Surgical instrument for meniscectomy and method of using the same

The method of utilizing first and second curved guides each having the same curvature and which curvature conforms substantially to the curvature of the periphery of a posterior portion of a meniscus for detachment of a posterior portion of a meniscus from its support comprising:

• inserting the first of the two curved guides into the posterior knee compartment between the tibia, meniscus, and coronary ligaments to a position extending adjacent to the periphery of the posterior portion of the meniscal base to be detached,
• inserting the second of the two curved grooved guides into the synovial pocket between the meniscus, femur, and synovia to a position extending adjacent the periphery of the posterior portion of the meniscal base to be detached,
• holding said guides in a fixed relationship to each other,
• passing a cutting tool into the posterior portion of the meniscal base to be detached, and
• guiding said cutting tool by the aforesaid curved guides to detach said posterior portion.

A surgical instrument for detaching a greater part of the posterior portion of the meniscus from its support comprising:

• a flexible elongated cutting blade having a cutting edge at one end and having two longitudingal side edges,
• first blade guiding means for insertion below the meniscus and between the tibia and coronary ligaments that attach to the base of the meniscus comprising a curved grooved guide and an elongated handle therefor, said handle and said blade guide being in substantialy the same plane,
• second blade guiding means for insertion intra-articularly into the synovial pocket above the meniscus, and between the femur and the adjacent synovia comprising a curved grooved blade guide and an elongated handle therefor, said handle and said grooved blade guide being in substantially the same plane,
• said first and second blade guiding means being separate from each other to permit them to be separately inserted into the knee,
• said curved grooved blade guides each having substantially the same size and curvature, and when held in complementary positions, said guides defining complementary grooves, that receive said two side edges respectively, for guiding a flexible cutting blade along a predefined path adjacent the periphery of the posterior portion of the meniscal base,
• a frame having an elongated portion for supporting both of said handles,
• means for securing said handles to said elongated portion of said frame for insuring that said curved grooved guides assume the aforesaid complementary positions so that their respective grooves will guide a flexible cutting blade,
• said frame having a change in direction adjacent the base of said grooved guides when they are mounted on the frame, to provide an extended portion of the frame which extends in a direction away from and generally aligned with those ends of said grooves which are closest to the handles, and
• driving means mounted on said extended portion of the frame for driving said blade with said cutting edge at the forward end of the moving blade and said side edges moving along said grooves respectively so that said blade will follow the curvature of said grooved guides and detach a meniscus accordingly.

A surgical instrument for detaching a portion of the meniscus from its support comprising:

• first and second curved blade guides each having substantially the same curvature as the other,
• first and second separate elongated handles for said first and second curved blade guides, respectively, each of said guides extending from one end of its elongated handle, being in substantially the same plane as said elongated handle, and including means for guiding a flexible blade along a curved path,
• a frame,
• a thin flexible cutting blade,
• means for attaching said handles to each other,
• means for attaching said handles to said frame to position the guides to receive said blade and guide it along said curved path, and
• means carried by said frame for driving said flexible blade in said curved blade guides so that said blade follows a path conforming to the curvature of said blade guides.

A surgical instrument comprising:

• cutting means,
• guide means for guiding said cutting means along a path substantially near the periphery of the posterior portion of a meniscus, in which said guide means comprises two separate guides,
• each of said guides having a guiding portion of a shape substantially conforming to the periphery of the posterior portion of a meniscus,
• one of said guides being adapted to be inserted intra-articularly above the meniscus to a position where it extends along a path substantially conforming to the periphery of the posterior portion of a meniscus,
• the other of said guides being adapted to be inserted intra-articularly below the meniscus to a position where it extends along a path substantially conforming to the periphery of the posterior portion of a meniscus, each said guide having a handle separate from the handle of the other guide, and
• driving means for advancing said cutting means along said guide means to detach the posterior meniscus.

