) during arthroscopic surgery. The hook may be actuated by a switch and can articulate into a standard tip for traditional manipulation of tissue, or into a rotated or articulated position. 
         [0008]    Other features and advantages of the present invention will become apparent from the following description of the invention, which refers to the accompanying drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0009]      FIG. 1  is a perspective view of an articulating hook elevator according to an embodiment of the present invention. 
           [0010]      FIG. 2  is a top view of the articulating hook elevator of  FIG. 1 . 
           [0011]      FIG. 3  is a cross-sectional view of the articulating hook elevator of  FIG. 1  and in an articulating position. 
           [0012]      FIG. 4(   a ) is an enlarged view of the distal end of the articulating hook elevator of  FIG. 1  and in a non-articulating position. 
           [0013]      FIG. 4(   b ) is an enlarged view of the switching mechanism of the articulating hook elevator of  FIG. 1  and in a non-articulating position. 
           [0014]      FIG. 5  is a partial cross-sectional view of the articulating hook elevator of  FIG. 1  and in a non-articulating position. 
           [0015]      FIG. 6(   a ) is enlarged view of the distal end of the articulating hook elevator of  FIG. 1  and in an articulating position. 
           [0016]      FIG. 6(   b ) is an enlarged view of the switching mechanism of the articulating hook elevator of  FIG. 1  and in an articulating position. 
           [0017]      FIG. 7  is a partial cross-sectional view of the articulating hook elevator of  FIG. 1  and in an articulating position. 
           [0018]      FIG. 8  is a lateral view of an elbow joint undergoing arthroscopy and with the articulating hook elevator of the present invention. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0019]    In the following detailed description, reference is made to various specific embodiments in which the invention may be practiced. These embodiments are described with sufficient detail to enable those skilled in the art to practice the invention, and it is to be understood that other embodiments may be employed, and that structural and logical changes may be made without departing from the spirit or scope of the present invention. 
         [0020]    The present invention provides an articulating hook elevator having a shaft, a proximal end, and a distal end provided with an articulating hook. The hook is configured to allow secure engagement and retraction of anatomical structures (such as neurovascular structures) during arthroscopic surgery. 
         [0021]    The hook may be actuated by a switch and can articulate into a standard tip for traditional manipulation of tissue, or into a rotated or articulated position. The switch mechanism (in the form of a mechanical cam) actuates the tip of an articulating hook elevator to a rotated or “bent tip” position, in the manner described in U.S. Patent Application Publication No. 2005/0203345, entitled “Articulating Paddle Elevator and Arthroscopic Method for Using Same,” the disclosure of which is hereby incorporated by reference in its entirety. 
         [0022]    Referring now to the drawings, where like elements are designated by like reference numerals,  FIGS. 1-7  illustrate an articulating hook elevator  100  of the present invention. The articulating hook elevator  100  of  FIGS. 1-7  may be used to manipulate and palpate tissue during arthroscopic surgery (for example, elbow arthroscopy) and to lift and/or retract tissue while maintaining capsular distention without damaging adjacent structures such as neurovascular structures, for example. The hook of the articulating instrument allows engagement and retraction of neurovascular structures without the risk of sliding off and subsequent injury of such structures during surgery. Thus, the hook elevator of the present invention allows more controlled arthroscopic engagement and secure lifting and/or retracting orientation desired by the surgeon, without accidental slipping or shifting and with minimal soft tissue edema to the patient. 
         [0023]    As illustrated in  FIG. 1 , the hook elevator  100  includes a shaft  20  provided in the shape of a cylinder and having a distal end  21  and a proximal end  22 . A handle  10  is disposed at the proximal end  22  of the shaft  20 , and an actuating tip or hook  50  is located at the distal end  21  of the shaft  20 . The actuating hook  50  has a configuration that allows it to securely engage (to hook) additional tissue structures (such as neurovascular structures, for example) and to retract these structures, without accidental slipping or shifting and with minimal tissue edema to the patient. The actuating hook  50  may be additionally used for manipulating and palpating tissue. 
         [0024]    As illustrated in  FIGS. 2 ,  3  and  4 ( a ), for example, the articulating or actuating hook  50  comprises a main body region  50   a  (in the form of a paddle) that is integral to a curved, hooked region  50   b  positioned at the most distal end of the main body region  50   a.  When the instrument is in a non-articulating position (such as the one illustrated in  FIG. 5 , for example), a longitudinal axis (including a main paddle surface) of the main body region  50   a  is about parallel to the longitudinal axis of the instrument. When the instrument is in an articulating position (such as the one illustrated in  FIG. 7 , for example), the longitudinal axis (including the main paddle surface) of the main body region  50   a  is about non-parallel to the longitudinal axis of the instrument. 
         [0025]    An actuator  40  is located at the proximal end of the shaft  20  and connected to the handle  10 . The actuator  40  comprises a lever or thumb trigger  44 , a link  42 , a cam  11  and an actuator  25  connected to the link  42  and the trigger  44 . As shown in  FIG. 3 , the actuator  40  also comprises a set screw  58  and a plurality of handle pins  53 . The actuator  40  is designed to cause the actuating hook  50  of the hook elevator  100  to be angled, for example at about 40°, when actuated. The actuating hook  50  is connected to actuator  25  by a plurality of pins  52  ( FIG. 3 ). 
         [0026]      FIGS. 4-7  illustrate the mechanics of the articulating hook elevator  100  of the present invention.  FIG. 5  illustrates the articulating hook elevator  100  disposed in the straight or “unlocked” position, while  FIG. 7  illustrates the hook elevator  100  disposed in the articulating or “bent tip” position and locked.  FIGS. 4(   a )-( b ) and  FIGS. 6(   a )-( b ) are enlarged views of the articulating hook and switch mechanism corresponding to the straight and articulating positions of the articulating hook elevator  100  of  FIGS. 5 and 7 , respectively. 
         [0027]    The articulating hook  50 , which rotates to an angle of about 40° (in the embodiment shown in  FIGS. 3 and 7 ) to about 120°, is connected to the actuator  40  which comprises the lever or trigger  44 , link  42 , cam  11  and actuator  25  connected to the hook  50  at the distal end. The switch mechanism  40  is mechanically connected to the hook  50  and, when actuated, causes the hook  50  to rotate to a 40° position, for example, as shown in  FIGS. 3 and 7 . In the straight position shown in  FIG. 5 , the trigger  44  is pushed in the direction of arrow A ( FIG. 4(   b )) and disposed in a front or “unlocked” position. This causes the actuator  25  to be biased towards the distal end of articulating hook elevator  100 . 
         [0028]      FIG. 7  illustrates the articulating hook elevator  100  in the “bent tip” or “locked” position, in which the articulating hook  50  is disposed in a 40° position. To rotate the articulating hook to the 40° position, trigger  44  is pushed backward in the direction of arrow B of  FIG. 6(   b ). Trigger  44  includes a cam  11  which pushes the actuator  25  backward or towards the proximal end of the actuator when trigger  44  is moved backward. This mechanical action causes the hook  50  to rotate 40° as shown. 
         [0029]    The articulating hook elevator  100  of the present invention described above with reference to  FIGS. 1-7  may be employed in various surgical medical procedures for manipulating body tissue and neurovascular structures during surgical procedures. For example, the articulating hook elevator  100  may be employed in endoscopic and arthroscopic procedures, including but not limited to elbow arthroscopy, knee arthroscopy, shoulder arthroscopy, and other arthroscopic procedures that require handling and manipulation (lifting and/or retracting) of tissue while maintaining capsular distention without damaging adjacent structures such as neurovascular structures, for example. 
         [0030]    To better illustrate an exemplary surgical procedure conducted with the articulating hook elevator  100  of the present invention, reference is now made to  FIG. 8 , which illustrate a side schematic view of a surgical site  90  of elbow joint  300 . A surgeon advances articulating hook elevator  100  in the “straight” or closed configuration into elbow joint  300 , as shown in  FIG. 8 , optionally through a small cannula or portal, for example. The “straight” configuration allows the surgeon to gently insert instrument  100  into the elbow capsule and out of adjacent vital neurovascular structures, such as the brachial artery, the median nerve and the radial nerve, for example. 
         [0031]    Once the articulating hook elevator  100  is inserted into the elbow joint, the surgeon then articulates hook  50  to a desired angle, for example to approximately 40° or 120°. The surgeon may also gradually increase or decrease the angle of the hook (for example, from a first position to a second position), as desired and in accordance with the characteristics of the surgical site. The hook of the articulating instrument  100  allows engagement and retraction of neurovascular structures (such as the ulnar nerve, for example) without the risk of sliding off and subsequent injury of such structures during surgery. The hook elevator of the present invention allows a more controlled arthroscopic engagement and secure lifting and/or retracting orientation desired by the surgeon, without accidental slipping or shifting and with minimal soft tissue edema to the patient. 
         [0032]    Although the present invention has been described in relation to particular embodiments, many other variations and modifications and other uses will become apparent to those skilled in the art. 
         [0033]    Although the present invention has been described in connection with preferred embodiments, many modifications and variations will become apparent to those skilled in the art. While preferred embodiments of the invention have been described and illustrated above, it should be understood that these are exemplary of the invention and are not to be considered as limiting. Accordingly, it is not intended that the present invention be limited to the illustrated embodiments, but only by the appended claims.