The method of detaching the posterior portion of a meniscus after surgical entry into the knee and preliminary detachment of the anterior portion of the meniscus using a surgical instrument that has cutting means, two separate guides which coact to guide said cutting means, each of which guides has a separate handle, each said guide substantially conforming in shape to the periphery of the posterior portion of a meniscus, driving means for advancing the cutting means along the guides, a frame having first and second portions that are at an angle to each other, said driving means being carried by the first said portion, said handles being detachably secured to the second of said portions, and said handles being detached from said frame when use of the surgical instrument in the operation begins, comprising:

• separately inserting said guides intra-articularly into a knee to position one of said guides beneath the meniscus so that it extends along the lower periphery of the posterior portion of the meniscus, and to position the other guide above the meniscus so that it extends along the upper periphery of the posterior portion of the meniscus,
• thereafter securing said handles to said second portion, and
• subsequently operating said driving means to advance said cutting means along said guides and in a path substantially conforming to the periphery of the posterior portion of the meniscus to thereby detach the meniscus.

The method of detaching the posterior portion of a meniscus after surgical entry into the knee and preliminary detachment of the anterior portion of the meniscus, using a surgical instrument that has cutting means, two separate guides which coact to guide said cutting means, each of which guides has a separate handle, each said guide substantially conforming in shape to the periphery of the posterior of a meniscus, driving means for advancing the cutting means along the guides, a frame having first and second portions that are at an angle to each other, said driving means being carried by the first said portion, and handles being detachably secured to the second of said portions, and said handles being detached from said frame when use of the surgical instrument in the operation begins, comprising:

• position the thigh and the leg at an angle to each other that will facilitate insertion of the guides into the knee in the manner hereinafter described,
• separately inserting said guides to position one of said guides beneath the patellar ligament thus orientating the tip of this guide intra-articularly, in front of the collateral ligament beneath the meniscus into the space bounded by the tibia, the meniscus and the coronary ligament, and to position the other of said guides intra-articularly above the meniscus into the synovial pocket formed by the meniscus, the femur and the synovia,
• thereafter advancing the guides into the posterior joint and until the curvatures of the guides conform to the periphery of the posterior portion of the meniscus,
• subsequently securing the handles of said guides to each other and then to the second portion of said bar, and
• thereafter operating the driving means to advance the cutting means along said guides to detach the posterior meniscus.

The method of detaching the posterior portion of a meniscus after the knee has been surgically entered and the anterior portion of the meniscus has been detached, using a surgical instrument that has cutting means, two separate guides which coact to guide said cutting means, each of which guides has a separate handle, each said guide substantially conforming in shape to the periphery of the posterior portion of a meniscus, driving means for advancing the cutting means along the guides, a frame having first and second portions that are at an angle to each other, said driving means being carried by the first of said frame portions, said handles being detachably secured to the second of said frame portions, and said handles being detached from said frame when use of the surgical instrument in the operation begins, comprising:

• insert the two guides, intra-articularly, separately with one above and one below the posterior portion of the meniscus,
• position the guides separately so that they follow the periphery of the posterior portion of the meniscus,
• thereafter secure the guide handles to each other and to said second portion of said frame,
• thereafter operate the driving means to advance the cutting means along said guides to thus detach the posterior meniscus.
• withdraw the cutting blade means out of the guides,
• detach the guide handles from said second portion of said frame,
• detach the guide handles from each other, and thereafter separately remove the guides from the knee.

A surgical instrument comprising

• an elongated frame that has a first portion that extends for a substantial distance and a second portion at an angle to the first portion,
• one end of said first portion being connected to one end of said second portion, the other end of said first portion being a free end,
• an elongated cutting blade having a cutting edge at one end,
• means supporting said blade on said first portion and mounting said blade for movement along a path parallel to said first portion with the cutting edge of the blade on the end thereof farthest from the free end of said first position,
• first and second curved separate guides each having an elongated handle, said guides defining complementary grooves for receiving the side edges of said blade and guiding the blade as it is moved into the guides, and
• mounting means for detachably mounting said elongated handles to said second portion and in parallel relation thereto to position open ends of said grooves in a position to receive the cutting blade as the cutting edge moves in a direction away from the free end of said first portion.

A surgical instrument comprising:

• a flexible cutting blade having a cutting edge,
• means for advancing the cutting blade to perform a surgical cutting action, and
• guide means for guiding said flexible cutting blade along a path substantially at the periphery of the posterior portion of a meniscus, in which said guide means comprise:
• first and second guides each having a handle,
• each said guide and its handle having the shape relative to each other that is shown in conjunction with the guide and handle of FIG. 7.